In My Humble Opinion…

bees

So, the world of birth is abuzz this month as ACOG (The American Congress of Obstetricians and Gynecologists) has released their newest Committee Opinion: “Approaches to Limit Interventions During Labor and Birth.”

This opinion might have left some scratching their head and saying, “Duh!” But I want to jump up and down squealing with joy! I think this is a fantastic step in the right direction from the OB/GYN leaders of America. They’re asking their members to consider: “If a pregnant Momma is low-risk, how can we keep her low-risk?”

The answer is: “Don’t intervene unless it’s medically necessary!”

I’m going to break down the recommendations and conclusions section of this Committee Opinion for you here, because there are lots of big, fancy words – and you might appreciate my attempt at a simpler translation. Also, we know that when information comes from people who wear white coats and carry stethoscopes around their necks, it sometimes carries more weight – even if we’ve already heard this same information from different sources. Just saying… In our culture, there’s a hierarchy when it comes to medical advice and opinion – evidence or bias, be damned!

So, this is not a perfect translation (and my editorial comments are included in italics) but in a nutshell here’s what the ACOG has stated in it’s Committee Opinion, Number 687 for February 2017: Approaches to Limit Interventions in Labor and Birth.

  • If a woman is between 39-41 weeks, and is in labor that’s started on its own, and has a baby that’s head down, the use of intermittent fetal monitoring and unmedicated comfort and coping techniques is a good idea. (Full-term according to ACOG. Intermittent – the fancy word that means there are breaks in between periods of monitoring.)
  • If a woman is still in early labor, she doesn’t have to come to the hospital right away as long as she and the baby are doing okay. It’d be great if she was offered frequent contact and support, as well as unmedicated comfort and coping techniques. (See what I wrote here, here and here (It’s a 3-part series!) about how to stay comfortable and pass the time of early labor at home before coming into the hospital.)
  • When women come into the hospital in early labor due to pain or exhaustion, they should be offered education and support, water to drink, encouraged to try various positions that might provide more comfort, and other unmedicated comfort and coping techniques like massage and how using the shower or sitting in warm water can be very helpful. (Hydrotherapy – the fancy word for drinking water, showering and/or sitting in the tub – are great ideas for comfort and can also help labor progress!)
  • OBs and other providers should inform those women whose water has broken at the onset of labor about any risks associated with waiting for labor to start on its own. If there are no other reasons to be concerned for the baby’s health, an informed woman can choose, and should be supported in her choice, to wait for labor to start on it’s own. The exception would be if a woman has tested positive for Group B Strep – antibiotics shouldn’t be delayed, and there may be a preference from both the provider and laboring woman to induce labor immediately, rather than wait for it to start on its own. (Many providers already use “expectant management of labor” – the fancy word for “watching and waiting,” but more providers might now be encouraged to wait before inducing immediately if water breaks at the start of labor.)
  • Evidence suggests that in addition to regular nursing care, continuous one-to-one emotional support is associated with improved outcomes for women in labor. (YAY DOULAS! And partners, and Grandmas, and BFFs and… DOULAS! You can read my post here about how a doula can be a great addition to your birth team.)
  • For women with a labor that’s progressing and a baby that’s doing well, routine breaking of the bag of waters is not necessary unless needed for internal monitoring. (Amniotomy – the fancy word for breaking the bag of waters before it has broken on its own – is often suggested as a way to “speed things up” but can be associated with more interventions and increased risk for Cesarean Birth if it doesn’t work.)
  • In order to promote intermittent monitoring, hospitals should adopt protocols and train staff on how to use hand-held Doppler monitors for low-risk women who would prefer this type of monitoring. (This one even surprised me! I thought they would suggest using the external monitoring belts less frequently, but hand-held Dopplers would be a fantastic improvement over current practice. So much easier and comfortable for laboring Mommas!)
  • Using a coping scale and the use of medicated and unmedicated coping techniques will help providers tailor interventions to meet the needs of each woman. (Some hospitals have already adopted the use of a coping scale instead of a pain scale, but this little tool can be very helpful in changing the mindset of a laboring woman from focusing on the level of pain she’s feeling to whether or not she’s coping well.)
figure-1-the-pain-intensity-scale-0-to-10-adapted-from-wong-baker-faces-pain-rating

