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What You Need to Know About Premature Birth

November 16, 2011 By Cara Terreri 5 Comments

Tomorrow, November 17, is World Prematurity Day — an event created as part of the March of Dimes Prematurity Campaign to raise awareness of and remember babies who died from premature birth. Worldwide, 13 million babies are born prematurely. Prematurity is the leading cause of death among newborns, and causes complications at birth and lifelong illnesses. In the last 25 years, the prematurity rate in the United States has risen by 36% — one of the highest rates for preterm birth in the world.

Sometimes, in cases of true complications, preterm labor and birth is unavoidable. In many cases, however, preterm birth can be prevented. If you are pregnant, there are things you can do to lower your risk of preterm birth.

Lowering Your Risk of Preterm Birth

Prenatal Care – Seek ongoing prenatal care from a reputable care provider. Whether your preference is for midwife or obstetrician, be sure to research your care provider’s history and practices. Ask about their rate of induction. If they don’t know it or report a rate ranging from 20-30+%, consider finding another care provider.

Induction – Inducing birth or scheduling a cesarean surgery prior to 39 weeks of pregnancy can lead to premature babies. Even if friends and family tell you different, every week counts! Babies undergo vital development up to the very moment of their birth. And, because your due date is just an estimate, it can be off by up to two weeks in either direction. So, a baby that is induced at 38 weeks may only be at 36 weeks gestation. If your care provider is pushing for early induction, ask questions! Learn what counts as true medical indication for early induction or cesarean surgery. If being “so done with being pregnant” is getting to you, hold tight and think of the babies born at 28 weeks, with mommies who would have given anything to make it to 40 weeks.

Education – The Internet is overwhelming. When it comes to making informed decisions in pregnancy and birth, the Internet is a good place to start, but not a good place to stop. Sign up to take a childbirth education class from a childbirth educator certified by a reputable childbirth education organization (there are many, but we really think Lamaze is tops!). Childbirth education provides the foundation for educated, evidence-based decision making for you and your partner throughout pregnancy and birth.

Filed Under Birth, Childbirth education, Choosing a care provider, Featured Story, Induction, Pregnancy, Preterm Birth, Working with a midwife Tagged With Preterm Birth, Preterm Labor

In Celebration of Midwives

October 7, 2011 By Cara Terreri Leave a Comment

In recognition of International Midwifery Week, Giving Birth with Confidence gives a shout-out and huge applause to all of the incredible midwives that serve women around the world. Your work and care is necessary and appreciated!

What does it mean to work with a midwife? According to the American College of Nurse-Midwives, midwives:

Believe the best model of health care for a woman and her family:

  • Promotes a continuous and compassionate partnership
  • Acknowledges a person’s life experiences and knowledge
  • Includes individualized methods of care and healing guided by the best evidence available
  • Involves therapeutic use of human presence and skillful communication

Honor the normalcy of women’s lifecycle events. They believe in:

  • Watchful waiting and non-intervention in normal processes
  • Appropriate use of interventions and technology for current or potential health problems
  • Consultation, collaboration and referral with other members of the health care team as needed to provide optimal health care

Do you love your midwife and want to do more to promote midwifery awareness? Consider joining Team Midwife to help other women learn about the great care that midwives offer.

Did you work with a midwife for your birth? How was your experience? Leave a comment to let us know!

Filed Under Birth, Featured Story, Pregnancy, Working with a midwife Tagged With Certified Nurse Midwife, midwife, Midwives Model of Care

How to Choose a Midwife

July 20, 2011 By FitPregnancy 2 Comments

By Jeanne Faulkner, RN, a labor nurse in Portland, Oregon

More women are choosing midwives, but lingering myths and confusion mean that many moms-to-be still have questions. We’ve got answers.

Midwives are being “rediscovered” by growing numbers of pregnant women today. According to the National Center for Health Statistics, in 2006 (the most recent figures available), they attended a record-busting 317,168 births—7.4 percent of all U.S. births; 96.7 percent of them took place in hospitals, 2 percent in birth centers and 1.3 percent in homes. To help you decide whether to go the midwife route, here are answers to some of the most common questions.

