pitocin warning

Pitocin is overused.

It is a brand of oxytocin that doctors will use to either start contractions, or keep the ones you've got going.  In the business-world of a hospital, it is an invaluable tool for managing an event that does not work on a dependable time clock.

But you see, it's so important that we don't forget that birth is not on a time clock.  Of course averages have been measured, but who is really average?  Your body is your body, and its uniqueness combined with that of your baby results in a truly singular birth that is far from average.

It is normal for labor to pause.  In fact, it's a coping mechanism.  If you were a cave woman back in the day, laboring to bring your baby into the world and suddenly -- ack! -- a saber-toothed tiger interrupts your focus.  What would you do?  Adrenaline would kick in, oxytocin would all but stop, blood flow would leave your uterus and shoot out to your appendages to get you the crap out of there.

That hasn't changed today.  If you're stressed and that saber-toothed tiger waltzes in the room in the form of your doctor, mother-in-law, or some bizarre point in labor that you've always dreaded, you're more than likely to stall out.  It's instinct.  It's survival.

So if your doctors start throwing out the word pitocin, first ask, "Is this an emergency?"  And if the answer is no, then give yourself some time.  Relax.  Take a deep breath.  Find a way to defeat that tiger and let your body continue doing it's thing.

Not only is pitocin harder on you (inhuman contractions on a very human uterus), there are also studies finally being done on pitocin's effects on your baby.  There are some.  ACOG just released a statement about it:

http://www.acog.org/About_ACOG/News_Room/News_Releases/2013/Study_Finds_Adverse_Effects_of_Pitocin_in_Newborns

Now don't fret, of course there are risks no matter what kind of birth you have.  Do your research, have an intelligent conversation with your partner, doctor, and support people.  You need to feel good about what you experience.  Your ability to care for that baby after he or she arrives will trump any experience your baby had during birth.

pain is a perception

Have you seen this video yet?  I love it.

Besides being hilarious, it proves one thing that I try to teach each of my clients:  pain is a perception.  These two men are seriously so far from experiencing childbirth ... sorry guys, there's just no way to really replicate it for you.  It's beautiful and intense and empowering and humbling all at once, and these little machines just can't do that. 

However ...
The guys in this movie are both experiencing pain.  And they handle it very differently.

Ladies, your birth can be whatever you want it to be.  Don't fight it.  Let it happen.  And for heaven's sake, think happy thoughts!

a little bribery goes a long way

I recently had a client who taught me a fabulous lesson. 

Let me back up.  In my doula experience so far, I have worked with a lot of women who want all the "emergency" benefits of a hospital, but still want a natural birth.  Since the set-up of a hospital is more businesslike and often doesn't mold as well to each gal's individual labor pattern, sometimes my job requires handling some awkward head-butting situations.  Nurses have a job to do, and they are doing it by the big boss's standards for several couples at the same time.  I have many nurses in my family, so I can tell you from experience that they are often overworked and emotionally taxed.  It's a tough job!  But of course, couples welcoming a baby into the world are incredibly emotional and -- it is my eternal hope and goal for my clients -- empowered and opinionated on how they want to go about it. 

My job is to stick up for the couple's needs.  At the same time, my individual belief is that creating a confrontational atmosphere is really only damaging to the birth experience, so I have been vigilant in finding ways to keep everyone happy. 

I have read and thought and tried different things to make friends with the nurses, to attend to my clients, and to word everything to everyone just so.

But this recent couple of mine made it all so much simpler for me: 
Just bring chocolate.

Bring me these and my heart is yours.

This couple's labor went through the nurse's shift change (very common), and the new nurse must've just come from something terrible.  She was sullen and short and barely made eye contact.  I began mentally ticking through things I could say to help her seem more human to us, but then my client-bless-her-heart says, "Honey, the chocolate," as soon as the nurse leaves the room.

 

Her husband pulled out a massive bag of Ghiradeli squares and the two of them arranged a lovely little bowl of treats between contractions.  I watched open-mouthed.  Duh.  Why haven't I thought of that?!

 

When the nurse came back in, they handed her their offering to share with the entire nursing staff and thanked her for helping them bring their child into the world.  And by golly, her face lit up and she did a 180.  For the rest of the day she was chatty and obliging and almost doula-ish.

