Feeling Thankful…

Thankful

I am thankful for a break.

I am on break from teaching for the next nine days. I know when I actually count how many days I’m off, and start telling other people about this out loud, that I really, really need a break. Don’t get me wrong, I love my job. I am one of the few lucky people who can actually claim that they would do their job even if they weren’t paid (if you’re reading this, and you’re my boss – please disregard that last statement. Thank you.) But what I do for a living requires a certain kind of energy, a certain level of engagement that fills me up – and after some time without a break – can drain me as well.

My schedule in the past ten days or so has been unusually full. I started very early one morning to teach a full weekend seminar, both Saturday and Sunday. I had a couple of days off and then began the team-teaching portion with two newly hired educators to get them up to speed in their training. I love this aspect of my work, but it usually involves extra hours after class has ended to recap and look ahead to the next week. I had a day off and then I taught a full-day weekend intensive followed up by a day of walking groups through the hospital for a tour of the unit where they will deliver. By the end of it all, I was pretty zapped.

I probably only put in about 45 hours over 10 days – but given the fact that most of that time is spent actively engaging an audience, it ends up feeling a lot more than that. What I find most interesting though, is that even if I end a full day only to have to get up early the next morning and go again, once I’m in the classroom and up in front of the group, I feel full of energy. To me, this is a sign I’m probably doing something that I’m supposed to do. Being “in the zone” much of the time I’m working means that I’ve finally put some of my individual strengths to good use. Let me explain this a little bit further.

I have four children of my own and they’re really great kids. I’m always amazed at how the same DNA can come together and create such different creatures. Not just in how they look but in who they are. My third child is a firecracker. Every family should really have one of these. They can make parenting super challenging sometimes, but they’re also really fun and highly dramatic. I love her to pieces but she’s been giving me a hard time since before she was born.

The night before I reached the 40 week mark, I woke up with a start. I didn’t have to go pee, so I couldn’t figure out why I was awake. The next morning I realized that she’d flipped during the middle of the night into a breech position which is why I woke up. I grabbed a bag of frozen peas and placed them directly on what I thought was her head. I switched out frozen corn for peas all day long and that night I slept with my bum straight up in the air to see if the cramped space between my ribs would be annoying enough to make her flip back into a head down position – and thankfully, it worked! (Sometimes you have to teach them a thing or two even before they’re born!) But she still managed to have the last laugh as she came out of me looking like Superman with one of her hands up by her face. Ouch.

This child is most like me. And parenting yourself is not always easy. I don’t want to sound arrogant, so let’s just say she’s got some of my good qualities. But unfortunately, she also has some of my not-so-good qualities, too. She’s independent to a fault, stubborn, impatient, and refuses to ask for help unless it’s absolutely necessary. Oh, and she talks – a lot. Every single parent-teacher conference we go to, the teacher says something along these lines. “She’s a great addition to the classroom, but if we could just work a little bit on her chatting with others while they’re supposed to be working…”

Hmmmmmm… I wonder where she got that from? I’m pretty sure if I asked my Mom what my parent-teacher conferences were like so many years ago, they’d be pretty similar. I got in trouble my whole life for talking too much in the classroom. I wasn’t trying to be disrespectful, I’m just the most social person I know. Seriously, I haven’t met anyone who craves to be with people more than I do – except maybe my own little mini-me daughter. I’ve had more than one conversation with her about how she needs to try and control her talking out of turn (I still struggle with this – meetings just about kill me!) but that she can look ahead and actually find a job, a career even, that supports her desire, her need to talk and be social with others. How do I know? I’m living proof!

The engagement that my job requires in order to be an effective educator is intense. And for the most part, I thrive on this engagement. I look for the opportunities for an exchange between myself and one of my couples to happen that causes an “Aha!” moment of clarity, understanding, or self-discovery. When this happens, I can literally feel it and I realize that what I do matters. Maybe not to everyone, but at least to this one person, in this exact moment. String a whole bunch of those moments together and you get to see what personal and professional alignment looks like.

I have no idea what my daughter will want to do with her life when she grows up. I certainly had no idea that I would ever end up being a Childbirth Educator when I was her age. I’m pretty sure I was close to thirty years old before I even knew such a job existed. But whatever she decides to do, I hope she’s as lucky as I’ve been to find something that aligns with her spirit.

