Preparing For Birth

http://blog.ican-online.org/2010/02/07/mother-sized-activism-nbc/

The International Cesarean Awareness Network wants you to get involved and speak your mind about what you think of the NBC “Live in the OR” piece from last week. Here is the link to ICAN’s official response.

The only way that mass media will be responsible for what they put on the airwaves is for real people, the  consumers to speak their minds.  Please click on the above think and go for it. Be heard. It does make a difference.

There is much in the news and in community talk how women are signing up for cesareans electively. I am very intrigued by this assumption and believe there is much misinformation regarding the topic out in the public for consumption. I am seeking to shed some more light on this topic.

Though this is not a scientific survey, I believe your experiences can help others in understanding why women are making this choice, as well as, potentially aiding other women in informed decision making.

If you have had or are planning an “elective” cesarean, I appreciate you answering this informal survey.  Answers can be submitted via confidential email to desirre@prepforbirth.com. By responding you are agreeing to allow me to use the information anonymously in a future blog, writing or other educational medium.

1. Was your “elective cesarean for a medical reason?  If so, what?
2. Was your “elective” cesarean for a non-medical reason?  If so, what?
3. How were you given informed consent?
4. What information were you given in the cesarean consent for benefits, risks, consequences, and alternative for you and your baby?
5. Were any words such as: Easier, safer, painless, no big deal, not risky, saves vagina or less pain used to describe potential experience?
6. Were you told your cesarean was necessary and found out later it was coded as elective?
7. Did you ever feel pressured or led by care provider to choose cesarean?
8. After your cesarean, did you feel you were consented fully enough prior to the surgery?
9. Did the cesarean “do” or live up to what you were told for you and your baby?  How so?  How not?
10. Would you make the same choice again or would you “go for” a VBAC?
11. What country do you reside?

Thank you very much for answering these questions. I am so grateful for input on this subject.

If you would like any information shared and attributed to you as a quote,  please indicate in your email to me.  As stated above, otherwise your identity will be kept completely anonymous and confidential.

Many times over I have heard something similar to “If only my insurance would cover the childbirth class, doula, that provider or birth location. Then I could have the birth I really want for me and my baby.” That statement sadly says to me that women are settling for a provider, birth location, type of birth even that would not otherwise be chosen.  Even so far as having a repeat cesarean because the insurance covered location or provider does not “allow” VBAC.

So practically how is someone going to get the desired provider, location or birth? First think of appealing to the insurance company to add a specific location (even home) or provider (even a  home birth provider) to the plan. This may or may not come to fruition, but unless the process is undertaken it isn’t even a possibility. Second, think outside the insurance box.  Be creative. I am a believer that almost 100% of the time there is a way. It may not be easy, simple, or lack stress but likely possible.

Here are some of my ideas for paying for the birth location, care provider, education, or doula support really desired.

Ask for family, friends, co-workers to donate to fund(s) in lieu of routine shower gifts (you will likely not use most of that “stuff” anyway no matter how much you think you will).

Trimming Down = Money Savings

• Satellite/Cable tv – Lower or cancel service.
• Cell phone – lower minutes, negotiate new fee structure, change plans.
• Household utilities – Lower thermostat, take short showers, heat or cold proof home.
• House phone – Get rid of all extras on phone that you don’t need or go VoIP. Even set-up answering machine.
• Food – Grocery shop sales only (no impulse buying), use coupons, eat at home, brown bag to work, no more fancy coffee drinks.
• Entertainment – Get Netflix instead of going out to the movies, visit with friends or family in their homes or yours.
• Shopping – Cut back on extras you do not need to live.
• Vehicle – Car pool whenever possible, only run multiple errands together, walk if possible, use public transportation is available.
• Housing – Move to a lower rent area or to a smaller home. Even consider moving in with family to maximize savings.

Extra Cashflow

• Sell any unneeded items via yard sale or something akin to Craig’s List. This can apply to second vehicle as well.
• Take on a second job that can be done from home or even with a multi-level company.
• Ask husband or partner to temporarily take on a second job.
• Do you gourmet cook,  write, musically talented, sew, knit, paint or craft? You may be able to sell your creations or services.

