Archive | May, 2016

Is Birth Like in Movies & TV?

23 May

Short answer? For the most part, a resounding, “Heck no!”

Moving on to the #5 topic in our “Preparing for Your Best Birth” series:

#5 Prepare Your Mind: Get a realistic view of birth and understand it as a natural, healthy process

Think about any births you might have seen in movies or on tv. My group birth classes always need to start by dispelling these myths and reframing the way we think about birth.

Picture this, for example: A pregnant woman with a large bump wheeling along her grocery cart into line when suddenly you hear a loud “pop” and there’s a huge gush of fluid all over the floor, in a most embarrassing way. As soon as it happens, suddenly everyone thinks it’s a huge rush and emergency to get her to the hospital and someone calls 911, or her beloved nervously rushes her to the car.

The real deal:

  • Labor doesn’t usually start with the water breaking. It only starts this way 8-10% of the time.
  • Once the water does break, it can be an absolutely normal day or two before contractions even start. There’s no rush to go to the hospital or birthing center (with a few exceptions)

Give me another example, you ask? You betcha. After that rush to the hospital, the mother arrives at the hospital and they cut to her on her back, in a hospital bed, contorting her face in such an intense way that you’d think she’s pushing a baby out of that part of her body. You’d also think in this moment that a first time mother’s labor as well as pushing stage is incredibly fast (hence the rush to the hospital at the first sign of labor).

The real deal:

  • Labors for first time moms are usually long, lasting (on average) 12+ hours, and can easily last for a day or two. Before you panic at the idea of such length, it’s important for me to point out that the biggest variability in this wide range of normal is the time spent in “early labor”, when the sensations in the body can be ignored and managed quite easily — very gradually growing in intensity over time, allowing the laboring woman time to get acclimated to the sensations.
  • The pushing stage can last anywhere from 15 minutes (less common for 1st time moms) to an hour and sometimes more. To reframe this in a way that helps it feel more manageable and feasible, mom is only pushing/exerting herself during the urges and contractions, with breaks in between in which to recuperate, recharge, possibly even grab a catnap. Often for moms whose pushing stage takes longer, her contractions are spaced farther apart, so that she’s having fewer opportunities to push and more time to rest.

In my classes, I go through a few of the many miracles of our and baby’s anatomy that can also begin to consider birth in a different way that it seems so much more manageable and can reduce fear and tension. So much about our anatomy is miraculous and can help us understand why we (along with our active-participant babies) can totally DO this!

Further Mind & Spiritual Preparation

Beyond understanding birth in a (likely) new way, there are further steps that can be equally important and can help this reframing to take deeper root. Here are a few of those:

  • Prayer – this involves surrender to and trust in a greater power outside of us (if you are not a person of faith, perhaps spend time considering what it means for you to surrender and trust this natural process)
  • Meditation / Mindfulness – If you are Christian, I have a scriptures for labor reference sheet here; it also has some Orthodox Jewish scripture traditions detailed at the bottom of page 2
  • Affirmations – A client of mine liked these by Mama Natural—there are both secular and Christian/scripture-based options. Hypnobirthing can also be a powerful option, and centers a lot around affirmations. When I purchased the 3rd edition, it came with a birth affirmations CD; hopefully the current edition does as well. Some of my students have done the Hypnobirthing Home Study or the Hypnobabies Home Study.

The real deal:

Birth is a game of patience.

Birth is what a woman’s body is created to do.

Birth is healthy.

Birth is normal.

We can trust this process!

I highly recommend reading the positive, empowering birth stories and other great info in Ina May’s Guide to Childbirthit’s my top birth education recommendation for expectant mamas that can help us begin to think about birth in a different way. It did that very thing for me in my first pregnancy, thanks to my girlfriend’s encouraging me to read it.

Next up on the list, we’ll discuss preparing your mind and body further through childbirth ed classes.

Further reading:

Ina May’s Guide to Childbirth by Ina May Gaskin
Mindful Birthing by Nancy Bardacke
Birthing from Within
by Pam England
The Business of Being Born / More Business of Being Born (documentary)
Hypnobirthing (Mongan)
Hypnobirthing Home Study
Hypnobabies Home Study

My Firstborn’s Birth Story, in Honor of His 11th Birthday

15 May

In honor of my son’s 11th birthday, which we celebrated this week, I wanted to post his birth story. What is below is mostly unedited, so please keep in mind this is from the perspective of a first-time expectant parent and far from a birth professional at that point in time, as I started pursuing birth work a few years after (although I have briefly added to or corrected a few things that were misconceptions at the time). Note: I changed my husband’s name to “Beloved” and my son will be named “Little Fella”.

 

Sunday, May 8, 2005 (Mother’s Day) – My mom had flown up from Texas to help us for about a month. She had been here for a few days and I really wanted to try to help myself go into labor with some activity. So, on Mother’s Day, my husband, mother and I took the subway from our home in Forest Hills, Queens, into church on the Upper East Side. After, Beloved went to work while Mom and I walked up to the Metropolitan Museum and took a “Museum Highlights” tour, walked to Central Park and saw all the beautiful tulips and daffodils in bloom, had hot dogs for lunch, walked back to subway, took subway down to the Flatiron district, walked over to a flea market or two.

5.8.05 Mother's Day

After a fun, long day, we returned home, walking home from subway. We tracked a total of approximately 50 blocks! I’m virtually certain this brought on labor!!!

