It Takes a Village: Preparing for Postpartum

27 Sep

And, drumroll please…after taking a few weeks of vacation and sharing birth stories, we’re finally up to the last point in our “11 Ways to Prepare for Your Best Birth” series.

#11 Arm yourself with support and resources for postpartum (postpartum doula, lactation consultant, moms’ groups, etc.)

What are the resources you might need as you become a good parent? Smart idea to consider these things now. What follows is not an exhaustive list, but can start helping you to think through the possibilities.

Your Village

First, rally any and all willing family and/or friends! This is the best time in your life to accept help if it’s being offered, or reach out and be proactive in asking if necessary. The biggest helps in early parenting are a) meals and b) housework. These are things you just don’t have time or energy for in the first few weeks. There are several great and free meal train websites (look here, here and here), so see if you have a friend, family member, or if someone at your church/temple/other religious community who can coordinate meals for the first few days or weeks after baby’s birth. (After my husband and I received the enormous blessing of meals upon both of our babies’ births, I “got” the power of it so much that I volunteered to be our church’s meals ministry coordinator.)

Lactation Consultant

While breastfeeding is certainly natural and can feel instinctive, it’s also a learned skill. Any learned skill takes time and usually requires some working out of kinks. Therefore, it’s wise to have a few names of and contact info for lactation consultants on hand in the event you could benefit from the expert support. There are multiple kinds of certifications; the main ones in my geographic area are: International Board Certified Lactation Consultant (IBCLC) and Certified Lactation Counselor (CLC). According to the International Lactation Consultant Association, an IBCLC is, “a healthcare professional who specializes in the clinical management of breastfeeding.” An IBCLC is considered a clinical caregiver vs. CLC more an educator. Because of this distinction, you will see more of a possibility of getting insurance to cover/reimburse for an IBCLC than for a CLC.

Postpartum Support & Counseling

Sometimes a new parent doesn’t feel like oneself on the other side of birth. If the not-quite-rightness lasts beyond 2-3 weeks after the birth, it’s very important to reach out for help. Help is readily available and no one should suffer in silence!

The different routes a parent could go for this kind of support:

  • Parent groups (generalized, or even better to seek out one specifically tailored to postpartum depression / perinatal mood & anxiety disorders)
  • Therapist / counselor (who can refer to psychiatrist if appropriate)
  • Psychiatrist

Postpartum Doula

A postpartum doula is a wonderful consideration, particularly for families who might not have family or friends who can support them through this major life transition. They are different from a baby nurse in that they are all about supporting the postpartum parent’s healing and helping the new parent(s) gain any tools, strategies, and skills they need to become more confident in parenting—as opposed to coming in and simply taking care of the baby. They are usually priced in a different way from a birth doula (who usually is a flat rate for her package) in that parents pay by the hour, often with a front-end minimum.

The most critical times to consider buffering with extra support: 1) the 1st couple of weeks after birth; 2) if/when one partner or helper leaves one parent home alone with baby for long stretches anytime in the first 3 months; 3) ~2 months after birth, when many babies’ amount that they cry every day peaks.


Helpful to equip yourself with plenty of local resources, but it’s also good to have some online/broader resources at the ready as well. Try to gather these resources before you give birth as you won’t have as much energy or time in postpartum to do research. There are several places you can gather these kinds of resources:

  • Talk to local parents. Word of mouth is the best way to find stellar local parents groups as well as postpartum professionals. If you don’t know any parents, you can connect with them by attending your local La Leche League meeting, searching on Facebook by your town, visiting churches, temples, community centers, or libraries. One awesome midwifery group I know in NYC creates moms’ cohorts based on due time and neighborhood — how awesome is that?
  • When you look for a birth class and/or doula, seek out a well-connected professional with a solid resource list available for clients. Often those professionals will have a resources page on their website plus a more expansive private resource list to support her clients
  • Seek out local family-oriented retail or educational establishments (this is could be in the form of a baby wearing or breastfeeding boutique, a retail or consignment baby/maternity shop, etc.). These venues, and sometimes your local library, often have personal connections, a resource list, or a community bulletin board with local postpartum professionals’ business cards.