Miscellaneous

• Barter
• Ask for payment plan.
• Look for less expensive supplies such as a “fishy pool” versus renting an AquaDoula.
• Choose a birth center or a home birth as the cost is significantly less than even a no-intervention natural hospital birth. Also your prenatal care is included in the fee unlike a planned hospital delivery.
• Hire a training doula. Often a lower fee.
• Start a savings account before you are pregnant.
• Plan ahead and pay down any existing debt prior to getting pregnant or in early pregnancy.

I hope some “light bulb” moments are had and there is encouragement in the ideas. There is almost always a way.

If I have left anything off the lists, please feel free to leave a comment and I will add.

There is much awareness and conversation of what the routine interventions are that can occur during the labor and birth process within the hospital environment.  These interventions can include induction, augmentation with Pitocin, epidural, or cesarean. In all my professional and personal roles, I am privy to a great amount of pregnancy and birth stories. Within these experiences there are many “silent” yet obvious interventions that are hidden in plain sight under the guise of protocol, practice and societal expectation.

My current list of hidden in plain sight interventions in no particular order that can make a difference on how a woman labors and ultimately delivers her baby is below.

• The uniform -Asking and expecting the mother to give up her clothes for the hospital gown.
• Who’s on first? – If care provider is part of a large practice or on-call group a woman may have never met or have any knowledge of the person who’s practice style and philosophy is helping to guide and steer her labor and delivery. On-call CP may or may not adhere to the birth plan the laboring woman worked out with her own CP.
• On a short leash – Continuous monitoring even if she is not high risk, medicated, or being induced/augmented.
• The big drag around – Requiring IV running with absence of medical need.
• Staying put – Asking or requiring the laboring woman to stay in bed for ease of staff without medical need.
• Ice chips and Jello – Disallowing snacks and sometimes even actual water even though labor is hard work.
• The marketing tool – Disallowing the laboring woman to get into the touted tubs or showers since it isn’t convenient for staff and she will not want to get out.
• One is enough – Limiting the amount or type of support persons a woman is allowed to have with her.
• I know more than you – Treating the laboring woman as if she knows nothing or shouldn’t know anything.
• If you don’t… – Instead of giving informed consent and refusal, telling only what bad could, maybe happen.
• Attitude and atmosphere – Negative, non-listening, lacking compassion, leaving the door open, ignoring requests, and the like when a woman is laboring.
• Only if you ask – Though some wonderful practices are in place, they are only offered if a laboring woman or postpartum mother ask/insist on it.
• Bait and switch – The official tour of labor and delivery and the reality of labor and delivery don’t fit together.
• New with bells and whistles – The pretty with all the fancy bells and whistles like wi-fi, flat screen tv’s, etc. have to be paid for somehow. Because of this investigate the intervention rates there.
• Routine vaginal exams – By and large VE’s are very subjective and can vary greatly between one person to the next on how they score a VE. This variation can deeply affect the course of a woman’s labor and delivery.  Women birthing in the hospital really only “need” a VE upon entrance for assessment of where she is in labor, if she desires an epidural/IV narcotics, if she is having a very prolonged labor, or if she feels pushy.
• Pushing the epidural – When a woman is moving, moaning, making noise or just doing her thing in labor and it causes the staff discomfort or worry.  It could even be that anesthesiologist is going in to surgery and it can only happen now.

Simply because a societal norm is birthing at the hospital, as well as, what routinely goes on there, doesn’t mean the hidden in plain sight interventions are wise or harmless.

My goal here is to give pause and broader thinking to what intervention means for labor and delivery as another tool in planning and preparing for childbirth with eyes wide open.

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Thank you!

Desirre

Many years ago I wrote this piece after attending my very first ICAN conference in San Diego in 2005. I read this and part of me weeps for her, for the me I was and for the women who are becoming part of this sisterhood willingly, wittingly or not.  My pain has been transformed into outstretched hands and heart. It has given me a sensitivity and awareness of the birth world I would probably have never achieved on my own had my births been perfect, idyllic and without this trauma.

I love you dear sisters and my life would be far less without each of you.