Figure 1. The Pain Intensity Scale: 0 to 10. Adapted from “Wong-Baker Faces Pain Rating Scale”

coping

Figure 2. The Pain Coping Scale: 10 to 0, developed to assess coping during labor and birth. Adapted from “Wong-Baker Faces Pain Rating Scale”

  • As long as there are no complications and fetal monitoring is still possible, a woman should be encouraged and supported to change positions often during labor – it will make her feel more comfortable and will help move the baby into the best position for birth. (Being upright and changing positions as often as possible, for as long as possible, allows babies to make all the twists and turns necessary to be born.)
  • Women should be encouraged to use whatever kind of pushing technique she likes and is most effective. (Gone are the days of telling women to assume certain positions and hold their breath for ten seconds! Yeehah!)
  • Unless it’s medically necessary to deliver quickly, women (especially those with an epidural) can be offered a period of rest before pushing – unless she feels a strong urge to push sooner. (“Laboring down” is a really nice way to allow your body to catch up with your labor. Your contractions might have already opened your cervix all the way, but until your baby moves down into a better position for birth, pushing just because “You’re 10 cm dilated – let’s go!” might not be as effective and could lengthen the overall time of pushing, causing undue exhaustion.)

Can you see why I’m so excited about this Committee Opinion?! It aligns so beautifully with what I know to be true for women in labor. Interventions are not “bad” and can be life-saving in certain circumstances.

But if we limit the routine use of these interventions and only use them when medically necessary, we are protecting the normal physiology of birth. And this will result in better outcomes for Mommas and babies.

I am so heartened by this statement from the ACOG and excited to see the impact this will have for laboring women and birth in this country. My sincere hope is that members of ACOG will review their own personal practice based on this Committee Opinion and see where they might step back from intervening too soon or too often. I also hope that pregnant women will read this and know that they should talk with their provider about limiting the use of intervention in their own pregnancy and birth.

Knowledge is power. Be informed.

(You can access the entire ACOG Committee Opinion here in all of its medical terminology, further explanation and extensively cited form. It’s a great read, in my humble opinion…)

Becoming Mother – The Interview

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I can’t remember how I found Sharon Tjaden-Glass and her book, Becoming Mother, but I’m very glad I did!

Becoming Mother is the book that Sharon wished had been written when she became pregnant for the first time: “I wanted the book that I eventually wrote. I wanted someone to be authentic with me. To talk about more than the physical. To go to the dark places. To show me what was hard and what was wonderful.” And Becoming Mother does all of this and more.

I recently sat down with Sharon via Skype and interviewed her about her book, pregnancy, birth and parenting experiences. The following are excerpts from that interview.

Barb: I found it interesting that you included your weight gain (and eventual loss) at the start of each mini-chapter of the book. It wasn’t focused on, or even called out – but why did you feel the need to include this as part of Becoming Mother?

Sharon: As women, I think we struggle a lot with body image and self-acceptance in American culture, and so this drives many of us to have that question in the forefront of our minds when we become pregnant: “What’s going to happen to my body? Will I gain a bunch of weight and never be able to lose it?”

The reason that I included the weight gain and loss in numbers was because I thought it would give pregnant readers realistic expectations for what that physical change is like. Of course, after having gone through the whole experience of having a baby, I understand at this point that the physical changes of pregnancy are not as monumental as the other changes. However, I wanted to meet pregnant women where they are when they first start reading this book.

B: That’s one of the things that I enjoyed most about your book – the focus on realistic expectations, the authenticity of it all. When you were newly pregnant, how realistic do you think your expectations were for after the baby arrived?

S: I wasn’t married to the idea that we had to take minimal time off, but I did know that it was important to me to keep the identity of my pre-mom self alive, even after the baby was born. Once she was born, we were more forgiving of ourselves in terms of going easy on not keeping up with the previous expectations. But we both held true to our commitment to “not totally lose” our previous selves.

B: In follow-up to this question, can you speak to that shift that occurs as a woman becomes a mother and her self-identity can become secondary to her new role as mother?

S: I sensed that it would be possible that I could “fall down this hole of parenthood” and lose my identity, not totally understanding that I’m a dynamic self and that I would always be changing, regardless of what happens in my life. Taking on this role as a mother has reorganized so many facets of my identity. It has also filtered how I see and experience the world. It’s impossible for me to tease apart “mother” from my other identities because it has affected all parts of my life. At the same time, I’m aware that I don’t want this role to “wipe out” my other roles, the other aspects of myself that make me who I am. Because I know that one day the all-encompassing role of “mother” will narrow and narrow as my child grows up. And soon they won’t need me in the same way that they need me now. So I want to make an investment in myself by cultivating those parts of me that will endure past this season of my life. Like with teaching and writing and maintaining friendships.

