Stop Birth Information Overload by Getting Back to Basics

With the wonderful world wide web available to us 24/7, the deluge of information we encounter (and seek out) during pregnancy can feel a lot like drowning. So many choices, so much to learn, so much to digest. There are times when everything seems to come into question — from what you eat during pregnancy to whether you should create a birth plan (the answer to that last one is yes, you should write a birth plan!). When you cut out the background noise and get back to the basic foundation of a healthy birth, you can better focus your energy on working to achieve the goals that will have the most impact on your birth experience and outcome.

The Lamaze Healthy Birth Practices are easy-to-follow measures that, when used together, add up to good outcomes for birth. Click through to each one for a more complete description along with an informative, short video. To give yourself the best chance of achieving these goals, find out if your care provider supports the practices. 

 

Did your birth follow some or all of the Lamaze Healthy Birth Practices? Which ones made the most impact? Which ones were the most difficult to achieve?

What is a Safe and Healthy Birth?

Adapted from The Official Lamaze Guide: Giving Birth with Confidence.

We are just one generation away from the days when a girl grew up on a farm watching the sheep and pigs give birth. Anyone who saw that year after year knew that giving birth was a natural process, a process that could be trusted. —Ina May Gaskin

The mission of Lamaze International is to promote, support and protect natural, safe and healthy birth through education and advocacy through the dedicated efforts of childbirth educators, providers and parents. A normal birth is one that unfolds naturally, free of unnecessary interventions. A woman’s body is beautifully designed to grow, birth and nurture a baby. To work properly, this elegant design requires patience and trust.

An evolving body of research repeatedly shows the danger of interfering without a valid reason in the natural processes of pregnancy, birth, and breastfeeding. Any intervention, no matter how simple it seems, may disrupt the normal process and create problems that, in turn, must be managed with more interventions. All interventions have side effects that can be risky for both mothers and babies. In light of such evidence, the World Health Organization (WHO), a leader in the international public health effort to promote normal birth, says that maternity care should aim to achieve a healthy mother and child with the least intervention safely possible.

In the United States, reality falls far short of this goal. Most births in the U.S. today are interrupted by procedures designed to start, maintain, and finish labor according to an arbitrary schedule. Few women experience their pregnant bodies unfolding and opening in their own time, in their own way. Ironically, normal birth isn’t the norm for American women.

Practices That Support Normal Birth

Research reveals not only the dangers of interfering in the natural process of birth, but also maternity care practices that help keep birth normal. The WHO identifies four care practices, and Lamaze adds two more (marked with asterisks: *). These practices ensure the best care for birthing women around the world.

  1. Let Labor begin on its own.
  2. Walk, move around, and change position throughout labor.*
  3. Bring a loved one, friend, or doula for continuous support.
  4. Avoid interventions that are not medically indicated.*
  5. Avoid giving birth on your back, and follow your body’s urges to push.
  6. Keep mother and baby together – its best for mother, baby, and breastfeeding.

Additional important information:

Lamaze Care Practices: What They Are & How They Can Help

Common sense tells us and research confirms that the Six Lamaze Healthy Birth Practices featured in these video clips and print materials are tried-and-true ways to make birth as safe and healthy as possible. But don’t take our word for it — click through to watch each of the short clips to learn more about safe & healthy birth and how best to achieve it, no matter where you give birth.

Introduction: Safe and Healthy Birth Practice - Download PDF

#1: Let Labor Begin on Its Own - Download PDF

#2: Walk, Move & Change Positions - Download PDF

#3: Have Continuous Support - Download PDF

#4: Avoid Unnecessary Interventions - Download PDF

#5: Get Upright & Follow Urges to Push - Download PDF

#6: Keep Your Baby With You - Download PDF

Download the complete booklet here.

Lamaze International partnered with InJoy Productions and their new Mother’s Advocate program to provide you with this free, evidence-based educational material.

Spot the Best Care

Knowing how to spot good maternity care is the key to getting it.

There are countless places on the Internet with information about being pregnant – this is probably not the first website you’ve visited! With so much information about pregnancy and birth available, how do you separate fact from fiction?

Lamaze International has simplified the scientific facts into six healthy birth practices to make it easy for you to choose the safest care, understand your options, and steer clear of care practices or unnecessary interventions that may not be the best for you and your baby.