What advantages do midwives offer?

The Midwives Model of Care views pregnancy and birth as normal events; as a result, midwives suggest and perform fewer interventions than are typical with most obstetric care. “Midwives focus more on nutrition and education,” says Judi Tinkelenberg, C.N.M., R.N., clinical director of Sage Femme Midwifery Service and Birth Center in San Francisco. “We do fewer routine, often unnecessary tests—for example, we don’t automatically do ultrasounds if they’re not needed. We make decisions with patients based on informed consent.” Midwives also spend more time with patients than most OBs do, which means they often offer more personalized care.

What exactly does “midwife” mean?

All midwives provide prenatal and postpartum care, attend labors and deliver babies. Some provide additional services, such as routine gynecologic exams and contraception care. But do your homework; anyone can call herself a midwife. Here are the distinctions:

>>Certified midwives (C.M.) meet American College of Nurse-Midwives (www.midwife.org) requirements, but they do not need to be nurses.

>>Certified nurse-midwives (C.N.M.) are nurse- practitioners who are certified by the American College of Nurse-Midwives.

>>Certified professional midwives (C.P.M.) meet North American Registry of Midwives (www.narm.org) certification standards.

>>Direct entry midwives (D.E.M.) are educated through self-study, apprenticeship, midwifery school or college- or university-based programs that don’t include nursing. They include certified midwives and certified professional midwives.

>>Lay midwives are sometimes called traditional, unlicensed or “granny” midwives. These women are educated through self-study and apprenticeships, and while they may be highly experienced and skilled, they aren’t certified or licensed.

>>Licensed midwives (L.M.) can practice in a particular jurisdiction, usually a state or province.

For more information on the different types of midwives, go to www.mana.org.

What’s the best kind of midwife?

That depends on whether you want a hospital or out-of-hospital birth, a low-intervention or medicated one. The most important thing is to make sure anyone you’re considering is qualified and experienced. “Direct entry midwives and certified nurse-midwives have different educational pathways, but they’re all well-trained and competent,” says Geradine Simkins, D.E.M., C.N.M., M.S.N., president of the Midwives Alliance of North America. Most C.N.M.s deliver in hospitals, while C.P.M.s have specific training and expertise in out-of-hospital births.

The Institute of Medicine and the National Commission to Prevent Infant Mortality praise the contributions of certified nurse-midwives in reducing the incidence of low-birth-weight infants and call for their increased utilization, and the new federal Health Care Reform Act strengthens the legitimacy of certified direct entry midwives.

Is it safe to go with a midwife?

Yes, as long as you have no pregnancy complications or risk factors for birth complications. For 60 to 80 percent of low-risk pregnancies, it may be even safer to go with a C.M. or a C.N.M. than with an obstetrician. That’s because midwives use less fetal monitoring and over-diagnose fetal distress less often, which means fewer interventions, such as C-sections and forceps- or vacuum-assisted deliveries. Studies show that C.N.M.-attended births are associated with 31 percent fewer low-birth-weight babies and 33 percent less neonatal mortality.

If you have certain health risks, including obesity, diabetes or hypertension or are carrying multiples, you might still qualify for midwife care, but only if it’s coordinated with an OB. If you want to give birth at home, make sure your midwife has protocols for a quick transfer to a hospital in case of an emergency.

How do costs and care compare with those of obstetricians?

Midwifery care can cost less overall, but C.N.M.s are sometimes paid similar rates as OBs. Insurance companies currently pay for most C.N.M. services, and under the new federal health care legislation, certified D.E.M.s will also be covered.

As for whether the midwife you see for prenatal visits will deliver your baby, it’s the same as if you were seeing an OB. “Many private practice midwives make a special effort to be at their own patients’ births, even when they share call with partners,” says Karen Parker Linn, a C.N.M. in Portland, Ore. In shared practices, several midwives work together. Patients see different ones during pregnancy and deliver with whomever is on call, though midwives sometimes come in for patients with whom they’ve formed a special bond, Linn adds.

Do doctors respect midwives?

