- Support is a key element to a woman having a positive birth and postpartum experience. As a birth partner, identify the resources you have for informational, emotional and physical backup early on.
- As you learn more about the process of birth, you will discover your strengths in offering support, and you can decide how you want to contribute to the birth of this child. Will you be the primary support, work more with the other team members or be by the mother’s side with your full love and support while others do the hands-on work? A birth partner can serve in any manner that helps the laboring woman, so be comfortable, even joyful, in whatever role you both agree upon.
- Whether you decide to actively work with the mother or just shower her with love, simply being present makes a difference. The birth partner is usually the one member of the team who best knows her desires and can interpret her cues and express her wishes to others. Your personal history with the laboring woman is something the rest of the team doesn’t have.
- In order to care for a mother in labor, you must also care for yourself. Eating and drinking during labor will give you the energy you need. Wear comfortable clothes and let the doula or nurse care for your partner while you take an occasional break.
- Ask questions. Unless you are birthing at home, you are in an unfamiliar setting surrounded by unfamiliar people. A doula can help you get the attention of the health-care provider so that you are heard.
- Be prepared to experience some strong emotions. Often, a birth partner is so absorbed in supporting the mother and remaining strong that he or she is surprised by the powerful feelings of love and awe that accompany seeing this incredible woman go through birth.
- You and the mother may have the most familiar voices to the infant. When you talk to the baby, he experiences a feeling of calmness that has a positive effect on his transition to the outside world. Stroking him will also reduce stress hormones and improve his breathing and temperature regulation.
- The postpartum period is a mix of joyous and difficult moments. The unpredictability of each day and getting to know your baby can sometimes make for a challenging situation.
- After the excitement of birth dies down a bit, enjoy quiet time with the mother and baby, and delight in the miracle of birth and the part you played.
Think of this as your “childbirth manual,” a step-by-step guide to prepare you for what lies ahead. We’ve divided the process into stages to describe the typical changes that occur as labor progresses. The first stage encompasses the very beginning of labor, when contractions begin, all the way through active labor, when your cervix is almost fully dilated. The second stage covers transition, when your body shifts from dilating to pushing, and the movement of your baby through the birth canal and into the world. Finally, there’s the third stage, when all of your hard work is done and your body begins to recover. You will most likely move from one stage to another fairly seamlessly. Although every labor and childbirth is unique—yours will unfold in its own way—the process is remarkably constant. Trust that your body will know just what to do.
- The cervix begins to soften, thin and move forward, and it may begin to open. The baby settles into the pelvis.
- At this point of childbirth, contractions may be noticeable as an achy sensation or as pressure in the lower abdomen or back. Contractions in this phase are usually irregular—starting and stopping; sometimes strong, sometimes mild. This is your body’s natural way of gearing up.
- This phase can last from a few hours to a few days.
- Don’t worry whether or not this is really labor. For the vast majority, labor eventually makes itself very clear.
- Try to be patient and have confidence that your body is doing exactly what it needs to do.
- Take good care of yourself. Eat, drink plenty of fluids, and rest or take a walk.
- Surround yourself with people that help you feel comfortable and safe. Your support team can keep you company and provide reassurance.
Early Labor (Latent Phase)
- The cervix continues to thin out and open, dilating to 3 or 4 centimeters.
- Labor is meant to be gradual, so this phase may take quite a while—usually about two-thirds of the total labor time. Over a period of several hours, contractions will become longer, stronger and more regular (about 5 minutes apart, each one lasting 25 to 45 seconds).
- A pinkish vaginal discharge (called “show”) usually increases as labor progresses.
- It can be hard to believe that this is it. Take time to settle down and work with the labor.
- Once again, the best thing to do is to take care of yourself. Alternate rest and activity (for instance, take a nice walk followed by a relaxing shower), eat easily digested foods and drink plenty of fluids.
- Many women find that the best place to be during this phase of childbirth is at home, where you can move about and do things for yourself.
- When contractions become so strong that you can no longer talk yourself through them, try using relaxation and breathing strategies. Your support people should be nearby, helping you to stay calm and confident.
- Keep the environment pleasant—perhaps listen to music, ask your partner for a shoulder massage or prepare the baby’s room.
- Contractions continue to become longer and stronger, until they’re eventually about 3 minutes apart and last for about a minute or more.
- During this phase, which generally takes from 2 to 6 hours, the cervix effaces and dilates to about 8 centimeters.
- Women in active labor usually get very focused as the hard work begins.
- Now labor has real momentum. Listen to your body and develop a rhythm with it.
- Do something active during the contractions, such as breathing in a pattern or moving around, and rest between contractions.
