I realize that I have totally neglected this blog (and website!), but it's true what they say...time really does fly! I've still been attending births although you would never know it from my relative internet silence. Today marks the day, three years ago, that my fourth child was born, and his birth taught me that it really is worth it to have a skilled care provider at your side, even when everything seems low-risk and previous birth history is completely unremarkable.
Just to be clear...I support the right of every mother to choose how she gives birth. Every choice comes with risks and benefits. However, I don't agree with the idea that a skilled, respectful care provider is an intervention in and of itself. Women have been choosing to have experienced birth attendants with them since recorded history; it's only in the last couple of hundred years that these attendants most commonly turned into surgeons...with disastrous results. After my first (fast and easy) birth experience in the hospital, I decided that I would rather have more personalized care prenatally and during labor, and that I would prefer to avoid the hospital if possible. I toyed around with the idea of an unassisted birth, mostly because we no longer had good health insurance...but after some careful thought and prayer, decided that we would choose a midwife who respected all of my decisions and would support a hands-off, physiological birth.
I found that in Janna Grapperhaus, CPM. She attended the uneventful birth of our second and third child, at home and then at her beautiful birth center in Charlottesville. Both births were short (2.5 and 1 hour or so, and straight-forward. And then there was Atlan, number 4.
Firstly, much to my embarrassment given my chosen work as a pregnancy/birth professional, I didn't find out I was pregnant until what turned out to be 14 weeks of pregnancy....because my husband made me take a pregnancy test! I have always had easy pregnancies, even in the first trimester, but with Atlan I didn't even have pregnancy cravings or aversions. My husband had been joking (I thought) that I was pregnant, but I was so sure that this wasn't possible that I completely brushed it off. But...there he was! Another boy. Three.....boys.....
The pregnancy continued uneventfully and relatively easily despite my shock and misgivings...FOUR children just seemed like craziness. Some days....it still does. My last two babies had been born at 41 and 41+4, so I knew that I was likely in it for the long haul. My other labors had all been fast, so we knew to prepare for another possible precipitous birth. When I woke up just 5 days past my EDD with a strong contractions, I was pleasantly surprised! Nervous about not making it to the birth center, I called by midwife...who just happened to be driving (home, at 3am!) close to our house. She offered to drive me to the birth center, so my husband got the other kids together and I got in the car with her and went to the birth center.
We got to the birth center, filled up the tub, and started the music. I knew that I wanted to wait for my mom to get there, so I focused on being somewhat still and just laying in the tub. I really didn't want to speed up the process. As my process, I'm not an "active" birther. I like to listen to music, sing, and lay in a tub, and not have anyone bother me. Thankfully, my midwife was willing to be hands-off and support these preferences. She even had the birth assistants hiding in the shadows! Every so often she checked Atlan's heart tones with the doppler.
About 2.5 hours later, my mom arrived (times might not be *perfectly* accurate....labor is a bit of a time warp). I decided that it was time to get the ball rolling and push this baby out, and contractions were definitely intense. I had planned to drain the tub so as NOT to give birth in water this time. Call me crazy, or call it an experiment...but I will say that it wasn't my best plan. I immediately regretted this plan, but it was really too late to get the water back in. This was my LEAST favorite experience with pushing. I have seen quite a few mothers LOVE pushing on hands and knees, or leaning forward, but this definitely did not seem to work for me in this instance. Still...he was roared out at around 6 am on November 12th.
Unlike my other babies, though, he didn't really cry, and his lungs didn't get properly expanded. He was, of course, still attached to the placenta, so he was getting some oxygen, but he needed more help. More help than I would have been able to give him. His breathing was very shallow, and he seemed very anxious and scared. None of that calmness that I had worked to facilitate for him after birth. Even with skin-to-skin and time to adjust, he just was not able to keep his oxygen levels up. His glucose levels were also low. Fortunately, we had oxygen on hand, a newborn pulse-ox to keep an eye on his oxygen levels, and glucose gel since it would be too dangerous to try to breastfeed him in the state he was in, due to the risk of aspiration. After a couple of hours which seemed like minutes, we had a hard decision. Do we call the hospital and transfer for a higher level of care, or continue to wait? But my midwife had one more "trick" up her sleeve.
I love homeopathy, but had never used it on a newborn. Janna suggested that we try a homeopathic remedy that is indicated when the individual is very stressed, hyper, anxious, and overly sensitive- Coffea. Yes, it's the homeopathic proving of coffee! She even had the tiny baby dosages of it, although she had rarely used it in hundreds of births. I looked at my baby, his little clenched fists and shallow breathing, and felt strongly that he didn't need to be in the hospital. He just needed to calm down and get some proper lung expansion and oxygen. So we gave him the coffea remedy, and within MINUTES his breathing slowed, his little body relaxed, and we all knew that he would be okay. I have never been so relieved, especially after having two other friends who had babies with similar issues in the hospital who ended up with babies in the NICU for over a week!
