Archive for the ‘Preparing For Birth’ Category

Childbirth Education Myths 3

Tuesday, February 18th, 2014

books-150x150To read the whole series, begin with Childbirth Education Myths 1.

MYTH #3: “The hospital class will be good enough.”
One of the best ways to be prepared for birth is to learn about birth. What happens in the normal, physiologic process? How do interventions (medical or non-medical) affect that process? What is the difference between the medical model and the midwifery model? Under what circumstances will each model benefit you? These are topics a hospital class will likely not tackle.

1) Limited information.
Hospitals often teach what is available at their facility. This makes sense, because hospitals are in the business of selling medicine. Their maternity department offers the medical model of care, and hospital childbirth classes reflect that. Their instructors are employed by the hospital, and the hospital has direct control over their curriculum.

The class offered at a hospital is more likely to focus on when to get to the hospital, what to do if your water breaks, protocols for epidural placement, and what to expect in a cesarean. They may cover logistics like where you go to get admitted, what happens there, and where you get moved around to. They will make sure that you are familiar with the routine protocols and procedures, which can be beneficial if you are planning to birth there.

They may or may not offer much information on non-medical pain management, the physiology of birth, doulas, or birth plans, as these are not things normally offered in hospitals.

2) Alternatives to the medical model are not offered.
Generally speaking, hospitals do not employ care providers like chiropractors, naturopaths, independent midwives, or other more holistic-minded care providers. If they do, they may not think to refer you for care from any of these areas, as they are not part of the medical model of care for birth. To learn about non-medical options, a local independent childbirth educator is going to be a wealth of resources and information for you.

3) Informed Choice vs. Informed Consent
Many hospital classes cater to the majority, who are anticipating the status quo American birth: Start labor, get epidural, have baby. While there is nothing wrong with a woman choosing that model, many hospitals operate under the assumption that this is the only model that interests women. Thus, they spend more time preparing moms for what to expect at the hospital than they do preparing them to cope with labor in whatever way seems right to her. If a mother wants something outside that model, a hospital class may not be the best fit for her, and she may feel as though she is sitting in a “How To Be Good Patient Class,” rather than a comprehensive, evidence-based, balanced childbirth class.

4) Availability of Instructor
Independent childbirth educators are often available by phone and email between classes, to help with homework, provide resources and referrals, and to answer questions. Hospital instructors may not have such ready availability. Their class sizes are usually much larger, so their ability to give one-on-one attention or instruction may be severely limited.

Questions to Ask Childbirth Educators:

  • What curriculum do you use, and what is it based on?
  • How much experience do you personally have in this hospital attending births? Do you have any experience working with the independent midwives in town to offer a balance in models of care?
  • Is this class going to teach in-depth about the physiological birth process?
  • How much time is devoted to labor coping techniques?
  • Are you a certified instructor? With whom?
  • Are you available for questions or concerns outside class? Can you refer to outside providers, and if so, whom?

In short, it’s not a bad idea to take the hospital class — just don’t let it be an exclusive source of information. There are a wealth of independent organizations that do an excellent job at preparing you for birth. There are methods like Bradley and Hypnobirthing, as well as comprehensive courses by Lamaze and CAPPA. (We’ll address method classes in this series as well, so stay tuned!)

For more on this topic, we found another excellent perspective here: 5 Reasons Not To Take Hospital Chilbirth Classes

Where did you take your childbirth classes? How did they help or hinder your understanding of birth? Did you have a good experience with the hospital?

Warmly,
Team Preparing For Birth

Dad Matters – A doula’s perspective

Sunday, September 29th, 2013

Many men in our culture are fairly apprehensive about birth. Most have never seen a real birth, or talked about it outside of sex ed. They are often nervous about birth itself, seeing their partner in pain, the what-ifs, and all that may come after. They doubt their ability to support their partner in her journey, and wonder if they’ll be strong enough.

In fact, they often doubt and fear and wonder just as much as their partners do, but are often not allowed to express it, because they’re not the ones giving birth, so they feel that they don’t really matter. They may feel like they don’t have much voice in the process, and are just expected to go along for the ride, smiling and nodding whenever the experts speak.

Yet, at the same time, they are expected to know everything about birth, protect their partner, communicate her wishes, and support her physically and emotionally without pausing for breath.

Many worry that they just can’t live up to all of that. It really is an awful lot to ask of one human being, after all. Especially since history shows us that there have always been many support people surrounding a mother during birth.

Still, many men don’t realize just how much they are capable of. They don’t realize that they matter, too, and that they can enter their partner’s birthing space with confidence, ability, and strength to meet the challenges of supporting a labor and birth.

 

So, how do we help fathers to step into the birthing space with confidence?

 

We free them to be who they are, that’s how. We let go of our expectations, and help them to form their own expectations and desires for supporting the birth of their child. We help them to see that they alone can define their role in the drama and sacredness of birth.

I would suggest two important things that may help a father gain confidence and acquire tools to help him fulfill the role he wants to play during birth: 1) Independent childbirth education classes, and 2) Hiring a doula.

The more a man knows, the less he will fear birth, and taking Childbirth Classes is one of the best ways to lower anyone’s fear level in anticipation of birth. Many men appreciate information given in practical, interactive ways, and independent childbirth classes are often right up his alley. He can join with like-minded dads, ask questions, and have his concerns addressed more readily.

Information is a great, big factor in helping couples manage their stresses and fears regarding birth—as much for the father as it is for the mother. As an educator, at the beginning of a series, I usually see high levels of apprehension, which quickly fade from week to week, to be replaced by realistic expectations and informed confidence in both parents.

This is just as powerful for the father as it is for the mother. When Dad has confidence in Mom’s ability, she believes in herself all the more, and Dad begins to see that he has power to influence her for the better! Dad is able to acclimate himself more readily to the realities of birth, and begins to realize that he is an important part of her support team. Perhaps the most important part.

He feels a little more ready to step into his support role, and probably has clarified what he wants that role to look like. He will feel more confident about what he can do, and more realistic about what he might not be able to do.

 

In which case, he may begin to consider…

 

Hiring a Doula to help him fill in the gap in the support team he might not be able to fill himself. If he participates in choosing and hiring a doula, he is much more likely to have his own expectations met, as well as those of his partner. When Mom and Dad are both fully supported, Dad is far freer to just be and do what his partner needs him to be and do.

While he will likely remember a lot of what he has read and learned about, that information may become secondary to him during the birth, and take a backseat to more immediate concerns in his mind.

He may become simply focused on loving this woman who is birthing his child. And why shouldn’t he? Why should he have to remember every counter pressure technique? Every massage technique, position change, or even the water jug and bendy straw? Why shouldn’t he be the face close to hers, his eyes beaming his love, concern for, and confidence in her?

A doula allows Dad to be front and center in the support role he always wanted to fill for Mom, in whatever way makes the most sense for their individual relationship in this particular moment. If he wants to be the Expert – he ought to be equipped to do that. If he doesn’t, then he needs the space and freedom for that, too. Or anything in between.

When he is free, all his anxieties and apprehensions tend to fall away, and he finds that birth is a challenging, beautiful, amazing space to be in with his partner. He finds that he is strong to meet the challenge, just like she is. Together, they grow in strength and confidence, becoming truly ready to meet this tiny new person they have made.

Doulas help open wide the door, making the birthing space more navigable, understandable, and pleasant for fathers. This, in turn, can only benefit the mother as she is able to rest in the support of her birth team. She no longer feels concern for her partner, because he shows no reason for her to be concerned. She is able to just birth.

Then, we can just step back and watch, as he exceeds all the expectations we have laid on him, and as he steps into Fatherhood in the way that makes the most sense to him and his new family.

Tiffany Miller, CLD, CCCE

An unexpected breech cesarean – A mother’s perspective

Sunday, October 28th, 2012

A guest post on an unexpected breech cesarean from a mother’s perspective. From the heart. Where reality meets birth.

 

My husband and I got married roughly four years ago and wanted a baby. Our plans to conceive a baby was derailed, as I lost my job shortly after we got married. We finally began trying in 2009 and 18 months later we found out that we were expecting. I was excited to finally be pregnant. The doctor confirmed my pregnancy and we got to see our baby for the first time on October 25th, 2010. I had a dream a few nights before our sonogram that we were expecting a baby boy. During my sonogram on December 29th, we found out that we were expecting a baby boy.

