Sea Turtles Laying Their Eggs

Sea Turtles

It’s a “Labor of Love”

 

We get off the boat and walk single file through back alleys and across the soccer field in the tiny town of Tortuguero, Costa Rica. Fernando, our guide, leads us through the grass and mud, pointing out the larger puddles so our group ranging in age from 8 to 48 might make it back to our hotel later, close to midnight, as dry as possible.

We trek for what feels like hours and finally stop at a covered structure in the middle of the jungle. We aren’t allowed to have our phones, or any other light source other than the ones our guides provide. The Costa Rican jungle is a very dark place – especially in the middle of the rainy season with the moon only sporadically peeking out between the clouds.

We’re met by a man dressed completely in black: hat, shirt, pants, shoes. The only light seen is the small red dot flashing from his walkie-talkie. Fernando gathers our small group together to give us instructions and explains what to expect next: “We’ll wait here until the scouts on the beach find a sea turtle which has made her way out of the ocean and is moving up the beach to begin the process of laying her eggs. We only have two hours of time to get the chance to see this happening, and we have no idea if we’ll be lucky tonight or not. If we hear from one of the scouts, we’ll begin our walk through the jungle immediately. It might be a short hike, or it might be a very long walk – we won’t know until we get the call. Until then, we wait.”

I ask a lot of questions and our guide is happy to oblige me. Fernando, is a local Tortugueran who lives in this small town on Costa Rican’s Caribbean Coast. He’s been guiding tourists through the rainforest-covered sandbar of the Tortuguero National Park  for years as a part of the Sea Turtle Conservancy. Their mission is to help protect the world’s endangered sea turtles. I can tell how much he loves these magnificent creatures that have been around since the age of the dinosaurs. Fernando is 65 years old and has been doing this work for over half of his life. He’s a wealth of information, and I’m an eager student – especially given that we’re here to see something that’s right up my alley – birth.

While we’re waiting for the call, I get a tutorial about sea turtles and how they lay their eggs. Sea turtles return to the beach they were born on to lay their eggs, season after season. There are several stages that a sea turtle must go through as they nest:

  1. She must first emerge from the ocean and ascend the beach. Sea turtles are very heavy creatures and they have to crest a wave large enough to get them out of the surf and onto the beach. She’ll be looking for “just the right spot.” And if she doesn’t feel like she’s found it, she’ll turn around and head right back into the ocean. The perfect place will be one that’s dark, quiet and has the right temperature variation so her released eggs will develop into an equal number of male and female baby turtles. The depth of the track that a sea turtle makes in the sand speaks to how heavy these creatures are. (The largest sea turtle on record was close to 9 feet long and weighed over a ton!)
  2. Once the right spot has been chosen for the nest, the sea turtle begins the digging process. She creates a “body pit” by using all four of her flippers. First, she removes the dry surface sand which will be used to cover up the nest once she’s done laying her eggs. After she’s created the body pit, next she has to dig the egg chamber using only her rear flippers and alternating between the right and the left, to scoop out all of the damp sand.
  3. When the egg chamber is deep enough and her flippers can no longer reach down farther to scoop out any more sand, she pauses and begins to have contractions which make her rear flippers rise up off of the sand.
  4. She then enters into a trance-like state and begins to lay her eggs. With each contraction, she might release anywhere from 1-4 eggs at a time. She continues to fill the egg chamber almost up to the top. (On average, sea turtles will release 110 eggs with each “egg clutch” and the range for egg clutches is 2-8 per season.)
  5. When her egg clutch is complete, she’ll close up the nest using her rear flippers the same as she did to dig the egg chamber – only in reverse. She places damp sand on top of the egg chamber and fills up the hole completely. She then presses the damp sand down with her massive body and lastly begins to camouflage the egg chamber by throwing the dry surface sand behind her as she moves forward. This is done to protect her eggs from predators.
  6. Finally, she makes her return trip, dragging her heavy body along with her front flippers and then waits in the surf for a wave large enough to carry her back into the ocean. She does not tend this nest again. Her job is done.