I know that in about a week, I’ll start to get that itch again – the desire to get back to what fuels me, what fills me up, what I’m supposed to be doing with my life.

And I’m thankful for that.

This is my official recruitment blogpost. :O) If you’ve ever considered working in the field of Childbirth Education, consider this a little voice whispering in your ear, “You’d be great at this! You should check it out!” Leave me a comment if you’re really interested and I’ll follow up, I promise. And one more thing… I’m super thankful for those of you who read and leave comments.

Are you doing something that fuels you, that aligns with your spirit? If so, how did you manage to discover it?

The Birth Scale Part II

Birth Scale II

This is a continuation on a piece I published the other day about “A Birth Story” blogpost I read in Longreads. If you’d like to read part 1, it’s right here.

With no judgement placed on the author or her birth story, there are some things that might have been very helpful for her and for anyone else preparing to give birth and hoping to avoid a Cesarean. I share some of them here.

I think the author’s birth could have been helped immensely by the presence of a doula. At one point, the author even acknowledges this by saying, “‘Oh, this is why people get doulas.’ But I was my own doula! I would not forget how to assert my right to a natural, unmedicated childbirth.” But that’s not always possible, acting as your own doula! Especially when you’re in the middle of an extremely long birth, or a birth that has caught you off-guard in its intensity.

A doula could have suggested that they not head to the hospital too soon, she could have given her partner a break, or normalized what was happening for them so that any feelings of panic or confusion would remain temporary and not take permanent hold of the labor. She could have offered suggestions on unmedicated comfort techniques and provided additional support for both the woman and her partner. A doula could have acted as a go-between and an advocate for this couple when questions started to come up and big decisions needed to happen. To feel like there was at least one person in the room acting as her personal advocate, providing her with the tools to move through labor and ask the necessary questions to make the best decisions in real time, might have made all the difference in this birth.

Writing a PCBP (Positive Cesarean Birth Plan) might have also been a help to her when it became a reality that this would be how her baby was going to be born. This is an idea that I’ve posed to all of my students over the years. Me, the woman who really discourages an actual “Birth Plan”, encourages everyone to write a PCBP. It allows you and your mind to go there – to consider Cesarean Birth. You can prepare your mind and your body – not for this inevitability, but for this possibility. When you allow your mind to even consider Cesarean Birth, you can begin to prepare for ways in which you can make this a positive experience instead of a negative one. Your partner has an actual plan to follow if Cesarean Birth becomes necessary. It gives them something concrete to do in an uncertain time and allows you to have some sense of control over a situation that can feel out of control. Writing a PCBP does not mean that a Cesarean Birth will happen to you. Women who are most at risk for having a negative experience with an unplanned Cesarean Birth are those women who never considered it. A Cesarean Birth is still birth. And even if it’s not what you might have wanted or hoped for, there can still be joy, excitement and anticipation of your baby’s arrival if you have a plan that makes this experience as family centered as possible.

In today’s environment, where we have rates of Cesarean Birth hovering at or above 30%, we need to push our hospitals and staff to consider how the management of birth and the policies of our institutions are contributing to that too-high statistic. But we also need to ask how we can work toward bringing down that percentage for ourselves? How can we reduce our own personal risk of Cesarean Birth? Can we have a back-up PCBP in case this is how our baby needs to be born?

Entering labor in the best health possible can reduce your chance of Cesarean Birth. So, begin taking care of yourself – mind and body – even before you get pregnant. Attending all of your prenatal appointments and continuing to care for yourself throughout your pregnancy will help. Taking part in evidence-based childbirth preparation classes that discuss all aspects of pregnancy and birth – not just natural childbirth techniques, but also interventions, medications and Cesarean Birth options – can best prepare you for the birth itself. Letting labor begin on its own, unless there is a medical indication for induction, will lower your risk. Staying at home through early labor and coming to the hospital or birthing center when you’re in active labor can also reduce your risk for unnecessary interventions and Cesarean Birth. If you are wanting an epidural, waiting to get one until you have an active labor pattern well established is an important step. And finally, understand that birth is hard work. Knowing that birth will require all of your strength, both mental and physical, to help you get through your labor should be something that every woman understands before she ever feels her first contraction. Providing the laboring woman and her partner with all the necessary tools, support and encouragement throughout their labor should be standard care in all of our hospitals and other birth settings.