- As the strength of the contractions increases, so does your need for support. All present should focus their attention on you.
- Changing positions frequently not only helps you stay more comfortable, but also enhances progress.
- The environment can influence your labor. Make it peaceful and personalize it
with music and dim lights.
- The cervix finishes dilating and effacing.
- Contractions are now powerful and efficient, so this phase is usually quite short (less than an hour).
- Some women feel nauseous, shaky, restless or irritable during this phase of childbirth.
- To keep from feeling overwhelmed, focus on one contraction at a time.
- Continue with breathing, vocalization (if it helps) and rhythmic movement.
- Even though rest periods are short, they allow you to relax deeply and restore yourself.
- Those providing labor support should offer close undivided attention, unwavering encouragement and praise. If you’re using a breathing pattern, your team should try “conducting” to help you focus or moving with you in rhythm to your breathing.
- Your body shifts from dilating to pushing.
- The baby makes his way down through the pelvis and birth canal.
- This phase can last from 15 minutes to several hours.
- Although it may take several contractions after full dilation to be noticeable, most women get an urge to bear down. Your body is giving you clear instructions on what to do. The urge to push usually gets stronger as the baby descends.
- Many women feel more clearheaded and have a renewed sense of optimism when pushing begins.
- Just before the baby is born, you may feel a burning, stinging, stretching sensation at the vaginal opening: A sure sign that you’re almost there!
- As the baby’s head emerges, it turns to one side to allow the shoulders to align and then the rest of his body slips outs.
- The urge to push usually feels strongest at the peak of the contractions and then fades toward the end. Just follow along and do what feels right. For most women, this means taking normal breaths as the contractions build and then pushing when it becomes irresistible.
- It may help to make sounds (much like athletes do) in response to what you’re feeling.
- Labor supporters should provide quiet, reassuring encouragement. There’s no need for yelling.
- If progress is slow, change positions. Squatting, all-fours and side-lying are all good options.
- Let go of any tension in your perineum. Applying warm compresses there may help you push.
- Rest deeply between contractions.
- The cord is cut, and your baby is quickly dried and placed on your abdomen.
- What a mix of feelings—excitement, joy, awe, and relief!
- The placenta is delivered, usually within the first 10 minutes.
- Your health-care provider will make sure you are comfortable. Cold compresses are often applied to the perineum to ease discomfort and reduce swelling.
- Many women get after-pains or “the shakes” after childbirth.
- Touch, caress and cuddle your baby without time constraints. Keep him skin-to-skin with you from the moment of birth.
- This is a good time for your first breastfeeding, which tightens the uterus and decreases bleeding.
- All routine infant procedures can be done without removing the baby from your side. Request that measuring, weighing and applying eye medication be delayed for a few hours.
As I sit here just days or hours (who knows?!) away from birth-day, I thought it would be helpful to share some of the ways in which I have been preparing mentally for the upcoming big event. Truth be told, with two small children running around begging to be entertained (school cannot start soon enough!), moments to focus solely on myself are far and few between. Nevertheless, I try and sneak in some time.
Pampering & indulgence. I cannot sing the praises enough for this well-known prescription for pregnancy woes. Whether it be a prenatal massage, pedicure or just a really long shower, treating yourself to something that you might not otherwise do makes you feel good, provides a mental break and recharges your soul to keep pressing forward.
Focused quiet time. I could have called this “meditation,” but for some, that may seem too serious, hokey or intimidating. Take 5-10 minutes to sit quietly by yourself, close your eyes and focus on your growing belly or imagine your upcoming birth. Incorporate some deep, cleansing breaths. If you’re so inclined, run through some imagery scripts you’ve practiced for birth. Find whatever it is that puts you in your happy place and use it.
Read. Not the latest bestseller — read positive birth stories. As you approach your own birth, draw on the experience and positivity found in women who have gone there before. I highly recommend the many birth stories found in the book Ina May’s Guide to Childbirth by Ina May Gaskin. Or, do a Google search on “positive birth stories.” At last check, this yielded more than 3 million results.
Sleep. Another oft-suggested piece of advice that is worth it’s weight in down-filled pillows. All of the sudden, my tiredness level has gone from a 5 to an 8.5. And even with two young children, I’m finding a way to sneak in a nap or two. TV time? Sure thing. Friends asking to take my kids for a few hours? Yes, please. Husband takes care of the kids’ bath and bedtime while I squeeze in an early evening snooze? You bet.