5.08.05 Mother's Day Forest Hills

The neighborhood where we lived at the time, Forest Hills (Queens).

Labor Stage 1, Part 1: Early/Latent

Monday, May 9, 2005, ~10:30am – wake up and it seems like I’m having contractions. I begin to record them, and they are coming every 3 minutes, but only last 30-45 seconds. This is a tad confusing to me as I had heard only scenarios where the contractions come less far apart but last longer, but not the reverse. Dr. R had given us the guideline to call her when our contractions were 3-1-1 (3 minutes apart, lasting for a minute, and this pattern going on for at least an hour or possibly two). So I wasn’t exactly sure what to do. At this point, the contractions weren’t enough to make me totally stop what I was doing, but they were slowly, gradually getting stronger. Beloved didn’t get up until probably around noon as he worked late the night before. I shared with him what was going on; he was extremely calm and suggested that we take a walk, then return home and have me take a warm bubble bath and then take a nap – all were things suggested to relax and see if contractions subside or continue to progress (ie to figure out if we’re actually in labor). I called work around 1:45pm to let them know I wouldn’t be coming in to work that evening because we might be in labor, and that Beloved would call as soon as he knew if he could make it or not (we worked at the same investment firm at the time).

~2:00 pm – Beloved and I take a walk to Stop-n-Shop as I needed to get a couple things. Was a gorgeous, sunny day. By this point I think I was having to almost stop walking when the contractions would come (or at least slow down). On our walk back home, we ran into neighbor Marilyn and her daughter and 5-month old granddaughter and had a short chat with them, telling them we thought we were in labor. Marilyn used to be a nurse, and she said, “maybe in the next 48 hours”—she didn’t seem to think I was very far along since I could still talk. At about 3:30pm upon our return from the store, we called our doula, Ellen Sidles Farhi; she advised me to take a bath and drink more water (she advised 16 ozs; I drank 40) and call her back in an hour. I did as Beloved and Ellen instructed and took a bubble bath; I think Beloved turned on my 6-hour-long labor mix on iTunes. Then I attempted to take a nap, but couldn’t sleep due to the strength and frequency of the contractions – a clear sign we were in labor. We debated over calling our OB, Dr. R, but decided against it. Just after 3pm, Beloved called work to let them know he wasn’t coming in to work. Boy, was I glad very soon thereafter!!!

Labor Stage 1, Part 2: Active

~4:00 pm – this is when we think the contractions became all-encompassing. Beloved called Ellen during this time; she had Beloved put me on the phone. I don’t remember what I said to her, but I do remember Beloved holding the phone up to me during a contraction so Ellen could hear my moans, at which time she had Beloved encourage me to keep the moans as low in pitch as possible, so Beloved kept gently guiding me to this lower pitch—has something to do with taking in more oxygen and vocal cords being more relaxed in lower pitches. She told us we were now in active labor. I think she might have asked me if I wanted her to come over yet, but I said we could wait a while longer. I had to sit on the birth ball, rhythmically moving right to left, back and forth, and at times banging my fist rhythmically on my leg, moaning; Beloved sat behind me to massage my back. In between contractions I would collapse on to some pillows on the arm of our loveseat. Seemed like we did this for quite a while.

Beloved did get in touch with Dr. R at some point between 4 and 7, but she didn’t really say much of anything, if I recall. He told her how the contractions had been progressing, and she asked him if we wanted to come in and be measured; he said we’d prefer to have our doula come to our house first. Dr. R said that was fine, and to call her once Ellen arrived. She presented the question: “If you arrive and you’re not dilated enough, will you want to go all the way home or stay nearby?”

Beloved called doula Ellen around 7:00 or a little after that, I think, to come join us. On the phone, she recommended I get into a warm bath. Beloved asked Mom to get pizza from Mazara’s down the street (I think he also sent her on another errand at some point during our early labor). Beloved fed me pepperoni pizza in between contractions while I was in the tub.

8:00pm

Ellen arrived around 8pm; we opened the window in the bath as it was quite warm (later we shut it some as I began to get a little chilly). I believe they called Dr. R when Ellen arrived to give her a heads up that we’d probably coming in tonight; Dr. R was already at the hospital delivering a couple other babies, so she said no need to call again, but just show up in triage when we were ready. Our tub is so tiny—I think it’s smaller than contemporary tubs as it’s older, in fact—it wasn’t ideal to labor in, but it definitely was helpful being in the warm water. When Ellen arrived, she asked Beloved to bring in and light a candle. It was my favorite Bartlett pear candle. They gave me liquids frequently to drink. I kept feeling like I had to pull myself up with my arms from having my bottom supporting my weight while sitting in the tub, as the back pain was quite bad.

11:15pm

We remained there in the tub until around 11:15pm or so; the contractions were coming pretty fast and furious, sometimes almost on top of each other. At this point, Ellen recommended that we start gathering our things to go to the hospital, saying we didn’t want for me to be in transit when entering the transitional phase of labor, so we should go now. It was pretty slow-going (as we learned in our class) getting ready to go as I had to stop for the contractions.

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Leaving for the birthing center! I’m clearly not enjoying things too much at this point.