B: Early on in the book, you talk about  about “surrendering” as the first step in this journey. This is what I’m talking about! I’m not a fan of plans so much, but love the idea of surrendering to the process. Vulnerability during pregnancy is so intense – what do you think about this?

S: I think pregnancy is a constant reminder that you are not in control. And it serves a purpose. The further along you get in your pregnancy, the more control you lose: how much weight you gain, how sore and achy your body gets, your ability to stay asleep all night. Labor intensifies that message that you’re not in control. You’re in so much pain and there’s nothing you can really do about it. You can’t go backward. The only way is forward.

And then after the birth, it starts to click about how these physical limitations that reduce your control help your mental state. You’re much more pliable to giving in to what your baby needs. Whenever it needs you. Whatever you need to do, you’re open to it. It’s not so jarring after pregnancy and labor. Because you’ve been prepped for the past 10 months.

B: “On the hard days, I think – We have made a big mistake.” I so relate to this sentiment! In fact there’s been at least one day during all four of my pregnancies where I have not only thought this, I’ve said it out loud! It’s so important to normalize feelings of ambivalence toward pregnancy – even when it’s a wanted pregnancy. Did you ever talk about this with other pregnant Mommas? Or did you feel like you needed to stay quiet, not tell anyone how you were feeling?

S: I did, (talk to other Mommas) but always in a joking way. I think humor about these feelings helps bridge into those conversations about how tough motherhood can be. You hear it in conversations all the time—when mothers want to “complain” about something, they use two popular methods. 1) Use humor or 2) Use qualifiers: I love my son, but sometimes…

I’m really not the kind of woman to pretend that everything’s okay, especially to people that know me. People that know me and ask how I’m doing, they know I’m going to be honest about how I’m doing. So I didn’t feel like I had to keep up a positive face for everyone to reassure them that I was happy about being pregnant or becoming a mom. If I was having a hard time, I owned that hard time and shared it. The problem with this is that some people feel that your statement that you’re having a hard time is actually an inquiry, or a signal that you’re seeking advice. I’m not. I’m hardly ever seeking advice. And if I want advice, I preface my comments with, “I really want your advice.”

B: If only people understood this! “When I want your advice, I will ask for it. Thank you very much!” I always say that unsolicited advice is usually not very good advice, anyway…

You do a great job writing your birth story.  And while I’ll encourage people to read Becoming Mother for all sorts of reasons, in particular, reading your well-written account of one woman’s journey – emotional and physical – through giving birth is intense, profound and not without challenges. I know you’re pregnant again and want to know how you might be handling things differently this time? What has changed for you?

S: It (self-advocacy) was extremely challenging (the first time). Robbie Davis-Floyd talks about this very thing—the authority of knowledge in childbirth. That doctors possess more scientific knowledge about childbirth and so we often defer to their judgement. But on the other side of this, women often don’t give any weight to their own bodily knowledge, their own intuition about what’s going on. It cannot be trusted. And I definitely felt like this. That if I pushed my own bodily intuition too far that the doctor would lash out at me. I felt like there was a drive for the doctors to have “birth be this one way.”

We have changed providers and place of birth because of this tension with the doctors. I wanted to have a provider who would allow my birth to be what it will be, rather than forcing it to be something that it’s not.

B: Which would you say was harder for you: birth or breastfeeding?

S: Breastfeeding by far—because my body was not responding in the way that it should have. Some women have labors in which their bodies cannot get the baby to descend or dilate enough or fit through the hips. That’s how it was with me and breastfeeding. Always like trying to thread the frayed end of a thread through a tiny needle.

B: I love that image. It conveys so well the level of frustration you feel about something that ends up being so challenging when you think you “should” be able to do it no problem…

How about your relationship with your husband, Doug? How was the first year post baby on your couple relationship? Is there anything that you wish you’d known before that you found out the hard way?

S: I wrote about this in detail on my blog in my post, “When I Became Real to My Husband.” I think this demonstrated to me that loving someone did not depend on what you have to offer the other person. (This is a great read for an authentic, real look at the postpartum couple relationship – Barb)

I wish I would have known that it would take close to a whole year for sex to be really enjoyable again.

