I recently responded to a comment that my concern with the rising cesarean rate in some way judges women or their birth. I wrote a passionate reply out of my heart for simply wanting the best start for families.Here you go:

R. Mack – Absolutely! I totally agree with you that the birth and the woman are no less valid when cesareans are necessary. Every birth is sacred – every new life is cherished, every new family is SO special and this is exactly WHY I wrote that post.

Every woman, baby and family deserves the best start to their life together as a family and our current maternity care system does not support that.

My main concern is that there is much more significant risk for the mother and the baby when these surgeries are performed without a good medical reason. As a doula and childbirth educator, I am aware of a significant number of women who have had cesareans not because they or their babies were doing poorly, but because an arbitrary time had passed, or because fear tactics and coercion were used to convince the mother she needed the surgery.
The WHO (World Health Organization) recommends that the cesarean rate for a given population should fall between 10% and 15% (http://www.who.int/bulletin/volumes/85/10/06-039289/en/).

When the rate falls below 10% (as in situations when mother do not have access to care) more mothers and babies suffer very poor outcomes. When the rate falls ABOVE 15% as is does here in the US and in many Latin American countries, more mother and babies suffer very poor outcomes due the risks inherent with the surgical procedure or the compounded risk from multiple cesareans.

I wrote this post in frustration with our current maternity care system that is NOT set up to support optimum health for women, babies and their families – with our cesarean rate now at 32.9% (for 2009) and climbing.

Another report recently published by the World Health Organization states: “Compared with spontaneous vaginal delivery,all modes of delivery involving an intervention. . . were associated with an increased risk of severe perinatal outcomes.” here is the link to the full report: http://whqlibdoc.who.int/hq/2010/WHO_RHR_HRP_10.20_eng.pdf

I know that becoming a parent is challenging and caring for a newborn can be quite the transition! My concern is that every mother and baby and family be given the very best – the healthiest start. And cesareans for no good medical reason vastly change the family’s experience in those first few crucial weeks – for no reason.

I do not judge a women her experience. I judge our system that is not striving to provide the best for our families. I am deeply saddened for so many women and families who’s start as a family was compromised because of unnecessary major surgery.

As a childbirth educator and a doula I strive to make sure that all of the families I work with understand this reality. That we don’t get to choose our labor and our birth. We can only choose how we respond to our labor and birth. I totally support every parent’s rights to make decisions and make the choices about their care in the process of their labor and birth. And occasionally when that labor and birth need to be surgical – that is FINE.

There is no guilt for the mother or her birth.

When I work with couples as their doula I WORK to make sure that they are respected throughout the whole process. I make sure that they understand everything that is going on. I make sure that they have the information and resources available so that they can make decisions for themselves that they feel good about. At the end of the day, I do not raise their child, the nurses and doctors do not raise, their child, THEY are the ones who will raise their child and live with the consequences of any and all decisions made during their birth process.

What I do not tolerate is fear mongering, scare tactics, ultimatums, and coercion by the birth team. I do not tolerate belittling the mother because she had certain hopes for her birth that are not being realized. I do not tolerate talking down to women or over them to their support team as if they are children. Ido not tolerate disrespect for women and families during their births. In my mind the climbing cesarean rate is systemic evidence that our maternity care system does not respect women and babies.

I do not tolerate that.

Just an amazing video!  Notably cool things about this video:

• the baby is born OP  - occiput posterior (aka “sunny side up”)
• it’s a waterbirth
• the head is born in the caul (with the bag of waters intact)
• this baby is SO EXPRESSIVE
• you can see the baby wiggling and turning at the perineum after the head is born

So while watching the thought that kept going through my mind was, “What is this baby thinking about? Does she even realize what is happening? She’s so expressive!”

What are your thoughts?

I went to an amazing Brio Birth training last weekend in Chicago.  It was so encouraging and exciting to be around other like-minded women and men who want to empower and educate young families about all of the choices we have when we are pregnant and giving birth.

While at the conference this weekend I met Eric who is a mother of two beautiful babes and also blogs over at Mouth Like a Mother.  So naturally I’m reading through her blog after I got home this weekend and found this great post about how the sisterhood of motherhood isn’t always nice and supportive – that we can actually be judgmental and mean. Mean Girls!?!  Who us? Unfortunately, it’s true.  Intro the Mommy Wars.

Which got my wheels spinning about this post.  Here you are newly pregnant and now you have so many CHOICES in front of you:

Where are you going to give birth?  At home? At a birth center? At a hospital? A waterbirth or not?