I think we drove away at about 11:45pm, with Mom driving, Beloved navigating, and Ellen and me in the back. I sat on a towel to absorb some of the shock on bumps—this was very helpful. Wished we had remembered to have water in the front of the car with us, as I think it was all in the back. The ride was much better than I had feared—no traffic, made quick time (what a perfect time of day to have drive there!)…I did have to moan during contractions (I had hoped to avoid that to avoid distracting Mom’s driving), but I also remember singing a couple of worship songs in between, which was peaceful and relaxing. I sat in the middle of the back seat, in between Ellen and the infant seat. I do wish, though, that I hadn’t been such a doggone law-abiding citizen and had ripped the seatbelt off so I could sit in any position that was NOT on my behind as every NYC pothole was pretty excruciating. I even did a little back-seat driving in the middle of it all—can’t stop this bossy lady! LOL (An aside—while I can’t remember exactly what things were funny, I do remember laughing a few times throughout labor here and there, which was nice and something I hoped for to help in the relaxation process.)

Labor Stage 1, Part 3: Transition

Tuesday, May 10, 2005, 12:20am

Arrival at Manhattan’s St. Luke’s Roosevelt hospital (about a decade later renamed Mt. Sinai West). The front entrance on 10th Ave. was closed, so we had to go around the side. Ellen parked our car in a nearby garage while Mom, Beloved and I went in through the emergency after-hours entrance. They waved us through to the elevator bank and said to head to the 12th floor. We went into triage, and they paged Dr. R. Mom had to stay in the waiting room, but Beloved came with me. Ellen arrived pretty soon thereafter. They gave me this tube-top type thing to put around my belly, under which they tucked the fetal monitor to do 20 minutes of fetal monitoring. They gave me a hospital gown to wear. A nurse drew blood. We thought they were going to give me a Hep lock, but then Dr. R requested that they not do that. Before Dr. R said this, Ellen asked me if I was okay with that, and I said I was (but with the hope that they wouldn’t have to use it).

Dr. R did an internal exam, and found that we were 7cm dilated. Good news!!! I was very excited and relieved to hear this, as you have to be at least 5-6 to be admitted into the birthing center. Dr. R was looking for 2 movements from the baby within 15 minutes on the monitor – apparently the baby must be this or more active in order to be admitted to the birthing center. She seemed very concerned and said she might have to hook me up to an IV if she didn’t see more movement. I immediately began to chug the Gatorade, and soon thereafter the baby moved several times (whew!). Also, during this monitoring time, I threw up all over the hospital bed they had me on.

Once everything was finished in triage, we went back out and got Mom and our belongings and went down the stairs with Dr. R to our Birthing Room (Room 1 of 3). She turned on the water for the tub, and then said she would be back in two hours and to call her cell should we need her before that. Got a quick photo with Dr. R before she left the room (good, too, since that was the last time I was clothed!).

5.10.05 Dr Rhee

Beloved changed the light bulb, got out snacks, set up the sound system—battery operated speakers with my iPod to play our labor mix. Mom got some ice and some cups. Ellen got out her lavender oil because the room smelled like bleach. I think I got in the tub pretty quickly and stayed there for a long time.

5.10.05 whirlpool bath (1)

The neighborhood where we lived at the time, Forest Hills (Queens).

Met a really kind nurse named Juno, who came in periodically to do a handheld fetal heartbeat monitoring. She had a bit of trouble locating where to find the heartbeat on my belly, but eventually found it. (I didn’t learn until a week after giving birth that this is a symptom of posterior presentation, just as was the erratic contraction spacing.)

After two hours, I believe I was still in the tub.

Labor Stage 2: Pushing

~4:00am – 4:45am

Dr. R does second internal exam—with me on my side on the floor next to the tub. This position for an exam was quite painful! She indicates we have not progressed—still at 7cm (but 9 cm at the back—backwards from what you want) and my cervix is really thick and the potential was there for it to continue to thicken to where Little Fella couldn’t get out (ie would end in a c-section). She recommended, “going upstairs for epidural and pitocin.” My strength and endurance was really waning at this point and I felt like I wasn’t sure I could go on naturally. I was extremely close to giving in to this, and I know I would have if a) Beloved and I hadn’t taken Emily Shapiro’s Bradley birth class, b) I didn’t have the support of Beloved, Ellen, and Mom. They lovingly, gently supported me and encouraged me, and never pushed or pressured me. It was the perfect delicate balance. I said, “I don’t know how much longer I can do this.” I asked Beloved to ask questions we had learned in our class such as, “What will happen if we wait/don’t?” My mom asked Dr. R something about why she would recommend epidural with pitocin (since she did it without and felt like it was fine), and I overheard Dr. R respond, “Because it’s inhumane; she’s in so much pain.” Somehow that challenged me—I felt like, “Don’t feel sorry for me just because I’m in pain.” (after all, we learned in class that it’s pain with a positive purpose!)

We finally decided to ask for more time and asked her if she would consider artificially rupturing the membranes (asked her first to leave the room so we could discuss it with Ellen). She returned to the room, agreed and was about to do it right then and there, but Beloved asked everyone to leave the room so he and I could talk briefly.

While they were out of the room and we were talking and praying, I stood from kneeling at the tub, felt a pop, and then a rush of warm fluid down my legs—my water broke spontaneously! God knew just what I needed to get a second wind—I felt like this was a sign that I could do it. (My mom later told us she thought Ellen had done something to break the waters, as she hadn’t realized Ellen was out in the hall, too, when it happened!)