 

So people, here's another thing to pack in your hospital bags:  bribery goodies.  Guaranteed to set up a wonderful atmosphere for your baby to enter the world in.

laboring positions

Finding different positions to labor in is all about two things:  keeping yourself comfortable, and giving your baby the space he needs to make his way into the world.

This great website has a little slideshow with several different positions that work wonders.  I would suggest practicing a little with each of these to see what feels comfortable to you.  Of course, all that may go out the window once the intensity of real labor hits, but there's no doubt it's helpful to have some idea of what you want or don't want.

A friend of mine helped me to show you a couple of my favorites:

In laboring positions I look for two things: movement and opening your hips.  This one does both.

I am a huge fan of the birthing ball.  Or exercise ball, as you probably know it.  Sitting on this allows you to hold onto your significant other (or doula, if that person is absent) and simultaneously get your back worked on. 

It's also perfect for the end of labor, when you are exhausted and not wanting to move at all.  You can roll around and keep your hips moving without breaking a sweat. 

This is another good one.  You can rock back and forth a little, and squat with the contraction if you've got the energy for it.  And once again, you can have people on both sides of you should you wish it.

And there is one final position I didn't quite get a picture of: laboring on the toilet.  This one does not create much movement, but it allows you to relax your pelvic floor in a way that nothing else does.  You'll need to try to use the bathroom every couple of hours during labor, so while you're there, stay a while.  It may be just the push you need to dilate that last centimeter or two.

Try these at home, see how they feel.

Scene From Penny Simkin's Comfort Measures - "The 3 Rs" & Slow Breathing

photos photos photos

One thing that every couple I have doula-ed for has requested is: pictures.  Everybody wants pictures of that life-changing day.  Who wouldn't?

But I do find significant variety in what people want photographed.  Some just want pictures after everyone is decent, coherent, and rested.  Others want pictures of that moment when they first meet each other face-to-face.  Still others want detailed photographs of the entire process.

Whatever you'd like, be sure you assign someone to be on picture-duty before everything happens.  Usually the hubby is not the best choice ... believe it or not, he's going to be quite distracted.  Moms can get distracted too.  Nurses are generally going to be quite busy with you and typically 2-3 other patients and won't have the time. 

Doulas can be extremely useful when it comes to picture-taking.  Some even have a little experience with photography.  I recently purchased this little beauty:

And I am excited to put it to work!

If you haven't been able to find a doula, then get a friend ... someone you trust, but not someone who will be too worried about you to keep at their task.  I found a blog of a gal who photographed her friend's birth, and the results are about the most adorable thing ever: http://www.amelialyon.net/personal/introducing-sweet-lola-dee.html

Once you've got your photographer figured out, you then need to decide what you want pictures of.  Here's some food for thought:

• How do you want to remember this experience?  Would you rather re-live every incredible moment, or focus on the happy ending?
• Do you want pictures of you and your significant other working together to bring your child into the world?
• How do you feel about blood?
• Would you be distracted from the intense work of labor if there was a flash or clicking going on every few minutes?  Could the camera be kept quiet and still do its job?
• Will you be embarrassed later by how some of the photos turn out?
• Would you like to have pictures of everyone there?
• Will the hospital allow pictures of the actual birth?  Most do not.  They don't want clients to have documentation against them should something go wrong.
• Would a simple point-and-shoot camera work?  Or will you need to seek out something more substantial?

Birth is an incredible, life-changing moment that you will never forget.  Photos are the best way to highlight your favorite parts, and beautify the less-than-favorite.  Be sure to work some kind of photography into your birth plan.

tethered

If you're anything like me, being trapped during labor sounds like the worst thing in the world.

Now, if you chose to have your baby at home or in a birthing center, you won't need to worry about that at all.

But if you are in a hospital, be it for personal reasons or insurance reasons (as was our case ... sigh), you will have to face being trapped.  Whether you are asked to stay in bed or not, all hospitals prefer to have quick access to those veins of yours.  Hospitals are always trying to prepare for the worst, and so will want to be able to shoot whatever they need to into your body at a moment's notice.  Having several nurses in my family, I know that opening up a vein is not always the easiest thing, and so is preferably done before any emergency pops up.

So, will you need to be stuck to a pole with tubes running into your arm?

Not necessarily.

Ask for a "heplock".

