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I had been having Braxton-hick for weeks. I never had them with my first so this was a whole new experience for me. I could feel her powerful kicks, and I knew she was strong. I talked to her often, telling her how excited I was for her to join our family. I started eating dates every day, and drinking Third-Trimester Tea. I was anxious about having yet another hospital birth, and even debated a last minute “unplanned” unassisted. But after much prayer, conversation, and thought, I decided it would be best for us to go ahead and go to the hospital. Michael promised me with the next baby, he would do everything in his power to make a homebirth happen. I knew I had to trust God to be my protector in the labor room, to be my Great Physician and Shepherd who would help, guide and protect me through the birthing process.

Friday morning, just over a week before her guess-date, I woke up around 3 am with fairly consistent contractions. I waited until Michael got up for work at 6 to tell him. He went on to work, and I made some tea and started getting things ready. I called my neighbor and friend who would be watching John, my oldest. After a while, the contractions tapered off. Disappointed, I walked the mile into town, hoping to kick-start labor again. While at my favorite thrift store, I ran into an acquaintance who’s wife was also pregnant. He shared with me that their baby girl had been born a few days earlier, in a beautiful unplanned unassisted birth. I was so encouraged and inspired by his story I almost didn’t mind that my labor seemed to have stopped.

 The contractions didn’t pick up that day, or the next. I tried not to be too disappointed and to make sure I really did have everything together and ready to go. I had been checking my cervix through my third trimester, and I was dilated to maybe a three and losing lots of clear mucous. I continued snacking on dates and red raspberry leaf tea. I knew it would soon.

Sunday morning around 1am I woke up to contractions about 7 min apart. I had to get on my knees in bed and quietly moan through them. I woke up Michael to let him know. We started to get everything together. I texted my doula and let her know what was happening. Around 5am the three of us decided it was time to make the drive. The contractions were about 5 minutes apart, and the hospital was a good hour and twenty minutes away, so we didn’t want to wait till the last minute. We woke up our neighbors and dropped off John. I was excited, but anxious as well.

Once in the car, the contractions stopped. I would have the odd one here or there, but nothing consistent like before. We stopped at a coffee shop so I could have some breakfast before we got the hospital, knowing we’d have to fight ridiculous “no solid food” rules once we got there. I had a couple strong rushes while we were there, but once again they stalled in the car. When we finally got to the hospital, we decided not to go into the labor ward right away. Instead, we walked the hospital grounds in the early morning light. We hung out in the hospital lobby. My doula had decided to wait before meeting us at the hospital, in case the contractions didn’t pick up again.

Finally I told Michael we should leave. Maybe I was just anxious about being at the hospital, and thought leaving would help. We went to a drugstore for some eye drops, a restaurant for some more food, and then tried to get a hotel room. Since it was still so early in the morning, they wanted to charge us for two nights. We decided against it. It was now about 7am and I had been awake for 6 hours with almost no sleep before that. We pulled into a park so I could lie in the back of the car and rest. After about ten minutes I decided this was stupid, labor had obviously stalled, and we just needed to go home. As we headed back up the hill, my contractions started again. I laughed at the irony. This baby just wanted to be born at home!

I picked up John from my friend’s house and walked home. Michael went to work to finish up a few things. I felt silly and stupid for having a “false alarm” like that. As John had been awake since we dropped him off that morning, we both laid down for a nap. I had a few more contractions but nothing I couldn’t sleep through.

Then around 11am they started to pick up again. I was annoyed. Couldn’t my body just make up its mind?! The contractions were very inconsistent. After consulting with my doula friends online, I decided not to encourage labor at this point. I took a warm shower and just tried to relax. No pressure points, no walking, just lots of water and rest, a Tylenol and a hot shower. The contractions remained consistently inconsistent. 12 minutes apart. 7 minutes apart. 10 minutes apart. 5 minutes apart. Michael came home, and he sat on the couch while I knelt over the birthing ball, just trying to relax. He would rub my back during contractions, and encourage John to help him.

