Risk Assessment

Risk

At the end of one of my weekend classes, a healthy and fit-looking Momma came up to ask a question.

“I’m 35 years old,” she began, and I already knew where this was going.

“And yours is considered a “Geriatric Pregnancy,” am I right?”

She kind of laughed and said, “Yep – ‘Advanced Maternal Age!’ And my provider wants to induce me at 39 weeks. I just wanted to know what my chances are of having an induction that goes okay. One that won’t end up with me having a Cesarean.”

Now, I don’t know this woman’s health history, and I’m not a medical provider, so I’m not going to debate this plan of action with her. But I could tell she wanted to know if this induction at 39 weeks would be considered “medically necessary.” Again, without knowing her personal health history, I wasn’t going to comment on that – it’s not my place.

So here’s what I said instead: “If your provider ever had a Momma over the age of 35 who had a “negative outcome” during a birth that went past 39 weeks, it might change how they practice from that point forward. But many providers are only looking at the risk of increased complications that can happen to all women over the age of 35. Is your provider looking at you as an individual, considering any other risk factors that might increase your risk? And what’s the risk, anyway? What numbers are being considered? This information might help you understand ”increased risk” really means for you.”

For example, a provider might read a study that states a woman’s risk of stillbirth increases after the age of 35. The provider might then choose to focus solely on the age of the woman in their care, and encourage an induction at 39 weeks to prevent stillbirth.

Now, stillbirth is a terrible experience which most people would like to avoid at all costs. But women need full information to be able to assess if their risk of stillbirth in waiting for labor to occur on its own is high enough to agree that an induction at 39 weeks is the right decision for themselves.

The risk is real, it’s true – but there are many other factors to consider in assessing an individual woman’s risk for any complication, not just the risks associated with “Advanced Maternal Age.”

I might be a little bit touchy on this subject, if I’m being honest! I didn’t get married until I was 28. I had my first child at 31. Baby #2 came along when I was 33 1/2. My third was born when I was (gasp!) 37, and the last one came along at the ripe old age of 41.

And while it is true that my relative risk of stillbirth climbed with my age, my absolute risk as a multipara (woman who’s had a baby before) with Baby #4 was probably lower than that of a primipara (woman who’s not had a baby before) at a much younger age.

Part of that lowered risk has to do with my proven record of straight-forward, healthy pregnancies and deliveries. And part of that lowered risk can also be attributed to the fact that I was much healthier at 41 than I’d been when I started this whole baby-making enterprise a decade before!

The language – older mother, mature, advanced maternal age, elderly, and my personal favorite, geriatric pregnancy – coupled with the assumption that a woman is automatically high-risk because of her age really bothers me!

The power of words cannot be understated.

And when a woman is told that she’s high-risk, strictly because she’s over the age of 35, this absolutely affects how she experiences her pregnancy and can have negative implications for her birth!

So with all of this as a backdrop, I suggested that this Momma do some research and that she might find some good information online. Rarely, do I send anyone to the inter webs for information. First of all – there’s just so damn much of it! How are you supposed to sift through all of the mountains of information that now exist in the world on the subjects of pregnancy, birth and parenting? But in addition to that, there’s so much out there that’s opinion only and not evidence-based – and that’s really scary!

So there are only a few online resources I recommend and trust for this kind of research. One of those resources is Evidence Based Birth. Rebecca Dekker, a PhD-prepared nurse researcher and founder of EBB, is on a mission of “Putting current, evidence-based information into the hands of communities so they can make empowered choices.”

Her references list used to research any one issue can sometimes be pages long, and her articles are always reviewed by a panel of experts before she publishes them online. Plus, they’re written for the lay person, not a medical researcher, so they’re easy to understand. Here’s the article from the EBB website that speaks directly to this issue of Advanced Maternal Age.

After doing this important work of researching, I encouraged this Momma to have some more dialogue with her provider about her particular situation. In the end, she might come to the same conclusion that an induction at 39 weeks is reasonable for her and her pregnancy. Or, she might not. But what’s most important, is that she’ll be engaged with her provider in a shared-decision making model and her decision will be made using full information.

In this day and age, I think we should be encouraging women to know what their risk is so they can make truly informed decisions for themselves about their pregnancies, their births, and their babies.

In the meantime – can we please come up with another way of describing a woman who happens to be having a baby at the age of 35 or beyond? The terms we’re currently using are demoralizing. And I should know!