All of a sudden, the flashing light on the walkie-talkie goes off and there are some whispered instructions from one of the scouts: some turtles have made their way up to the beach and Fernando is given the coordinates of where to find them.

We break up into smaller groups and head off through the jungle again in single file with only the light from Fernando’s headlamp to guide us. When we get to the beach even that light is extinguished and we’re told not to talk above a whisper and to not move any closer as nesting sea turtles can feel vibrations through their bellies on the sand and will avoid nesting if they feel a potential threat or think a predator is nearby.

We huddle together at the tree line and wait for the scout on the beach to give us the go ahead to move in closer. We’re told that it’s important to not move in until she’s in the process of releasing her egg clutch. Once that part begins, it can’t be stopped until all of the eggs have been delivered. Her trance-like state during delivery would allow us to have a closer look.

After what seemed like a really long time, we’re told to come out of our hiding place and move in closer – but not because the sea turtle is laying her eggs. She’d started the nesting process and had found what appeared to be a great spot, but changed her mind and was now heading back out to sea.

We keep a safe distance, but are able to watch and follow this magnificent creature as she makes her way down the beach. She’s massive! Her shell is at least 4 feet from top to tail, and while we have no scale to weigh her, the track she leaves in the sand is several inches deep!

I’m struck by how intense this process is. She’d already put in so much work! She dug her body pit and even began scooping out her egg chamber – but something was just not right. Maybe the temperature of the sand was off by a degree or two, maybe she felt the spot was not as well protected against predators as she’d like – but for whatever reason, she stopped the process mid-birth and turned around to go back into the water.

I find out from Fernando, that each sea turtle only has a few days to release an egg clutch. He couldn’t be sure, but she might have one or at most, 2 more evenings to try and make her way back to the beach and find a better spot to lay her eggs. Those eggs, once released, will sit in the nest she’s created for about 45-55 days, on average. The eggs themselves are usually oval in shape and have a “pouch” of air to allow the baby sea turtle to breathe as it makes its way up and out of the sand. When the sea turtles begin to hatch they do so en masse, all of them working together to break free from their shells, causing the dry sand to spill out and around the other eggs causing them to rise to the surface together.  Sometimes this process is called a “turtle boil” because the sand looks as though it is bubbling up like water boiling.

Baby sea turtles are “phototactic” and use the reflected light of the moon off the waves in the surf to guide them back into the ocean where they spend their early years hiding and growing, hopefully into adulthood. Where they will begin the process of fertilizing and laying their own egg clutches back on the beach where they were born, and so on. Sadly, it’s estimated that only 1 in 1,000 baby turtles will get this opportunity.

I feel so lucky to have had the chance to witness an endangered sea turtle’s process of nesting. I was so impressed by this Momma’s willingness to do everything she needed to do to give her babies the best start in life. Even if that meant getting half-way through the process, only to determine that the conditions were not ideal and carry herself back out to sea and try again the next night.

It makes me think about how motherhood is so strikingly similar across species!

We, as birthing women, also need to have ideal conditions in order to give birth. And whether we realize it or not, we’re using all of our senses – including our gut – to determine if things “feel right” before contractions can begin in earnest. Only then are we able to move into the trance-like state of active labor and bring our babies into the world. And once our little ones have been born, how hard we also try to protect them and bring them safely into adulthood!

If you ever get the chance to witness any part of the sea turtle nesting process, go for it! Sitting quietly on the beach of Tortuguero National Park, with the ocean waves crashing on the shore, and a raging storm miles away providing us with a spectacular light and sound show, we got to watch these strong, determined, and powerful Momma sea turtles do the hard work of labor and birth.

And this is something that I’ll remember for the rest of my life.

I dedicate this post to our amazing Costa Rican trip guides, Gabby & Fico, as well as our incredibly knowledgeable and passionate Sea Turtle Conservancy guide, Fernando. The work that Costa Rica is doing as a whole to help preserve and save endangered species is of huge benefit to us all. Thank you.

