How One Mom Moved & Grooved Throughout Her Labor

The following is a post republished with permission from blogger, doula and mother of two, Kristen Oganowski of Birthing Beautiful Ideas. This post also appeared on our sister blog, Science & Sensibility, as part of their Healthy Birth Practices blog carnival.

According to the Lamaze Healthy Birth Practice paper on [moving during labor], research shows that:

…when compared with policies restricting movement, policies that encourage women to walk, move around, or change position in labor may result in the following outcomes:

  • less severe pain,
  • less need for pain medications such as epidurals and narcotics,
  • shorter labors,
  • less continuous monitoring, and
  • fewer cesarean surgeries (Lawrence et al., 2009; Simkin & Bolding, 2004; Simkin & O’Hara, 2002).

In fact, no woman who participated in any of the research studies said that she was more comfortable on her back than in other positions (Simkin & Bolding, 2004). No study has ever shown that walking in labor is harmful in healthy women with normal labors (Storton, 2007).

So it is easy to see why walking, moving, and changing positions is a healthy birth practice!

For this post, I’d like to document and describe the ways that I walked, moved, and changed positions throughout my labor.  And this is because I think that it is important for women to have access to images of real women who are really laboring and who are really able to walk and move and change positions throughout their child’s birth.

Worth noting is that for most of my labor, I just followed my body’s signals and natural instincts when changing positions.  Sometimes, I also changed positions based on what my doula suggested. 

And for the entire time, I found my labor to be an intensely powerful, empowering, and healthy experience.

A few “stats” about my labor before I begin:

  • Even though this was my second child, I was a “first-time laborer” since my first child was born via a pre-labor cesarean section.
  • My labor began with my membranes rupturing.
  • My contractions began approximately 1 1/2 hours after my membranes ruptured.
  • My entire labor lasted a little over 14 hours (or 15 hours if one were to count the irregular, painless contractions I was having in the hour before my water broke).
  • I labored at home for approximately 8 1/2 hours before leaving for the hospital.
  • My cervix was 1-2 cm dilated and nearly 100% effaced by the time I was checked at the hospital.
  • Three hours later, my cervix was dilated 4 cm.
  • Just over one hour later, I was fully dilated.
  • I actively pushed for about 35 minutes before delivering my healthy 8 lb. 3 oz. baby.
  • And I moved and grooved all throughout my labor.

This is what it looked like.

kneeling

Here I am in early labor, kneeling over the armrest of the couch.  Obviously, the contractions weren’t terribly intense at this point since I could still talk on the phone.  (I do believe, however, that I ended up throwing the phone onto the end table about ten seconds into my next contraction!)  Nonetheless, even though the contractions weren’t very intense, I still found that this position helped to relieve the discomfort that they caused.

What else does kneeling help to do?

It can help to relieve backache, it can encourage the rotation of the baby, it can help a mom to move and/or rock through her contractions, and it also provides a mom’s labor support team with access to her lower back for counter pressure.  One can also kneel over a birth ball or over the back of a raised hospital bed.

side-lying

Here I am laboring on my side.  I was still in the early phase of my labor, so I wanted to relax as much as possible before the really hard work began.  I used one of my hypnobirthing deepening exercises to help me do just that.

How does side-lying help a mom during labor?

It helps to promote rest and relaxation in early labor, it can help to improve fetal oxygenation (especially when a mom is on her left side), it can help to slow down a precipitous second stage, and it can help to encourage fetal rotation.  It is also a good “alternative position” (instead of lying flat on one’s back) for a mom using epidural analgesia.

standing

Here I am standing to stop for a contraction after walking around the house for a while.

Standing and/or walking throughout labor gives a woman the advantage of gravity to help the baby descend, it encourages the rotation and descent of the baby, it can help to bring on more productive contractions, and it also helps the baby to be well-aligned with the mother’s pelvis.  What’s more, it is yet another position that gives a mom’s labor support team access to her back for counter pressure and/or other touch-based comfort measures, if she desires them.

One of the other great standing movements is to slow dance with one’s partner, doula, or other labor support person.  (I slow-danced with my husband, Tim, right after this picture was taken!)  Besides providing emotional closeness(especially if one is dancing with one’s partner), dancing can offer a mother all of the benefits of walking or standing while allowing her to take some of her weight off of her feet.

hands and knees

Remember how I mentioned the “really hard work” that was on my horizon?

It had definitely begun by the time this picture was taken.

And laboring on my hands and knees felt like the most comfortable and most natural position for me to be in at this point.

Being on one’s hands and knees during labor can help to relieve backache (which I was definitely experiencing here), can encourage the rotation of the baby, and can also allow access for back massage and/or counterpressure.  Doing pelvic rocking while on one’s hands and knees is also an especially good exercise for encouraging the rotation of a baby in the occiput posterior position.

standing and leaning

Here I am standing and leaning against the stairs.

As with most upright positions, this position gives moms the advantage of gravity, it can encourage more productive contractions, it can help with fetal rotation, and it can be more restful than standing alone (and putting all of one’s weight on one’s feet).

Since the stairs are pictured here, I should mention that I also made quite a few trips up these stairs during my labor.  Climbing stairs can also enhance rotation of the baby and pelvic mobility, and it may help to “speed” up one’s labor even more than walking does.

Worth noting is that most of those trips up the stairs were taking me to our bathroom, where I spent a good deal of time laboring on the toilet.  (For obvious reasons, I have no photos of this!)  Laboring on the toilet gives a mom the assistance of gravity while still allowing her to “rest,” and it may help her to relax her perineum.  (It is usually not recommended for moms who have trouble with hemorrhoids, however.)

birth ball

Here I am sitting and swaying on my birth ball.  This proved to be tremendously helpful during the time that I labored at home.

In addition to offering a mom the advantage of gravity, swaying on a birth ball can help to enhance pelvic mobility.  It is also much more comfortable than merely sitting on a chair!