Around 3pm I decided to go lay down again. I had to moan through contractions, and they were almost unbearable without Michael rubbing my lower back. But they were still so inconsistent. They definitely weren’t following a pattern of getting stronger and closer together. I had my parents on standby, as they had a six-hour drive ahead of them, I doubted they would make it in time for the birth. Then, at one point, I looked up to see John throwing up all over the floor. What?! He suddenly had diarrhea too! I called my mom and asked if they could come down. It could still be a few days before the baby came, but I didn’t want to have to send a sick kid to the neighbor’s house! Nor take care of one by myself in prodromal labor. So they packed up and started the journey down, not a moment too soon.

I texted my doula and asked her to come over so she could work on my back and give Michael a break. I decided to take another shower in the mean time to calm the contractions. I checked my cervix again, and it was still very high. So high I couldn’t tell how far dilated I was. But, I could touch her head! I had been having bloody show all day, so I knew my plug was gone, but thankfully my water was still intact. As I undressed in the bathroom, I happened to glance in the mirror and see a purple line on my lower back. “No way!” I thought. A purple line running up the butt crack is a sign of dilation. Once the line reaches the top of the butt, it signals that the cervix is at 10 cm. But I couldn’t be at 10cm already, could I? The contractions had been so inconsistent, and I didn’t feel like I was in transition, mentally or physically.

I stepped in the shower and tried to just relax. As another wave came over me, I heard myself pray, “Oh God, please let Michael forgive me for what I’m about to do!” That made me pause. What was I about to do? Suddenly I realized, “I’m going to have this baby right now!” I could feel her moving lower and lower into my pelvis. I stayed in the shower till all the hot water ran out, filled with doubt about going to the hospital still, half hoping that she would suddenly come and I would get my accidental freebirth.

I got out of the shower, and realized I couldn’t stand by myself during contractions. I had to lean on Michael and sway. My knees gave out with each surge, and they left me feeling weak and nauseous. They had all of a sudden jumped to three minutes apart, consistently. Michael asked if I wanted to go back to the hospital again. I was scared. I didn’t want another false alarm. It was such a waste of gas and everybody’s time! After Michael reassured me it was ok, we would make the drive 20 times if we had to, I agreed to go.

Getting in the car was the last thing I wanted to do at this point, and I was genuinely concerned we might have a roadside baby. But we called our neighbor to come get John again, and texted our doula and my parents to let them know what was going on. I found out later our doula was almost to our house, so she just turned around and followed us down. Thankfully the contractions slowed down in the car again, but stayed regular. I felt like there was a baseball between my legs the whole time. And of course, we hit every red light along the way.

At one point, as I felt another surge building, I said out loud “I don’t want to do another one!” Michael rubbed my hand, which helped distract from the sensations in my belly. But that contraction was definitely harder. I knew I had to keep a positive attitude. “Just one more,” I kept thinking. “I can do anything for 1 minute.”

We finally arrived at the hospital. Since it was after 6pm we had to go in through the ER. I had to fill out some forms, even though I was preregistered. They called for a wheelchair. I explained I didn’t need one, I didn’t want to sit down anyways, but the aide insisted she would get in trouble if she didn’t bring me up with a wheelchair. I told her she was welcome to bring the wheelchair with us, but I was not sitting down. We used it to bring up the luggage.

Once in triage, I changed into the hospital gown. I was too tired to protest or care at that point. I sighed and resigned myself to lie down on the monitors. It was awful lying down like that. When the nurse left, I turned to Michael and whimpered, “I hate this. I wouldn’t have to do this if we were at home.” He had already promised me our next baby would be a home birth, but that didn’t make this hospital birth any easier.

The on-call midwife finally came in to check me. I was only 6cm. I was so disappointed. I realize now that I had likely closed up from being in the car and at the hospital, and I probably was 10cm at home. But at the time I was only 6cm, and felt so discouraged. I didn’t even have an idea of how much longer we’d be there before she was born. The midwife informed me of my GBS positive status, which I knew about already, and mention the routine antibiotics. I told her I was familiar with the risks and had decided to forgo treatment. After a brief lecture, I was finally shown to a labor/birth room.