  • Let Labor Begin on Its Own: The research around induction of labor has become so convincing that many hospitals are clamping down on inductions that don’t have a strong, compelling medical reason. But not everyone has caught up with the research yet. Be wary of induction that’s suggested because your baby is “measuring big,” you’re a few days past your due date, or your mom wants to schedule her travel. For the best chance at a healthy baby and healthy mom, it’s best to let your baby and your body tell you when it’s time.
  • Walk, Move Around and Change Positions Throughout Labor: In childbirth, gravity is your friend. It helps to move your baby down and makes it easier for your baby to fit and rotate. Movement is also a natural and active way to manage labor pain.
  • Bring a Loved One, Friend or Doula for Continuous Support: Doctors, midwives and nurses work hard to meet the needs of their patients. But few women find a care provider who will stay by their side throughout labor. A continuous support person, such as your partner or a doula, can help you feel safer and more comfortable, and help your labor progress.

  • Avoid Unnecessary InterventionsMany interventions may seem like they would make childbirth easier, but they can have unintended consequences and can make birth more difficult and less safe. Knowing the difference between something that’s medically necessary and something that’s done purely out of “routine” can help you feel equipped to partner with your care provider in making important decisions.
  • Avoid Giving Birth on Your Back, and Follow Your Body’s Urges to Push: The last birth you saw was probably a Hollywood portrayal of labor, with a woman giving birth on her back in a hospital bed. But, did you know that you don’t have to be on your back when you give birth and wait for your care provider to tell you when to push? During pushing, ease your baby down and out when and how your body tells you to and choose the positions for birth that are the most comfortable for you. By responding to what you are feeling, you will make birth easier and safer for you and your baby.
  • Keep Mother and Baby Together – It’s Best for Mother, Baby and Breastfeeding: During pregnancy, you and your little one were inseparable. Continuing that important connection after birth is best for you and your healthy baby. Skin-to-skin contact helps your healthy baby stay warm, cry less, and be more likely to breastfeed. In fact, interrupting, delaying, or limiting the time that you spend together may have a harmful effect on your relationship and on successful breastfeeding.

Historical Perspectives: Lamaze Healthy Birth Practice 2 and 4

“Walk, Move Around and Change Positions throughout Labor” and “Avoid Interventions that Are not Medically Necessary”


This month in our Historical Perspectives series, we’re focusing on Healthy Birth Practices 2 and 4.  Encouraging mothers to use movement throughout labor (#2) goes hand in hand with avoiding routine medical interventions (#4) that interfere with the mother’s ability to get out of bed, so we’ll consider them together.

Why is movement so important for labor?  Labor is movement – the baby is descending and rotating her way through the birth canal, the uterus is contracting, the cervix is dilating.  When mothers add their own movement to the baby’s, they can effectively work together to help labor progress.  As Lamaze Healthy Birth Practice 2 notes, movement and upright positioning “is the best way for you to use gravity to help your baby come down and to increase the size and shape of your pelvis.  It allows you to respond to pain in an active way, and it may speed up the labor process.”[1]

Movement is a natural response to physical discomfort.  If you’re carrying something and it hurts your arms, you shift its position.  We don’t just “take it” – we move!  So why, so often, are women prevented from having freedom of movement during labor?

Healthy Birth Practice 4 gives us part of the answer.  Many times, routine interventions like IVs, continuous External Fetal Monitoring (EFM), and continuous blood pressure monitoring make it difficult for mothers to labor out of bed.  Some nurses are more accepting than others of a mother laboring on a ball or in a rocking chair while continuous monitoring is taking place, but walking any distance would be impossible.

The other part of the answer can be found by taking a look at our birth culture.  When did these kinds of interventions become “routine?”  And when did labor move into the “labor bed?”  Let’s take a look back and see what we find.

Where We’ve Been

If you didn’t watch the video presentation of the history of birth last month, I highly recommend visiting the Mothers’ Advocate channel on YouTube and watching the video clips “Images of European Childbirth from the 1500s” and “Changes in Birth Practices”.[2]  Even before the 20th century, the differences between midwife-attended births and physician-attended births are clear.  While midwife-attended births happen with the mother upright and out of bed, those with physicians feature the mother lying in bed.

