Happy World Doula Week!

WDW

I can’t let this week go by without a shout-out to all of the wonderful women I know personally, and professionally, who’ve taken up the call to become a doula. A doula is a woman trained to assist other women in childbirth and/or to support a new family following the birth of their baby. And this is the week we are celebrating women all over the globe who do this incredible work!

Over 20 years ago, I was working as a temporary office monkey between jobs and wondering what it was that I wanted to do with the rest of my life. Across my desk one day came the company’s monthly newsletter and on the front page was an article about “doulas.” I’d never heard of this word before, and the concept intrigued me.

A few days later as I drove home during my lunch hour, there was a story about doulas on NPR’s show, “Talk of The Nation.” I had a “driveway moment” and couldn’t get out of the car until the story was over. My curiosity was growing. 

But it wasn’t until my best friend announced her pregnancy and asked me to be at the birth that I got serious about this idea: “Maybe I should become a doula!” I’m not an overly woo-woo person, but all of these things seemed to be pointing me in the direction of birth.

After some searching, I found out that The Seattle Midwifery School (300 miles North of my home in Portland) was offering a doula training that would conclude before my friend’s due date. Everything seemed to be lining up – so I signed up. I was hooked on birth immediately, and the rest, as they say, is history.

I never went so far as to complete the work of being certified as a doula. Finding scheduled evening and weekend hours as a Childbirth Educator kept me in the world of birth and allowed me to focus on having my own family. But every now and again, I’ve had the honor of being a doula at the births of friends, neighbors, or women who had no support or financial ability to pay for a doula.

It is such a gift to be with a woman when she’s giving birth. Helping her find her inner strength and witnessing the parents and the baby lock eyes on one another for the first time – it’s one of the most awesome experiences ever (that word is so overused in our culture, but this is one area where it’s completely appropriate)!

So,thank you to all of the women who’ve answered the call to become doulas. You are very special women, indeed. You have an immense capacity for nurturance, calm, strength and advocacy. You’ve got incredible stores of flexibility, skills and knowledge and you’re somehow able to continue to do the hard work of labor support on little sleep and not a lot of food. You are the best example of how continuous physical and emotional support can make all the difference as this couple transforms into a family.

I have nothing but the utmost respect and praise for the work that doulas do in the world of birth. But don’t just take my word for it. Google “benefits of doulas” and you’ll get 359K hits in about a half of a second. There aren’t any studies that I know of that show anything other than positive results of having a doula with you in birth. If you’d like to read more about the benefits of doulas, read this article written by Rebecca Dekker on Evidence Based Birth.

Having a doula at your birth can be linked to:

  •  Reducing the incidence of c-sections      
  •  Shortening the length of labor      
  •  Reducing epidural and analgesic requests      
  •  Increasing breastfeeding initiation and continuation     
  •  Increasing mother’s satisfaction of birth experience      
  •  Reducing the incidence of postpartum mood disorders     
  •  Increasing new parents’ confidence in the care of their newborn

There’s really no downside to having a doula with you in birth or postpartum! A doula is worth her weight in gold. If you’re interested in finding a doula for your birth or for postpartum, one place you can look is the DONA International website. Other places to look would be your friends and co-workers. A lot has changed in 20 years! Many more women are using doulas in their birth and postpartum and personal recommendations can give you so much more than a website directory! Many CBEs also have referrals they can provide, if you ask.

My tips for hiring a doula: Don’t get stuck on how many births they’ve attended, or what “extras” they might provide (photography, massage, etc.) These might be wonderful additions, but I think it’s more important you feel you can hang out with this person for 24+ hours. A professional doula won’t have an agenda for what your birth “should” look like. She’ll be willing to support you, and your choices in birth. Make sure your doula and your partner can work together. If you’ve chosen well, your doula will help your partner feel like they had just the right support so they could be involved in the birth at the level they were most comfortable with.

Doulas can be an amazing support when a birth goes really well, but even more so they when a birth goes rogue. Your doula can help you remember what matters most to you in this birth experience and help you get as close to that as possible. On the other side of giving birth, you’ll share a bond with this woman forever and she’ll be an important part of the birth story you’ll remember for the rest of your life.

