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!

Childbirth in the hospital - Navigational Tips

There are many reasons why a woman chooses to birth in the hospital. Women have the right to choose where and with whom she will birth regardless of what another would choose.

Women need the tools to navigate the hospital setting. She and her baby ARE unique. They are human beings. Laboring women are often placed under one-size-fits-all standing orders and protocols. Because of this, pregnant women need to be very careful regarding the books read, the types of birthing shows viewed, the care provider chosen and the childbirth class taken prior to entering the hospital to birth.

Here are some tips for a truly healthier and safer experience:

• Take the hospital tour - ask lots of questions - induction rate, induction medications and/or procedures routinely used, average cesarean rate for first time moms, VBAC rate, pitocin use rate, epidural rate, use of non-medical pain relief, natural childbirth rate, IV use versus heplock, percentage of moms who utilize doulas, is pain management highly suggested to every laboring mom, monitoring norms, availability of tub or shower for labor, standard protocol on eating and drinking in labor, use of non-supine pushing positions, mobility in labor, are the labor and delivery nurses open to anything goes in labor, what is protocol on immediate postpartum baby care, is there a lactation staff available....
• Read the pre-admit paperwork. If you are not sure what it says, ask a paralegal or lawyer to look at it. Be certain that you agree with what you are signing. Do not sign epidural consent form or cesarean consent form at pre-registration. You want to be fully consented during true decision making time. Be sure though to be familiar with benefits, risks and consequences of everything ahead of time.
• Take a non-hospital childbirth class.
• Only agree to induction for a true medical reason - (suspected big baby, pre-pre-eclampsia, being tired of pregnancy, care provider going on vacation, relative will be in town, being past your "due date", just because you can - are not medical reasons)
• When induction is necessary - choose a foley catheter to ripen the cervix over misoprostol (cytotec, miso, or the little pill) and if labor establishes upon cervical ripening - decline pitocin or ask to keep it very low over a longer period of time.
• Keep your "water" (amniotic sac) intact until it breaks on its own. This can keep infection probability much lower, lessen risk of cord prolapse, and lessen the discomfort of contractions among many other things.
• As long as a mom and baby are low-risk - wait until well into active labor to arrive at the hospital - contractions 3 minutes apart and lasting a minute or more. Shortening the time in the labor and delivery room usually keeps interventions and medications to a minimum.
• Any birth and immediate postpartum preferences need to be discussed PRIOR to labor with your care provider. A concise birth preference plan can be given to the nurse upon arrival.
• In the event a cesarean is necessary (hopefully not created by interventions and medications in labor), discuss with your care provider prior to labor what you would like to have occur (partner in OR, no separation of baby from mom, pictures taken, etc. - for a complete list, please email me).
• Make postpartum baby care decisions prior to arriving at the hospital. You do not need to have a pediatrician or family practitioner picked out ahead, as the floor doctor will oversee your baby's care. If you are unsure of what you want, it is always acceptable to delay any immunization, vitamin K injection, eye ointment, etc. until you have the opprtunity to investigate further. As a parent you have the right to say yes or no to anything.

The key thing to remember is that as a consumer, you are paying your care provider for a service, for the hospital staff to attend you respectfully, and for the use of the room you are renting. You do have rights. Protocols and practices are not laws. You can say yes or no to anything or everything.

As a woman you are making parenting decisions throughout labor, delivery and early postpartum that should be respected, honored and can have lasting consequences. There is no do-over.

Remember to be a driver - not a passenger!

If Grandma can do it, so can you. Birth that is.

So the idea that women just aren't the same these days and no longer able to spontaneously go into labor or birth in our society has been bounding around in my head for weeks spurned by re-reading an inspiring story written by a local doula. I have read this story many times and each time I am struck by the power in it. As I initially sat down to write this blog a week or so ago, I thought I really need to include this writing so I spoke with the author Gina P. She graciously gave me permission to use the story knowing it would be forever in cyber space. I have chosen to edit down the story a bit to retain more privacy and am abbreviating the name as requested. Please enjoy.