Thankfully, it’s not all bad. Based on this article, us “Geriatric Mommas” will have the last laugh: “Women who had their last child after 33 were twice as likely to live to 95 or older, compared with those who had their last child by 29.”

I’m not a math whiz by any account, but if my calculations are correct, this means I will live to be at least 125 years old seeing as I had my last baby eight years after the magical cut-off  of “33” as quoted in this article.

But before I get my hopes up, I think I’d like to know what my absolute advantage is, not just the relative advantage based on my age.

Know what I mean?

The Tooth Fairy

tooth-fairy

“Okay, Mommy – I’m going to ask you a question, because I know that parents don’t lie.”

Thing Four said this to me yesterday afternoon while standing in our kitchen, home early from school with his first-of-the-season cold. I tried to distract him by offering him a snack. But, he would not be deterred.

“I’m not hungry! I need you to answer this question, because I know you won’t lie to me.”

I knew what was coming… How? He’s my fourth kid, he lost his tooth in the middle of math class yesterday, and he was jumping up and down about the dollar that he found under his pillow before he headed off to school in the morning. I got myself ready.

“Okay. What’s your question?”

“Are you the Tooth Fairy?”

I tried to stall. “Why are you asking me that?

“Because a big kid at school today said that there’s no such thing as a Tooth Fairy and that it’s just the parents. I want to know if he’s right or not.”

The moment of truth. Ugh. I’ve walked down this path before, three times already. But with Things One, Two & Three they hadn’t posed the “Is (fill in the blank) real? Or is it just you and Daddy?” question until they were ten years old. Ten! In this day and age, I think ten might be pushing it when it comes to still believing in the magic of childhood and I was so happy that they did! Because, honestly, I still want to believe. But when I answered their questions, it was only to confirm what they already knew. Each of them expressed sadness – they were hoping against hope that magic was still real – but none of them were at all surprised.

As my tender-hearted, sweet and sensitive seven-year old boy stood before me with complete trust that I was going to confirm what he knew without question – that the Tooth Fairy was in fact very real – my heart was aching for him. The words, “Too soon! Too soon!” kept echoing in my head. He noticed my pause and asked again, “Are you the Tooth Fairy?”

“Are you really wanting the answer to that question right now?” This has been my go-to response for the older three on so many different topics over the years. I feel like it gives my kids an out if they aren’t really ready to hear the answer. And sometimes, my question stops them from going any further. My little guy’s smile started to falter and his bottom lip quivered a bit, but he still said, “Yes.”

When I told him that it was his Daddy who did the work of the Tooth Fairy his face crumpled and he started to cry. In that moment, I wanted nothing more than to find the older kid who’d given him a hard time at school earlier in the day, teasing him about still believing in the Tooth Fairy – and wring his little neck.

Instantly, I was transported back to the day I was five years old – FIVE! – and my older brothers, ages eleven and thirteen at the time sat me down and told me that none of it was real. They laid it all out – and I bawled my eyes out.

I decided to do my best to soften this moment for my little guy and asked if I could hold him in my lap and try to explain.

“I don’t ever want you to feel foolish or that you’ve been tricked. I don’t want you to think that we’ve lied to you.”

“But you DID lie to me! When I asked you in the past if if the Tooth Fairy was real, you always said yes!”

“Ah, but the Tooth Fairy IS real – your Daddy’s real, isn’t he?” (A loophole, I know – but I was needing to think fast…) “You could think of him as being the hands and feet of the Tooth Fairy. And the story of the Tooth Fairy been told forever! Longer than even when I was a little kid!” (That always makes them understand the passage of time. My kids think I’m ancient!) “I’d like to think that maybe the story started because somebody’s kid lost their tooth, it freaked them out, and the parents told them about the Tooth Fairy coming to take the tooth and leaving them a gift in exchange to make it all less scary. To make it more exciting and magical! It was never done to be mean-spirited or hurtful. Are you angry with me?”

“I’m angry that I ever believed in the first place,” he mumbled in between sobs.

“But didn’t believing in the magic of the Tooth Fairy make it special for you?”

“Yeah –  but it wasn’t real.”

“But the real magic is that your Daddy and me and all of your siblings -” I began, but he cut me off.