Physical Therapy

Sometimes our birth and/or healing doesn’t go as we expect. Occasionally we might have some physical issues to work out such as abdominal separation or pelvic floor muscle issues. In the event that this is a felt need for you on the other side, there are available resources such as pelvic floor specialists as well as other more general physical therapists who could work on abdominal issues. I would encourage seeking out a PT or other body worker who specializes in the perinatal phase of life.


A few of my favorite online resources:

Breastfeeding

Perinatal / Postpartum Counseling & Support

A few of my favorite NYC local resources:

Breastfeeding

Postpartum Support & Counseling

Other

Baby Emma Sue’s Birth Story (as told by mama Melissa)

20 Sep

melissa

Today I have another student story for your reading pleasure!

I was due with my little one on July 29. At my 40 week check up, my OB informed me that – sigh – I was only about 2cm dilated and not effaced. She wanted to chat options and I asked her to do a membrane sweep. She doesn’t ‘love’ membrane sweeps because they can cause infection (her words) but she did a gentle one and also stretched out my cervix. That was Wednesday.

(It should be noted, I was very over being pregnant after the two-weeks of an intense heat wave. I was miserable, unable to move and just ready to meet my baby.) 

My OB and I decided we would schedule an induction for the following Wednesday, week 41. She would be out of town for week 42 if baby hadn’t arrived by then, so she would be there to deliver the baby. Also, she agreed to keep it low intervention as much as possible, to still allow me to have a natural birth.

On Wednesday night I noticed some baby movements and more frequent contractions, but nothing to cause alarm. My discharge was still the same. My best friend Cody was in town and came to visit, and we ate spicy Thai Food and relaxed. I had no idea what was to come in 24 hours.

Thursday morning I woke up bright and early and noticed that my mucus plug was starting to come out – hoorah! I woke up my husband in excitement and since it was finally a cool morning, we walked the length of Astoria Park

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Photo credit: AstoriaParkAlliance.org

– I don’t remember what I was feeling physically, but mentally I knew I was coming to the finish line. I let my doula, Annie, know about the changes and her and my husband agreed they would both go to work that day and if I needed them, I would reach out.

Thursday afternoon I had a massage with my friend Anthony from The Giving Tree and by this time was having more contractions and much more discharge. (Annie said it was fine to get a massage at this point). I let him know I was starting to labor (I’ll never forget his face, he looked so shocked!), and asked he hit all major induction pressure points.

He did.

By Thursday night, during Hillary’s speech at the DNC, my contractions officially began. They were intense, frequent and the real deal. I had them all during the night, starting at every 12 minutes around 1am at one point, around 3am, they were 4 minutes apart, lasting about a minute. When I was active, they were frequent – but when I rested, they were tame – so would be about 9 minutes apart. I labored all during the night and had Brian sleep, so he would be ready for what was to come.

I stayed in bed and found that going on all fours or puppy pose was the best way to breathe through the contractions. After each contraction, I would have to go to the bathroom where liquid would just come out of me – I didn’t have to push or anything, it just naturally came out. I wasn’t sure if my water had broken or what – especially since i wasn’t sure what “water breaking” felt like.

Around 5am my contractions were much more intense so we called Annie, she advised us to relax since although intense, they were not frequent enough at this point and not consistent. She eventually came over around 9am and helped me through some more contractions, but we sent her home an hour or so later since the consistency wasn’t there. Again, she told me to relax and when I did, contractions were happening every 10-11 minutes.

We left a message late morning for my OB giving her an update, mainly wanting to let her know that when I was active, contractions were happening frequently, and when I was resting, they were every 10 minutes. Again, we also weren’t sure if my water broke since I still had a leak of fluid after each one.

Around 2pm or so, we heard from my OB who called just as my contractions were moving from every 6 minutes to every 5. I had just had a tough one that left me in tears and spoke to her as a new one was coming. She told us to get to the hospital immediately because she could hear the intensity in my voice.

We let Annie know and made it to Mt. Sinai West about an hour later. The car ride wasn’t as awful as I was expecting it to be. Because of my yoga background, I was able to go inward with the pain and Annie was able to time contractions based on my breathing.