Most hospital-based midwives are well-respected by OBs. Out-of-hospital midwives? Not as much. Most out-of-hospital births are safe, but when trouble arises and patients are transferred to hospitals, doctors sometimes feel like the clean-up crew for high-risk deliveries.

“Midwives are fantastic options for low-risk women,” says Kathleen Harney, M.D., chief of obstetrics for Cambridge Health Alliance and the C.N.M-managed Cambridge Birth Center in Massachusetts. “Their philosophy and training are more focused on birth as a healthy, natural process. Doctors are trained to think something adverse may happen,” she explains. “The truth is somewhere in between. Working in concert with midwives reminds OBs not to be overly interventionalist.” .

5 questions to ask a midwife

1. What is your training, experience and certification, and do you have references?

2. Where do you deliver—at home, in a birth center and/or in the hospital?

3. What percentage of your prenatal patients do you actually deliver yourself?

4. For an out-of-hospital birth, what’s your emergency backup plan?

5. Do you take medical insurance?

Filed Under All Recent Articles, Birth, Choosing a care provider, Pregnancy, Working with a midwife Tagged With Certified Nurse Midwife, hospital birth, midwife, midwife care, Midwives Model of Care, natural birth

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

January 28, 2011 By Cara Terreri 2 Comments

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!

Filed Under All Recent Articles, Birth, Birth Center, Birth plans, Birth stories, Blog Carnival, Childbirth education, Choosing a care provider, Coping with pain, Healthy Birth Practice, Induction, Labor, Pregnancy, Working with a doula, Working with a midwife

Finding the Right Health Care Provider and Birth Place

November 19, 2010 By Cara Terreri 2 Comments

The following is a guest post article by Ann Grauer, CD(DONA), PCD(DONA), LCCE, FACCE, a Lamaze certified childbirth educator, prominent doula and sought-after speaker.

Maybe you haven’t started buying baby gear yet, but there are two major items that you should be shopping for: a birth place and a health-care provider. If you’re healthy and have a low risk of complications, giving birth at home or in a birth center is just as safe as at a hospital.

Location, Location, Location
A comfortable environment and lots of support so that your body can do its job are most important. At a birth center or your home (attended by a midwife or doctor), you’ll have a team trained in labor support that sees birth as a normal life event rather than an emergency waiting to happen. You have a much better chance of giving birth without medical interventions if you’re surrounded by people who share your birthing goals.

If you choose to give birth in a hospital, there are a few things you should be aware of. Many hospitals routinely rely on medication and technology, rather than using them only when you need them for a specific problem. It also can be harder to relax and work with your labor in a hospital, but it doesn’t have to be. Choose a hospital that encourages you to stay active in labor and does not impose a lot of restrictions on you (like not eating or drinking and requiring continuous electronic fetal monitoring). The support and encouragement of people who know you and who care about you will help you feel safe in an unfamiliar place. You also might want to consider hiring a doula. 

Midwife? Physician? Obstetrician?
Your next step is finding a health-care provider who works in the birth place you’ve chosen. A doctor who gives a good gynecological exam may not be the best person to guide you through pregnancy and birth. Take time to consider the following three options:
  • A midwife provides pregnancy and birth care. They have deep respect for the natural process of pregnancy and birth. Certified midwives (CMs) and certified nurse midwives (CNMs) have advanced training and have passed rigorous certification exams; CNMs usually have a master’s degree. Studies show that midwifery care is not just safe but is very appropriate for healthy, low-risk women.
  • A family physician provides comprehensive medical care, including prenatal care, which recognizes that most pregnancies don’t require intervention.
  • An OB/GYN is a surgeon who specializes in the care of the female reproductive system. Family physicians and midwives will refer you to an OB/GYN if complications arise. 
Trust Your Instincts
Ask your friends and coworkers who are already moms about their providers and interview those that sound promising. Above all, listen to your gut. If something doesn’t feel right, that provider isn’t for you.

If at any time you don’t feel comfortable with your health-care provider or planned place of birth, it’s okay to look around and consider making a switch. The insight you gain during the months of pregnancy may lead you to realize that who you chose in the beginning is not who you wish to have with you at birth. When the big day comes and you have a trusted provider by your side, you’ll be glad you took this decision seriously.