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Being Present

Being Present

Or, “The True Gift of Labor Support”

I got called out of retirement and had the privilege and honor of being the doula at the birth of Baby M born just over two months ago.

I’ve been asked by many couples over the years if I would consider being their birth doula. It’s always a bittersweet moment for me, as I love being a witness to birth almost more than anything else in the world. But with four kiddos, two part-time jobs, a relationship with my hubs that I like to see flourish, and this writing gig of mine – I have ZERO time to attend births.

So, when M & A asked me if I would be their doula at the end of the first night of our 4-week series, I told them what I usually tell all of my students making this request: “Oh, that’s so sweet – but I’m not really doing births. My life is just a little bit too full to consider this a realistic option right now…”

They were a little bit disappointed – but said they understood and they’d see me next week. I promised I’d send them an email that included thoughts on hiring a doula, what to look for, what questions to ask, and a few referrals for local doulas that I thought were really great.

The next week, I asked if they’d decided on a doula yet.

“Ummmm, no. We only want you.” This flattered me, but I knew when their due date was and not only would I be teaching a ton of classes around that time, I was also scheduled to leave town to go to my niece’s wedding. There really was no way.

“I really wish I could be your doula – but it’s just not going to work out. I think you should contact some of the people that I’ve referred you to and we can chat more about this next week.”

I’m guessing you’ve figured out what happened next.

Every week they’d come back and say that they hadn’t talked with any of the referrals and finally they decided that if I couldn’t be their doula, they’d be just fine on their own.

Now, I think couples can do really well on their own, but it’s hard to deny what the evidence shows about having the continuous presence of a doula during labor and delivery – statistically better outcomes for both Mommas and babies!

On the last evening of class, M & A gave me a book and a thank you card which read, in part: “We would be remiss not to formally ask you to consider if you would attend our birth. We completely understand your busy teaching schedule and travel plans and if it relieves any hesitance or pressure, we wouldn’t plan to rely on your presence. In our minds, the structure would be that if it worked out such that you were free and available, we’d love it if you would join.”

I mean, really, how could I say no to that?

This was a couple that I believed would be just fine if I wasn’t able to be there on the big day – I didn’t for a second think they were trying to say the right thing to get me to agree. They were being completely sincere and were speaking my language… I’ve always felt that when labor begins, the people that are supposed to be there to witness the event somehow end up being there. If I was meant to be at their birth, I would be there.

So, we came up with a really interesting split-fee set-up: one amount for the pre-birth “Phone Doula” work that I would provide for them which included: a formal interview about their birth wishes, some assistance creating a template for what really mattered for them in their birth experience, some questions to spark discussion with their provider, and the availability to answer any questions and advise them as they came ever closer to the birth of their baby. And if I ended up being able to be at the birth, there would be an additional fee.

The real gift of labor support is being fully present to an expectant family.

And for me, that began when they hired me. It wasn’t as if I dropped everything I was doing, but we had some regular text check-ins and a few phone calls to see how M & A were doing as the due date drew ever closer. I slept with my phone on and next to my headboard at night (I usually have it turned off, far away from where I sleep and covered up as any “Ping!” noises or even the battery light is enough to keep me awake!)

I kept my phone with me at all times and was checking it much more often than is usual and I’d get back to M & A as quickly as possible after receiving any contact from them.

And on Saturday, April 8th, I began my formal “it could happen at any moment” doula-watch. M called to report that A was having contractions and that “It might happen tonight!” While I appreciated his excitement, after hearing that they were both scarfing down Mexican food at 11 o’clock at night, I encouraged them to get some sleep as I didn’t think that they were going to have a baby anytime soon.

I received word from M in the early morning hours that A had slept soundly through the night – confirming what I thought was happening… Great early labor, but nothing to be getting too worked up about.

Over the next several days, I was in pretty close phone contact with M & A as they navigated what seemed to be prodromal labor. They were handling it so well and really only needed quick check-ins for reassurance that they were on the right path and that everything they were experiencing was normal and good work for what was to come.

On Thursday April 13th, the call finally came: A’s water had broken! I think they were both excited for this very positive sign of labor finally happening, although the contractions hadn’t progressed enough to call it “active labor” yet.