 

False Labor Runs

Everything was going smoothly with the pregnancy, despite a few false labor runs. I began having false labor around 35 weeks. My contractions were coming every 5-7 minutes consistently; however, they weren’t changing my cervix. After 2 false labor runs during the middle of the night, my baby decided to wait until his due date to be delivered. A few days before my due date, things took a turn and my birthing plans were tossed out the window.

My doctor ordered an ultrasound on May 24th, the day my baby was due to check on the fluid levels since my fluid levels began dropping off after I reached my due date in a previous pregnancy. The ultrasound tech was checking the fluid levels and they were within the normal ranged. However, she discovered that my baby was now breech. He decided to turn breech over the weekend. All throughout my pregnancy, he was head down. In fact, on the previous Friday when my doctor checked me, he was head down during my exam.

My Dream Birth Was Thrown Out the Window

When the ultrasound technician found his head up in my ribs, I immediately knew that I was going to have to deliver him via c-section. I was devastated that I wasn’t going to have the labor and delivery that I had been planning in my head for months. I wanted to have a natural birth with minimal interventions. My dream labor included: freedom to get up and move around, walk the halls to help progress labor, labor in the bathtub, and less fetal monitoring. These dreams faded away quickly as my doctor scheduled my c-section.

Manual Inversion Was Too Risky

My doctor offered to attempt to manually turn the baby. If she could get him turned manually then she would proceed with inducing labor. However, she explained the risks to me and told me that I had an anterior placenta. She said the risks included: placental detachment, placental tears, and bleeding. These risks scared me to death and I felt that it was best to proceed with a C-Section.

I was so miserable and uncomfortable that I went ahead and had a c-section, but if I had the knowledge that I know now and had the money to hire a doula, I would have paid for one. A doula is a trained and experienced birth coach. They are trained to help support a mother emotionally, physically, and provide information about the choices they have to make in regards to their care. After speaking to a wonderful doula on twitter, I personally feel that I might not have been so quick to agree to a c-section. Desirre told me that there are ways to try and get the baby to turn on its own or even attempt to deliver him breech, since I had previously had successful births. But I didn’t know that when I had to make a decision about my C-Section.

Doulas Can Help Mom’s Who Have C-Sections

Doulas can even be hired for C-section births. They usually don’t participate in the actual surgery but they can provide support during the preparation and during postpartum care. A C-Section wasn’t as bad as I thought it was going to be. The hardest part was the uncontrollable shaking that I experienced as the anesthesia from my spinal block was wearing off. I felt that the spinal anesthesia kept me from enjoying those first moments of breastfeeding my baby.

 

Christy is a wife to her loving husband of 4 years and a mother to three beautiful children – Ages 15, 11, and 15 months old. I am the owner and founder of Uplifting Families. In my spare time, I enjoy blogging, spending time with my family, going to church, and playing games. I can be found on twitter at @upliftingfam

F.E.A.R.

Thursday, August 30th, 2012

I have been thinking on the F.E.A.R. (False Evidence Appearing Real) acronym.  What else can it mean? Fear itself can be a positive or a negative. Fear can be a stumbling block or a motivator.

I enjoy coming up with affirmations and words that alter the view especially as it relates to pregnancy, childbirth and postpartum. I have been and know so many who have fear thrust upon them by friends, provider, family, strangers or have deep fear from previous experiences or from the unknown lurking ahead.

Take my words, come up with others and make your own acronyms to work with the FEAR surrounding you, inside you and take away its power.

 

F                      E                     A                     R

Feeling, Freedom, Fix, Fire, Fierce, Forge, Find, Fortitude, Frame, Fight, Force, Free, Forever, Forgive, Feel, Fearless

Everything, Exist, Eradicate, Excite, Envelop, Empowered, Encourage, Enhance, Expectation, Effort, Exquisite, Endearing, Encourage, Enhance, Effort, Expectation, Exquisite, Equal, Excel, Expert, Ease, Engage

Admit, And, Am, Advocate, Amplify, Armed, Above, Answer, Awareness, Act, Assist, Attitude, Ally, Appear, Admire, Ask, Alter, Apprehension, Action, Alive

Rest, Respect, Rise, Release, Rage, Rights, Ready, Resonate, Relief, Repair, Rely, Resist, Rejoice, Roar, Risk, Release, Re-frame, Rephrase, Remain

 

Please share additional words you come up with!

Social Media and You

Sunday, October 16th, 2011

Get your pregnancy, birth or postpartum story heard!

I am looking to interview several mothers/families who have been positively changed, supported or impacted emotionally, physically, socially, educationally and/or spiritually during the perinatal (pregnancy, labor, childbirth, postpartum) and/or into the first year of mothering/processing birth outcomes through the use of/participation in social media outlets (Twitter, Facebook, Google+, Forums, Message Boards, etc.).

Purpose: Information will be used to complete a speaking session about birth and social media, as well as, material for additional writing, educational sharing opportunities.

If you are interested, please email me by October 31, 2011 with your contact information, when due if pregnant, how old your baby is if in the postpartum period and how you were affected by social media.

Contact: Desirre Andrews – Owner of Preparing For Birth LLC, birth professional, blogger, mentor, healthy birth advocate and social media enthusiast. Site: www.prepforbirth.com

Email: desirre@prepforbirth.com

Writing Your Own Birth “Plan”

Sunday, October 16th, 2011

A birth plan has more than one purpose. It begins as a value clarification exercise, then becomes a communication tool with your care provider and ultimately a guide of needs and desires during labor, delivery and postpartum. Even if your birth location does not ask for birth plans, it is a good idea to write one for your own benefit.

Step 1

Clarifying your needs, wants and desires. Here are the  Birth Menu of Options and Assessing Your Feelings we use in class  to begin the value clarification process.  The birth menu is most helpful when you begin by crossing out what you are not interested in, highlighting the items you know you want and circling what you need to research. The AYF worksheet is for you and your husband/partner/non-doula labor support person to go over together to ensure you are on the same page and open up conversation. Doing this prior to 35 weeks of pregnancy gives you more time to coordinate with your care provider or birth location. If you have a doula or are taking a childbirth class, she/he can help you in this part of the process as well.

Step 2

Write down in order of labor, delivery, immediate postpartum and in case of cesarean needs and desires. Your plan really needs to be within one typed page for easy reading and digesting by care provider and staff. The only items that must be listed are care options that are outside of usual practices, protocols or standing orders. Here is the Sample Low Intervention Birth Plan we use to help you see a finished format and types of pertinent information that may be necessary to list.

Step 3

Take your written plan into your care provider. This is a conversation starter, a beginning, a partnering tool. As I encouraged above, early to mid 3rd trimester gives you more flexibility in communicating with your provider and setting your plan in motion. It also gives you opportunity to change providers or birth location if you cannot reach a comfortable agreement.

Step 4

Make any changes.Finalize.  Print out final copy.  Give one to care provider, have one in your bag for labor and birth, give one to doula (if you hired one). Though this is not a binding or legal agreement it can go a long way toward the type of care and birth you want.

Step 5

Gestate peacefully until labor begins!

Could this be labor?

Wednesday, September 21st, 2011

For first time mamas, previously induced mamas or those who have loads of prodromal labor, getting a handle on the nuances of when labor is going to start or if it is lasting labor can be really confusing. There is no way to know exactly when labor is going to start, but there are many things to look out for that can give clues and signs that onset of  labor is sooner rather than later.

Here are my favorite categories to look at and simple ways to decipher what is going on with your body at the end of pregnancy.

Remember to take a look at the whole puzzle picture not just one piece.

  • Vaginal Discharge:
    • Loss of mucous plug (after 38 weeks);
    • Steady mucousy output;
    • Thin and watery mucous;
    • Blood tinged – similar to the beginning or very end of a menstrual period. This means there is effacement and ripening of the cervix going on and even a bit of dilation happening.
  • Contraction Characteristics:
    • Longer and more intense contractions that most often find a pattern;
    • They do not stop or even increase with activity change;
    • Sudden increase or onset of regular Braxton-Hicks;
    • Low period crampiness, pelvic heaviness, off and on backache, thigh achiness.
  • Other symptoms
    • Increased nesting;
    • Insomnia or excessive tiredness;
    •  Flu-like symptoms;
    • Intuition/Instinct;
    • Loose bowels;
    • Weight Loss in the last week.
  • Testing out contractions for possible labor:
    • Change activity level – if resting get up and move, if moving sit down and rest;
    • Drink a large glass of water;
    •  Eat a snack, preferably higher protein;
    • Take a bath or shower.