Talk. While some like to draw inward when preparing for a big event, others feel the need to reach out. Hopefully, you have someone in your life who represents a positive birth influence. This could be someone who had an empowering birth experience or perhaps it’s just someone who truly believes in you and does a good job of building your esteem. Make weekly (or more often, if feasible) dates to talk to this special person and share your thoughts and anxiety as you lead up to birth.
What were/are some of the things you did to get “in the zone” for birth?
I cherish the opportunity to be able to write here on Giving Birth with Confidence, so I put a lot of thought into what I want to write about, or what I think women will get the most out of. I originally thought of the idea to write a single post about the six Lamaze Healthy Birth Practices. When Cara suggested making it a six post series, I couldn’t thank her enough for the idea!
We’ll start at the top with “Let labor begin on its own.” With nearly half of all women being induced today, avoiding labor induction it not as easy as some may think.
Lets face it, the last couple weeks of pregnancy are miserable, uncomfortable, and downright painful for some women. One thing women do not always take into consideration at the end of pregnancy are the risks of labor induction and the benefits of allowing labor to start on its own without medical intervention to jump start. There is little information being given to pregnant women about labor induction and the risks associated with the procedure.
Why should women let labor start on its own?
There are a variety of different reasons :
- Pitocin contractions are much stronger than contractions of a normal labor. I can attest to this as I have had pitocin with one labor, and a natural labor with my second child. Pitocin causes much stronger contractions which can have an impact on mom and baby.
- Induction normally requires an IV line, which can make getting comfortable, changing positions, or moving around much more difficult.
- Because induction drugs like pitocin cause longer and stronger contractions, this can can cause the baby to go into fetal distress, which is typically exhibited by heart rate issues.
- When your labor starts on its own, in most cases, you know that your baby is physically ready to be born.
A 2007 research study showed an increased risk for complications in induced labor which included :
- Increased use of vacuum extraction, or forcep-assisted delivery.
- Cesarean section (40% of all inductions will end in a cesarean delivery)
- Increased use or need for an epidural, or medication based pain relief methods.
- Babies born with low birth weight.
- An increase in late pre-term deliveries. (33-36 weeks gestation)
- Longer hospital stays.
- Increased NICU stays for the newborns.
How do you know if labor induction is necessary?
In some cases and conditions during pregnancy, a labor induction may be medically necessary, and it is important you speak with a trusted provider about the risks and benefits to weigh out your own situation.
The American Congress of Obstetricians and Gynecologists (ACOG) formally known as the American College of Obstetricians and Gynecologists has set guidelines for necessary labor induction. The six situations that ACOG has identified and recommended induction for are:
- Ruptured membranes for longer than 12-24 hours. Meaning, if your water has broken, and your labor has not started within 12-24 hours, augmenting of labor may be medically necessary. This does not mean, however, that the baby must be delivered within 12-24 hours of the water breaking. It means that your labor may need to be induced to speed up the process toward birth.
- You have an increase in your blood pressure caused by pregnancy or a condition called preeclampsia.
- Your pregnancy is post term, or overdue. The definition of “overdue” is over 42 weeks gestation.
- You have other health issues such as diabetes or gestational diabetes that could have an impact on the health of your baby.
- Your baby is growing too slowly, or may be suffering from a form of intrauterine growth restriction (IUGR).
- An infection in the uterus.
When is induction not necessary?
In many cases taking place today, induction is not medically necessary. Some of these reasons include:
- A suspected “big baby.” If you and your baby are healthy, an induction for suspected fetal macrosomia (a baby bigger than 8 pounds 12 ounces) is not a reason for an induction. Plus, doctors cannot accurately predict the size of your baby — even with an ultrasound.
- You are uncomfortable.
- Your amniotic fluid is low, but you and your baby are otherwise healthy.
Nearly every single woman I know (myself included!) is uncomfortable toward the end pregnancy! There is a bowling ball sitting on our bladder and grinding into our pelvic bone, for crying out loud! Consider it preparation for the many uncomfortable situations motherhood will bring your way, ha!
What questions should you ask your provider if induction is suggested?
Being a critical thinker, investigator, and overall research into your care is almost always a smart idea, and will help you in the long run. I learned this through my first pregnancy, and it made my second pregnancy and birth much more pleasant. Some sample questions for your provider include:
- Why are you recommending labor induction?
- What are the risks to me and my baby if I wait for labor to begin naturally?
- Can we try more natural methods of induction before using drugs?
- What natural methods of induction do you recommend?
- Are there any research studies for my situation that show how not having an induction can increase the likelihood of an unhealthy outcome?
- Is my induction likely to be successful?
- What is my Bishop Score and how does that impact my success rate?
