Birth is Best

One week ago today, I had the privilege of being at the birth of a good friend. It is the only home birth that I have witnessed, besides my own, and it just really touched me. The mama was such a strong and powerful woman during her labor and her midwives remained totally in the background until they were needed. Baby was born into warm water, with his family around him, to dim lights and quiet voices. It was a special experience. I wanted to just write a few things down while they are fresh in my mind.
-
Birth is best when we stop focusing on due dates. The pressure of going overdue in our society is HUGE. Before most women have reached their due date they are being hounded by friends and family to find out why that baby hasn't been born yet. Science has yet to discover why babies come when they do, and I think it is best to assume that there is a very good reason that baby chooses the day he is born. Any woman who has been pregnant knows all too well the physical and emotional discomfort that the last weeks of pregnancy can bring, so it very important to honor pregnant mothers with support and love, not questions and comments about how the baby is getting too big or that something must be wrong. Baby will come at just the right time if we allow him to.
-
Birth is best when moms have choices. Choices about where to birth -- home or hospital, when to give birth -- no pressure of inductions, how to give birth and choices about who will be in attendance. Did you know that homebirth and even a birth attended by a midwife (in a hospital or birth center) is illegal in some states? This means that in this country women have more choices and options when it comes to terminating a pregnancy than they do when it comes to making choices about their maternity care and how/where they want to give birth? A woman should also have the choice, after making an informed decision, to give birth vaginally after having a c-section if that is her desire.
-
Birth is best when we stop looking at the clock. One of the main differences you will notice if you get to witness a homebirth with awesome midwives, is that no one is going to stick their hand in a vagina and check dilation (even if you beg them to), unless there is a pretty good reason. Smart midwives understand that how far dilated someone is is not really an indication of much. We've all heard of that woman who walked around dilated to six centimeters for days before her baby was born, or the woman dilated from zero to 10 in the space of an hour and nearly had her baby in the car. Every labor is different, just as every baby is different. When we get stuck on the numbers it can be so disheartening to hear something that we didn't want to hear or give false hope when we still have hours of laboring ahead. The process of birth is a journey towards surrender, giving in to the process, letting our body just do its job as it is designed to do, without getting hung up on how you think it is supposed to happen.
-
Birth is best when we center on the mother and honor her. Pregnant women are more than cute bumps and adorable maternity clothes and accessories. While it can be fun to open a million presents and play silly games about guessing which chocolate bar has been smeared in which diaper, an event that honors the pregnant mother, and her journey towards birth and motherhood are seriously lacking in our society. If you ever have the chance to attend (or better yet, plan or be the recipient of) a mother's blessing, I encourage you to do so. Gathering women together to send love and best wishes to the expectant mother is so special and deserved. I was very interested to learn recently that these types of events were very common during the early years of my own personal religious culture.
-
Birth is best when we trust that mom (and dad) know best. I guess this is all the stuff that happens after the birth, all of the decisions that come when little baby is here. What baby will eat, where baby will sleep, shots, circumcision, discipline, etc. Everyone will have an opinion that they want to share, but it is important to remember that mom knows what is best for her child, and we don't want to do anything that will damper the natural instinct that she has to care for her children. I can be guilty of this, so I think it is a good reminder.
-
I have a friend who told me that birth is like a wedding -- it should happen exactly how the mother (bride) wants it to. And this is so true...weddings take much preparation and planning, there is excitement and stress, we invite who we want to be there (no one would dream of crashing in on a wedding uninvited), we choose our location and attendant carefully, and through it all the bride is center stage, the one given the most consideration, the most honor. Birth can and should be the exact same way. Birth is best if it is.

Worried About a Big Baby?

Like many women, I've watched my share of pregnancy/birth shows (like A Baby Story), and recently I've noticed that many of the moms are told at some point towards the end of their pregnancy that they could possibly have a "big" baby and should consider induction. Having a larger than normal baby can be some women's biggest fears when it comes to childbirth.

The difficulty lies in the idea that there is no way of truly knowing how big a baby will be at birth. Fundal height measurements are affected by amniotic fluid levels, baby's position and mother's body. Ultrasounds have not proven completely accurate in measuring how big a baby actually is. Even a skilled practitioner cannot be totally sure of a baby's size by palpitation (although some really like to try and guess).

I think the key to a healthy and happy birth is truly accepting the idea that women's bodies are designed to give birth. We will grow a baby that is the perfect size for us. The greatest majority of the time, all will be well with our labor and delivery if we trust our bodies to do what they are made to do without interference.

If you would like to do further reading on the subject, check out this wonderful article by a very experienced birth doula.

Kegels -- the Exercise For "Down There"

I remember being about 34 weeks pregnant with my second son when my midwife sat me down and had the "kegel talk". She basically informed me that if I had a desire to minimize perineal tearing at birth, prevent urine leakage, and have a speedier recovery, I needed to get serious about doing kegel exercises on a regular basis. Previously, I had been half-hearted, at best, in my efforts to exercise my pelvic floor muscles, not doing anything with any regularity -- a kegel here, a kegel there, even though I knew the potential benefits. I suppose, until my midwife got serious with me, I didn't truly understand the benefits of kegels for not only pregnant women, but women of all ages.

The Kegel exercise is named after a doctor who developed the exercises to tone and strengthen the pelvic floor muscles. These muscles act like a hammock, holding up the uterus, bladder, and bowel. A strong pelvic floor prevents organ prolapse (vaginal, uterine, rectal) and urine leakage, while promoting healing to the perineum. The exercise also tightens and strengthens the muscles in the vagina, providing greater sexual sensation.