I was excited for them as well – I’ve had prodromal labor myself and I know just how frustrating it can be if it continues past a couple of days – and we were closing in on six days at this point! I was also thrilled they’d gone into labor before I left to go out of town – but, I was scheduled to teach a class that evening and I hadn’t arranged for a sub yet.

It took some finagling on my part (and a small bribe of chocolate and beer) to enlist my friend and colleague Jen to take my class for the evening – but the details weren’t figured out until about 4 pm that afternoon. During the day, M & A made their way into the hospital and I continued playing Phone Doula for them, encouraging them at one point to try some exaggerated marching through the hallways to see if they could get the labor to pick up speed. Apparently, this was a hit with all of the nurses – they loved it!

I finally arrived at the hospital around 6 pm and after saying hello, A had what was, by the reaction, her first real-deal contraction, saying “Whoa! That one was really different!” I laughed and said, “Well, now that your whole birth team is here we can get serious and have ourselves a baby!” And, in fact, about eight hours later that’s exactly what happened!

I won’t give a play-by-play of the entire labor, other than to say that, I fell in love with this couple as I watched them work together to bring their baby into this world!

The act of giving birth, watching partners support the one they love giving birth, and witnessing the birth of a family is sacred work to me. And in this sacred space, time stands still as we are all present to one another, living only in this moment together.

And while it’s nice to know a few things about breathing, and positions and other comfort measures – the real gift of labor support is in being present.

Some people might doubt how having continuous labor support can make such a difference in positive labor outcomes for Mommas and babies – but in our ever-increasingly-barely-ever-present culture, I think it makes more sense now than ever!

As a birthing woman settles into her rhythms and rituals, making claim to the strength she might not have been aware of until this moment, she’s able to ask for whatever she needs – RIGHT NOW – to realize this act of co-creation. She opens herself, both figuratively and literally, to bring forth this new life from within.

And in this moment-by-moment experience, everyone focused and working for one purpose, a miracle occurs: it’s not just a baby that is born, but also a mother, a father and a family. These people are now connected to one another, and they will be, for their whole lives! To witness this in whatever role – doula, nurse, provider, friend or family member – is also a gift that connects all of us in this one moment in time.

I was really exhausted after this beautiful birth! And I couldn’t figure out why at first – I mean, I was only there and working hard from 6 pm until about 2:30 in the morning. In the world of birth, that’s not a lot of time! And then I realized why… It had been awhile since I’d been so focused and present in a continuous way for such a long period of time. And it’s intense to be truly present to the sacred for any period of time.

But oh, what a gift!

I dedicate this post today to M & A and Baby M. I’m so honored to have played a small part in witnessing the birth of the three of you as a new little family! Thank you for your persistence in hiring me, and for giving me the idea of being your “Phone Doula.” I’m so happy to be connected to you in this way.

PS – We’re also connected in one other very important way… Baby M and my son, Alejandro, share the same birthday (only 15 years apart)! I’m pretty sure that this is another sign that I was meant to be fully present at this birth.

And The Oscar Goes To…

Oscar

Just yesterday, I taught a “Comfort Measures for Labor” class. It’s a short and sweet intensive class that examines the mind/body connection and the power of relaxation, rhythm and ritual as coping tools for labor and delivery. We practice the #1 comfort measure – breathing. And the class ends with a labor boot camp circuit: a hands-on practice session where we put it all together: massage, position changes, music, and breathing.

I knew over half of the group yesterday, as many of the couples had been in my classes before and were wanting that extra practice before the big day. But there were also some veterans in the group – three couples were there to use the class as a refresher because it had been a couple of years or more since they’d given birth.

As they were moving from station to station practicing different positions, I’d change up the breathing we’d practiced earlier. This was to simulate the intensity of the contraction. I’d have them do one of three levels of breathing: deep belly breathing throughout (early labor), light and shallow chest-only breathing while holding one frozen bottle of water (active labor), or chest-only breathing combined with vocalization, while holding two frozen water bottles, one in each hand (transitional labor).