We arrived at Mt. Sinai at 2:30 and had to wait in triage until 4:30 just for vitals. Everything was feeling a bit more intense, and I was more anxious at this point. At 6:30p I was finally taken in for a monitor read + cervical check. I was about 3cm dilated and the OB on call on the Triage floor wanted to send me home, but noticed my fluid was low, likely because of all the leaking. She called into the OB on call for my doctor, who wanted to admit me – hooray! There were talks about a possible induction, but by this point everything was getting pretty intense and I was just relieved that my pregnancy was at the finish line. This was the only time I slept – I probably slept about 20-30 minutes with the HR monitor on me.

Unfortunately, we came at a pretty busy night and had to wait in triage until 11p, which is when we were assigned a bed in L+D (Labor and Delivery). This was the worst of it – I was laboring up and down the hallway, in too much pain to eat and just wanted a bed. I was very self conscious to be laboring the way I was in the waiting room since there were other families there, so walking was the route we took. When we finally got into L+D, I felt like it was finally real.

I was super impressed with the L+D rooms at the hospital as well – each bathroom had a decent sized shower and small jacuzzi tub. The room was large, a comfy recliner for Brian and a chair for Annie. We had the option to dim the lights and I just felt very much at home. It wasn’t hospital-esque as I was imagining. We met our nurse who was a bit intense, but I can’t complain too much about her.

11:45 came around and I met one of the OB’s on call – I was 4-4.5 dilated, 90% effaced and [baby was at] -2 station. This was an improvement since I was in triage, but I knew I still had a ways to go. The OB offered to stretch out my cervix and I happily obliged.

There was a concern with the baby’s tracings, so I was stuck on a heart rate monitor the whole time, which wasn’t my preference. Also, because my fluid was low, I was also on an IV. This also was not what I wanted, and to make it worse, I had to lay on my side to get a better read of the HR for the little babe. I tried to not let this get me down, despite the fact that I desperately wanted to walk around and take advantage of the jacuzzi, but I knew this was best for the baby. (I had taken a bath at home when I was having contractions and it felt so nice, so I was bummed to miss another option at a bath).

Around 1am my water broke! What an intense feeling – I felt a pop in my body and started freaking out, not knowing what it was, until I felt the rush of fluid coming out of me. Annie called our nurse and she came in, and I also met the OB who would deliver my baby, Dr. Jason Kanos – he was amazing and I instantly knew that despite I was hooked up to these machines, I would have the labor I wanted to have. He had a dry sense of humor and was straight to the point, which is something I took for in a doctor. At this time, I was about 6cm dilated, 100% effaced & -1 station. Hooray – some improvement!

He asked about pain management and I told him I only wanted an epidural if it was medically recommended (ie: if I was getting tired) or if I needed it. He offered me narcotics and nitrous oxide (laughing gas), which is new not just to NYC, but the US. Annie and I were so excited to have this option, so we took it!

As soon as he left and the nurses were setting up the Nitrous (it took them over 30 minutes to set this up since they had never used it before…) I threw up. This made Annie super excited, but this was the LAST thing I wanted/needed! Fun fact: Annie rinsed out my basin and put some peppermint essential oil in it, so when I threw up again, it was a much calmer experience – even the nurse took note of this tip!

After I threw up, I felt the baby dropping and knew I entered into transition – this was about 2:20am. The nitrous was finally ready and I must say, it didn’t do much for transition contractions! You have to hold the mask to your face, breathe it in as you’re getting a contraction and then breathe it out. It just felt like another hassle and thing I had to do, while trying to handle the intense contractions as well. I only felt “buzzed” once and that was early on in transition. Looking back at it now, it felt like it was just a distraction more so than pain management.

I also began to feel lots of intense pressure around this time as well – it felt like I had to poop and I had an urge to poop, but everyone was telling me not to push and that I didn’t have to poop, which was getting frustrating. I demanded a cervical check at this point, because I was convinced I was going to poop out this baby. At 2:50am I was about 6-7cm dilated and still in this -1 station! Dang!

I had 40 minutes of intense transition contractions – lots of yelling and trying to get on my back since being on my side really intensified it. I was still using nitrous at this point, but again, it was a pain and having someone hold the mask over my face was annoying. I just wanted to yell and push and remember saying “I don’t even know what noises I’m making or where they are coming from!”

I still had to poop and the nurse finally took me off all the machines around 330a to let me go to the bathroom to “poop”. Of course, nothing happened, but Annie told me to stay there for as long as I needed, since it helped quiet me down. Once I got into bed, I was allowed to lay on my back – finally. This was around 3:30am.