“Wait! Elisa, Ale and Lulu know there isn’t a Tooth Fairy?” a new round of tears coming down his sweet, little cheeks. “I’m the only one in this family who didn’t know?!”

And I was again transported back in time to what I remember feeling when I found out: a weird mix of wanting to fiercely believe that magic was absolutely real, wanting to remain young and innocent – and being utterly despondent that I wasn’t as grown-up and mature as my older siblings, feeling foolish for not realizing that it was all pretend.

“You know, each one of your siblings asked me the same question you just did, only they didn’t ask until they were about ten years old. Asking now, when you’re only seven makes it a lot harder on you. But you asked me to tell you the truth. So, I did. I’m so sorry you’re sad. But the magic of all of us wanting to create special excitement for you as you’re growing up, the fact that we all wanted to keep this alive for you is still very, very real. And, you have to admit – it’s kind of magical that you go to bed with a tooth under your pillow and when you wake up – it’s gone and there’s a dollar bill in it’s place!”

He wasn’t really having any of it at the moment. I knew that I just needed to love him up and hold the space for him and his emotions. And that I also needed to figure out how to not ruin every other bit of magic still left. Not yet. “Too soon!”

“Well, what about…” he trailed off.

I responded quickly, “Listen, magic is real as long as you want to continue to believe in it.”

“What do you mean?”

“Well, your fourteen year old brother just lost a tooth last year, right?”

“Yeah.”

“Well, he put his tooth under his pillow and the next morning what did he find?”

“A dollar.”

“See? The magic still works as long as you believe in it. But if you’re ready to stop believing in the Tooth Fairy – the magic stops.”

Did I mention my kid is smart? He got it immediately and answered, “Well, I still believe in the magic  – ALL of it.”

“Then it will still happen! Your Daddy will continue to be the hands and feet of the Tooth Fairy and when you lose a tooth and put it under your pillow, magically, a dollar will be there when you wake up.”

This was not the end of the conversation, of course. We hashed this out for at least another 30 minutes. He had loads of questions, but was quick to only ask those he felt ready to hear answers to. He needed to ask his Dad what he did with all those teeth over the years. He wanted to be the one to let his older siblings know that he knew. He had to figure out why some older kids kept the magic alive, and others felt the need to crush it.

He woke up this morning and climbed into bed between us and announced. “I’m still sad about all of this, you know.” I know, me too buddy, me too. But I still choose to believe. I choose to believe that the magic is not that a little fairy, (or in Puerto Rican tradition, a little mouse) picks up your lost tooth and leaves a gift in exchange. I choose to believe that the real magic lies in the desire to make this world with all of it’s harsh realities a little softer around the edges – to sustain just a bit of wonder in our minds and hearts for as long as possible.

I don’t know if you tell your kids that the Tooth Fairy is real or not. This isn’t supposed to be a “how-to” or “I do it like this” kind of post. Just one Momma’s way of finding her way with her littles about the big and not so big stuff of everyday living. And hoping that the decisions I’ve made in how I choose to speak to my children about magic and wonder keep these things alive in their minds and hearts for as long as they choose to believe.

Our world needs a little magic and wonder. Maybe now more than ever before.

World Breastfeeding Week – But Is It Always Happy?

Bottle Baby

“It’s really hard sometimes. I’m frantically trying to mix the bottle and he’s really hungry and upset and I could comfort him so much more quickly if I could just breastfeed him. I wish I knew why they didn’t do what they were supposed to. Why didn’t you work?!” She looked down at her chest and aimed this last question directly at her breasts as she let out a heavy sigh. When she looked up I saw her forced smile, but I could also see the pain in her eyes.

I reassured her, “Your baby is gorgeous and thriving, so you must be giving him exactly what he needs!” And then the conversation shifted to how bottle-feeding was going. I was happy to hear that they’d found a formula that the baby was tolerating well and that Dad had jumped into help with feeding his newborn son – a happy and alert four-month old, curious about the world around him.

The assumption is, that if a woman has the equipment and a baby has the breathe-suck-swallow-reflex, all you need to do is put the two together, and – Voilá! Breastfeeding happens, no problem! And when it does work out that way, it’s fantastic! But it doesn’t always work out that way. In fact, I think a lot of women would place breastfeeding challenges at the top of their list of unexpected outcomes – but only after they’ve had their baby.