Do you plan on pain medication?

If you have a boy will you circumcise?

How are you going to feed your child?  Will you breastfeed? Will you pump? Will you use a bottle? Will you use formula?

Will you stay home with your child? How long? Day care or not?

And did you know that each and every one of these questions and the decision represented by them can be incredibly divisive depending on who you talk to.  And in some circles simply stating your preference or the decision you are planning on making give your family’s circumstances can invite much criticism and judgement from others – from your co-workers, your family, even your best friend. Or on the other hand others perceive that they are being judged for not making the same choice you are.  That by choosing to breastfeed your baby you are in some way condemning them for choosing to switch to formula at six months? Even though I have had those experiences first-hand just describing it sounds absurd.

So here I am to say that the Mommy Wars exist and that we need to do our part in not fanning those flames.  At the end of her post Erica pleas for more of the sisterhood – where we all can allow each other the freedom to make a choices that may differ  and let that be OK. . . It’s OK. . . Really.

I want to echo that plea.  My perspective is that I am super supportive of natural childbirth.  Research shows that statistically mamas and babies fare better when there are fewer interventions.  However, that does not mean that I look down my nose at mamas who choose epidurals for pain management in labor.  I commented over at Erica’s blog that my longest labor was a whopping 12 hours.  My labors were very straightforward, down-to-business labors and not very long as far as how long labors can go. As a doula I have supported mothers who opted for an epidural at 30 hours or once their high BP mandated that they lie on their left side for the duration of their labor.

Were those choices wrong? Absolutely not.

We cannot control the labors we are given.

However,

We CAN control how we support women.  And as pregnant people we can control the choices we make in light of of our particular situation.

So from one woman to another, from one mother to another, we can end the Mommy Wars if we just take a moment to walk a mile in another’s shoes. We must recognize that our  education, experience, and instinct that informs the decisions we make may vastly differ from the education, experience, and instinct that another mother is basing her decisions on.

This past weekend we talked a lot about the definition of a successful birth as one in which the couple makes good informed decisions about the labor they are given. I love that!   That is my goal as a childbirth educator – to let you know what choices are available to you in various situations so that you  - as the people who will be raising this child  - can make decisions that you feel great about given your situation.

So if you have any questions about the decisions you will be making over the next few months and want to know more of your options don’t be afraid to take a great class or read some great books, so that you can be informed and confident in whatever your circumstances may be.

Related Posts:

I’m Pregnant. Now what? – Part 1

What to Expect from Your Childbirth Class

“Woot!”

Or perhaps your reaction is, “What?!!?”

Whether your pregnancy was planned, long awaited, and certainly expected, or you find yourself with one of the 50% or so of unplanned pregnancies, those first few moments, days, and weeks are filled with a whole host of emotions.  Combine that with all your newly pregnant hormones and, “wow!”  some serious adjustments are taking place in your life.

Pretty soon into the process you’ll find yourself making an appointment with a medical care provider.  Most likely this is with the same provider who does all your healthy gyn care.  This is fine for the first appointment, but I’m here to say that the person who does all of you gyn care may not be the best fit for you throughout your pregnancy and your birth. Your needs for an annual pap exam are very different that your needs as a pregnant and birthing woman.

The Listening to Mothers II survey shows that most women simply pick a care provider covered by their insurance. 83% of us didn’t visit any other providers to see if there might be a better fit elsewhere.  Ladies, it’s probable we do more research buying a camera to take pictures of this baby than we do on the providers who care for us in our pregnancy and our births!

As a woman guilty of the above – I kept the same provider (through three pregnancies!) that did NOT share the same perspective on birth that I did – I strongly urge you to look at your views on birth, look at the options available to you and go with the best fit. I wish that I had.    It’s OK if the provider who has done your annual exams since high school does not catch your baby.

So the first step is to read up a bit on pregnancy and birth and see what kind of care and birth fits you the best.  Some great places to start are:

• Pregnancy, Childbirth and the Newborn by Penny Simkin, Janet Whalley and Ann Keppler.
• The Pregnancy Book by Dr Sears
• The Birth Book by Dr. Sears
• Your Best Birth by Ricki Lake and Abby Epstein
• The Doula Guide to Birth by Ananda Lowe

There are two main perspectives on the spectrum of philosophy regarding caring for women during their birth year.  They are the midwifery perspective and the obstetric perspective.

