Why is PAIN a Four-Letter Word?

Pain

I taught a class recently that was a little different. It only meets once and focuses on the brain-body connection, the practice of comfort measures, and how to stay in a coping mindset throughout birth. There’s no discussion about the stages of labor or when to go to the hospital. This class is like “extra” practice for the uninitiated, or in the case of one of the Mommas in this particular class, a “refresher.”

Karen* introduced herself as a “veteran.” She went on to say that she’d chosen to have an unmedicated birth with her first, but it had been “really painful!” She needed more tools to help her cope with labor this time around.

She added quickly, “Don’t worry, ladies. You’ll forget all about the pain.”

Although I appreciated her attempts to not frighten the group of newbies assembled, I’m not sure if I completely agree with her statement. Some women don’t forget the pain of their labors – at least not entirely. And I’m not sure that encouraging women that they’ll forget their pain is necessarily helpful as a preparation technique.

However, her statement did end up being the perfect segue to talking about the “P-word.”

In our culture, pain has become a nasty, four-letter word that we want to avoid at all costs. There’s a thriving multi-billion dollar industry counting on the fact that people want only to take a pill to make their pain, physical or emotional, go away.

When we talk about labor, women don’t want to even think about the pain, let alone focus on it. I’ve found that most women fall into one of three approaches when it comes to labor pain and how to cope with it:

1) “The At-Home, DIY Epidural Kit Approach,” which of course, doesn’t exist. These are women who believe that there is no way they’ll ever be able to get through labor without drugs.

2) “The Grin and Bear It Approach,” which translates to women saying no to drugs, even if it becomes truly unbearable.

3) “The Just Breathe the Right Way Approach” which some women believe will not only allow you to experience birth without the use of pain medications, but also without any pain at all!

None of these approaches sound right to me. All of them have unrealistic expectations built in. And you know, I’m not a fan of unrealistic expectations. So, I’ve come up with my own approach to labor pain and how to cope with it. I’m calling it, “The Why Don’t You Wait and See Approach.”

There is a difference between pain and suffering. Pain is a physical sensation that occurs in the body, most often associated with illness or injury. (In the case of labor, it’s important to note, there is no illness or injury – barring any complications, you are healthy, and labor and birth are normal, biological events.) Suffering represents the emotional reaction to that pain.

In, “The At-Home, DIY Epidural Kit Approach,” too many women decide long before birth ever begins, that they will never be able to handle their contractions without pain medication. Why? Because they’ve bought into Hollywood Birth. Think of the last birth you saw on TV or in a movie. What about that scene would ever make you feel like you could give birth without drugs? Actually, what about that scene would ever make you want to get pregnant?

When women only see this dramatic and intensified Hollywood version of birth, it’s hard to imagine they could ever find labor to be tolerable, let alone something to look forward to. In this mindset, women often start their labors in fear – which actually increases their sensations of pain with each and every contraction. It’s a self-fulfilling prophecy. Making assumptions about your pain tolerance and ability to cope with contractions before labor ever begins is the surest way to undermine your real ability to remain in a coping mindset from start to finish.

But what about “The Grin and Bear It Approach?” Women adopting this approach have equated that they can only have an empowered birth experience if they don’t have any drugs – no matter what. No matter that their labor is extremely long and their baby is in a unfavorable position. No matter that there was a death in the family the same week they’re giving birth. No matter that this labor is kicking their behind and they stopped coping with contractions hours ago. They’re no longer just feeling pain with their contractions, they’ve crossed the line into suffering. These women believe that they’ll feel accomplishment after their births – and are completely shocked when instead they feel overwhelmed and like they were barely hanging on.

Many of the proponents of natural, unmedicated birth talk about enjoying contractions, finding bliss or even having orgasms while giving birth. In “The Just Breathe the Right Way Approach,” women might think they’re doing something wrong when they discover that their birth actually hurts. Maybe it hurts a lot. Talk about disappointment! They thought they’d be blissed out, having orgasms left and right, but that’s not what they’re experiencing at all

(Don’t get me wrong! I’ve actually met two women who did, in fact, have the most massive orgasm of their lives while giving birth! So, it can happen. But when I asked them how they did it, both of them essentially said, “I don’t know. It just sorta happened.” Have you ever gone in search of an orgasm while having sex? It goes into hiding – like witness protection program hiding! This might be one reason why orgasms during birth are not super common.)

We seem hell-bent on trying to avoid pain in labor and I’m not exactly sure why. 

To me, pain and pleasure are two sides of the same coin. We can’t really understand pleasure, if we don’t have something to compare it to. And while I would never classify my contractions as pleasurable, I definitely would describe the breaks in between as pure bliss. I would work hard through each contraction, pushing myself to my own personal limits, and then blessedly, there would be sweet relief on the other side of every single one of them.

It’s true that each contraction grew longer, stronger and closer together. And the breaks in between definitely got shorter. But if I was able to maintain that coping mindset, I knew this meant I was getting closer to holding my baby in my arms.

“The Why Don’t You Wait and See Approach,” allows women to stop preemptively deciding what they’ll be feeling when they go into labor. No one knows what their pain tolerance is for labor, because the pain you feel with contractions is so very different than any other kind of pain you’ve experienced before.