Filed Under All Recent Articles, Birth, Birth Center, Choosing a care provider, Homebirth, Pregnancy, Working with a midwife

A Tale of Two Homebirths

October 26, 2010 By Amy Romano 6 Comments

I have two kids, and they were both born at home.  My births were almost carbon copies of each other.  My daughter and son were both born at 39 weeks and 4 days, labor started with water breaking, contractions followed about 30 minutes later, and then labor progressed very quickly.  I had a second degree tear both times in the same spot (ouch), and experienced urinary retention and required a straight catheter both times (double ouch). It’s weird, I know – most women don’t have two kids with such similar births.

There was one major difference, though. At my second birth, my midwives could have been arrested just for being there. They were Certified Professional Midwives (CPMs) with a combined 30+ years of experience but the state I lived in at the time didn’t recognize this national credential.  Neither do 22 other states. Some states actively criminalize home birth midwifery while others have outdated statutes that simply don’t recognize CPMs. But the impact is the same: it marginalizes midwives from the very system that optimizes the safety of home birth: the care providers and facilities that can intervene when complications develop.

I was fortunate that I didn’t need this safety net. But had I encountered problems in my first birth, the procedure was clear: My midwife would have called the obstetrician she worked with, who I had already met during a routine 36 week visit, and she would have accompanied me to the hospital, freely sharing the information in my medical record, giving a verbal report to the doctor, and staying by my side to provide continuous emotional support and comfort. My prenatal record and labs would already have been at the hospital and the doctor would prepare whatever resources and staff were necessary based on the report she got by phone from my midwife – whether that was an epidural for pain relief or a crash c-section.

Had the same complication arisen in my second birth, I honestly don’t know exactly what would have happened. I was lucky that the doctor who backed-up the birth center practice where I worked at the time was willing to do a “special favor” and be my back-up doctor for my own birth. He didn’t do this for other women planning home births. There were a few other doctors in the surrounding areas who would provide “parallel care” to women having home births, which would have meant going to double the number of prenatal visits even though I was healthy, had a toddler at home, and a full-time job. And I’d have to travel a good 30-45 minutes for those prenatal consults, since those doctors weren’t right in my community. I probably would have declined to bother with this since, given my history of rapid labors, I knew it was unlikely that I’d even make it to a hospital 30 or 45 minutes away, and would end up going through an ER closer to home for my care. As for my midwife, she may or may not have been able to transparently share the records from care up to the point of transfer, and she may or may not have been able to stay by my side. It probably would depend on the circumstances of the transfer and whether the receiving hospital was hostile toward or accepting of home birth midwives. After all, she could end up in jail just for bringing me there, even if by doing so she saved my life or my baby’s life.

If ever there was a disincentive to provide safe care, this is it: the fear that by securing access to proper treatments, the midwife faces the possibility of incarceration, loss of livelihood, and financial ruin. And the irony is that in many of the cases where midwives get into trouble, the baby and the mother turned out healthy. In other words, the midwife initiated a transfer appropriately and in a timely manner and the system – as fragmented as it is – actually worked to achieve a good outcome. But all it takes is one person to lodge a complaint, even if the woman herself is happy with her care, and the house of cards comes tumbling down.

Who benefits from this way of doing things?  We’ve already seen that women, babies, and midwives don’t. I don’t really believe that doctors or hospitals benefit, either. Instead of having an orderly system for receiving referrals, staff have to piece together the bits of information in the moment, while caring for a patient who probably doesn’t want to be there and has just been separated from the care provider with whom she has built up nine months worth of trust. The state doesn’t benefit, either. When my son was born safely at home, my husband signed the birth certificate. In other words, the state can’t track the outcomes of practicing home birth midwives, but is called on to investigate when a member of the public makes a complaint.