- Is my cervix ripe? (Your provider can tell you if your cervix is ripe. Women who are induced before their cervix is ripe are much more likely to have cesareans, even if cervical ripening drugs are used.)
One important thing to remember: A due date is not a deadline! Studies have shown that estimated due dates, in many cases, are up to two full weeks incorrect in either direction. Even with advances in ultrasound technology, and other methods for dating a pregnancy, there is still room for error.
Want to know more about letting labor begin on its own? View this short, informational video from Lamaze.
- 1st Healthy Birth Blog Carnival: Let labor begin on its own
- 2nd Healthy Birth Blog Carnival: Walk, move around, and change positions throughout labor
- 3rd Healthy Birth Blog Carnival: Bring a loved one, friend, or doula for continuous support
- 4th Health Birth Blog Carnival: Avoid interventions that are not medically necessary
- 5th Healthy Birth Blog Carnival: Push it real good!
This time, we’re bringing our 6th Blog Carnival to Giving Birth with Confidence. As usual, the bloggers offered up such insightful, thoughtful contributions and I believe yet again that we have one of the best collections on the topic out there on the internet!
Why does keeping moms and babies together after birth matter? Because separating moms and babies is harmful.
Kimmelin Hull at Writing My Way Through Motherhood and Beyond writes:
The research on this issue is crystal clear: babies do better in the first minutes, hours and days, the more time they spend in skin-to-skin contact with their mothers. Their breathing and heart rates remain more stable. Their body temperatures fluctuate less. Ditto for their blood sugar levels. They cry less and they nurse and sleep better, too.”
Danielle at Momotics also reviews the harms of mother-infant separation and suggests that her baby’s 30 hour stay in the NICU for management of blood sugar instability may have been preventable if the hospital had allowed for skin-to-skin contact instead of routine separation. She also points out that skin-to-skin contact exposes newborns to normal bacteria on the mother, which can protect them from getting sick from hospital-acquired bacteria.
All of this just from putting our newborn’s baby against our own? Kristen at Birthing Beautiful Ideas says it simply (and beautifully): Women have superpowers!
Perhaps babies have superpowers, too. The power, that is, to protect their mothers from postpartum depression. Lauren at My Postpartum Voice discusses the amazing health benefits for preterm or low birthweight newborns who experience “Kangaroo Care” — skin-to-skin contact with their mothers in the neonatal intensive care unit. Research also suggests that Kangaroo Care offers protection or relief from postpartum depression. Lauren reports on a study in which no mother developed depression during their Kangaroo Care stay.
Research aside, what about common sense? From the baby’s perspective, the “maternal environment” represents a familiar landscape in which to feel safe and avoid distress (which has well-documented physiological effects.)
Danielle at Informed Parenting describes the moments after birth from the perspective of the baby held skin-to-skin:
Then suddenly he is enveloped in warmth, laying wet and slippery on his mothers chest. He hears it- the beating of his mothers heart. He hears her voice, so clearly for the first time. He knows what he needs and he seeks out that attachment, the physical bond to tie them back together. Little toes flex and dig into his mother soft belly as he wiggles and squirms forward, his little mouth open and questing. The sound of her voice draws him forward. Her arms support him in his journey. In a feat of strength and coordination that is truly amazing he reaches his goal and re-establishes their physical bond. As he suckles her nipple, drops of liquid gold land on his tongue.
Mamapoekie at Authentic Parenting describes a similar scenario, and then contrasts it with the far more common scenario:
You are being pulled away from the one smell and feel you knew to again another entirely different setting. They prick you and it hurts and they rub you down and put stuff in your eyes, it stings even more than the light! You are starting to feel very desperate, very helpless.
From the mother’s perspective, we yearn for closeness with our babies, to take in every detail of their newborn bodies. After all, we’ve worked so hard to grow and give birth to them.
Molly at first the egg writes that while the yearning instinct is deeply primal, yearning is not part of birth when mother and baby are kept together. With gorgeous pictures from her own birth in 1981 and her son’s birth in 2006, Molly shares,
My mother had to yearn for closeness while she fell in love with me. I am so grateful that, twenty-five years later, my newborn and I got to have it.
Kori at Babble.com’s Band On the Diaper Run, who as one-half of the band Mates of State, just hit the road for their summer tour with kids in tow. She shares a powerful testament to the importance of a strong support network to keep her working family together. Her story begins with her yearning for closeness just after her first daughter’s birth:
I shouted across the room, with a strong, primal urge, “Give her to me..I want to hold her..I need to feed her!” Until finally, she was in my arms. I didn’t even recognize my own voice, the words just came out. I needed to have her with me. They really couldn’t ignore me.
