Childbirth Preparation: Prenatal Ponderings

Today pregnant women need to be consumers and self-advocates. Many childbirth classes are teaching strategies to better these skills. This is not by chance, but rather by the often one-size-fits all packaging and management from pregnancy onset to labor through immediate postpartum in the care provider offices and hospitals of today.

Many routine tests are done prenatally. Though prenatal care and these tests can help further healthy outcomes for moms and babies, too often women can be funnelled into a cycle of unnecessary fear, stress and choice limitation while in reality still healthy and maintaining normal pregnancy.

Below is a listing of common prenatal tests and practices for you to question (what is it for, what does it improve upon, what can it lead to in other tests or interventions, is it for low-risk moms and babies, what will I do with the information), research and decide on are:

• pregnancy test by urine dip or blood work
  
• ultrasound to date the pregnancy
  
• blood pressure reading each visit
  
• weight measure each visit
  
• urine test - check for protein in the urine
  
• fundal height measurement as pregnancy furthers
  
• gestational diabetes testing
  
• triple screen testing (AFP)
  
• just because ultrasounds
  
• ultrasound for fetal size
  
• routine ultrasound for fluid level as "due date" approaches
  
• biophysical profile(s) as "due date" approaches or passes
  
• membrane sweeping
  

It is vitally important that you are equipped and aware of your care provider's philosophy and usual practices.

What are you willing to do? What are you willing to bypass? How responsible for your pregnancy and birth are you willing to assume? At the end of the day you are ultimately the one who has to live with the choices you or your provider make.

Be a driver - you are more likely to arrive at the destination you desire.

Push! Bringing Baby Forth During Childbirth.

"Pushing felt good." "The urge to push was unstoppable." "I felt like I was going to split apart." "It hurt so much more than I thought it would." "I didn't want to push." "Why did I have to hold my breath and tuck my chin?" "Why were people yelling at me?" "All I wanted to do was breathe and not push." "What is the deal? I was told I couldn't get a baby out on my side, squatting, hand and knees or when I arched my back and threw my head back." "If I would have pushed in another position would I have torn so much?" "Would I have avoided a cesarean pushing in another position?"

The myths surrounding pushing in our culture are widespread. Over and over women are told unless they push in the "C-position" or reclined position with tucking chin and holding breath "purple pushing" there is no way they can effectively push out a baby. Interestingly, when not coached, most women choose to squat, stand and lean or use a variation on hand and knees to deliver their babies.

So why are we told there is only one way to effectively deliver a baby and expected only to do that?

Here a few reasons I have come up with:

• 98% of babies in USA are born in the hospital versus at home or birth centers with midwives.
• Most OB's are not trained to catch in any other position, are trained to see with their eyes for one orientation, and do not know how to "see" with their hands.
• In hospitals, nearly ALL women - in some areas close to 100% are medicated with narcotics or more likely with epidural anesthesia.
• Beds are almost used 100% for hospital deliveries versus a birth chair, birth stool, toileting, squat bar, standing or leaning.

Using alternate positions in pushing (unless you are a small percentage of women who prefer the "C-position"), can reduce trauma to the perineum, shorten pushing time, allow for movement of tailbone thus opening the pelvis more, can lessen stress on the baby, and give mom more sense of control over the birth.

Using alternative breathing techniques other than holding the breath as in directed pushing to a count of ten or more can allow for baby to get more adequate oxygenation and be a more gentle process for both parties. A mom may spontaneously push while breathing non-specifically, she may grunt and growl, she may hold her breath for a moment and then exhale several times during a pushing episode, she may do a slow-exhalation with mouth relaxed and slightly open (open-glottis) while pushing, breath slowly/rhythmically and not push actively allowing for passive dissent of baby through contractions.

Most un-medicated or lightly medicated women will choose a position and breathing style that works for her in the event she is allowed to trust her body, trust the process and feels supported. We don't really need to do anything.

I urge you to have deeper conversations about pushing and delivery with your care provider BEFORE you go into labor.

• Find out what positions your provider is comfortable or willing to catch in.
• Ask about use of compresses and perineal massage
• Ask about only using coached pushing if really needed
• Ask about percentage of women under provider care "require" an episiotomy
• Ask how long pushing will be tolerated
• Ask your provider what his or her philosophy about pushing and delivery is.
• Ask for evidence to support practices. Actual studies not just verbal.
• When you arrive at the hospital, speak to the nurse about what you want to do and the what you and your care provider have agreed upon.

Here's to pushing with confidence, using your instincts and following your body!