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Birth plans. Epidurals. Natural Childbirth. Doulas. Induction. Cesareans. And more…

The list of decisions about birth goes on and on…

More women are becoming dissatisfied with the status quo in American maternity care, and are asking for something outside the norm for the hospital where they plan give birth. Naturally, this might make for some conflict between a birthing mother and her care provider and nursing staff.

Conflict.

There. I said it. Right out loud.

There might be conflict in the labor and delivery room when a mother is giving birth. I am not writing this post to tell anyone how to avoid conflict, but how to manage it in a healthy way, so that the birth experience is not characterized by the conflicts that arise, but by the solutions everyone involved is able to come to.

Here are some do’s and don’ts that may help you in the labor and delivery room to self-advocate effectively, while creating a human connection with the nurses and provider caring for you and your baby.

DON’T: Expect care providers or nurses to offer much in the way of comfort during labor.
It is not the responsibility of a care provider or nurse to make a birthing mother comfortable. Their first priority, and indeed, their entire job, is the safety of mother and baby. Period. Your comfort is a distant second to safety, and that’s exactly the way it should be.

DO: Hire a doula to offer you comfort and support.
Your comfort is the entire responsibility of your doula. Period. That is all that she is there for. Emotional, physical, and informational comfort and support are her expertise. You will not be disappointed if you lean on a doula for this need.

DON’T: Make demands.
This only causes a heightening of conflict. If you want something different than protocol, shaking your fist and demanding it is not the right tack. You might get your way, but you may not end up getting the best care if you treat the nurses as if they were there to grant your every wish.

DO: Ask for exceptions.
Think about it. How would you feel if a stranger came to your house, and began to dictate to you how to load your dishwasher, feed your kids, or fold your towels? You would be offended. This is what we do when we demand our way in labor. When you want something outside protocols, try this: “I understand that this is your normal protocol, but I need you to make an exception for me this time. Thank you.” This invites conversation and cooperation, and is less likely to put a nurse (who is technically your advocate) on the defensive.

DON’T: Be rigid.
Refusing to budge on the smallest things is unfair, especially when you are asking for things outside the box. Remember, you are a rare breed to these nurses. Asking them to step outside their norm is a big deal. Respect that.

DO: Be flexible.
Compromise is the name of the game. For example, here in Colorado Springs, a Hep lock buys you pretty much anything you want in most of the hospitals. It helps them to see that you are reasonable, and that you understand why they do what they do. It makes them far more open to your requests and out-of-the-box needs.

DON’T: Wait until you are in labor to make your birth plan known.
It is completely unreasonable to spring a birth plan on unsuspecting staff and providers. You can’t count on appointment conversations to be remembered, simply because of the sheer volume of patients a hospital-based provider might see in any given month. Not to mention the fact that you are likely to have a care provider you’ve never met catching your baby!

DO: Discuss everything on your birth plan prentally.
Write your birth plan early, in second trimester, and tackle one issue at a time in those 7-10 minute appointments. Discuss the benefits, risks, and alternatives ahead of time, and really make sure you and your provider are on the same page. If they are willing, have them sign it–this doesn’t make it a legal document, but it proves to the staff and on-call doc that your care provider is on board with all your requests.

In short, it pays to be kind. Always be kind. You never know what kind of day your nurse or care provider has had. You have no idea what is going on in the room next to you. I am not making excuses for bad or disrespectful or hurried care. I want to remind you that everyone in scrubs is a human being, just like you. There is rarely a reason to walk into a labor and delivery ward with guns blazing. Even if you had no other choice in your care. The ones providing it are just as human as you are, and if you can leave them feeling respected and understood, you are helping to pave the way for the next woman who wants out-of-the-box care.

It may be your birth, but it has ripple effects. Whether it’s for the positive or negative is, at least in part, up to you.

How do you handle differences of opinion in your care? What are the most diplomatic ways you have used to self-advocate without a situation erupting into WWIII?

Grace & Peace,
Tiffany

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

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!

A birth plan has a few real purposes. It can act as a values clarification exercise for you and your partner. Then it is a vehicle to open communication with your care provider about your needs, desires, wants for labor, birth and postpartum.  What you want and need matters.

 A brief one page plan with an opening paragraph with bullet point information specific to individualized care and desires not usually within your care provider’s standing orders or usual protocols of the birth location.

I advise you take the written birth plan to a prenatal visit at least a month prior to your given estimated due date. This gives time for conversation, to have a clear understanding of expectation and agreement.

If it becomes apparent that you and your provider are not on the same page, you then have time to seek out another provider that fits you and you fit with.

Remember it is not a legal document that your location of delivery or care provider must adhere to.

=======================================================

Birth Needs and Desires for: _______________________. 

Care Provider:_________________.

Estimated Due Date: _________________.