And from the family’s perspective, keeping mother and baby together in the hours and days after birth helps them develop a rhythm together and begin to bond and grow as a family. Lauren at Hobo Mama wrote:
Sam, Mikko, and I stayed together from the time we entered our room, three hours prior to the birth, until we all exited as a new family two days later, and it was absolutely the best way I can think of handling it.
boheime at Living Peacefully with Children believes that both birth and bonding are easiest when the mother feels well cared for, and can simply be with her baby to find the right rhythm. She relies on her very willing husband as her primary support for both.
With the birth of each child, he has taken off 2-3 weeks from work in order to cook, clean, and help out however I need him. It’s because of his support that I have been able to focus on getting to know each of our children, establish breastfeeding with them, and not feel as though the entire house has fallen apart.
With so many documented harms from mother-infant separation, not to mention the primal urge for mothers to hold their babies, routine separation of mothers and babies is a mainstay of modern obstetrics, and may give rise to the epidemic of breastfeeding problems.
Sheridan at the Enjoy Birth Blog remarked that her students who have given birth before are among the most surprised that mothers are “allowed” to have their babies with them right after birth. She writes:
It is shocking to me how many moms who are taking my Hypnobabies class for the 3rd or 4th baby and they are amazed that they have the option of keeping the baby on them for an hour or two.
After participating in many hospital births, Carol van der Woude at Aliisa’s Letter also had an awakening about how unnecessary hospital routine are. She describes the first time she saw a home birth:
My wonder at the miracle of birth was renewed. I watched as the baby emerged and the umbilical cord was left intact. The pulsating cord delivered oxygen to the baby as he made the transition to life outside the womb. The baby was placed on the mother’s chest, skin to skin, for warmth. The infant was comforted and stimulated in his mother’s arms.
Lamaze educator Nicole VanWoudenberg who blogs at A Little Bit of This and a Little Bit of That was in fact one of those women who didn’t know about the importance of immediate and close contact after birth until after she had had several babies. She describes her first and last births. After her first birth:
They cleaned her up, weighed and measured her, gave her the vitamin K shot, the eye ointment and whatever else, I was stitched up and approximately 45 minutes later, I got my burrito-baby. Seriously, she was diapered and all wrapped up in towels!! I did not know better, and left her like that while “bonding” with her. Did I have breastfeeding issues? Absolutely. Are the two connected? Absolutely.
For her fourth baby, born at home, she recalls:
I didn’t wait 45 minutes to receive my son. I birthed him and brought him up to my chest, for skin to skin snuggling myself. And there he stayed while we marveled at the wonder of birth, and his appearance! I only let him go while I got out of the pool to birth my placenta. As soon as I was settled on the couch, he was back in my arms, skin to skin – starting to nurse. He breastfed the best, and the longest of all four of my children. Are these two things connected? Absolutely.
Molly at Talk Birth discusses the Birth-Breastfeeding Continuum in her post. She writes:
New mothers, and those who help them, are often left wondering, “Where did breastfeeding go wrong?” All too often the answer is, “during labor and birth.” Interventions during the birthing process are an often overlooked answer to the mystery of how breastfeeding becomes derailed.
Kmom at The Well Rounded Mama reviewed the research surrounding “Baby-Friendly” practices, points to a study that reported only 8% of babies actually experience the six Baby-Friendly practices, and then examines breastfeeding issues in women of size. She writes:
The role of aggressive birth interventions in the lower rate of breastfeeding among obese women typically goes conveniently unexamined in the research. Breastfeeding failure is blamed solely on fatness, when in fact, the high level of interventions in obese pregnancies and births may also play a significant role.
Laura Keegan, author of Breastfeeding with Comfort and Joy writes about the birth stories of women she works with in her practice. “A common theme in all of these stories has been the shock from the denial of contact with their babies or the importance of having that yearned-for close contact at birth,” and asks, “How many breastfeeding problems could be prevented if we facilitated this close contact at birth?”
So, why are women and babies separated? Usually for routine care. But it doesn’t have to be that way.
Sheridan at the Enjoy Birth Blog is one of several bloggers who remind us that nurses can do everything they need to do for a healthy baby with the baby in the mother’s arms. She writes, “I understand that nurses have jobs they need to get done, checklists to mark off, but this time is so precious and these routines can wait!”
Fortunately, a new video has just become available to train hospital staff to incorporate skin-to-skin contact after both vaginal and cesarean births. Jeannette Crenshaw reviewed it on Science & Sensibility.