Grandma C

"... She was born in 1911, and contracted polio as a child, leaving her with a hunched back and a contracted pelvis. ...Her first son was born in 1931. He was a large baby, but she welcomed that in a time when babies often died. Large meant healthy. Her second son was born in 1939, another large boy, and again healthy. In 1945, she was going through menopause and found a mass in her abdomen. She had exploratory surgery to find the mass and remove it, but when my mom was found in her uterus, she was stitched back up and pleased to carry a baby to full term. My mom was born vaginally after this surgery, a footling breech. Again, her contracted pelvis, small stature, and psychological barriers were no problem, and she had an otherwise uncomplicated birth with this baby! She lived to be 92.

When I see or hear about the inherent disbelief that babies can be born for whatever reason, I tend to think about my Grandma C. She really had the odds stacked against her in many ways throughout her life, but having babies was never a problem for her. She didn't know any better than to just give birth. It makes me cry to see how some (most?) women feel about their uterus, pelvis, cervix, and vagina. And how this is perpetuated. Grandma C. was shamed by society to keep even the normal processes like menstruation a secret from anyone (unfortunately, even my mom), but she gave birth because it was her job as a wife and mother. And if it wasn't a problem for her, I wonder how many of the problems that are discussed with other women nowadays are true. I wonder how much of her hard work keeping house and tending older children helped her to give birth. At the end of her life, Grandma C. was ridden with dementia, and she would tell a few stories over and over again. I listened each time as she would tell of life on the farm as a young girl and how much of a burden she had to carry. But giving birth was something she felt she did pretty well.

About the author: Gina is a birth doula and childbirth educator in Colorado who strives to help prevent primary cesareans and to support all women who want a VBAC. Viva la revolucion!

By today's standards would this strong, capable and physically imperfect woman be "allowed" to just birth? The disturbing truth is NO she likely wouldn't. She would almost assuredly be told she couldn't ever birth children, that she is far too physically broken, and if she did carry a pregnancy to term that she must have a cesarean to safely deliver a healthy baby and mother.

By no one telling her she couldn't do it, she just did it. She knew it was one of her jobs in life. A usual expectation. I would venture to guess it wasn't easy, but nothing worthwhile is ever easy.

I will echo Gina and question, how much of what women are led to believe today is not based in truth? How many women are led down the path of fear to induction, medication, instrumental delivery or cesarean because they are being told over and over they cannot or should not labor and birth normally? Too small, too skinny, too fat, too young, too old, too scarred, too imperfect, too overdue.....This is not true. We need to stop believing that we inherently cannot.

Plain and simple fear instilling care, induction, augmentation, continuous monitoring, epidurals, cesareans and everything that goes with them - places low risk women and babies into a category of high risk, lessening the ability to JUST DO IT. Even truly high risk moms and babies are being hindered, but that is a note for another day.

Labor can be tough, it can be blissful, painful, orgasmic, you name it. It is anything and everything. My hope is that women will stop believing these lies and again start believing that it is something women are meant for, a normal expectation.

Be encouraged by Grandma C and all those like her. My heartfelt thank you to Gina for allowing me to inspire others with her writing.

Pax,

Desirre Andrews CCCE, LCCE, CLD, CLE
http://www.birthingtouch.com/

You can find the money to have the childbirth you desire!

I far too often hear women saying "My insurance doesn't cover the location, provider, type of birth I REALLY want. Well it will be okay anyway, won't it?." Or "We just bought XXXXX and cannot afford to pay for care out of pocket."

I wonder what are you willing to do to have the childbirth you deeply desire? It seems in other aspects of life when there is something we really want, somehow we find the time, money, etc. to attain it. Childbirth IS that important. Investing in what will help you achieve a normal birth can be preventative of unwanted interventions and cesarean.

Below is a list of ways to find the money for the birth center, family practitioner, home birth midwife, out of network provider, doula, independent childbirth class, waterbirth or whatever your heart is set upon to help in preparation and delivery of your baby.

A list of practical ways to find the money you need:

1) In lieu of traditional baby shower gifts (honestly much of the stuff is unnecessary to having a baby except for a good baby wearing item) - ask for a group gift of the provider or location payment (or at least monies to get you well on your way).