While Dr. R was out in the hall, Ellen told us it seemed like Dr. R began to work out in her mind the logic of why we were having difficulty—once they came back in the room, it dawned on her that Little Fella was posterior (geez, I could have told them that! Had a hunch for the prior two weeks that he was, even mentioned to Dr. R, and had been trying to take measures to encourage rotation, but apparently it hadn’t worked and I didn’t have the bandwidth in labor to realize it!). Just goes to show what a little waiting can do. I’m not sure if she would have been as quick to recommend pitocin/epidural had she realized this earlier, but I’ll never know. Dr. R then said she’d come back in an hour, and told Ellen we should get in knee-chest position to encourage Little Fella to turn as he was posterior (aka “sunny side up”).

~4:45am – 5:30am

Beloved spoke with Dr. R for a moment, and during this, I felt compelled to hang from something (as I’d seen in Ina May’s Guide to Childbirth—a primitive labor position)—there wasn’t much of anything in the room to hang from, but I hung from a bar in the tub while standing outside the tub. Once she left, Ellen and the nurses got me on the bed in the knee-chest position, which couldn’t have been more awkward—had to have my face on a pillow, not supporting myself with arms at all—to work on turning him. I was having really strong pushing urges at this point and Ellen tried to help me to resist the urge (by having me do lip trills) since that wasn’t the goal at the moment…I think that I had some (constipated) bowel movements during this time (so much for embarrassment or modesty!!!) with the pushing urges that I couldn’t seem to resist. The nurses were great, cleaning it up immediately as if it didn’t even happen.

I didn’t realize it, but toward the end of this time, Beloved tells me I said to him that I wasn’t sure how much longer I could go on. He went out into the hall to talk to a nurse and ask if we could get Dr. R back soon. He really wasn’t sure what to do; how to help me. At that moment Dr. R walked up!

~5:30 – 6:30am

Dr. R returned to the room to examine me, and this time she said we were fully dilated and ready to push!!! Little Fella had successfully turned anterior. So incredibly grateful! There was some talk about what positions we wanted to try; Beloved suggested a supported squat, but no one seemed to be too keen on that (I was, but wasn’t being very participatory at this point)…After Beloved questioned the openness of the pelvis pushing in the semi-reclined position, Dr. R said in her 20 years of experience, the semi-reclined position with holding my legs up wide and up to my chest would prove most effective in this situation. We started in this position; I wanted to and did sit on the toilet. Things progressed quickly there, to the point where Dr. R said, “I can’t deliver/catch this baby in a toilet!” (I was thinking, “why not, if it works?” But of course, it seems like she would have had more trouble minimizing tearing through perineal massage with my perineum face down!) So after just a few minutes on the toilet, she said, “Lisa, I need you to get on the bed again and this baby will come right out.” So I decided to trust her on that and heed her request, though in retrospect I still really think an upright position would have been more efficient. Got back on the bed; was having major issues lying down with acid reflux, so thankfully they elevated me a little bit—put a pillow or two behind my head. I wish they had elevated me more so we would have been working with gravity a little more, but then perhaps that would have sped things up and increase tearing? Who knows. Apparently, though I don’t remember it, the nurses tried to suggest getting the “wedge” which would have put me in semi-reclined position but for some reason Dr. R resisted it—I want to request it next time; I think she would have allowed it had I requested it instead of the nurses, but I didn’t know what a “wedge” was!!!

I had to pull my knees to my chest, but had people helping me by holding a foot, etc. Dr. R would tell me when to push and would—so slowly—count to ten each time. I always felt like I couldn’t make it all the way to 10, and often didn’t make it. They were encouraging me to not let any air escape as I pushed, but I didn’t always feel it possible. I remember vaguely that Beloved was whispering in my ear all the perfect things (“we’re going to see our baby soon”…”you’re doing great”…etc.).

I think in between pushing at some point, Dr. R said that I needed to push really low and not up in my chest, like in singing—she was really speaking my language since I’m a trained singer (though I’m quite sure she didn’t know it) and I think that helped a lot. I felt an incredibly strong burning sensation as he began to crown, as all the books told us. Dr. R did perineal massage as he was crowning to help stretch the perineum and reduce tearing. They told me when he was crowning, and said he had a lot of hair; Dr. R told me to feel his head, which I definitely wanted to do to help make the goal more tangible. I couldn’t believe how much hair was there!!! Amazing. Pushing got really intense, of course, and eventually he came out—his body pretty much slipped right on out once his head came through. Beloved said he thought that part happened a lot faster than in videos we watched.

I remember seeing Beloved’s face in amazement as he almost broke down in joyful tears—that tied for the best part, along with the nurses immediately wrapping Little Fella in a towel and placing him on my chest as he cried and cried (we learned in class that this is actually a good sign of a healthy baby!).

Labor Stage 3: Placenta Delivery

The placenta seemed to be delivered with one easy push quite soon after Little Fella was born. Dr. R said I had a small tear and had to stitch me up.

Labor Stage 4: Immediate Postpartum

5.10.05 Grayson birth.JPG

He went directly to my chest, just like it should be!

