Sunday Stories: Birthing Center Example of a Calm Natural Childbirth

I’ve been very passionate about sharing how birth can be a calm experience recently. Here’s another video of a natural childbirth from The Baby Place  Birthing & Midwifery Center. There is nudity and a close up of pushing, just as a warning for my squeamish readers.

I appreciate that the transition to the birthing center was later in labor and very calm. Mom was already somewhere around 7 cm when she arrived at the hospital. When it came time to pushing, this mama did an absolutely amazing job of breathing her baby down and out. Notice that she pushed in an upright position and her midwife is supporting her perenium rather than pulling out the scissors to cut it. Also, they waited until the cord stopped pulsing to cut it, so this little guy got his full blood supply.

I can’t get the video embedded, but you can click here to view it. Beautiful video. Enjoy.

Trust Birth: Time-Tested Mantra or Expression of Blind Faith?

If you’ve hung around natural childbirth circles for any length of time, you’ve probably heard the saying “trust birth.” Pregnant women, they say, should not doubt their bodies’ natural ability to labor and birth a baby. When left well enough alone, birth will go just fine. Some accompanying phrases to the “trust birth” mantra are, “your body knows what to do,” “that baby will come when he’s ready to be born,” “babies know how to get themselves out,” “the body is smarter than we are,” “women have been birthing babies for thousands of years,” and “follow your intuition.”

Has the phrase “trust birth” earned- well- our trust? Can we indeed put faith in the natural process of labor and delivery? And if not, can we conversely chant, “trust intervention?” Have interruptions to the natural process of birth shown themselves to  be foolproof?

I think an illustration might come in handy to help us understand these questions.

I trust my husband. I trust that he is faithful, that he will be kind and forgiving to me when I mess up, and that he will help me when I ask him for help. I trust that he is a caring father who will do everything possible to help raise our son lovingly and in strong character. I even trust that when he says he can make dinner, that I will end up with a tasty meal at the end of the evening.

Why is it, though, that I trust my husband? Did I meet him on the street, marry him the next day, and simply believe that all of these things would be true? Of course not! I trust him because he has proven himself over and over to me. My trust is not blind faith. Rather, it is informed from what I have seen and experienced over one year of friendship, almost three years of dating, and two and a half years of marriage. Six and a half years of spending the majority of my time in various situations with my very best friend has taught me a lot about how he functions. He has most definitely earned my trust.

On the flip side, no matter how much I trust my husband- say, that I trust he can cook me a good meal and give me a night off- there is always that slight possibility that he could mess up. He COULD burn the food. Even if he was the most experienced of chefs, he might accidentally forget the chicken in the oven, or he might cut his finger on a knife, or he could possibly start a grease fire if he wasn’t being careful.

Does this reality, that my husband is a fallible human, cause me to run around fretting the entire time he’s making dinner? Certainly not! Yes, I suppose it could happen. Yes, we do have smoke detectors and a fire extinguisher in our house, just in case something were to go awry. Yes, I do have bandages and a first aid kit, supposing he took a chunk out of his finger during prep work. And I am willing to step in and finish dinner if need be, or even to order pizza if neither of us can fix it. While I have those back-up plans in place, I expect that everything will probably turn out just fine, because I trust my husband’s ability to cook dinner.

Now, I know that birth is an event of much stronger gravity than cooking dinner. However, I think we can take some of the principles from my illustration into consideration when questioning the phrase, “trust birth.”

When we don’t interfere with the process of birth, it goes just fine 85-95% of time (depending on who you ask). Women have  indeed been giving birth for thousands of years, and I personally believe that God designed the process. Labor and delivery, for the most  part, has become a time-tested event that we can usually expect to go well. 

However, we do live in a fallen world, and there is that 5-15% of complications and frightening times in birth. Do we worry and fret the entire time that we’re in labor, thinking, “oh no, oh no, what if something goes wrong?” We cannot really afford to be fearful of the “what ifs,” as we cannot control whether or not they will happen, and sometimes the worry itself creates self-fulfilling prophecies. All that fear of the unknown does is make our labor scarier and more difficult. Likewise, we cannot blame ourselves if something does go wrong, because it can still happen even under the very best of circumstances.