If I taught breastfeeding – which I don’t, I’m not trained to do so – my classes would probably focus on the challenges that a woman might face. (Remember me? I don’t call myself “The REP” for nothing!) I recognize the valid concern that if all we talk about are the challenges of breastfeeding, that this might discourage women from attempting breastfeeding in the first place. I get that. But it’s all in the delivery of the information!

There’s a balance to strike between “Here are some challenges that you might face when you’re breastfeeding” and “Wow! Breastfeeding is going to be waaaaaay harder than you think!” I continue to hear from so many women that they wish they’d known more in those early days and weeks about how challenging breastfeeding might actually be for them.

Now, I’m lucky enough to have friends who are excellent breastfeeding educators and lactation specialists and I know first-hand that they do talk about breastfeeding challenges – both in the classroom and one-on-one. Maybe this information just isn’t able to fully sink into the minds of these pregnant women who are still fixated on how they’re going to get the baby out.

In any case, women share with me how their feelings of being unprepared lead them to feeling “broken” and then guilty at not being able to do what is best for their baby (“Breast is Best!” after all. Yes, they know… they hear it all the time.) It literally breaks my heart.

In Portland, Oregon if breastfeeding goes well for you, than this can be a wonderful city to live in. We’ve got Baby Friendly hospitals, amazing IBCLC trained lactation specialists, great initiation rates, some impressive longevity rates, and many people feel more comfortable breastfeeding in public here than in other parts of the country because they see it all around them and know that what they’re doing is largely supported.

But, if for any reason, breastfeeding does not go well for you, than living in Portland, Oregon can be really tough. There’s a lot of judgement about bottle-feeding in this town. Maybe this is also true where you live?

I’m not trying to promote bottle-feeding over breastfeeding. I breastfed all four of my kiddos until they were close to two years old. I promote breastfeeding all over the place, personally as well as professionally. I am a breastfeeding advocate.

AND I’m also a new parent advocate.

I want to support these new parents – even more so if they’ve had to make a challenging decision while feeling vulnerable and still trying to find their way in their new roles as parents.

I want to provide positive attention to those women who’re truly unable to breastfeed or who’ve made the decision to bottle-feed their babies for a number of different and valid reasons. Oftentimes, this can be the most difficult decision they’ve had to make as a new Momma. Most of the women that I know personally who’ve had to switch to any amount of supplemental feeding for their babies have only done so after weeks and months of trying to get breastfeeding to work. The amount of effort they have exerted is nothing short of Herculean.

So, how can we better support Mommas who’ve had to make a decision that goes against the way want to feed their baby, when they’re confronted with the reality that breastfeeding is no longer an option?

I’d just like to acknowledge that for some women, “Happy World Breastfeeding Week!” might not be that happy. Those of us who’ve been able to breastfeed can be grateful that breastfeeding was not that challenging for us, or if we did have challenges we were able to move past them and continue to breastfeed. But maybe can we also try to be more supportive, truly supportive, of the Mommas who’ve had to make other, different, hard choices around the issue of breastfeeding?

Instead of judgement, let’s offer each other a soft place to land in this challenging and trying world that is new parenting. Be gentle with one another. Be gentle with ourselves. We’re all doing the very best we can for our babies, and they’re thriving because of our tender love and care. This is hard work, and we need all the support we can get.

What was your breastfeeding relationship like with your baby(ies)? Easy-peasy, challenging-but-doable, or it-just-didn’t-happen? How do you feel about that? Were you able to find support? Where? Please share your comments with me. I appreciate them and YOU so much!

Why is PAIN a Four-Letter Word?

Pain

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

*Not her real name.

Hopelessly Devoted to You…

Devoted

de·vot·ed
/dəˈvōdəd/

adjective
adjective: devoted
1. very loving or loyal.
“he was a devoted husband”
synonyms: loyal, faithful, true, staunch, steadfast, constant, committed, dedicated, devout; fond, loving, affectionate, caring, admiring
“a devoted follower of the writer”
2. given over to the display, study, or discussion of.
“there is a museum devoted to her work”

I love this dictionary entry for “devoted.” I would consider myself a very devoted Momma, partner, friend, daughter, sister, employee and Childbirth Educator. When I’ve found someone or something that I believe in, then it’s deserving of my full devotion. I resonate with both of these definitions, because I don’t think it’s enough to say that you’re “very loving and loyal” to a person or an idea. I think you need to show that devotion through action, which is where, “given over to the display, study or discussion of” comes in.