 They will open up your vein, but they won't attach you to anything.  You'll have to labor with a needle in your hand, but at least you won't be stuck to a pole.  They cap it off so you can move around as you please.
It's another one of those compromises ladies wanting a natural birth in a hospital will likely need to make.

birth plans

Have you considered writing a birth plan?

Think of it as more of a set of preferences.

Births rarely go exactly according to plan.

However, I still think it's a great idea to think happy thoughts and repeatedly visualize that perfect experience.  Here is the birth plan I wrote up for the birth of my little girl:

Birth Preferences for Allison and Mark Gunn

Patient of Dr. Gregory Chan

Due Date November 30

Attending the birth: Mark Gunn, husband; Elizabeth Wolgast, doula

Hello one and all!  We are the Gunns and are so very excited to welcome our newest little one into the world.  We searched a few different hospitals and birth centers to find the right fit for our little family.  We decided on your hospital, and have made a list of things we would love to have happen, although we are completely aware that no birth ever goes according to plan!  Thank you for all your efforts to make our baby’s birth day the best it could be.  We are excited to be working with you.

Right off the bat, there are a few things you should be aware of with me:

•  I am allergic to penicillin.  Should I need something of the sort, please use something else.
•  This will be our second child.  The birth of our first was wonderful and uncomplicated, but not exactly the best experience.  We are looking forward to this one being much better.
• We want a very natural, un-medicated labor.  Please do not suggest drugs to get me through.  If there is any positioning or relaxation techniques you know of, I would love the support! 
• I am worried about being trapped in bed.  Please help me to find ways to keep moving.  I do not want to be on the fetal monitor the entire time.

First Stage of Labor Preferences

•  I will be attempting to do most of my laboring in the comfort of my own home.
• Once at the hospital, I would like to continue on with a quiet, relaxing atmosphere as much as possible.
•  I do not want drugs suggested unless my child or I are in danger. 
•  I am hoping to maybe use the shower, the birthing ball, and movement to get through labor pains.  I will be bringing along a doula for support, and would love any wisdom your staff has to offer!
• I would prefer intermittent fetal monitoring if at all possible. 
•  I would prefer a heplock instead of being tethered to a pole.

Second Stage Preferences:

•  Once I feel the urge to push, I would like to push in a few different positions (squatting, side-lying) until the baby is about to be born, in which case I’ll do what the doctor needs me to do.
•   I would like to attempt mother-directed pushing, unless I’m very out-of-it and need the guidance.
• I would love any assistance you can give to keep me from tearing.  Compresses, massage, oil … whatever works.
•  Should tearing happen, please do not perform an episiotomy unless you feel that I might tear into the urethra or clitoris.  That would be a bummer.  As I was cut with my first birth, I assume that area would be the place to tear anyway.
• Please place the baby directly on my skin after birth.
•  Please allow my husband to cut the cord, and please give it a bit of time to stop pulsing.

 Care of Our Newborn

• Please do not bathe the baby.  We would like to give her the first bath.
• Please leave her with us as much as possible.
• We do not want any immunizations at all and will sign whatever we need to.
• Please wait a couple of hours before giving her Vitamin K and eye cream.

 Afterward

• Please allow my two year old and mother to visit as much as they can.
• Should any other visitors show up, bring them in!  (As long as it has been a couple of hours since the birth.) 
•  Please leave our baby with us.
• We are anticipating wanting to leave the hospital within about 24 hours, but who knows … maybe I’ll be so comfortable and relaxed that I’ll want to stay the full two days. 

Thank you again for taking the time to skim through this.  We understand that you are busy and see all sorts of births.  Thank you for helping to make ours special to us. 

make sure your birth partner knows ...

One of my favorite parts of being a doula is helping your significant other to help you.  I promise every single one of them really truly wants to ... its just that most of them have no idea what to do.  Of course they know you better than anyone and love you to pieces, but that love often generates all sorts of worry and frustration as they witness what you are going through. 

(Which, might I add, is a great reason to have a doula:  bring someone to the party who has only your interests in mind -- not the hospital's -- without stressing over every little discomfort you may feel.  Doulas make a fantastic team with your birth partner!)

