Archive for the ‘natural birth’ Category

Preparing For Birth – The Passage from She Births

Sunday, October 11th, 2009

The below writing in my opinion is one of the most eloquent and beautiful takes on labor and birth I have read.   I am using it by permission of the author, Marcie Macari from her book She Births.   I encourage you to go to her site and see her offerings.  Inspiring and fantastic. Thank you Marcie for allowing me to bless others.

I have and will continue to use this piece as a visualization with clients and class participants.  Enjoy!

“The Passage” from She Births by Marcie Macari

The earth shook. The women gathered.

The chanting of The Women Of a Thousand Generations began,  their hands intertwined.

I breathe low, moaning deep through my body to touch the depth of sound they generate.

And for a moment I am with them.

“We’re here-with you, you are one of us-you can do it!”

One of them

I breathe.

The coals glow-mocking my strength

Embers flick their tongues tormenting my courage.

I step onto the coals-

The Women Of a Thousand Generations push closer to the embers- their faces glowing from the coals.

I keep my eyes on them, focusing on THEIR ability to push through the pain, to keep walking in spite of their fear- remembering that they made it to the other side.

I find MY courage and step again.

I feel the embers, and wince.

The Women start beating a drum.

I find their rhythm in my abdomen, and slowly move forward:

One step- look at the face.

Second step- focus on the eyes.

Third step…

I see the African dancers, rehearsing their steps as I walk my last few.

I see the circle being set-the fire at the center,  the food and festivities.

This will be the stage for my welcoming into this elite group- this Women Of a Thousand Generations.

My heart swells.

I am close to the end now, and my body starts to shake-

Spirit stronger than flesh.

I want to give up-to step on the cool grass

And off these coals.

I look for the faces, and my eyes meet theirs.

One of them smiles.

She who is With Woman, reaches out her hand

Her face is the clearest, eyes at my level.

“Listen to your body and do what it tells you” She says-no trace of concern.

The chanting changes: “Listen to your bo-dy”

In rhythm, hands are again joined, like an infinite chain.

I realize just how many have gone this way before me.

The one who smiled places her hand on the shoulder

of the One who is With Woman- with me, and I breathe,

stretching out my hand to grasp the outstretched.

I am about to cross over-

Silence comes over the Universe.

I near the end-

my body aches,

my mind is empty of everything but that last step.

Last step.

Hands grasped.

Cool grass. On my toes, cooling my feet-

my arms reach out to claim my prize-

“Reach down and take your baby.”

I hold him to me tightly, and proudly take my place in the chain.

I am now a Woman Of a Thousand Generations.

The celebration begins.

Excerpt from She Births: A Modern Woman’s Guidebook For an Ancient Rite of Passage, by Marcie Macari.

“There is more to Birth than the physical process of having a baby. Birth is a Spiritual Rite of Passage for women, offering an opportunity for profound transformation. She Births challenges each woman to consider how their Birth Choices profoundly affect not only their lives individually, but the world as a whole.”

Preparing For Birth – Affirmations

Friday, October 9th, 2009

Guarding what you put into your eyes, ears, and mind is such an important part of pregnancy and birth.  As women we learn socially, from one another.  When we allow the pervasive negativity (TV, horror stories, fearful education, good patient education, unsupportive comments, etc.) to take root we lose so much inborn knowledge and wisdom of all the women who came before.  I encourage you to read the below affirmations, use them, tweak them, and then write your very own. Place affirmations everywhere that you are. Encourage others around you to also speak them to you. whenever you think of labor and birth, recite your affirmations.  Build in the positive at any opportunity. If someone gets a negative experience out to you, stop and ask what she would have or could have done differently if she was able.