Once birth moved to the hospital at the turn of the 20th century and “twilight sleep” for labor and birth became the all the rage, there was no other labor position for mothers than strapped (literally, in most cases) to their labor beds.

The use of “twilight sleep” was eventually phased out, but the medical management of birth continued, and new interventions in the birth process became common.  In 1958, Dr. Edward Hon reported the first uses of external fetal monitoring, and medical colleagues from around the world soon began using the technology to detect fetal distress in high-risk pregnancies.  However, “[b]y 1978, it was estimated that fetal monitoring was in routine use in over half of labors.“[3]  Once EFM became the norm, the mother’s ability to move was restricted.

Problematically, EFM became routine without being proven to be helpful or safe.[4]  In fact, the technology rapidly became used more and more for low-risk mothers: the percentage of low-risk mothers monitored in 1988 was 76.3%, compared to just 62.2% of high-risk mothers.[5]  According to the Listening to Mothers II Survey, completed in 2006, 76% of mothers were montitored continuously during labor and 80% reported having an IV.[6]  So, interventions originally intended for high-risk women only are now routine, without any benefit to mothers or babies.

When considering freedom of movement during labor, it’s important also to mention the development of the epidural.  Dr. John Bonica, who worked with pain management for wounded soldiers, developed the epidural block technique in the 1940s.  His wife Emma, who nearly died from complications from ether anesthesia during the birth of their first child, was the first to receive an epidural during their second child’s birth.[7]  The popularity of the epidural has surged in recent years, and it is now the most frequently used form of pharmacological pain relief.

Women using epidurals can’t put weight on their feet, and because epidurals require continuous EFM, an IV, a urinary catheter, and maternal blood pressure and heart rate monitoring, their freedom of movement is severely restricted.  In order to preserve the position changes that help labor for the mother using an epidural, Penny Simkin developed a series of rotations called “the Rollover”.[8]  So, epidural use, while it does restrict freedom of movement, shouldn’t mean that the mother doesn’t move at all.

Where Do We Go from Here?

In 2009, ACOG revised its guidelines on continuous EFM.  George A. Macones, MD, who headed the revision, points out that

[a]lthough EFM is the most common obstetric procedure today, unfortunately it hasn’t reduced perinatal mortality or the risk of cerebral palsy. In fact, the rate of cerebral palsy has essentially remained the same since World War II despite fetal monitoring and all of our advancements in treatments and interventions.[9]

Lamaze’s Healthy Birth Practice 4 is aimed at reducing the number of women who undergo unnecessary interventions in the birth process, which often lead to complications that require further intervention.

According to the Listening to Mothers II Survey, epidurals are used by 76% of mothers (or higher, depending on the hospital).[10]  As women continue to use pharmacological pain relief options (like the epidural), they need to know what techniques they can use to help their labor progress.  Lamaze’s Healthy Birth Practice 2 encourages women to understand how freedom of movement helps the progress of birth, which can then be applied to their unique birth experiences.

 


[1] Healthy Birth Practice #2.  Reference to P. Simkin & R. Ancheta, The Labor Progress Handbook (2nd ed.). Malden,MA: Blackwell Science, 2005.

[2] Mother’s Advocate YouTube Channel: http://www.youtube.com/user/MothersAdvocate.

[3] Freeman, Roger K., Thomas J. Garite, Michael P. Nageotte.  Fetal Heart Rate Monitoring.  3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2003.  Available on Google Books.

[4] Ibid.

[5] Ward, Joyce.  “The Evolution of External Fetal Monitoring from Use in High-Risk Women to Routine Practice: A Critical Historical Perspective.”  1999.  Available at http://www.instituteofmidwifery.org/MSFinalProj.nsf/a9ee58d7a82396768525684f0056be8d/1e5626880167e04

0852569fc00610cf3?OpenDocument

[6] Listening to Mothers II Survey.  Available at www.childbirthconnection.com.

[7] http://painresearch.utah.edu/crc/CRCpage/Bonica.html

[8] Simkin, Penny.  The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions.  3rd Edition.  Harvard: The Harvard Common Press, 2008.  284.

[9] http://www.acog.org/from_home/publications/press_releases/nr06-22-09-2.cfm

[10] Available at www.childbirthconnection.com.