Both sections begin with health professionals teaching pregnant women about immediate skin to skin care prenatally, and on admission to the hospital—which “sets the stage” for immediate skin to skin contact as a normal part of the birth process. After the vaginal birth, the clinician immediately places the baby on mom’s abdomen. After the cesarean birth, the nurse immediately places the baby on mom’s chest, above the sterile field and drapes, as the doctor continues the surgery and the anesthesiologist monitors the mother. The baby’s father is at mom’s side in both segments…Both sections show competent nurses assessing the newborn, providing care, and supporting the mother and baby as the baby moves through the 9 stages of skin to skin.
Also on Science & Sensibility, I discuss a new vital sign for nurses to document after birth, the duration of skin-to-skin contact. I argue that this data may help hospitals comply with new Joint Commission perinatal quality standards.
If hospitals are serious about improving their exclusive breastfeeding rates, they should get serious about measuring the duration of skin-to-skin care. A new study in the Journal of Human Lactation demonstrates a strong dose-response relationship between skin-to-skin care and exclusive breastfeeding at hospital discharge.
The Nurse Blogger at At Your Cervix looks at how weighing babies can be done more humanely, when the time comes (after skin-to-skin contact and breastfeeding). She vows to start weighing newborns in the prone position on soft layers of blankets and states the expected outcome of her new approach:
newborns in the prone position while being weighed, lying on soft blankets, will be more content, with decreased startle reflex, as evidenced by reduced or absent crying.
Let us know how it goes, At Your Cervix! Or better yet, publish your results!
Dionna at Code Name Mama points out that circumcision is another common reason mother and babies can be separated, and is not medically necessary.
The reason that American medical associations (and the vast majority of medical associations worldwide) do not recommend routine infant circumcision is because it is not medically necessary. And as the Lamaze Healthy Birth Practice Paper #6 details, “experts agree that unless a medical reason exists, healthy mothers and babies shouldn’t be separated after birth or during the early days following birth.” Consequently, unless there is a medical reason to circumcise your newborn son, it is inadvisable to agree to this unnecessary medical procedure.
Cesarean surgery is another major contributor to mother-infant separation after birth. But if this Blog Carnival has achieved anything, it has been to get the blogosphere talking about the fact that skin-to-skin contact is possible immediately after cesarean surgery. A powerful video emerged and was passed around in several of the bloggers’ contributions and on Facebook and Twitter:
Kathy at Woman to Woman Childbirth Education asks, “If you had a C-section, were you able to have your baby put skin-to-skin in the operating room? Did you even know that was a possibility?”
CPN at Cesarean Parent’s Blog got skin-to-skin contact with her baby after her cesarean without even asking for it, and didn’t know what a gift it was until after learning that this is not standard practice. She compares her experience to the typical experience in “reality” TV shows about birth, noting that OR staff do not just separate babies from their mothers for assessments, but for “silly things…, such as having foot prints taken, diapering, and tight swaddling, all before baby gets to meet their mom.”
Birthing Goddess also wrote about the care of mothers and babies after cesarean birth, including the importance of a “Baby Moon” and plenty of support during the longer recovery.
As much as I wish every woman to experience a truly undisturbed and gentle birth, I also know that as of today, close to one out of three women in North America gives birth in the OR. It is up to us to demand things to change for the sake of our children, up to us to bring back a more humane and healthy perspective on birth. Hospital policies can be changed, but the consequences of risky practices for our children can’t. As a community, we can also support our fellow moms who have gone through a difficult birth, help them adjust to motherhood and their new babies, without judging, with compassion and care.
All of these bloggers agreed that, until our system changes, women who want skin-to-skin contact with their babies after cesarean birth need to speak up and ask for it. At Stork Stories…Birth & Breastfeeding, the OB nurse/change agent author writes about how she made immediate skin-to-skin contact happen in the operating room after a mother gave birth by cesarean:
“Give him to me, give him to me! He has to be ON me! You just took him OUT of me, now he HAS TO BE ON ME!” She was literally trying to sit up. Anesthesia was drawing up meds for her (that was his answer). I said “OK here he comes!” So I didn’t ask anyone’s permission this time….. just held that naked baby in one hand, snapped open her gown with the other and helped him move in. I asked for a warm blanket and looked up to see the other nurse and doctor staring at me. I said “Seriously… she’s exactly right, he does belong ON her!”
A system that pits babies’ needs against those of mothers give poor care to both.
Molly at the Citizens for Midwifery Blog muses about the phrase Maternal-Fetal Conflict and discusses the need for terminology that accepts mothers and babies as interdependent:
I think it is fitting to remember that mother and baby dyads are NOT independent of each other. I have written before about the concept of mamatoto–or, motherbaby–the idea that mother and baby are a single psychobiological organism whose needs are in harmony (what’s good for one is good for the other).
