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. . .

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

Yesterday, both the Chicago Tribune and the New York Times ramped it up with pieces on issues greatly affecting the health of mothers and babies.

The Trib ran a great piece on the whole issue of VBAC and how it’s actually not as risky as it’s often presented to be and how it should be readily available  option for women.

Health Experts: Most Repeat C-Sections Unnecessary

Then the NYT ran a great article about a Brooklyn Lactation Consultant who provides women with wonderful breastfeeding support and advice.

The Breast Whisperer

Noruishing a Baby

I love her ground rules:                1. Enjoy the baby.   2. Feed the baby.

Sometimes the first few weeks of an infant’s life can be so stressful (ours was with our first) for new parents that rule number 1 can be forgotten.   I love that she sees her job not simply as getting breastmilk into babies, but fostering the relationship between mothers and their babies.

Underlying both of these articles, which appear to be about two very different things, is the issue of adequate support for women and families during the childbearing year.  Giving women the options, the benefits and risks of these options and then letting them decide which they are most comfortable with and then SUPPORTING them through the outcomes gives families a much better start.

Many times the disappointment I hear in women’s voices when they tell their story about breastfeeding or birthing comes not because of a bad outcome, but it comes at the point in the story when they felt most alone and least supported.  Had these same women been truly supported in a decision that they were allowed to make in those moments, instead of a decision they were coerced into, I believe that in the same situations with the same outcomes, these women would be telling their stories in a very different way.

Adequately supporting mothers and families during the birth year is definitely one major reason that drew me to teaching childbirth classes, serving as a doula, and referring women to La Leche League and lactation consultants when needed.  I support whatever decisions families make for themselves – if a woman herself chooses a repeat cesarean or to formula feed knowing all the benefits and risks on both sides, that is her choice.  What kills me is when women are backed into corners and finding themselves headed toward a repeat cesarean or formula feeding mainly becasue they didn’t have good support for the choices.

This past October I was interviewed by the Chicago area  TribLocal newspaper about being a doula and what role we play in the birth process.  I love how she talks about the role of doulas supporting dads and partners as well.

I really enjoyed the interview because it made me realize how much I really love what I get to do as a doula and childbirth educator.

Check out the article here.

Some of these situations we cover are  not necessarily dangerous for the mom or baby, they just change the options that are given to the couple.  Being post-date or going past the due date is one of these.  Depending on your caregiver’s policy induction may highly encouraged anywhere from 39 weeks 6 days to 41 weeks 6 days.  That is a BIG difference.  And if both mom and baby are fine, then they have a lot of options including refusing an unnecessary induction at 40 weeks on the dot.

Another option-changer is breech position of the baby.  While there is a movement in Canada to encourage vaginal delivery of breech babies, the recommended route here in the US right now is surgical.  And since many OB’s do not have the proper training or experience with vaginal breech deliver, I am not comfortable advising moms to ask for vaginal breech delivery with inexperienced caregivers.  So, for parents who find out before the onset of labor, there are many things they can do to encourage the baby to turn: lots of positions for mom to try, chiropractic adjustments, acupuncture, etc can be effective at turning many babies.

So when preparing for these discussions tonight, I came across Dr. Onyeije’s presentation on avoiding a Cesarean.  It mirrors so many of the things I try to stress in class, the  most important being finding a caregiver who shares your perspective on birthing.

That one thing can pave the way to avoiding so many difficult situations for a pregnant couple.  If you are wanting a natural childbirth and go to a practice with a high rate of intervention, then you will probably be very discouraged.  If you want every bit of technology used on you and your baby from the first twinge and you are with a more laid back practice, you will be so frustrated when they send you home from the hospital when you are at 3cm and still in early labor. It makes SUCH a difference.  I they to encourage couples that statistically they will not be the exception.  Exceptions are out there, but you can’t expect to be the exception for the particular practice you are using.

So here it is: 

It’s beautiful.

Before we get to the statistics, having a doula at a birth simply makes sense in today’s environment.

Women who are given continuous emotional and physical support during their births tend to be more calm and relaxed and less fearful during the birth process.  Having someone experienced and trained in what is normal, to help women into positions that aid in the baby’s descent and maternal comfort all the while telling the mom that what she is doing is safe and normal helps tremendously.  Adrenaline produced by tension, fear, and anxiety in the mother are all shown to slow down and even halt the birthing process.