B: Right? All the books say “Six weeks! Six weeks!” Well, not my book…

Last question: What do you think about the great American myth of being Superwoman on the other side of becoming a mother?

S: Do you know Brené Brown? (Do I ever! She’s my future BFF – she just doesn’t know it yet…Barb) She talks about shame triggers, body image and motherhood. I feel like the myth of Superwoman in motherhood is just one more way to control and shame women. “Women are judged by their willingness to follow the rules and men are judged by their ability to break them.”

Well, Sharon Tjaden-Glass broke a few rules herself in that she wrote her book, Becoming Mother, even as she was going through her own pregnancy, birth and early parenting journey.

For Sharon, “Being creative isn’t something that I have to work at. It’s something that I am. I just have to make time for it. If I don’t make time for it, I feel blocked and unfulfilled.” And we are all the better for her commitment to staying creative and sharing her account of what it was like for her as she was Becoming Mother.

I want to thank Sharon for taking the time to talk with me about her experience and encourage readers who are pregnant now or know of someone who is, to consider this book as part of their overall preparation. It’s a well-written, honest account which provides realistic expectations (of which I am always a fan!) of what it’s like to move through pregnancy, birth and new parenting. You can purchase a copy of Becoming Mother here. And you can follow Sharon Tjaden-Glass on her blog here.

How Pregnancy & Birth Transformed Me

 

Transformation

It’s not a new idea: Pregnancy and birth are powerful, transformative experiences. But I believe this power to transform happens every single time you’re preparing to become a parent, whether it’s your first time or your fifth!

Each of my pregnancies and births taught me and transformed me anew. The focus is usually on how much the first experience of pregnancy and birth transforms a woman into a mother. And this makes sense: the first time you do anything, makes the biggest impact. Everything’s new and it ends up feeling like all the really big stuff happens the first time.

But, actually, each time we say yes to becoming a parent – biological, adoptive, even if the pregnancy ends in loss – the decision to become a parent marks the start of the transformation process.

Growing up, I would have been considered a “tom-boy.” Even though I was quite comfortable in my body (I liked being a girl!) and I was solid in my heterosexuality (I really liked boys!) I’ve never considered myself to be super feminine.

My imaginary friend as a preschooler was a baseball-loving boy named Michael. If you were looking for me I’d probably be outside climbing trees or catching crawdads in the lake. I hated dolls and never played with them (the irony of this is not lost on me!) and I’d much rather play soccer or football with the boys than do anything else with the girls. And while all of these might be pretty stereotypical examples, they’re all true.

As a kid, I was hyper-aware of how boys were treated differently from girls. Even at a young age, I figured out that this difference had nothing to do with intelligence or character – it was because they were boys. I realized early on, that there was power in being male. Maybe this is one of the reasons why I hung out with boys more than girls when I was growing up. I wanted some of that power. 

(Or it could just be a part of my hormonal make-up. Once, in a conversation with my 13-year old son, I mentioned that I might have more testosterone than most women, to which he replied, “Mom you’ve got more testosterone than most men.” Ha!)

In any case, I’ve always been aware of the power imbalance that exists between the sexes based solely on gender, and I don’t think it’s cool. 

But when I became pregnant the first time, almost immediately, I realized something:

Women are the ones who are really powerful.

Our bodies, the very same bodies that might keep us from claiming the highest positions of power in business, politics, and lots of other areas, are co-creators of human life. Being newly pregnant and making this discovery, I remember thinking how sad it was that my husband was “just a man” and would never be able to experience what real power was all about.

For instance, I created a brand new organ to nourish my developing baby because, duh – I was that cool. And by virtue of being a woman, I created my baby’s bones, her brain, all of the internal organs, her skin, a couple of ears, some hair, her fingernails, eyelashes and a bunch of other stuff. I was making a brand new human being from scratch. And even though it was incredibly demanding, exhausting, and hard work, I did it 24/7! I created this new human being while working, teaching – even while I was sleeping!

All of a sudden, my relationship with being female was completely transformed! I didn’t become any less “tom-boyish.” My testosterone to estrogen/progesterone levels have stayed about the same. But everything about how I felt about being a woman had been transformed. I made my peace with being female in a male dominated world because I had discovered the real truth: Women are powerful beyond measure!

It was unexpected, this transformation. In fact, I’d wondered before I ever became pregnant if I was going to hate the physical limitations of my pregnant body. And while I can’t say that I loved every minute of it, overall I thought that the whole process was amazing. And that I was awesome!