  • I will take labor one contraction at a time. I can do ANYTHING for a minute or two.
  • I am able to make the best possible choices for a healthy, joyful birth.
  • I TRUST my body to labor smoothly and efficiently.
  • My design is PERFECT to birth my baby.
  • I trust my baby and body to choose when labor will begin.
  • I will receive the start of labor and I will labor well.
  • I accept the unknown of labor and birth.
  • My baby already knows how to labor and come into my arms.
  • I am well equipped to mother my baby.
  • I can make choices and decisions based out of love/evidence not fear.
  • I embrace the concept of healthy pain.
  • I am welcoming my contractions.
  • I have enough love to go around.
  • There is always enough love for me.
  • I am strong, confident, assured, and assertive and still feminine.
  • I am helping my baby feel safe so that she can be born.
  • I am a strong and capable woman.
  • I am creating a totally positive and new birth experience.
  • My pelvis is releasing and opening (as have those of countless women before me).
  • I am accepting my labor and believe that it is the right labor for me, and for my baby.
  • I now feel the love that others have for me during the birth.
  • I will treat my mate lovingly during the birth.
  • I will have exactly who I need supporting me for my birth.
  • I am birthing where I will be the safest, most peaceful, and most encouraged.
  • I have a beautiful body. My body is my friend.

If you would like to add to my list, please email me at desirre@prepforbirth.com.

Birth Center Colorado

Tuesday, September 22nd, 2009

Though most hospitals have “birth centers”, they are really nothing more than the labor and delivery floor where births take place. The only freestanding birth center in Colorado is the Mountain Midwifery Center.  MMC is owned and run by Tracy Ryan, CNM  along with 4 other main midwives along with supporting staff.

What is a birth center? From the MMC site: “A Birth Center is designed to be a “Maxi-Home” not a “Mini-Hospital.” Here we strive to allow women to labor and birth in a true home-like environment while providing one-on-one care that helps ensure superior mom and baby outcomes. The Birth Center is not just pretty birth rooms, it is an education-intensive program of care. From your first visit through the birth of your baby and beyond, the Birth Center is designed to facilitate healthy choices for families.”

Located about an hour from Colorado Springs in Englewood, the birth center is a fantastic location to birth.  Check it out!

Preparing For Birth: Question of the Day #3

Tuesday, September 1st, 2009

Please share with me what encouraged, supported, and enabled you to continue in labor and delivery.  I may use your quote later in a post!!!

Email me at desirre@prepforbirth.com or simply add comment to post.

Pushing for Birth – another look

Tuesday, August 18th, 2009

“Pushing felt good.” “The urge to push was unstoppable.” “I loved when I got the urge to push!”. “I felt like I was going to split apart.” “It hurt so much more than I thought it would.” “I didn’t want to push.” “Why did I have to hold my breath and tuck my chin?” “I grunted and threw back my chin.” “Why were people yelling at me?” “All I wanted to do was breathe and not push.” “What is the deal? I was told I couldn’t get a baby out on my side, squatting, hand and knees or when I arched my back and threw my head back.” “It felt so good to put support at the top of vagina.” “If I would have pushed in another position would I have torn so much?” “Why did the nurse and doc keep putting their hands in me while I pushed?” “Would I have avoided a cesarean pushing in another position?”

The myths surrounding pushing in our culture are widespread. Over and over women are told unless they push in the “C-position” or reclined position with tucking chin and holding breath “purple pushing” there is no way they can effectively push out a baby. Women are told that spontaneous or limited bearing down will take much longer. When in fact that is untrue.

Interestingly, when not coached, women spontaneously know how to push, how to breathe properly and how to help baby descend. As a matter of fact, most women choose to squat, stand and lean or use a variation on hand and knees to deliver their babies and even nap in between pushing cycles.

By the comments above pushing can be wonderful, challenging, or even both.  Outside influence can hinder or encourage a woman. She is very vulnerable and usually tired, but then the second wind comes.  She knows her baby will be here soon.  She knows that after the hours of getting out of her own way and letting her body do the job it was designed for, she can now DO something. Second stage can last minutes or hours, though it is like early and active labor more rest than work. Women may even sleep in between contractions.

So why are women continually told there is only one way to effectively deliver a baby and expected only to do that?