As you can see here, using this particular position with the birth ball also allowed me to gain the advantages of leaning, to receive some emotional support from Tim, and to get the back-relieving benefits of counterpressure from my amazing doula, Chris.  So this was really the “mother” of all laboring positions!  (Sometimes I can’t help myself when it comes to silly birth-puns…)

hospital bed

Here I am at the hospital, lying on my side just as I did at home during early labor.

I was strapped to the wires and transducers needed for the electronic fetal monitor (and didn’t have access to the telemetry unit yet), so my range of mobility was significantly limited.  And even though I needed to rest and “re-group” after a night of laboring and after discovering that I was “only” 1-2 centimeters dilated, the very fact that my range of motion was limited seemed to make coping with my contractions more difficult.

In fact, the time that I spent in the hospital bed, strapped to the monitors, was the only time that I ever considered asking for pain medication during my entire 14-hour labor.

water

But then I got in the water.

Oh, the water!  Take a moment to review the look on my face in the above picture and then the look on my face as in the picture to the right.  These pictures were taken within about three hours of each other.  And in the one to the right, I am a little less than two hours away from holding my baby in my arms.

Hydrotherapy during labor (which also includes laboring in the shower) can be very relaxing and can help to reduce the intensity of the pain of contractions.  Notably, women are generally advised to avoid getting into a tub or jacuzzi until they are at least 4 cm dilated since getting in the tub “too early” can contribute to irregular and/or less frequent contractions.

In addition, although these items are not visible in the above photograph, moms laboring in the water should also have access to a cold drink (my choice was Gatorade) and cool washcloths so as to help regulate their body temperature.

(Although a bigger tub–or an actual birthing tub–would have been preferable to the hospital’s small bathtub, I was still able to float in between contractions and to move my body during contractions.  In other words, I was still able to move and change positions while in the tub!)

side pushingI began pushing while lying on my side.  Although I did not find this to be the most comfortable and advantageous pushing position for me, pushing on one’s side does have some specific benefits.  In particular, this position encourages good fetal oxygenation, it is helpful for moms with elevated blood pressure or who are using epidural analgesia, and it allows the mother to rest in between contractions.

I eventually moved to my hands and knees while pushing and then rested in a sitting position in between contractions.

As one of the many optimal birthing positions, pushing on hands and knees can help to improve fetal heart tones, it can assist with fetal rotation (especially for a baby in the occiput posterior position), it is an excellent position for a woman expecting a large baby, and it can help a mom to avoid a laceration or an episiotomy.

alec's here!And it was certainly a position that helped this first-time-pusher to deliver her 8 lb. 3 oz. baby after only 35 minutes of active pushing!

Why Choosing “Free Range” Labor May Make Birth Easier

[A Lamaze news release]

Close your eyes and imagine a woman in labor.  If you picture the scene as it occurs regularly in movies, on television and in hospitals everywhere, you probably see her lying in a hospital bed, hooked up to an IV and wearing belts around her belly to continuously monitor the baby’s heartbeat and the contractions.  Her “range” is limited to a few square feet. 

What’s wrong with this picture?  A lot, according to research. 

“The best way to keep your baby moving down and out is to keep your own body in motion.”  said Marilyn Curl, CNM, MSN, LCCE, FACCE and president of Lamaze International.  “Being confined to bed, tethered to monitors and IVs, interferes with the body’s ability to move the baby through the pelvic bones and down the birth canal.” 

Many hospitals have routine protocols like continuous fetal monitoring that limit movement and the use of epidurals commonly requires confinement in bed. 

Researchers have examined published studies that compared policies that encouraged movement during labor with policies that restricted movement. The conclusions show that the policies which encourage women to walk, move around, or change positions during labor may help women experience:

  • less severe pain
  • less need for pain medications, such as epidurals and narcotics
  • shorter labors
  • less continuous monitoring
  • fewer cesarean surgeries
  • lower likelihood for an episiotomy and use of vacuum extraction or forceps

Why does movement during labor have these effects?  Staying upright during labor means that gravity can aid the body’s natural efforts, which let the pelvic bones open as much as possible.  Women who are laying on their backs confined in bed lose this advantage, which increases the likelihood that the baby will be unable to navigate through the pelvic bones.
 
“It’s frustrating to see women routinely put on their backs and confined to bed and then be told that they ‘failed to progress’ or that the baby ‘didn’t fit’ through their pelvis when a simple move into an upright position could easily resolve both situations,” said Marylou Carrico Tietz, LCCE, FACCE, a Lamaze childbirth educator from Bethesda, Md. and president of the Washington, D.C. chapter of Lamaze International.  “Women need to be encouraged to listen to their bodies in labor and question routine hospital policies that may slow their progress.”  

Lamaze educators find that many women also report that movement during labor is an effective pain management tool, reducing pressure on the lower back, increasing space within the pelvis and allowing for an easier descent.  Tietz continued, “The mother’s movement throughout labor can help ease the baby through tight spots in their journey to being born.  The easier it is on the baby, the easier it tends to be for the mother as well.”

The best ways to avoid unnecessary confinement to bed include:

  • Choose a care provider who supports “mobile moms” – If they express support, put their answer to the test and ask what percentage of their patients end up staying up and mobile during labor.
  • Know the facts on fetal monitoring – In low-risk mothers, research shows that occasional checks of the baby’s heart rate are just as safe as constant monitoring.
  • Know the facts about epidurals – The benefits are well known, but also consider the possible drawbacks.  Switching positions can help get babies “un-stuck” but an epidural will render you mostly immobile.
  • Choose the right support – A doula or labor support person who will help you stay moving and can “negotiate” with your care provider or nurses, as needed.  They can also help you manage each and every contraction.
  • Use a birthing ball when you need a rest – Remember that you may need to bring your own, since many hospitals still don’t support women laboring in upright positions.
  • Stay upright during the pushing phase too – Many care providers will “let” mothers walk or sit up during the dilation phase, but will put them on their back or bottoms during the pushing phase.  These positions shrink the pelvis and make it harder to push the baby out.
  • Don’t be afraid to insist – It is difficult to go against hospital routine, but remember that many hospital routines are in place for the comfort and convenience of staff, not the health and safety of you and your baby.  The easier the birth is for you and your baby, the better the chances of a safe and healthy outcome for both of you.