After doing these things if contractions continue and increase in intensity over another hour or so likely labor is becoming established. Congratulation! As always, contact your care provider at the agreed upon time.

A Guide to Finding Your Doula

Tuesday, August 2nd, 2011

Building a labor support team is part of conscious preparation during pregnancy for your labor,  birth and life with the very newborn. Hiring a labor doula continues to gain in popularity for the expecting family. Your doula comes alongside you in pregnancy through labor and delivery with some additional early postpartum follow-up.  For additional after birth support, a postpartum doula is a great addition.

Step 1: Finding a Doula

  • Inquire with friends, family, local support/informational groups (for example – ICAN, LLLI, Birth Network, Birth Circle, Cloth Diaper store), childbirth educators, care providers, prenatal massage therapists, prenatal exercise instructors, lactation experts and chiropractors for referrals.
  • Use your favorite search engine and type in your city or area name with the keyword doula
  • Search training and certifying organizations such as CAPPA, DONA, ICEA ToLabor , Birth Works and Birth Arts International
  • Search general doula sites such as All Doulas, Doulas.com, About.com, Doula Match or Doula.com

Step 2: First Contact

Once you have located local area doulas, the next step is  to make contact. You will likely find that most doulas are women though occasionally you will find a male doula in your area.  After visiting any websites; phone or email only the doulas that most interest you and fit your particular needs.  Generally there is not much need to contact more than three perspective doulas.

During your initial phone conversation or in your email be sure to include:

  • Full name
  • Contact information
  • Estimated Due Date
  • General location where you live
  • Care Provider
  • Birth Location
  • Top needs and desires for birth
  • If referred, by whom
  • Any financial considerations

Step 3:  Setting up the Interview

I encourage after the phone or email contact and response, set-up in-person interviews with the doulas you found most compatible with you.

  • Unless the doula you are meeting has her own office, interviews are usually held in a public place such as a coffee house, restaurant, library, park, or shopping center. If you meet at a place where beverages or food will be ordered you can offer to pick up the tab for everyone if you desire, but it is never expected.
  • Your partner, husband or other support who will be attending the birth needs to be at in-person interview if at all possible.
  • Expect the interview to be approximately an hour and to be free of charge.

Step 4: The Interview

The interview is to gain more detailed information from the doula, as well as, share more  about yourself and what you want.  It is customary for the doula to either email ahead of time her client packet or bring it with her to the interview. It may include her professional profile, client agreement, services, and support details, as well as, additional offerings.

Suggested Interview Questions:

  • Why are you a doula?
  • What is your philosophy of childbirth?
  • Where did you get your training?
  • Are you certified? Why or why not?
  • How long have you been a doula?
  • What is your scope of practice?
  • What types of births have you participated in?
  • What types of birth locations have you been to?
  • How many births per month on average do you attend?
  • How many clients would max you out in a month?
  • Have you ever missed a birth? Please explain why.
  • Do you specialize in working with a specific type of clientele or birth plan?
  • What has been the most challenging birth you have attended? Why?
  • How do you work with my husband/partner/other support?
  • Have you worked with my provider before? If yes, please describe the experience.
  • How many prenatal visits would there be?
  • In general, what is covered in the prenatal visits?
  • Will you help me make a birth plan?
  • Please explain how your fee is structured.
  • Do you accept barter?
  • Do you have a back-up and do I meet her ahead of time?
  • When do you go on-call?
  • Do you labor at home with me?
  • What do you do if I am induced or need to schedule a cesarean?
  • When will you see me postpartum and what does it include?
  • What are your expectations of me as a client?
  • How long do I have to decide before you would contract with someone else around my EDD?

Of course that is a fairly long list of overview questions. Brainstorm some of your own. The interview is not meant to be a free prenatal visit, it is simply to find out if you and the doula are a fit personality wise and in how she practices.  Most doulas do not expect to be hired on the spot. You  need time to think and process after each interview. If a doula is pressuring you to hire on the spot because she fills so quickly, that could be a red flag and cause for you to take a pause.

Step 5: Hiring the Doula

Within 1-2 weeks,  contact the doula you would like to hire and proceed and those you did not choose to let them know you have hired someone else so they will not be holding your EDD space open any longer.

Details to be clear about when initially hiring your doula:

  • Sign and return the agreement/contract she gave you at the interview (if applicable).
  • Return any intake paperwork by mail or email.
  • Payment  – First portion of fee is usually paid upon hiring a doula.
  • Ask her usual business hours and contact preference for non-emergencies or labor related needs.
  • Let her know your contact preferences and all phone numbers to reach you and your spouse/partner or other support.
  • Set the date and time for the first prenatal appointment. Give her directions if your home is not easy to find.
  • Get clarity on what routine contact she would like from you (updates after care provider appointments, etc.)

Happy doula-ing!

Say What? Getting a handle on birthy terminology.

Wednesday, February 16th, 2011

So often I am in conversation and forget that everyone does not eat, drink and sleep birth related information like my peers and I do.

I have put together a list of useful terms and definitions to take the “What?” out of navigating the host of terms surrounding pregnancy and birth.