If you’re able to stay in a coping mindset, it’s completely possible that you can get through your entire labor experience without any need for pain medications.

Most likely, you’ll experience at least some level of discomfort in the middle of a contraction. You might describe your contractions as really painful, but tolerable. You might feel like your contractions are too intense for you to continue to handle them on your own. Who knows? You might win the labor lottery and have a big ol’ orgasm!

The point is – you have no idea what to expect. So, stop trying to predict how your labor will unfold and how you’ll respond before you’re ever in labor. Be open. Remain flexible. Wait and see. Then, make your best decision about how to cope with your contractions as they are actually happening, so you can look back on this experience and feel strong, empowered and confident that you participated fully in your birth.

What was your personal approach to your birth experience? Was it spot on from before birth, or did you have to switch gears in the middle of your labor? How does “The Why Don’t You Wait and See Approach” resonate with you? Please leave me a comment. I love to hear from you!

*Not her real name.

Breathing – It’s Not Just for Labor Anymore!

Lung

As a Childbirth Educator, I’m charged with teaching my students about ways they can successfully cope with contractions. This includes all sorts of techniques: position changes, medications, hydrotherapy and the original coping technique: breathing.

Breathing gets a bad rap, as far as I’m concerned. In movies and TV shows, Childbirth Preparation classes are a joke, and breathing is the punchline.

It’s no wonder my students are ready to laugh during this portion of the class. So, I acknowledge how ridiculous it is to “practice” breathing. After all, isn’t it something that we do all the time without thinking about it? Breath goes in and out without a lot of thought because it’s an essential function necessary to stay alive. So, why do we even need to teach laboring women (and more importantly, their partners) how to breathe?

Because at some point in the process of giving birth the intensity of the contractions is usually strong enough to take your breath away – at least momentarily.

When we stub our toe in the middle of the night, we don’t continue to breathe in a slow and controlled way. No, we usually jump onto the foot that’s not hurt, grab the toe that is, and hold our breath while letting a few choice four-letter words escape in between short gasps for air. This won’t make us feel any better, but it’s something that almost every person does unconsciously when we’re in pain.

Why does this matter when we’re in labor?

At the time we give birth, the largest muscle in the entire body will be the uterus. The uterus is made of smooth muscle tissue – the same type of tissue that lines other organs like the esophagus and stomach. These muscular organs are “pre-programmed” to do their jobs. These organs just do what they’re supposed to do.

If you’re following along, dear reader, than maybe you’ve already figured out that the uterus is also a “pre-programmed” muscular organ that knows what it’s supposed to do, too. But it needs two very important things in order to do it’s job well: blood flow and oxygen. Without these two essential items, the uterus will still attempt to do it’s job of thinning and opening the cervix and then later, pushing the baby down and through the birth canal – but it won’t be able to do it very well.

When we feel a contraction come on and the intensity is climbing, if we hold our breath (which is the typical and most natural response) not only are we starving the largest muscle in our body of the essential ingredients necessary to be successful in it’s job, but we also lessen the amount of oxygen that gets to our baby in utero. And, we do absolutely nothing to address the pain of our contractions – in fact, holding our breath during contractions is likely to increase the sensation of pain.

So holding our breath during labor is a lose-lose-lose situation.

When I’m teaching this topic to my students it’s super important that I have their full buy-in right from the start. If I don’t, then focused breathing won’t be something that they’ll use in labor. They won’t find it to be helpful at all in coping with their contractions. So how do I encourage buy-in?

I tell them a few true stories pulled from my own life that have absolutely nothing to do with labor to show them how breathing made the experience tolerable and increased my ability to cope. And I make sure to show how breathing can be used to help with challenging situations, be they physical or emotional.

Situation I: A is for Avocado, B is for Breathing and C is for Coping

I had an unfortunate incident with an avocado a couple of years back. When you’ve heard people say, “Never pit an avocado with a knife while holding it in your hand” – listen to them. It’s a very bad idea. And one that cost me six stitches in my middle finger. I ended up at the ER.  And after the initial lidocaine pinch, the nurse started to sew me up. But this was a pretty deep wound and I was still in quite a bit of pain. I asked her to please stop (or, I might have just yelled, “STOP!” at the top of my lungs – the details are unimportant), and then closed my eyes and started to breathe deeply. After my rhythm was established, maybe 4-5 breaths in, I told her she could continue, which she did. And while I was still able to feel some discomfort, I wouldn’t have described it as “pain.”

My nurse was impressed with my coping technique and asked me what I was doing. “Labor breathing,” I replied. “If it doesn’t work in situations like this, I have no business teaching it to my students. It’s a waste of my time and their money.”

Situation II: Houston, We Have a Problem!

Back in the day, I used to love it when there was turbulence during a flight. It was one of my favorite things in the world! I felt like I was on a roller coaster!

But then I had to make not one, but two emergency landings (flying through the Midwest on a Summer afternoon can result in this, I’ve found…) and the thrill was gone. Now, whenever I fly and we hit a patch of bumpy weather, I feel my blood pressure rise by at least twenty points and my heart feels as if it’s permanently lodged in my throat. I have to use deep, slow breathing to calm my brain so that my body receives the message: “Everything is going to be okay.”