Doulas are amazing women and I’m happy to publicly honor them in this way! A special shout-out to Liesl & Kathie (doulas) and Beth & Marilyn (midwives) for all of the doula-ing they provided me and my husband during the birth of our four children. I mean this honestly when I say it – we couldn’t have done it without them!

If you know a doula, please take time to honor them in some special way this week!

ZUMBA!

Zumba

I arrived at my class this evening ready to teach. It had been awhile since I was last at this location, and with the recent “ice storm” I left early not knowing what traffic would be like at rush hour. It wasn’t that bad and I was happy to clock in right on time to start prepping my classroom.

This particular class meets in a conference room in a clinic. It isn’t the best set-up for a Childbirth Education class, to be honest. The space is a little on the small side, it can get really warm, and the lighting is either ALL ON or ALL OFF.

So to get around these drawbacks the class size is limited to eight couples only and more recently, a table lamp has been purchased. In my opinion, it’s all worth it if it makes life easier for these families to have this option as a closer location, or one that works better for getting their classes in before their due dates. And in any case, the people who work at the clinic are really nice and I love my job, so it doesn’t matter that much.

But I still appreciate having a little extra time to set up when I’m at this location. I usually have to haul tables around to maximize the room space and the computer is a little slow in accessing my PowerPoint slides. It’s nice to be there with plenty of time to feel settled before my families start showing up at 6:15 for their 6:30 class.

As I came around the corner around 5:35 this evening, I heard some really loud music blaring from my classroom and the door was closed. I turned to someone who works at the clinic and asked, “Do you know what’s going on in there?”

“Oh, it’s a Zumba class!”

Wait, what?

“Ummmm… I’m supposed to be teaching a Childbirth Preparation class in there for 16 people in an hour.”

“I think they’ll be done by 6 pm.”

Okay… Not what I wanted to hear. But I wasn’t going to interrupt the class, they were in full swing and I could here them getting down to some serious Zumba-esque tunes.

(If you’ve never done a Zumba exercise class before, you really should try it at least once in your life. It’s a complete blast! The music is always ridiculously loud, like rock-concert-level-loud and has a lot of Latin or Indian (think Bollywood) influence, plus it’s one of the best cardio work-outs of all time! You will sweat like you’ve never sweat before. I’ve taken it as an exercise class before and really enjoyed it. And a couple of years ago, a girlfriend of mine had a big birthday party where we were encouraged to show up up in 80s work-out gear (think Olivia Newton John in her “Let’s Get Physical” days). We drank lots of Margaritas and ate mountains of chips with guacamole and then we did a 90-minute Zumba class. Seriously, it was one of the best birthday parties I’ve ever been to! But, I digress…)

Despite my fondness for Zumba, what I’d just heard put me in a bind as I needed/wanted more than 30 minutes to set-up for my class. I texted my supervisor to let her know what was happening and asked that she try to get to the bottom of this so it didn’t end up being a regular gig, and started setting up as best I could in the hallway outside the classroom.

At 6 pm, I poked my head in the room and found that I had to holler above the outrageously loud thumping club music, “I HAVE TO TEACH A CHILDBIRTH CLASS TO 16 PEOPLE IN THIS ROOM IN 30 MINUTES!” A young woman turned toward me and said/shouted, “OH! I’M SO SORRY! I DIDNT KNOW THERE WAS ANYTHING SCHEDULED FOR THIS ROOM! WE’LL BE OUT OF HERE BY 6:15!” And then the door closed.

Well, shoot. (For the record, that’s not the word I was repeating over and over in my head at the moment.) That just cut my set-up time in half – again. I went from having an hour to get the room all set-up to having only 15 minutes.

At this point, my students started showing up and I was forced to have them wait in the call center for a little bit, encouraging them to “get to know one another a little bit better.” To their credit, the Zumba class attendees sprung into action at 6:15, trying as best they could to help me set up the classroom. There wasn’t a whole lot they could do for me, but as I walked into the room I could feel the heat and – definitely smell the sweat – of about a dozen Zumba enthusiasts hit me full-force. I looked at the group of them assembled and begged, “Can you please find me a fan?” Which, thankfully, they did.