I read this birth story several times, and each time I reacted in one of two different ways. My heart aches for this this woman and any other birthing woman who has ended up feeling like her birth was not what she wanted or hoped for. But it also made me stop to think whether or not I’m doing everything I can to live up to my own tagline: “Saving birth one story at a time.” I need to make sure that I’m doing my part to help women have positive birth experiences.

I taught a wonderful class of students over the weekend – and I wanted for them what I want for every birthing couple I come in contact with: that in the retelling of their own birth story, they are proud of their own participation and feel empowered in their own decision making. Even if, especially if, their birth ends up looking like nothing they would have expected. My hope is that through my classes, women and their partners feel like they’re actually receiving all the tools that they need to feel prepared to participate fully in their births, to ask questions, get those questions answered to their satisfaction and then feel empowered to be decision-makers in their births.

About eight months ago a Momma from one of my classes ended up with an unplanned Cesarean Birth. She realized in her actual birth that the scale that she was using before labor had changed and she used her B.R.A.I.N. throughout to make the best decisions she could for her labor, her baby and herself. She wrote me her birth story, and I want to share excerpts of it here in contrast to the one written for Longreads.

Hi Barb,

So the birth story…I ended up inducing labor at 41 weeks and 5 days. My doctor was fine with waiting two weeks past the due date, but no longer. And I wasn’t comfortable waiting any longer myself. I went in to have the baby monitored twice during that last week and the heart rate was great and there was plenty of amniotic fluid. We opted to induce two days before the two week mark as my doctor was 1) on call for a 24 hour period and 2) I wanted to have the baby before I hit the two week mark….That said, I had been dilating well and was over 4 cm dilated when checked 3 days before we induced. I saw my acupuncturist three times during those last two weeks to help induce labor as well. Jay and I were very reluctant to induce labor but my intuition told me that it was time.

The Pitocin did its thing rather quickly and my contractions started within an hour of induction. (6 hours later) When the doctor arrived I was still at 7 cm dilation…I had been at 6 cm during the last check. The doctor was perplexed though as the baby still hadn’t descended into my pelvis. She also noted that the baby was facing forward and that the head was tilted sideways at an angle… I managed for several hours but eventually asked for the epidural… In hindsight I am very glad I did. In the moment I was also very glad I did. I could sense a bit of disappointment from my doula but I didn’t care…I had decided this was going to be my birth experience and I was going to enjoy it and feel empowered. 

So I labored with the epidural for another 6 or 7 hours and didn’t dilate much more than 7.5 cm. The baby still never descended. The baby’s heart rate was very steady the entire day so there was no sense of emergency during my labor. At about 16 hours in the doctor started expressing concern that the baby was not going to descend properly…they went in with that probe device and verified that my contractions were more than strong enough to push the baby down…therefore had deduced he was stuck.  At that point I was ready for the C-section. 

I was able to talk to Jay, my doula, and the doctor and get a feel for what the procedure would be like. The anesthesiologist was fine with letting both Jay and the doula in the room. All agreed to put the baby on my chest immediately after birth to let him nurse. The operation went great…it ended up being all women (with the exception of Jay and Baby Sean)…the doula took tons of great pictures. The doctor and staff were in great spirits and all were laughing and joking when Sean arrived at 11 pounds!! The doula even told me later that it was the warmest, non-clinical-feeling Cesarean she had ever witnessed. Sean was huge, his head was 15.5 inches in diameter and at the angle he was hitting my pelvis, there was no way he was ever going to descend. In my opinion, the induction was necessary to start labor…but that baby was never going to have been born vaginally. In a different place or era, I don’t think he and I ever would have made it without Cesarean being an option. 

I hope if I have a second child that I will have a successful VBAC, but I must say that the experience wasn’t that bad and that I was grateful that surgery was an option. I have zero regrets.

I was fortunate to experience labor and also fortunate to accept medical intervention when necessary. I look back at my birth and time at the hospital so fondly…when I drive by (the hospital) on the Interstate my heart swells with sentiment every time 🙂

Thanks for listening and for being such a great instructor. Jay and I felt strong and empowered and we owe a large part of that to YOU!!

