Hopes and Fears

May 5, 2011 at 2:44 pm (Doula, Education)

At the beginning of the first class of my childbirth series, I give the parents in my class a questionnaire.  I ask about their impressions of pregnancy and birth, and their hopes and fears.  I love hearing what each person shares.  Is pregnancy exciting for them?  Scary?  Tiring?  Spiritual?  I also enjoy hearing about their fears.  If we can be honest about them, our fears can shine like a spotlight on areas where we need to focus.  If someone is afraid of a Cesarean, then we can explore that fear.  What would it look like?  What is the process?  Why might it happen?  What are the worst parts of it?  How could it be empowering/joyful?  By exploring fears, we find opportunites to turn disempowerment into choice and freedom, because we have the freedom to choose how we will meet any challenge that arises.  Fears can be tough to look at, but they allow us to do some really deep and powerful work.

I am also delighted to hear parents’ hopes.  At this class, we heard from the mamas first.  Their hopes resembled one another- hoping for a peaceful birth, a natural birth, a birth with lots of support.  Then, with a bit of prodding, the first dad shared his hopes.  One of them was that his wife would be able to “fully realize her potential as a woman.”  She giggled when he said that, and he blushed, but I was brought near to tears by the sincerity of his wish.  What a beautiful hope- that birth, this big, powerful unknown, would allow the woman you love to show herself in all her glory.  What an amazing love this young papa harbors for his wife, that he would want her to fulfill her potential.  This is the kind of love that is deepened by childbirth, and by the creation of a new family.  I’m excited to see this dad react to the awesome ability that I’m sure his wife will show when she gives birth.  And I’m looking forward to hearing him say, from that moment on, “You won’t believe how amazing my wife is.  She’s incredible.  She’s strong.  She brought new life into the world.”

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Due Dates

March 28, 2011 at 10:44 am (Education, Informed Consent)

There are two common questions that everyone asks a pregnant woman:  Are you having a boy or girl, and when is your due date?  There’s a lot of emotion surrounding this date- moms look forward to it eagerly as they anticipate meeting their baby, and friends keep track of it so that they know when to expect the big day.  When a mother has her baby before or after the Big Day, people are often concerned by this deviation from their expectation.  And for mamas with a set date in their mind, it can be a big emotional challenge to go past that date…..possibly weeks past it.  Why is the Due Date such a big deal, and what does it really mean?

The Due Date is just an estimate

This all-important date is based on the assumption that pregnancies go on for exactly 280 days.  These 280 days, or 10 lunar months, are calculated with the assumption that the pregnancy started exactly two weeks after the start of the mother’s last menstrual period.  There are a couple of problems with this method of calculation.  First of all, several studies have been done to see how long the average pregnancy is when labor is not induced.  The average pregnancies described by these studies range from 279-288 days.   So we’re already shortchanging our natural gestational cycles by estimating on the low end of this range of averages.  And if a mom has a cycle that’s longer than 28 days, then her ovulation will happen later in that cycle, pushing her true due date even later.  Since the standard calculation method doesn’t take into account differences in cycle length, some women may have a due date that’s as much as a week earlier than it should be, if all physiological factors are taken into account.  Knowing this, it really helps to keep in mind that the due date is just an estimate, and potentially an inaccurate one- it’s not a definite date!

The Due Date is the midpoint of a range

Normal physiological pregnancy can last anywhere from 37-42 weeks, with the due date falling on week 40, right in the middle.  In all studies on length of pregnancy, the majority of women had their babies somewhere in that 5-week range, with a few percent having their babies before 37 or after 42 weeks.  A pregnant woman is not truly post-dates until she progresses beyond 42 weeks.  However, with our cultural fascination with the due date, we’ve led many women to think that there’s something wrong if they go past that midpoint date, instead of helping them to wait until 42 weeks before they consider themselves late.  Our obsession with The Date makes it really hard for the 50% of women who go past their due date (and that percentage is higher for first time moms).  Keeping all this in mind, it’s a good idea to just pretend that your due date is a week after the date your doctor has given you. That way, if you have your baby earlier, you’ll be happily surprised, but if you go to the date, you’ll still feel like you’re normal.  An alternative is to tell everyone that you have a “due month”- “I’ll probably have my baby sometime between June 8th and July 4th.  We’ll see when she decides to come!”