The students started filing in, and even though I was still taping things up and my classroom was not set up to my personal standards, class went off without a hitch. In fact, I actually covered more information tonight than I was supposed to, and so next week I have the luxury of being able to do some review and maybe even cover a little extra information at a more leisurely pace.

The reason I’m sharing this with you, is that I find it so interesting when I’m forced to “practice what I preach.”

I talk so much in my classes about how birth is too big to be planned and how you can’t really control it no matter how much you might want to – and that’s actually true of life.

You can set all the plans you want about how your day is going to play out, but in reality none of us has absolute control over any of it. We might leave early, in order to get somewhere with extra time to set-up and there’s an accident on the highway and you’re delayed by 30 minutes, or there’s ice on the roads and class needs to be cancelled, or there’s a group of sweaty people working out their Zumba-booties in your classroom when you arrive – and guess what?

You figure it out. You take a breath, realize that no one was trying to make the situation difficult for you, attempt to be as pleasant as possible (it makes it so much easier for everyone involved), suck it up and do what needs to be done.

There it is.

Birth, work, parenting, life – not as much control as any of us would like. And it’s nice sometimes to be reminded of this and realize that we have a choice to view any situation we’re in as either an opportunity or a challenge.

It’s not what’s actually happening that matters, but how you respond to what’s happening that matters.

Wow – very philosophical post today and written in one go right after my class ended, but a nice perspective to share: so happy that I’m still learning after all these years of teaching.

(And, of course, how could I reference ONJ without sharing a little bit of this goodness with all of you? I think it would make a really great song for a Zumba class, don’t you?)

Today’s Top 10 List: Ways to Support a New Family

Top 10

Top 10 List of Things YOU Can Do to Make
Our Lives as New Parents Easier

  1. Please stop by the store and pick up the following: (Provide a specific list) (Include the basics that you know you’ll go through in a week and at least one yummy treat you only buy every once in awhile as a special snack. This is not supposed to be a full shopping trip! The person spends $20 on the things you actually need and you’ll appreciate this so much more than receiving another onesie – no matter how cute it might be.)
  2. Please buy me some postpartum panties – a six-pack would be great! Color: black, size: (You might need a size up from your usual, as your body will still look and feel about six months pregnant in the early postpartum period) (This request might fall to a specific person in your life, not just someone random… You know who that special person is!)
  3. Bring us dinner! Here’s the link to our Meal Train account: (the url web address linked to your account) Please drop it off in the cooler on the front porch and leave without knocking. You can text us at this number: (cell # so you won’t have to answer the door) to let us know it’s been delivered. We will sing your culinary praises as we eat your yummy food. We so appreciate your understanding that the pressure of entertaining anyone feels overwhelming right now as we’re still getting the hang of this parenting thing.(Food is THE single greatest postpartum gift anyone could ever give you. Accept all offers until they run out!)
  4. If you can spare an hour or two in the early afternoon it would be amazing to have you come by and hold the baby so I can take a nice, long, hot shower. If you’d consider tucking me and the baby back into bed together and then folding a load of laundry before you leave? I will love you forever! (You will not believe the amount of increased laundry one eight pound little human can produce!)
  5. If you’re more of a morning person, you could come by to make me a quick and easy breakfast (not too early, please) – and then clean out my fridge. If this could happen on a (the day of the week you usually put out trash and recycling) that would be even better! (If they’re willing to take the bins to the curb for you before leaving, let them! That’s one less chore partner will have to take care of this week!)
  6. If you want to vacuum and straighten up while I sleep with the baby it would be like a dream come true for me when I wake up to a cleaner house. Thank you! (Too many Mommas clean house while the baby sleeps, instead of resting or sleeping while the baby sleeps. Having someone take care of a few housecleaning basics is a tremendous gift!)
  7. Are you an animal lover? Have we got the job for you! Come and spend some time giving our pet(s) a little extra TLC. (Pet’s name) is feeling pretty neglected right now and it’s breaking our hearts. (This is a challenge for lots of new parents, you don’t need to add “felling guilty about not taking the dog for a walk” to your new normal. Have someone else do this for you until you can figure out a new routine.)
  8. Come over and hang out with me during the most challenging part of the day (sometime between 5-10 pm). You can pretend to be (partner’s name) and help me out so that he/she can get out of the house and take a break to do something fun by him/herself or with friends. (Having some downtime is so important for BOTH Momma and partner. You will come back feeling rejuvenated for your work as a new parent.)
  9. Do you like to shop for clothes? If you’d head over to Goodwill and pick me up a couple pairs of pants in this size (pant size should 1-2 sizes up from your normal) that would be fantastic! (Mommas hate wearing maternity pants when they’re no longer pregnant, but it makes no sense to buy another whole wardrobe when your body might just need a little more time before fitting into your old clothes. Having someone pick up a few items that you can wear that have a button and a zipper – not stretch pants – helps a new Momma feel better about herself and her postpartum body.)
  10. Come over and hold our baby so we can get out of the house and do something together. It will probably be less than 2 hours (unless we check with you and the baby’s still asleep) It’s so important that we get to do something just for us. (This “date” might not be anything more than a walk around the block at 1 in the afternoon, but you must look for opportunities to connect with one another away from the baby. If for no other reason than to talk and listen to one another uninterrupted.)