Many women, I presume, approach the situation the way I did: ignorance is bliss. I didn’t really want to hear the answers to the hard “what if” questions, so I didn’t dwell on them. Besides, I didn’t really have any other options. The only other midwifery practice in my community was the one I worked at, and I preferred to keep my personal and professional lives separate, and I knew enough about the hospital in my community to know that I didn’t want to give birth there unless it was the only safe place to be. I assumed because I was healthy and had already given birth at home, everything would probably turn out fine. I knew my midwives were competent and caring and would do everything possible to keep me out of harm’s way. But I didn’t really know how my care would unfold if I needed urgent help that was outside of my midwives’ scope of practice or skill set. I put trust in a system that couldn’t have been more dysfunctional, and I was lucky that, in the end, I didn’t need to rely on it.

This post is part of a blog carnival to raise awareness about Dr. Agnes Gereb, a Hungarian gynecologist and midwife who was jailed for attending a precipitous birth at her birth center in Budapest, despite apparently providing proper care and exhibiting swift judgment.

Filed Under All Recent Articles, Birth, Birth stories, Blog Carnival, Choosing a care provider, Homebirth, Pregnancy, Working with a midwife

What Does Pushing Feel Like?

September 24, 2010 By Desirre Andrews 4 Comments

Women often ask me what pushing feels like. As an educator and doula it is probably one of the more challenging concepts to address.

Some of the imagery can be quite vulgar.  “Push like you are pooping.” Do women REALLY want the image of pooping out their babies?! Or the imagery puts pushing in a neat box. “The urge will overwhelm you and you cannot help it.” “You will just know.” Those do not adequately speak to what can occur. Some women get no urge to bear down until the baby is very low and engages the nerves. Others will have the urge when baby is high and dilation isn’t complete. Still other women do not get an intense urge at all regardless of pain management or natural birth.

For that matter, great rectal pressure may be felt, intense abdominal pressure felt, incredible pelvic pressure may be experienced,  or frankly not much at all can be felt.

I believe whatever a woman’s body does is right for her birth and her baby.

Below are many quotes that others openly offered to help women everywhere have a deeper understanding of what pushing is like.

Quotes from real women

“My babies #1-4 practically fell out. #5 I was in what looked like early labor for 4 days. Midwife assistant came over, checked me, I was at 7 cm but ‘not in active labor’. I got into it quickly! Long story short I pushed, painfully, for 3.5 hours, baby had 11″ cord with a true knot. She needed to be pinked up but is almost 3 and is doing well.”

“When I was coached to push (w/ no 3–first natural birth) I was in agony. When I was left alone and did not push (w/ no 4), life was good.”

“I feel like if I can just get to the pushing phase, it will be a breeze from there.” (and it was. The whole “surrender/dilate” phase is much more challenging to me than the whole “take control/pushing” phase.)”

“Pushing was fantastic with my 2nd baby and awful with my 3rd! It was really surprising because after my 2nd birth I thought “Okay so pushing is the really fun and satisfying part! That’s when it gets EASY.” Then my third birth totally shocked me. Pushing was the most painful and difficult part of the birth. I had stayed so calm and collected… until then. Every pregnancy and birth is so different!”

“I love the way it feels to have a baby move through me and into my waiting hands.”

“The mirror really gave me focus and helped me push very effectively when I inspired by seeing a peek of baby head.”

“I *loved* pushing. I didn’t do it for very long (two contractions), but it was so great to finally get there. I was told to purple push (not in those terms – the nurse told me to hold my breath), and intellectually I knew I shouldn’t, but I tried it and it really did feel like I was more productive that way. I felt like a warrior. It was awesome.”

“Before anyone hates me for only pushing through two contractions, you should know that I’d been in labor for three days – so it all comes out in the wash ”

“Pushing with my 2nd was horrible. 3+ hours of the worst pain I had experienced at that point in my life. Turns out her little fist was up by her cheek (um ouch) and her head did not mold much. My 3rd I did not push because she was precipitous and we were trying to get to the hospital. I felt like all the energy in the world was gathering and swirling at my fundus and then suddenly flowed through me carrying her with it. It was the best physical experience of my life.”