I noticed right away, how the first-timers were very uncomfortable making any kind of noise while practicing transitional labor breathing. Even when I told them I would make more noise than all of them combined, they still were close to silent. But not the 2nd timers! All three of these couples quickly sunk into a remembered rhythm in their bodies, their breathing and in the noises they were willing to make on each exhale.

Now, for sure, practicing breathing and positions with a group of relative strangers is goofy! It’s a little bit ridiculous, actually. And – it’s also very true that holding one or two bottles of frozen water will never, ever be close to what a contraction feels like! But practicing with ice (or even better, ice water) gives your mind and body something to work through as you practice different positions. This can be very helpful in preparation for the real-deal.

I found it interesting how both Mommas and partners who’ve gone through this before were so willing and able to drop back into that experience. And even if they felt a little or a lot uncomfortable, they remembered how much it helps to make noise when we feel tension in our bodies. Vocalization is such a great way to release and let go, which is so important as we move through our labor experience.

When I was having my third baby, I started to want to vocalize through the tougher contractions. I’d not done this before with my first two, so this was new to me (even though I teach it all the time!) But instead of going for it, I was making these small “ooooooooooooooh” noises with each exhale.

My husband, sitting in front of me, took one look at my contorted face and said, “You look constipated. Are you wanting to make some noise, like this?” And with that he opened his mouth wide and started bellowing, “OOOOOOOOOOOOOOH!!!” I quickly followed suit, opened my own mouth wide and really made some noise.

And it felt good.

We kept it up through each contraction, basically screaming at one another through the peaks, and then we’d dissolve into laughter when the contraction was done, because… It was ridiculous! But oh, so helpful! Without even realizing it, my husband had become my “birth partner in crime” and given me the permission to do whatever I needed to do to continue to cope with my contractions. What a gift!

In my classes, I encourage partners to be on the lookout for any rhythms, rituals, and vocalizations that Momma is doing – and then do them bigger and louder so that she feels free to express herself fully in finding those coping and comfort measures that work best for her.

While it’s often true that the veterans in the group are the ones that are willing to make the most noise during a childbirth preparation class, that’s not always the case.

A handful of years ago, there was a woman in my class, let’s call her Nancy, who must have had some sort of background in theater. Whenever we would do a practice session, she would become a method actor. Watching her was like watching someone in a movie. She didn’t care at all that there were at least a dozen other people in the room. She was amazing! Not over the top, just fully committed to her role of “laboring woman in the throes of giving birth.” 

She gave it everything she had. Nancy’s partner had to work like crazy just to keep up with her! I’ve always wondered how she might have worked through her real labor. Was she as loud and expressive as she’d been during our practice sessions? Or was she more quiet and reserved as she found different coping rhythms and rituals that worked for her?

In my mind, I imagine her roaring through her pushes: freely expressing herself without inhibition, her encouraging partner by her side – not embarrassed, not shushing her – giving her the permission to release and let go of each and every contraction through her voice. In all my years of doing this work, I’ve ever seen anyone else so willing to dig deep and make some noise during our practice sessions. As far as I’m concerned, the Oscar goes to… her!

And to all the other Mommas and their supportive partners out there, loudly or quietly, finding their own rhythms and rituals as they bring their babies into this world.

What about you? Were you loud or quiet as you gave birth? What were your rhythms or rituals that you did spontaneously in birth that helped you cope with your contractions? Were you surprised the coping and comfort measures you chose?

Why is PAIN a Four-Letter Word?

Pain

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

*Not her real name.

Breathing – It’s Not Just for Labor Anymore!

Lung

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

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

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

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

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

Why does this matter when we’re in labor?

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

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

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

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

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

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

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

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

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

Situation II: Houston, We Have a Problem!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Magic 8 Ball

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

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

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

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

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

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

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

Guess what really happened with these two women?

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

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

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

But we all still do it! Why?

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

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

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

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

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

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

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

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

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

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

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

Due Date – How About Due Month?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So try this little exercise…

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

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

And that is something you can count on.

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