Seems a long distance the ivory tower to the ground.  The surprise in finding the thorny bushes with burrs that dig deep and puncture again at will? Well meaning onlookers say “Well a hundred years ago you both would have died?”  And the farce begins.  Stuff it down because it is crazy not to be grateful for the surgeon’s hand.  Smile and pretend all the twisted darkness inside doesn’t really exist.  The oft daily chore mixed with joy of caring for a baby whom we are unsure is truly our own.   The continuing assault during lovemaking when a cringe comes from the depths when a loving and hungry hand brushes the incision site.  “How can he think I am beautiful?  How can he possibly want this?”  Another thing of beauty and perfection quashed underneath the burden of the surgeon’s handprint.  Oh no say it hasn’t already been a year.  The birthday.  THE birthday sounds so exciting but terror strikes.  Preparation to be happy, preparation to feel joy.  Preparation not to shortchange our amazing gift of a child under the pain of the surgeon’s knife print.

The anticipated day meant to birth us into motherhood and my child into my waiting hands to my craving breasts, I was birthed into the Sisterhood of the Scar forever.

While “teaching” childbirth class the topic of being a consumer is addressed often in a variety of ways.  I have a firm belief that a woman has the ability to understand, be well educated, and make her own decisions based on what she wants and needs. It is in no way in my job description to tell someone else how she must birth, how to do it in the right way.  She is the one who needs to take the information, explore it and apply it to her self and situation.  Being a consumer in her childbearing year is a key component.

I have a great and deep sense of obligation to give truthful, helpful, real life applicable information to the families I am blessed to work with.  Due to this my mantra is – “You go home or stay home with your baby and are the one who must live with the decisions and outcomes from them. Not the doctor, midwife, nurse, doula, educator – no one else.  We all go home to our own lives. So if you have to live with all that happens then do your best to choose wisely to what you can live with.”  No mother escapes the outcomes and the legacy it leaves behind forever no matter who makes the decisions for her. Even if it seems easier at the time to allow others to call the shots, I can hope the epiphany of this will help the pregnant woman to push for what she really needs and wants instead of being a passenger in her own process.

Birth options are integrated into prenatals and/or class structure as  we discuss birth philosophy, birth planning, re-interviewing care provider, realistic expectations for chosen birth location, and interventions and medications.  Most often I find that women have no idea that there are so many options available for the asking or available in a reasonably close proximity to our local area.  This tells me that care providers expect the burden of knowing the options is to be on the pregnant woman to find out about, explore, and ask for.  She may find that in this process she and her care provider/birth location are either well on or not on the same page with her needs and desires.  This is where she can decide if needed to seek another provider and/or birth location.  There is nearly always a way, it may mean more work, effort, and at times out of pocket expense. Some women choose to relocate, ask for help with out of pocket expenses in lieu of baby shower gift, petition insurance to cover the “right” provider… Really as a consumer the burden is on her to find the right fit and go for it.  It is not for her to fit into whatever is the local expectation for her as a birthing woman.  This comes down to something akin to buying a car because the dealer tells you this is the car you must buy because everyone else has bought it and even though you it clearly does not suit your needs, you still buy it.  I have never heard of that happening, yet I hear of women day in and day out having this sort of exchange in during prenatal care through the birthing day.

When it comes down to it, I really want women to have what is individually needed and desired. Who is paying the bills? Who is keeping the hospitals, birth centers, ob/gyns and homebirth midwives in business? Those caring for birthing women ought sit up and take notice. You all wouldn’t exist without birthing paying for your services. Yes, every provider or birth location has a practice style, protocol base,  etc. So why not honestly explain expectations, protocols, practice style in detail at the first visit or during the tour so the mother who is hiring you or birthing at your location can decide whether or not right off the bat if this is a solid fit? No one provider or location is going to fit with every mother nor is every mother going to fit with every provider or location.  Whatever a provider or birth location is good at, expects,  and is striving to be, put it out there so the mother coming in knows what she is buying in to.

My dream is that birthing women will know all the options and subsequently exercises her right to the care she desires even if it means walking with her cash or insurance card since ultimately she lives with all that transpires positive, negative, or in between.