(This is not to say that all midwives are one way and all OB’s are another.  You will find midwives whose practice habits reflect the obstetric perspective and OB’s whose practice habits will reflect the midwifery perspective.  This is simply an exercise to help you figure your preferences for your care and find a provider who fits your perspective.)

The midwifery perspective:

“The care of pregnant women [is approached] as a collaboration between two equals, with the [provider] pledged to fully informing you and advising you in the decisions you ar egoing to make about prenatal care and plans for birth. They practice what some have described as low-tech, high-touch method of care. [They] see pregnancy as a natural process that, for most women, needs no intervention. . . . [Care] is centered on you and with you all the way through your pregnancy. . “ from p. 76  of Your Best Birth by Ricki Lake and Abby Epstein

“They tend to focus on mor eholistic care, catring for the whole woman, which in addition to your physical health means asking you about your diet and your relationships, the stresses you’re feeling, and what is going on at work and with your kids. The process is personal and intuitive as well as medical and tailored to thewoman’s individual needs.”  from p. 78 of Your Best Birth

The obstetric perspective:

Starts with the assumption that “. . .pregnancy and birth are medical events and so maternity care should be seen in the [care provider's] terms, not women’s terms.” from p. 20 of Marsden Wagner’s Born in the U.S.A.

Training for the obstetric perspective covers “all there is to know about abnormal pregnancy . . . The [provider] must ba active and vigilant for any indication that your birth is starting to move into dangerous territory. At any moment something could go wrong. To monitor the crisis. . . the technology, technicians, and interventions that [are needed] are only available at the hospital.” p. 66 Your Best Birth

So some questions you need to ask yourself at this point include:

• What kind of care for my pregnancy and birth do I prefer?
• Do I have a high-risk pregnancy and need a care provider who can manage a high-risk pregnancy?
• Which kind of care will make me feel safest?
• What kinds of providers are available in my area?
• Where do I want to give birth?  Where will I feel safest giving birth?
• Who cares for women at my desired birth place?

Here in Salem, Oregon we are fortunate to have many options with care providers.

We have home birth midwives:

• http://www.motherbabymidwifery.com/
• http://www.birthwithlove.7p.com/
• http://growingfamilymidwifery.com/

We have midwives who attend births at an out-of-hospital birth center:

• Bella Vie Gentle Birth Center

We have midwives who attend births in hospitals:

• Salem Midwives

And plenty of obstetric practices as well.

Water birth is available for women giving birth at home, at Bella Vie Birth Center and at Santiam Memorial.

After figuring out where you fit on the spectrum of caring for women in their birth year, you now need to find our where your chosen provider is and if the both of you  match up.  If you want all the technology present and available for your birth, a home-birth midwife is not a good fit for you.  On the other hand, if you want someone who is going to let nature take its course as long as you and the baby are fine, an OB who practices active management from the positive pregnancy test is not a good fit for you.

Also here in Oregon, if you are pregnant you can get insurance through OHP for you and your baby.  Also if you are on OHP you have these same options regarding birth place.  If you are considering home birth and will need health insurance through OHP, contact your desired provider before signing up as certain options must be chosen when registering for OHP in order for the home birth to be covered.

I love to think about pregnancy and birth and parenting as this journey that we are on.  By examining how you want to be cared for and the kind of birth you desire helps you to imagine what one stop on this journey might look like.  The are so many paths we can take in giving birth to our babies, and identifying what kind of stop you want to make in giving birth can help you make decisions now to keep you on the path toward that path.

I know that we cannot control our pregnancies or our labor and our birth, but we can control the choices we make along the way.  We can control who we choose to support us and care for us in our pregnancy and our birth.  Choosing a care provider who shares a similar perspective on birth as you do can help to ensure that when you make the stop for birth it has the best chance to resemble the kind of birth you were envisioning from the very beginning.

I’d love to hear from those of you who have made this journey already and how you feel about your choice of care provider and how you felt that impacted your birth.  Also for those of you still on the path.  Do you feel like your care provider is a good fit?  Why or why not?  Ad do you feel like you can switch if you needed to?  What are the factors that impact this decision for you?

Other posts you might like:

• 10 Ways to Avoid an Unnecessary Cesarean

• Midwifery Care

• All About Due Dates

With my first pregnancy, at some point after the euphoria (or shock – or both!) of finding out I was pregnant wore off, I settled into being pregnant and enjoyed the little email blasts every day telling me how big my  little peanut was.  I couldn’t wait to get into the maternity clothes and actually look pregnant.  Finally, not too long after the baby bump ceased being a bump and was registered its own zipcode, I came to a realization:

This baby is going to come out of my body.