Historical Perspectives: Lamaze Healthy Birth Practice #1

 “Let Labor Begin on Its Own”

By Shannon Valenzuela, PhD, LCCE

The purpose of this series is to explore the historical context behind each of the Lamaze Six Healthy Birth Practices in order to understand where we’ve been, where we are, and where we need to go from here.

This week, we’re focusing on Healthy Birth Practice #1: Let Labor Begin on Its Own, which recommends that labor induction should be avoided unless there is a medical indication.  According to ACOG’s 2005 guidelines, there are six medical reasons for labor induction:

  • your water has broken and labor has not begun
  • your pregnancy is postterm (more than 42 weeks)
  • you have high blood pressure caused by your pregnancy
  • you have health problems, such as diabetes, that could affect your baby
  • you have an infection in the uterus; your baby is growing too slowly[1]

In its 2009 revision of the Induction Practice Bulletin, ACOG indicated that there are possible nonmedical indicators which might make induction prudent, though not necessary.[2]  According to both ACOG and the Milbank Report, the national average induction rate is 22%, a figure that leads ACOG to advocate for a reduction in unnecessary elective inductions.[3]

So this is where we are now: needing to reduce the overuse of the practice of labor induction in order to improve outcomes for both mother and baby.  But how did we get to this point, and where do we go from here?

 

Where We’ve Been

The knowledge of certain practices (such as rupture of membranes or nipple stimulation) or substances (herbs like blue cohosh) that could induce a woman to go into labor have been known for centuries.  In fact, descriptions of ways to “mechanically” open the cervix can be found in both ancient and medieval medical writings.[4]  The idea of getting labor to start before it begins on its own is nothing new, but it was not until after birth moved to the hospital at the beginning of the 20th century that the practice of labor induction became more common.

The use of Twilight Sleep (a combination of the drugs scopolamine and morphine) in the early 20th century necessitated that women be hospitalized and tied down because they were either conscious but unaware of their surroundings or completely unconscious.  This in turn required that doctors find ways to intervene and manage the processes of labor and birth.[5]  For an amazing video presentation of this period in the history of birth, see the video clip “Changes in Birth Practices,” on the Mothers’ Advocate channel on YouTube.[6]

In 1906, Henry Hallet Dale discovered that pituitary extract could induce contractions, and in 1909 this extract was first used to induce labor.  By 1913, it was rapidly gaining acceptance by the obstetrical community.[7]  Because the outcomes were unpredictable and, in many cases, highly dangerous for mothers and babies, pituitary extract fell out of favor after a few years.  When the structure of oxytocin was finally mapped in 1953, it made the production of a synthetic version possible, and this has been in common use since 1955.[8]

It was during the heyday of the rise of this new birth culture – with its new technologies for the medical management of childbirth and the unconscious or barely conscious birthing mother – that Grantly Dick-Read released Childbirth without Fear (1944) and Ferdinand Lamaze released Painless Childbirth (1946).  These books and organizations like Lamaze® International (formerly ASPO/Lamaze, founded in 1960), emphasized the need to educate women about their bodies and the process of birth.  And, as birth technology evolves, the need for education grows.

Even with the advent of synthetic oxytocin (Pitocin), the rates of labor induction were still fairly low, until recently.  In 1990, for example, the induction rate was only 10% — by 2006, it was 22%.  This jump correlates with the similar rise in the rate of cesarean birth, which is now over 30%.[9]  Looking at these statistics, we have to wonder why there has been such a significant jump over the last two decades.  What’s happening in our birth culture?

 

Where Do We Go from Here?

As we look back over the history of birth, we can see a definite ebb and flow in the use of technology.  For example, after the discovery of x-rays in 1895, practitioners used them to monitor fetal well-being.  The dangers of radiation exposure weren’t discovered until the 1950s, at which point practitioners reduced their use.  When ultrasound was discovered in 1958, it replaced x-rays as the diagnostic tool of choice.[10]  So, the enthusiastic adoption of technological advances often seems to lead to their overuse, only to be scaled back as research shows where those technologies are most beneficial.