Feel free to add to this list or write your own Top 10 List to hand out to friends and family so they have concrete ideas of how to help you in the postpartum period. Lots of people make offers of support – but as new parents, we either don’t know what to ask for in those first few days/weeks, or we feel badly about reaching out for help when we need it the most. Your Top 10 List helps eliminate both of these issues. Make sure to have it hanging on your fridge in the last weeks of pregnancy as well, so visitors are prepared to provide you with the specific support that you know you’ll need!

 

With a nod of appreciation to Elly Taylor for sharing this blogpost by childbirth activist, Gloria Lemay, I’ve come up with this version of the “Top 10 List of Things YOU Can Do to Make Our Lives as New Parents Easier.” It’s an attempt to encourage expectant parents to create their own list of ideas so friends and family can support them in the immediate postpartum period.

I’d planned only to create something to use in my classes, but after I’d written it out – it seemed appropriate for it to land here as well. Read it as intended: a worksheet where couples make it their own by inserting specific information in the blanks. If nothing else, I hope it’s an assist to expectant couples so they can feel more comfortable asking for help that’s practical and allows the giver to feel wonderful by completing one of these small acts of service that will be so appreciated by the receiver.

Did I miss anything? What would you add to this list? Please share your thoughts in the comments section.

 

Practical Packing for L&D

Packing

This post is for all the Mommas who’ve asked me over the years, “What should I pack for the hospital?” But it’s especially for two particular Mommas who asked me over the weekend. One posed this question during an express class and I didn’t have time to get into my list, so I directed her to the one that was in her book. The other asked me on the tour if I had the info I was sharing with the group in written form. I promised that if she checked out my blog this week, I’d have it in writing for her. And I don’t go back on my promises.

So here, without further ado, is the world’s most practical packing list of things to consider packing for labor, delivery and postpartum. This is not comprehensive, these are just things that I know will get used and -bonus! – you probably already have them all.

Grab two separate bags – one will be for labor and delivery and one will be for postpartum and can stay in the trunk of your car until after the baby is born.

Pack your postpartum bag first – this one’s easy. It’s whatever you and your partner would normally pack if you were to go away together for a long weekend. All the toiletries you’ll need and comfy clothes that you’d like to wear while getting to know your newborn. The hospital usually provides nursing gowns, “special” undies, and the monster pads that you’ll be wearing for the first couple of days, so unless you have personal issues with wearing these, I’d just let the hospital worry about it.

But for going home, Mommas will want to pack something they wore when they were about six months pregnant – something that is loose and comfortable. You’ll lose a lot of weight according to the scale after you give birth, it just won’t look like you have. Remember: It took nine months to put the belly on, please be gentle and give yourself nine months to a year to take that belly off.

The only thing you should need to pack for your baby is an outfit for them to go home in. And, then… a back-up outfit. They almost always decide to do a huge poop as you’re trying to leave the hospital and you’ll have to change everything and put them into something new.