While worrying about possible complications doesn’t do any good, it is ultimately wise to be prepared for complications, no matter what type of birth you’re having. As Birth Sense stated so reasonably, “My point of view is that it is not a lack of trust to prepare for the unexpected, but expect to not need those preparations.” It would be foolish and naive to think that nothing could ever go wrong at a birth, but dreadfully unhelpful to spend countless hours running the “what ifs” in your head. Prepare for the worst, but hope (and expect) for the best.

Can we trust birth? I think that in a completely natural delivery, with proper prenatal care and preparation, we can expect that things will probably be fine. It would only be blind faith to assume that it would always be just fine.

Can we trust intervention? When the benefits of the interventions outweigh the risks, we should make judicious use of them, understanding that they may or may not always fix the problem. While interventions are often effective, we cannot blindly trust them either, assuming that they will always save us.

We need to prepare for the unexpected in all situations, whether our birth is natural or managed for whatever reason. We trust that birth is a normal event, but we have plans for the unforseen. When we opt for interventions, we should know the probable and possible outcomes. We should expect for things to go well, but always be flexible and ready to face surprises.

Keeping Cool Through Contractions vs. Passing Out at a Prick

If you started to fall while walking with your baby, what would you do? Well, when I crashed while walking downhill with my son a few days ago, I did what any mother would naturally do: try to catch my son. I did just that. He was totally fine- he didn’t even cry! I, however, did not catch my own fall and ended up with an impact split in my knee that went down to the muscle and required a trip to the urgent care clinic and 11 stitches (which is part of why I’m a little behind on blogging).

I gave birth completely naturally- I had not so much as a Tylenol. You would think, therefore, that I would be tough as nails about a little hole in my leg. However, the trip to the clinic told a different story. I nearly passed out when they injected me with lidocaine because I’m such a chicken when it comes to needles. At the end of the stitching, I could still feel a bit of it (though barely) and I was wincing every time she passed the needle through. And I’ve been limping around the house the past two days (even though I’m really probably just fine), making faces every time I feel a little discomfort.

What was the difference between this pain and the pain of giving birth?

Are they different types of pain? I’m not a doctor, so I’m sure I don’t totally understand the concept of how pain works. That being said, I don’t think that they are actually different types of pain (aside from the fact they were in different places and different causes). I think my brain was receiving “ouch” messages in both cases. Here’s what I think made the difference:

Pacing of Pain

When I busted up my knee, there was no pacing of pain. It was a crash then immediate pain that has persisted for days, though dulling as time goes.

In labor, the pain starts out as minimal and gradually increases. This gives your body and brain time to adjust to the rising pressure of contractions. Also, in most cases, there is “resting time” in between each contraction during early and active labor. This natural pacing gives mom time to collect herself and meet the contractions as they come. (Note that there are, of course, exceptions to this normal pattern of labor.)

Purpose of Pain

In the event of falling, a car crash, or a sports accident, there is no real purpose to the pain, except to tell you that something is wrong. It’s almost always an unfortunate event that ends in medical treatment and perhaps painkillers. You have nothing to show for it afterwards besides your bruises and scars.

In labor, the pain has a wider range of purposes, many of them positive! Generally, the pain is because your body is opening, working towards meeting your baby. Each contraction is a signal of dialation, effacement, stretching, and preparing for delivery. Sometimes specific pains, such as back pain, are indicators of a need to change positions or move to make labor more comfortable. A pain that feels “wrong,” or dreadfully unusual to a mom can also be an red flag to check and make sure everything is going alright. Finally, the toiling of labor (even if treated with medication) brings the greatest reward to a mom afterward- the joy of meeting her baby.

Perception of Pain

When you have an accident, you usually just react with an “ouch!” (or your own choice of exclamations). The suddenness of the pain gives you no time to collect yourself. Even treatment and recovery isn’t looked upon fondly, because you tend to wish that you  never really got hurt in the first place.

Even if you dread approaching labor, you at least know that you will meet your baby at the end. All women, whether experiencing natural, medicated, or cesarean delivery, have an end in sight that they are striving towards: holding that precious one in their arms. This very fact has drawn out great strength in women to face labor head on. The perception of the pain is changed because they are already willing to go through anything for their child, even without having met them.