The problem, in short, isn’t necessarily the technology – the problem is the application of the technology to situations where it isn’t warranted.  With ACOG’s recent revision of its induction guidelines, the buzz in the media on the dangers of late preterm birth, and the growing number of studies revealing that inducing for non-medical reasons doesn’t contribute to best outcomes, perhaps we’re witnessing the beginning of the ebb in elective labor induction.[11]

Lamaze’s Healthy Birth Practice #1 is part of this movement toward equilibrium, boosting awareness and encouraging mothers to demand the best care for themselves and their babies.

 


[1] Lamaze Healthy Birth Practice #1.  http://www.lamaze.org/Portals/0/carepractices/CarePractice1.pdf

[2] ACOG Press Release.  http://www.acog.org/from_home/publications/press_releases/nr07-21-09.cfm

[3] Milbank Report.  http://childbirthconnection.org/pdfs/State-Level-Maternity-Care-Statistics.pdf.

[4] Sanchez-Ramos, L. and A. Kaunitz. “Induction of Labor”.  http://www.glowm.com/index.html?p=glowm.cml/section_view&articleid=130.

[5] “Obstetrics and Midwifery.” Encyclopedia of Children and Childhoodwww.faqs.org/childhood/Me-Pa/obstetrics-and-midwifery.html.  Also see “Conception and Birth.” Encyclopedia of Children and Childhood.  http://www.faqs.org/childhood/Ch-Co/Conception-and-Birth.html.

[6] Mother’s Advocate YouTube Channel: http://www.youtube.com/user/MothersAdvocate.

[7] Sanchez-Ramos and Kaunitz.

[8] Ibid.

[9] O’Callaghan, Tiffany. “Too Many C-Sections: Docs Rethink Induced Labor.” TIME Health Online.  August 2, 2010.  http://www.time.com/time/health/article/0,8599,2007754,00.html.

[10] “Conception and Birth.”

[11] For an example of media coverage, see “Hospital Bans Elective C-Sections and Labor Inductions.” Parenting.com. July 12, 2011. http://www.parenting.com/blogs/show-and-tell/melanie-parentingcom/hospital-bans-elective-c-sections-and-labor-inductions.  For more information on the studies on labor induction, see Childbirth Connection (www.childbirthconnection.org).  For information on the campaign against late preterm birth, see the March of Dimes (www.marchofdimes.com).

Shannon Valenzuela is a certified as a Lamaze Certified Childbirth Educator and has also trained with DONA International as a birth doula. She is the mother of four boys and a baby girl, who provide her with energy and inspiration. Prior to becoming a childbirth educator, Shannon taught English Literature at the college and high school level. She graduated in 2000 Summa Cum Laude with a B.A. from the University of Dallas, and received her M.A. (2004) and Ph.D. (2007) in English Literature from the University of Notre Dame.  

Mama and the Media Part 3: Surfing the Net During Pregnancy

In this series of posts, we’ll take a look at one of the most powerful influences on your life as a parent–the media.  I’ll give you my doula/childbirth educator/mama scoop on what’s most likely to build your confidence and what’s just going to freak you out!

Without a doubt, most mamas today look to the internet for guidance.  A Google search for “pregnancy” yields about 314 million results.  Type in “birth” and you’re looking at about 696 million!  Think it might be difficult to sort through what is worthy of a bookmark and what deserves a spot in your trash? Oh, yes!  This is by no means a complete list, but here’s a few that are definitely worth your click:

lamaze.org –This is NOT a shameless plug.  Lamaze’s website is a fabulous resource for expectant families to find evidence-based information, videos of Lamaze’s “Healthy Birth Practices,” a directory of childbirth educators, a community of support, and my personal favorite, the weekly email newsletter, Building Your Confidence Week-by-Week. It is hands-down the best one out there, giving you real, useful advice, not just telling you what item of produce your baby most resembles each week.

childbirthconnection.org – I am a firm believer that if you aren’t informed about your options, then you don’t have any. Childbirth Connection’s slogan is “Helping Women and Health Professionals Make Informed Maternity Care Decisions,” and their website definitely delivers.  It is chock-full of information about medical procedures, interventions, and serious scientific evidence in a very user-friendly format.  The icing on the cake is the Listening to Mothers survey, a compilation of data from thousands of births coming from the mamas themselves. It’s an invaluable tool in making informed decisions and also in transforming maternity care to make it safer and healthier for mamas and babies.