Steph, Jay & Baby Sean

I include that last line of her story, not to reflect on me as their Childbirth Educator, but so that you can see how she claims feeling strong and empowered for herself. I might have played a part in that, but she knows that I only played a small part. This is the best line in her whole story as far as I’m concerned. I absolutely love this birth story! This Momma was clear-eyed and owned every decision she made throughout her birth. The way Steph gave birth might not have been what she’d wanted or intended to have happen, but she’s still proud of herself and her story. And both Steph and Jay will continue to remember their baby’s birth as a special and beautiful experience. There’s nothing more that I could hope for!

Is it possible to have a birth not go according to plan, but still feel very positive about it? What are your thoughts on creating a PCBP (Positive Cesarean Birth Plan)? When you gave birth, did you feel prepared or not? What would have helped you?

The Birth Scale

Scale

In the wee hours on Saturday morning, I was reading a post on Longreads titled, “A Birth Story” – so you know it piqued my interest. It’s a long story, and I applaud Longreads for publishing it in it’s entirety. All too often, we’re only given sound bytes, just sexy headlines and maybe a short summary of a story. Longreads stories have a ticker that tells you how long it will take you to read through a piece. In the case of “A Birth Story,” the estimate was 57 minutes – much too long for me to read at one go before heading into work that morning. But that was completely okay by me, because about halfway through the post, I just wanted to stop. The story completely depressed me.

According to the subtitle, the author of this piece “had the perfect pregnancy and the perfect birth plan – and then she went into labor.” Given my personal belief that birth is too big to plan, and that I very rarely meet a woman who has had a birth go perfectly according to her Birth Plan, you might think that I was eagerly wanting to read a story that supported this viewpoint. But nothing could be farther from the truth. I braced myself for what would be yet another woman’s sad tale of a birth gone wrong. Another woman’s retelling of how she expected this, but in the end, got that.

Our birth system in this country is broken on so many different levels, and I was prepared to read this story and again feel like our system had somehow failed another woman. But as I read on, I realized something else. I’m not sure that we’re adequately equipping today’s expectant woman with enough of the right information to even begin to realize the birth they’re hoping for.

I met with some labor and delivery nurses recently at a training for advanced labor comfort skills and many of them expressed frustration. They’re frustrated that when they first walk into the L&D room, they already feel like they need to be on the defensive, as many of today’s laboring women are entering the hospital with an attitude of “us against them”. The nurses expressed that they really do want to be advocates for these couples and help them to achieve the birth they’re hoping for, but feel like they’re often met with suspicion. Some nurses expressed understanding why there might be feelings of suspicion and thoughts of having to “fight” for the birth they wanted. But they also sensed that many of these women were not prepared to fully participate in a birth that they wanted to be free of intervention or medication.  

In reading this woman’s story, I felt sad for her, because even though she frequently stated that she was fine with whatever happened next, I didn’t believe her. I could be wrong, but I think she has a lot of unresolved pain and trauma from this birth. On the one hand, I’m happy that she wrote about her birth and maybe experienced some level of catharsis in doing so. On the other hand, I consider my expectant families and feel like this might be just one more “horror story” writ large. Where are the good ones? Where are the positive stories that can lift expectant families up and help them have hope for a birth story they’re happy to tell others about?

At the same time I’m left feeling sad for all of us – hospitals, providers, nurses, doulas, natural childbirth advocates, childbirth educators, Mommas and their partners – because in this birth story there were too many cracks, too many places where this birth could have had a very different ending. Let me be clear. I am not offering any information here to negatively reflect on this woman’s experience or her choices. There is no judgement intended. I only wish she had a different story to tell and these are some thoughts about how it might have been different.

This is what the author has to say about her relationship with her provider:

“I don’t even particularly like my doctor. I love her as a character. I love her from afar. I admire her. I would never choose to interact with her. She makes me uncomfortable. She is cerebral, nervous, she over-explains and my jokes are off-putting to her, but I think she likes them. Every interaction with her I am left feeling like, What was that?! Why was that so hard? We don’t connect, she and I. Somehow, this helps me trust her better. Our relationship is strictly professional, unmuddied by affection.”