Many women choose to change their perception of the pain they are experiencing in order to acheive a natural birth. Some use visualizations, some use breathing, some dance and move, some sing, and some use hypnosis. All of these can help moms to make it through labor without medical pain relief. Even if this is not your own personal goal, the reality of meeting your baby can drive you forward to make it through labor in whatever way you can.

Even if something hurts, the context of the pain can really change the way you think about it. Labor is not the same as an unfortunate accident. It is not random. Rather, it is designed. It can teach us about ourselves. But, mostly, labor gives the most valuable treasure of all at the end of its struggle. No matter how the delivery occurs, birth is a beautiful passage that creates both a baby and a mother. That is what makes every ounce of pain worth it.

Why I Chose Natural Birth

Why have a natural birth? If I told people during my pregnancy that I wasn’t planning on an epidural, I was asked, “Why put yourself through that if you don’t have to?” Why, indeed? Is it so I could pat myself on the back afterwards? It is so I could feel like a martyr? Is it to prove something to other women, or to feel more like an “earth mother?”

Well, no. I did not choose a natural birth for any of these reasons. Here are three important reasons why I chose to birth naturally:

1) For my body.

The term “Natural Childbirth”, or “NCB,” as some like to call it, loosely means that the mother gives birth without any drugs or interventions. It seemed to me that it was best for my body to avoid the risks and possible complications caused by commonly used medication and interventions if at all possible.

For example, the hailed epidural, while often providing excellent pain relief, can also bring about a fall in maternal blood pressure, nausea, and vomiting. It can slow labor down considerably. Epidurals are also associated with a higher cesarean rate, which can certainly be considered harder on the mother’s body than a vaginal delivery. They sometimes create long term side effects for mothers, such as spinal headaches,  and its possible to have rare but life threatening reactions to an epidural.

However, it’s not only the epidural that carries risks and adverse effects on mom’s body. Pitocin, the commonly used tool to augment labor, creates harder and much more painful contractions for mom. This often leaves the mother asking for more meds to ease the pain. Narcotics can depress mom’s breathing. IVs can lead to fluid in the mother’s lungs and diluting of red blood cell concentration (this anemia in labor predisposes mom to bleeding). Artificial rupture of membranes makes contractions harder on mom before they need to be, as well as increase the risk of infection.

These interventions all create secondary effects. Once mom takes medication, she needs electronic fetal monitoring (EFM) to watch the baby. If it’s internal monitoring, this means she is now attached to the machine. If she has an epidural, she’ll most likely need a urinary catheter since she cannot feel to go herself. And an epidural itself significantly decreases or completely cuts off mom’s mobility. Lack of mobility makes for slower labor, makes for a less physiologic birth because it doesn’t help the baby make her way down the birth canal , and often restricts the mother to the lithotomy position for pushing (this creates even more complications for mom’s body).

Phew! Maybe my body could handle labor a whole lot better if I just let it do it’s thing!

2) For my mind.

I’ve heard several mothers say that the narcotics given in labor made them feel drunk or drowsy, but didn’t take the edge off the pain too much. Some moms might prefer this sleepy, “out-of-it” state of mind, and it might help some mothers relax enough so that labor can progress smoothly when tension otherwise might have taken over. I personally, however, felt it was important to be “all there” for labor and delivery. I wanted to be alert and aware for my first meeting with baby- not half-asleep.

I’ve heard the argument that all the interventions in labor can create adverse psychological effects. How so? Well, they say that being hooked up to an IV, EFM, urinary catheter, and having an epidural in the back, along with being on my back, legs up high in stirrups, and constantly being poked at “down there” (frequent internal examinations) can make a woman feel helpless, non-participant, exposed, and more like a sick patient than a mother working on meeting her child. I cannot attest to this personally because I have not had this experience. I’m sure that some women might not mind this process so much, but to me, it sounded terrible. I wanted to remain active and feel in control of my labor.

This part might sound weird to some mothers, but for me, it was emotionally important to feel everything. I wanted desparately to experience the process as fully as possible. I wanted to be in touch with my body and my baby, to listen to his cues to move this way or that way, sit, dance, moan, or bellow. I felt that I wouldn’t appreciate the process of labor as much if I didn’t feel it. I felt like meeting the baby would be all the more enthralling if I had to work to get there. It seemed that the absolute bliss of delivering my child would be even more magnified if I fully understood and lived and smelled and tasted and breathed every second of labor and delivery.