Avoiding unnecessary medical intervention is part of Lamaze’s Six Healthy Birth Practices.  Based on recommendations by the World Health Organization and backed by extensive research that supports a woman’s natural ability to give birth, these practices are:

  • Let labor begin on its own
  • Walk, move around and change positions throughout labor
  • Bring a loved one, friend or doula for continuous support
  • Avoid interventions that are not medically necessary
  • Avoid giving birth on your back and follow your body’s urges to push
  • Keep mother and baby together; it’s best for mother, baby and breastfeeding

To learn more about the Lamaze Six Healthy Birth Practices, please enroll in a Lamaze childbirth education class and visit www.lamaze.org/healthybirthpractices.

Preparing for Birth Before Going Into Labor

By Gayle Sato

The words “easy labor” may seem like an oxymoron, but there are steps you can take, both throughout pregnancy and during labor, to make your experience less stressful and more comfortable, less clinical and more joyful. And although the following tips won’t guarantee you’ll have a sweat-free, pang-free birth, they can help make your labor and delivery more manageable.

1. Start preparing now. When you’re in the grip of labor, it’s too late to crack open that self-hypnosis book or locate a birthing ball. Preparation counts. Case in point: Squatting increases the size of the pelvic opening by about 28 percent. But if you wait until you’re in labor to try it for the first time, your squatting stamina won’t add up to … well, squat.

2. Seek higher education. Take a childbirth class, and enroll as early as possible: Not only do classes fill up fast, but some run 12 weeks, which means you need to start them in your second trimester. Learn about the different stages of labor so you know what to expect. Ask tough questions—and “stupid” ones, too. Find out your doctor’s philosophy on epidurals vs. nondrug ways of managing pain, as well as on Cesarean sections. “The better prepared you are, the more choices you have during labor,” says nurse practitioner Lynette Miya, M.N., R.N.P., co-owner of Bright Beginnings & Beyond, a childbirth and family resource
center in Redondo Beach, Calif. “You don’t want to arrive at the hospital without any idea of what’s going to happen.” Once labor starts, no surprise is a good surprise.

3. Take a prenatal yoga class. “The most important thing women learn through yoga is how to focus,” says Carmela Cattuti, L.P.N., founder of Yoga for Pregnancy & Fitness in Boston. “Yoga also strengthens the entire body, increases flexibility and gives you stamina. But maybe more importantly, it helps your mind relax.” This, in turn, leaves your body free to go about the business of birthing.

4. Hire a certified doula. Doulas are nonmedical professionals trained to provide emotional and physical support as well as information to women during pregnancy and labor. Studies have found that with a trained doula’s continuous support, epidural use decreased by 60 percent; C-sections, 50 percent; oxytocin use for induction, 40 percent; forceps use, 40 percent; and average length of labor, 25 percent. To locate a certified doula in your area, visit dona.org.

5. Give yourself options. During my first labor, breathing exercises gave me a massive sinus attack. Worse, I was out of tricks—no alternative pain-coping techniques, no weapon handy to beat my husband for getting me pregnant. Don’t let this happen to you. Learn several techniques to manage pain, such as self-hypnosis, position changes, heat packs and different breathing methods; bring music to play for relaxation. “If you don’t know what your options are, you don’t have any,” says Tracy Hartley, a certified doula and owner of BEST Doula Service in Southern California.

6. See no evil, hear no evil. Some childbirth educators believe graphic images, catastrophic tales and words of discouragement (“You’ll never be able to get that monster out without a C-section!”) can affect your subconscious and
create a mental block during labor. At best, negative thoughts make labor stressful; at worst, they’ll actually intensify pain. Change the channel, cover your eyes, tune out or walk away when the subject matter makes you uncomfortable. Bonus: Being able to do this will help you ignore all the unwanted advice you’ll get after the baby is born.

7. Set the mood. For most women, a dark, quiet environment is ideal during labor, so ask your nurse or partner to dim the lights and minimize noise. Little touches make a difference: a favorite pillow, pair of socks or soothing scent. “Aromatherapy, especially the scent of lavender, is very calming in labor,” says nurse practitioner Miya.

8. Don’t take labor lying down. Upright positions, such as standing, walking, kneeling, slow dancing, sitting and squatting, allow gravity to help move the baby down and out. “Sometimes, getting the baby into the pelvis is like fitting a key into a lock,” Hartley says. “You need to do a little jiggling. Rocking back and forth on your hands and knees may get the baby into position.”

9. Get wet. Early in labor, a warm bath is a blessing. Later, the sustained warmth and weightlessness that water provides can feel more like a miracle. If you have access to a warm tub during labor, run—OK, roll, if you have to—and take the plunge. (Be sure to get your doctor or midwife’s green light before doing so; there’s a risk of infection if your water has broken.) If a soak isn’t possible, take a shower.

10. Stand your ground. Labor transforms you, but it won’t make you suddenly love lime Jell-O, New Age music or the sight of your in-laws as you breathe through a contraction. People may press all kinds of suggestions on you during labor; listen but don’t feel you have to go along with them. It’s your body, your baby and your labor, so stick to your guns. Consider it practice for when your baby is a teenager.