When you’re giving birth to your baby, there has to be a level of trust between you and the other members of your birth team. Otherwise, when it’s time to make big (or even little) decisions during the actual birth, you won’t feel like they’re working on your behalf, that they’ve got your back. Everything they say you’ll second-guess and wonder if it’s true or medically necessary. With a trusting relationship with her provider, this woman could have had the exact same end result to her birth, yet she might have felt very differently about how things turned out. But maybe she never received the message that it’s always okay to switch providers.

I’m not saying that it’s easy to switch providers – it’s not. But if you feel at any point during your pregnancy that you have issues of mistrust with your provider, then by all means express those issues! Give your provider the opportunity to win back your trust, and move on if they can’t. Fire them and find a provider that you can have a trusting relationship with. You would never have a guy in a repair shop rebuild the engine of your car if you didn’t trust them – why would you have a provider that you don’t trust be in the room with you during your baby’s birth? You’re not a “difficult patient” for making this hard decision – you’re just an active participant in your healthcare.

The author mentions that she’s gone to “natural childbirth classes” – but did these classes do an adequate job of preparing her for the reality of her birth? I’ve already talked about how I think it’s perfectly okay to say that birth, for most women, will be painful. I’m happy when I hear a woman say that her birth was not painful. But I don’t think that we need to sugar-coat birth. I think we should be straight up about it and make sure that women who want a birth without medications or interventions are prepared for the level of sensation they will likely feel and the participation that will be required of them to get through it.

I’m concerned that the childbirth classes this woman took didn’t prepare her for that level of participation. And she expresses such a negative relationship with all interventions and medications even before labor has begun that when she makes the decision once she feels like her body “was washed up” and she gets the epidural, she writes, “Bring on the cascading interventions. And they came.” But it’s almost as if the outcome had been preordained and there was no other way around it. She even questions at one point “Was I walking the plank?” toward her unplanned Cesarean, and then “(I was always walking the plank.)”

This makes me wonder if her classes had covered interventions and medications at all. Had anyone taught her how to use the B.R.A.I.N. decision-making tool? This is the acronym that I and many other Childbirth Educators use when discussing interventions and medications in birth.

B = Benefits: what are the advantages in choosing this intervention or using this medication at this time?

R = Risks: what are the potential risks or drawbacks in choosing this intervention or using this medication at this time?

A = Alternatives: are there any alternatives to try avoiding the use of this intervention or medication? Are there any alternatives to try and achieve the same intended result?

I = Intuition: what does your gut have to say about using this intervention or medication at this time?

N = Nothing: what would happen if you did absolutely nothing at this point? If you just took the approach of “watch and wait?”

This part of classroom teaching can be tricky for some educators – they are committed to making sure that their Mommas have a birth that is free of complications. And this is most likely to be the case when there are no interventions or medications used during birth. Unless they become medically necessary. There are times when using an intervention or medication makes the most sense, no matter what the birth plan says.

But an educator must make sure that the objective of the B.R.A.I.N. activity is realized. Women must understand that there is a scale upon which they must weigh every decision of their births in real time. They need to realize that every suggested intervention has a true benefit, a true alternative and a true risk.  And the scale that they use to weigh decisions in the classroom or at their desk while typing up their Birth Plan is one thing, but the scale upon which they’ll need to weigh these decisions during the actual birth might be something else entirely. Unless this objective is achieved in class, a laboring woman has not been given the tools necessary to be a participating decision-maker in her own birth.

Stay tuned for part two of this post, where I will compare this experience with a similar birth story from one of the Mommas from my own classes, who’s unplanned Cesarean Birth had a very different outcome.

Words Matter.

Words Matter

This past week, I had the chance to talk with two different Mommas about their births. Even though their births were very different from one another, there was one aspect that they both felt compelled to share in the re-telling of their birth story. Each of them stopped and dwelled on it long enough for me to recognize how important it was to their overall experience. So, I’m sharing it with you all here just as a gentle reminder to those of us who work with birthing women: Words Matter. A lot. More than you realize. In the context of giving birth, some words will take on deeper and greater meaning and have such emotional impact that it can change a woman’s whole perspective on her birth. These same words can spark negative memories for her for years to come when they retell this story – to others, or just to themselves.