Here are a few thoughts to chew on:

  • 98% of babies in USA are born in the hospital versus at home  with or without a midwife or at birth center with midwives in attendance.
  • Most OB’s are not trained to receive a baby in any other position. They are trained to see with their eyes for one orientation and have not learned to “see” with their hands.
  • Most OB’s are trained to sit in front of the mother on a stool like a catcher.
  • Staff and OB’s want something to do when really the woman pushing is the only one who needs to be doing anything.
  • In hospitals, nearly ALL women – in some areas close to 100% are medicated with narcotics or more likely with epidural anesthesia disallowing freedom of mobility and body presence.
  • Beds are used virtually 100% for hospital deliveries versus a birth chair, birth stool, toileting, squat bar, standing or leaning.
  • Women are programmed to be in one particular position because it is virtually all we hear about from others and see in the media.
  • Women are not taught to trust their instincts and to listen to their body and baby during birth so instead they look outside to gain understanding of what to do.
  • Nurses are trained only is “pushing” women in the new classic C position with vigorous perineal and vaginal “massage”.
  • Women are limited to a specific pushing time and often in the one position before a cesarean is performed even when mom and baby are doing well.

When a woman chooses a variety of positions for pushing without hindrance (this can include the C position) it can:

  • Reduce trauma to the perineum, labia, clitoris, and urethra
  • Shorten pushing time
  • Allow for movement of the tail bone thus opening the pelvis more
  • Can lessen stress on the baby
  • Give mom more sense of control over the birth
  • Changes the pelvic shape to aide baby in molding and adjusting
  • Allow for fetal ejection reflex to occur
  • Allow for a euphoric and natural state to occur

Using alternative breathing techniques other than holding the breath as in directed pushing to a count of ten or more can allow for baby to get more adequate oxygenation as well as,  be a more gentle process for both parties. A laboring woman may breathe in several different ways during pushing.

She may:

  • throw her head back and open her neck with an open mouth while breathing to comfort and pushing
  • spontaneously push while breathing non-specifically
  • she may grunt and growl
  • she may hold her breath for a moment and then exhale several times during a pushing episode
  • she may do a slow-exhalation with mouth relaxed and slightly open (open-glottis) while pushing
  • breathe slowly/rhythmically and not push actively allowing for passive descent of baby through contractions

Most un-medicated or lightly medicated women will choose a position and breathing style that works for her body allowing for the natural progress to occur, usually culminating in the fetal ejection reflex at the very end.  Instead of forcing a woman into a cookie cutter type position, she needs to be given the opportunity to trust her body, trust the process, feel the process and feel supported. Otherwise, we don’t really need to do anything.

I urge you to have deeper conversations about pushing and delivery with your care provider BEFORE you go into labor. The answers to the questions may be a green or red flag for you. Pay careful attention that your questions are really answered to your satisfaction.  It is your provider’s job to prove to you why he/she practices the way he/she does.

  • Ask your provider what his or her philosophy about pushing and delivery is.
  • Ask provider to describe what pushing normally looks like with his/her patients.
  • Ask how many hands off deliveries your care provider has done.
  • Find out what positions your provider is comfortable or willing to GENTLY receive your baby in.
  • Ask if provider performs perineal massage? If so, have it described to you. GENTLENESS is the key here. No one needs to tug, pull and yank your vagina, labia, and perineum.
  • Ask your provider if spontaneous pushing and delivery are supported.
  • Tell your provider you will agree to coached pushing after you have tried everything you want to do
  • Ask about percentage of women under provider care “require” an episiotomy
  • Ask how long pushing will be tolerated before wanting you to have a cesarean or instrumental delivery.
  • Ask for evidence to support practices. Actual studies not just verbal.
  • If you are having a hospital or birth center birth upon arrival and admittance speak clearly to your nurse about what you plan on doing for pushing.

Here’s to pushing with confidence, using your instincts and following your body!  Here’s to finding the provider with a normal outlook on pushing and delivery.