It’s amazing to witness how much my brain controls my body! But even more amazing is how the simple act of focused breathing positively impacts that brain-body connection. When I breathe in this way, it’s almost as if I’m able to see my body move away from the stress response right back into the relaxation response. I am able to control, quite well, my “Fight or Flight” response – just by using my breath to my advantage.

On our most recent family vacation, our flight was delayed for 2 1/2 hours do to a big afternoon thunderstorm in Florida. When we finally got cleared to fly, I was already anxious because while the storm had moved off and we weren’t going to be flying directly into it, I knew we’d be hitting some pretty bad turbulence as we passed through the big, dark layer of clouds ahead of us.

When the captain came on to tell us it would be “a little bumpy” for the next 30 minutes or so, my anxiety started to climb and that old familiar feeling of “Fight or Flight” started to kick in.

Both sides of the family live 3,000+ miles away. We will always have to fly to visit our extended family. And I am unwilling to pass along the fear of flying to my children.

So when turbulence begins, for the sake of my children, I automatically close my eyes and try to appear as though I’m only resting. I breathe slowly and deeply, in and out through my nose, paying attention only to the rhythm of “In, 1-2-3-4 and Out, 1-2-3-4.” And on this last trip, this seemed to be working just fine.

Until the plane took a sudden lurch to one side, and my rhythm got interrupted. I could feel my blood pressure rise and my pulse quicken. So, then I tried a new angle – “What if I add a little mantra to the mix? Just to see if I can get the gremlins that are running around my head screaming, ‘This plane is going to fall out of the sky!’ to shut up?”

So, along with my deep, slow breathing I began to repeat over and over again one little word: calm. And with that, I felt everything that had gone up begin to come back down again.

My pulse slowed, my heart left my throat and returned to my chest, my blood pressure was no longer so strong that I could feel it pounding in my veins. And then, amazingly, despite another 25 minutes or so of pretty heavy bouncing around, I felt myself almost fall asleep! (I will never actually sleep on a plane. The other 250+ passengers on board don’t realize that it’s me staying awake that’s keeping the plane in the sky. Irrational, I know, but that’s what I believe.) The gremlins in my head were finally snoring softly and the bumps on the plane began to feel no more worrisome to me then bumps you would feel in a car on a long road trip.

While I doubt I will ever love turbulence again – that would be a pretty big stretch for me – I love being able to find real-life situations where I can see the tangible benefits of breathing and how it can help both my mind and body.

I encourage you to explore this idea on your own. The next time you’re feeling anxious, afraid, stressed – see if deep, slow, focused breathing can help you in the same way it does for me. If you’re able to see the day-to-day benefits of breathing in your everyday life, then “Breathing as Labor Coping Technique” starts to feel like something that might actually work during birth.

Besides, you’ll want to master this technique for parenting. Deep, slow breathing is a lifesaver for many new parents as they’re negotiating their “new normal.”

Breathing – it might not be just for labor anymore, but it’s still one of the best things you can count on for coping with emotional stress or physical pain.

Did you use breathing as a labor coping technique? Did it work for you? If it didn’t, would you say it was because the physical pain became too intense, or was it that emotionally you were no longer able to get the gremlins in your mind to shut up? If it did, do you share this technique with expectant parents? You should, it can make a difference!

Making Predictions During Birth – About as Magic as the 8 Ball!

Magic 8 Ball

Did you ever have a Magic 8 Ball? I did. I loved that thing. I loved being able to ask a question, any question, and have the almighty oracle predict my fate. Inside the little window floated a single die, with twenty possible answers to life’s biggest questions. Some of which included: “Signs point to yes” and “My sources say no.” When the Magic 8 Ball was certain, yes or no, then that was it. But sometimes there would be the confounding response of “Cannot predict now.” That always meant another hard shake of the ball and the search for a more straight forward answer. No matter how many times it took to get one!

I think too many of us are looking for straight forward answers to one of the biggest questions of all time. We want so badly to be able to predict what is by it’s very nature unpredictable – birth.

Today, I want to speak directly to those of us who work with pregnant and birthing couples.

Could you stop setting them up? Stop making predictions? Please, I’m begging you!

I recently had a reunion with some of my families. More than once I heard the report that someone on their birth team tried to make a prediction during their birth experience. I groaned and asked, “Why do they do that?”

One new Momma said, “so then, the nurse said to me “You’re really cooking! I bet we’ll have a baby before lunch!”

A second Momma said “the doctor came in and told me to get ready for a really long night, because he didn’t think I was going to have the baby until the next afternoon!”

Guess what really happened with these two women?

The first Momma’s labor came to a complete standstill about thirty minutes after her nurse had predicted a late morning baby. She started watching the clock and when the lunch hour came and went unceremoniously, no baby to be found even considering entering her birth canal, she became despondent and discouraged. She started to freak out that something was wrong with her body – with her baby. Given the strong connection between the mind and the body of a birthing woman, it’s no wonder all of this extra anxiety shut her body down for hours! It took an incredibly long time (and a new nurse at shift change!) before this woman’s labor started moving again. She ended up giving birth close to midnight – twelve hours longer than had been “predicted.”