As for the “Labor and Delivery Comfort Bag,” don’t think you have to bring different lotions and massage tools. You shouldn’t have to go out and buy a bunch of stuff – it’s completely unnecessary. What you’ll end up using you probably already have. While I think it’s fine for the Momma to gather all the items for this bag, it’s better if partner packs it so they know what’s coming to the hospital and where it is in the bag. Once you’re admitted to a room on the L&D floor, partner needs to make sure to unpack the bag, or you won’t remember to use anything you’ve brought with you.

Things to consider:

A way to hold your hair off your face. Even if you only have bangs, you might want them out of your face and eyes.

What do you want to wear in labor? The advantage to using the sexy hospital gowns (with the open-air option in the back – ooh, la, la!) is that there are a million of them and if one gets dirty you can always put on a new, clean one. Birth is messy business. But if putting on a hospital gown will make you feel like a sick person, then wear something from home instead. Just make it something you won’t mind getting rid of after birth – because it will probably end up in the trash can.

Laboring Mommas get overheated during the pushing stage and their heart rate can mimic that of their baby in utero climbing somewhere between 130-160 beats per minute. It’s not unusual for women to take off their gowns because they’re so hot. If you’d like a little more coverage, a sports bra (that you don’t care about) under whatever it is you’re wearing would be a great idea. The quickest way to get your baby on your chest, skin-to-skin, after birth would be to cut the bra off, because trying to wrestle out of a hot, sweaty sports bra is like giving birth – and we’re only doing that once, if we can help it.

Moving onto partners: pack some good quick snacks you can grab to eat that will sustain you and help you help her throughout the birth. You can’t tell a Momma in active labor, “I’ll be right back! I’m just going to jet down to the cafeteria to grab something to eat. I’ll be back in about a half hour.” Not unless you want to hear about this for the rest of your life.

Pack a swimsuit for yourself. Every laboring Momma should be planning on using hydrotherapy (a fancy word for the shower or tub) to help her cope with contractions. Depending on the size of the tub, you might be able to get in with her. But you’ll definitely both be able to fit in the shower together and your nurses will continue to check on Momma’s progress. They’re super comfortable with naked pregnant people, but wildly uncomfortable with naked non-pregnant people! Cover up.

You’ll want to bring toiletry supplies, including glasses, contacts, a toothbrush and toothpaste for you both: Mommas will sometimes throw up late in labor and nobody likes barf breath. If you, dear partner, have eaten nacho cheese Doritos in the past six-eight weeks, she’ll be able to smell it on your breath. Don’t let that be the reason she’s throwing up!

Throw a hoodie into this bag, because her temperature might be all over the place during labor and you’ll appreciate being able to put on and take off an extra layer.

Mommas might feel overheated, but still have cold feet. Warm socks or slippers would be a good idea. The floors in hospitals are cleaned several times a day and are a lot cleaner than your floors at home, but they are hospital floors. Wear some sort of foot covering.

Pillows from home will be appreciated both during and after birth. Hospital pillows suck – they’re good for propping you up in the tub, but not much else. Your pillows will smell like home, which can be extra soothing, and will help get you better situated for breastfeeding on the other side. Make sure they’re coming in bright pillowcases so the hospital doesn’t mistake them as part of their stash.

Lip goop is a necessity! It seems inconsequential, but can become a huge irritant during birth if she’s using breathing as the great coping technique that it is, and her lips become dry and chapped.

Last, but absolutely not least, remember to make your “Birth Mix.” Yep, I’m talking about taking the time to come up with the playlist of music that you love and would want to listen to as you’re giving birth to your baby – the emphasis here is: music that you love. If you love Enya, or whale mating calls, or songs from the rainforest, then by all means make that mix. But if that’s not for you, remember there’s nothing that says you can’t rock out to whatever music you really enjoy. Quiet and mellow music has it’s place in labor – but so does AC/DC. You’ll want to have a mix of music to chill to and music to move to so that when it’s required, you can change the energy in the room.