5.10.05 Grayson on mom's chest.JPG

Lots of skin-to-skin

5.10.05 Grayson after birth.JPG

Beloved, Little Fella, me and my wonderful mom

They clamped the umbilical cord, though I completely missed it, and then asked Beloved if he wanted to do the ceremonial cutting. To my surprise, though I didn’t know about it until much later, he did it, and with no hesitation about the blood. I think fairly soon thereafter, we got started on breastfeeding, with the help of Ellen as well as nurse Danielle. Ellen left soon thereafter as it was her own son’s birthday.

5.10.05 cutting cord.JPG

Clamping the cord

We offered to order breakfast for everyone, but about 30 min to an hour after his birth, the nurses’ shift was over and we got a couple of new nurses so they all declined (I think one, Mary Ellen, might have been a lactation consultant?). Our new nurse, whose name escapes me, was totally lovely – extremely caring, personable, clear in her instructions on various things about taking care of baby, etc.

5.10.05 juno nursing help.JPG

Juno, the stellar nurse who supported us through labor

At some point, they took Little Fella to the side of the bed to administer the state-mandated Vitamin K shot and erythromycin eyedrops. I love that they never took him out of the room! All three of us slept together in the nice big birthing room double bed throughout the day in between feedings. Once the breakfast arrived, Beloved and Mom fed me bites of fruit, eggs, French toast, freshly squeezed OJ while I fed Little Fella…was all SO yummy! Mom went and napped and watched tv in the family room for a while throughout the day. In the afternoon, the pediatrician came by to check him, and a guy came by to do a hearing test, which he passed. After filling out birth certificate and other paperwork, they wheeled me out in a wheelchair (required by hospital), holding Little Fella–we left the hospital around 9:45pm, and got home around 10:30. Welcome home, sweet baby boy!!!

5.10.05 Baby GrayJust before discharge to head home, the new and happy family unit!

Since that day, lots of amazing things have happened…

tonys family pic 8x10-001 copy

The neighborhood where we lived at the time, Forest Hills (Queens).

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Ever seen this gif from Broad City? That’s our little fella!

Happy 11th Birthday, dear son.
We are so proud of you and are honored to be your parents!

 

Ways to Prepare Your Body for a Smoother Pregnancy & Birth

9 May

Now for #4 on our “11 Ways to Prepare for Your Best Birth” series. I’ve gathered some of my expert friends to contribute their expertise.

Prepare your Body: Focus on Nutrition, Exercise & Bodywork

There are a number of really smart things you can do to prepare for the “marathon of indeterminate length” that we call labor.  For a first-time labor, it’s really a game of endurance and patience as it can last 12 hours up to a couple of days with a nice and slow build up in labor sensations. We all too often go into labor without much physical preparation. I ask you: would a marathon runner or any endurance athlete go into her big race without many weeks or months — and likely some expense — dedicated to conditioning their body to give them the best strategic advantage? So it goes with birth, my friends, and I dare say birth is that much more important to make a priority! Below are some ways you can best prepare your body, as well as baby, whom we call the “passenger”, for “winning” your own rite-of-passage marathon.

Nutrition

You probably already know that nutrition can help your and baby’s health. For many of us this means simply taking prenatal vitamins. These vitamins, however, are more about preventing deficiencies (“insurance”) than promoting optimal wellness. There’s so much more to it than that! Did you know nutrition affects every aspect of your pregnancy, with things you can proactively do for you and your baby’s healthy birth, as specific as:

  • Help prevent gestational diabetes mellitus (GDM) and preeclampsia
  • Thicken the lining of your bag of waters and thereby lessening the likelihood of your waters breaking at the onset of labor? (It’s to your advantage if this isn’t the first thing to happen.)
  • Lessen your chances of needing to have antibiotics before or during labor — most commonly due to urinary tract infections (UTIs) or a high colonization of Group B Strep bacteria
  • Reduce likelihood of a too-big (macrosomic) baby or baby not growing enough (intrauterine growth restriction/IUGR)

Check out these great Nutrition Basics for Pregnancy & Healthy Meal Ideas from my expert CEA/MNY colleague, Lena DeGloma of Red Moon Wellness (Park Slope, Brooklyn). Also see “Eating for Two” from Choices in Childbirth, and remember that “eating for two (or more)” does NOT mean your intake by the same amount! Focus on a diet of nutrient-dense foods and variety, with lots of healthy protein and healthy fats, vegetables and fruits.

Exercise

A healthy level of prenatal exercise will give you an advantage by:

  • helping baby into a good position through movement (pelvic movement, in particular)
  • making you stronger / increasing muscle tone
  • increasing circulation *Please note that the farther along in pregnancy you are the more careful you need to be about raising your heart rate for extended periods of time.
  • building stamina for the “marathon of indeterminate length” (i.e. labor)
  • building a greater body knowledge of the muscles required to “push” for birth

Prenatal yoga is one of the favorites because there’s such flow to it, isn’t overly vigorous, and there are specifically prenatal yoga classes as compared to other fitness classes that don’t have prenatal-tailored classes. It also helps prepare a mom for the deep abdominal breathing and mindfulness that are so beneficial for not only pregnancy but also labor. For those in NYC, I highly recommend Juliana Mitchell at The Yoga Room — all of my students adore her! Here’s a concise list of the benefits of prenatal yoga.