The second Momma and her partner settled in for their “really long night.” But soon after she started second guessing her ability to handle the contractions that felt like they were right on top of one another. Instead of recognizing that her labor had kicked in big time and she was almost fully dilated, she thought that she was “just wimping out.” She was feeling very disappointed in herself and her ability to cope with what she’d been told by her provider was supposed to be early labor. Imagine the surprise when her husband had to run out of the room to grab someone to come catch the baby! It had only been about ninety minutes since she was last checked. So much for their marathon labor!

Birth is unpredictable. It can slow down, and appear as though it’s stopped altogether. It can speed up in the blink of an eye. The issue is not the unpredictable nature of birth, it’s our intense desire to make it predictable that’s the problem! There are way too many unique variables in every labor experience to make it impossible to predict consistently what will actually occur.

But we all still do it! Why?

Pregnant Mommas and their partners hear the due date and create an expectation that this is the day the baby will arrive, instead of recognizing their due month as closer to the reality of when the baby will actually be born.

As a Childbirth Educator, I’m guilty of it as well. I teach, as most do, textbook averages for birth. But do I explain that as a first time Momma, it’s completely within the range of normal to have a birth go super fast? Do I adequately prepare them for an ultra marathon labor experience? We all need to be more on top of this, so our students understand it is possible to have active labor begin almost immediately! And it’s also possible to be in early labor for three days before any changes in their cervix occur. As Childbirth Educators we need to provide our students with realistic expectations of the unpredictable nature of the birth process itself.

But once they’re at the hospital, too many nurses and providers think they’re doing a service for these women when they try to predict what will happen next. I know that this is not born of ignorance. These are professionals who have been at this job for a long time – decades in some cases – and they’ve seen an awful lot. The laboring woman in front of them is presenting as many have before her. The mind just wants to go there. “Here’s a pattern that I’ve seen before. So I’m going to predict what will happen next.” And in a lot of other areas of life, this might not be a bad policy. But not when we’re talking about birth.

This unpredictability of birth (and our refusal to embrace it) is what trips all of us up when it doesn’t have to. In fact, I would argue that we’re missing out on the most important aspect of birth while we’re busy trying to predict what will happen next.

As expectant couples, you go into birth with a rock solid Birth Plan that you wrote a month before your first contraction. But due to circumstances you could never have predicted, your birth has gone rogue. If you’re still clinging to the plan of your ideal birth (as opposed to participating in your real birth) you’re setting yourself up for disappointment instead of moving through your birth as it unfolds. When you’re able to adopt this attitude of flexibility, you’ll be surprised at what you’re really capable of! “Wow, this is not at all what I expected, but look at us and how we’re handling this completely unpredictable experience together!” It matters how you respond to your birth in real time, as it really happens. Not based on what you had predicted (hoped, wished, or expected) would happen.

As Childbirth Educators and Doulas, we are hurting ourselves and our couples when we try to make predictions about how we think our couples will move through their births. Let’s not prejudge how the people we work with will cope with their labors. Let’s give them all the benefit of the doubt in that they will have births that are, by nature, unpredictable. Let’s try our best to prepare them better for that reality.

As for the L&D nurses and providers who encounter these women in labor and try to make predictions about what will happen next, please understand how much that undermines a woman’s confidence in her ability to know her own body. For the woman before you, it doesn’t matter one little bit how many times you may have witnessed what she’s currently experiencing. She doesn’t need predictions from you about how much shorter or longer her birth might be. She just needs your support and your listening ear – right now. Even the least experienced laboring woman will be able to provide you with clues about what is actually happening in her body. And this is so much more valuable than what you think might be happening in her body.

I completely understand why we do this whole thing of planning and discussing averages and making predictions – all of us are wanting to avoid vulnerability. But vulnerability and birth are inseparable. They have to be. Birth without vulnerability lacks the key ingredient that’s necessary for deep and lasting transformation to occur.

All of us who work in this field should be experiencing that transformation on a regular basis. That’s why most of us got into this whole thing in the first place – the beauty, the mystery, the surprise, the unpredictable nature of birth stirs something in our soul. After each encounter, we should leave that new family feeling grateful we were once again able to witness their transformation – and be transformed ourselves at the same time. This is how we can continue to best serve our families, when we recognize the sacredness of our own work with them and strive to preserve that sacredness for our families no matter how unpredictable their birth ends up being.

There is magic in birth – it’s just not of the 8 Ball variety.

Experienced parents: Did you try and make predictions about your pregnancy, birth or parenting? Did any of them come true? Did anyone on your birth team try to make a prediction about your birth? How did his make you feel?

Due Date – How About Due Month?

CalendarOne of the first things that every pregnant couple needs to let go of as soon as possible is the expectation of having their baby be born on a specific day. This is just not something you can count on. When you, your provider, or an internet application attempts to calculate your due date some very big assumptions are being made.

First, that you know the exact date of your LMP – or last menstrual period. You find that date by using the first day you began bleeding on your last menstrual period. Some women will know this without question. They’ve been trying to get pregnant, or may even be using IVF or other means of getting pregnant that really require a heavy amount of tracking in order for conception to take place within a certain timeframe. But, remember the window for conception is a little bit bigger than you think! You can get pregnant any time from about 5 days before ovulation occurs right up to the actual day of ovulation. So knowing exactly when you conceived your little bundle of joy might not be as predictable as you think. And then don’t forget all the other women who, quite honestly, have no idea what their LMP is! “Umm… I think it was the 15th. Maybe?!”