Once we were alone in the room, Michael asked me if I would reconsider the antibiotics. He had known my plans before hand, but hearing the midwife’s lecture had made him nervous. I agreed to go ahead and get treatment. I had been on the fence about denying the antibiotics anyways, so his request was all I needed to hear. We told my nurse we had changed our minds, and she went to tell the midwife, and also let my doula in. My doula instantly set up shop, setting up a diffuser with lavender essential oil and getting out her labor balls to massage my back. She also had some peppermint essential oil on a cotton ball, which really helped with the nausea I was feeling after each surge.

The nurse had asked me to lie back down on the monitors for a few minutes. I asked if we could wait till after the next contractions. She agreed and went about her business, setting up equipment and preparing the IV. Since she was so busy, I decided to stay standing up until she asked me to lie down again. She put the IV in my hand while I was leaning against Michael and my doula was rubbing my back. I stayed like that for a while, with Michael and my doula taking turns rubbing my back and being my support. As it turned out, I never did end up going back on the monitors.

Finally my mom showed up. My dad had dropped her off and gone on up to our house to pick up John. It was very special for me to have my mom there. She had offered to be there when John was born, but since I was laboring all night I felt bad and told her to go home. Now I realized how much it meant to both of us to have her there. My mom has always been a huge advocate of natural childbirth, having herself used the Bradley method. I have learned so much from her about birth while growing up. I loved having her by my side for this experience.

After a while I felt my legs getting tired. When my doula mentioned getting on the bed, I quickly agreed. I climbed up and knelt on the bed, leaning against the raised headboard. It felt so good to be able to relax my whole body against the sheets. I munched on ice, spoon-fed to me between surges, and I also asked to hold the cotton ball of peppermint oil myself, so I didn’t have to ask for it every time. I still had no idea how much longer things would be. I only knew I could do one more.

Suddenly I felt her head low in the birth canal, and I HAD to push. “UUUGGHH I’m pushing!” I moaned loudly. The nurse calmly asked me to roll over so she could check me. “Um, no!” I thought. When she asked again, my doula leaned down and repeated the question to me. I shook my head violently. No freaking way could I move right then. One contraction rolled into another as I groaned and pushed. I felt the nurse’s hand (I don’t know why she couldn’t have just checked me like that to begin with), reach in and touch the baby’s head. Obviously my back was turned so I didn’t see what happened next, but I was told later that the nurse turned and ran out of the room, ripping her gloves off and yelling for the midwife as soon as she hit the hallway. My mom turned to my doula and did a fist pump. The baby was coming!

With my first, I had a pushing urge, but it definitely wasn’t quite so intense. This time, it was like taking a giant poop. She HAD to come out NOW! “I want her out of me!” I yelled. I let out a growl/scream and pushed as hard as I could. I knew I was probably going to tear; I didn’t even care, I just wanted her out! I tried to breathe her down, to pace myself, but the urge to push was overwhelming. I don’t even remember a ring of fire, just an intense urge to get her out.

The midwife came in, and when she saw how I was positioned over the bed exclaimed, “Well, that’s one way to do it!” She asked if I wanted to deliver in that position. I nodded. Even if I wanted something else, no way could I move. I found out later she had never helped deliver a baby in that position before. I felt proud to have given her that experience.

When the baby started to crown, in my mind I could see her dark head of hair coming out. I wanted to ask what color her hair was. My son was blonde with blue eyes, but all pregnancy I had been dreaming of my brown haired, brown eyed baby girl. I just couldn’t get the words out. I was screaming as I pushed, gasping in air loudly. Any thought of keeping my voice deep and low was gone from my mind. Finally, I felt her slip out of me.

I instantly sat upright and ripped open the snaps of the hospital gown so it fell off of me, ready to reach down and grab my baby girl. “Don’t sit on her!” everyone said. “How silly,” I thought. I wasn’t going to sit on the baby I had just pushed out! I was much too aware of her for that! “Give her to me!” I kept saying over and over. But they didn’t give her to me, they were too busy suctioning and drying her off. Finally the midwife asked, “So, how do you want to do this?” “Just, pass her between my legs!” I said, while thinking “duh!” And finally they handed my sweet little girl to me. She had brown hair! I held her tightly and they helped me turn over and lay down. Baby Joelle had arrived at 10:05 pm, barely two hours after we arrived at the hospital.