While prenatal yoga has many benefits, former student of mine, NYC personal trainer and proud new dad Michael Eisenstein makes the following important points:

“While yoga is a wonderful practice and prenatal classes can absolutely help pregnant moms navigate pregnancy, yoga (like anything else alone) is not enough.  There are no “pulling” motions in most yoga practices because most yoga practices do not incorporate external resistance.  Most yoga involves pushing motions and isometric holds and this can leave the muscles on the back side of your body that you need to pull things and stay upright weak.  The muscles on the back side of your body (posterior chain) become more important as pregnancy continues because your center of gravity shifts as your belly becomes larger.  The increased weight of your belly can strain on your back as you hold yourself upright.  If the muscles on the back side of your body are not strong enough, this can lead to back pain during the later stages of pregnancy.”

So, you can see it’s very helpful — even important— to do some strength training prenatally as well.

Keep in mind that over-exercise is always inadvisable. Prenatally, it’s extra important to listen to your body and not “push through” like you might have before you were pregnant— particularly in the 2nd & 3rd trimesters. Bodily changes such as the release of a hormone called relaxin loosens the ligaments in a pregnant body, which is good for birth but can put her at increased risk of injury if doing a too-rigorous workout — among other things.

Also, anything that too vigorously tightens the pelvic floor muscles can lead to issues. For example, dancers are always taught to keep their pelvis tight/tucked in, which can lead to tightness in these muscles that need to release in birth. So, working a) under your care provider’s guidance, b) with a teacher/trainer who can tailor things to your specific situation (for New Yorkers, get in touch with Michael (eisenstein.michael  at gmail dot com) or take classes with Juliana), and c) in conjunction with the below bodywork can be especially helpful if you fit into this category.

Check with your care provider to identify the best approach for you.

Bodywork

So much of birth relies on alignment and balance in the mom’s body so that baby can find the most optimal position to come through the pelvis. Through the stresses of life and any physical or emotional trauma, our bodies all too often become way out of whack by the time we are in our childbearing years and therefore need some help discovering balance once again. Here are a few things I recommend seeking out:

  • Chiropractic care – helps mom’s body get into a healthy alignment, which not only helps prevent mom from getting a lot of aches and pains throughout her pregnancy, but perhaps more importantly allows baby to get into a healthy position (read: shorter, smoother labor). My amazing chiropractor (see resources below for Dr. Vella’s info) would like me to mention to you the idea of “the earlier, the better” — that is, the sooner you can work on your alignment, the easier it will be for baby to get into an ideal position in mom’s pelvis towards an easier labor.
  • Cranial Sacral (or Cranio-sacral) Therapy – serves similar purpose to chiropractic care. CST is a light-touch manual therapy used to encourage the body’s self-correcting mechanisms.

Earth + Sky Healing Arts owner Katinka Locascio (Long Island City, Queens) gives her insights:
Cranial sacral therapy can be very effective in pregnancy. It can help align the structure and center the hips and pelvis.  This helps baby get in good position and drop into the pelvis near the end of the third trimester. Cranial sacral therapy helps balance the nervous system, so its particularly helpful for moms having trouble sleeping or who are feeling anxious or have had a trauma come up while they are pregnant.”

  • Massage therapy (including Mayan uterine massage) – works well in conjunction with chiro care or CST; helps with both the above as well as helping release tension and thereby allowing the underlying skeleton to better adjust.

More from Katinka:
“Massage is wonderful in pregnancy; in fact the best massages of my life were all while I was pregnant. The body is so receptive and the tissue respond easily, thanks to all the relaxin present. Many women find it also helps them snag a much needed midday nap while they get a massage.  Massage can address common concerns like piriformis syndrome (when your buttox area gets tight in pregnancy), tight shoulder, low back pain, swollen feet and calf cramps. Touch is oxytocin-stimulating so it’s normal to get small Braxton Hicks contractions when receiving massage in our last trimester.  It’s also a reason why many of our clients who are past their due date find they go into labor shortly after a massage! The relaxation, centering and oxytocin hit can all help ease the body into labor when the time has come. Most importantly, massage is a great way get in some self-care while you still have control over your own schedule!”

and on Mayan uterine massage:
“Many woman have scar tissue on their sacrum from fall or injuries. I always tell my clients that the last three weeks of pregnancy are a window of opportunity for women to resolve old scar tissue or structural imbalances, many of which precede pregnancy but may impact the nerves that run from the sacrum to the cervix which are very important for labor. Good bodywork at the end of pregnancy can clear the pathways for a good birth. Thanks to all the relaxin present, this bodywork help resolve old patterns that would have taken months to work through when she’s not pregnant.  I see it as a little gift for the mom after all her hard work carrying the baby!”

  • Acupuncture – Acupuncture has been shown to help women go into labor closer to their due date, and can also be used to manage various discomforts of pregnancy. I personally recommend having weekly acupuncture sessions in at least the last 4-5 weeks of your pregnancy as way to avoid unnecessary induction (be sure to seek out someone who is experience in the perinatal period). See NYC Serenity Health Arts acupuncturist Christiane Seibert‘s insights on the topic here.
  • Pelvic Floor Physical Therapy – Studies show that 64% of women experience prenatal urinary incontinence and 50% of pregnant women experience pelvic girdle pain? Seeing a pelvic floor specialist such as NYC’s own Lindsey Vestal of The Functional Pelvis can prepare your pelvic floor for a great pregnancy, birth and postpartum. Check out more info and a helpful infographic on her website here and a recent podcast interview she did here.