In thinking about your due date, just remember that it’s a number that’s estimated based on a formula and that doesn’t take into account your body and your baby’s individuality.  As long as you don’t have a medical reason to have your baby by the date on your chart, give yourself the freedom to gently ignore your due date.  Remember that it’s normal to be pregnant up to 42 weeks, and that you have upwards of a 95% chance of having your baby by then.  Relax, give yourself time, and schedule a pampering session for your due date….and the next few days after, as well.  And let your friends know that the baby will come when she’s ready, on her own schedule, and that you’ll be sure to let them know when the Birth Date (instead of the Due Date) arrives!


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Questions to Ask Your Doctor or Midwife During Pregnancy

November 20, 2010 at 7:41 am (Doula, Education, Hospital Procedures, Informed Consent)

Your care provider and her or his philosophy about pregnancy and birth can shape the emotional tenor and physical experience of your labor and birth.  Ideally, you might want to interview three or four care providers before settling on one.  Here’s a short list of questions that you can ask providers- the answers will reveal something about both their practice and their personality, which can help you in making your decision.

If you already have a care provider, these questions can give you a sense of how your doctor or midwife likes to practice.  If her or his answers differ from your preferences, then you can begin a discussion to explore your options.  If there are any procedures that you would or wouldn’t like that are not in your care provider’s routine scope of care, you can request that whatever you’ve agreed on be noted in your chart, for future reference.  The information you glean from these questions is also helpful in constructing a birth plan.

Questions:

Do you have any recommendations for childbirth classes?

Are you likely to deliver my baby?  Can I meet your backup(s)?

What percentage of your patients deliver vaginally?  By Cesarean?

About how many patients out of 10 are induced?  How many go into labor naturally?

Have you worked with any doulas?  Are there any you could recommend for me?

What do you think of birth plans?

How long could I go with my amniotic sac broken before you’d want me in the hospital?

Do you do episiotomies?  If so, what would make you want to do one?

How often do you perform amniotomies (breaking the bag of water)?  Why do you do them?

How often do you perform cervical checks during labor?  What do you do if a client doesn’t want to be checked?

Are you comfortable with me eating and drinking during labor?

Are you comfortable with me walking and moving during labor?

How do you feel about natural, nondrugged labor?  Would you support me if I chose not to have an epidural?

Are you comfortable with me pushing in positions other than lying on my back or semi-sitting?

Will you deliver a baby in the water?

How do you manage the delivery of the placenta?

This is just a short list of questions.  You can find a more extensive list of questions here.  Remember that it’s not just what your care provider says when they answer your questions, but also how they answer, that’s important.  For instance, when asking about specific procedures, if your doctor says “Oh, all women in my practice…….”, then s/he might not have a lot of flexibility regarding your individual needs.  If your doctor is surprised that you would ask about unmedicated labor (“Why would you want to feel the pain?”), it might be a good time to question his/her belief in your body’s ability to give birth without intervention.  The best care providers are the ones who use their skill and knowledge appropriately, and balance the medical care they provide with the autonomous decision making of their clients.  You have the opportunity to find a care provider that fits well with your outlook and wishes.  Don’t hesitate to “shop around” until you find someone you feel really comfortable with!