mothering.com – From pregnancy to puberty, you will find it here!  This site is a perfect combination of solid information and interactive community.  Mothering.com covers pregnancy, breastfeeding, parenting, and more, with a natural approach that’s not “hippy,” it’s healthy. The MotheringDotCommunity message board has dozens of groups–you’re guaranteed to find a least one where you belong.

babyfit.com – A healthy mama is a happy mama, but it’s not always easy.  This site offers nutrition and exercise advice from preconception, pregnancy, postpartum, and beyond complete with online support groups, personalized nutrition and fitness trackers, and several great email newsletters.  The best part?  It’s all free!

breastfeedinginc.ca (formerly drjacknewman.com) – If you are breastfeeding, you NEED to bookmark this site.  Dr. Jack Newman is North America’s lactation guru.  His website offers incredible information about why and how to breastfeed, dozens of articles to troubleshoot common problems, and videos so you can actually SEE how to nurse your little one comfortably and successfully.  Even more amazing is that if you need extra help, you can contact the good doctor himself, and he usually responds within 24 hours.

Happy browsing, Mamas!

Six Tips for Gentle but Effective Hospital Negotiations

By Jessica English, CD(DONA), LCCE

Is the hospital you’ve chosen totally supportive of the six Lamaze Healthy Birth Practices?  Once you educate yourself on the elements of a healthy birth, there may be times you need to advocate for yourself and your baby. Hopefully you’re able to choose a birthplace that largely supports your goals for birth, but if that’s not possible, here are some suggestions that might make negotiating easier.

1. Talk it out beforehand, and get it in writing. If something is particularly important to you, talk it over with your midwife or doctor at an office visit. For example, if you know it’s standard for women to get a routine IV in labor, explain your concerns to your provider ahead of time. If you can agree that you will not have a routine IV for a healthy, normal birth, ask your provider to write that in your chart and either put it in writing on a prescription pad, or sign your birth plan. That way, if your doctor or midwife isn’t in the building when you arrive in labor, you’ll have that piece of paper to back you up. Individual midwives or doctors usually have the power to override routine policies for their own patients.

2. You’ll catch more flies with honey than vinegar. It’s great when moms and dads are passionate about healthy birth. Unfortunately, sometimes that passion can leave them feeling confrontational. You don’t need to start off with guns blazing. I suggest to my students that they are firm but very polite when working with the staff. Is continuous monitoring the policy at this hospital? You might say to the nurse, “Our midwife OK’d intermittent monitoring. We’d be so grateful if you could help us with that.” And if her answer is no, try again. “This is so important to us. I know it’s not the standard, but we really appreciate your understanding. We did OK it ahead of time.” Nurses, midwives and doctors are just people. A gentle approach is usually received much better than angry demands, and you’re more likely to get what you want. Be likeable.

3. Brainstorm. If you can get your nurse or provider working with you, they may start to take ownership of your ideas. Try asking for their help to brainstorm a problem. For example, a dad or other support person might say to the nurse between contractions, “We really want the baby to stay skin-to-skin after birth. Can you help us think about how that might work? Can some of the routine things be done while the baby is on her chest? What if we waited to weigh and measure him?” Or maybe continuous electronic monitoring is required because of a medical complication, and you’ve been asked to stay lying down in bed. Ask your nurse or provider to help you think through other options, such as laboring with continuous monitoring on the birth ball, on hands and knees or sitting upright. If they respond with reasons why something won’t work, you can always throw out a phrase like, “Let’s try together.” When people are part of the process they generally respond better than if you simply list your demands.

4. Bring a doula. An experienced doula has usually seen other families successfully negotiate in the hospital environment. She probably knows what’s possible and may have some techniques for helping you “get to yes.”  For example, hospitals in our area require 30-40 minutes of continuous monitoring when a woman first arrives, with intermittent monitoring as an option after that time. The mom is usually asked to lay on her side in the bed for this monitoring, which is hard for most women to do when they are in active labor. Sometimes the nurse will stay and hold the monitor device on her belly, so that she can still move with her contractions without losing the baby’s heart tones on the monitor. Once one of my doula clients had a nurse who was not willing or maybe not able to stay. The nurse kept insisting that the mom lay on her side, and the mom kept insisting that she couldn’t do that because it would make the contractions too intense. I asked if it might be possible for the dad to hold the device on her belly. The nurse happily agreed. She was able to leave and still get the monitoring she needed, the mom was able to continue standing and leaning with her contractions, and the dad was happy to help.