The second assumption is that you have a 28-day menstrual cycle. Some of us do – but only about 10-15%. The rest have cycles that can vary anywhere from 21-35 days in length. And then even that number can vary from month to month. Life events, varying degrees of stress or illness can mean that the number of days between periods fluctuates and doesn’t always remain consistent or regular.

But what if we use ultrasound to determine the almighty due date? How accurate is that?

Well, it ends up being slightly more accurate than using the LMP calculation, but it’s not perfect, either! According to this great article from Evidence Based Birth and Rebecca Dekker, there’s an optimal time to receive an ultrasound to determine gestational age, and that range is between 11-14 weeks. The most common time for a woman to receive an ultrasound, however, is somewhere between 16-20 weeks. The study referenced here showed a significant decline in accuracy happening at that 20 week mark. And 3rd trimester ultrasounds are even less accurate than earlier ultrasounds and LMP. But even if a woman has an ultrasound at the optimal range of 11-14 weeks, this study found that about 68% of women gave birth + or – 11 days of their estimated due date via ultrasound! If you were a betting person, these are not good odds for putting any amount of money down that a baby will be born on a specific day

Calculating a due date can be helpful, I guess. It allows your provider to have a guide by which to measure the growth and development of your baby in relation to your gestation. And it also allows Mommas and partners to have some idea of when pregnancy will finally be over! And it is a helpful planning tool! It lets friends know when they should send out invites to the baby shower, and it allows the Grandmas to figure out when they should be flying out to help after baby is born. It’s helpful. It is. 

But, unfortunately, by the time I see couples in my classes this due date has long been cemented in their minds as “The Day The Baby Will Be Born.” As if any other date will be off somehow. In reality, less than 10% of babies arrive on their actual due date. Some studies place this number even closer to 5%.

You’re actually considered “due” for about 2 weeks before that due date and about 2 weeks after that due date. So, it would be wise for you to start considering your due month, rather than your due date. Why is this so important? 

The exact trigger for spontaneous labor is not really well understood. But it’s widely regarded that there’s a complex interaction between the baby and the Momma that causes the uterus to begin contracting and labor to start.

Some ideas that have persisted over time include the following: a significant shift in the estrogen/progesterone ratio prior to labor beginning. When estrogen levels increase toward the end of pregnancy, it increases the levels of prostaglandin production which is known to assist in the ripening of the cervix. These heightened levels also increase the number of oxytocin receptors that exist on the uterus, as well as increase the contractility of the uterus overall. The baby’s adrenal glands and pituitary glands may actually play a significant role in controlling the timing of labor. The fetal production of the hormone cortisol can lead to increased levels of prostaglandin, as well increase the maturation of their lungs which in some way might trigger that babies are ready to be born.

In “normal person speak,” the hormones of the Momma and her baby play an important role together in signaling the start of labor. If and when it is possible, we should honor this natural, normal and physiological start to labor. It benefits both Mommas and babies – not just in pregnancy and birth, but also in their immediate postpartum experience. 

Women who get very attached to their due date as the day their baby will arrive have a couple of potential issues from the get-go. If the baby comes anytime in those two weeks prior to the due date, couples can find themselves either caught completely off-guard or risk feeling and acting as though they have had a pre-term birth. This, in turn, might cause them to parent with unnecessary caution, concern or added anxiety, when in fact – their baby was born term, just a little bit before the estimated due date. 

Women who deliver on the other side of their due date, women who are already sick of being pregnant, face an even bigger challenge in my opinion. Because, let’s face it, at 38 weeks gestation most pregnant women repeat this mantra daily, “Get it out of me – now!” They start counting not only the days they go past their due date, but the hours, and then the minutes and then the seconds… It’s a slow and painful kind of self-inflicted torture.

It’d be great if much earlier in pregnancy, a couple could realize the futility of trying to determine the actual date that the baby will be born and instead focus on the due month

So try this little exercise…

Your estimated due date as determined by LMP, ultrasound or what your provider has told you is: (A)_____. The date on the calendar 14 days before this due date is: (B)_____. The date on the calendar 14 days after this due date is: (C)_____. Now you know the approximate timeline in which your baby will make their arrival, their due month.

Begin to look at your calendar in this new way. Tell everyone you know that you now understand that your baby will arrive sometime between dates B & C. Get a marker and highlight those dates on the calendar if it will help you to get rid of the idea that your baby will come on a certain and particular day. It is, and has always been, only an estimate.

And that is something you can count on.

Experienced Parents Please Share: When you were pregnant, how invested were you in your due date? Did your baby actually arrive on that date? Was your baby “early” or “late”? What would you have done differently if you’d considered your due month instead of a particular date?