That will probably hurt. A lot.

And since I grew up watching mass media, several images flashed through my brain:

An enormously pregnant woman is standing on a bus.  A pop is heard followed by a massive gush of water.  The camera pans down the the small pond forming at her feet.  Immediately her face contorts into a grimace of anguish as she grabs her abdomen, bends over, and howls because her body has now been gripped by an enormous contraction.  Immediately everyone on the bus reacts as if her baby is going to fall out on the floor any second and pandemonium ensues as this woman is rushed to the hospital because this is an EMERGENCY.  [the camera pans across faces of fear, terror and horror. A baby is going to be born!]

The scene cuts and we follow a harrowing ride through some giant city, and then we find the woman in her hospital room.  She is in agony.  Here is where the scene will go one of three ways:

Option 1: It is too close to the birth for the mother to get any pain relief and we will finish watching this mother give birth flat on her back yelling and screaming and cursing everyone in her presence as there is no end to her torment.

Option 2:  The woman is able to get an epidural. Then and there she decides to leave her hsuband or partner for her anesthesiologist.

Option 3: Something relatively benign happens that the writers of the show declare an EMERGENCY. The woman must have an emergency cesarean in spite of the fact that the hospital has just lost all power.  The woman and the baby nearly die on the table because of complications from the surgery, but the doctors are the heroes because they saved their life. Never a mention that in real life this mother would never have had a cesarean for that particular situation.

Well, I told myself, that’s just Hollywood.  What have my mother/sisters/friends/aunts told me about birth?

This is what I heard my friends telling me about their births:

“I couldn’t feel to push the baby out so the doctor had to cut an episiotomy and use forceps.”

“After the baby was born I had a spinal headache that wouldn’t go away and had to lay flat on my back for a month while caring for my newborn. It was awful.”

“After the cesarean it hurt to walk, it hurt to nurse, it hurt to cough. I was miserable for a month”

“My incision [from my cesarean] got infected so I had to go back in to the hospital for a few days.”

“I felt strapped in and trapped the whole time which made it hurt worse. I was miserable so I got the epidural.”

There was NO WAY I wanted to go through any of  that!

Hollywood wasn’t helpful.  My friends were terrifying.  What were my mother/grandmothers/aunts telling me about their births?

1977 – small town hospital, my mother giving birth to me: “My labor was long, and they were going to do a cesarean. However the anesthesiologist for the hospital died that night so they couldn’t do one.  We called our friend the pastor and they prayed for us at church and you were born that Sunday at noon. You were just fine.”

1946 – small town home birth, my grandmother: “My oldest was 18 months old.  I had the baby, and the doctor started finishing up to go home.  The nurse who was with him said that she thought there was another baby in there.  The doctor checked and said, “Well I’ll be damned!” Pretty soon after that your mother was born.  We had no idea we were having twins, but I was pretty big.  They were both over 7 lbs and healthy.  I was pretty busy after that.”

As I was thinking about the birth experiences of the people close to me, I pretty soon saw that what most of my friends were describing was not a result of labor and giving birth, but the result of interventions they had while in labor.

• Epidurals that interfered with pushing and led to episiotomy and forceps.
• Epidurals placed incorrectly that led to excruciating headaches
• Pain resulting from major abdominal surgery
• Increased discomfort from being strapped to all number of monitors and IVs and BP cuffs etc.

My mom was in a crazy situation in the 70’s and she did it!  My Grandmother had a planned homebirth of unexpected twins and she did it!

Soon I realized that my fears were not around giving birth, but with all the interventions that go along with birth. I had survived Coach Jon Lederhouse’s Orange Hat Days (the toughest workout of the season) on the Wheaton College Swim Team, so I was pretty confident in my ability to deal with hard working muscles.  Plus I had heard that in labor you got breaks between contractions –  unlike on Orange Hat Days.

My grandmother had twins at home.  I could do this.

It was 2001 and we were in Spain and did not have access to all the amazing childbirth classes that are available now. We did, however, get hold of a great book by Susan McCutcheon. It is now a bit dated, but for us at the time, the relaxation scripts were fantastic and the whole idea of the emotional signs of labor was invaluable to my husband. So we practiced the scripts in the book and went to our maternity center’s  childbirth preparation classes.