I’m lucky to have a partner who was willing and excited to accept this transformation. He never felt threatened as I discovered this new personal power in my female form. Too often, when the person we love most in the world starts any transformation process, instead of supporting them, we get scared. We fear they’ll outgrow us, or no longer need us, so we try to tamp it down, make it not quite so big. Without even realizing it, we tell our partners through our lack of enthusiastic support, “You can be transformed, but just a tiny little bit.”

Transformation is a big word. Webster tells us that it is:

a thorough or dramatic change in form or appearance; a metamorphosis during the life cycle of an animal.

But that’s exactly what pregnancy and birth offer all of us: powerful transformation – but only if we allow it. We don’t need to go in search of this transformation, we just need to notice it when it happens.

And when we do notice it happening, try not run away from it. Don’t be afraid of it. Feel it out a little bit. Embrace it. Talk about it with your partner. Assure them that this transformation you’re experiencing is about both of you growing into your new roles as parents. And then notice and appreciate the transformation as it happens for them as well.

For every woman and her partner, the transformation that can occur is unique. It’s a culmination of all of your experiences to date. And every single transformative experience we go through, birth or otherwise, has something to teach us – if we’re willing to learn.

My first pregnancy and birth taught me what real power was and that I’d possessed it all along. My second taught me what really matters in a birth story and it wasn’t at all as I’d thought. Number three taught me that there were still lots of surprises in life and to not to get too attached to things going my way. And my fourth taught me that the mental/emotional experiences of pregnancy and birth are at least as important and in some ways, even more important, than the physical experience.

Every time I was transformed. Maybe that transformation was most obvious with my first, but even if the subsequent transformations were more subtle, they remained equally life-changing. Each one of these powerful transformative experiences taught me important things about myself, my partner – and life. They’ve been instrumental in shaping who I am and how I move through the world today. 

How about you? Did you notice any transformation while you were pregnant or after you gave birth? If you’ve had more than one child, would you agree that the first time was the most obvious transformation for you? What have pregnancy and birth taught you?

Boys (And Some Girls?) Don’t Cry

BoysDontCry

My six-year old son stood in front of me with tears streaming down his face and his lips in a full downward pout – so different from his usual dimpled, teeth-just-coming-in, goofy grin. He was crying because he’s feeling anxious about starting up swim lessons again. In January.

I knelt down to make eye contact and said, “It’s okay you’re feeling anxious – but buddy, January is far away and there’s so much life to live between now and then. When it’s January 9th, we can revisit how you’re feeling, okay?” He asked, “Have you ever felt this way?” I answered immediately, “Of course! Lots of times!” And that’s when he said, “Yeah, but I’ll bet you’ve never cried about it before. You never cry about anything.

Ugh. He’s right. I don’t hardly ever cry about anything. For real. I’ve been this way my whole life. It’s not that I don’t have feelings – I feel very deeply – it’s just that my feelings rarely ever bubble up to the surface and spill out of my eyes. That’s all.

But – I cried at each and every one of my births. Big, loud, wracking sobs with tears easily flowing down my cheeks. No checking in with myself about how I was feeling or what I was feeling or if these feelings actually merited tears or not, just wet saltiness streaming down my face as I locked eyes with my baby in that inexplicable moment between before and after.

Before you were a dream, an imagined little person floating around inside of me as our hearts beat as one, connected in the way only a mother and her unborn baby can be. After you are here, now, and we are meeting face to face for the first time. You are the living definition of miracle.

I wish that my children could remember me crying at our first meeting because it would mean all that much more to them knowing me as I am in their everyday life: strong, resilient, able to handle anything that’s thrown my way, and as my 13 year old son likes to tease, having “more testosterone than most men.”

I find that curious, really. The fact that I don’t cry is seen as such a masculine trait. How sad for all the boys and men out there who happen to cry easily! They’re seen as too sensitive and encouraged from far too young to “Stop that crying!” All too often on the receiving end of that stupid phrase that gets thrown at them when their tears start to flow, “Man up!” Men are taught from such a young age that to be a real man, they need to act a certain way.

I’m uncertain if that’s where my own challenges with crying comes from. I’m a girl and I’ve always identified as being female. But I was a huge “tom-boy” as a child. You could count on finding me in the middle of the field, captain of the pick-up football team, long before I’d be caught dead playing with dolls on the sidelines. Maybe I, too, picked up on the social cues that were handed down by the dominant culture to my friends – most of whom were either boys or other “tom-boys” like myself. Maybe I adopted that same code and misidentified being strong with being able to hold back tears.