Birth Blog Carnival Round-Up: Positive Experiences with Healthy Birth Practices

The language we use to describe birth is a tricky and often touchy issue. I had originally referred to the posts for this birth blog carnival as “birthing success stories,” but as one reader pointed out, using the word “success” implies that birth can also be described in terms of “failure.” Women, listen up: you cannot fail at birth. For this birth blog carnival, Giving Birth with Confidence will share stories from women who describe a positive birth experience in which they were successful at implementing one or more of the Six Lamaze Healthy Birth Practices.

What is a ”Healthy Birth Practice” anyway?
The Six Lamaze Healthy Birth Practices are tried-and-true ways, based in research and best medical evidence, to keep birth as safe and healthy as possible. Understanding these practices can help you alleviate common birthing fears, know how to manage pain with minimal or no medication, and provide the foundation for informed discussions between you and your care provider.

After collecting the stories for this carnival, I noticed several recurring themes. Just like you can’t make a cake without flour, it appears that a positive birth experience requires certain elements.

Nearly every contributer mentioned the importance of their care provider.

Kristine of Lamazing suggested in a post at Mother’s Advocate to do your research when choosing a care provider:

“…take the extra time, make the extra office visit, to find a great fit for you. Birth is a big deal — spiritually, emotionally, physically, you name it. You want someone with you who is on the same page: who reads your birth plan, who takes extra time when needed, and who is responsive and listens well. Don’t be afraid to change providers, either: better a change in the midst of your pregnancy than a rough birth experience with someone you didn’t trust to begin with!”

Tricia at The Planet Pink interviewed her midwife prior to the birth of her third child:

“The hubs and I made an appointment and met with a midwife who we quickly agreed would be the perfect person to partner with. She was laid back and relaxed and not at all concerned about making my pregnancy or labor fit into a certain box.”

Laboring at home for as long as possible is a big deal.
For first-time families, it’s easy to get caught up in the excitement and want to rush to the hospital or birthing center at the first sign of labor. I know because I did it too. Laboring at home until your contractions are regular and “longer-stronger-closer together,” however, can have a big impact on your overall birth experience.

Tricia at The Planet Pink talks about how she spent an entire day (not completely convinced she was in labor) walking the mall, enjoying lunch with her husband, walking her neighborhood, watching movies, bouncing on a birth ball and spending time in the tub before finally experiencing consistent and strong enough contractions to leave for the hospital at 3:00 am. When she arrived, she was 8cm dilated!

Now, on to those Healthy Birth Practices.

Letting labor begin on its own.
All of our contributors went into labor at home, on their own, and were supported in the hospital/birth center to labor without artificial induction or augmentation by Pitocin.

After beginning to dilate at an early 32 weeks and being put on modified bedrest, Jenny of Conscientious Confusion knew she was really in labor when she felt a small gush of water at 2:00 am, three days after her due date. Her son was born later that morning.

Sheridan of Enjoy Birth provided for our birth blog carnival an excellent resource for moms on induction (complete with videos!), including risks and rewards and how to know when an induction is medically necessary. Sheridan says, “It amazes me to hear that moms often get induced without even knowing why. … I would love it if moms would inform themselves on this choice early in their pregnancy.”

Walking, moving around and changing positions throughout labor.
All of our birth story writers shared wonderful details about moving around in labor, from walking to squatting to soaking in a tub.

With the guidance of her doula, Sheryl of Little Snowflakes found an effective laboring position:

“My doula suggested raising the hospital bed so that I would have something to lean against during the contractions. That turned out to be my favorite position to manage the contractions! When a contraction would come, I would stand up, bend over, bury my face in a pillow on top of the bed, and hold [my husband's] hands.”

In contrast, Sheryl commented, “It felt HORRIBLE to experience a contraction lying down. I could barely handle it!”

Kate Hodges of Two Bee Birth Services shares a story from one of her clients who experienced a vaginal birth after cesarean (VBAC). Mom, Marianne, describes:

“I tried a few different positions, however I did not feel like walking around or standing up like I had anticipated. I spent a good bit of time in the jetted bathtub, which really helped with the pain.”

Bringing a loved one, friend or doula for continuous support.
The old adage of “it takes a village to raise a child” also holds true for birth. Genuine and loving support can have a huge influence on the duration, pain management and enjoyment of birth.

Jenny of Conscientious Confusion looked to her husband for support:

“He was always encouraging me and reminding me to breathe calmly and relax. Every time I did that, it helped so much. … When I was pushing, he was right behind me, pushing right along with me. It was so helpful to see him concentrating just as hard as I was, and he was always there with a cool washcloth.”

Marianne at Two Bee Birth Services said of her third birth:

“…this has definitely been the quickest, easiest recovery. Although it was a very hard delivery, with the help of my husband and [my doulas] Kate and Claire, I had a successful, unmedicated VBAC.”

Avoiding interventions that are not medically necessary.
Did you know that many of the routine hospital procedures during birth aren’t always medically necessary? Get to know these procedures and learn when they are and are not needed.

Armed with intervention research, Marianne at Two Bee Birth Services commented:

“The hospital staff was wonderful and they honored my request to have no IV and limited monitoring.”

Tricia of The Planet Pink spent her labor with a hep lock, a device (usually inserted on the back of your hand) that provides access  to hook up an IV line if it is needed. This allows you to labor without being tethered to an IV.

Avoiding giving birth on your back and following your body’s urges to push.
The standard image of birth in a U.S. hospital is of a woman giving birth on her back, legs pulled back and someone coaching, “Now, bear down and push! 1, 2, 3, 4….” Not surprisingly, the purple-faced, flat-back pushing is not effective.

Patty Reis, a mother who e-mailed her birth story for the carnival, writes about pushing:

“[The nurse] announced that I was complete and could push whenever I felt like it. Well, all I understood at that point — and you have to remember, there’s no blood circulation to the educated brain at this point; it’s all in the uterus, where it should be – was that something was wrong with me because I didn’t have any feeling to push. So I announced it.  The nurse quieted me and told me the baby would come out whether I pushed or not. Well, I was sure relieved about that!”