It doesn’t escape me that the cost of these things can quickly add up. So, if you need to, it’s best to choose 1 or 2 modalities, seeking out providers who are expert in the perinatal period, and go as regularly as you can (or as regularly as the doc thinks you need to). This is better than trying each modality only once, as dabbling will tend to be significantly less helpful. Perhaps you can find a practice who covers more than one of these modalities, and ask if they offer a discount package price.

Something also very important (and free!) is giving your body plenty of rest. Your body is working on creating a human life, and particularly as you approach your marathon of labor, you need to think strategically and go to bed earlier than you normally would. Particularly because it gets harder and harder to sleep well the bigger baby grows inside, it’s all the more important to rest up for your marathon of indeterminate length! Christiane Seibert points out, “Maybe even more important than all the things you “do” are those you “don’t do” so that you can get plenty of sleep at night and rest during the day.” See her other tips for a healthy natural pregnancy.

For further reading/action:

Dr. Louis Vella (chiropractor) – 21-76 Steinway St., Astoria, NY, 718-726-5454
Earth + Sky Healing Arts
 (Long Island City, NYC)
The Functional Pelvis
Michael Eisenberg, Personal Trainer – eisenstein.michael  at gmail dot com
Prenatal Yoga May Result in Less Labor Pain, Shorter Labor (Prenatal Yoga Center, NYC)
Serenity Health Arts
Spinning Babies – tips for identifying baby’s position & toward optimal fetal positioning
Spinning Babies Daily Essentials Video
Surprising Benefits of Exercise (Mothering)
The Yoga Room

How to create your “dream birth team”

1 May

The next topic on our “11 Ways to Prepare for Your Best Birth” series is:

Create your dream birth team

Here are the team members for your consideration:

  • Care Provider – Midwife or OB
  • Birth Doula
  • Partner
  • Family/Friend
  • Nurse(s) (in a hospital setting)

Another wise consideration at this point would also be equipping yourself with postpartum resources such as getting names and contact info for at least one lactation consultant and postpartum doula (some birth & postpartum doulas are also lactation consultants). We’ll talk more about those in a future post.

Care Provider – Midwife or OB

There are several general differences between the midwifery and the OB models of care. Keep in mind these are generalities, and there will of course be exceptions to these general trends.

Midwives:

  • Expert in natural, normal, low-risk birth (important to note they do work in conjunction with an OB should the need for surgical birth arise)
  • Holistic focus on health, wellness, prevention
  • Labor/birth as normal physiological processes
  • Lower rates of using interventions
  • Midwives tend to spend more time with their patients, helping their patients feel at ease, feel cared for, and feel heard

Depending on your insurance, it might take some calling around to find a midwife who is covered by your insurance. In NYC, it’s often easier to get full coverage when a midwife is under the umbrella of an OB’s practice instead of in a midwifery-only practice. However, you may also want to inquire about the possibility of a reimbursement scenario. Much of the time independent midwifery practices tend to be worth the less-than-ideal insurance logistics with the thought of avoiding unnecessary interventions — that is, a midwife working within an OB practice can often present certain pressures for practicing a more medicalized model of care, making it sometimes a less than ideal scenario. In most cases, though, still a better route for a healthy, low-risk expectant parent.

OBs:

  • Primary expertise/training is in surgical birth — many OBs go through med school and never see an unmedicated, vaginal birth
  • Focus on managing problems & complications
  • Often see labor/birth as dependent on technology
  • Higher rates of using interventions
  • Due to problems in the U.S. healthcare system, many patients tend to have extremely brief appointments with long wait times and often walk away feeling like they have unanswered questions

I also want to mention that there’s a common misconception among low-risk pregnant parents that working with a high-risk OB is the safest way to have a good birth. This is certainly the way to go for high-risk pregnant parents. However, for low-risk parents, it’s better not to go with a high-risk care provider as they are more accustomed to using medical interventions readily, putting a low-risk, healthy woman and baby at an increased risk of unnecessary intervention.

As you interview potential providers (or try to determine if your current OB/GYN is the right one for you in this new scenario of giving birth), check out these smart questions to ask from NYC’s own Choices in Childbirth. Ask yourself, as you talk with your care provider or potential candidates, “Do I feel heard and respected with this care provider?” Surveys show that feeling respected and heard in birth is one of the key factors in a satisfying and positive birth experience.

Moving on to others on your support team, and as you consider how many people and who to have on your support team beyond your clinical care provider, it’s important to know hospital policies. Many traditional Labor & Delivery rooms (at least in NYC) only allow 2 non-hospital staff support people in the room, where birthing centers tend to be larger and may allow for 3. Another thing to consider is that, from a hormonal and physiological perspective, women tend to labor best with few people around…yet we almost always do need a couple of carefully selected people to be very hands on to help with pain management as labor sensations intensify. Therefore, think about your best strategy for “minimum people/maximum support”. This most often will mean partner (if applicable) and a doula.

Birth Doula

A doula (from the Greek word meaning “a woman who serves”) is a trained, non-clinical professional who provides continuous emotional, physical, and informational support in the weeks leading up to and throughout labor as well as in the immediate postpartum. She helps to bring a sense of calm to the labor, which can be indispensably helpful and strategic, particularly for first-time, nervous parents. Having someone there to tell you, at every unnerving turn, “This is normal,” can help everyone breathe easier, help to labor at home longer (thereby avoiding the all-to-common unnecessary interventions), and help labor progress more readily with wise strategies. Having someone who has a vast toolkit of massage techniques, labor positions, pain management techniques up her sleeve to help you along the way is truly priceless. Even childbirth classes can’t replace the power of a doula as a strategic tool — they very much complement each other.