We delayed cord clamping for a while, but the midwife was concerned about the amount of blood. She asked if I wanted a shot of Pitocin, which I declined, and then told me she needed to cut the cord and get the placenta out. I asked what the concern was, why the rush? She simply said she needed to make sure I wasn’t bleeding behind my placenta. (What? Whatever, I had just had a baby, I didn’t care). She put traction on the cord and pushed HARD on my stomach till the placenta gave way. I tried putting baby on my breast to help, but she wasn’t quite interested yet.

After the placenta was born, she assessed me for tears and informed me I would need one stitch for a minor tear. I asked her if it could be skipped. She left it alone for a while to see if it would stop bleeding, but after a few minutes told me that it had started bleeding again when she opened it back up (um, no duh! If you open up a cut again it’s going to bleed!). I begged her to not give me any stitches, that I would just keep my legs together. But she didn’t think much of that idea. I finally caved. She did one stitch, and then said I needed another. The second one hurt so bad. I could feel every tug and pull of the needle. “This is exactly why I didn’t want stitches!” I thought.

The stitches were the only real problem I had with my hospital birth; that, and the fact that my baby wasn’t passed to me right away. But overall, it was about as good of an experience as you can get in a hospital setting. It certainly wasn’t the home birth I had wanted, but it was still a wonderful, empowering experience. Even though the midwife hadn’t even had time to read my birth plan, she still respected me enough to ask for informed consent and respect my wishes. I really appreciated that. Thanks to her, my wonderful husband, my doula, and my mom, our family had grown to four with little drama. And for that, I praise God.

Joelle Akiko

March 30, 2014, 10:05 pm

5lbs, 15.7 oz, 17 in.   

Published in Birthing Stories

Pregnant women: print this out and hand it right to your partner, you will thank me later.

By now you’ve already gone through the excitement of a positive pregnancy test, received the hugs and high fives from friends and family, and made the decision whether to find out if you’re expecting a he or a she. Now, though, it’s starting to sink in: you have to have this baby! This cheat sheet is by no means everything that your partner will need to know on the big day, rather it is something to fall back on if it’s go time and all the information from childbirth classes fly out the window.  

By now you’ve learned more about the uterus and cervix than you ever thought you would; even heard about something called a mucus plug. Now it’s time to connect the dots, to understand just what’s going on down there, in there, and out here. The uterus and cervix, believe it or not, are actually one in the same. The cervix is the gateway to the uterus, which contains your baby, the placenta, amniotic sac and nearly a gallon of fluid!

Early Labor: How to Know & What to Do!

When the early stage of labor begins, the cervix begins to thin out and become softer, allowing it open easily.  She may feel what is described as a shooting or pricking sensation along with mild cramping, similar to PMS cramps for some. She will probably be able to maintain a nice conversation with small pauses while going about her business. The best thing to do is to go about what you had planned and focus on your last few hours or days as just a couple (or more!) It’s also important to note here that if she has had a cervix check done at the midwife or doctor’s office, it may not mean much. Some women are 4 centimeters for weeks before going into labor. My mother went from 0 centimeters to nearly having me in the hospital parking lot!!

Active Labor: What now!?

The next stage is active labor, this is when the cervix begins to open at a more rapid pace and your baby begins to make the journey into the pelvis. This is strong, amazing work, and she should be treated as it is by everyone in the room. Contractions become stronger, longer, and take on a regular pattern, happening every few minutes.

This is the time to encourage and support every single minute. Suggest that she relax her mouth and muscles while contracting, letting out deep sounds from her belly along with deep breaths to give oxygen to your baby (fun fact: the mouth, anus and vaginal muscles are all related! Relaxing and opening them helps labor progress effectively.

Physical support is critical during this time frame. You don’t have to be a licensed massage therapist to give her fantastic pain relief, just rub wherever you see her tensing up, especially the shoulder area. Alternate hot and cold cloths on her face and the back of her neck, this will help with her constant temperature changes.