Rethinking Early Labor Series: PART III

Re-Think IIIn my last two posts, I discussed how laboring women and their partners are being encouraged to stay at home and away from the hospital for most, if not all, of their early labor. But the definition of early labor has changed. It is now believed that a woman is still in early labor until she reaches about 6 cm dilation. This means most women will be at home working for longer periods of time through the early phase of labor. It’s not enough to encourage women to stay home. We also need to provide some ideas about how to stay home and continue to cope with contractions of early labor without anxiety settling in. This is the final post in my three-part series, “Top 10 Things to Consider in Early Labor.” Here are the last 5 ideas from that list.

6) Clear your day. If either of you had been planning on being at work the morning that labor begins, call in and let one trusted person know that you might be in early labor. Ask them please to not tell the entire office your news as it might prove to be super early labor, or maybe just a good bout of practice labor  – and you don’t want to have to field a ton of phone calls, emails or texts from your excited co-workers.

7) Plan a date. This is the one thing that I get the most heat for encouraging people to consider, but I swear it helps you get your mind in the right place for the start of your labor experience. Most first-time Mommas have loads of time between when labor begins and when they reach active labor. And if you have something to look forward to as labor begins, you’re more likely to enter into early labor with a more positive attitude. This can definitely impact how well you’re able to handle your early labor. This labor day date doesn’t have to be anything special, but there should be some actual direction to it, a potential theme. I’m not sure it’s enough to say, “We’re going to watch a bunch of movies” or “We’re going to play board games.” Which movies do you want to watch? (Make sure they’re pretty emotionally charged – those that are can help boost your oxytocin levels by up to 47%!) Get out the board games and lay down a challenge. Card games that can go on forever are really great because they can be left hanging if your labor should pick up speed. If the weather is nice, plan a picnic lunch. If it’s not, picnic on your living room floor. Go for a walk – just make sure that you pass by your car every 1/4 mile or so in case labor changes dramatically. You don’t want to have to walk 5 miles back to your car with really challenging contractions if labor moves from early into the active phase while you’re out and about. This date should be focused on distraction and enjoyment. This is the last time you’ll be able to go out as a twosome without the baby or without paying for a babysitter. Don’t waste this opportunity. 

8) Consider hiring a doula. (This actually could have been #1 on my list of things to consider if I were rating them, but I wrote this list more chronologically in terms of what to consider as labor progresses.) Having a doula who is yours and yours alone ready to take your phone calls or texts in early labor or even stop by your house to check in with you can really make a difference in your continued ability to progress in early labor at home and away from the hospital. A doula’s expertise about what labor looks, sounds and feels like for most women will mean that she can normalize what you’re experiencing. She can also suggest comfort measures that can help you continue to cope and remain comfortable in your home for longer. When I’ve asked new parents from my classes what advice they would offer to expectant couples, they usually say, “Tell them to stay at home for as long as possible!” Having a doula to check in with might allow you to do just that. And doulas only get better as labor progresses! If a doula is not possible for any reason, who else can you check in with during this long and sometimes frustrating early phase of labor? What does your provider have to say about contacting them in early labor? If you contact the hospital looking for guidance they will often either refer you back to your individual provider – or tell you to come in to be checked. This defeats the entire purpose of trying to stay home in early labor. An unnecessary trip into the hospital is a real bummer and can start you down a path you might be trying to avoid. Do you have a friend or family member that’s given birth before that you might be able to touch base with for reassurance that you’re moving in the right direction even if it feels long and slow-going? Enlist their help to be that touchstone for either you or your partner during this early part of labor. Remember, reassurance is key during this early phase.

9) Use those comfort and coping techniques that you learned about in an evidence-based childbirth preparation class.  Initially, you might find that focused and intentional breathing are all that you need to get through the peaks of contractions. But don’t forget to think about using different positions, sitting on the birth ball, getting into the shower, vocalizing, looking at a focal point, enjoying lots of massages, using rhythmic movements and getting plenty of encouragement from your birth team members as ways to help you continue to move through your early phase of labor and into the more active phase. Understand that you will need to do some of the hard work of labor before any medication will be a realistic option for you. Pay attention to this section during your classes, even if you are “planning on the epidural.” You’ll need to use some of these techniques at the end of early labor while you’re still at home, for sure while you’re making your way into the hospital and definitely when you first arrive as you move into active labor.

10) Wait until your contraction pattern gets to at least 5-1-1, maybe even 4-1-1, before you head into the hospital. What does this mean? You want to wait until you have a labor pattern where contractions are 5 or 4 minutes apart when measured from the beginning of one contraction to the beginning of the next contraction, each individual contraction is 1 minute long, and this has been happening for at least 1 hour. In addition to this, your contractions should be strong enough that during the peak of each one, you are unable to walk, talk or smile. You are all business and your full concentration is on getting through each contraction. When this is the case, you’ll be working hard and that means that you’re moving through early labor and into active labor. This is the perfect time to come to the hospital or birthing center as any distractions there will have less power to negatively impact your labor progress.

How long will all of this take – this early labor? For most women, it will be the bulk of their labor overall. If you had a 24 hour labor, you could expect  maybe16 hours of it to be in early labor! For the majority of women, they should expect to be laboring at home for about 2/3 of their overall labor. (This is, of course, based on averages of labor and your situation would be contingent on so many different things that makes this just an example. You could be at home shorter or longer than this and all would be in the realm of “normal.”)