We never really did figure out 1) Why Atlan was so stressed by being born 2) why his blood sugar was so low, or 3) why he didn't get a good breath, although all of those could be interconnected. What I do know is that, without the skills, experience, and tools that my midwife brought to the birth team, Atlan's birth story could have been very different. He needed assistance that I just didn't know how to provide, and without Janna by our side, we likely would have had to transfer to the hospital and undergo antibiotics and a 48 hour stay at BEST. And I wouldn't been able to keep him with me and watch him like a hawk for the next week!
That's a long story to say that...I am so happy that I had a great care provider. I wish that all women had this option, although I know that many just don't. But I also think that it's worth a diligent search to find a care provider who will respect your autonomy and also step in when it's just necessary. Because sometimes, as mothers, we just need help.
And that's okay!
Many couples, no matter what type of birth they are planning for, arrange a music playlist for labor as part of their labor preparation. For various reasons, though, I've found that often this carefully chosen playlist is forgotten when labor actually begins. Maybe it's nerves, or the change to a new location, or the stress that both are going through, but I'm here to remind you. DON'T FORGET THE MUSIC. It can be amazingly helpful and powerful as a coping mechanism. Fortunately there are several ways to use music to relax, find a rhythm, and encourage the hormones that aid in physiological birth. Today I'm going to discuss listening to music, singing, and dancing, and why you might want to plan to try these during your own labor and birth.
Labor has been exhausting but with your birth team you're almost through the hardest part. The lights have been low, you brought your favorite essential oils, you've used the tub, birth ball, and shower for pain relief, and NOW THE TIME HAS COME. You start feeling "pushy". Finally you know what that means. The sharp pull at the peak of contractions begins to be replaced by a totally different, nearly unexplainable feeling. You have to get that baby OUT.
The nurse rushes in, pages the doctor, the lights come on (ESPECIALLY the big one pointed at your vagina), the bed is broken down, and you are instructed to 'HOLD YOUR BREATH AND PUUUUUUSH. COUNT TO 10 WITH US!' And now you start to understand why they call it "purple pushing". It isn't pretty or fun. The whole energy of the room has changed, and you're not sure that you like it. (DISCLAIMER- this doesn't happen at ALL hospital births. But it is VERY COMMON due to how most doctors and hospital staff have learned to manage the pushing stage. Listen to women tell their birth stories...you'll see the trend).
I love to discuss the benefits of physiological pushing. What does that mean exactly? It's letting the birthing mother decide when and how to push her baby out. It doesn't mean:
I always bring a copy of this lovely blog post by Rachel Reed of MidwifeThinking with me to prenatal visits with families that I'm working with, because it really emphasizes how the mother is the expert in pushing out her baby. Risks of "purple pushing" or directed pushing include:
Even though study after study has documented the risks of directed or purple pushing, the physiological pushing has been slow to take hold in most hospitals. This survey from 2005 documented that only 21% of women pushed when they felt like pushing. Over 90% gave birth on their back or semi-reclining. Some reasons for this likely include the fact that upwards of 60% of women in most areas choose an epidural, which leads to more management of pushing, but also it's just a fact that most birth professionals are taught directed pushing in their trainings, and they rarely see or experience anything else. Humans are creatures of habit, and we tend to fall back on what we know.
This study review has a great overview of the differences between physiological and directed pushing. Women who are pushing instinctively often push only for 3-5 seconds and then take a short breath, before pushing again. They tend not to close their mouths or clench their jaws. The mother often will chose a position such as kneeling or hands and knees. She might not put her chin to her chest and push "down" to the baby. I very often see women wanting to arch back and do just the opposite! There really are no "rules", and a position that works for all women. Remember: a woman's body knows how to give birth! Listen to it.
Now that you know that it's evidence-based and healthy for a mother to push when she feels like it, and in positions of her choosing, what can you do to maintain your physiological birth even if you are being encouraged to do something different? I love this article about saying "no" to purple pushing, but I've found that it's really not that simple when that moment comes. So here are my tips for saying 'no' and being successful at mother-directed pushing no matter where you are.
Strategies for Physiological (Mother-Directed) Pushing in the Hospital
The bottom line is that mother-directed pushing is safe for the mother and her baby. If you discuss this with your care provider and they are unwilling to consider this option, you might want to think about finding a care provider who will work with you, and the birth that you would most like to have. Or, you can share some of the linked studies with him or her and ask them to reconsider.