The basic things I tell these loved ones to do while you are laboring alone include the following:

• Distract, distract, distract.  While you still can.  I promise labor will get to a point where you can't ignore it any more.  Until then, relax.  Have some fun.  Go for walk.
• Move her!  At least every hour.  If you're trying to catch up on some rest, then just rotate from side to side.  It'll help that little one find the easiest way out.
• Keep her hydrated.  Don't forget to drink.  Juice will add some energy and calories to get her through it.  Let her eat what she wants as well.
• Use the bathroom.  Every couple of hours.  That baby is sitting on top of her bladder, and if it is full, it will keep the head off of the cervix and slow down dilation.

And of course, make sure this person knows how much you love them, and not to take anything you say in the next few hours too harshly.

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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.

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.

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.

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)

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.

for your partner

Having now been on both sides of the coin during birth, I have a lot of respect and empathy for your support person.  Typically this will be your husband, mother, or close friend.  In all cases it is someone who loves you and wants the best for you, but is often unsure of how to best help. 

If your birth partner is desiring to be very involved in the birth of your child, have them read "The Birth Partner" by Penny Simkin.  I absolutely loved this book.

Here are some of my favorite parts of a guide created by Penny Simkin for training doulas.  It is also meant to be used by the birth partner. 

1.  Pre-Labor

• The cervix will ripen, efface, and move forward.  May experience non-progressing contractions
• Mother may feel tired, discouraged, anxious.  May overestimate progress or focus too much on contractions.
• You might distract her, if possible.  Alternate with restful activities.  Try some natural labor stimulating measures.  Encourage food and drink, there is a long road ahead.  Stay with her.

2.  Latent Phase

• The cervix continues ripening, effacing, begins dilating.  Progressing contractions, some bloddy show, rupture of membranes. 
• She may feel excited, confident, optimistic, or anxious and distressed.
• You might ask what she thinks about during the contractions, suggest more positive thoughts, give her feedback and not false praise.  Try a few relaxation techniques, focus your attention on her, and remind her to drink, pee, and change positions regularly.

3.  Active Phase

• The cervix dilates from 4 to 8 or 9 cm.  The head of your baby will rotate into the best birthing position.
• She may feel she has reached "the moment of truth".  She may feel trapped, or realize that labor is not within her control.  She may become quiet and go inward, resenting interruptions.
• You should speak quietly and positively, and remind her of her progress.  Follow her lead; if she is quiet, be quiet.  Help with different comfort measures and changing positions, bathroom, and fluids.  Help her to follow her original preferences regarding pain medications.

4.  Transition

• The cervix dilates the last two centimeters, and the baby begins to descend.  Contractions will be close and the intensity will be at its height.
• She may feel lost in the intensity of it.  She may tremble, need guidance and reassurance, and vocalize or find a soothing rhythmic physical movement.
• You may need to take charge if she seems to loose it; remind her how strong she is, how far she has come, and how close she is to the end.  Hold her, do not rub her, and acknowledge her pain.

5.  Possibly a Resting Phase

• The uterus may "catch up" with the baby, whose head is now out of the uterus and in the birth canal.  There may be little or no observable activity.  Care giver may relax, or worry and start calling for pushing or pitocin.
• She may feel relief at the break, confidence, and optimism.   She may feel renewed, more aware of her surroundings, and possibly a desire to get on with it.
• You should help her change positions, and remind her of the importance to release pelvic tension.

6.  The Descent

• The baby rotates and descends.  The head will rock back and forth between bearing down efforts. 
• She will push with contractions or on demand if she is on pain medication.  She may feel inadequate, need reminders of what to do, or feel alarmed at the feeling of her baby's head.
• Be positive, report on progress.  Help her achieve effective pushing.  Remind her to release tension in her perineum, and suggest changing positions to speed progress.

7.  Crowning and Birth

• Baby's head no longer rocks back and forth, it emerges.  Perineum is most vulnerable to tearing.
• She may feel a "rim of fire", a stretching or burning.  She may avoid pushing by panting.
• Don't rush her, let her do what she needs to.  If the caregiver is directing her efforts, stay close to her and support her position.

I love this list.  I have simplified it for your partner; Penny's is a bit more detailed and useful.  But this is something, and I hope it helps.  It is important for you both to feel confident and prepared as you welcome your child into the world.  Probably my favorite thing about being a doula is witnessing the process of change between a couple as they work together to bring their baby into the world.  It humbles and amazes me.  There is nothing more incredible than witnessing the birth of a family.