As practice through the ages and evidence shows, support during the birth process can be greatly beneficial to both mothers and babies. It is not about having an experience. It is about healthier emotional and physical outcomes for mothers and subsequently for babies as well.  Putting together a support team is not as simple as inviting a family member or friend along. There are many components to consider as this is the most intimate time to allow others to share in except for the conception of your baby.

Prior to putting together your Labor Support Team (LST):

You and your spouse/partner are generally the only persons who can speak on your and the baby’s behalf unless another individual has a medical power of attorney for the labor and postpartum time period. Learning how to be a self-advocate is an important piece of the support team puzzle.  Answering very specific questions prior to looking at who ultimately will be with you at your birth will be helpful to you in addressing specific needs, goals, philosophy, and expectations.

• What education and self study are you doing during pregnancy?
• Do you feel confident and equipped to birth your baby?
• Are you confident and at ease with your provider?
• Are you comfortable with his or her requirements and practice style?
• Are you comfortable with the policies, requirements, and protocols of your birth location?
• Do you have special circumstances or health concerns?
• When you close your eyes who do you see being the most supportive of you and your choices?
• Are you a single mother or is your spouse/partner deployed?
• What type of help does your spouse/partner or your main support person need?
• How involved does your spouse/partner or main support person need?
• What type of physical support do you need (massage, positioning help, any chronic pain or health issues to contend with?)?
• What type of emotional support do you require (affirmations, encouragement, quiet and positive, no questions asked, reminders…)?
• What type of educational/informational support do you expect to need?
• Are you comfortable discussing needs and desires with provider?
• Do you feel confident in addressing the staff at a hospital or birth center?
• Do you have a birth plan?
• Planning a natural birth?
• Planning an epidural in your birth?
• Traveling a distance to your birth location?
• Are there any specific cultural barriers or needs that ought be addressed?
• What other considerations or needs might you have?

Now that you have answered the questions, it is likely a much more clear picture why being specific about your LST is so important.  This is an opportunity to look at and personalize what is needed in labor.  It is not for anyone else to decide what it will look like, who is going to be there, and who is not going to be there.

Putting together your LST

The birth of a baby is only less intimate than the act of making the baby. Inviting anyone into the area surrounding this event can affect the process positively or negatively. Privacy, comfort, safety, and honoring the birth of a baby are a must so choosing the person(s) to take the journey with you needs to be well thought out. Some candidates for a LST are on the below list.

• Husband
• Partner
• Mother/Father (other family members)
• Friend
• Older Children
• Doula (skilled and trained labor support)
• Care Provider (OB, Midwife or Family Practice Doctor)

Many on the list are pretty obvious choice considerations. The best person(s) to have around you during labor and birth will aim to provide what you need physically, emotionally, and by way of information while supporting your decisions and desires without bringing in negativity, fear, bias against what you want, distrust for the process, anger, a sense of undermining, etc. Your support team can make or break the outcome of your labor and delivery simply by what he or she brings into your birth.  Your birth is not about any one elses satisfaction, background, needs, wants or the like. This is your birth, your baby’s birth.

The one person on the list you may or may not have heard of is the labor doula. The labor doula was born out of this need.  Essentially this is a woman of knowledge and skill in pregnancy, birth, and immediate postpartum (yes there are a few men in who are labor doulas as well) who comes alongside a pregnant woman (family) offering education, physical support and emotional support to both the mother and partner/husband/other support.  A doula does not take away from a husband or partner during the process.  Doulas are shown to decrease interventions, cesarean, epidural use, narcotics use, need for induction, and increase satisfaction, bonding, breastfeeding success, and more! For more information regarding labor doulas, click here  http://prepforbirth.com/2009/08/09/what-is-a-labor-doula-what-does-she-or-he-do/.

From the Birthing Front

Here is a sampling from women who have birthed, are pregnant or attend women in birth who answered the question “Why is having a supportive birth team important?

“…because a woman in labor is in the most vulnerable state of her life. When I was in labor I needed someone holding my hand telling me I could do it… telling me all those incredibly intense sensations were, indeed, normal. I was vulnerable, and my support team protected me and supported me as I gave birth.  “For me, feeling “safe” didn’t just mean feeling safe physically… it meant feeling emotionally safe to welcome the vulnerability that labor brings and thus to be able to let go” Lily B.