3) For my baby.

Most importantly, I chose to birth naturally for the sake of my little one. We are so careful during our entire pregnancies to do the best for our babies. We (hopefully) give up smoking and alcohol (if you partook in your non-pregnant state), we limit our caffeine, and we make sure we don’t eat anything undercooked. We take prenatal vitamins religiously, avoid anything with the label, “If pregnant or breastfeeding, ask a doctor,” and are extra careful of our growing bellies. Yet, at birth, so many women quickly and sometimes carelessly sign up for medication that can and often does have adverse effects on the baby (in their defense, often without knowing the possible effects).

What are some of these risks I avoided by choosing to birth naturally?

An epidural can cause serious drops in baby’s heart rate, makes for longer labors (sometimes less tolerable for baby), and makes for an increased rate of vacuum extractions, forceps deliveries, and cesarean sections (which can create additional risks for baby). Are narcotics safer? Remember that they can depress mom’s breathing, leading to less oxygenation for the baby. Narcotics can also adversely affect fetal heart rate. Pitocin, often used to augment labor after an epidural (or for other reasons, some of which are not medically indicated) makes for longer, harder, stronger contractions, making the baby much more likely to experience fetal distress. Artificial rupture of membranes makes for higher risk of infection for mom and baby. IVs dilute mom’s red blood cell count, therefore also reducing oxygenation to the baby. Glucose containing IVs can have adverse effects on baby’s sugar levels and lack electrolytes. These IVs lead to low blood sodium in the newborn (putting the baby at risk for seizures and apnea). They also cause fluid overload. This excess fluid can get into the baby’s tissues and lungs (making for breathing diffuclties). Excess fluid can increase the likelihood and severity of newborn jaundice, and can also cause a type of transient pneumonia. Internal EFM requires a prick in the baby’s scalp, which isn’t at all a major injury, but I didn’t like the idea of it unless I really needed it to check for suspected fetal distress.

Keep in mind that many interventions decrease mom’s mobility. When this happens, mom can’t help baby move down, open up the cervix, and travel through the birth canal nearly as easily. However, if mom can get upright and move, she helps the baby to keep shifting downwards. Being upright in the second stage of labor means a shorter pushing time and more oxygenation to the baby (no pressure on major blood vessels this way). A physiologic birth is good for the baby too!

Finally, just as I wanted to be “all there” for the first meeting of my child, I wanted him to be “all there” too! It is widely acknowledged that babies whose moms receive medication during labor are more likely to be sleepy and have trouble suckling at birth. The drugs get to the baby too, and can interfere with initial bonding. Those first moments are so precious, and I really wanted my baby to be just as alert and aware as I was.

Disclaimer

I do understand that in a true emergency interventions can be life saving, and I am certainly not opposed to them as a whole. Even in non-emergency situations, when the benefits of interventions outweigh the risks and they are needed for medically indicated reasons, they can sometimes make birth safer for mother and baby. I do believe that most of the aforementioned interventions exist for a reason, have a place, and can have some positive effects. It is less than helpful to vehemently deny them in every single circumstance. However, I strongly feel that it is important to know the risks and benefits of each intervention before signing up for any of them.

Also, for the record, I don’t believe that asking for an epidural or nartcotics makes you a sissy or a weakling. Every mom has her breaking point, and I don’t think any of us can judge when that might be for someone else. Sometimes having some pain medication (perhaps in an extremely long labor, for example) might be what can give rest or some peace of mind to the mom and allow her to look back on the birth as a positive experience.

Concluding Thoughts

I think the important thing here is that we weigh our choices in childbirth carefully, with full understanding of the risks and benefits of each intervention. That way, if mom does decide she needs medication, or if she truly does need Pitocin (as I did for post-partum hemmorage), or if a cesearean might actually be needed, she understands her options and is prepared to work with the outcome of her choices. This also helps her to feel more in control and more positive about her labor and delivery choices.