I am planning on a no to low-intervention labor and delivery.  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 a running IV.
• Limited vaginal exams after initial assessment.
• In the event an induction and/or augmentation is medically necessitated-
  • Ripening – Foley Catheter instead of Cytotec (misoprostol), Cervadil or Prepadil
  • Pitocin – A very gentle and slowly administered dosage increase.
  • AROM – will only consent to if an internal fetal monitor is a must.
• Spontaneous pushing and delivery in any position I am most comfortable with.
• External pressure and/or compresses instead of any perineal or vaginal stretching.
• No cord traction or aggressive placental detachment, including deep uterine massage.
• Delayed cord clamping for at least 10 minutes or until my placenta spontaneously detaches (baby can receive oxygen or other assistance 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. I will hand express if necessary. I will hand express if needed to syringe feed my baby.
• 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 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
• 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
• I am willing to hand express if baby cannot get to breast right away.

This “plan” may be copied, pasted and edited  for use by others.

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 birth plan is designed to facilitate communication between you and your provider, especially necessary if you are  birthing outside the home environment.  Secondly, it is to offer information on the individualized care you as the mother would like during labor, birth and immediately postpartum for you and your baby.

It should be brief (no more than one page) and only have the bullet point information that is specific to individualized care and desires not usually within your care provider’s standing orders or usual protocols of the birth location.

It is important to take a written birth plan to a prenatal visit at least a month prior to your given estimated due date in order to have a clear understanding of expectation and agreement. If it becomes apparent that you and your provider are not on the same page, this gives can give time to seek out another provider that fits you and you fit with. Remember it is not a legal document that your location of delivery or care provider must adhere to.

 =======================================================

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 a running IV.
• Limited vaginal exams after initial assessment.
• In the event an induction and/or augmentation is medically necessitated-
  • Ripening – Foley Catheter instead of Cytotec (misoprostol), Cervadil or Prepadil
  • Pitocin – A very gentle and slowly administered dosage increase.
  • AROM – will only consent to if an internal fetal monitor is a must.
• Spontaneous pushing and delivery in any position I am most comfortable with.
• No cord traction or aggressive placental detachment, including deep uterine massage.
• Delayed cord clamping for at least 10 minutes or until my placenta spontaneously detaches (baby can receive oxygen or other assistance 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. I will hand express if necessary.
• 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 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
• 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

This “plan” may be copied, pasted and edited  for use by others.

A clean slate. A fresh start. Hope and dreams reactivated. Passions toward change are stirred. All of this by the calendar rolling over from one year to the next. It is not just  anew year though, it is a new DECADE to set precedent in. To make a mark. Oh the possibilities and opportunities that are ours to reach for and accomplish.

In the spirit of all of this, I decided to make an #in2011 wish list on New Year’s Eve 2010 and with some help from a few friends here is what flowed out.

#in2011 breasts will be viewed as nurturing, comforting, and beautiful.

#in2011 the majority of women will be served under the midwife model of care for the majority are low-risk and will remain so.

#in2011 Childbearing women will be greeted with open arms by providers with their questions, needs and knowledge.

#in2011 pioneering social media women will gain even more ground in their work liberating childbearing women.

#in2011 delayed cord clamping and physiologic third stage will become the norm.

#in2011 doulas will be respected as educated, knowledgeable birth professionals by staff and care providers.

#in2011 childbearing women will be given opportunity not limited

#in2011 Those striving to improve the maternity system at the ground floor as educators will be mutually respectful and supportive.

#in2011 Doulas from all backgrounds and organizational affiliation will be open to one another, supportive, sharing.

#in2011 a woman with needs and opinions with not be marked for a cesarean because of it.

#in2011 Homebirth transports will be treated with dignity and respect.

#in2011 Stigma of mental illness and motherhood will be adsressed by every childbirth care provider. RT @WalkerKarra

#in2011 Childbearing women will not have to live in fear of their providers.

#in2011 We CAN change the world together for childbearing women. Put your words intro action.

#in2011 More birthing women will have low-intervention births that lead to healthier outcomes.

#in2011 Childbearing women will be seen, heard, respected and offered a variety of care options.

#in2011 there will be less imbalance of power between maternity patient and provider.

#in2011 childbearing women will rightfully claim their health records as their own -RT @midwifeamy

#in2011 we will wake up to and address the shameful disparities in access to and outcomes of maternity care RT @midwifeamy

#in2011 Less pointing fingers among insurance companies, providers & orgs that continues to feed this ever medicalized maternity system.

#in2011 I would like to see an equal playing field with accessibility to all to maternity research, guidelines, statistics…

#in2011 I would like see accountability for providers and institutions in their maternity care practices.

#in2011 I would like to see hospitals treat only the patients they serve the very best – high-risk or in-need mothers and babies.

#in2011 I would hope more women stop blindly trusting and do their own research for pregnancy, birth and postpartum.

#in2011 I would like to see arrogance leave the treatment room. It is not a personal affront for a patient to have an opinion and needs.

#in2011 I hope women are treated as holistic beings especially in pregnancy.

#in2011 I hope for care providers to be transformed into partners with their patients instead of authorities.

#in2011, I want to see care providers and family members taking postpartum mood disorders seriously. RT@smola04

#in2011 I hope women stop being treated with hostility and looked down upon for wanting something more in pregnancy, birth and postpartum.

#in2011 I would like to see more women receiving comprehensive postpartum care from their OBs and hospital based midwives.