I've said it before, and I'll say it again. You can have a great birth no matter where you choose to be! Hospital, home, birth center...but it never hurts to know what you want, to communicate those wishes clearly, and to bring a supportive team who knows you well to help you achieve that goal.
A supportive birth partner, and a doula, can help to remind you of the plans that you made before you reached a point in labor where it's easy to think that 'those details weren't important, so let's just get this over with.' But you might feel differently once the hormones wear off. (I speak from personal experience when I say this, can you tell?) It's normal to feel like you need reassurance and guidance during this phase of labor, but remember that YOU are the only one giving birth to your baby, and your body knows what to do! Have your birth partner remind you of that! It's not the last time that you'll need to lean on your instincts as a mother to do what's best for your child.
What was your experience with pushing your baby (or babies!) out? Do you have any other suggestions for supporting mother-directed pushing? And thanks to the mothers who shared their beautiful birth pictures to show the various positions that women can choose for pushing!
Google Maps, GPS, Garmin...as someone who has always been missing that "internal compass" that I've heard wonderful things about, I am very grateful for their existence. I depend on them (probably way more than necessary) whenever I need to go somewhere unfamiliar. And 95% of the time, the ETA on the GPS is right on. I have no idea how it can be so accurate, but I'm sure it involves lots of technology and maybe invasions of privacy. Who knows. But I can have the confidence that if Google Maps tells me that "your route is clear and I should reach my destination at 5:00 pm", that I almost certainly will arrive at 5:00, or within a couple of minutes of that time.
There is something SO reassuring about that certainty. I can plan my day around it. I can schedule an appointment and not worry about getting lost for 20 minutes. I can tell my kids that I'll be back at a certain time.
In our modern lives, we are now accustomed to being able to schedule most things. We like to have the assurance that we know what's happening and when. How long events will last. It is likely this desire to know WHEN labor will start and how long it might last that drives the routine measuring of cervical dilation before and after labor begins. But guess what?
YOUR CERVIX IS NOT LIKE GOOGLE MAPS. Any measurement only tells you where you ARE. Not where you were, where you are going, how you'll get there, or how long it will take.
What if the cervix WAS like Google Maps? Well, a cervix at 3cm dilation with regular contractions would give baby and ETA of about 8 hours. 7 cm? Baby's ETA= 4 hours. And in reality, this mindset is common! Here's an example:
I really cannot stress this enough, because this confidence in the predictive power of the cervix is now ingrained into how we think about birth in the United States. So, what's a better illustration for the cervix? I think I've found one.
The cervix acts more like a TARDIS.
Sometimes you might feel like you are stuck in the present dilation, with no end to labor in sight...
Or maybe you are feeling like labor will never begin, even though the cervx is "ready"...
You might feel that your cervix skipped past early labor straight to the really difficult part and didn't even ask permission.
Did you know that your cervix can UN-Dilate? Yep. I've seen it happen. But it doesn't matter! Because it can dilate again faster than it did before!
Or maybe you feel that you missed labor completely and jumped straight from pregnancy to motherhood.
AND THAT'S PERFECTLY NORMAL
So please, please...don't think of your cervix like Google Maps. So much more is involved in the labor process than dilation. The cervix has to soften, your baby signals that he's ready, the uterus has to contract, baby has to rotate and descend, ligaments need to stretch, etc. Try to remember that even if you read a hundred birth stories, that yours will be unique. Gather a great, positive birth team, trust your intuition, take every contraction one at a time, and enjoy your ride on the labor TARDIS.
What do you think?
What I Believe About Your Birth
I have so many ideas for blog topics running around in my head. Induction options? Vitamin K shot for newborns? Twin births? But none of them are jumping out at me. Instead I wanted to share what I believe about pregnancy and birth, and what I hope you will use to guide your pregnancy and birth also.
This world that we live in is full of negativity. Surrounding us there are others who tell us how we should feel, what we should look like, the "best" way to feed ourselves, even how much to drink! Individuality is rejected in the interest of averages, medians, "normal". But what about YOU? Are your needs the same as my needs? As your neighbor's or her sister's? NO WAY. Who is the best person to decide what you are capable of and what you need?
Here is what I believe about you.
I believe that your body is amazingly designed, and that it knows how to grow a healthy baby.
I believe that you are the best judge of how you are feeling during pregnancy, and that intuition is powerful.
I believe that you are capable of gathering information and making informed decisions for your health and that of your baby.