But being devoted to someone or something might mean saying or taking action that’s not very popular. Sometimes, being devoted means standing up for your own truth – even when others, maybe especially when others, try to tell you your truth is wrong or has no merit. Being devoted doesn’t mean that you always agree. Being devoted to a person or an idea, means you have to be the mirror at times. In wanting this person or idea to reach full potential, you have to be willing to shine a light in the darkness. Being devoted is both thrilling and frightening at the same time. But it’s not usually easy to be on the giving or receiving end of real devotion.

I can remember a few times in my marriage, where my incredibly devoted husband told me what I needed to hear. Let’s be very clear: it wasn’t what I wanted to hear, but it was exactly what I needed to hear. And I’m sure he can tell you some stories about my job as his personal mirror: “This is what I see. This is not who I know your best self to be.” Not easy discussions to have, but they can be game-changers, in my opinion.

When it comes to my work with expectant families I am devoted to the overall well-being of new Mommas, partners and their babies on their transformative journey of becoming a family.

But sometimes, that devotion can look a little bit more like “tough-love.”

I’m very devoted to the idea that women have positive and empowering birth experiences because I feel like this moment in a woman’s life can truly be transformative. It can set the stage for how well she moves into her role of Momma. It can either positively or negatively affect the couple’s relationship right from the very start. She can end up parenting from a place of inner strength, wisdom and confidence – or spend her entire parenting journey second-guessing every move. Her birth experience might only be a day in her life, but it can affect the rest of her life.

Wow – that’s big stuff.

And now for the tough-love talk. (Please remember that this is coming from a very loving and loyal place.)

Women need to start taking more personal responsibility for their births.

There are some providers, nurses and hospital policies that can get in the way of a woman’s positive and empowering birth experience. And there are plenty of other birth advocates decrying this very issue. But that’s not the whole issue. Women need to recognize their role in all of this. They need to take more personal responsibility for their birth experiences because if they don’t, birthing women, their partners and the families they’re trying to create together end up paying the price.

Women giving birth today, are doing so in a climate where information is everywhere and available all the time. Even though “Dr. Google” is not a great resource, it’s who they most often turn to for information – much of it biased, out-dated, and not evidence based.

Our maternity care system has become “us against them” when it comes to birth. I’m not sure it’s even possible to have a positive and empowering birth experience if you believe that having a hospital birth is going to suck. But if you really do feel this way, than take some personal responsibility for yourself and make different choices about where and with whom you’ll be giving birth. Your reaction might be, “It’s not that easy.” I know it’s not easy. I’m not saying that it is. What I’m saying is that it’s vital to own your role in the birth experience – even when it’s not easy.

When I was pregnant with my second baby, I had to make some big decisions. My beloved provider had moved out of town and our insurance had changed. So, I was going to have a choose a new provider and place to give birth.

Instead of doing my own research, I listened to a colleague and chose a midwife at a hospital that didn’t have the best reputation in town: too big and impersonal. Red flag #1 The clinic was pretty far away from where we lived, which meant my toddler and I had to deal with 40 minutes of driving for an appointment that lasted only 10 minutes. I hated it. Red flag #2 The hospital tour guide focused more on the big-screen TV than answering my questions about birth balls and squatting bars. Red flag #3 My midwife was part of a group practice, so it was not guaranteed that I would have her for my birth. Red flag #4 Now, none of these might pop up on your list as red flags – but they were on mine and I chose to ignore all of them. I knew, at several points along my pregnancy journey, that this was not the right choice for me, but I refused to take personal responsibility for this. And although my birth was quick and easy, my overall birth experience was very negative.

I hadn’t done my due diligence to make the best decisions for myself when and where I could. And it was this piece that I struggled with most in my early postpartum days with my newborn. I look back and realize my negative feelings around that birth experience had nothing to do with the birth outcome. It had everything to do with how I had dishonored myself and failed to make the best (although not easy) decisions I could to set myself up for the best experience possible.

Writing a Birth Plan is not enough. Having good intentions is not enough. Hiring a doula is not enough. You need to understand just how much work is involved in making this birth experience positive and empowering for yourself. No one will be making that happen for you. You need to make it happen. And that means getting real with yourself before you ever put pen to paper to capture your birth preferences.