What I remember from that class is laying flat on my back (ouch!) on a yoga mat listening to a cassette tape of a man go through some script that every other line ended with:

“Ray-la-ha-thee-on  to-tal.”   (It was all in Spanish.  ”Total relaxation.”)

Except it was really hard to relax on a yoga mat on a cement floor on my back with a 7 months old fetus and ginormous uterus (that now has its own zipcode, remember?) ceasing all circulation to my lower extremities.   Yikes. I quickly figured out that my left side felt MUCH better.

So we practiced the relaxation scripts from the book, and they worked great the whole night while labored at home.  Once we got to the maternity center, I must be honest with you that with my first birth, the relaxation exercises only got me so far.  (I’ll go into some of my reasons why in another post.) After about 7cm (transition!) it was my husband’s support and my own sheer will and determination that got me through. Fortunately that last bit of labor lasted only about an hour.

40 minutes of pushing and a healthy baby girl was born!!!  (I might mention that I’m only 5′3″ and she was 8 lbs. 3oz!) She’ll be nine this year.

So some of the tools that helped  me deal with the intensity of that birth were:

• the unwavering support of my husband
• relaxation exercises that we had practiced
• knowing the emotional map of labor
• confidence that family members before me had done the same thing
• confidence in my body’s ability to do hard work

In the end, did it hurt? Yes.

Was it agony or anguish or torment?

No.

Did I suffer or experience unbearable pain?

No.

Did I feel triumphant and amazed and exhilarated and enthralled at what my new baby and my husband and I had just accomplished?

Absolutely.

Did I feel like I could do anything after having just done something so powerful with my body?

Without a doubt.

It was amazing.

Holding this brand new soul to my breast and staring into her eyes – there is nothing like those moments.

My husband and I had a fantastic birth with only a handful of tools when I was in labor.   Students who take my class finish with way more tools at their disposal than we ever realized were available when we were having our first baby:

• Having a skilled support person (husband, doula, etc)
• Several different relaxation techniques
• Comfort measures for labor
• Specific techniques for the partner to support the mom
• Knowledge
• Positive birth stories
• Positions to ease pain in labor
• Positions for pregnancy
• Exercises to promote optimal fetal positioning for faster labors
• Ways to eliminate extraneous pain in labor
• Low-risk behaviors to help you to avoid certain interventions
• How nutrition impacts your pregnancy and birth experience

I cover so many tools because every woman is different, every body is different, every baby is different, and every labor is different.  Some tools that work for some women in some labors, will not work for others with their labors.  I want my students to have as much as possible working for them and with them in their labor.

Ready or Not, your baby is coming! Let me just say, being prepared for what’s coming with  a comprehensive class can make an enormous difference in your experience.

Classes run for 10 weeks.
I teach from 6:30-9 pm on Wednesday evenings.

Naturally I get asked about the classes I teach.  Here is a bit more about my perspective on birth and the topics we cover in class:

Birth is a normal physiological process for almost all women.

I am committed to natural, unmedicated birth but do understand that sometimes situations arise that may cause a mother to need some help.

I believe in the importance of being educated to know your options so you can make choices that are best for your family and your situation.

I am dedicated to breastfeeding from birth.

I am inclusive and welcome all types of families and support situations.

I stay updated with current evidence based research.

I am supported by Brio Birth through local leadership as well as a central office and continuing education.

Brio Birth provides updated materials to stay fresh and relevant for 21st century families.

These are some of the topics we cover in class:

• comfort measures for  labor
• optimal fetal positioning
• breastfeeding
• stages of labor and birth
• how the partner can support the mother
• nutrition for pregnancy
• relaxation techniques for labor
• techniques for dealing with a long labor
• techniques for dealing with a short labor
• pain management options  in labor
• postpartum needs

While we cannot control the labor we are given, we can control how prepared we are going into labor.  Couples who take my class finish feeling prepared and empowered for their upcoming birth.   Dads and partners especially finish feeling much less fearful ready to be supportive and involved in the birth process.

I am thrilled to be part of the process of helping parents prepare for the day they will meet their child.

If you would like more information about signing up for a class click here.

The last time I posted I was in the flurry of packing and organizing our entire move from Chicagoland to the West Coast. Now we are on the other side, settled in a beautiful neighborhood in Salem, OR.