Keeping mother and baby together after birth.
There are so many documented benefits to keeping mother and baby together, skin-to-skin, immediately after birth, and yet, so many hospitals separate the pair shortly after birth. As long as mother and baby are healthy, exams, weight and measurement, and bathing can be put off until later.

Jenny of Conscientious Confusion, who was at a birthing center, had a similar experience:

“After the birth, they did not remove Little Sir from my chest for a hour or more — all the checks and tests were done there on my chest and I was able to breastfeed as soon as Little Sir was able to figure it out, with [my husband] right there the whole time.”

Sheryl of Little Snowflakes describes her post-birth scenario:

“Benjamin stayed on my chest for the first hour of his life. He latched on like a pro within minutes and I fed him on and off for that first hour. It was so incredible that he just knew what to do. My midwives knew that it was really important to me to have that first hour of skin-to-skin and waited to do the newborn exams.”

And for some parting advice? Kristine writes at Mother’s Advocate:

Bring goodwill with you. Believe that everyone helping you in the hospital, from the front desk to the checkout desk, is there because they genuinely, honestly want to help people — you included. The labor and delivery wing of a hospital is almost always the happiest part of the whole place, and for a good reason! Know that even if the technician who straps on your name band is grumpy at the moment, he or she entered the profession to help you. And be flexible! No one can predict the course of their labor before it happens. No one. If you find your labor going down a path you didn’t anticipate, breathe and discuss everything you want to with your provider.”

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Thank you to all who participated in our first birth blog carnival of 2011! Your healthy birth stories will help inspire, inform and demonstrate to women that positive, safe and healthy birth experiences are possible.

Be sure to visit Science & Sensibility for other posts in this birth blog carnival!

Birth Day, Your Way

By Charlotte De Vries


With your body and life changing in profound ways, it isn’t always easy to feel in control as your due date approaches. Creating a birth plan helps you make decisions early on and build confidence before labor and birth. Your plan is a source of strength and inspiration, not a rigid map of what must be done. It isn’t about checklists or completing a form. Every pregnancy and birth is unique, and one plan does not fit all. Sift through information from health care providers, classes, books, friends and family, and get to know your options. Keep an open mind and a peaceful, positive outlook. A plan isn’t any guarantee that your birth will go just as you envision it. Plan for the unexpected. Consider these key factors:

Environment
You probably already know where you’ll have your baby, but you can still shape that environment so it becomes a private, safe space where your voice will be heard and your choices will be respected. Choose a few ground rules, such as closed doors, restrictions on who can come in and out, and a minimum number of machines.

Support Team
Do you want a doula? Will siblings be present? The people who will be with you to offer support during labor and birth should be central to your plan – their job is to make you feel confident, comfortable and safe. Share your desires clearly. Remember that what is obvious to you is not necessarily apparent to them.

Pain Relief
There are many natural ways to cope with the valuable and important pain of labor. Simple measures like walking, movement, massage and aromatherapy are noninvasive with no risk to you or your baby. Remember: Pain is central to the design of birth – it is not an unfortunate side effect. Express how you would like to manage it and consider the natural, safe alternatives to anesthesia. Trust your ability to cope with the pain.

Freedom to Move
Moving around as you wish and choosing your own positions for pushing is important. Make it known if you’d prefer to forgo machines, monitors and drugs.

Meeting Baby
Your early moments with your newborn are just as important as your labor and birth. This is intimate time to connect and bond. If mother and baby are well, hospital routines and procedures can wait. Protect the first moments you meet and marvel at each other as you begin your lives together.

Lamaze Breathing: What You Need To Know

Once upon a time, the hallmark of Lamaze chidbirth education was “breathing” (hee, hoo, hee, hoo). Over the years, Lamaze has evolved into a comprehensive approach to childbirth, part of which are comfort measures for labor; breathing is one of the suggested comfort measures. So what does it mean to “breathe?” Here’s a little on what you should know (excerpted from The Official Lamaze Guide: Giving Birth with Confidence by Judith A. Lothian and Charlotte DeVries):

 

Breathing in Pregnancy:  A Daily Check-in
Finding the time, energy, and peace to face your fears—or do anything that requires mental focus—is a challenge in our culture. One pregnant woman shared that after years of working at her office, she’d tuned out the sounds of phones ringing and computers clicking. She didn’t even notice how noisy her office was until an older coworker looked at her across the bank of desks and said, “You’re bringing this child into a world of sounds my babies never heard.”

It’s true: In just a decade or two, technology has changed the world dramatically. From cell phones to ATMs, from microwave ovens to Facebook friends, from high-definition DVDs to iPods, technology fills our days with vivid images and messages. It’s a noisy, busy world that can crowd out the peace we need to connect with ourselves.

Connecting with yourself is an important task during your pregnancy.  It’s a big job to pay attention to all the physical, emotional, and spiritual changes you’re experiencing. It takes concentration to envision a future that includes a new role and a new person. Finding a place of stillness for a few moments each day can help you do this crucial work.

Even if your space and your schedule are crowded, you can find a place and time to keep a daily appointment with yourself. Perhaps you can retreat to the corner of your bedroom, the bathroom, a closet, or an empty room at your workplace. Perhaps you can sneak a moment before others wake up, after they’ve gone to bed, before you get in the shower, or during your lunch break. You might want to “check in” at the same time each day so you treat this appointment with yourself as the important time it is.

Your daily check-in may be a few moments of silence, meditation, or prayer. You can use this time to get in touch with not only your feelings, but also your body and the little one who is taking up more and more of it. Close your eyes for a moment and listen to your breathing, then take an inventory of yourself: Are there any tense areas in your body—neck, shoulders, throat, hands, back? Is anything nagging at your mind? Doing a full-body and -mind check will help you identify what needs to be released, relaxed, or dealt with.