Are you making choices that resonate with you? Don’t concern yourself with what your sister, BFF or members of your book club would choose. What do you want? Make some decisions for yourself. But don’t stop there! Get some quality, unbiased, evidence-based information that supports these decisions as being right for you. And then own those decisions – at least until you go into labor.

Once labor begins, you have to be prepared to make some decisions in real-time, as birth unfolds. Birth is too big to be planned out on an 8 1/2 x 11 piece of paper! And that scale you used to weigh benefits and risks in the classroom doesn’t get to come into labor and delivery with you. You get a brand new scale that you’ll have to use to weigh the benefits and risks all over again to make the most informed decision you can – while you’re in labor.

You must be a full participant in this birth from the very beginning all the way through to the end in order to feel that transformative strength and empowerment. My own personal experience, coupled with 20 years of working with thousands of couples, allows me to make this statement from a place of confidence: Feeling empowered and positive about your birth experience is less connected to how your baby is born, and more directly linked to how you feel as your baby is being born.

When you give birth from a place of confidence that you did everything you could in the moment to honor yourself and your process, it’s hard to feel anything but empowered. There are moments throughout your pregnancy and birth where you’re called to stand up and make a decision that might not be easy, that might not be popular, that might not even be what you wanted. But in honoring yourself in this way, you can claim full participation and own your birth experience.

When you do this, you show devotion to yourself, your partner, your baby, your family – and this is where it all begins.

What are you devoted to? Does this resonate with you? Are you still able to feel my deep devotion to you (despite my tough love)? I really do only want the best possible experience for you. And I can’t use this title for the post without giving you this link to the ever wonderful ONJ singing her heart out – enjoy, you’ll be singing it all weekend.

This was part of an exercise from The Writing Den, where we were asked to define what we are devoted to. Bringing more personal responsibility into the birthing experience is one of those things I’m devoted to. If you’d like to find out what your true devotion is, come join this group of committed individuals answering the call. It’s an inspiring place to be!

Almost: Very Nearly, Not Quite

Almost

I’m almost done. October 31st – the last day of this year’s 31 Day Project. Last year at this time, more than anything else I felt a huge sense of relief that it was finally over. This year I feel different. I feel a sense of accomplishment. I hit the “publish” button pretty early in the day most of the time (I think there was only one evening that didn’t happen until 10 pm. Last year this was a regular occurrence. In fact, I posted once at 11:59!)

I’m the kind of person who makes rash decisions every once in awhile. Not big and bad decisions that end with regret, but ones where I’m not completely aware of what I’m saying “yes” to. Which, for me, is good. It allows me to be audacious and just do it. Then, my tenacity and unwillingness to ever quit something once I’ve started, keeps me going – even after I realize how much harder this thing is that I’ve gotten myself into. (I did the same thing when I signed up to walk my first marathon. “How hard can it be to walk a marathon?” Pretty hard, it turns out.)

That was last year’s experience: “I want to start a blog. I haven’t written one before. So, maybe the best way to do it is to commit to writing a post every day for an entire month.” What was I thinking? Well, this year I knew exactly what I was getting myself into and I think that might explain why it went so much more smoothly. I’d also like to think that the writing I’ve put into my book and the essays that have been published or are in the works, means that writing is easier for me now than it was a year ago.

But the best part of this whole process has been the process. There’s a lot to be gained by having a daily practice of writing (thank you, Saundra Goldman). And I think I’ll continue to try and write daily (that doesn’t sound like a firm commitment, does it?) But whether or not I’ll be hitting the “publish” button every single day is another matter altogether. My blog posts won’t be a daily occurrence and maybe that will be welcome relief for my FB friends who haven’t been able to keep up. (Do I have another 31 Days in me? I just might… But we’ll talk about that next year!)

I just came back from a weeklong writing workshop focused on the new direction of my book project and this will take center stage for me in the months to come. But I’m still committed to writing blogposts about bellies, birth and babies for the foreseeable future. These are the subjects that I’m most passionate about and I can’t imagine that I’m all done having something to say or learn about these topics.

Today, on the very last day of my 31 Day Project, it’s tempting to think that I’ve run out of things to write about. And this morning it almost feels that way. But the definition of almost is: “very nearly, not quite.” I love the wiggle room this provides. I’m going to take a few days break and see what comes up that needs to be written about the pregnancy year – from conception to the end of that 4th Trimester.