  • AROM – Artificial Rupture of Membranes – using a finger or tool to open the amniotic sac to to allow the fluid to release.
  • Birth Center – Free standing location usually run by one or more certified nurse midwife. True birth centers are almost always independently run. They are not overseen by a hospital or in a hospital. May be near a hospital. Often set-up like a home birth space and epidurals or other pain medications are not available.   Hospital “birth centers” are labor and delivery floors not birth centers in the true sense of the term.
  • Bloody Show – Mucous and blood mixed together as dilation and effacement occurs.  Starts off as blood tinged mucous and becomes heavier as labor progresses.
  • Braxton-Hicks – Practice contractions that do not dilate or efface the cervix often felt at the top of the uterus versus the bottom.
  • CBAC – Cesarean Birth After Cesarean – This is a repeat cesarean after a woman desires and tries to have a vaginal birth after cesarean.
  • Cervix -The lower portion of the uterus that provides an opening between the uterus and the vagina. Also known as the neck of the uterus that softens, effaces, dilates and changes position during labor.
  • Cesarean – Baby born via a surgical incision made through the abdomen into the uterus.
  • Contraction – Tightening and loosening of your uterus. Productive contractions are often felt at the bottom of the uterus, start out like period cramps and progressively grow stronger, longer in length, and closer together.
  • Doula – Is an assistant who provides various forms of non-medical and non-midwifery support (physical and emotional) in the childbirth process. Based on a particular doula’s training and background, the doula may offer support during prenatal care, during childbirth and/or during the postpartum period. A birth doula provides support during labor. A labor doula may attend a home birth or might attend the laboring at home and continue while in transport and then complete supporting the birth at a hospital or a birth center. A postpartum doula typically begins providing care in the home after the birth. Such care might include cooking for the mother, breastfeeding support, newborn care assistance, errands, light housekeeping, etc. Such care is provided from the day after the birth, providing services through the first six weeks postpartum. In some cases, doula care can last several months or even to a year postpartum – especially in cases when mothers are suffering from postpartum depression, children with special needs require longer care, or there are multiple infants.
  • Effacement – The thinning of the cervix which occurs before and while it dilates.
  • Endorphins- Any of a group of peptide hormones that bind to opiate receptors and are found mainly in the brain. Endorphins reduce the sensation of pain and affect emotions.
  • Epidural - A medical method of giving pain relief during labor. A catheter is inserted through the lower back into a space near the spinal cord. Anesthesia is given through this catheter, and results in decreased sensation from the abdomen to the feet.
  • Episiotomy – A surgical procedure to widen the outlet of the birth canal to facilitate delivery of the baby and avoid a jagged rip of the perineum. (Natural abrading or tearing is preferred and episiotomies are not evidence-based to be used except under specific circumstances).
  • ERCS – Elective Repeat Cesarean
  • First Stage – Early, Active, and Transition. This encompasses the effacement to 100%, dilation to 10 centimeters/complete, position movement of cervix from posterior to forward as contractions begin while staying longer, strong and closer together prior to pushing and delivery.
  • Foley – A foley catheter is used to release the bladder if a woman unable to urinate due to an epidural, post surgery, or with a swollen urethra post birth.  It can also be used for successful cervical ripening in lieu of cytotec.
  • Fourth Stage – First hours after placenta is delivered.
  • Fundus –  Top of the uterus. During labor contractions the fundus thickens and gets more firm as the strength of contractions increase and dilation increases.
  • HBAC – Home Birth After Cesarean
  • Ina May’s Sphincter Law -Tapping into the concept that if one sphincter is open and relaxed, the others will also open, relax and be able to handle, quite adequately, the task at hand. This also includes the aspect of birth requiring privacy, sacredness, and honor as well so a woman feels safe, unwatched and supported.
  • Induction – To attempt to artificially start labor usually by pitocin, artificial rupture of membranes with or without cervical ripening (Cytotec, Cervadil, Prepadil or Foley Catheter).
  • Intervention – Anything that does not exist in a spontaneously, naturally occuring labor and delivery that is done.
  • Kegel Exercises – Named after Dr. Arnold Kegel, consists of contracting and relaxing the muscles that form part of the pelvic floor (sometimes called the “Kegel muscles”).
  • Lochia – Post birth bleeding that though a wound site from the placenta detaching from the uterine wall, it mimics a heavy and long menstrual period.
  • Midwife – Is a person usually a woman who is trained to assist women during pregnancy,  during childbirth, and postpartum as well as the newborn post birth.  There are many types of midwives – some work in the home, at birth centers or in the hospital.
  • Miso – Misoprostol is the pharmacological name for Cytotec a drug used for cervical ripening and induction though a controversial, off and against label used ulcer Medication
  • Mucous plug - The mucous that blocks off the non-dilated and non-ripened cervix for protection.
  • Natural Birth – Labor and vaginal delivery free from intervention except for intermittent fetal monitoring. In the hospital only a saline lock and intermittent monitoring. Can also mean no monitoring.
  • Obstetrician – Is the surgical specialty dealing with the care of women and their children during pregnancy, childbirth and the immediate post birth time.
  • Oxytocin – A hormone made in the brain that plays a role in childbirth and lactation by causing muscles to contract in the uterus (womb) and the mammary glands in the breast. It also plays a role in bonding with mate, child, and socially.
  • Pelvic Floor Muscles -The sphincter mechanism of the lower urinary tract, the upper and lower vaginal supports, and the internal and external anal sphincters. It is a network of muscles, ligaments, and other tissues that hold up the pelvic organs.  Includes bladder, rectum, vagina and uterus.
  • Pelvis -The basin like cavity formed by the ring of bones of the pelvic girdle in the posterior part of the trunk in many vertebrates: in humans, it is formed by the ilium, ischium, pubis, coccyx, and sacrum, supporting the spinal column and resting upon the legs.
  • Perineum – The area between the anus and the vulva (the labial opening to the vagina).
  • Pitocin (oxytocin injection, USP) is a sterile, clear, colorless aqueous solution of synthetic oxytocin, for intravenous infusion or intramuscular injection.
  • Placenta -The organ that develops during pregnancy that transports nutrients to the fetus and waste away from the fetus. The placenta is attached to the uterus and is connected to the fetus by the umbilical cord.
  • PROM – Premature Rupture of Membranes – when the amniotic fluids releases before labor starts.
  • Prostaglandin – Any of a group of hormone like fatty acids found throughout the body, esp. in semen, that affect blood pressure, metabolism, body temperature, and other important body processes such as cervical ripening.
  • RCS – Repeat Cesarean
  • ROM – Rupture of Membranes
  • Saline Lock/Buffalo Cap/ Hep Lock – Is the apparatus that the IV line hooks into.  It is silicone tubing that is lightweight with a plastic needle that stays under the skin to allow easy vein access.
  • Second Stage – Pushing phase after cervix is completely dilated to delivery of baby.
  • SROM – Spontaneous Rupture of Membranes during labor.
  • Stripping membranes –  Pressing the amniotic sac away from the inside of the cervix.
  • Third Stage – Delivery of baby to delivery of placenta.
  • UBAC – Unattended Birth After Cesarean
  • Umbilical cord – The cord that transports blood, oxygen and nutrients to the baby from the placenta.
  • Uterus -The muscular organ in which a fertilized egg implants and matures through pregnancy. During menstruation, the uterus sheds the inner lining.
  • Vagina – A muscular canal between the uterus and the outside of the body. Also known as the birth canal.
  • Vaginal Birth – Baby born vaginally with or without medication and intervention.
  • VBAC – Vaginal Birth After Cesarean
  • WBAC – Water Birth After Cesarean

Celebrating the Birth of Our New Location

Wednesday, December 22nd, 2010

DATE: January 15, 2011

TIME: 10am-2pm

LOCATION: 6180 Lehman Drive, Suite 103, Colorado Springs, CO 80918

WHO’S INVITED:  Mothers and families, birth professionals, related professionals, friends, media and anyone interested in learning more about what Preparing For Birth has to offer the expecting woman and her family!

What To Expect: Food, conversation, door prizes and an all around good time!

If you are interested in donating a door prize or bringing in your mompreneur/birth biz related marketing materials,  please contact Desirre for details at desirre@prepforbirth.com or at 719-331-1292.

Download the Open House Flyer.

Grateful For My Birth(s) Carnival

Wednesday, November 24th, 2010

I am so thankful to all of the submissions I received for this Why I am Grateful for my Birth(s) blog carnival. I have found no matter what a woman can learn something and be grateful for something in every birth experience no matter how difficult or wonderful. Enjoy these quips and please go to their blogs to read in completeness.

Tiffany Miller of Birth In Joy says in an excerpt from her post The Most Important Piece, “I am thankful that Mom believed in my ability to breastfeed my new baby, even though it hurt at first. She never told me that I had so severely damaged her nipples, as she tried to learn with no support whatsoever during my own newborn days. Nary an ounce of bitterness did she carry from that time. She knew and accepted that my path was my own, and supported me completely.” She goes on to further outline how the mentoring and support of her mother paved her way.

How grateful she is for all four natural births and her mother’s unwavering assistance. Assistance and presence she could never imagine doing without.  Just beautiful and shows how important in our lives are the ones who came before.

Kristen Oganowski of Birthing Beautiful Ideas in her post Your Births Brought Me Here writes this gorgeous, tear inspiring letter to her two children about what amazing changes they spurned in her own life, in the very life that they would come to know. Without one birth, would the other have come along the way it did?

Here is an excerpt: “When you both were born, I called myself: Graduate student (unhappily).  Teacher (happily).  Feminist (always).  Mother (timidly). Today I call myself: Doula (happily).  Birth and breastfeeding advocate (unflinchingly).  Blogger (smirkingly).  Writer (finally).  Feminist (permanently).  Mother (confidently).  Graduate student (temporarily). Your births brought me here, to this place where I am (finally) content and impassioned. All wrapped up  with a Love, Mom.

Our next post is by Sheridan Ripley of Enjoy Birth. She writes very plainly about how grateful she is for varied experiences that give her insight to what other women experience and that she is better able to support them.

Here is a peek.

  • If I had only amazing natural birth experiences would I have judged those moms who choose epidurals?
  • If I had only vaginal births would I have understood and fought so hard for VBAC moms?
  • If I only had easy times creating that nursing relationship with my boys, would I have been as supportive of my moms struggling with nursing?

Very poignant and open…..

We come to Bess Bedell of MommasMakeMilk.Com came to a place of self-awareness, peace and a fierceness to help others in her experiences. Like others her heart grew and expanded with her own knowledge and walk. A strength and confidence awoke in her to the benefit of so many coming after.

My two births birthed a new women. A mature women who has opinions, knowledge, experience and a passion in life. If I had not had my c-section I may never had given VBAC a second though. The lack of VBAC support and availability would probably never have entered my radar. My second birth showed me that success and perfection are not the same but both are wonderful and I can be happy for and embrace a mother and her experience even if it wasn’t a completely natural, completely med-free birth. Both of my experience have prepared me for the future. My future of birthing, and next time I plan on birthing at home, and my future of educating and supporting pregnant and birthing mothers.