I spent the summer with our family getting to know our new home, our new neighborhood, and our new town. Graciously, families in our neighborhood have been incredibly welcoming and have folded us into the fabric of their lives. Their generosity, support and friendship made this into a summer that will always stand out as remarkable in our family’s story.

This fall I began teaching Natural Childbirth Classes again and I love it. After 5 month break, I was definitely ready to begin again. Tuesday evenings are a highlight in my week. I am also taking on clients again as a doula.

I am so excited about being able to support moms and babies and families as a childbirth educator and a doula here in Salem.

In the Childbirth class I teach we talk about transition. It can be one of the most intense parts of a woman’s labor.  This is when her body works to open up her cervix that last stretch before being able to bear down and actively work with her body to push the baby out.

We talk about how this is the point in the labor when even the most composed, polite woman you’ve ever met might start to get really cranky and use words you didn’t know were even in her vocabulary.   She might be sweaty one minute, freezing the next, shaking, nauseous, or even throw up.   No matter how her labor has been up to this point, this might be the part where she starts declaring that she’s done and can’t go on.

Mercifully, nature made this most intense part also the shortest. And some women sail right through and hardly notice transition at all. They glide right through labor, and before you know it, they start grunting a little a the tops of the contractions and soon enough they are working hard with the effort of pushing.

Ever since I dove into learning more about birth every day, I can’t help but compare regular life to the miraculous process of birth.  So here’s my personal birth comparison for the day:   while I am not in any way pregnant or about to birth a child, I am very much so in transition.

We are actively showing our house (yes, we dare in this crazy market!) and rain or shine we are moving to Salem, OR,  from Chicagoland on June 14.   So from managing the details of moving an entire household across half a continent, to trying to pack and simultaneously keep the house show worthy, plus finishing up a course at our local community college, and saying good bye to so many wonderful friends here – I don’t know whether to throw up, swear, throw things, or cry from one minute to the next.

The one thing I do have going over a laboring woman is that I DO know exactly when it is going to end. We have a date set and somehow from here to there I know it is all going to come together. In labor you know you have been told that transition is the shortest bit, but when you’re in it, you don’t know when it’s going to end. I can become all-consuming and overwhelming. That’s when you’re support team of your partner and your doula step in and look you straight in the eye and without a doubt inform you that “You are strong. You can do this. You ARE doing this. We are with you and you WILL get through this and get to see and touch and hold your beautiful baby before you even know it.”

If you ever find yourself supporting a woman through transition, here are some helpful tips from Mother’s Advocate.

Penny Simkin also has some terrific recommendations for Comfort Measures for Labor.

And if your partner is doubting her ability to go on in labor or she is becoming overwhelmed with the intensity, Simkin’s Take Charge Routine can work wonders, and finally,  Nicole at Bellies and Babies has a great post describing the emotional intensity of transition.

Too bad there isn’t such thing as a moving doula – someone to hold my hand, wipe my brow, and tell me that somehow I’ll get to the other side as I cram our life into boxes.

• What a Doula can do For You
• Midwifery Model of Care
• To Push or Not to Push. . .

Wow.  The CDC just came out with the numbers for 2008:

32.3%

of all babies born in the U.S. last year were born by Cesarean section.

• 12th consecutive year that the Cesarean rate has increased
• the total number of births decreased 2% from 2007 to 2008

See that dip when the rates went down a bit?  That was in the 1990’s when the trend was to encourage moms to have a VBAC.  Then policy changed and we are now at the height of an epidemic that doesn’t seem to be slowing down – especially if an entire state can have an average cesarean rate of 40%.

So in light of the craziness that is going on in U.S. hospitals, you can do a few things to increase your chances that your birth isn’t just a 1 in 3 crap shoot of whether or not you end up with major surgery:

10 Ways to Avoid an Unnecessary Cesarean

Avoid Unnecessary Induction

Carefully Choose Your Provider

Have Great Support at Your Birth

Avoid an Unnecesarean

By the time we get to second stage of labor (aka pushing) in the Childbirth Ed class I teach I have already stressed how important it is to move around in labor, listening to your body. When we get to second stage I get another opportunity to talk about how important changing positions, using gravity, and moving can be for the pushing stage of labor.

I describe pushing the baby out kind of like trying to take off my wedding band – with the pelvis being like the ring (I know it’s not perfect, but you’ll see what I mean in a sec.)  I’ll  grab hold of my wedding band and pull forcefully toward the tip of my finger.  In variably, it moves a fraction and then gets stuck.  The flesh between the band and my knuckle gets all bunched up, my finger starts to turn frighteningly red, and I begin to wonder if the ring will ever come off. On my second try, I tug on the ring while gently jiggling it back and forth.  This time it moves right along without any trauma to my finger at all.