For me, the benefits of routine interventions didn’t seem like they could outweigh the risks, especially when there are so many effective natural means of pain relief and labor progression. Every intervention, even if effective, also creates side effects that may be less than desirable. I felt that labor went much more smoothly when I allowed my body to do what it was made to do naturally- work that little baby out! Overall, my natural childbirth was the best experience of my life. If my future health, labors, and babies allow it, I would love to do it that way again.

Much of this information gleaned from:

Goer, Henci. The Thinking Woman’s Guide to a Better Birth. The Berkley Publishing Group, New York, New York. 1999.

Collecting Positive Birth Stories

Many women in America today see birth as a terrifying unknown, a dreaded trial that they have to get through before they can finally meet the baby. Much of this fear is due to the current media representation of labor and delivery. Part of what I would like to do with this blog is to correct our perception of birth by sharing positive and encouraging birth stories, whether they be in written or video form, at hospital, birth center, or home births.

Birth is a life-altering experience, one that brings out the greatest weaknesses and greatest strengths that each mother posesses. Birth is not usually described as an easy process, and almost always involves pain and some aspect of unpredictability. It is my firm belief that all women should be honored when they bring children into the world, no matter what the mode of birth was. Also, I do not think that any woman should be made to feel badly if her birth was not ideal or if she had to change her plans. I do believe, however, that birth does not have to be a frightening, horrible experience. Rather, it can be a beautiful experience: one that taught you deeply about yourself, showed you that you were capable of things you never thought possible; a passage that tempered you on the way to meeting your precious child, and an event that can be fondly remembered and treasured. I believe that we can help some women to overcome their fears and work towards acheiving the type of birth they desire by sharing stories that are inspiring and empowering.

I would love to collect more positive stories to share with expectant mothers. If you have a birth story that you would like to share or a birth video that you would reccommend, please contact me at thebirthbug@gmail.com. Let’s start changing the way women see birth!

I thought I would start by sharing a lovely video of a pleasant homebirth. Enjoy!

Birth Animosity and a Guide to Sanity

I’ve been reading all sorts of blogs and forums on childbirth recently, and almost any article actively pro- or anti- ________ (fill in the blank: natural childbirth, interventions, homebirth, etc.) is followed by a long strand of back and forth comments, each series seemingly more vicious than the next. The banter is reminiscent of two kids on the playground, each convinced he knows what he’s talking about:

“Oh yeah? You think you’re so smart? Where’d you learn that?”

“Well, just listen to this story- that means it has to be true!”

“Wow! That story makes you look like a total idiot!!!”

And on and on and on…

Why is it that birth issues are discussed this way? Maybe it’s because birth is so personal, or maybe it’s because we’re so passionate about the choices we made, or maybe it’s because we were hurt by a particular experience so we speak out against it. These are valid feelings, but I need to be frank here: I’m very tired of all the name calling, credential waving, antecdotal gossiping and bragging, and arrogant and opinionated birth animosity that goes on across the web. All of this is anything but helpful for women who are trying to make educated decisions about their birth. It is not constructive for mothers to maliciously degrade others’ birthing methods, nor  is it beneficial to self-righteously exalt the Way they themselves birthed.

There are two extremes that are mainly at play here: 1) The “all natural childbirthers are presumptuous, irresponsible martyrs who are only advocating NCB for the money involved or for the sake of ther own egos” group, and 2) the “all doctors are conspiring to make higher paychecks, don’t care at all about women, and have an all-consuming control/power complex that overrides their practices” group.

It is my strong conviction that probably neither of these assumptions are usually  the case (although it’s true that sometimes each group does play into its own stereotype). Let’s be honest here- blanket statement generalizations are rarely true. (Remember the true or false questions in school? If the statement contained the words “always” or “never,” as a rule, the best answer was probably false.) And yet, this is what so many of us do, day after day- point fingers at broad groups, make assumptions based on very little evidence or experience, and go around spouting off about why we are right. I’ll be the first to admit that I have been guilty of this in many areas.

While this practice might seem gratifying and self-affirming to some, or just harmless press to others, in reality, it is hurtful and uninformative. This kind of behavior needs to stop. The following is an attempt to reintroduce some sanity into these online birth forums, and more importantly, some kindness and consideration into our relationships with others.