Thank you for reading my words and providing me support, encouragement, and comments along the way. And to all the other 31 Dayers out there – Congratulations! We did it!

Have you enjoyed this series of posts about the 4th Trimester? Was there anything that you wished I had written about that I didn’t? Please leave me some suggestions. Right now, I’m almost out of ideas. :O)

Mmmmm… Bacon

Bacon

Just four days ago the mighty Internet screamed at us “BACON CAUSES CANCER.” Actually, the report was about red and processed meat, but every news story written about this subject had a big picture of bacon attached to it. (What can I say? I’m so on trend.)

Was it sheer coincidence, my rebel without a cause tendencies, or both that contributed to our family eating red meat not once, but twice in the past four days? Beef Stew on Tuesday and Butter Noodles with Beef on Wednesday – both were dee-licious! The fact that we hadn’t cooked red meat in our house for the past six months, was a little ironic.

Initially, my kids were worked up about the dinner offerings this past week – which allowed us to have a great discussion about hype, and media coverage, and ratings grabbing behavior, and how to read studies with a critical eye that looks beyond the headlines.

These are also great things to remember as new parents. There will almost always be something that you should or should not be doing at any time for fear of really screwing up your children. Sometimes these things flip flop and end up in direct opposition to one another. So it behooves you to read headlines not as gospel truth but as an article to read yourself and determine if a) it’s sound scientific and evidence-based information b) it builds on the studies that have come before and is adding to mounting evidence for or against something c) it’s statistically significant and the risk of doing this behavior or avoiding that behavior will make a real difference in your quality of health or life.

I’m not going to list out specific parenting decisions here. Why? Because, I’ve got my own way of parenting. And the parenting decisions I make are likely influenced by a lot of different things: my family of origin, my friend circle, the books I’ve chosen to read, or the pediatrician that my children see.

If I were to state my opinion about “Parenting Issue A” one of two things might result: 1) someone reads it but they parent exactly the opposite of me and feel the need to argue about it or 2) someone reads it and feels like I’ve just endorsed something as the “right” way to parent their child. That’s a little too much responsibility, for me. And quite frankly, it doesn’t place enough responsibility on you as new parents. That sounds harsh and I’m sorry if you’re picking up on that tone, but it needs to be said.

I want you to parent your child the way you feel is right for your family. It doesn’t have to look at all like how I did it, or your siblings did it, or how your own parents did it. And while it makes sense to pay attention to what studies say about “best practices” and parenting, those best practices might not work for you and your family.

An example that comes to mind is how we chose to let our babies stay up with us until we went to bed (after the craziness of that initial 4th trimester had settled down, mind you). My husband wanted to be able to see and hold his baby after he got home from work. My first ate every two hours around the clock until she was eight months old. It didn’t make sense to us that we’d put her down in a crib upstairs while we hung out together watching TV in the basement, only to have to get up with her every couple of hours. So, we just kept her with us the whole time. I would feed her, then my husband would snuggle her until she fell asleep on his chest or in his arms and he’d keep her there until she wanted to eat again. When we were all ready to go to sleep (we’re night owls in this house!) we’d go up to bed together.

I can assure you that this will never be listed in any book or study about being a “best practice” on how to get your baby to sleep at night. I can also tell you that there are lots of people who will read this and think that we were completely crazy! But, still, it was a practice that we repeated with each of our four children and it worked beautifully for us as a family.

I’m not looking for validation or vilification for making this choice in how we parented our babies around the issue of sleep. I’m just sharing with you how we came up with a solution that was right and worked for our family. I want you to consider what’s working for your family along with all the scientific evidence and best practices out there and remember that almost everything extreme is not good for you. There is such a thing as drinking too much red wine, or eating too much dark chocolate, or – yes, it’s true – scarfing down too much bacon. But there’s also such a thing as using your common sense and realizing that moderation is key. Try to keep this in mind even as headlines are using extreme tactics to gain your attention.

Finding out what works for your family, those unique parenting decisions that you make that are “just right” for you, boosts your new parent confidence level in a way nothing else can. Not even bacon.

Have you come up with any parenting decisions that sit outside the “norm” or hide in the shadows of the headline grabbing new trend? How confident do you feel about making some of your own decisions about the best way to parent you child?