Encourage changes in position, being on all fours, sitting and bouncing on a Pilates ball, and side lying on the bed are all great choices.  Avoid laying on the back as much as possible, contrary to popular belief, this can actually close the pelvis and make baby journey uphill.  Make sure you always have a water bottle handy, offering it to her constantly, even putting the straw right in her mouth. Snacks on hand will keep her energy up, but remember too that labor can be a time for puking. So choose foods that are high in protein, healthy fats and natural sugar while keeping in mind that it needs to be able to come back up as easy as it goes down.

When to make the call

By now, you may be wondering if it’s time to head into the hospital or call the midwife (for home birthing families.) While there is no right or wrong answer, short of actually seeing the baby coming out (CALL 911!) it’s a personal decision.

The general rule is 4-1-1: contractions that are 4 minute apart, lasting at least 1 minute, for 1 hour, but we all know that not everyone plays by those rules, babies included.  Some better signs to look for are emotional markers.  She may begin to enter a phase of self-doubt, you may hear the tell tale “I can’t do this!” mantra.  It’s common shortly before the quickest and most intense part of labor, transition; by the way, the appropriate response to this is always “You are doing it!”

She may be short on conversation and might be short with you, period. Don’t take this personally, it means that she is in the labor zone and conserving energy whenever she can. Physically, you may notice that she is starting to get closer to the ground and, sorry to say, but she may start farting. A lot. Your partner may also poop a bit. If you need to take a moment to giggle, let it all out now; we can almost guarantee that she is self-conscious about this. If she does do either, put down the air freshener. Most birthing women will poop on the table.  Pretend it didn’t happen, instead tell her how she’s getting so close to having her baby! She will thank you later. Isn’t it funny that in labor, rudeness and flatulence are encouraged? These are all great signs that point towards going in.

You will need to speak to you practitioner about the procedure for calling and arriving at labor and delivery before hand.

At the Hospital!

Once at the hospital, your support is a top priority! Quite a few first timers believe that their doctor, midwife or labor nurse will be there 24/7, but this is rarely the case. Nurses are the unsung heroes of the maternity ward (bring them cookies, seriously) and often take on a huge patient load to help many mamas birth. Your care provider usually comes in to “catch” your baby and maybe to discuss options with you once in awhile. There are exceptions, of course, but this is why it pays to be prepared (and hire a doula their expertise will help greatly…just saying!)

As she enters the transition phase, contractions will come very close together and she may look like she is in a totally different place. She may not be able to respond, so consider suggesting position changes, keep giving her water and food (depending on hospital policy) and through each contraction, remind her of how close she is. This is the most common time to ask for pain relief, usually while she is in the middle of a walloping contraction. Remind her that she is going to be holding her baby very, very soon and maybe suggest: “Let’s talk about an epidural in three more contractions,” so she can make a real, informed choice at a better time. Generally though, transition only lasts thirty minutes to an hour before pushing begins, it is both the hardest work and the most relieving as it means you are almost there!

All About Pushing

First timers always ask, “when will I know to push,” trust me you will know. She may start feeling as though she needs to use the toilet really badly. She may start making grunting or growling noises. If you haven’t already, this is the time to hit the “call nurse” button.

While each practice or hospital may have different policies on pushing, evidence shows that any position other than the back is best to let gravity do the work.  Yes, babies do come out! The pushing you see on TV, with the people shouting “ONE! TWO! THREE!” are only usually used in labors where mama has had a strong epidural and is no longer able to feel the need to push.  When she knows she has to, she rarely needs someone else to guide her.  The best encouragement is to remind her to follow her body, to push when it feels best for her.  

It’s Baby Time!

When your baby is crowning, you could ask for a mirror to hand to her if she’d like to see the action or encourage her to reach down and touch her baby. This may be too much for her, so say something like “wow, he/she has a lot of beautiful hair!” this will remind her of her ultimate payoff. Then, it’s baby time! Out comes a new, amazing little creature, covered in waxy vernix; encourage having the baby placed skin to skin on your partner’s chest. Now would be a great time to remind your care provider if your partner would like to keep the cord pumping precious blood to your baby while still attached and uncut, as well as a reminder if she has chosen not to receive Pitocin to deliver the placenta unless medically necessary. The placenta, thankfully, does not have bones and usually detaches and comes out by itself within a few minutes to half an hour, usually with just one push.