And lastly my own blog post entry. I know I rarely speak of my own births in any detail unless it is one on one. As a community member, advocate, doula, educator, I strive NEVER to be an intervention on a woman. Today I decided to give a small window into my own experiences and why I am grateful. Please read and comment freely – Grateful For My Births.

Thank you so much to those who submitted posts. The openness of other women allow all of us to learn, grow and share as we are meant to within a healthy society. We are not there yet, but I have a hope that through this sort of connection, we are healing some brokenness.

In reading all these posts, not one is the same, not in tone or style, but every woman was changed positively in the end.

Grateful For My Births

Wednesday, November 24th, 2010

Focusing on Thanksgiving, I asked others to submit a “Why I am Grateful For My Birth(s)” blog post.  In the spirit of that, here is my own blog posting. Stay tuned for the Carnival of posts to be up by Thanksgiving morning.

I myself have had four varied labors and births, one of which could be considered a “normal” and natural birth experience.

From my first labor and birth, I learned that maternal ignorance no matter the intention can get you into the OR  I had to travel 45 minutes to my birth location, was only a 2 cm but nurse admitted me because she did not want me to go all the way home (she of course did not tell me that or we would have rented a hotel room nearby to labor in), I then allowed the same nurse to perform AROM at 3 cm’s because she figured it could speed things up because early labor you know is slow often for first time mothers.Walked stairs for hours but….. Now came the pitocin because my waters were broken and I was not moving fast enough. Then came horrid, blinding back labor. At some point I got a partial dose of fentanyl. Then another. Finally in transition about 20 hours in, I thought I wanted the epidural. I did not get one as I was complete and pushed for nearly four hours. Then finally after a failed vacuum assist to rotate his head and help me I ended up in a cesarean for deep transverse arrest for an acynclitic, deflexed baby head.

Baby number 2 27 months later and I was for sure in no way going to get to the hospital before I was in very well established labor. VBAC, whatever, I knew if things were okay. I would never have pitocin in labor again or have my waters broken. So I labored beautifully, with no fear, hey there was some ivory tower mama left in me still. After having contractions work up to 2 minutes apart and 90 seconds long, I decided it was time to leave. My husband ran back in the house and put a water proof pad on my seat (what a very intuitive man). On the way during the 15 minutes ride to the hospital, my water broke, I mean BROKE – kaplooey. Yep water proof crib pad saved the passenger seat if our minivan. In triage I was checked and behold I was a stretchy 9 cm’s. Everyone was so happy. A VBAC good for you mama. No saline lock. Some monitoring. Then the trouble started.  The on-call doc came in and was impatient. I pushed for about an hour (mind you I was a VBAC) and when he was low enough she cut an episiotomy and used forceps on him.  Very little conversation, my husband just said she insisted and there he was. So a natural labor and almost natural birth. I still felt great. Episiotomy was far less painful than surgery…. I got my VBAC. Though  my baby ended up in NICU overnight because of forceps. That was awful. We were both very mad after we could process it. He nursed well nonetheless. Took him home the next day.

Labor and birth number 3 is told in detail on my blog post A Woman’s Voice Birthed Into Fullness so I will not report on it here.

My 4th labor and birth had me in the place of I am arriving at the hospital very late in labor even though this time I was a 1VBA2C mama. Funky contractions of a few hours each over three nights including one trip to the hospital thinking it MUST be labor, had me sitting at 7 cm’s dilated WITHOUT being in labor. How did I know that? I asked my midwife to check me every day after the short bout of contractions. I just laughed and laughed about being in “transition” dilation wise but not being in labor. On the fourth night of when the contractions started, I said OKAY I am having this baby. I did some nipple stimulation and acupressure over an hour, next thing I know 3 minutes apart contractions then closer. We got to the hospital I was 8 cm’s, walked for a half hour. Then I was 9 cm’s and pattern was back strong. Midwife came. After some odd and funny asides. I allowed AROM baby was +1 and in good position. She promised me. PROMISED me as I glared her down that this would not cause another cesarean. Baby was in perfect position. Gulp. OK. I trusted her and knew she did have our best interest at heart. No baby did not fall out. Have I mentioned I have an android pelvis? I was completely shortly after that and pushed. He was born about 45 minutes later. That for me was such a short amount of time to push. He was in my hands and on my chest with the exception of maybe two minutes for FIVE hours post birth. FIVE. He had about a 14.5″ head and came out over an intact perineum.  I was, well, normal, everyday, usual. Yep. I basked in the no nonsense aspects of it.

I learned so much through all my labors and births. Through #1 that though I made many excellent choices in my care provider and birth location, heck we even took out of hospital independent birthing classes, that maternal ignorance and a willingness to believe no nurse would do something that could cause harm was really am ivory tower point of view that women can just have babies. I knew I could birth, but knew I needed to know even more.

Through #2 that on-call providers can be dangerous people and that I COULD birth.

With #3 my voice came into being. I turned into who I am now. Like a butterfly with the roar of a lioness.

And #4 oh my baby. I became normal, just like every other woman who had a natural labor and birth. Just another birthing woman. Not special. I really liked that title.

Yes I am grateful or I would not be the advocate, doula, educator, flag waving proponent of informed consent AND refusal, strive to help and support women in their childbearing years…. oh so much more. I am grateful because in all of this I have found my calling.

Thank you to K, L, J and D for being my sons.  Thank you to bad on-call doc, well meaning but harmful nurse, horrid nursery staff, and C.E. the midwife who believed in me and my body as much as I did.

The Best isn’t Better. Usual is where It is at.

Thursday, September 16th, 2010

There has been much ado surrounding the language of breastfeeding being normal and usual versus the best for baby and mother in great thanks to Diane Weissinger. It is so valuable to recognize that while we all desire to be the best, we often hit the normal everyday averages in life. We are comfortable reaching a goal that seems more attainable. Best or better can feel so far out of reach where average and usual seem quite in reach most of the time. None of us generally want to be below the average or usual. Thus the language of the risks of NOT breastfeeding is so vital.

I would like to see the same type of language revolving around pregnancy and birth as well.

In the overall picture here is the usual occurrence: Ovulation leads to heightened sexual desire, which leads to sexual activity, which leads to pregnancy, which leads to labor, which leads to birth, which leads to breastfeeding…..

So how do we look at language as an important part of our social fabric and belief systems surrounding this process?

Let us look at contrasting statements of what is often heard and how a positive point of view can be adapted.

Pregnancy is: a burden, an illness, an affliction, a mistake, something to be tolerated……

Pregnancy is: a gift, wonderful, amazing, part of the design, someone to grow…..

Labor is: scary, worth fearing, the unknown, unpredictable, painful, to be avoided, to be numbed from, to be medicated, to be induced, out of control, unfeminine…..

Labor is: what happens at the end of pregnancy, hard work but worth it, manageable by our own endorphins and oxytocin, an adventure, not bigger than the woman creating it, to be worked with, worth be present for, is what baby expects……..

Pushing and Birth are: terrifying, physically too difficult, only works for women who are not too small, short, skinny, big, fat, young or old, responsible for pelvic floor problems, out of control, horrible……..

Pushing and Birth are: what happens after dilation completes, to help baby prepare for breathing, bonding and feeding, sometimes pleasurable, sometimes fast, sometimes slow, able to occur in water, standing, laying down, squatting, on hands and knees, often most effective when a woman is given the opportunity to spontaneously work with her baby and body, not always responsible for pelvic floor issues, amazing, hard work, worthwhile, sets the finals hormonal shifts in motion for mother and baby……

Is it really BETTER? I say no. It is usual and normal.

  • Spontaneous labor is not better – it is the expected usual occurrence at the end of pregnancy.
  • Unmedicated labor and birth is not better – it is what the body mechanisms and baby expect to perform at normal levels.
  • Unrestricted access to movement, support and safety in response to labor progression is not better – it is the usual expectation to facilitate a normal process.
  • Spontaneous physiologic pushing is not better – it is what a woman will just do, in her way.
  • Spontaneous birth is not better – it is what a mother and baby do.
  • Keeping mother and baby together without separation is not better – it is what both the mother and baby are expecting to facilitate bonding, breastfeeding, and normal newborn health.

Denying the norms and adding in unnecessary interventions, medications and separation is creating a risky environment for mothers and babies. Thus increasing fear, worry,and even a desire to be fixed at all costs.

Perhaps even worse, an atmosphere has been created where the abnormal has become the expected norm and the normal has become the problem to be eradicated.