It may take a little practice to find the right muscles to exercise, but a great way to initially practice the contraction is to try and stop the flow of urine while you are going to the bathroom (do not make a habit of stopping and starting your urine flow, as it can actually weaken the pelvic floor, but just try it initially to find the right muscles). If you succeed, then you have just practiced the most basic move. Try it a few more times until you feel confident that you know what muscle to squeeze. You should feel your vagina tighten and your pelvic floor move upward. In relaxing the squeeze, you will feel your pelvic floor move down and your vagina relax. As your muscles get stronger -- and you get more experienced -- this movement will become more pronounced.

As far as a regimen goes, most proponents of the exercise say you need to do about 200 a day to get the benefits. My midwife recommended finding four different times a day that I could spend five minutes doing kegels. I usually was only able to fit in two times a day. I recommend that each session include 10 sets of 10 quick squeezes (with a 10 count rest in between each set of 10) followed by 10 sets of long squeezes (with a 10 count rest in between each set of 10). This should develop into a lifelong habit so that you can see lifelong results.

How to Avoid a C-Section

I recently read an article posted on CNN (linked to by several blogs that I read) which listed very succinctly five ways to avoid a c-section.

1. Don't get induced unless medically necessary

2. Labor at home until you're approximately 3 centimeters dilated.

3. Choose your hospital, and your practitioner, carefully

4. In the delivery room, ask questions if your practitioner says you need a C-section.

5. Get a doula.

Please read the whole article to get more details. With the amount of hospitals who are willing to allow patients to attempt V-BACs (Vaginal Births After Cesarean) nearly disappearing off of the landscape, it is even more important for pregnant ladies to be informed of their practitioner's and hospital's cesarean rates. And while a doula cannot "protect" a woman from getting a c-section, working with a doula can help you endure the last weeks of pregnancy, avoiding induction, and labor in the comfort of your home for as long as possible.

Birth Planning

Many pregnancy websites and books suggest that you write up "birth plan" before your delivery in order to share your preferences with your care provider ahead of time. You can also have that birth plan put in your file, so that those that you come in contact with at the hospital or birth center will have access to that information. Things that you might include in your birth plan are your desires for who is present at your birth, ideas about pain management, what you want done with baby after delivery, etc.

I heard something interesting last night at my doula meeting, from some very wise and experienced doulas about how to write a birth plan. They suggested that instead of trying to orchestrate every detail of your birth from lighting to cord clamping (using the laundry list templates that you can find around), pick about three things that are most important to you about the labor and birth to write down and document. The idea is that if you focus on the big picture and less on the minor details, you will be more likely get what you want when you ask for the big things, and receive a warmer reception from your physician and attending labor and delivery nurse.

Those long lists with all of the check-boxes do have a use, however, in my opinion. These can be used as great communication tools for your partner, doula, and your care provider prior to delivery. They can not only help you form ideas about what you would like your birth to be like, but to also identify things that you can be flexible on. It is important to ask whoever is delivering your baby what they perceive as "typical" for their deliveries -- Do they encourage movement? What pushing positions are "allowed"? What is their percentage of episiotomies? What tends to happen to baby after delivery? Do they delay cord clamping? Do they take baby right away or do they put the baby on mom's chest? These types of questions can help you get a feel for your doctor's style, especially if she takes the time to answer your questions and meet your concerns, if you have any.

When approaching birth, it is important to balance a feeling of "go-with-the-flow" with "honoring mother's and baby's experience", as many aspects of your birth you just will not have any control over (timing and length of labor and pushing, how baby is engaged, etc.). This should not diminish the fact, however, that you are the most important person, save baby, in the room when you are in labor. You deserve to be respected, honored, listened to and spoken to directly. If your partner and doula are aware of your "ideal" birth, they will have the ability to support you in a way that will leave you with positive feelings about your birth experience. And if you can single out a couple of the most important things to you and share them with the hospital staff, in writing, you will be more likely to have them "hear" you without overloading them with too much information.

Picking out your most important wish for each stage of labor makes it simple:

1. What is your most important need during labor? Do you want to be allowed to move? Do you want to labor in the tub? Do you not want medication offered unless you ask? Do you not want an IV?
2. What is your most important need while you are pushing? Do you want to try squatting if baby is having difficulty descending? Do you want to push on your side (protecting your perineum)? Do you want someone to count for you or do you want silence?
3. What is your most important need once baby is born? Do you want the cord clamping to be delayed? Do you want baby immediately on your chest? Do you want to establish nursing before tests and weight are done?

Remember to share this short list with your care provider ahead of time, so they can tell you that they are completely on board for what is on your birth plan. Better yet, have them sign it. For the majority of the time that you are laboring (even if you have a midwife) you will be attended by a labor and delivery nurse who will be accustomed to "hospital policy". If you have something on your birth plan that is different than what is normally done at your particular hospital, your nurse will have your doctor's written permission in hand (they might also call them for further confirmation) to allow you to exercise your wishes without the impediment of the hospital staff. This is why a shorter list is so useful and will most likely have a warmer reception than a three page script.

If it makes you feel any better, I was one of those who brought a three page script, along with about 17 extra copies (in case it got lost), to the hospital. I don't recommend it. Everything turned out okay, but I definitely got several eye-rolls from my nurses when I asked them if they had read my birth plan.