“I have heard some say that pushing feels good.. um, I personally have not experienced that and I have had clients remark the same … :p”

“Hmm…Definitely the best part of labor and delivery. For me though – never had any “urge” to push but still had baby out in 20 mins…I think I was feeling determined being a VBAC mom…still, would have been easier if I felt the need to and not just contractions. “

“Heard lots of clients say it feels good after hours of labor”

“Difficult. I had an urge to push “early” every time. Once I got to the “ring of fire” it was awesome though.  I knew I almost was there.”

“Ahhh, I’m not so fond of the pushing. Did it for 2 1/2 hours with my daughter (LOA) and though it was only about 20 minutes with my boys, they were both OP. That was, shall we say, unpleasant. I cannot relate to those who’ve told me it was such a relief!”

“My labor was surprisingly short, only 6 hours and she’s my first baby so far. I woke up in active labor and at 4 cm and I wanted to push THE WHOLE TIME! It was horrible having the nurse say I couldn’t push yet when I wanted to so badly, but once I did get to push, oh my goodness, it felt incredible. So much control and power, it felt so good to finally work to end. 3 big pushes and there she was. ”

“Sheer, immeasurable power. Unbelievable!”

“Babies actually come out of your butt. Don’t let anyone tell you otherwise.” One of my clients recently said that. ”

“Birth is shockingly rectal” – Gretchen Humphries. She was totally right.”

“Pushing with my first felt like I was satisfying an urge, an uncontrollable urge. It felt almost desperate I couldn’t stop it. (kinda like having that rectal urge when you REALLY have to poop). Pushing with my second was no big deal, I followed my urges again and pushed 3x and out she came in her 10# glory. It was extremely satisfying and powerful I felt like I had just finished exercising. Amazing!”

“The ring of fire OH MY it is indeed! Though as soon as the burn started the whole are went numb almost like too hot or too cold numb and the power of the urge to push my son out was almost beyond description.  Pushing was never easy for me as I have an unusual pelvic shape.  But my last son WOW no molding and quite a large head to birth him was incredible really.  No tearing, just some abrasion.  Recovery was a snap.”

“I had at the point of delivery what was the best orgasm of my life!”

“Pushing was totally primal.  I had an incredible urge and it took over.”

“The pressure of the baby entering deep into my pelvis and vagina was wild and almost overwhelming.”

“Feeling my baby when he was partially inside and partially outside of my body was a euphoric and surreal moment. The hour of pushing was well worth it.”

Bottom line – you and your baby are unique. You work together during all parts of labor including pushing through to delivery. Be confident. Use your intuition. Follow what your body desires to do.

Questions and Answers

  1. I have had a previous episiotomy, do I need another one automatically? No you don’t.  Depending on how your scar has set and the position you push in the scar can re-open or it adhesions in the scar will need to be broken up.  I would suggest perineal massage prenatally if there are any adhesions to break them up and soften the area prior and to choose a pushing position that doesn’t put all the tension on that exact area.
  2. Is is wrong to push when I am not fully dilated? Not necessarily.  Now I think grunty smaller pushes with those contractions can be effective to complete dilation if you are in transition.  Prior to that change the position you are laboring in to change where baby is placing pressure.  Knee chest can be very effective to abate very early pushing desire.
  3. What if I poop during pushing? Some women will pass some stool and some won’t.  An open bottom is vital to pushing, so it is a normal but not always occurence.  A fantastic nurse, MW or doc will not actually wipe it away but simply cover as to not cause constriction of the sphincter muscles which can disturb the pushing progress. If it is possible to discard the stool without disrupting you, it will be done very quietly, quickly and discreetly.
  4. I am very modest, do I have to have all my “glory” showing? Absolutely not.  You can maintain good modesty all the way up to delivery.  Even then you do not need to be fully exposed.  Truthfully a home birth or birth center birth with a midwife if likely going to help you have your modesty concerns respected and honored. Really no one needs to put hands in you during pushing, needs to stretch anything, or needs to see everything either.  A midwife is trained to see by taking a quick peek or simply to know when she needs to have hands ready to receive baby and to offer external positive pressure if mom wants.
  5. Is there a “right” position to push in? There IS a right position for you, your baby and your pelvis. The only way to know is to try a variety of positions, pushing spontaneously and listening to your body.  Generally the lithotomy or semi-reclined position disallows the tail bone to move up and out to create more space. Side-lying, squatting, leaning in a mild squat, hands and knees, hands and knees with a lunge, and even McRoberts can be excellent to open a pelvis to a large degree. Pay attention and go for what feels right.