And some sing-along music is a great idea, too. If you open your mouth in between contractions to sing the chorus of your favorite song, it’s really hard to stay tensed up. If your jaw is open, your cervix is opening. If your jaw is clenched tight, so’s your cervix. It’s called the “Sphincter Law.” I didn’t come up with this, renowned midwife Ina May Gaskin did. And here’s what she has to say: “The state of relaxation of the mouth and jaw is directly correlated to the ability of the cervix, the vagina, and the anus to open to full capacity. A relaxed and open mouth favors a more open vagina and cervix.” Something to think about, for sure.

As for any other items you want to bring with you – go for it. This is just a list of what I consider the absolute basics and extremely practical things to consider when packing your “Go Bag.” As a Momma of four, I’m nothing if not practical.

Happy packing!

Are there things that I’ve missed? What other (practical) items would you consider essential to the labor and delivery bag? I’d love to hear what you think should be added.

Just Dance

Dance

Childbirth Educators usually encourage their families to consider dancing their babies out. Why?

Well, it’s an upright position which helps gravity do it’s job of bringing the baby down before it comes out (essential to the process, really). Dancing allows her pelvis to be nice and loose, and every move of her hips provides a tiny bit more room for her baby to make all the twists and turns that are necessary to be born. It also allows the woman and her partner to be in a position that really promotes intimacy and connection. This, in and of itself, can increase contractions and progress the labor due to increased oxytocin production. And lastly, dancing is a really easy position which can be cranked up or down depending on the circumstance. Is she trying to get her labor to pick up speed, or does she just want a slow swaying rhythm to help keep her in a coping mindset as labor intensifies?

I usually introduce this position in class as the “Middle School Slow Dance.” You know what I’m talking about, Momma places her arms around partner’s neck and their hands rest on her hips. Because I went to a Catholic school as a child, we were told by the nuns to not get too close – we had to “leave room for Jesus!” I’m pretty sure that when you were making this baby your bodies were not three feet apart, so leave Jesus out if it for now and move in really close.

There’s always a moment of awkwardness in class when we start practicing positions – especially this one. I get it – there’s usually a bunch of other people in the room and it seems silly. But if you practice positions before labor ever begins you’re much more likely to actually use those positions while having your baby.

Once families are in position, it cracks me up that I always have to remind them that the position is called “Slow Dancing” for a reason – dance, people! That movement of hips swaying from side to side, even if only a little bit, can have a real impact by providing a calming rhythm and some movement to help the baby maneuver through the pelvic structure and down the birth canal.

We can make this position even more comfortable for Mommas if we encourage them to lean directly onto their partner’s chest and drop their arms to their sides. Making this position more comfy for the partners might mean having them lean up against a wall, or sitting them on the edge of the labor and delivery bed – positioned just at the right height – so they can feel supported as they support her.

In my classes, this is about the level of dancing I can get my couples to practice ahead of time and in front of a small crowd of people. But, I’d love for them to think about dancing for real when they’re actually in labor.

I did some dancing this weekend – it was kind of spontaneous, and it might have involved a few beers and maybe some Karaoke – but it made me feel so good. My calf and neck muscles ached a little bit the next morning, and at first I couldn’t understand why. But then, I thought back to the jumping up and down and a little bit of head-banging that went on the night before and a big smile came to me. My whole body was remembering how happy I’d felt in those moments the night before, and then – bonus! – I got to experience the residual happiness I had in the memory of it all.

I think dancing in whatever way feels good to you – to try and induce labor, to distract yourself during early labor, or to encourage rhythm and ritual in coping with contractions as they intensify in active labor – should be taught and encouraged in all of our classes. I’m even considering another certification to teach families how to dance their babies out. I found this organization called, Dancing for Birth, while I was looking for YouTube video examples of how women have used dancing to either start their labors or get their babies out.

What do you think about adding dancing into your prenatal fitness routine, your labor and delivery toolbox, and even as part of your postpartum recovery? It feels like forever since I had my last baby – only 6 1/2 years, really! But I think if I were to have another (it’s never going to happen – I’m all done!) I’d consider using much more dancing throughout the process to help bring my baby into the world. Dancing your baby out might make the whole process much more fun and enjoyable – something to look forward to with excitement. And you know I’m all about that!

Did you dance your baby out? Does this sound impossible? Or does the thought of using dance to move through your labor sound wonderful? Let me know your thoughts about attending classes that specifically teach you how to dance for birth.

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.