elective induction

I know, I know.

It's so hard to not be able to plan the day you're baby would arrive.  You're a busy gal, you've got plenty on your plate ... dropping it all and bringing a new life into the world feels impossible in our scheduled world.  I understand; I do it on a monthly basis for my clients and it is no small thing.

But there is quite a bit of research out there showing that babies do best inside their mamas.  Your baby is staying inside of you for a reason, and most of the time ... it's best to go with the flow.  Now, of course there are times where this is not at all true; and thank heaven we have technology advanced enough to help your baby!

If the word "induction" starts getting thrown around, ask your caregiver for what they would call a "risk analysis".  It's essentially a big pros and cons list; giving you a much more detailed idea of what would be best for your baby.

Be aware that most hospitals aren't even allowing elective induction any more, according to Medscape.  There is simply too much information out there supporting those last few weeks of development in the womb; enough that professional caregivers can't justify early inductions without a serious cause.

" 'Something we didn't even anticipate as a benefit of this policy, but was a delightful surprise to see, was a decreased admission rate to the neonatal intensive care unit,' Dr. Healy told Medscape Medical News at the meeting."

Read the whole article; it's not too long and quite interesting!
http://www.medscape.com/viewarticle/804700

Educate yourself so you can feel confident in what you chose.  If your baby needs anything, he or she needs confident, loving parents.

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!

Penny Simkin: Using Doulas for Birth Care - Midwifery Today Birth Essent...

All my training materials came from this wonderful woman. Love her.

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

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. 

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.

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.

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

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

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.' "

a nod to technology

Most of my posts have been regarding natural childbirth; our own abilities and our potential to discover them.  But let me take a moment to say simply that technology truly is a blessing.

We live in a time where the physical nature of birth is fairly well understood; doctors are trained to look for warning signs and to prevent any serious threats.  Machines calculate heart rhythms, asphyxia, amniotic fluid content, and countless other things.  Labor can be sped up or stalled, the pain can be minimalized and even taken away.  Surguries are quick and many medications can help with the healing process afterwards.

Many, many lives have been saved.

As a doula I have already witnessed the benefits of having these technological safe-nets, and have seen them used exactly as they should be to improve the health and well-being of all involved.  They were not routine, they were not to save time, and they worked side by side with the laboring mother's body -- which, in my opinion, always seems to know more than of the machines.

We are blessed to have these options available to us.  I will continue to provide more information about more natural childbirth, as that is the kind of birth in which my abilities will be most utilized.  I have also chosen to provide this kind of information because in my own life, I knew quite a bit about all the technology available to aide birth, but I understood and trusted very little in the potential of my own body.  So most in most of my posts I'll be passing along the things I am learning.

But for heaven sake, if you are in labor and miserable, don't feel guilty.  Get the help you need to make your experience a positive one.  Your baby and your husband need you to be there, physically and emotionally.

Sometimes our mindsets about pain and performance get in the way of the body's natural process of birth.  Sometimes our body's natural process is to be in labor for many days.  Sometimes our own health or the health of our babies are not up to the processes. 

We are blessed to have the option of life-saving medical advancements.