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Thursday, 06 February 2014 22:04

With Woman

It has not been long that I've been a doula. My training is nearing completion with a few more births to be evaluated. I take great pride in my training efforts; read far more than required, watch every film and documentary, listen earnestly to other birth workers and other mothers like myself who have experienced a birth trauma, only to redeem their experience with a subsequent birth. I think I can confidently say "I know the basics" just as confidently as I can say "there is so much to be learned". 

As a training doula, I often focus my learning on techniques to be used: massage, Rebozo, essential oils, memorizing positions and their uses. Important stuff, as in most descriptions of a doula these are the highlights of our work. We know how to help you cope, physically. We know the process, and believe in the process, of natural childbirth. We also know about the interventions and how to work with them so they don't fall into the "cascade" we birth workers fear will take away from the childbirth experience. Ask any lay person what a doula does, and if they know anything about us at all, they will know that we can help you deal with the pain of labor. 

But despite all the wonderful uses and intentions of those techniques, I fear I have left out focus of a key factor of my work. As a doula can tell you, the most beneficial part of having a doula at your birth is the CONSTANT SUPPORT. I knew this. I believed this true. And yet I still didn't understand the extreme impact that statement has. 

WITH WOMAN. 

Not "doing it with woman", not even "helping a girl out". WITH. With? Such a simple implication of a word. Defined easily, categorized simply.

Not until the last birth I attended did I truly understand the full weight of importance of "with" in my role as labor support.

Although, I should have as I experienced it in my own birth of my second child. In my personal experience of a rather quick labor/birth (6 hrs total), I did not want coping techniques to be used on me. I was fighting off the panic of how quickly my birth approached. I holed myself up in the smallest room of my house and made a small nesting area reminiscent of the way the dogs my family bred in my childhood did. I was offered a simple, and known to be quite effective, hot water bottle; but the presences of the gentle, loving, midwife's apprentice and the trying of that physical ease made me loose focus. I did not like either, and so I stayed alone in my safe place listening to the conversations of my husband and midwife, my mother crushing ice for me in the kitchen, my father retreating to another area of the house so not to disturb the process; alone and content working internally to handle my labor. 

And then, eventually, I came out of my nest because I honestly felt a little out of the loop. I wanted to be near the people. I entered the hardest of my labor there, with them. I needed them there. I did not need them to assist my labor and frankly they couldn't have anyway. No, I just needed them. After a unfavorable positional change I remember grabbing my midwife's knee suddenly as a heavy contraction hit before I was ready. Her face was shocked by my sudden grasp as I up until this point had labored within myself, not reaching out for help. And then her eyes told me what I needed to know:

"I know it's hard. I know you're working harder than you ever have. I know." 

After that moment I felt a new level of trust. Not because she helped ease my pain or even because she said some scholarly fact about transition being the hardest but shortest part, but because she empathized and validated my experience..... all in a look. 

WITH WOMAN.

Yes, a doula can offer you many helpful things to deal with your labor but not all who labor want a massage or a positional suggestion. Some just need you to be WITH them. To hear them when they cry out that they don't want to do this or that they don't think it can be done. To know they are suffering. To somehow with your presence tell them you understand. Perhaps a word of "but you are doing this" or "your work is paying off" or even "you are further than you realize and doing more wonderfully than you think" but mostly just WITH. 

The last birth I attended was a mother's 3rd and first attempt at a totally natural and un-augmented childbirth. Much like my own, quickly moving. She fought her labor until she couldn't fight anymore. She voiced her retreat of intent for this birth so I could hear it, not because she really meant she wanted to give up but because someone had to know how difficult it was. And I did. I knew. It was hard and it was fast and it wasn't exactly how she pictured herself laboring. Once she had told me and I agreed that it was hard, she stopped fighting it. She danced beautifully the dance of a laboring woman, drawing her baby further through the pelvis. And when her dance was sufficient she found herself a bed to rest in. And when her rest was sufficient, she pushed the baby out in 2 waves without voicing to anyone that it was happening (in fact, in that dark hospital room, we nearly missed that the baby was being born, let alone a doctor to be present for its entirety!). Her birth was beautiful and it was hers. She was strong, even when she tried to say she wasn't. I did not help her with counter pressure or positions as I so often do. No, instead I was simply "with". 

With woman.

To sum up the whole, the best part, the most important part, is that I, and all the striving birth workers in our present, past and future, are WITH you, woman. Every mother that has ever been is WITH you, birthing goddess. And if you need to be validated while you work to bring your baby earth-side, just look to the woman at your birth-she is WITH you in this momentous right of passage and that, I hope, will sooth your soul. 

Published in Birthing Assistance

3 things that the internet, books and movies cannot tell you about labor and birth.

  1. What does it feel like?
  2. How long it will take?
  3. What will happen?

We want to know in absolute detail because we need to prepare ourselves.

So we read books, attend courses, and use google extensively to research information around subjects of the signs of labor and the stages of labor. Surely, we will find the answers there? Well, yes, we find all the answers and more. However, at some stage we realize that all we really know is what it might feel like, how long it might take, and a deeper understanding of what might happen.

So we read birth stories and watch birth movies and every single one is different! How scary is that?

So is there anything that we know for sure about labor? YES THERE IS……

Every labor is unique, individual and variable.