The blogger at Thoughtful Birth discusses bonding as an act that involves both the primitive brain and the rational brain, and happens easiest when the birth and postpartum settings facilitate the woman’s integration of the two.
Certainly the ability to override the physical is an amazing skill that allows a woman to overcome a traumatic birth to bond with her baby, or even to bond with an adopted baby. But when we take it for granted that a mother will use her powers of reason to bond with her baby no matter how much we abuse their relationship, we ignore the way the emotional, physical, and spiritual sides of ourselves participate in the birth and bonding process. Pregnancy and labor involve neurochemical and physical changes that make it easier for us to be mothers, and that emotional and hormonal dance does not end with labor.
Michelle at The Parenting Vortex suggests that what happens in the moments right after birth remains a mystery to many pregnant women, but these moments represent a major life transformation for both the woman and the baby, who now become separate but interdependent beings. She writes:
Reforming birth practices in countries where birth has become a highly medicalized event means recognizing birth as a multi-dimensional, life changing event for all members of the family. When birth is recognized and honoured as an emotional, spiritual, transformational AND biological process, then the importance of keeping a new baby and mother together will become more apparent.
Last weekend, when discussing childbirth among women at my husband’s firehouse, mostly girlfriends and wives, I was shocked when most of the women discussed wanting a natural birth. It was a pleasant change—one that I have been working so hard toward!
I started doing some research after my discussion and came across a quote on natural childbirth in The Official Lamaze Guide that really struck a chord:
“In spite of evidence, U.S. maternity care continues to sabotage normal birth rather than support it. In 2002, the Listening to Mothers survey learned that among nearly 1,600 new mothers across the U.S., 44% had labor induced, 71% did not move freely during labor, 93% had electronic fetal monitoring, 86% had intravenous lines, 74% gave birth on their backs, and almost 50% of their babies spent the first hours after birth with hospital staff. Only 1% of the women experienced all six care practices that promote normal birth, and none of these women gave birth in a hospital.”
Lots of alarming statistics in there. This first-ever national survey of U.S. women’s childbearing experiences gives us a look into the way women are giving birth today in spite of evidence showing that these practices are outdated, unfounded, or harmful rather than helpful. Let’s take a closer look into each of the statistics listed and learn ways you can try to avoid becoming “one of the statistics” when birthing in a hospital:
44% of women had their labor induced. (!!)
That is a huge number for labor induction, especially since labor should only be induced for necessary medical reasons. Letting labor begin on its own is key for a healthy birth experience for women. It is also the way our bodies are meant to work in the natural stages of pregnancy. Labor induction is not a procedure that is risk free—it can increase the risk of premature birth, cesarean section, abnormal fetal heart rate, fetal distress, shoulder dystocia, and increase the risk of your baby needing to be admitted to the NICU.
To reduce the incidence of unnecessary induction, find a provider with a low labor induction rate, and research the policies of the facility where you plan to give birth. This may be tricky, as many hospitals do not publicly advertise their rate of induction, cesarean surgery or other interventions. You might be lucky enough to find it on your hospital’s Web site. Or perhaps your hospital’s rating and feedback is listed on The Birth Survey. If not, take a hospital tour and be sure to ask LOTS of questions. Knowing information ahead of time gives you the opportunity to change your place of birth if you’re uncomfortable with their practices.
71% of women did not move freely during labor.
Being confined to a bed while laboring is not ideal by any means. Not only does it decrease the size of your pelvis, but it also can cause lowered blood pressure and fetal distress. Better positions to give birth in and labor in include:
- Hands and Knees
- Side Lying
- Knees to Chest
- The Sitting Position
93% had continuous electronic fetal monitoring.
This is a high number despite the fact that several studies have shown no improved outcome to mothers and babies with continuous electronic fetal monitoring. Also, recently, there has been a number of controversial articles about fetal monitoring and how medical professionals are reading the fetal heart tones. Many think that the over-analyzing of small decelerations in fetal heart tones is leading to a higher rate of unnecessary cesarean births. There are situations where monitoring may be a beneficial procedure, but in most birth situations, intermittent monitoring is safe.
86% had IV Lines.
Having an IV line in place in a laboring mother means that hospital staff has easier access to administering fluid and medications if needed. However, being attached to an IV line also restricts a laboring mother’s movement, interfering with her ability to change positions. Something that may help is requesting a “hep lock” in place of an IV line. A hep lock is a device that is inserted into a mother’s hand or arm so it is ready in case an IV line needs to be hooked up. Also, drinking and eating during labor will help to eliminate the risk of needing any kind of IV fluids during labor.