I feel very strongly that it’s not enough to encourage women to “stay at home as long as possible” without providing some real tools about how to do just that. We have been fed a cultural construct about birth that makes it seem impossible that we could be in early labor walking around the neighborhood, going out for a bite to eat – passing the time of these short and do-able contractions without it being a huge, dramatic experience. Women need to have more confidence in their bodies and their ability to judge for themselves whether or not they are in labor. Too often they feel they need to have someone else tell them they’re in early labor for it to be “official.”

Coming to the hospital and being told to go home can be devastating for a woman, not just because it’s an unnecessary and uncomfortable car ride, but because it makes her second guess her ability to make the call and determine what “real labor” looks like. Providing women with the “Top 10 Things To Consider In Early Labor” is my contribution to helping women feel like they can cope with early labor and feel prepared to stay home as long as possible to progress in their labor and reduce their risk for unnecessary interventions, medications and Cesarean Birth.

I’ve never had a woman come through my class saying, “I can’t wait for all those interventions – bring ‘em on!” Most are wanting to avoid all of them if possible. Waiting through the early phase of labor before coming to the hospital or birthing center is an great way to start their individual birth story.

How can we, as Childbirth Educators and new parents get the word out about rethinking early labor? What other practical ideas do you think should be added to my “Top 10 Things to Consider in Early Labor?” I’d love to offer as many tips as possible for my expectant families, please feel free to share your own ideas in the comments.

Rethinking Early Labor Series: PART II

 Re-Think III

In my last post, I identified that laboring women and their partners are being encouraged to stay at home and away from the hospital in early labor. But the definition of early labor has changed. It’s now widely believed that a laboring woman needs to get to about 6 cm dilation before active labor has begun. With this change in definition comes a longer amount of time working through contractions at home in early labor. In my opinion, it’s not enough to just encourage women to stay at home for longer periods of time. They need some concrete ideas on how to normalize early labor and pass the time together without added anxiety. To that end, I offer my “Top 10 Things to Consider in Early Labor.” For this post, I’ve listed the first 5 things to consider.

1) If labor contractions wake you from sleep, stay in bed. If these contractions are real-deal, then you won’t really be able to sleep through them, maybe more like rest. But once you realize that you can comfortably have a contraction while lying down, then you should do just that. The bigger question is, do you wake your sleeping partner yet? Some women will say, “Absolutely!” and others will say,”No way!” Check in with your partner to make sure that if they’re wanting to be awakened at the first sign of labor that you honor those wishes. Just make sure that they’re on board with the “stay in bed” regimen first. No need to get up and bust a move until your body requires you to do so.

2) Get busy. Yep, that’s exactly what I’m talking about. A little nipple stimulation, or better yet, great sex can have fantastic results in helping your body continue to move forward in labor. I say great sex, because it’s the combined efforts of prostaglandins found in semen acting to ripen your cervix plus the release of oxytocin when you orgasm that can contribute positively to getting the party started. As long as your water hasn’t broken, there should be no concern in using this technique to help move things along. What a great, connected way to begin labor together! Plus – it might be a while on the other side of baby’s arrival before you’ll be ready to go there again, so you should definitely take advantage while you can!

3) Once you’ve gotten out of bed, drink a big glass of water and go pee. These three things – changing position, drinking a big glass of water and peeing – will give you needed information about whether or not this is the start of early labor or just your irritable uterus talking. Real-deal contractions will continue no matter what position you’re in and if you change the status of your bladder (which, so conveniently sits beneath your uterus) it can help you figure out whether or not this is the start of early labor. If after changing position, drinking a big glass of water and peeing you’re still having contractions that seem fairly regular, you could choose to check in with your provider and let them know you think you might be in the early phase of labor. You could always wait to check in too, but sometimes touching base with your provider helps calm any nerves you might have as labor is just beginning.

4) Eat something. I don’t care what it is and, really, neither should you. At this point in your labor, eat whatever sounds good to you and something that you wouldn’t mind seeing again later in labor (if you get my meaning). Nothing super heavy or spicy or greasy – but other than that, fuel your body. It will be doing a lot of hard work today and you want to make sure it has what it needs to help you get through. Eating in labor should never be denied to you, but it’s important to note that many hospitals have a clear liquids only policy when a woman is laboring in the hospital. One more reason to stay at home when things are just getting started. It’s super challenging to try and give birth to a baby when you’re starving! Eat at home until your body tells you, “No more food, thank you – I’m all done.” This usually won’t happen until you’re farther along in active labor.

5) Take a shower and get ready for the day. Most of us would like to head in to this experience of giving birth looking and feeling as good as possible. So at the very least, a shower is a great way to start. Some women will go into this experience au natural, and others will want to have their hair and makeup done before the harder work of labor begins. I’ve even known some women who’ve had their partners give them a little mani-pedi to help pass the time (often with hilarious results!) There’s no right or wrong to this one. It’s most important that you feel good about yourself as labor is just beginning. Also, any amount of time a you take to get yourself together while contractions are still manageable allows time to pass more quickly – always a plus.

These are only the first 5 on my list of “Top 10 Things to Consider in Early Labor.”

As you can see, they focus on the practical.