Preparing For Birth – A sample low-intervention birth plan

Thursday, August 13th, 2009

A birth plan is a tool to express your desires and needs for birth and initial postpartum, as well as, to make sure that you and your provider are on the same page.  Your birth plan should be brief (no more than one page) and only have the bullet point information that is specific to your care and desire or not usually done by your care provider or birth location.

Discuss with your care provider prior to labor and bring a copy with you to your birth location.  Remember it is not a legal document that your location of delivery or care provider must adhere to.

Here is a sample plan for an out of the home birth:

Birth Needs and Desires for: _______________________. Care Provider:____________________________________.

Estimated Due Date: ____________________________.

Labor

I am planning on a no to low-intervention natural birth.  I plan on being mobile, lightly snacking, drinking orally, and having ___________ present.   I understand that intermittent monitoring of me and my baby will be necessary.  I want to be fully consented for any procedure that may come up and fully participate in the medical care for myself and my baby.  I understand that there is pain management available to me, I will ask for it if I so desire.

  • I plan on wearing my own clothing. I will ask for a gown if I change my mind.
  • I would like a saline lock in lieu of an IV
  • In the event of an induction and/or augmentation is medically necessitated-
    • Ripening – Foley Catheter instead of Cytotec (misoprostol)
    • Pitocin – A very slowly increased dosage
    • AROM – will only consent to if an internal fetal monitor is a must.
  • Delayed cord clamping for at least 5 minutes (baby can receive oxygen or other helps while still attached to me).

Postpartum and Baby Care

  • Request that my baby is on my belly or chest for assessments and warmth (even oxygen can be given on me)
  • Delayed bathing
  • Delaying vaccinations including eye ointment and vitamin k.
  • Exclusive breastfeeding, no pacifiers, sugar water, or formula
  • No separation from me unless absolutely medically necessary not just protocol.

Cesarean: In the event a cesarean becomes necessary and is not a true emergency requiring general anesthesia.  I would like to keep the spirit of my plan A to plan C so the delivery can be as family centered and intimate as possible.

  • Only essential lighting
  • Only essential conversation related to the surgery and delivery
  • Lower sterile drape or have a mirror present so I may see my baby emerge
  • Only one arm strapped down so I may touch my baby
  • Pictures and video
  • Aromatherapy as I desire for comfort, abate nausea and to mask surgical odors
  • Baby to stay with me continuously in OR and recovery
  • If baby must leave OR for treatment, my partner/spouse goes with baby and I would like my ____________ to stay with me so I am never alone.
  • Breastfeed in OR and/or recovery
  • Delayed immunizations
  • Delayed washing and dressing of baby
  • No separation from me except what is absolutely medically necessary

Choosing your birth location – A tip sheet

Monday, August 10th, 2009

Choosing the place of birth for your baby – It is incredibly important that you understand where you fit best prior to choosing where to birth your baby. Take hospital and/or birth center tour, call and talk to L&D floor, get facts on home birth by talking to home birth midwives, other moms who have had home births, online and in books. Being intellectually safe is not the same as being safe. Know the facts before you choose.

· Does the location offer what is most important to you (tubs, birth balls, wearing own clothing, intermittent monitoring, fetascope monitoring, etc.)?

· What are standard protocols and practices that are followed? Is individualized care a norm there or is cookie cutter style?

· Is water birth available?

· Are birthing stools or non-reclined pushing and delivery positions encouraged?

· What are the no/low intervention rates? These numbers are tracked monthly.

· What is the induction, epidural, cesarean rate? Are VBAC’s supported and encouraged?

· Are mom and baby friendly practices used? (no routine interventions, no separation of mom and baby, breastfeeding is the norm, movement in labor is utilized, doula accompaniment is accepted, labor induction rates are low, etc.)

· What if I choose to decline an intervention, medication or procedure? Will my decisions be respected? Are patient’s rights taken seriously?

Points to Ponder afterward

· Will I be able to have the type of birth I truly desire?