 

Breathing Benefits from Yoga Practice
Yoga, an ancient form of exercise that includes breath control, meditation, and body postures, has become popular among pregnant women. It’s easy to understand why: Many yoga exercises include movements that open the pelvis. Yoga also teaches rhythmic breathing, concentration, stamina building, and relaxation. Some women who do yoga report improved physical coordination and more balanced emotions.

 

Lamaze Classes and Breathing
Lamaze classes prepare women for a safe, healthy birth by providing the most current, evidence-based information about birth, simplifying birth, and helping women navigate the maze of modern obstetrics. Be wary of “Lamaze” classes that spend a lot of time practicing relaxation and breathing and little or no time building your confidence or discussing how to keep things simple and how to have the safe, healthy birth you want in the birth setting you have chosen.


Breathing: Finding Comfort in Labor
When allowed and encouraged to, a woman will naturally move, moan, sway, change her breathing pattern, and rock to cope with contractions, eventually finding the right rhythm for her unique needs. Such active comfort-seeking helps her baby rotate and descend and helps prevent her labor from stalling. As her contractions get stronger, her body releases endorphins—nature’s narcotic—to ease her pain.

Conscious Breathing
Conscious breathing (especially slow breathing) reduces heart rate, anxiety, and pain perception. It works in part because when breathing becomes a focus, other sensations (such as labor pain) move to the edge of your awareness.

Conscious breathing is an especially useful labor tool because it not only keeps you and your baby well oxygenated, it’s also easy to learn and use. It’s naturally rhythmic and easy to incorporate into a ritual. And best of all, breathing is the one coping strategy that can’t be taken away from you—even if you’re stuck in bed attached to an electronic fetal monitor and intravenous fluids.

Conscious (or patterned) breathing used to be the hallmark of Lamaze childbirth education. For many women, it’s still an important way to stay relaxed and stay on top of their contractions. It’s true that conscious breathing can help you relax and feel less pain during contractions.  There’s no “right” way to breathe in labor, despite what others may tell you. Slow, deep breathing helps most women manage the pain of contractions. But the right way for you to breathe is whatever feels right to you. Issues like your number of breaths per minute, breathing through your nose or your mouth, or making sounds (like hee-hee) with your breaths are only important if they make a difference for you.

It may help you to have a visual focus to accompany your conscious breathing. You can recall an image with your eyes closed, focus on a picture or special object from home, keep your eyes on your partner, or simply stare at a spot on the wall. You may also find that as labor progresses, faster, shallower breathing—like a dog gently panting—feels better. You’ll figure out what works best for you. And what works best will probably change as you move through labor.

Many women “practice” breathing during pregnancy by using conscious breathing when everyday life presents stressful situations, like being caught in traffic, running late for an important meeting, or worrying about any number of things.

Find Your Rhythm
At some point in labor, you’ll “find your rhythm” or “get in a groove,” much like a marathon runner does. You’ll be living in the moment, doing without thinking.  To others you’ll appear to be in another world. Your movements will be rhythmic; you’ll relax between contractions; you’ll respond to contractions in the same way over and over again, perhaps shaking your arms, rolling your head, breathing slowly, chanting, or praying.

You’ll be totally focused, but you won’t necessarily look comfortable. You’ll look like you’re working very, very hard—which you are. When this happens, you’ll know endorphins are working their magic—dulling your pain and helping you ride your contractions intuitively. You’ll be doing exactly what you need to do. You won’t need to be rescued; in fact, the worst thing that could happen to you at this point is to be disturbed or interrupted. A healthy dose of encouragement, support, and respect are all you’ll need from your support team.

Do you have experience with conscious/patterned breathing during labor? How did it affect your birth experience?

Three Things Nurses Wish Moms Knew About Childbirth

I discovered an article yesterday that lists the top three things labor and delivery nurses wish that women knew about childbirth (compiled from a poll created by the Perinatal Advisory Council). Take a look — this is positive, encouraging advice from the women who work in the trenches!

1. Almost all agree women should take labor and delivery classes (94%)

  • “Usually the more prepared women are the better the experience. The fear factor decreases and with it so does the pain.”
  • “Women think that watching The Baby Story and similar shows on TLC, etc., is preparation for childbirth, and is realistic. This is not the typical birth experience.”
  • “It should be mandatory for women to take classes prior to childbirth for the labor and delivery and baby care/breastfeeding experience.”
  • “I believe it helps the mothers be more informed, realistic and work well with labor and delivery and care of themselves and newborn.”

2. Most believe a pregnant woman should prepare a birth plan (79.8%)

  • “Developing a birth plan takes conscious thought and may assist (especially first time) mothers with being more informed about options.”
  • “A birth plan is good as long as they are aware of the need to be flexible with it and not expect for everything to go exactly as planned.”
  • “I think creating a birth plan can be an educational experience for the patient.  However, I’ve noticed a lot of people use pre-made birth plans from the Internet, which doesn’t really help them to be more knowledgeable about the process of labor of delivery.  I’m not convinced simply having a birth plan will help patient’s to be more knowledgeable or prepared about the process.”
  • “Birth plans must be created with a health care professional who understands the realities of what is available at our particular hospital.”

3. More than half welcome (the right) doulas (63.3%)

  • “It depends on the doula; some are great and some interfere with nursing care.”
  • “A doula can be a great support if a woman is trying to have an unmedicated delivery. A woman really needs one-to-one care when she is laboring without any pain meds.”
  • “Continual labor support from a confident and knowledgeable support person makes a huge difference in outcomes.”
  • “Doulas can be helpful as long as they are supportive, not adversarial with the nursing staff.”

 

You can more about creating a good birth plan here and here.