Once I got back into bed, I wanted to push and my body felt like it was just pushing itself. We didn’t have a nurse in the room and Annie urged me to not push (since we didn’t know how dilated I was) and I was beginning to lose hope. The contractions were so intense, I was on zero pain management and started to say “I can’t do this anymore” “I can’t!” which Annie + Brian knew were two things I didn’t want to be saying. Everything seemed to happen really fast this hour, but also felt like it took forever. A new nurse came in (mine was on break which is why I had gone an hour with no nurse) and by 4:30am Dr. Kanos arrived and said “You want to push? Let’s push!” He did a check and said everything was fine and scrubbed up.

I began pushing at 4:40am – Brian said it was about 4 pushes and at 5am Emma Sue was born! 8lb 4oz.

Since we didn’t know the gender, Dr. Kanos let Brian announce the gender, and he also cut the cord. I had a small second degree tear, so did need stitches, which hurt. (Don’t believe the books when they tell you that having a baby on your chest will distract you from stitches!). I also bruised my tailbone, which we realized the following day, which was a concern of my OB (who thought I would actually break it), because of how the baby was positioned in my body.

…& that’s it! 30 hours of laboring, very much worth it and seriously makes me feel like I can do ANYTHING in life!

 

Baby Ryan’s birth story (told by mama Kat)

13 Sep

Today I’m posting another birth class student’s happy birth story. Enjoy!

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We have some happy news to report – Ryan was born last Sunday, August 28th, at 4:01pm. He weighed in at 6 lbs 14 oz and was 21.75″ long! I started feeling “Braxton Hicks contractions” at 9am Saturday, remarked to myself about their consistent timing (8-1-1) and went about my day shopping for nursing clothes and going to prenatal yoga.

After yoga my contractions started becoming painful and were happening more frequently but still I was convinced this was “false labor”. I set up multiple stations (shower, yoga mat in bedroom, bed) for managing the painful contractions. Tom was away at a bachelor party in Southampton and I deliberated whether to call him back home but after another hour realized regardless of what “this” was I was not going through an overnight of it without Tom.

When he arrived home four hours later he timed my contractions at 3-1-1, got the midwives on the phone, had them listen to one of my contractions and was promptly told to come in; he called the doula and let her know that we were passed the laboring at home phase and going to the hospital and she agreed to meet us there.

After 15 hours of laboring at home we arrived at the hospital; I was informed that while I was 80% effaced I was only 2 cm dilated and baby was in -3 position; only because of my currently high blood pressure was I admitted. It was another grueling 16 hours before baby was born and there were a series of fortunate events leading to us having the best possible team (highly experienced midwife happened to be on-call, L&D (ie Labor & Delivery) nurse was doula trained and studying to become a midwife, my mom was allowed in despite the two-person support limit).

In the end I was successful in having the natural birth I envisioned despite baby’s posterior position and extended time with baby’s head pressing significantly on my pelvis in the -3/-2 position. He came out looking like an Incan god (MAJOR cone head) and was treated “under the lights” for 42 hours due to jaundice caused by blood differences (I’m O+). We learned A LOT from the nurses in the nursery so were ultimately happy to have lost the privilege of “rooming in” that we had initially desired.

In the maternity suite there were a series of UNfortunate events that led to mass miscommunication between caregivers (pediatricians, nurses, midwives, doctors, etc.) and stress about when and if we would be discharged together. On Tuesday night we were both sent home, despite Ryan not getting the circumcision planned, with plans for follow-up blood work with our pediatrician for jaundice monitoring. We are exhausted but not overwhelmed and are happy that we had the opportunity to “study up” to advocate for ourselves and Ryan throughout our natural hospital birth.