After this there’s not much else to say. Bask in your love for your partner as well as your new daughter or son. Go ahead and enjoy that oxytocin high; both of you have earned it. You only get one birth experience for each child, why not do everything you can and hire the best fitting doctor/midwife and doula support for your family? Do your research, find your voice and give your partner your all, for your baby—for your whole family.

Published in Birthing Assistance
Monday, 04 November 2013 19:58

Experience vs Information: Your Choice

This post started out as a piece on optimal cord clamping, but has become a whole new beast. (Optimal, or delayed cord clamping is the process whereby the umbilical cord is left to cease pulsating before cutting). I read and I researched, after which time, this article changed tracks. I don’t need to tell you the pros and cons of delayed cord clamping. You can read all about it on the websites listed below. After which time you can make your own mind up. 

Could this be my shortest ever blog post? No, what all this lead me towards is the fact that in so many cases, women are not given factual evidence-based information to make a choice. Often it is the experience of others that leads us toward making our decisions, when it should be the combination of experience and information. 

It is in our nature to want others to have the benefit of our own experiences. Informed choice happens when we consider the experience of others and combine it with scientifically proven, evidence-based information. Sharing experience is a vital way to keep ideas flowing. Experience, or the stories that we tell, should serve as a motivation to gather more information on a particular topic; people usually make choices based on what is best for them. Being that individuals are unique, this will vary from person to person. I have made different choices in all four of my births. Many of them ill informed, but all of them mine. I hope to share my experience, tell you a story, then give you some information so that you can make your choice. First, a non-birth related example:

My husband is the sort of person who falls in love with a new product, and immediately wants others to experience the same revolution that he has. If something makes his life easier, cheaper or gives him pleasure, he shares his experience with all around him. When we were first married, we bought an “upside down” fridge. He would show all his friends the said upside down fridge, spout the benefits on not having to bend down to get vegetables, and marvel at the convenience of the mighty upside down design. Despite his enthusiastic sales attempts, I don't think any of the afore mentioned friends jumped aboard the upside down fridge revolution. I am sure that they looked at them, but made their choice based on what suited them and their family and not solely on the eloquent ramblings on my husband. Simply put, they listened to his experience, did their own research and make the choice that was right for them. 

So often advice is based on the experience of others, and not the evidence and information available. Many women that I speak to don’t know that they have a choice in regards to management of the umbilical cord after birth. The World Health Organization (WHO) recommends an actively managed third stage of labor, (another choice here, as you can request natural or physiological third stage) but recommends that after the birth of most infants, regardless of gestational age or weight, the cord should be left for 1 to 3 minutes before clamping.  

When I discussed my preference for a natural third stage with my fourth child, my caregiver refused. She told me that there are too many risks of postnatal hemorrhage, and that she would “not allow it.” We went back and forward over the issue of delayed cord clamping and a natural third stage. Eventually she “allowed” me to have optimal cord clamping if I would agree to an actively managed third stage. Interestingly, I have learnt while researching optimal cord clamping, that what I fought my caregiver for is exactly what the WHO recommends should be standard practice. It was her experience that women having their fourth + baby were are greater risk for hemorrhage. I accepted her expertise and experience as my sole source of information. 

I don’t want to underplay the importance of closely monitoring the third stage of labor. I understand in many cases, administration of an oxytocin based drugs has saved lives. In my circumstance, had I done my own research, and searched for evidence-based information, I would have refused active management. I was very low risk, regardless of the fact it was my fourth birth. I am left wondering how many birth related choices are influenced by experience instead of evidence. I was educated, informed and proactive, but still managed to be persuaded to do things differently based on the words that were spoken to me, and the manner in which they were delivered.

You always have choices. Don't let anyone take them away. You wouldn't go out and buy an upside down fridge simply because my husband, or even a well versed fridge expert told you they are the bomb. You might use his experience to motivate you go out and learn more about them; hey, you might even go out and buy one. Choice is always there, beware of advice and experience that disguises itself as information, and it truly becomes yours. 