#in2011 I hope that women will openly mentor those coming up after them to better understanding and expectations in birth.

#in2011 I hope social media efforts have even more impact on unveiling the hidden and progressing healthy birth practices.

#in2011 I hope less mamas are unnecessarily cut open in pursuit of delivering a baby.

#in2011 I hope to see midwives working together no matter the track they came up on. Being respectful and open.

#in2011 I hope to see women who have experienced amazing births be loud and proud sharing the good news without fear.

#in2011 I hope that midwives of all types will be fearless in their pursuit of their model of care for women.

#in2011I hope that hospitals and providers realize they need to offer individualized care to women and babies for the health of it.

#in2011 I would like to see women openly breastfeeding their children without shame or discrimination.

#in2011 A drop in the cesarean rate would be progress toward healthier practices.

#in2011 I want to see women in droves having their eyes opened and being fierce about the care they receive. About their maternity options.

#in2011 I would like to see less care providers offering up defensive and fear based medicine to their maternity patients.

#in2011 I hope for more accessibility to home and birth center births for women and babies.

#in2011 I would like care providers to view women as a sum of all parts, not a uterus growing a baby more valuable than she is.

#in2011 I would like to see more women taking charge of their care, taking personal responsibility and being powerful pregnant women.

#in2011 I desire more respect and autonomy for maternity patients.

#in2011 For women who want a VBAC to easily find an accommodating provider.

Is all this attainable in one year? Perhaps not, but pushing toward the positive and never taking the eye of the reason for all of this, the childbearing women and families, I do believe we can change the world and make the maternity care system as a whole a safer, healthier  and more respectful place.

What is on your 2011 wish list? If you would like to have it added here, leave a comment.

Reader Additions:

Kay Miller:

I hope that we (doulas/educators) can stop alienating the providers, instead partnering with them to provide the best care possible for the mamas and babies that we work with.
I hope that doulas/educators and providers can have mutual respect for one another, and realize the value of the care and support that each provides.
I hope that while we work to change the negatives of health care for pregnancy, birth, and postpartum, that we can remember to openly recognize and affirm the positives.
I hope that families will make decisions based on education and research, not on fear.
I hope that both “sides” stop using fear tactics to persuade families to make certain choices. A decision to home birth due to fear of hospital birth is still a decision based on fear.

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.

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.

I sit here and ponder Why childbirth education is important?. I am an educator because I think it can be a vital piece to the preparation puzzle prior to welcoming a baby.  I use the word “can” versus “is” due to the fact that all educational offerings are not created equally.

It is known that only a percentage of expecting mothers attend a childbirth class series. Perhaps they believe the staff will explain everything when they get to the hospital, they really have a deep trust in the process and are reading up on everything, or since they are having a home birth that additional education is unneeded. Whatever the reason, women are not getting the foundational information that can be incredibly helpful toward confidence, ability, decision making and mothering far beyond the birth itself.

A good childbirth class series (or rather perinatal class) is well worth the monetary and time investment for most first time mothers and can benefit those who have already birthed.  My post on choosing a childbirth class is a good jumping off point to figuring out what type of course suits the individual expecting mother (her partner or labor support).

A class series worth the time and effort will be comprehensive in nature, not just covering labor and birth. What does that look like? A class that covers midway third trimester pregnancy through 4-8 weeks postpartum. It is content that is deep and is applicable to real life.

A sample of course content:

• Pregnancy Basics
• Common Terminology
• Normal Physiologic Changes and “helps”
• Exercise
• Nutrition
• Prenatal Testing
• Birth Plans
• Informed Consent
• Communication and Self-Advocacy Skill Building
• Overview of spontaneous Labor and Birth
• Labor milestones with Comfort and Positioning Strategies
• Overview of all Options in Labor, Birth and Postpartum
• Labor Partner Role
• Immediate Postpartum
• Navigating first weeks Postpartum
• Overview of Infant Feeding and Norms
• Bonding
• Medications and Interventions
• Cesarean and VBAC
• Unexpected Events
• Role-playing Scenarios
• Relaxation and Visualization Practice
• Local/Online Resources

How the educator reaches her class is fundamental to the learning process and take away of participants.  I encourage women to interview the potential educator. Finding the right fit in a class is no different that in provider, doula or birth location.

Even if a woman knows she wants an epidural, TAKING A GOOD CLASS is vital because she will be having a natural birth the epidural is on board and her Plan B could very well be a natural birth. Being prepared will only serve her well in the fluid process known as labor and delivery.

Gaining knowledge that will help a woman to partner with her provider, address her own needs fully and help her to define her own birth philosophy gives her a leg up on being responsible and in charge in her own health care and even outcomes.

The vast scope of what a solid class series can offer an expecting mother (her partner or support person) is incredibly valuable and can not be understated. A class that provides for encouragement, comfort, safety, respect, connection, structure, evidence-based information and real life application can plant seeds and prosper skills that will carry a woman well into her mothering years. These skills are for life, not just for labor and birth. I am stunned often by how birthing knowledge carries me in daily ability with my own family.

Here’s to happy and deep learning!