The two examples I want to share might not seem to include very harsh words or over the top comments, which is why I want to highlight them. You see, it isn’t enough to not be cruel with our words when a woman is giving birth, we need to realize that she is filtering everything that is being said to her through the lens of vulnerability. She is fully exposed, physically and emotionally. And the words she hears have more meaning, more weight. These words which normally might not offend at all, can be taken as judgement in how she is “handling her labor” or “conducting herself” while trying to have a baby. It’s not just our words that we need to soften, we need to create an atmosphere where a woman feels safe and secure while giving birth. Then words, maybe even the same words, would be received differently.

One Momma said that she felt like there’d been little to no encouragement when she started to push her baby out and to her, pushing felt like it was never-ending. She had no idea from her nurse or provider if she was making any progress and she was getting really tired and frustrated. So, as they asked her to give them yet one more push, she started making some pretty loud noises to help her get through her tiredness and frustration. And that’s when her nurse shushed her.

In the retelling of this story, this Momma stopped and we talked about this detail for a pretty long time. She said that she remembered thinking in her mind, “Did you just tell me to be quiet? Are you kidding me? I’m trying to give birth here and I need to do it quietly? What, am I embarrassing you?” She, of course, didn’t voice any of this – which is a shame, because this will be a detail that this woman will play over and over again and she might feel like she was silenced during her birth. Whether or not this Momma actually quieted down makes little difference. In her memory, she was shushed by this person – at a moment when she needed to roar.

Had she felt some level of encouragement and support during her pushing, her memory of this part of her birth could be very different. If this same nurse had taken the time to tell her what great progress she’d been making or even validating for her that pushing can be tiring and frustrating but that she was actually getting somewhere, she would have established a relationship with this birthing woman. Then, if she’d started to make a lot of noise with her pushes that same nurse might have been able to lean in and whisper in her ear, “Take all of that energy and put it straight into your pushing! Channel that noise and grunt your baby down and out. You are doing such a great job!” And even though, effectively she would still be quieting this birthing Momma, it wouldn’t be received that way. This same Momma might have told this part of the story differently: “I was getting super frustrated and making tons of noise with each push, but when she told me to grunt my baby out and let me know I was doing a great job I just got really serious after that – and then the baby was born! She totally helped me get focused on my pushing.” Or something to that effect.

The other Momma I talked with had gone through and incredibly long labor – close to 70 hours – and when pushing finally started to happen, she reported that one of her nurses kept telling her, “You’ve got to grab your legs and pull them back if you’re going to be able to birth this baby!” Now granted, this was maybe their 4th or 5th nurse because of the length of the labor, so she might not have been fully clued in to everything this Momma had already gone through. But in the re-telling of her birth story this Momma stopped as well and said that she wanted to tell the nurse “Why don’t you get up in this bed and pull your legs up after 60+ hours of labor? And then you can tell me what to do!” This Momma said that she couldn’t stand this woman standing next to her and wanted her to shut up and leave the room. Again, she questioned whether or not she had actually said any of this out loud (she hadn’t).

As birth workers we might not realize that what we say and how we say it matters so much – and it’s not limited to the actual birth itself.

I feel like I owe an apology to a new Momma from one of my recent classes. She ended up having a very fast and furious birth – 8 hours total from start to finish. And her partner told me her story just yesterday. She said that in the midst of giving birth the Momma felt like I’d lied to her! I had said that I didn’t enjoy my first pregnancy much, but that I loved my first birth. Of course, I had a typical long and slow-to-rev up labor with my first, and she felt like she’d gotten no breaks. Her partner told this to me kind of jokingly, but I take it to heart. My experience is only that – my experience. And I need to be aware that my words matter.

How and what I say in my classes will come back to women in the midst of their labors. Have I really prepared them as best I can for variables in birth? Have I encouraged them to ask questions and use their voices when and where they feel they need to? I don’t ever want a woman to feel silenced while she’s bringing her baby into this world.

We need to understand that women must be extraordinarily supported while giving birth. They are already doing so much! Everything else they perceive during their birth must be supportive, encouraging, respectful, kind and loving. During birth, this window of vulnerability opens wide and it’s our words and actions that will have the most impact. She’ll never forget this day. But what will she remember? Each of us who do this sacred and most important work of birth need to remember that we will continue to live on in her memory and in the retelling of her birth story.

How do you want her to remember you?

If you work with laboring women, does this ring true? Have you ever witnessed, or unfortunately found yourself speaking, words that now you realize to be less than positive or helpful? What words do you use that seem to have a lasting, positive impact?