74% gave birth on their backs.
Laboring and giving birth on your back is pretty much the worst position. I recently wrote about this in two posts, Positions You Should Be Giving Birth In Part 1 and Part 2. Decreased pelvis size, blood pressure complications, lack of gravity to help with the birth itself are all huge factors in the supine (back-lying) position.
50% of babies spent the first hours of life with hospital staff. (!!)
Many mothers are not familiar with the benefits of skin-to-skin contact with your baby after they are born. The first few hours are critical for mother-infant bonding. Unless your baby is experiencing complications or needs NICU care, babies should be kept with their mother in the first few hours — baths, weighing and measuring, etc. can all wait. Babies who have skin-to-skin contact after birth:
- Cry less
- Have more stable temperatures
- Have more stable blood sugars (with the lack of skin-to-skin contact with my second son, because of my cesarean, made a change in his blood sugar which resulted in a 30-hour NICU stay)
- Breastfeed sooner, longer, and more easily
- Are exposed to normal bacteria on the mother, which can protect them from getting sick from unhealthy, or other types of bacteria, especially if birthing in a hospital
- Have lower levels of stress hormones
Only 1% of these women experiences all 6 Lamaze Healthy Birth Practices.
Having a birth plan, and being an advocate for yourself and what you want for your birth experience in a hospital is key here. Communicate with your care provider and create a written birth plan to share with your care provider as well as the hospital staff when you arrive for baby’s birth. Make sure your partner knows about your birth preferences so he/she is comfortable talking with and reiterating to your provider and hospital staff on the big day.
When it comes to birthing in a hospital, being an empowered patient is critical to having a healthy and happy birth experience. Read, do research, take a Lamaze class, interview care providers and hospital settings — learn all that you can to be informed and make the best choices for you and your baby.
Photo from Inexplicable Ways.
Both men and women in less-industrialized nations used to, and in some places still do, squat on a daily basis in their jobs, to use the bathroom and as a means of waiting, eating or resting. We Westerners do not squat. Unless we’re trying to shape up for swimsuit season, and even then, the practice is usually short-lived.
Why is this important, you ask? Katy Bowman, MS, a biomechanical scientist and author of the blog Katy Says, describes how repeated squatting changes the physical structure of our body to prepare it for birth:
“The squatting action, preferably done since birth, creates a wide pelvic outlet (the space where the baby passes out). Starting from childhood, squatting to bathroom aids in the ideal ossification (bone shaping) of both the pelvic bones and the sacrum. The wider the outlet, the safer and easier the baby passes through. Squatting also lengthens the muscles of the glutes, hamstrings, quadriceps, calves, and psoas. When these muscles are tight, they can actually reduce the movement of the pelvic bones and increase stress and pressure on the baby (and mama) during delivery. Back then and today still, the populations of people who move a lot (and I don’t mean exercise an hour per day) have better, easier births.”
Of course, there’s no way to dial back to childhood and change our ability to squat. You’re either born into a culture that squats or not. There are ways, however, to incorporate squats into your pregnancy fitness routine (What? You don’t have a fitness routine? Well, now is the time to get started!) to reap the benefits during birth. Katy advises:
“The squatting action, preferably done since birth, creates a wide pelvic outlet (the space where the baby passes out). Starting from childhood, squatting to bathroom aids in the ideal ossification (bone shaping) of both the pelvic bones and the sacrum. The wider the outlet, the safer and easier the baby passes through. Squatting also lengthens the muscles of the glutes, hamstrings, quadriceps, calves, and psoas. When these muscles are tight, they can actually reduce the movement of the pelvic bones and increase stress and pressure on the baby (and mama) during delivery. Back then and today still, the populations of people who move a lot (and I don’t mean exercise an hour per day) have better, easier births.
1. If you aren’t walking at all, begin with one mile, increasing your distance by 1/2 a mile every two to four weeks, until you hit 5-6 miles per day. Doing all your mileage at once will help you with endurance, but if you are feeling tired or sore, break your distance up over the course of a day.
2. Start your squatting program NOW. Hamstring and calf tension (both muscle groups down the back of the legs) tuck the tailbone and pelvis under, instantly impacting the size of your delivery space. FUNNY STORY: I made the mistake of trying to teach my pregnant sister this exercise while she while she was giving birth. I’m not going to write down what she said here. ”
Check out the rest of Katy’s blog post for more background information on squatting and crucial tips on how to squat correctly – yes, there is a wrong way to do it. Want to know another awesome thing about squats? They protect your pelvic floor… but that’s a discussion for another day!
Photo by Katy Says.