Over to you now- make your choice. Here is some evidence-based information on optimal cord clamping and different options for the management of the third stage of labour. 

Midwife thinking - the placenta the essential resuscitation equipment

delayedcordclamping.com

Dr Sarah Buckley on the third stage of labour

thirsstageoflabour.org

Published in Birthing Facts

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
Thursday, 16 February 2012 13:46

Hospital Birth Step #4: Developing a Birth Plan

Creating a birth plan is, in my opinion, an essential step towards planning the hospital birth you want. As I’ve previously discussed, there are many options and considerations regarding birth that you should familiarize yourself with so that you can feel confident that you have made the choices you want prior to going into labor. A birth plan can help you identify aspects of labor, delivery, and newborn care that you still need to explore, as well as help you communicate your wishes to your provider and the hospital staff ahead of time. While creating a birth plan is not necessarily a guarantee that events will unfold exactly as you wish, it will enable you and your support team (partner, doula, friends,) to make choices on the fly, when the last thing you want to do is make decisions.

There are a number of ways you can start building a birth plan. There are many sites that discuss different components of a birth plan, and others that actually give you a template. You don’t have to use any of these, or you can pick and choose which parts you want to include in yours. This link is to a worksheet on the Earth Mama Angel Baby website that you can fill in the blanks and check off boxes that pertain to your wishes. It includes many obvious options such as labor positions, who you do and don’t want to be present, circumcision, and induction options. There are also as others that I had no idea were even options to consider like enemas, pubic shaving, and frequency of vaginal exams.

Another consideration is how you word your birth plan. This article was a great help for me and can help to give you perspective on how your plan may be viewed by others. While our wishes are important, the way we communicate those wishes can make all the difference in the world. When you write your birth plan, discuss your preferences rather than listing your demands. Nurses and doctors in hospitals are quick to push for interventions and pain medications because it often makes their jobs more predictable and easier to manage. If you do not want interventions and pain medications, you should say so, but try to do it with the same respect and understanding that you would like them to treat you with while you are in labor. I’m not saying that you should kiss their behinds to get what you want, but outlining your wishes in a way that acknowledges the hospital staff’s challenging work may elicit a greater willingness by them to work hard to respect your wishes.

This template is also a great one for mama’s planning a natural birth in the hospital. It has many natural birth and newborn care options that other templates don’t include such as Vitamin K options, and delayed cord clamping. Reading through this one may also give you ideas about what you want to look in to before creating your own birth plan, even if you are not sure about your desires for a completely natural birth.

I could give you a list of all the things to consider, but the list would be long and you will likely learn more from your own investigation of birth plan options. Take your time developing your birth plan and reading up on all the options available. Your desires may change as you progress through pregnancy, but starting the plan now will allow you time to make informed decisions before you’re thrown into labor and don’t have the option to Google something.

Once you have finalized your birth plan, (I would suggest not doing so until you are about 6 weeks from your EDD, but don’t wait too long,) print out multiple copies. Bring one with you to your next prenatal appointment with your provider, mail one to the hospital with your insurance paperwork, give one to each of your support people, and put an extra copy or two in your hospital bag. Discuss your birth plan with your provider, and evaluate his or her reaction to your choices. If you find that your provider is not receptive to your plan or your wishes, try to find out why, and if you are met with a great deal of resistance, you may want to consider switching providers. Also, discuss your plan with your support team so they have the opportunity to clarify any questions they have.

Building a birth plan can be an empowering experience and bring you closer to feeling confident in your ability to birth your baby how you would like. When I was in the nitty-gritty of labor, I was not capable of listening to my options with a critical ear, much less making decisions. I felt a sense of confidence knowing that I wouldn’t have to articulate my wishes, because they were already laid out on paper for anyone with questions to reference. A birth plan may not be an insurance policy or guarantee that your labor and delivery will go exactly as you envision, but it will help you focus on your task at hand: birthing your baby!

 Go back to: Step #3: Selecting Tests and Procedures for Prenatal Care

Go ahead to: Step #5: Learning About Routine Interventions in the Hospital

Go to: Birthing Methods Menu

Published in Birthing Places

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