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Adelynn’s Birth Story

23 Aug
My due date was July 4, and I went in for a check up July 6 after not being dilated at all week prior. Doctor said I was 1cm on July 6. The morning of 7/7 comes and my hubby (Dan) goes to work like normal. I feel crampy around 8am but think it’s just normal and has happened before. I shower and start to feel cramping in my thighs. I darken the living room and put on a movie as we talked about in class. I can’t concentrate on the movie at all!
I text with my doula, Anne, and she says eat a nice breakfast and start to use the TENS machine. I hook up the TENS and text my hub around 10ish to come home because I still don’t feel right. I have more intense burning in my thighs and am not coping as well just breathing. I text Anne that I can’t focus anymore and am not able to text anyone. I am not able to eat breakfast.  I throw up all the coconut water I had been forcing myself to drink that morning.
Dan takes the train home from work gets stuck in train traffic. By the time he is home around 10:45, I need counter pressure on my thighs for relief. I have bloody show and there’s just so much blood; way more than I expected. He tries to make me eat cereal I can barely get it down. The TENS machine provides some relief. He tries to time contractions but can’t keep up with caring for me and the app. It feels better to sit on the toilet and I start to want to bear down.
Anne comes and it’s a relief! I can barely talk to her. It doesn’t feel good to side lie or hang over the ball or couch. I end up giving myself a hemorrhoid from bearing down for relief. No positions we try feel good; all I want to do is sit on the toilet and bear down with each contraction. They keep telling me to stop pushing!
My water breaks—like actually what you see in the movies: A pop and a large gush all over the bedroom floor! Dan is freaked, but Anne is calm and reassuring. Dan later admits he thought the baby would be out with it on the floor, LOL! Dan calls our Doctor to tell them and my contractions are 3 minutes apart and lower back counter pressure doesn’t feel good. I keep telling them I’m bearing down! They say come in to the hospital now, like I knew they would. Dan makes me a protein drink like he takes at the gym since I hadn’t been able to get anything in me since the morning.
I wanna push! Anne suggest we call Uber since I was pushing and not listening to them. Trying to pant through was tough!! Gripping their arms felt good! I left marks on Dan’s arm from gripping so hard. I say I want to go to the hospital! I knew that it would be okay to push there and that’s what was bringing me relief.
Uber comes around 1pm. Dan forewarns him I’m in labor but water already broke. I’m going through so many pants and pads already between bleeding and leaking fluid. Car ride seems to take a while; I try not to look at traffic. I’m able to eat a little bit of a Cliff bar (thanks Anne!). I can talk in between contractions; they don’t last too long, but I don’t think anyone is really convinced I’m as far along now and progressing so quickly. I had wanted to stay home for as long as possible and knew once my water broke I was on a “clock” but I didn’t care; I wanted to push and knew I could do that at the hospital. Driver keeps beeping his horn; Anne is calm and tells him to stop!
I bear down in the car and throw up a little more from trying not to. I make eye contact with Dan and breathe with him. He has me panting and trying not to bear down. When we get to the hospital I’m moaning loudly—being loud and vocal felt good ! I’m hunched over the security desk and they get me a wheel chair. I can hardly see at this point; everything is a blur. I’m wheeled in right away and doc says, “You’re 10 cm dilated and ready to go!!” I say, “I can push!??” Doc says, “Yes!” Phew, it feels so good! It’s about 2pm and there is no time for the antibiotics for my GBS strep. Doctor mentions an epidural (how it’s always an option), but I just kept asking to push. I try to move myself so I’m higher up but doctor explains the angle is best lying more down. I’m given a hep lock but remember still advocating for my birth plan despite being so far along.
I go through what seems like 5 rounds of pushing. I didn’t mind being coached or told what to do. It wasn’t bad until she started crowning. The doctor asked if I wanted to see or feel; I say no, but he encourages me to feel her head. It’s soft and mushy. I know where and how to bear down but am not giving it my all because, well, crowning sucks!!
Note about photos: This particular hospital’s protocol was for partner and doula to wear a mask for the pushing stage. This is not standard in most hospital settings in NYC at the time of posting.

I have energy and feel so elated his was the exact birth I wanted! I’m on a fetal monitor but all is well. I scream a little about how much it hurts, but she’s out! She comes out crying and we have immediate skin-to-skin and breastfeeding. More painful is the after birth stuff. Doc says I’m bleeding a lot and trying to get the placenta and everything out is not fun. They hook me up to oxytocin (aka pitocin) and I remember just questioning everything being so informed from class. (Lisa’s note: read more on active management of this 3rd stage of labor, which is standard in NYC hospitals)

Doc says I didn’t tear! Dan gets to cut the cord and do skin-to-skin as well. She gets her Vitamin K shot and I wipe off her antibiotic eye cream (Erythromycin) after it’s administered (Lisa’s note: In NY State, these two newborn protocols are required, not optional—see info here). There is no room ready for us upstairs, so just us—the new family of 3—get some intimate quality alone time together to just take it all in. Dan is in awe and so proud, and I feel like a superstar champion! It was everything I could’ve asked for! There was no time for any interventions and it was just picture perfect!