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Pain in Labor

May 3, 2010 at 3:18 pm (Comfort Measures, Doula, Education) (, , )

Lots of mamas ask me “What does labor feel like?”  “How much does it hurt?”  “Can I prepare for labor pain?”  Pain in labor, the big P word, can be a touchy subject to discuss prenatally.  Some doulas I know don’t use the word at all, instead mentioning “intensity”, “rushes,” and “waves.”  While I will definitely use the words “pain,” and “birth” in the same sentence, I also find myself qualifying it with many adjectives, to help modify the tenor of that charged word.  I do that for two reasons. 

First, not all women experience labor as pain.  In fact, some people even claim that any well-prepared woman will not feel the work of labor as pain, as long as she is sufficiently relaxed and not fearful.  Although I won’t go so far as to say that pain is not a part of labor for the majority of women, I am aware that expectations help to shape reality.  If, prenatally, a woman is not deluged with the expectation that her labor will be painful, then she might have a clearer mental and emotional path toward a pain-free labor.  So I, as  a birth professional, don’t want to shape a woman’s experience based on my own experiences- I want her to use her own words and feel things in her own way.

But what about the women who do experience labor as pain?  Are they done a disservice if the P word is never mentioned by well-meaning birth advocates before they enter into Labor Land?  I suspect that the vast majority of women I’ll encounter as a doula have already heard about many painful labors, and have a well-rooted idea of birth as painful.  So how can I help those mamas prepare prenatally for their coming birth?

Here’s what I tell mamas: For most women, birth is painful.  At the beginning, it is manageable.  At some point, it will reach a level of intensity that you may not have felt at any other time in your life.  But that pain is not the “something wrong” pain of an injury or illness.  It’s pain with a purpose- it teaches you how to move your body to best birth your baby, and it teaches you what an incredibly powerful, capable woman you are.  And there are things that can make the pain worse, and things that can make it more manageable.

The three most important things that have helped my birthing clients experience the sensations of birth with relative ease are: a quiet, safe environment, an attitude of acceptance, and the freedom to move.   And much of this can be cultivated and practiced before the actual birth.

A quiet environment helps a mama sink out of her neocortex, her thinking brain, and into her more instinctual mind.  She becomes less thought and more experience, less brain and more body.  If people don’t try to engage her by asking questions or chattering with each other, then the path to mental stillness is easier.  And this internal and external quietness has a big reward: endorphins.  Endorphins are the body’s natural pain relief, the internally produced morphine.  They are naturally produced when we go through painful or high intensity experiences.  They don’t always take away the pain of labor, but they soften the experience of it.  Endorphins can be counteracted by catecholamines, including adrenaline.  Adrenaline is produced when we start thinking a lot and becoming anxious, or when we feel that we need to defend ourselves.  So if a mama is made to talk and think, or if she is scared, nervous, or stressed out, she will not have as many benefits from her endorphins.  Prenatally, to encourage an endorphin-producing state, mama can do progressive relaxation exercises, prayer, or meditation.

The attitude of acceptance goes hand in hand with the quiet mental state, but it is a distinct thing.  Basically, it means allowing the birth process to happen, physically, mentally and emotionally.  It is an open state, non-resistant.  When a mama has this kind of attitude, then her labor energy can flow through her body without blockages.  And when she doesn’t resist the energy of labor, and yes, the pain as well, then she will feel less fear.  To cultivate this attitude of acceptance beforehand, a mama can practice saying some positive words or phrases in the shower, on the toilet (strange, I know, but it helps to associate the energy of opening on the toilet with the opening that will happen during birth), and in bed at night.  She could say things like, “I am open.” “I welcome this experience.” “I am joyful.” “Iam relaxed,” or any other positive statement that feels good.