5. Don’t stop at the first “no.” If you’re asking for something outside routine hospital policy, the first answer you receive will probably be no. Expect that first no, and be pleasantly persistent, using all the techniques mentioned above. I know one woman whose nurse kept telling her there was no way she could have the special requests she’d made for her planned cesarean, such as having both her husband and her doula in the operating room and having her baby skin-to-skin on her chest while the doctor finished the surgery. The mother just kept nodding and smiling and saying, “I understand, but this is what I want. How can we make it happen?” Her negotiations were successful, and her doula and husband were both at her side when that beautiful baby was laid on her chest almost immediately after his cesarean birth. Had she accepted that first no, her birth experience would have been much different.

6. Remember, it’s your body, your birth and your baby. If it comes down to the line, remember that no one can force you to do anything or accept any intervention that you do not want. Shared decision making requires your consent. I remember my client who was pushing on hands and knees with a nurse, only to have a midwife come in at the last minute and tell her to turn over on her back. She asked why, and the midwife replied, “I don’t deliver babies this way.” Between strong pushes, the mom simply said, “No.” The midwife told her again to turn over, and again the woman said, “No.” The midwife successfully caught the baby while she stayed on her hands and knees. It was a beautiful birth! It can be intimidating to have professionals in scrubs and white coats telling you to do something, but if there is no clear safety reason for the request, it is always your right to say simply and clearly, “No.” After all, it is your body, your birth and your baby.

Jessica English, CD(DONA), LCCE, is the owner of Birth Kalamazoo, which offers birth and postpartum doula services, natural childbirth and breastfeeding classes, and in-home lactation consults. A DONA-certified birth doula and Lamaze-certified childbirth educator, she teaches an 8-week series of classes called “The Best of Natural Birth.” She is the editor of DONA International’s eDoula newsletter. A longtime writer and business woman, she also works as a consultant for organizations and birth professionals.

How One Mom Moved & Grooved Throughout Her Labor

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

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

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

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

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

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

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

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

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

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

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

This is what it looked like.

kneeling

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

What else does kneeling help to do?

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

side-lying

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

How does side-lying help a mom during labor?

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

standing

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

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

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

hands and knees

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

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

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

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

standing and leaning

Here I am standing and leaning against the stairs.

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

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

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

birth ball

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

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

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

hospital bed

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

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

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

water

But then I got in the water.

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

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

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

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

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

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

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

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

We’re Having a Blog Carnival – And You’re Invited!

 

We want to hear your birthing success stories!

 

Last year, Lamaze celebrated its 50 year anniversary in childbirth education. During the fall annual conference (held jointlywith the International Childbirth Education Association who also marked 50 years), Lamaze unveiled a video that summarized their accomplishments over the past five decades, as well as mapped out the work still needed for the present and future.

The video exhibits the many successes that professionals have seen in the world of maternity care and birth since 1960. Here are Giving Birth with Confidence, we want to hear from you moms and dads with your personal stories of success and triumph in birth. 

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Here’s how you can participate in Giving Birth with Confidence’s first blog carnival of 2011:

1)  Watch this video from Lamaze to learn more about where we’ve been, and where we’re going in terms of advocating for safe, healthy (and happy!) birth practices. (While this video was created for maternity care professionals, I can assure you that it is relevant and useful to every mother and father who has ever had a baby or is expecting a baby.) 

2)  For further inspiration and ideas, review the Six Healthy Birth Practices.

3)  Write up your success story of implementing or experiencing one (or more) of these evidence-based care practices during your own birth.

4)  Complete your post and upload it to your blog or website no later than Wednesday, January 19. Please also e-mail me at cterreri [at] lamaze [dot] org to let me know when and where they are available!  Also, make sure your post links back to this one (http://givingbirthwithconfidence.org/2011/01/were-having-a-blog-carnival-and-youre-invited/).

5)  If you don’t operate your own blog, but would like to participate, e-mail me your guest post for this event.

6)  Watch for the Blog Carnival Round-Up to be posted here on January 28.

~Happy Posting!~

Note:  if you are a professional reading this and would like to share a success story, please consider also linking to Science & Sensibility where a similar blog carnival is underway!