Note: This is posted, as always, with permission from new mom Alyssa, with minimal edits.

Mother-Baby Dyad: Snuggle to Heal, Grow & Thrive

27 Jul

We’re on the home stretch in our “11 Ways to Prepare for Your Best Birth” series and only have 2 left!

#10 Keep mother and baby together, with lots of skin-to-skin – it’s best for mother, baby, and breastfeeding

To clarify the title of today’s post: Think of the mother and baby as one unit in the first 3 months of baby’s life; we call it the “mother-baby dyad”. They need almost all the same things in the postpartum period — lots of snuggling, nourishment, rest, support, love.

I previously wrote a blog post on this topic after attending an all-day class with renowned perinatal neuroscientist and neonatologist Nils Bergman, so will refer you to it here: Snuggle with Your Baby: Benefits of Skin-to-Skin. The focus of that post was mostly about the benefits to the baby of skin-to-skin (aka “kangaroo care”).

I want to also detail a few benefits of this closeness for the mom (or non-postpartum/breastfeeding parent or family member, for select bullets):

  • Helps parent to bond and connect with baby
  • Helps parent get to know and understand their unique baby and baby’s more subtle signs in an acute and helpful way
  • The closer baby can stay to breastfeeding mom, the more restful it is and therefore the more conducive to healing from giving birth
  • Thanks to oxytocin (the “love” hormone) produced by skin-to-skin and, in even greater amounts, through breastfeeding helps mom feel happier and more relaxed, thereby reducing the chance of suffering from postpartum depression
  • The oxytocin is also helping your uterus heal, helping shrink your uterus (called “involution”) toward its pre-pregnant size each time you feed your baby in the first few weeks
  • The more mom can hold your baby skin-to-skin, the more frequently baby will tend to breastfeed, which bodes well for a healthy milk supply

I want to acknowledge that there are instances in which mom is not available to hold baby skin-to-skin, and absolutely it’s still helpful from a physiological perspective for dad, partner, or another family member or friend to hold baby skin-to-skin. So boost those endorphins and have fun snuggling away on your sweet baby!

More reading

Snuggle with Your Baby: Benefits of Skin-to-Skin (Birth Matters NYC)
7 Reasons To Be Skin-To-Skin With Your Baby After Birth
 (Mommypotamus)
Skin-To-Skin Care After Birth: A Practical Guide (Mommypotamus)
Birthful podcast: Ep. 56, SylviaHouston, Skin-to-Skin
Video: Dr. Nils Bergman on Skin to Skin
http://ninobirth.org/
http://www.skintoskincontact.com/home.aspx
http://www.kangaroomothercare.com/
Giving Birth with Confidence (Lamaze) – The Wonder of Mothers: Skin-to-Skin Care
Video: Keep Your Baby with You After Birth
Birthful podcast: Ep. 56, SylviaHouston, Skin-to-Skin

 

Push it, Girl, Push It Real Good: 2nd Stage of Labor

20 Jul

Okay, so I totally just revealed that I was product of the 80s and cheese out on that era of music (she says, referring to the post title’s nod to the 1987 Salt n Pepa song)! We’re up to #9 on our 11 Ways to Prepare for Your Best Birth series:

#9 Avoid giving birth on your back, and follow your body’s urges to push

Today we’ll talk about the 2nd stage of labor, in which our uterus is pushing the baby down and out and we get to meet our sweet baby.

Avoid giving birth on your back

First: Avoid giving birth on your back (also known as “dorsal lithotomy”). I’ve never worked with nor heard of a laboring woman who, if left to follow her body’s instincts, would choose to lie down on her back. Isn’t it kind of bogus that we tell women in pregnancy to stay off their backs for so many weeks and then in labor we order them to get on their backs to push a baby out? A woman should be allowed to have full freedom of movement and choose whatever positions she finds most instinctive and least uncomfortable throughout her labor, including the pushing stage. This will virtually never mean lying on her back.