I believe much of the rush into the hospital happens as a result of what women are fed about birth from seeing it portrayed on TV and movies from when they were just little girls. It’s hard to get your head wrapped around the idea that birth is normal. That for most women, it starts out slow and stays at a slow and steady pace for a good, long while. It’s hard for a pregnant woman to imagine that she might actually maintain normal activities for most of her early labor. It’s hard for her partner to let go of the idea that they won’t be racing into the hospital at break-neck speed!

But there are real reasons to encourage laboring Mommas to stay at home for as long as possible in early labor: they’ll feel more comfortable in their own homes, wearing their own clothes, eating their own food, stepping in and out of their own shower… If we can normalize and recreate a picture of early labor as something do-able for most women and provide some thoughts on how to help pass the time of early labor at home with as little anxiety as possible, then she can move through early labor feeling confident. Confident in her ability to recognize when she should be heading into the hospital, and confident in knowing that she’s lowered her risk of unnecessary interventions, medications and Cesarean Birth.

My next post will be about the remaining 5 on my list of “Top 10 things to Consider in Early Labor.”

Rethinking Early Labor Series: PART I

Re-Think I

In doing some research for my book, just recently I read an article entitled, “What is women’s experience of being at home in early labour?” This article cites that there were four main reasons women came into the hospital “too soon” despite knowing that there was no need to arrive before active labor was well established: Reassurance, Uncertainty, Pressure from Others, and Permission. This article made me want to write a blog post (which has now ended up being a 3-part series!) about re-thinking early labor. I’m interested in how we, as Childbirth Educators, can do a better job at preparing our couples for the realities of early labor. Later in the series I offer concrete things to consider in helping women and their partners pass the time of early labor and stay at home longer. This is one of the most effective ways to avoid unnecessary interventions, medications and Cesarean Birth. 

First, a definition: Early labor, also known as the “latent phase” is so named because you’re not yet in active labor. This phase is most commonly the longest part of a woman’s labor experience and can easily take up 2/3 of the entire process over all. For over 60 years, we used Friedman’s Curve to describe early labor as moving from 0 cm dilation to 4 cm dilation. In very recent history, this curve has been under increased scrutiny and it’s now more widely believed that active labor does not really begin until a woman has reached 6 cm dilation.

This distinction between onset of active labor changing from 4 cm to 6 cm dilation is important. What this small shift in definition implies for today’s providers is that they should be willing to wait awhile before making the proclamation that a laboring woman who is taking longer to dilate has “failure to progress.” Hopefully this will translate to a more “wait and see” approach rather than moving too quickly to medications, interventions or surgery for the delivery of her baby.

But the implications for today’s laboring Mommas is also significant because this means that she will likely be working longer and harder at home in the early phase of labor before coming into the hospital.

As a Childbirth Educator, I have the specific challenge of encouraging the students in my classes to stay at home for potentially much longer periods of time when they (or their partners) might have great anxiety about doing this. How do we help a woman increase her chances of avoiding unnecessary interventions, medication and Cesarean Birth, but also address the level of anxiety that she (or her partner) might feel about continuing to cope through early labor at home?

First, reassuring every woman that her body is amazing and completely capable of giving birth to her baby should be a top priority. Too many of today’s pregnant women lack that celebration of their bodies and instead of feeling beautiful, strong and capable – they often feel insecure, disconnected and unsure of themselves. First time Mommas especially tend to feel like everything that happens to their bodies while pregnant is so foreign and strange that it’s hard to believe that any of it is normal. Any amount of information we can provide a woman about her body that reinforces how she is exquisitely made for the process of giving birth should be addressed early on in our classes.

The normal progression of labor should be presented in a way that boosts a woman’s confidence. Great care should be taken to explain what early labor really looks, sounds and feels like for the majority of women so they can begin to release the cultural construct that says labor is unbearable from start to finish. Women need help realizing that the depiction of birth they see repeated over and over again in movies and TV shows is done purely for dramatic or comedic effect. In reality, most first time Mommas can expect a slow and steady marathon pace of labor rather than a mad dash to the finish line. This information can help them realize that when early labor begins (after their initial moment of freak-out) they should settle in for what will most likely be a long wait until it’s time to come to the hospital or birth center.

Okay – so, maybe they’ve bought into this idea of waiting until their contractions get to a pattern of 5-1-1, or even 4-1-1, before making the move toward the hospital or birth center. They’ve read the articles that tell them that their chances of having unnecessary interventions and medications go up if they come to the hospital too soon. They don’t want to come in only to be sent home again. They get it.

But how do they manage to stay at home when labor drags on and on? If their water hasn’t broken yet (and for the majority of women this will be the case. Their water won’t break until they’re in active labor or actually pushing their baby out), how will a woman know definitively that she’s in labor and then feel like she has what she needs to pass the time of early labor at home? How can she do this in a way that progresses her labor and doesn’t make her crazy with anxiety? 

That’s where Childbirth Educators come in – we have to convince Mommas, and their partners, that it makes sense for them to stay at home for all, or at least, the majority of their early phase of labor. But – we have to provide them with real and concrete ways to do this.

In my next post, I will share with you the first five ways we can do that from my “Top 10 Things to Consider in Early Labor”.