· What location will I ultimately feel most comfortable in physically, emotionally and spiritually?

· What location is ultimately safest for my specific needs (I am currently a low-risk or high risk)?

· Is insurance or lack of it the reason I am choosing the location?

· Do I have realistic expectations for the location?

· Am I willing to take responsibility for my birth in the location?

· Is staff open to working with a doula or natural birth?

· Are there any compelling reasons to choose one location over another?

What is a labor doula? What does she (or he) do?

Sunday, August 9th, 2009

Women have supported women throughout the ages.  In our very busy and ever transient culture, the woman to woman education and support of yesteryear is sorely lacking.  It is very common for an expecting woman not have family nearby or to have support women who know the ways of natural, normal pregnancy, labor, delivery and immediate postpartum. 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.

Below is a detailed description of what a doula is and does according to CAPPA a wonderful organization that trains a variety of doulas and other birth professionals.

What is a Labor Doula?

A doula is a person who attends the birthing family before, during, and just after the birth of the baby. The certified doula is trained to deliver emotional support from home to hospital, ease the transition into the hospital environment, and be there through changing hospital shifts and alternating provider schedules. The doula serves as an advocate, labor coach, and information source to give the mother and her partner the added comfort of additional support throughout the entire labor. There are a variety of titles used by women offering these kinds of services such as “birth assistant,” “labor support specialist” and “doula”.

What Does a Doula Do?

The following is a general description of what you might expect from a CAPPA certified labor doula. Typically, doulas meet with the parents in the second or third trimester of the pregnancy to get acquainted and to learn about prior birth experiences and the history of this pregnancy. She may help you develop a birth plan, teach relaxation, visualization, and breathing skills useful for labor. Most importantly, the doula will provide comfort, support, and information about birth options.

A doula can help the woman to determine prelabor from true labor and early labor from active labor. At a point determined by the woman in labor, the doula will come to her and assist her by:

  • Helping her to rest and relax
  • Providing support for the woman’s partner
  • Encouraging nutrition and fluids in early labor
  • Assisting her in using a variety of helpful positions and comfort measures
  • Constantly focus on the comfort of both the woman and her partner
  • Helping the environment to be one in which the woman feels secure and confident
  • Providing her with information on birth options

A doula works cooperatively with the health care team. In the event of a complication, a doula can be a great help in understanding what is happening and what options the family may have. The doula may also help with the initial breastfeeding and in preserving the privacy of the new family during the first hour after birth.

What does a doula cost? This can be a huge spectrum and is defined by where you live.  A labor doula may volunteer, work for barter, or basics like gas reimbursement, childcare coverage, snacks, etc.  I have heard of fees from $100 to $1800 (mind you this is in NYC).  On average I would say a labor doula costs $250-$600 in many areas.   Call around or visit websites in your area to get a firm idea.

What about insurance? Private doulas usually do not bill insurance though many will give a super bill to be submitted for reimbursement by insurance.  many insurance companies after some effort will pay a portion of the fee as an out of network provider.

Will a doula provide my complete childbirth education? Sometimes.  Often not.  Some doulas are educators. I provide classes separately from doula services. The labor doula will often fill in the blanks and personalize the education the client already has.  Many doulas have lending libraries or recommended reading and watching lists.

If I am going to a birth center or having a homebirth will a doula still benefit me? Yes in both cases.  When going to a birth center a doula would labor at home then arrive at the birth center at the same time as the laboring mother just as with a hospital birth.  In a homebirth scenario the doula who is not a midwife and does no medical tasks is often a welcome extra set of hands and does the same emotional and physical support as she would do in any other location.

Does evidence support that having a doula in attendance has benefits? YES. Here are some of the benefits. Lowered epidural, narcotic, induction, cesarean, and instrumental delivery rates. Increased satisfaction, breastfeeding, and bonding.  Also shorter labors!

For more information, email me at desirre@prepforbirth.com.

Is pain in childbirth something to fear?