Finally, position changes can do a lot to help mama navigate the pain and other sensations of labor.  Sometimes, one position (such as lying on the back) might feel intolerable, while another (such as standing and swaying) might feel doable.  This difference in sensation is teaching mama what positions are most helpful in opening her up and allowing labor to progress.  As labor goes further, it may get to a point where no position feels really good.  This is a great sign that labor is nearing the end, and it’s also time to listen to the body in a different way.   Sometimes, during transition and pushing, the positions that feel the most intense are the ones that are doing the most work.  So, at this point, a mama could choose a resting position, and allow her body to do all the work (a great choice at the end of a labor!), or she could choose an upright position where there is a lot more energy, and therefore more ability for mama to add extra power to the work her body is doing.  I remember this moment in my first birth, where I had been pushing though the first 2/3 of each contraction, and then resting as they eased off.  I finally got to the point where I realized that, if I wanted to see my baby any time soon, I’d have to find the strength to push beyond what I thought I could manage, to push all the way through the contraction and the pain.  And once I started doing that, I found more power and energy than I thought I possessed.  And I found that, even though the pain became more intense, there was also a great delight in feeling my baby finally move under my pubic bone, and very soon after that, into the world.  Once I stopped fearing the pain and trying to lessen it, and instead I stepped into the center of it and surrendered myself to it, I found that I could do more than I ever thought I could.  In this way, pain taught me not just how to labor, but also that I was capable of doing anything that I needed to do, and that I had more than enough strength and courage for the task of parenting my beautiful new baby.

So yes, for many women, there is pain during labor.  But it’s pain that you can work with, and it’s pain that will teach you a great deal about yourself, your body, and your potential.  As Pam England says in Birthing From Within, “Labor is hard.  It hurts.  And you can do it.”

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How to Prevent Preeclampsia (Toxemia)

January 7, 2010 at 11:54 am (Education) (, )

A common reason for induction of labor is pre-eclampsia, which is a group of symptoms that includes high blood pressure, swelling, protein in the urine, and headaches, to name a few. The common understanding is that the cause of pre-eclampsia is a mystery. Although genetics and nutrition are thought to be factors, there’s no advice as to what, specifically, mothers can do to avoid this syndrome, or why it happens.

If we accept that bodies are intelligent, and that they do things for a reason, then what reason would a pregnant body have for raising the blood pressure?  And is there anything that can reverse that reaction, and restore a state of health?

In Holistic Midwifery, author and researcher Ann Frye outlines the mechanism which leads to preeclamptic symptoms.  In a normal pregnancy, the mother’s blood supply increases by 50% over her nonpregnant blood volume.  This expansion is made possible by the mother eating enough protein and drinking enough fluids.  Salt is also essential in this process, as it “works together with albumin to maintain normal circulating blood volume”- if you don’t eat enough salt, then fluid leaks out of your bloodstream and into the intercellular spaces, which causes swelling.  So protein, fluids, and salt are essential in pregnancy.  When the blood supply does not expand as expected, then the liver and kidneys have to work harder to remove toxins, and the heart has to work harder to pump the less-than-needed blood through the placental system.  The liver compromise leads to headaches, nausea and abdominal pain.  The kidney compromise leads to protein in the urine, and the kidneys also signal the body to create higher blood pressure, in an effort to get the blood where it needs to go.  These symptoms can become very serious, and even proceed to eclampsia, which can lead to maternal death. (Frye; Holistic Midwifery; Labrys Press 2006, p. 828-844)

The mother’s body needs a lot of blood to support a healthy pregnancy.  Diet is the most important factor in whether she will make enough blood or not.  Food is the pregnant mother’s best friend, and if she uses it well, she may be able to avoid the common and dangerous complications of pre-eclampsia.   In general, a mother should eat 80-100 grams of protein a day, including several different sources, and paying attention to food combining if she’s a vegetarian.  She should drink at least 2 quarts of fluid a day, mostly water, and she should salt foods to taste.  This may seem like a lot of food, but the body is doing a lot of work during pregnancy, and food is it’s most important fuel and support.

If you are dealing with high blood pressure during pregnancy, make sure to begin eating plenty of protein and drink plenty of water.  Frye recommends protein at every meal and every snack for liver-compromised women.  Seeing an acupuncturist or a homeopath is also helpful- those healing techniques will help to restore your body’s compromised internal balance.

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