“Birth is one of the biggest events that define a woman’s life. When she is in labor her senses are heightened by the hormones going through her body. Her perception of those around her will make or break her birth experience. A trained experienced birth team knows how to keep the emotions of both professional and non professional people positive and empower the woman to birth not only her baby but a stronger more confident self into being.” Amber-joy T.

“A supportive birth team can mean the difference between a physically healthy birth and a birth that can take months to recover from. Regardless of the actual events at a woman’s birth (vaginal birth, cesarean, medicated, non-medicated, home, hosptial, birth center), a supportive birth team can also mean the difference between having a happy, rewarding, and empowering birth and a birth in which the birth is not owned by the mother emotionally. Mental health can be more important than physical health and more costly to treat down the road. Always take care of yourself emotionally.” Nora M.

“Birth is such a vulnerable and powerful experience. I remember that I had to tap into a side of myself that I had not yet known until birth. Every *vibe* from others around me affected my state of mind during the process. Without the complete support of my birth team, and husband, I would’ve when that point of surrender hit, given into the doubts and crumbled under the pressure; But becauseI did have a supportive team, I was empowered to press forward and experience the most amazing moment of my life uninhibited.” Julie W.

So now take a moment to think about who will offer you what you need and help you attain what you want in labor and delivery.  Having continuous support no matter the type of birth you want is important because you and your baby matter.  Your birth matters.

Here is a compilation list of childbirth related quotes and sayings that I find powerful, interesting, affirming, or simply thoughtful.  Please feel free to respond with your own favorites.  The author of the quote does not need to be famous. I would be happy to expand the list. Enjoy!

Birth may be a matter of a moment. But it is a unique one. Frederick Leboyer

If you lay down, the baby will never come out! Native American saying

In men nine out of ten abdominal tumors are malignant; in women nine out of ten abdominal swellings are the pregnant uterus.  Rutherford Morison

Birth is the sudden opening of a window, through which you look out upon a stupendous prospect. For what has happened? A miracle. You have exchanged nothing for the possibility of everything.” William MacNeile Dixon

No one who has ever brought up a child can doubt for a moment that love is literally the life-giving fluid of human existence. Smiley Blanton

On the birth of her 2nd son Owen. ‘I wanted to give birth as opposed to being delivered!’ Ricki Lake

Do it afraid. Krista Cornish Scott

Birth is not only about making babies. Birth is about making mothers ~ strong, competent, capable mothers who trust themselves and know their inner strength. Barbara Katz Rothman

Having a highly trained obstetrical surgeon attend a normal birth is analogous to having a pediatric surgeon babysit a healthy 2-year-old. M. Wagner

Water birth is one of many lovely ways to enter the world. Judy Edmunds

The parallels between making love and giving birth are clear, not only in terms of passion and love, but also because we need essentially the same conditions for both experiences: privacy and safety. Sarah Buckley

The effort to separate the physical experience of childbirth from the mental, emotional and spiritual aspects of this event has served to dis empower and violate women. Mary Rucklos Hampton

The wisdom and compassion a woman can intuitively experience in childbirth can make her a source of healing and understanding for other women. Stephen Gaskin

It is true that naturally occurring labor can feel larger and greater than the woman birthing.  This is not so as she creates from within the very hormones that increase the strength, power, and frequency of her work of labor. That is the good news, it is from her, for her, by her.  Desirre Andrews

We have a secret in our culture, it’s not that birth is painful, it’s that women are strong. Laura Stavoe Harm

The knowledge of how to give birth without outside interventions lies deep within each woman. Successful childbirth depends on an acceptance of the process. Anonymous

We try to give a birthing woman freedom to find the right position for her own needs and comfort. Unfortunately, in our society we think of birthing as something done while lying down. Michel Odent

Only with trust, faith, and support can the woman allow the birth experience to enlighten and empower her. Claudia Lowe

Natural childbirth has evolved to suit the species, and if mankind chooses to ignore her advice and interfere with her workings we must not complain about the consequences. We have only ourselves to blame. Margaret Jowitt