Let me say that again, in case you did not get it the first time.

Every labor is unique, individual and variable.

In other words – we can tell you a whole lot of facts, but afterwards there is a good chance that you will look back and say “well that never happened to me. Did I miss something? ”

Like Josie who attended my birth preparation classes and called me after her baby was born to update me. “I never had early labor” she said, “it was just BAM, straight into active and 3 hours later he was born.”

Physiologically all the things that happen in early labor must happen in order for labor to progress. However, the way we experience them on a physical level is unique, individual and variable. In Josie’s case, she never experienced anything physical until she was in active labor- at which time she made her way to the hospital to find that she was already 7cm dilated. Her body had been making physiological changes for hours (possibly days) before that – without her being aware of it. She was so chilled and relaxed that she never took much notice of it and so labor progressed smoothly; and in her case pretty quickly.

The problem with learning the facts is that a lot of them focus on the physiological changes like the dilation of the cervix. Although these signs are important, they are measured by invasive procedures like vaginal examinations (these are usually done at the hospital by your midwife or doctor). Wouldn’t it be great if a sign board flashed up saying “Well done, you have just completed early labor and you are now entering the active phase? Sharp turns predicted for the next 8 hours. Expected time of arrival 16h45 “

Well yes, that would be helpful. Lovely in fact. But totally inaccurate. For instance if you were Josie, you missed the early labor sign board and active labor for her was 3 hours not 8. For Sarah, there were sharp turns for 8 hours which turned into a steep uphill battle and resulted in emergency evacuation.

So let’s take a look at what happens on a physiological level and some of the variables in each stage.

EARLY LABOUR

How long might it be?

8-12+ hours is the average of very mild, not much happening, is-this-really-it type sensations.

What is happening in your body? What physiological changes are happening that would cause the sensations you might feel?

Your cervix is soft, ripe, and yielding. You may (or may not) experience backache or period like cramps lasting anything from 15 - 45 seconds and usually at irregular intervals. You may notice that your belly hardens and feels tight during surges. Your cervix responds to the surges by starting to shorten and open. According to the stages of labor, dilation of up to 4 cm happens in “early labor” sometimes without you even noticing it.

What might you feel?

Confused - is this it? Or is it just more Braxton Hicks? You might feel a combination of excitement and fear (of the unknown).

What should you do?

If it is the middle of the night or early hours of the morning, roll over and go back to sleep – if you really cannot sleep through the surges then get up and distract yourself, go for a walk, watch TV or find something to do that takes your attention away from just waiting for the next surge to time it. As long as possible – ignore it until it is impossible not to. At that stage you should be nearing or possibly in active labor - which for some women is the longest or most intense phase of labor. Others find pushing and birth to be the most intense.

ACTIVE LABOR

How long could it be?

6-8+ hours is the average but it can be as little as 2 and as long 20 (sometimes more).

What is happening in your body? What physiological changes are happening that would cause the sensations you might feel?

Your cervix is probably soft and open to at least 4 cm, possibly more.  You might be feeling slight pressure over your pubic bone if your baby is low and well engaged. This is great as the pressure of the baby’s head over your cervix helps it to dilate.  Your uterus has established a good rhythm of regular surges that are doing the work of opening the cervix and nudging the baby down.

What might you feel?

By this stage you would normally be experiencing regular surges lasting at least 60 – 90 seconds and coming at regular intervals of at least every 5 minutes or less. You will find that you need to breathe through the surges to stay focused and talking during surges is hard and feels unnecessary. You become quieter and more serious, more inwardly focused – deep down you know that this is real labor. You might also be experiencing backache if your baby is in a position that exerts pressure over your sacrum.

What should you do?

If you are having a hospital birth, this would be a good time to go or at least be ready to leave, depending on how far the journey is and what road conditions are like. If you are at home, call your midwife and make sure you have everything ready. You might think about getting into your tub at some time during this stage.

Most important is to consciously relax using your breath - long, full, deep breathing through surges and easy breathing between surges. Remember that the spaces between the surges are every bit as important as the surges themselves – they are a time to rest and recover. Stay focused and present.

Use visualization techniques to “see” what is happening in your body while you “feel” it. Allow your instinctive brain to take over and let your body do what it knows how to do. Move your body, work with the sensations and use them as a feedback to know how to move and what positions feel good and “open.” Let go and surrender to the power of labor. Let go of how long it might take. Let go of what might happen and let what is happening happen. Be in your body. Connect with your baby.

If you are able to let go and let flow then active labor establishes a beautiful rhythm of strong surges that nudge the baby down and at the same time pulls the cervix up to its widest diameter. Once that happens you can follow those same instinctive urges to breathe or push your baby out into the world.

In order to allow labor to unfold in its own unique, individual, and variable way we need to trust:

  1. The process of labor
  2. Our bodies
  3. Our partner
  4. Our midwife/doula/doctor
  5. Our place of birth

We also need to let go of any ideas of what should happen and just allow whatever is happening to happen whilst understanding that the physiological changes are accompanied by changes in your behaviour, your attitude, your breathing, and your activity.

By listening, trusting, and responding to these changes you will instinctively know that things are moving along. You will know that it is time to call the midwife or get to the hospital.

 

Published in Birthing Assistance

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