A Birth Story: Lauren & Baby Naomi

On Monday, June 14, I went to work just to do patient phone calls and desk work. The nurses I work with hadn’t let me hardly touch a patient for days so I knew I could get a few hours at work and not over exert myself. I worked about a half day and then went to the chiropractor for a routine visit. My midwife recommended chiropractic care to help with the baby’s positioning and also for my pelvic/hip alignment. On the way home I felt the urge to do a major grocery shopping trip, so off to Giant I went to stock up on essentials. Over an hour later, I finally got home, only to commence a kitchen overhaul…cleaning out the fridge and reorganizing the cabinets. After my nesting cravings had been satiated I was able to relax with my husband, Adam, until about 10:30 pm when I started to have some Braxton Hicks contractions. Hoping to sleep through these minor contractions, I was asleep by 11:30 pm, but then was up at 2 am due to the discomfort that was coming with each contraction. At this point, it felt mostly like moderate to severe menstrual cramps, not so bad. I was excited and hoping that maybe this was “it” so I started tracking the frequency of each surge. All night my contractions came with some regularity, but they were too inconsistent. On Tuesday morning around 8 am I spoke with my midwife who suggested I try to rest and keep my appointment for that afternoon.

On the birth ball, with Adam supporting my back.

At my appointment around 2 pm, I found out that I was only 1cm dilated which was a little discouraging at the time. Megan (the midwife) was really concerned that I was so exhausted and suggested I try to get some sleep that night because true labor could be weeks away. At her suggestion, I accepted some prescription sleeping pills, knowing that I needed the rest. Unfortunately I had a reaction to the sleeping pills which caused me to be incoherent and in and out of sleep all night. I found myself in the tub around 5:30 am, listening to my iPod and breathing through each surge.

On Wednesday morning, I didn’t feel rested and the contractions were getting stronger. I spoke with my hypnobirthing instructor on the phone and made another appointment with the chiropractor in hopes that she could help “get things moving.” I also made an appointment with an acupuncturist, hoping that maybe stimulating the right pressure points could help get me into active labor. While at home, I just sat on my exercise ball, bouncing around or trying to relax in the tub. I found that my surges were increasing in intensity but I was still able to breathe through each one and stay very relaxed, calm and positive. I’ll take a moment to note that as prepartion for birth, I listened to relaxation exercises and birth affirmations as part of my hypnobirthing class. Because of this, I was able to quickly go into a deep state of relaxation and allow my body to respond to uterine surges with ease. Around 2 pm I checked back in with my midwife requesting to be assessed prior to my acupuncture appointment; my contractions were about every 5 minutes and I was just plain curious to see if things were progressing. 

Meeting Naomi for the first time.

At the birth center, the midwife told me I would not be making my appointment for acupuncture because I was 7 cm dilated and she wanted to admit me! I was relieved to know I really was in labor and excited to have the baby! Adam and I went upstairs and chose our birthing room, a large room with private jacuzzi tub and comfy queen size bed. Adam unpacked the car and brought my exercise ball in for me to use. After a little while I asked my nurse, Ann to get the tub ready so I could relax in there for a bit. I labored in the tub for a couple hours, Adam rubbing my shoulders and my mom massaging my low back during each contraction. My ipod speakers were set up with some relaxing music and the recording of birth affirmations previously mentioned. I was allowed to eat and drink as I wanted and was encouraged to take fluid by mouth since I did not have an IV like at a hospital.

 Around 7 pm, I was presented with the option to have my membranes ruptured. I was really exhausted from not sleeping for 2 nights and really wanted to get things moving so Adam and I decided to go ahead and do it. Afterward, the contractions became increasingly intense and I changed position from the tub to birthing stool. After pushing for about an hour I moved onto the bed so that I could be better supported. At 9:50 pm, Naomi Christine was born after about 1.5 hours of pushing.  My labor was calm and relaxed until I had to push. While I wouldn’t say that it was painful, pushing required every ounce of my being because I had been sleep deprived and unfortunately had not eaten enough that day.

Our first family photo.

While I received some sutures, Adam took off his shirt and held Naomi ”skin-to-skin” with him. Then, she went right to my chest and stayed there for 2 hours. She had absolutely no problems with jaundice, having passed two meconium stools in the first 4 hours of life, and my milk was in at 48 hours. I attribute these things to the uninterrupted skin-to-skin time of bonding and nursing in those first hours of life. I’m thankful that my first birthing experience was what I envisioned. I felt empowered, in control, and had minimal medical interventions.

Week of Giveaways: Maternitique Gift Certificate

This giveaway is now closed.

Welcome to day three of the Giving Birth with Confidence Week of Giveaways! We have lots of fun and useful items to give away, so be sure to visit the site each day this week and enter to win. If you’re just joining us, visit Monday and Tuesday’s posts for another chance to win!

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Today’s giveaway is a $25 gift certificate to Maternitique, an online boutique that features natural products for pregnancy, maternity and baby. As a mom who has recently taken a vested interest in choosing safer household and body care products, I am in love with this site’s philosophy toward natural and organic products in pregnancy.

Maternitique’s products reflect what mothers and midwives have always intuitively known, and what modern research is only beginning to prove: that the lifestyle choices we make before, during and after pregnancy—beauty and skin care, diet, exercise, stress management, pain and symptom relief—affect fetal health, childbirth outcomes and newborn development.

Owner Tara Bloom tells us why she founded Maternitique: “I loved being pregnant, giving birth, and becoming a mother, and I want to help other women enjoy the journey to motherhood as much as I have. Women deserve the best throughout pregnancy and they shouldn’t have to worry about what’s safe. That’s why I’ve hand-picked products that pamper moms while protecting babies.”

Maternitique has a site full of awesome products, but probably one of the most unique (that I’ve seen) is their “Lighten My Labor” line, which includes naturally based, non-toxic mists, lotions and gels to encourage calmness and trust throughout labor. The Lift Me Body Mist, developed by an OB/GYN nurse practitioner, is infused with light scents of neroli and lavender oils to refresh and cool during labor transition.