Bottom line, our language matters and will help shape for the positive or negative the future of birth.

Building Your Birth Support Team

Monday, November 23rd, 2009

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?

“I didn’t realize that I didn’t have the right kind of birth support until it was too late. This in no way is meant to say that my practitioner, or the staff, or my husband were not supportive . . . they were, but I didn’t have anyone on hand to advocate for my needs. Even though I prepared extensively for a natural birth and hired a CNM, I ended up having a cesarean. I firmly believe that the most important member of your hospital birth team is your doula.” Kimberly J.

“…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.

“Because it means the difference between a baby and mom being healthy vs. the million of things that can go wrong if a mom is stressed, confronted, or generally ignored.  Support during birth, whatever that means for the mom, is more important in my hunble opinion than support during pregnancy. Giving birth in a hostile or unfriendly environment is dangerous.” Rachel A.

“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.

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.

Preparing For Birth: 35+ and Pregnant

Wednesday, September 16th, 2009

Hourglass

The disturbing trend in treating ALL  “advanced maternal age”  mothers (over 35 at the time of impending birth) high risk continues to grow despite lack of evidence to do so.

My original post from 3.5 years ago still rings true today.

They are being subject to weekly Biophysical profiles or Fetal Non-stress tests tests that are normally reserved only for high-risk mothers and babies from as early as 32 weeks in pregnancy.  On top of the scans, these mothers are often pressured to agree to an early delivery of their babies by means of labor induction or cesarean even without other risk associations.  This is growing more and more prevalent especially for women over 35 who are first time mothers.

I have heard even from women that at their first OB appointment they are being told they will be induced at 39 weeks as a standard of practice and expectation for signing on with said provider.  The seed of fear and worry is being planted that their growing baby will die if the pregnancy goes to 40 weeks or longer.  What a way to start out a provider/mother relationship.  I would call that a red flag of immense proportion.

So what really is the big deal with “old” mothers?  This study Advanced Maternal Age Morbidity and Mortality correlates various medical issues with “AMA” mothers though the biggest hot button is an elevated yet unknown cause of perinatal death.  This statement alone has caused a huge shift in the way these mothers are viewed regardless of  overall pregnancy health and absence of any known risk associations. ACOG’s February 2009  Managing Stillbirths maintains there is a risk to older mothers with no explanation as to why there is a risk, what the percentage of  risk increase is or any prevention protocols.  Seems dodgy since the other groups noted in the bulletin have all the data included.

There are some serious problems with any practitioner taking this study and applying it across the board to “AMA” women.  The study even says so much, “It is important to note that the findings of this study may not be generalized to every advanced-maternal-age obstetric patient in the United States. Although the FASTER trial patient population was unselected, meaning that patients were not excluded based on any confounding factors such as race, parity, BMI, education, marital status, smoking, pre-existing medical conditions, previous adverse pregnancy outcomes, and use of assisted reproductive care, there may have been significant patient or provider self-selection.” So the population could have been skewed from the get go by provider or patient selection, along with the fact that it seems the only point of homogeneity is present in that most of the women were Caucasian.  Throw all these women in a pot and see what happens?  Next step is to make protocols and change practice style upon weak findings?

The study also shows an increased risk for cesarean by “AMA” mothers.  “As with prior literature, this study demonstrated that women aged 40 years and older are at increased risk for cesarean delivery. Older women may be at increased risk for abnormalities of the course of labor, perhaps secondary to the physiology of aging. It is possible that decreased myometrial efficiency occurs with aging. Nonetheless, maternal age alone may be a factor influencing physician decision making. It is uncertain whether the increased rates of cesarean delivery are due to a real increase in the prevalence of obstetric complications or whether there is a component of iatrogenic intervention secondary to both physician and patient attitudes toward pregnancy in this older patient population.” Very interesting. So “old” women are perceived as being unable or problematic so they have less successful vaginal birth outcomes. Now that is a self-fulfilling practice style with a huge dose of ageism thrown in.  I also wonder what the cesarean rate in this age grouping is going to be due to these protocols.

Let’s get to the perinatal and neonatal death risks.  The study says: “Studies regarding an increased risk for perinatal mortality in women of advanced maternal age have been controversial. In this study, the increased risk of perinatal mortality was not statistically significant for patients aged 35–39 years (adjOR 1.1). Age 40 years and older was associated with a statistically significant increased risk of perinatal loss (adjOR 2.2). There were only 119 stillbirths and 37 neonatal demises in total. As a result, we could not draw any meaningful conclusions about the etiology or timing of perinatal mortality in women of advancing maternal age. The reason that advanced-maternal-age patients may be at increased risk of perinatal mortality is unknown. The failure of uterine vasculature to adapt to the increased hemodynamic demands of pregnancy as women age is a proposed explanation. So in conclusion, we have no idea why this might occur and have no way of counseling “AMA” mothers to lower the risk especially those over 40. Another noteworthy thought is that this study had 79% under 34 year old women, 17% 35-39 year old women, and only 4% women over aged 40.  So with such a small grouping ALL women considered “AMA” are being put under very heavy handed protocols to delivery their babies in the 39th week of gestation.

In closing, I find it difficult to believe that anyone who reads this study would change practice style because of it and move pregnant patients who are otherwise maintaining a healthy pregnancy without risk associations to a high risk model of care. Amazingly the study itself says the same thing, “In summary, the majority of women of advanced maternal age deliver at term without maternal or perinatal adverse outcomes.” And, “The role of routine antenatal surveillance in women aged 40 years and older requires further investigation because these women seem to be at increased risk for perinatal mortality, including stillbirth. Although the likelihood of adverse outcomes increases along with maternal age, patients and obstetric care providers can be reassured that overall maternal and fetal outcomes are favorable in this patient population.”

Couldn’t have said it better myself.

Since the original posting – – – instead of women being told they must be induced in the 39th week they are now being “offered” non-medical, cesareans as a first course of action.  This sort of pressure is not evidence-based or even medically ethical in my opinion.

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.

Preparing For Birth – Common Pregnancy and Childbirth Terms

Tuesday, August 25th, 2009

Below is a compilation of common terms and acronyms that women often will come across during pregnancy, labor, and delivery.  Check back as more will be added from time to time.