All of the moving and changing positions while pushing  – hands and knees, lunge (or Captain Morgan position),  side lying,  squatting,  sitting on a toilet, standing – are the equivalent to the jiggling I did to ease my ring off.  Lying flat on your back and pushing with all your might for two hours or more is the same as grabbing my ring and yanking full force.  In theory yanking can get my ring off, but there sure are gentler more effective ways of doing so.

If you are interested in a gentler more effective way of pushing your baby out check out this fantastic video from mothersadvocate.org:

While we are talking about pushing, I have to mention the fact that you may be asked to not push when you feel VERY much like doing so.  In fact, if you are having the overwhelming urge to push it is going to be a lot like throwing up, except this time your body is throwing down.  You can’t help it.  Your body is on a mission of expulsion and you are along for the ride.

So let’s say you find yourself in a situation where your body is very much telling you that PUSHing is what needs to happen and the people  around you are telling you not to.  The first thing you do is find out WHY.  If there is a good reason why you shouldn’t be pushing -  like you went though transition at how and now you are in the car and you really don’t want your baby to be born on Lake Shore Drive.  Or if  your baby’s cord is prolapsed and the pushing is jeopardizing the baby’s oxygen – those might be situations in which you might not want to push.

If that’s your situation there are a couple of things you can do: Blow Raspberries.  This is where you blow forcefully and let your lips flap away.  Like if you were going to imitate a horse noise.  I used to call this “horse lips” until a client misunderstood me and thought I said they were getting out the forceps. For me they are now forever “Blowing Raspberries” as I don’t like to terrify women in labor.  Blowing out like this keeps you from holding your breath and bearing down.

I have had personal experience with this one with my second child.  She came unexpectedly fast and I didn’t have the luxury of birthing in a facility with L&D rooms.  I was in an L room when the throwing down began and I the nurse desperately needed to get me to a D room two floors below!  My dear second daughter could have been born in an elevator, but I wasn’t too excited about that so I did my best to not encourage my body and two pushes was all it took once we got to the D room.  (I certainly hope they put some more thought into the design of that place down the road!)

Then there was the time when I was a doula for a primip (mama giving birth for the first time) who was having an exceptionally quick labor. I didn’t even made it to their home to support them it went so fast.  As I was turning down their street the dad called me to say they were headed to the hospital.   I saw their car pass me, made a U-turn and pulled up right behind them.  I stayed on the phone with the mom while following them to the hospital.  She was vocalizing loudly in the back seat and it sounded like transition.   I coached her as best I could through a hands-free device.  All things considered she was doing marvelously.  Soon I heard a catch in her voice and knew that she was feeling like pushing.  So for the next 10 minutes getting to the hospital we blew raspberries to each other on the phone.   She did a fantastic job and was able to push her beautiful baby out in two pushes once she got to L&D.

So there are times when it might be a good idea to not push even though you feel like everything in your body is focusing on bearing down.  However, I have witnessed on several occasions in several different hospitals circumstances where a mother is experiencing an overwhelming urge to push and everyone around her is telling her not to, and the only reason is because her chosen care provider is not in the building yet.

One time it was another surprisingly quick primip.  Other occasions it was winter in Chicagoland and the labor progressed quicker than the snowplows could keep up with the snow, so the doc was in transit.  Every single time a L&D nurse was present and every single time there was also a qualified OB on the floor who could have stepped in at any moment.  All of these mothers were unmedicated.  The main reason the mother was told not to push was because the staff wanted to wait until the mother’s chosen care provider arrived on the scene.  Arrgh!

If this is your situation and you don’t care who catches your baby (an L&D nurse can catch a baby just fine) then go ahead and push!  Not pushing with an overwhelming pushing contraction is pure misery.  If  not pushing along with you body saves your baby’s life, I am all for it.  However when it is simply for the convenience of someone other than the birthing mother, I am all for tuning in to your body, informing the staff that the baby is coming – doesn’t matter who is or isn’t in the room – and birthing your baby.

Another great resource for pushing and following what you body is telling you can be found here.

You may also like:
Good Things Come to Those Who Wait – Successful VBAC mom who did tons of scooching and changing positions in second stage