Thursday, August 6th, 2009

The most often fear I hear about is pain in childbirth.  It comes across as if the pain is some external force that is larger and badder than any other entity imaginable. I believe the dramatic cable channel birth shows, network tv shows, a very high epidural rate, and the rampant sharing of scary birth stories has done much to reframe what labor and delivery is today.  Though it started way back in our country about 100 years ago with the writings of Joseph DeLee who believed that women needed to be saved from birth.

Pair those with the idea that we are supposed to always feel perfect, never have an ounce of discomfort or pain in our lives (have you seen the Tylenol advertisement that quips “One more step to a pain free world”?), well it sets up an unreasonable expectation and core understanding that there is no way as a woman “I” can handle it and why should “I”?!

I shake my head that women can think we are SO fragile and cannot tolerate or thrive in such a thing as labor and delivery.  We can be fierce, strong, tender, loving, organizational, multi-tasking, boo-boo fixers, community builders, compassionate, change makers, history makers – let alone having the ability to grow a brand new person (even if in our hearts through adoption or other ways).  WOW we are amazing.

Women are all those things and much more.  Believe in the design, abilities, and intuitive nature.

Back to the pain.  So what if it hurts?  It may. It may not.  Sometimes the work of labor means discomfort or pain though it isn’t normally the sort of pain or discomfort that is alarming.  It is powerful.  It is the woman who is making the hormones required to start labor and keep it progressing.  A woman’s body is designed to offer up endorphins to match the increasing strength of the contractions along with oxytocin.  Her own body medications are powerful and can bring a strong degree of relief though they do not change the incredible power that each woman makes and experiences in labor.

Positioning movement can assist in rotating baby into a more comfortable and optimal position such as, pelvic rocks, lunges, swaying on birth ball, stair walking, curb walking, talking to baby, knee chest, advanced sims,  and a woman listening to her body to find the right movement.

Emotional pain need to be recognized and worked through in whatever way serves the laboring woman best.  Obtaining an epidural will usually not quash emotional pain and may increase it.  If fear creeps in, contractions can become painful.  Addressing the issue at hand, having support around you to, and making the space her own can help.

If at the hospital and there is something happening that is infringing on the mother’s rights or is antagonistic, she may want to consider asking for another nurse or doctor to come in and help the situation and/or seek out the patient advocate.

When it comes to physical pain or discomfort a variety of techniques can be employed. Some of these are – position changes, getting into tub or shower, hot and/or cold compresses, having a doula present, snacking and drinking in labor, refusing routine interventions, massage, visualization, vocalizations, prayer, meditation, relaxation, hypnotherapy, listening to music, soothing smells, visuals, and textures, having supportive people including care provider and using a birth ball.

If another woman shares an incredibly painful birth story, ask questions.  Was she induced? In bed the whole time? Lacking support? Lacking education? Poor baby position?  Augemented labor? Was she scared? Did she feel empowered? In a stressful environment?  Questions that will help understand where the pain came from.

Women can do ANYTHING for a minute at a time culminating in hours after the many months of growing and nourishing a baby on the inside. The work of labor and delivery also can bring a sense of comfidence and ability into mothering her baby on the outside.   Easy it will likely not be, but anything worth something requires effort, steadfastness, and often discomfort.  It is in that place we grow and show what we are made of.

Be confident.  Women are strong!

Cesarean vs. VBAC: A dramatic Difference

Wednesday, July 22nd, 2009

I have been invited to share with you an intimate and challenging (and graphic) journey of a mother from an unexpected primary cesarean, physician decided repeat cesarean and a home water birth after those two cesareans.

Before you watch it, take a deep breath and have an open mind. A box of tissues may be in order as well.

Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

Watch how a baby is delivered in a cesarean birth and see the dramatic difference of what both the mother and baby experience in a home water birth after cesarean.


Thank you Alex for allowing me to share your story!  Many blessings to you and yours.

For more information on cesarean recovery, support, prevention and VBAC information go to www.ican-online.org.