  • AROM – Artificial Rupture of Membranes – using a finger or tool to open the amniotic sac to to allow the fluid to release.
  • PROM – Premature Rupture of Membranes – when the amniotic fluids releases before labor starts.
  • SROM – Spontaneous Rupture of Membranes during labor.
  • ROM – Rupture of Membranes
  • Miso – Misoprostol is the pharmacological name for Cytotec a drug used for cervical ripening and induction though a controversial, off and against label used ulcer Medication
  • VBAC – Vaginal Birth After Cesarean
  • HBAC – Home Birth After Cesarean
  • WBAC – Water Birth After Cesarean
  • UBAC – Unattended Birth After Cesarean
  • CBAC – Cesarean Birth After Cesarean – This is a repeat cesarean after a woman desires and tries to have a vaginal birth after cesarean.
  • ERCS – Elective Repeat Cesarean
  • RCS – Repeat Cesarean
  • Natural Birth – Labor and vaginal delivery free from intervention except for intermittent fetal monitoring. In the hospital only a saline lock and intermittent monitoring.
  • Vaginal Birth – Baby born vaginally with or without medication and intervention.
  • First Stage – Early, Active, and Transition. This encompasses the effacement to 100%, dilation to 10 centimeters/complete, position movement of cervix from posterior to forward as contractions begin while staying longer, strong and closer together prior to pushing and delivery.
  • Second Stage – Pushing phase after cervix is completely dilated to delivery of baby.
  • Third Stage – Delivery of baby to delivery of placenta.
  • Fourth Stage – First hours after placenta is delivered.
  • Oxytocin – A hormone made in the brain that plays a role in childbirth and lactation by causing muscles to contract in the uterus (womb) and the mammary glands in the breast. It also plays a role in bonding with mate, child, and socially.
  • Pitocin (oxytocin injection, USP) is a sterile, clear, colorless aqueous solution of synthetic oxytocin, for intravenous infusion or intramuscular injection.
  • Prostaglandin – Any of a group of hormone like fatty acids found throughout the body, esp. in semen, that affect blood pressure, metabolism, body temperature, and other important body processes such as cervical ripening.
  • Uterus -The muscular organ in which a fertilized egg implants and matures through pregnancy. During menstruation, the uterus sheds the inner lining.
  • Cervix -The lower portion of the uterus that provides an opening between the uterus and the vagina. Also known as the neck of the uterus that softens, effaces, dilates and changes position during labor.
  • Vagina – A muscular canal between the uterus and the outside of the body. Also known as the birth canal.
  • Perineum – The area between the anus and the vulva (the labial opening to the vagina).
  • Pelvis -The basin like cavity formed by the ring of bones of the pelvic girdle in the posterior part of the trunk in many vertebrates: in humans, it is formed by the ilium, ischium, pubis, coccyx, and sacrum, supporting the spinal column and resting upon the legs.
  • Pelvic Floor Muscles -The sphincter mechanism of the lower urinary tract, the upper and lower vaginal supports, and the internal and external anal sphincters. It is a network of muscles, ligaments, and other tissues that hold up the pelvic organs.  Includes bladder, rectum, vagina and uterus.
  • Fundus –  Top of the uterus. During labor contractions the fundus thickens and gets more firm as the strength of contractions increase and dilation increases.
  • Placenta -The organ that develops during pregnancy that transports nutrients to the fetus and waste away from the fetus. The placenta is attached to the uterus and is connected to the fetus by the umbilical cord.
  • Umbilical cord – The cord that transports blood, oxygen and nutrients to the baby from the placenta.
  • Bloody Show – Mucous and blood mixed together as dilation and effacement occurs.  Starts off as blood tinged mucous and becomes heavier as labor progresses.
  • Stripping membranes –  Pressing the amniotic sac away from the inside of the cervix.
  • Mucous plug - The mucous that blocks off the non-dilated and non-ripened cervix for protection.
  • Lochia – Post birth bleeding that though a wound site from the placenta detaching from the uterine wall, it mimics a heavy and long menstrual period.
  • Cesarean – Baby born via a surgical incision made through the abdomen into the uterus.
  • Obstetrician – Is the surgical specialty dealing with the care of women and their children during pregnancy, childbirth and the immediate post birth time.
  • Midwife – Is a person usually a woman who is trained to assist women during pregnancy,  during childbirth, and postpartum as well as the newborn post birth.  There are many types of midwives – some work in the home, at birth centers or in the hospital.
  • Doula – Is an assistant who provides various forms of non-medical and non-midwifery support (physical and emotional) in the childbirth process. Based on a particular doula’s training and background, the doula may offer support during prenatal care, during childbirth and/or during the postpartum period. A birth doula provides support during labor. A labor doula may attend a home birth or might attend the laboring at home and continue while in transport and then complete supporting the birth at a hospital or a birth center. A postpartum doula typically begins providing care in the home after the birth. Such care might include cooking for the mother, breastfeeding support, newborn care assistance, errands, light housekeeping, etc. Such care is provided from the day after the birth, providing services through the first six weeks postpartum. In some cases, doula care can last several months or even to a year postpartum – especially in cases when mothers are suffering from postpartum depression, children with special needs require longer care, or there are multiple infants.
  • Birth Center – Free standing location usually run by one or more certified nurse midwife. True birth centers are almost always independently run. They are not overseen by a hospital or in a hospital. May be near a hospital. Often set-up like a home birth space and epidurals or other pain medications are not available.   Hospital “birth centers” are labor and delivery floors not birth centers in the true sense of the term.
  • Intervention – Anything that does not exist in a naturally occuring labor and delivery that is done.
  • Saline Lock/Buffalo Cap/ Hep Lock – Is the apparatus that the IV line hooks into.  It is silicone tubing that is lightweight with a plastic needle that stays under the skin to allow easy vein access.
  • Foley – A foley catheter is used to release the bladder if a woman unable to urinate due to an epidural, post surgery, or with a swollen urethra post birth.  It can also be used for successful cervical ripening in lieu of cytotec.
  • Induction – To attempt to artificially start labor usually by pitocin, artificial rupture of membranes with or without cervical ripening (Cytotec or Foley Catheter).
  • Epidural - A medical method of giving pain relief during labor. A catheter is inserted through the lower back into a space near the spinal cord. Anesthesia is given through this catheter, and results in decreased sensation from the abdomen to the feet.
  • Contraction – Tightening and loosening of your uterus. Productive contractions are often felt at the bottom of the uterus, start out like period cramps and progressively grow stronger, longer in length, and closer together.
  • Braxton-Hicks – Practice contractions that do not dilate or efface the cervix often felt at the top of the uterus versus the bottom.
  • Episiotomy – A surgical procedure to widen the outlet of the birth canal to facilitate delivery of the baby and avoid a jagged rip of the perineum. (Natural abrading or tearing is preferred and episiotomies are not evidence-based to be used except under specific circumstances).
  • Ina May’s Sphincter Law -Tapping into the concept that if one sphincter is open and relaxed, the others will also open, relax and be able to handle, quite adequately, the task at hand. This also includes the aspect of birth requiring privacy, sacredness, and honor as well so a woman feels safe, unwatched and supported.
  • Kegel Exercises – Named after Dr. Arnold Kegel, consists of contracting and relaxing the muscles that form part of the pelvic floor (sometimes called the “Kegel muscles”).

Preparing For Birth – Has episiotomy been replaced by this practice?

Tuesday, August 25th, 2009

In recent months I have noticed that during the end part of pushing and through delivery, care providers and/or nurses are doing very, very aggressive vaginal and perineal stretching.  This is not the gentle perineal massage I have seen in the past.  Even though I do not believe even that is necessary, it certainly was a far cry better than this.

To demonstrate, take your index and middle fingers from both hands and place them in your mouth on both sides with fingers facing in an outward pulling position inside your cheeks.  Now pull outward, stretching your cheeks and lips while “massaging” the inside.  Start gently, then get more aggressive. This is happening while soon a large malleable and smooth object will be pressing along those worked tissues.

How long do you think it would take for you to become swollen and bruised from this activity?  Can you imagine that there might be small tears and abrasions would be present from this if you continued for up to 30 minutes?

Now imagine after all that activity you have a large object in your mouth inhabiting the entire area including the widely opened and stretched lips. Next instead of you gently pushing the object out under your own control and power, you are told to NOT push it out but to allow for it to be removed for you. So imagine you already hyper extended lips being pressed further open with quite some force until it move through your open mouth.

How do you think the over worked, sore, possibly swollen,  and forcibly stretched tissues will react? Do you imagine tearing and damage?

Incredibly challenging and graphic descriptors to be sure.

Now imagine the alternative, there is no stretchy and pulling.  The large malleable and smooth object enters the space slowly so your mouth has time to adjust and accommodate it.  As the object approached your open lips, you slowly offer pushes to allow your lips to slowly stretch more than the norm.  Though it may sting and pull it is bearable.

Imagine now what your tissues would be like after that?  Sore? Some abrasion or some natural tearing?  Swollen a bit?  Even some bruising? Sure in reality you could be.  Accommodating a human baby through your vagina is a different experience than the usual.

How did the two processes sound to you?  To me I would much prefer the second one. Hands down.  How about your husband or partner?  Do you think this would be remotely decent to witness and then think ahead to actually having sexual activity with you again?

Though in my area, I rarely see an episiotomy done, I do see this very aggressive handling of the vagina and perineum routinely now.  To add to this, I am seeing more tearing severe tearing as well. When I ask the women about how their bottom is healing and feeling, I hear about more soreness, swelling, and bruising in the women who experience this.

So what do you do about it? Saying no to episiotomy during appointments and in making your birth plan is not enough.  Talk to your care provider ahead of time about the type of care you expect in late pushing and delivery. Talk to the nurse who is with you when you begin pushing. Tell your husband or partner to be on the look out for this aggressive technique so you can say NO. I also find that having warm compresses covering your perineum and vaginal opening can help abate it to a degree.

Here’s to a much healthier vagina, labia, and perineum post birth!