Here are a few reasons lithotomy (either flat on your back or semi-reclined) doesn’t feel right to a laboring woman at any point in labor—especially during pushing:

  • In labor, we often have discomfort in our backs, and lying on our back only increases that uncomfortable sensation
  • Lying on the back is the most closed position for the pelvis; our wise instincts lead us more often to sit, squat, or get on all fours — significantly more open positions for the pelvis.
  • The vast majority of us, at least in our adult lives, have never passed a bowel movement while lying on our backs in bed. A laboring woman often pushes with the contractions very effectively while upright or sitting on the toilet because that’s where she’s used to coordinating her abdominal muscles and releasing the pelvic floor ones. Then if a care provider comes in and disrupts that process by ordering her patient on the bed, suddenly when she’s out of the familiar territory she feels totally disoriented. This is normal and to be expected, so I’d say, “just say no!”

Actually, that’s a little late for the communication. I would recommend doing that if you must, but it would be better for you to have conversations with your care provider now, prenatally, about this point in labor and get a sense of how flexible your care provider is for the moments of baby’s head crowning and for baby’s birth. In a hospital setting, most OBs/midwives aren’t there with the laboring woman for the earlier stages of pushing until the baby is very close to crowning, at which time they’d come to stay with you until an hour or so after the baby’s birth. For the early stages of pushing, one or more nurses would be the continuous support, monitoring the descent of baby through the birth canal and getting your care provider when it’s time. So, in an unmedicated birth there’s usually a good deal of freedom of movement until the OB/midwife comes. This is assuming, of course, that you get a natural-friendly nurse (tip: request this if you’re hoping for an unmedicated birth upon arrival at the hospital in labor).

Follow your body’s urges to push

When a woman’s labor progresses to the degree that her cervix reaches 10 cm dilation (=openness of the cervix) and 100% effaced (no lip/edge of the cervix in the way of the baby’s head), which we also call “complete”, it signifies the end of Labor Stage 1 and entering Labor Stage 2 (Pushing).

For many unmedicated women, around the same time she’ll get an uncontrollable, overwhelmingly strong urge to bear down and push. This urge can be hugely helpful for women, particularly when it’s our first time to experience labor. It takes the insecure feeling of, “how in the world do I do this?” out of the equation entirely because the urge is SO strong and helpful.

It’s equally normal for other unmedicated women’s urge to take a while to be triggered. If you find yourself in this latter camp, here are my tips for you:

  1. If hospital staff are pressuring you to push immediately, ask if there’s any reason you can’t wait to actively push until the urge is triggered. (In the mean time, your uterus will continue to do lots of that work for you.) That is, there’s no rush to start actively pushing just because you are “complete”—contrary to what hospital staff might make you think due to their being stuck in their ways of regular all-too-impatient protocols.
  2. Change positions. Often the simple act of changing position can trigger the urge. (It’s a good general rule of thumb in labor, in fact: When in doubt, change positions to encourage progress.)

In a hospital setting, the nurses are accustomed to the majority of women getting the epidural and therefore not feeling this natural, instinctive urge to push. Therefore, they are trained to default to a highly coached, loud method of the “valsalva maneuver”, aka “purple pushing” because women are encouraged to bear down vigorously and hold their breaths for unnaturally long periods of time. With this method, nurses loudly and slowly count to 10 while yelling, “harder, harder!…that’s good!…go, go, go!” and often scold the laboring woman if she lets her breath go before they reach 10. For most women, this coached method will really only be needed if a) we’re rushing things and not waiting for the natural urge to push comes (as is standard in most hospital settings), or b) a woman has the epidural and most likely won’t feel the urge and therefore may welcome some guidance (particularly if it’s her first time to give birth). It is far from the most likely non-breath-holding method you’d use with the physiologically organic urge to push and tends to lead to greater likelihood of fetal distress due to oxygen deprivation.

I would add that, in the 2014 ACOG report on things hospitals can do to reduce the unnecessarily high cesarean rate in the U.S., they ask hospitals, “Why are you putting women on a deadline in this stage of labor?” — that is, most hospitals have set a fairly arbitrary time limit on the 2nd/pushing stage of labor. Usually it’s a generous 3-4 hours, but there’s really no reason to move to a c-section solely because “time’s up” if a mom and baby are doing fine and are up for pushing longer. With this, keep in mind here that studies have revealed that hospitals take 15-17 years to adopt new recommendations, no matter how evidence-based, wise, or urgent they are to incorporate.