I believe that as your body grew a healthy baby, that it can and will give birth to a healthy baby.
That you know how to give birth in the same way that you know how to eat, drink, and breath.
I believe that YOU ARE THE EXPERT when it comes to YOUR pregnancy and birth.
What does all of this mean for you?
It means that although I have chosen certain paths for my own pregnancies and births, that I will not impose those upon you.
That I will provide as much information as you would like to have access to, but I will not insist on any particular reading material or choice.
I will always be the one whispering 'You can do this; I believe in you."
Bengkung Wrapping- Tips and Tricks
Over a year ago I started learning more about traditional Bengkung wrapping, and then last October I was able to try it out myself after the birth of my third baby. Now that I have had the opportunity to wrap over a dozen mothers, and to wear the wrap myself, I am happy to offer some tips and tricks that may help the modern mother to wear the Bengkung wrap most comfortably. Some of these will apply more to the person doing the wrapping, and others to the person who is wearing the wrap.
Let's be honest. Hospitals aren't really the optimal environment for many women to give birth. This is not me attacking hospitals or anyone who works there, it's just being aware of basic biology. But, the majority of my clients and the vast majority of birthing women ARE giving birth in hospitals, so it's important to know what their limitations are, and how to work around them to optimize the environment for your birth. So, in this post, I'm going to list a few characteristics of hospitals and how to minimize their effect on the birthing mother and baby.
Before we begin, I think the fundamental point to remember is that YOU ARE THE CONSUMER. Ask questions before agreeing to any interventions. Use your B.R.A.I.N (it's an acronym). You, or your insurance company, are paying more for this stay than you would for a 5-star resort! All hospitals have "policies", but some of these are not based on evidence, but fear of lawsuits, or even just routine. Some things (bright lights, certain birthing positions, for example), are just easier for the staff. Don't be afraid to insist on what you know to be best for YOU. This is the birth of YOUR baby, not the hospital's baby. They are there to assist you, and most will be happy to help out as long as you make it very clear what your wishes are, within reason.
Many of these solutions will take planning and effort, but it's worth it!
I am writing this post as a follow-up to this article on the historical evidence against placenta consumption. Although I realize that Christians may disagree on this subject, I thought it would be helpful to assemble some of the principles in the Bible that may help an individual Christian to decide if placenta encapsulation or some other way of ingestion is in harmony with that person's conscience. Even if you don't consider yourself to be a Christian, you may find some of these arguments interesting.
The three main points that I feel are relevant to this discussion are these:
.....Maybe. I dislike speaking in absolutes, but I do realize the value of a catchy title!
So, why on earth would I say that? Chickens don't even "give birth". They lay eggs. Very true.
Also true is that I've only had chickens for a week and a half now. But, even in that amount of time, they have reminded me of principles that apply to birthing women and those of us who support them.
Let me go back a few weeks....
Taking a Stand
This is a deeply personal post. It's not my natural inclination to share my feelings in such a public way, but I am feeling deeply grieved by the stories being circulated on Facebook and other social media, to the point of sleeplessness, and I feel a need to share my perspective on embryos, babies, tiny humans.
You know the women that always have a pregnancy test stashed away in case they have a late period? The ones that gleefully announce every pregnancy via Facebook, Twitter, and Instagram? Or maybe they arrange elaborate baby reveal parties to let everyone know about the new addition to their family.
I never was one of those women. In fact, I've only ever taken three pregnancy tests. They were ALL positive. I waited until the last minute with all of them, until there was no other option other than positive. I cried every time.
All of my baby "announcements" were rather sheepish, weighed down by the fact that once again I had failed at "fertility awareness". With the first two babies, I didn't even tell most of my friends until it was obvious that I was "either getting fat or pregnant", as a friend put it. That was around 16 weeks, almost 4 months in.
In fact, despite my current occupation as someone who supports women in giving birth to their babies, I never really planned on having children. I'm not sure why exactly; my parents were and are loving, supportive, and generally a great example in raising responsible children.
The night that I found out I was pregnant with our third child, I had an appointment scheduled. My mind was heavy with concerns over how we would afford another child, how we would find space, and how upset my husband was. (He thought that maybe I had arranged things to get pregnant, but really I didn't know then, and still have no idea, how we got pregnant with our first OR third baby. We were being careful, I thought.) On the way back, one of our Kingdom songs came on. As I listened to the words of the Psalmist and beautiful melody, I sobbed. It was as if the song was written just for me.
I look at birth from the perspective that our bodies are wonderfully made, and if we really believe that and work with the birth process and nourish our bodies properly, they will function optimally, most of the time!