Many couples say that the doula is just as much there for an involved partner as for the laboring woman — she alleviates a good deal of the enormous pressure and stress off. Hear me, however, when I say that she does not in any way replace a partner who wants to be involved (and whom the laboring woman wants to be hands-on support). She strategizes with the woman/couple before the labor on how they would like her to support them, and this is different for every family. If you end up having the day-long or days-long first labor, too, it’s indispensable to be able to tag team with labor support as needed, or double up as things get so intense that she desperately needs several (all) hands on deck. Check out what most doulas include in their services here. I recommend interviewing more than one doula to find the right one for you — one you’ll feel entirely at ease with. Think of yourself (ie laboring parent) at your most vulnerable and in a highly suggestible state as you make this choice. I’ve never met a woman/couple who didn’t, after all is said and done, swear by hiring a doula as the best decision they could have possibly made toward a better birth. Check out some interview questions from Choices in Childbirth.

Be sure, too, to ask your care provider (once you’ve found the right one for you) if they are supportive of hiring a doula, since you want your team to work well together. Hopefully their answer will be yes; most natural-friendly care providers should be very supportive of a doula’s role. To my thinking it could be red flag should your care provider not be doula-friendly, but again, you’d want to probe and understand their reasoning before coming to this conclusion.

Partner/Spouse

When the partner is able to be at ease (often with a doula’s help), a loving, involved, supportive partner is the most important person in the room to aid in the laboring woman’s labor progress in a healthy way. He is the one who best can help elevate the most critical hormone in labor, the “love hormone” — oxytocin. Through partner’s touch, eye contact, perhaps making out, even sex (until membranes have ruptured and if both are in the mood), that oxytocin can be boosted, thereby strengthening the power of the uterine contractions and helping baby down and out.

I want to point out, however, that not every pregnant woman wants her partner/spouse to be her labor support. Every couple’s relationship dynamic is different, not all optimal for this particular task. I want to put this out there because we’re living in a day and age in which dads/partners are often expected to be labor support. For many couples this is ideal, but not all. For a woman who is in this camp, it’s very important to intentionally assemble a support team who she feels will help her labor well.

Family/Friend

You might opt to have a parent, sibling, other close family member, or friend support you through your labor. Ask yourself the following questions to help make a smart decision:

  • Do they have experience with birth? If yes, is it positive or negative? — best to have someone knowledgeable and with an overall positive view
  • Do they view birth as a healthy, natural, normal process or are they fearful of it?  — you only want someone in the room who sees it as the former and will not bring any fear or anxiety in the room, as this dynamic will not help your labor to progress in a healthy way
  • Are they healthy, strong, have stamina for the long haul of labor? — this is essential for the kind of support a laboring woman often needs
  • Do they know when to speak and when to be silent? — both referring to being quiet during contractions as well as being respectful and not combative with anyone in the room, including the laboring woman, her partner (if applicable), or the hospital staff

While we’re on the family/friends topic, also think carefully about who you tell you are in labor. Will those people come to the hospital immediately and — even if only by their mere presence in the waiting room — cause you to feel pressured, to feel like the “watched pot that never boils”? Will they constantly text or call? This can certainly impede progress. One smart strategy you could use is to assign a family/friend who will not be in the laboring space to be the point person whom everyone can bug, but no one in the laboring room should have that unhelpful distraction. Once you’re where you’re going to give birth, I actually recommend just silencing or, better yet, turning off phones altogether if possible. You’ll need to have it on while laboring at home to interface with your care provider and perhaps to occasionally time contractions if it’s a smartphone, but once you’re with them, ask yourself if you really need it on as a potential distraction.

Nurse(s)

Another person you won’t really get to choose per se but that is there throughout your time in a hospital setting is one or more nurses. A couple of recommendations here:

  • One of my recent students had the wise idea to request a nurse (upon arriving at the hospital) who is experienced with/supportive of natural birth — smart for anyone aiming for a natural, unmedicated birth.
  • Bring treats for them (home-baked or store-bought cookies can be nice, or a baby’s birthday ceremonial cake, donuts…no healthy crudité here, please, many nurses say! Doesn’t have to be food; some of my doula clients have made little thank you gifts. If you do this, be sure to take enough for several rounds of nurses, as you never know how many will be helping you.
  • Labor support partners, learn nurses’ names and be kind to them, working to create an amicable atmosphere while standing your ground and speaking up for mom if/as needed.

Spend time considering and discussing with your partner (if applicable) what your ideal birth team will look like, and then find and secure your optimal partners for a better birth. It’s worth the time, I promise!

Further Exploration:

Your Birth Team (Choices in Childbirth)
Discover Midwifery Care (“Our Moment of Truth” from the American College of Nurse-Midwives)
The Doula Book (Klaus, Kennell & Klaus) 
Doulas of North America International (DONA)
 – learn more about doulas, find a doula in your area
Doula interview questions (Choices in Childbirth)
Questions to Ask Your Care Provider (Choices in Childbirth)
Midwives Model of Care (Citizens for Midwifery)

 

 

 

 

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