Here is the BEST article I’ve ever read on the topic of instinctive pushing.

If you’ve given birth before, or if you are a birth professional, I invite you to chime in with your experiences and insights! What worked for you? What didn’t work?

Further reading

2014 ACOG report summary (Choices in Childbirth; full report link found on this page as well)
Second Stage of Labor: You Don’t Have to Push by Nancy Tatje-Broussard
Supporting Women’s Instinctive Pushing Behaviour During Birth (Midwife Thinking)
The Anterior Cervical Lip: How to Ruin a Perfectly Good Birth (Midwife Thinking)

Patience is key: On Spontaneous Labor & Avoiding Unnecessary Induction

10 Jul

Did you think I forgot to finish the “Preparing for Your Best Birth” series? I promise I didn’t! I just went on vacation and decided to take a pause and post some birth stories written by my students so I could truly vacation. Now I’m back from Lake George and feeling refreshed.

So, let’s finish these last few points on the list over the next few weeks!

#8 Allow labor to begin on its own & avoid interventions that are not medically necessary

I admit, the first part of this one is hard. It’s so incredibly common to have a sense of wanting the pregnancy to be over and meet your baby already—largely because baby is getting uncomfortably cozy in there as he grows and is kicking you in the ribs, making it hard to get enough rest and the like. It’s quite common for one of these things to happen around or soon after passing the (estimated) due date:

  • A pregnant woman requests induction
  • A care provider simply says, “it’s time” (insinuating there’s a need to synthetically initiate labor, even in the absence of an evidence-based reason to induce).
  • Or, a care provider uses the words “getting big” in referring to the baby’s size—which undoubtedly instills a good deal of fear in any woman who ever hears this!

Not good reasons to induce, my friend.

I encourage you to resist the temptation to request or agree to an induction (solely based on dates or size) as you approach or pass your due date.

Here’s why. Did you know that baby initiates labor when she is done “cooking”, so to speak? There is a protein that is sent out from baby’s lungs when they are finished developing and ready to breathe the ex-uterine air (throughout the pregnancy, baby gets her oxygen through the umbilical cord). This triggers an inflammatory response in the pregnant parent that triggers labor. Additionally, March of Dimes says babies aren’t fully developed until at least 39 weeks, and also points out that important in-utero brain development happens between 35-40 weeks. Therefore, in the absence of any unusual medical indication to start labor, it seems logical and optimal to wait for baby to trigger labor rather than getting unnecessarily involved in ways that could put baby at risk.

Keep in mind a couple of other things:

  • The estimated due date is just that—an estimate. There is a 5-week window (37 weeks-42+ weeks) that falls within the (large) range of normal for baby being ready to be born. Dating is often inaccurate, unless you know exactly when you conceived.
  • Even if you have the accurate date of conception, also remember that both baby and mom are organic, unique beings who weren’t created according to nor behave in line strictly with textbook-rigid timing. Therefore, everyone’s optimal timing is different.
  • We live in a litigious environment, so care providers will often intervene (induction + many other interventions) because that is their best defense in the event of lawsuit from a bad outcome. There’s also just an unfortunate general sense of impatience in a clinical/hospital setting. It is therefore up to us to move through the perinatal period as informed consumers so as to know the difference between this scenario and legitimately wise uses of interventions.

So, the bottom line in a healthy pregnancy is: it’s best to wait for baby to initiate labor.

A bit more on the “avoid interventions that are not medically necessary”. Your best strategic tools along these lines are:

  • Labor at home as long as possible
  • Buying yourself time as many times as needed if/when interventions are suggested (assuming the suggestions are not emergencies; and never assume an urgent tone in your care provider’s voice equals emergency as it rarely does. Probe, ask questions!). In case you could use some clarity on what your rights are in childbirth, check out the Rights of Childbearing Women from Childbirth Connection.
  • Take birth classes in order to learn about the good vs. questionable reasons for the many interventions as well as the current state of your local birth environment and facilities. This way, you’ll know the questions to ask and how to make informed decisions

A little bit of patience goes a long way. You can then use that time, while waiting for baby, to study up or simply rest and enjoy the quiet in your last few pre-newborn weeks and days.

Further Reading

March of Dimes

 

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