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One Giving Birth with Confidence reader will win a $25 gift certificate to Maternitique!
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Here’s How to Enter

Everyone has three chances to win — choose one or all three!
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1. Visit the Maternitique Web site then come back here and leave a comment on this post telling us about your favorite product that they carry.

2. Create a login and become a member of the Giving Birth with Confidence online community. It’s FREE and easy. Leave a second comment on this post to let us know that you’re a new member or if you are already a member.

3. Tweet about this giveaway with the following text: Enter to win today’s #giveaway week: Mom Gift Certificate! To enter, post a comment at www.givingbirthwithconfidence.org & RT this message! Be sure to come back here and leave a third comment to tell us that you tweeted.

This giveaway is open to anyone, worldwide. It will end this Sunday, August 15 at 11:59 p.m. EST. Winners will be announced on Monday, August 16. Good luck!

The Mother Lode of Pain: Getting It All Wrong at the Boston Globe

This post was published in 2006 on the original Giving Birth with Confidence blog. It provides concrete information on the role of pain in labor and shares a beautiful analogy that describes why women would want to experience childbirth fully.

Dr. Darshak Sanghavi author of “The Mother Lode of Pain,” the cover story of the Boston Globe Magazine on July 23, 2006, skims the surface of historical and empirical research and presents us with the most biased and inaccurate story I have read in many years.

At the center of the story is Dr. Sanghvi’s belief that choosing to feel pain in labor is “odd.” “Especially when there is effective, safe, and available pain relief.” He suggests that women who choose to have a normal, natural birth and experience the pain that accompanies labor and birth are “attracting notice”, “setting up an artificial trial that precedes entry into a highly selective sorority”. He goes on to say “It creates drama. It captures attention”.  His most shocking, and utterly ridiculous statement is “…reliance on pain to create meaning during childbirth indicates a constricted imagination.”

If Dr. Sanghavi had actually done a serious rather than a superficial review of the literature including consulting the Cochrane Library for the most current research and recommendations for maternity care he would have discovered that pain during labor and birth is not “an utterly primitive thing” but plays an incredibly important role.

Pain early in labor lets women know they are in labor. And as oxytocin levels rise, the uterus contracts more effectively to dilate and efface the cervix, and the pain increases. Women respond to the pain they are feeling by trying to find comfort in a wide variety of ways (if allowed any degree of freedom). They moan, change position, walk, sit in a tub of water, are massaged, eat and drink, sing, listen to music. The list is endless. The key is that each woman in labor manages her pain in unique ways that work for her. What she is feeling guides her to finding just the right thing to do. Eventually endorphins kick in and the result is that women go into a dream-like, highly intuitive state and that helps them manage the pain of contractions too. Without pain there is not the same kind of endorphin release. Not surprisingly, if pain is eliminated (with an epidural) naturally occurring oxytocin is not released in increasing amounts. The normal, natural process of birth has been interfered with and there is a need for medical interventions…starting with pitocin. Being able to manage the pain of labor actually helps labor progress by insuring high levels of oxytocin and also by encouraging the mother to move helping baby to settle into and move through the pelvis. Pain is also protective especially during second stage as the baby moves through the pelvis and is born. Women who do not have an epidural respond to what they are feeling at this stage by changing position, and tensing and releasing vaginal and pelvic floor muscles, and in that process protect the birth canal, the perineum and the baby. Pain promotes the progress of labor, protects mother and baby, and helps women find comfort. It is not an unnecessary side effect and eliminating it completely alters the course of labor and sets the stage for interventions and complications.

Women choose to experience (and manage) the pain of labor because it makes birth safer for them and for their babies. At the end of the day the reward for that hard, sacred work are feelings of elation, even ecstasy. And a baby that is alert, competent, and able to nurse easily and well right from the get go. If Dr. Sanghavi had more than a rudimentary knowledge of the process of normal birth and the important role pain plays in that process he might not think the way he does.

As I write this I am looking out the window to the sea in rural Ireland. Later today I will walk down a small lane through farmers’ fields to a little cove to swim. I could get there a lot quicker if I drove it and since the walk back up that lane is very steep in several spots driving would be so much easier. And it takes so much time to walk. The swim would be the same. I would be relaxed and refreshed at the end of my outing. But this is what I would have missed. Feeling the sun and the wind on my face. The sense of well being as I walk, slowly and them more rapidly, getting into a rhythm. Stopping to pick wild flowers (not part of the plan at the start). Picking and eating a few blackberries from the bushes that line the lane. Watching a boat on the sea and wondering what it is doing. Stopping to watch a calf nursing. Smelling the honeysuckle. Chatting with a farmer friend who is moving his cattle from one field to another. And on the way home, up that steep hill, changing the way I walk, slowing up, sweating with the exertion, taking breaks, noticing the blueness of the sky, delighting in how good the wind feels blowing my hair, stopping again to talk, now about how cold the sea was, how fine the day is. Taking gulps of icy water. Eating part of a chocolate bar. Daydreaming. Shaking my legs as they resist the climb. I arrive home refreshed, relaxed and tired. The swim happened. But so much more did too. And therefore the meaning of this lovely afternoon is totally different. I wonder if Dr. Sanghavi thinks that my decision to walk not ride to my little cove is odd and indicates a constricted imagination?

And what if I had not been permitted to eat and drink on my walk, what if I had been tethered to an intravenous and continuous monitoring (just in case I slipped and fell and broke my ankle), what if my pulse was taken every few minutes to make sure I wasn’t too stressed? What if I had to do it all in great haste? That walk would most certainly have lost its allure. In fact instead of a delightful challenge it would become a misery. The ride in the car would seem reasonable!  Like medication in labor — safe, effective and available?

I am irate that thousands of women will read an article that perpetuates the myths that pain in labor serves no purpose and that working hard in labor is “odd.”