Preparing For Birth – Quotes from Women on What Pushing Feels Like

Thursday, August 20th, 2009

A couple of weeks ago I went on a quest to find out just what pushing was like for other women.  As an educator and doula it is probably one of the more challenging concepts to address.  Why?  Well some of the imagery can be quite vulgar.  “Push like you are pooping.” Do women REALLY want the image of pooping out their babies?! “The urge will overwhelm you and you cannot help it.” That also is not quite right some women never get the urge until the baby is very low and engages the nerves and some women will have the urge when baby is high and dilation isn’t complete (I did not say premature because I believe when the urge comes pushing “gruntily” with the peaks is alright as perhaps that will facilitate complete dilation and rotation of babe).  Some women feel great rectal pressure, some feel it in their abdominal muscles, and some don’t feel much at all going into it. Hey I do not believe we need to be fixed in this area.  I think whatever a woman’s body does is right for her body.

Below are many quotes that I frankly trolled for to edify women everywhere on the spectrum of what pushing is like. I could bore you to tears with the physiologic nature of the process but that isn’t what you really want to know now is it?! If you have questions on the new perineal massage, please refer to my previous entry http://prepforbirth.com/2009/08/25/new-episiotomy.html.

Quotes from real women

“My babies #1-4 practically fell out. #5 I was in what looked like early labor for 4 days. Midwife assistant came over, checked me, I was at 7 cm but ‘not in active labor’. I got into it quickly! Long story short I pushed, painfully, for 3.5 hours, baby had 11″ cord with a true knot. She needed to be pinked up but is almost 3 and is doing well.”

“When I was coached to push (w/ no 3..first natural birth) I was in agony. When I was left alone and did not push (w/ no 4), life was good.”

“I feel like if I can just get to the pushing phase, it will be a breeze from there.” (and it was. The whole “surrender/dilate” phase is much more challenging to me than the whole “take control/pushing” phase.)”

“Pushing was fantastic with my 2nd baby and awful with my 3rd! It was really surprising because after my 2nd birth I thought “Okay so pushing is the really fun and satisfying part! That’s when it gets EASY.” Then my third birth totally shocked me. Pushing was the most painful and difficult part of the birth. I had stayed so calm and collected… until then. Every pregnancy and birth is so different!”

“I love the way it feels to have a baby move through me and into my waiting hands.”

“I *loved* pushing. I didn’t do it for very long (two contractions), but it was so great to finally get there. I was told to purple push (not in those terms – the nurse told me to hold my breath), and intellectually I knew I shouldn’t, but I tried it and it really did feel like I was more productive that way. I felt like a warrior. It was awesome.”

“Before anyone hates me for only pushing through two contractions, you should know that I’d been in labor for three days – so it all comes out in the wash ;-)”

“Pushing with my 2nd was horrible. 3+ hours of the worst pain I had experienced at that point in my life. Turns out her little fist was up by her cheek (um ouch) and her head did not mold much. My 3rd I did not push because she was precipitous and we were trying to get to the hospital. I felt like all the energy in the world was gathering and swirling at my fundus and then suddenly flowed through me carrying her with it. It was the best physical experience of my life.”

“I have heard some say that pushing feels good.. um, I personally have not experienced that and I have had clients remark the same … :p”

“Hmm…Definitely the best part of labor and delivery. For me though – never had any “urge” to push but still had baby out in 20 mins…I think I was feeling determined being a VBAC mom…still, would have been easier if I felt the need to and not just contractions. “

“Heard lots of clients say it feels good after hours of labor”

“Ahhh, I’m not so fond of the pushing. Did it for 2 1/2 hours with my daughter (LOA) and though it was only about 20 minutes with my boys, they were both OP. That was, shall we say, unpleasant. I cannot relate to those who’ve told me it was such a relief!”

“My labor was surprisingly short, only 6 hours and she’s my first baby so far. I woke up in active labor and at 4 cm and I wanted to push THE WHOLE TIME! It was horrible having the nurse say I couldn’t push yet when I wanted to so badly, but once I did get to push, oh my goodness, it felt incredible. So much control and power, it felt so good to finally work to end. 3 big pushes and there she was. :)”

“Sheer, immeasurable power. Unbelievable!”

“Babies actually come out of your butt. Don’t let anyone tell you otherwise.” One of my clients recently said that. :)”

“Birth is shockingly rectal” – Gretchen Humphries. She was totally right.”

“Pushing with my first felt like I was satisfying an urge, an uncontrollable urge. It felt almost desperate I couldn’t stop it. (kinda like having that rectal urge when you REALLY have to poop). Pushing with my second was no big deal, I followed my urges again and pushed 3x and out she came in her 10# glory. It was extremely satisfying and powerful I felt like I had just finished exercising. Amazing!”

“The ring of fire OH MY it is indeed! Though as soon as the burn started the whole are went numb almost like too hot or too cold numb and the power of the urge to push my son out was almost beyond description.  Pushing was never easy for me as I have an unusual pelvic shape.  But my last son WOW no molding and quite a large head to birth him was incredible really.  No tearing, just some abrasion.  Recovery was a snap.”

“I had at the point of delivery what was the best orgasm of my life!”

“Pushing was totally primal.  I had an incredible urge and it took over.”

Questions and Answers

  1. I have had a previous episiotomy, do I need another one automatically? No you don’t.  Depending on how your scar has set and the position you push in the scar can re-open or it adhesions in the scar will need to be broken up.  I would suggest perineal massage prenatally if there are any adhesions to break them up and soften the area prior and to choose a pushing position that doesn’t put all the tension on that exact area.
  2. Is is wrong to push when I am not fully dilated? Not necessarily.  Now I think grunty smaller pushes with those contractions can be effective to complete dilation if you are in transition.  Prior to that change the position you are laboring in to change where baby is placing pressure.  Knee chest can be very effective to abate very early pushing desire.
  3. What if I poop during pushing? Some women will pass some stool and some won’t. You may here that when pushing the right way you may pass some.  Hey open bottom is vital to pushing, so hey it is a normal but not always occurence.  A fantastic nurse, MW or doc will not actually wipe it away but simply cover as to not cause constriction of the sphincter muscles which can disturb pushing progess. If it is possible to discard the stool without disrupting you, it will be done very quietly and discreetly.
  4. I am very modest, do I have to have all my “glory” showing? Absolutely not.  You can maintain good modesty all the way up to delivery.  Even then you do not need to be fully exposed.  Truthfully a home birth or birth center birth with a midwife if likely going to help you have your modesty concerns respected and honored. Really no one needs to put hands in you during pushing, or needs to stretch anything, or needs to see everything either.  A midwife is trained to see by taking a quick peek or simply to know when she needs to have hands ready to receive baby and to offer external positive pressure if mom wants.

Check back later more Q and A to come as more questions are sent to me.

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?

Interviewing your care provider for pregnancy and birth – A tip sheet.

Monday, August 10th, 2009

Choosing your care provider: Use this as a template for the interview process or to discern you are of the same philosophy and belief system with current OB or Hospital/Birth Center Midwife.

· What is birth philosophy? What is philosophy of pregnancy?

· What makes up majority of experience in practice? Has provider seen normal labor and birth? How often?

· How is the “due date” approached? When is “full term”? When is “overdue”?

· Will questions be answered over the phone?

· How much time will be spent with me during each appointment?

· What if I hire a doula? Are there restrictions on the doula I may hire? If yes, why?

· Are there restrictions on the type of childbirth or breastfeeding class I take? If so, what and why?

· What routine tests are utilized during pregnancy? What if I decline these tests?

· What are intervention rates? (IV, AROM, continuous monitoring, episiotomy, etc.) Cesarean rate? VBAC rate? Induction rate? What induction methods are used? When are forceps/vacuum used? These numbers are tracked.

· What positions is care provider comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing? Water? How often do patients deliver in positions other than “c” position?

· If I choose an epidural, when can I get it or when is it too late?

· What about a birth plan? Does CP agree with them or not?

· Is an on call rotation utilized or does CP attend all own patients? Will back-up or on-call CP honor the requests we have agreed on?

· Are there any protocols that are non-negotiable? If you cannot refuse – you are not consenting.

· What if I choose to decline a recommended procedure or intervention? Will my decision be respected?

· How long is provider with patients during labor?

Points to ponder afterward:

· Did you feel immediately comfortable and respected at the interview? If already with a CP, do you feel comfortable, respected and heard at each appointment?

· Was or is care provider willing to answer questions in detail without being annoyed?

· Is choosing your care provider based on your insurance or lack of insurance?

· What are you willing to do in order to have the birth you really desire? Birth location?

· How much responsibility are you willing to take for the health care decisions for you and your baby?



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