 

This article has been reposted with permission from Preparing for Birth, http://prepforbirth.com/.

Filed Under All Recent Articles, Birth, Birth stories, Healthy Birth Practice, Labor, Pregnancy, Working with a midwife Tagged With Labor, pushing

Have You Taken The Birth Survey?

August 25, 2010 By Cara Terreri Leave a Comment

Have you heard about The Birth Survey? It’s an ongoing, online maternity care survey that provides a place for women to give feedback about their birth experiences with specific doctors, midwives, hospitals and birth centers. The feedback is then made available in a searchable online database that provides resources to help other women and families to make more informed choices when choosing maternity care providers and birth settings.

 

The main goal behind The Birth Survey is to provide access to information that will help women of childbearing age choose maternity care providers and institutions that are most compatible with their own philosophies and needs. The survey was created by the non-profit organization, the Coalition for Improving Maternity Services (CIMS), a coalition of individuals and national organizations with concern for the care and well-being of mothers, babies, and families. The CIMS mission is to promote a model of maternity care that will improve birth outcomes and substantially reduce costs.

 How great would it be to have access to feedback and information on all of the hospitals, OBs, midwives and otherwise through just a few clicks? The Birth Survey is currently in the building process with its database, which means YOU need to go and take the survey to help make it complete! The survey takes about 30 minutes to complete, and you have the option to save and come back to it later.

Here’s what else you’ll find at The Birth Survey:

  • Survey results in the way of ratings for doctors, midwives, hospitals and birth centers
  • Intervention rates by state for hospitals and birth centers
  • State by State links to info on the health of mothers and babies and access to VBACs
Filed Under All Recent Articles, Birth, Birth Center, Birth plans, Choosing a care provider, Health and well-being, Healthy Birth Practice, Pregnancy, Working with a midwife Tagged With The Birth Survey

A Birth Story: Lauren & Baby Naomi

August 23, 2010 By Cara Terreri Leave a Comment

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.

Filed Under All Recent Articles, Birth, Birth Center, Birth stories, Coping with pain, Healthy Birth Practice, Labor, Pregnancy, Working with a midwife Tagged With birth story

Great Expectations: Liz @ 14 Weeks

July 24, 2010 By Liz Abbene 2 Comments

The fog has lifted!  I’m on my way back to normal (as normal as a pregnant woman can feel.)  After one final week of ridiculous nausea, I’m feeling much better.  The fatigue seems to have diminished and has returned to my usual level of mom-doula-wife fatigue. I am hopeful that I have turned a corner and will finally be able to eat foods that have slightly more nutritional value than spiral-shaped macaroni and cheese.

Since my uterus is tipped backwards, the baby’s heartbeat has been previously undetectable with the midwife’s handheld doppler.  We were hoping that it would be this week and had explained to three very excited kids that we might be able to hear the baby at my check-up the other day.  However, no one could have anticipated what happened when my midwife put the doppler to my belly. After the usual few seconds of static, the sounds of a truck driver on a CB radio began emanating from my uterus!  The looks on the children’s faces were priceless, and the midwife remarked, “Mmm, that’s never happened before!”  After a solid 20 seconds of trucker talk, she was able to pick up the right frequency again, and finally we heard the familiar thumping of a baby’s heart.  Needless to say, I was a bit skeptical that it was actually my baby after the major technological glitch, but it was still a fabulous sound.

I’ve also been reassured by the tiny little movements that I’ve been feeling lately. After over a week of ruling out gas, and discovering that there is a pattern to the movements (usually after a big sneeze, which is happening a lot lately, or eating a meal), I am convinced that it’s definitely my little nugget squirming around in there.

Filed Under All Recent Articles, Great Expectations, Health and well-being, Pregnancy, Working with a midwife Tagged With midwife care, Pregnancy, second trimester
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