But, the gorgeous thing about being fully present during birth is that there’s no way to stay completely hidden or protected from feelings of vulnerability and surrender. If you are fully present the wonder, the crazy intensity, the recognition of the part you are playing in the birth of this miracle just plows into you – and you are transformed.

I’ve seen it happen to many couples over the years. She might find a strength that she didn’t even know she had. And he might find a softness that had always been there but had been locked away for far too long.

I’ve witnessed this (only in reverse) four times for me and my wonderfully already sensitive and easier-to-cry-than-me husband. He’s stepped up and provided me with exactly the strength and confidence I’ve needed so I can let go and rediscover my softness and vulnerability that stays hidden most of the time. Allowing yourself to let go of any pretense, any plan of how things should look, sound or feel and instead just be in the moment is where the real power of birth happens.

A few years back, I was invited to meet a baby not even a day old by the new parents who’d been students in my class. As the new Momma was getting some key points on lactation from her nurse, I turned to her proud partner and asked him to tell me about the birth from his perspective.

This very masculine, business-minded, Ironman tri-athlete looked at me and said something I’ve never forgotten, “Watching her give birth and seeing the baby come into this world just broke me wide open.” I could feel the shivers of recognition run down my spine. “Yes!” I felt the exact same way in all of my births. Broken. Wide. Open.

These words might intimidate the uninitiated. It might even scare the hell out of you. But I encourage you to embrace those feelings so you might experience that same level of transformation. It’s nothing short of breathtaking.

You might even find yourself crying from the miracle of it all.

If you do cry easily, were you amazed to find that despite any tears that were shed, how strong you felt after giving birth? If you are not an easy crier, were you surprised by how easily your tears fell at the moment you first saw your baby? I’d love to hear your responses below in the comments.

And for your listening and viewing pleasure, you knew this was coming, right?

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.

Ready or Not?

Ready

As the couples file out of the classroom at the end of my Childbirth Preparation series, I usually ask them something: “Are you ready?” This might seem like a loaded question, and it is. I’m hoping that I’ll hear something along the lines of, “I guess I’m as ready as I’ll ever be,” or “I’m not sure you can ever feel completely ready.” If that’s the response I’m getting, then I feel like I’ve done my job.

That might surprise you. Shouldn’t they walk out of the room feeling like they’re completely ready to give birth and become parents? I don’t think so.

I hope they feel a sense of increased confidence in their ability to meet the challenges of birth head on. I hope they feel more prepared for what might or might not happen. I hope they’re broadening their expectations of what a positive birth story looks like. I hope they’ve come closer together as a couple during their de facto date nights with me. But do I want them to feel completely ready? No, I don’t.

I spend a lot of time encouraging my families to lean into their feelings of vulnerability, to explore what it feels like to have the earth shifting below their feet, to be okay with not feeling ready. Because, there’s no way any one of us has every truly been ready for the transition to parenthood. I taught classes for two years before I had my first baby, was I completely ready? I may have had more information than most, but no way did I feel completely ready.

I think all of us who work in this field of prenatal and parenting education need to take our jobs seriously and try our hardest to prepare our families for the realities of birth, breastfeeding, and new parenting.

I think we need to remember that it’s okay to help them set realistic expectations of themselves, their partners and their babies.

I definitely wish there was more time devoted to adequately address the postpartum period (I’m hatching some new ideas and curriculum to address the ever-widening gap that exists between what expectant parents are willing and able to take in prenatally about that 4th trimester and what they will actually be experiencing in those first days, weeks and months after their baby arrives. Stay tuned).

But I’m okay with their honest assessment after my classes end that, no, they are not completely ready for this life change. This doesn’t worry me at all. Quite the opposite – it makes me feel as if they were really taking it all in and coming to their own conclusions that they’ll probably never feel completely ready.

That’s life, yes? Always changing, always evolving, always keeping us a little off-guard.

And just when we think we’ve discovered the pattern to perfect parenting, our babies will remind us that they are not automatons that prescribe to one and only method. They’re forever changing and evolving as well. We all are.

Are you ready for that?

How ready did you feel to become a parent? What could we as professionals in this field have done to help you feel more ready? Do you think it’s okay to not feel completely ready for this life transformation?

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!