As labor and delivery floors are staffed with fewer nurses and more technology, women are increasingly not provided with continuous support in the standard hospital environment. Many labor and delivery nurses are too burdened with the duties of monitoring the mother and baby’s physical well-being along with the hospital paperwork and protocol to be able to provide the kind of intense non-medical emotional and physical support a woman needs in labor. Having a doula present ensures that a woman is supported by a trained professional whose sole focus is to take care of the non-clinical needs of the mother.  A labor and delivery nurse is constantly juggling her responsibilities to care for laboring women, follow hospital protocol and the orders given by the woman’s care provider – a doula’s primary responsibility is to her clients.

So, back to the stats:

DONA International, the organization through which I am certified as a birth doula, has published a position paper.  It is well worth the read.  In this paper they highlight some studies that attempt to document the value of doula support.  Some of the highlights of what they found were:

• Women who have doulas are safer:

26% less likely to have a cesarean section(major abdominal surgery), 41% less likely to have a birth assisted by vacuum extraction or forceps, and doula care even reduces the likelihood that the child would score less than a 7 at a five minute APGAR

• Women who have doulas have shorter births:

the average length of the labor is decreased by by 25%

• Women who have doulas have less painful births:

Doula support has also shown to facilitate less painful labors with women using analgesics and anesthetics 28% less than women without doula support

There are some things in life that just make good perfect sense and having a doula  or someone trained and equipped to provide continuous emotional and physical support for women at a birth is crucial.

I have another doula friend who likes to joke that her clients don’t get epidurals for pain in labor – they get epi-doulas.

And please don’t think that I am naive to think or suggest that women with doulas will have pain or discomfort free labors.  I have had three babies  – all of them were un-medicated births.  I understand the intensity of the  pain a laboring woman can have – and I know that many of the suggestions doulas have can make that pain manageable.

We were overseas for their births and we made the best choices we could in our given circumstances (no doulas).  Looking back I think we did a great job considering, but there were definitely moments when it would have been very helpful to have had an advocate translating (literally and figuratively!) the system to us.

For example, with our second, we went in for an un-scheduled induction.  Looking back, I was in early labor and didn’t know it and the doc was just trying to hurry things along. At the time, I thought that if we didn’t induce, then something seriously awful could happen to me or the baby.  Later during the induction, We couldn’t tell if I had simply a regular IV or one with Pitocin.  We had a lot of questions during that birth that a doula would have been able to help with and ease my/our anxiety through the whole process.

I truly love being a doula.  Supporting women and families through the amazing transition that is labor and birth is a honor that I am thrilled to have – every time.

Klaus, Marshall H, John H Kennell, and Phylis H Klaus.  The Doula Book: How a trained Labor Companion Can Help You Have A Shorter, Easier and healthier Birth (Da Kapo Press, 2002)

“DONA International Position Paper: The Birth Doula”, p. 3: Hodnett E, Gates S, Hofmeyr G, Sakala C.  “Continuous support for women during childbirth.”  The Cochrane Database of Systematic reviews 2003. Issue 3, Art No. CD03766. DOI: 10.1002/14651858.CD003766.

“Caregiver Support for Women During Childbirth: Does the Presence of a Labor-Support Person Affect Maternal-Child Outcomes?”, American Family Physician, October 1, 2002.   http://www.aafp.org/afp/20021001/cochrane.html

Bradley, Robert.  Husband Coached Childbirth (Fifth Edition): The Bradley Method of Natural Childbirth. (Bantam Books, 2008).

Related posts:

• Where can I find safer, lest costly Maternity care? With a Midwife

• So what’s in the doula bag? 20 Indespensible items for birth
• Consumer Reports: On Birthing

My faves: 

• The Nature of Natural Birth – I love this one because we get to see how beautiful and intimate birth can be.  This mother gets great support from her husband, midwife,  and doula.  No matter how many times I watch this one, I tear up.  If you want to be inspired, check this out.
• Prevent Cesarean Surgery -  This video is completely different than the first as it highlights a very different reality and aspect of our birth culture today – the Cesarean Epidemic.  You get to hear firsthand from mothers who have had cesareans and some of the unintended consequences they endured as a result of their surgery.  I love this video because it outlines steps families can take to prevent unnecessary Cesareans.
• Home Birth of Judah Darwin -  I have always loved this video.  I love this couple’s story.  I love how we get to see a woman working really hard in labor, yet she describes it in her subtitles as “intense and strong and amazing.”  She also gets amazing support from her midwife and doula and husband.  At one point we see her getting the double hip squeeze and later hear her getting coached to focus the intensity on moving the baby down.  Amazing support.  So many women’s birth are sabotaged for lack of excellent emotional support, so I love it when I see and hear stories of women being tuly supported throughout their births.  Women are increibly strong during birth, yet we are also incredibly vulnerable as well – making great support essential.
  

So I could write so much more about all of the great videos submitted in this contest,, but I’ll leave it to you to comment on your faves and why. . .