Women who would like a natural childbirth or homebirth- please:

• Do not assume that doctors don’t care at all about the desires of women in birth. I’m sure that many do care. Some may have differing opinions of what is best (or what is normal in a birth), so this is where respectful discussion of your desires for birth comes in. If he or she still disagrees, find a differnt caregiver.
• Do not assume that all doctors are money hogs. I’m sure that these doctors do exist, but we cannot presuppose the worst of everyone.
• Do not assume that all doctors are anti-NCB. Many OBs are welcoming to women who want to birth naturally, and will work with women to acheive that goal. If yours does not support you, then find one who will.
• Do not assume that all hospitals are evil places. It is true that lawsuits, time limits, finances, emergency mindsets, and protocols do influence hospitals a lot, and can tip the scales against natural childbirth. But hospitals do have good in them, and can sometimes save lives because of the available equiptment. There are hospitals that are more natural birth friendly than others. It is important to weigh the pros and cons of hospitals (and the likelihood of differing complications- natural or intervention-induced) carefully when considering a place of birth.
• Do not assume that you will be mistreated if you give birth in a hospital. I have heard many sad stories where this is the case, and I am so sorry that so many women have been wronged in this way. However, I have also heard many wonderful stories where women have been treated with kindness and respect in a hospital. Try to get to know some of the people who will be there when you give birth to help determine the treatment you will receive (I know this can be difficult to get to know everyone, but you could at least try to meet with the each of the doctors and midwives in your practice who could be on call the day of your labor).
• Do not assume that all interventions are terrible. While I believe they are widely overused, I do think that they have a place and can help a woman who is truly having natural complications in labor.
• Do not assume that women who receive pain medication are “sissies.” I myself am not in favor of pain medication becasue of the risks involved and what they take away from the birth experience. I also strongly believe that any woman who chooses them should definitely know the pros and cons of doing so. However, absolutely no one is in any place to judge how another women feels in the middle of labor and the decisions she made.
• Do not assume that all homebirths are perfect. While it’s rare, things can sometimes go wrong. I encourage participation in proper screening and precautions to minimize risks.
• Do not assume that midwives are better than doctors. They each have their own strengths and they cannot compete with one another. In an ideal world, they would work together more often than they do.

Doctors who do not usually attend natural childbirths or homebirths; please:

• Do not assume that women who want a homebirth are irresponsible. They are making informed decisions and choosing what they believe is the best for themselves and their babies, and most of them do take reasonable precautions.
• Do not assume that NCB advocates are in it for the money. I’m sure that these people do exist, but to say that most are is just as unfair as saying that all doctors are money-hogs.
• Do not assume that NCBers are trying to be bad patients or to purposely aggravate you. Even though you do this day in and day out, for each woman, her birth is extremely personal and she wants to make it the best she can. If she challenges your opinions or seems skeptical, please respectfully explain to her why you would like to do a certain procedure. If you don’t have a good reason other than it’s routine, then maybe you should reevaluate why you’re having her do it.
• Do not assume that you can rush through routine things with a woman in labor. Be gentle and explain things as you go. It can make a world of difference in helping her feel calm and secure during her most difficult hour.
• Do not assume that all homebirths go wrong. Remember, you only see the transfers, not the rest of the women who give birth peaceably at home. Treat the transfers with kindness.
• Do not assume that women who want a natural birth just want it for their egos. Birth is a life-changing process for women, and doing it naturally is very important for some. For most, it is not so they can brag. Most women who want a natural childbirth want it because they feel it is the best for their babies and their bodies. Some also feel that experiencing the instense pain of childbirth can be an empowering and beautiful process, and can magnify the bliss of first meeting their child.
• Do not assume that doctors are better than midwives. They each have their own strengths and they cannot compete with one another. In an ideal world, they would work together more often than they do.

I think we all need to take a step back and reevaluate our attitudes and motivation before we speak. Is it to prove we are right? Is it to make someone else look bad? I am not against having valid opinions and strong feelings about some of these matters. I am all for critical thinking and discernment when it comes to making decisions regarding birth. Also, I think it’s totally okay to disagree on what we think is the ideal birth. My point here is that we could all use a little more grace in our interactions with others, particularly in these crazy online comment boxes. Perhaps if we all followed the old adage of “think before you speak,” avoiding gross assumptions, and mixing in some tact and courtesy, the birth animosity that we see so much of would gradually diminish.