Never underestimate the power and determination of a pregnant woman who is told she cannot. Desirre Andrews

Birthing is the most profound initiation to spirituality a woman can have. Robin Lim

Women’s bodies have their own wisdom, and a system of birth refined over 100,000 generations is not so easily overpowered. Sarah Buckley

Babies are bits of star-dust blown from the hand of God. Lucky the woman who knows the pangs of birth for she has held a star. Larry Barretto

No other natural bodily function is painful and childbirth should not be an exception. Grantly Dick-Read

Birth is an experience that demonstrates that life is not merely function and utility, but form and beauty. Christopher Largen

Women today not only possess genetic memory of birth from a thousand generations of women, but they are also assailed from every direction by information and misinformation about birth. Valerie El Halta

One is constantly having to balance the high expectations of modern health care with the need to respect the human soul. This is especially so with birth. Benig Mauger

There is no way out of the experience except through it, because it is not really your experience at all but the baby’s. Your body is the child’s instrument of birth. Penelope Leach

“Birth is the sudden opening of a window, through which you look out upon a stupendous prospect. For what has happened? A miracle. You have exchanged nothing for the possibility of everything.” William MacNeile Dixon

A woman can only enter a hospital while not in labor for a non-medical induction by her own two feet.   Desirre Andrews

“A newborn baby has only three demands. They are warmth in the arms of its mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three.”" Grantly Dick-Read

“Birth is powerful…..let it empower you” Anonymous

“Childbirth is more admirable than conquest, more amazing than self-defense, and as courageous as either one.” Gloria Steinem

“Deep within each woman, lies the Knowledge of how to give birth without outside interventions.” Unknown

The pains of childbirth were altogether different from the enveloping effects of other kinds of pain. These were pains one could follow with one’s mind. Margaret Mead

To enter life by way of the vagina is as good a way as any. Henry Miller

The need to pursue healthy birth options and birth rights for women and babies doesn’t end with our own births for women will always birth after us. Desirre Andrews

There are always questions on what is the normal length for labor and what is not.  Women in labor are not static.  Though there may be averages, falling outside of those may not be reason to manage labor by augmentation or cesarean.   Patience and individualized care tend to be the biggest keys to better labor outcomes.   Of course, maternal emotions, fetal positioning, maternal movement in labor or lack thereof, use of epidural or other pain management, provider or staff attitudes, over use of vaginal exams, continuous monitoring without risk association, and other can influence the normal course of labor.  There is no one-size fits all time-line to put on a mom and baby.

Generally as long as a progressing labor doesn’t all of a sudden stall out, become unorganized, or stop without a reason (see above), dystocia may not be present at all.

Below is a compilation list of information relating to progression of labor and dystocia.

Dytocia Defined First time Mothers AAFP

diagnostics – reassessing the labor curve.pages

Varney’s Midwifery Book

http://emedicine.medscape.com/article/260036-overview

Spontaneous Vaginal Delivery – AAFP

Labor Progress Handbook excerpt.

http://www.guideline.gov/algorithm/5587/NGC-5587_6.html

Helpful hints for keeping labor progressing:

• If at all possible (lacking medical necessity),  do not arrive at the hospital or birth center prior to well established labor (contractions as close as 3 minutes apart and a minute or more long).
• Eschew labor induction for any reason other than medical.   http://prepforbirth.com/?s=labor+induction
• Decline pain management if at all possible.
• Labor in the water.
• Continue to eat and drink in labor.
• Hire a labor doula.
• Attend evidence-based childbirth classes – not good patient classes.
• Attend meetings in your community who promote natural, healthy birth practices: ICAN, Birth Network, local doula organization, etc.
• Read variety of books – http://prepforbirth.com/products-page/books-videos-and-more/
• Surround yourself with those who believe in you.
• Be confident that you can birth!

Remember, a mother and baby are a unique pairing.  Some labors are short and some are long. Progress is defined by much more than cervical dilation. There is a huge spectrum of normal. No mother and baby will fit into a box.

Lastly, prior to labor also make sure you understand what your provider’s expectations are and how dystocia is defined.  That alone can determine whether or not you will have a successful vaginal birth.