2) Trim down your budget - do you need the highest satellite or cable package, forgo eating out or picking up expensive drinks, forgo weekly entertainment expenses, have a yard sale or post on community boards all the items you do not use (your home will be much less cluttered for it), what about your cellular service - trim back if possible, sell your car and buy something less expensive, forgo expensive hair cuts or other beauty maintenance

3) Ask for family and friends to donate to your XXXXX fund.

4) Petition your insurance company to add XXXX provider or location to their provider list.

5) Figure out all your co-pays and see if you are really spending more or close to the same anyway for what you don't really want and can actually afford the care you really desire.

6) Set-up payment schedules with provider or location - often care can be paid for over the time of your pregnancy in increments.

7) Do you have a barter to offer? Try it!

8) Move to a lower cost home to save in rent or mortgage. Hey even moving in with family temporarily can work. Extended support is often a blessing.

9) Open a 125k flexible medical spending account (thanks to my DH for reminding me about this). This money comes out of your paycheck pre-tax and you can get reimbursed for out-of-pocket medical expenses in one calendar year, it lowers your taxable income and helps you attain what you want.

Sometimes sacrifice is needed. Sometimes just a bit of trimming. Being under the thumb of insurance or lack thereof doesn't have to define your options. Get creative. There is almost ALWAYS a way. It is worth it to you and your baby.

Merry Christmas! Desirre

Random Childbirth Thoughts - Do these sound too familiar?

These are quotes made up by a friend and I to cause a pause and thinking to occur. Sadly, they may sound very familiar to public opinion these days. This is meant to be a spoof, but also is a social commentary on how we as a society are giving up on the precious and magnificent work of normal labor and birth. As women, we are incredibly blessed to be the life growers and to bring life forth from our own bodies under our own power. The work of pregnancy, labor and delivery is just a glimpse into the daily work of being a mother. Motherhood like pregnancy through delivery is not always easy but at the end of the day worth it. I fear we are losing something of vast importance in our society.

This entry is biting and almost roast-like. Read with caution!

• "Not my mama's vagina! Mine is only for sex."
• "MY MRSA Antibiotics are so slimming..it was worth the infection I got during my cesarean!"
• "Ob's say Vaginas are no longer for non-sexual use due to stressors destroying the capability for penis use"
• "Men everywhere question the duality of vaginal use. Should they allow women to use their vaginas for birth?"
• "Women are just saying NO to multi-purpose vaginal use"
• "My vagina is progressive and evolved - no childbirth for me!"
• "Kegels, schmegels - just get the cesarean."
• "I thought to myself..they can't really do vaginal tightening..but I can always have another tummy tuck!"
• "It was GREAT being able to schedule my induction...and the baby being in the NICU for a week meant that I got plenty of rest and was able to shop without interruption!"
• "I was so ready for motherhood! I had a postpartum doula, a nanny and lots of dr. bronner's bottles! Oh, and once the baby came, the sleeper, the vibrating chair, the swing...they saved me! I never had to pick the baby up once! Just pacifier and away!"
• "No vaginal birth for me! I am a modern woman."
• "But none of my friends are using their vaginas for birth!"

Are you thinking yet? Screaming? Yelling at me? And by the way, it is okay to laugh.

Desirre

Childbirth Education - Think outside the big box location

So let's chat about childbirth education. Of the reported 30% of expecting parents who attend childbirth classes the majority go to the hospital where the birth is planned instead of seeking out independent options. I want to challenge you to think about how strange that is. Does it make sense that the information presented will REALLY be balanced, unbiased and evidence-based? Many protocols and practices used during labor and delivery in the hospital are designed as a one size fits all, no suited to each individual mom and baby. More importantly, they are not designed to suit the usual low-risk mom and baby (the majority of moms and babies are normal and low-risk), but can actually make a mom and baby appear or become high-risk. Some refer to hospital classes as "good patient preparation" classes because of lack of inclusive information. I will admit, that all hospitals do not offer education in this manner, however, in my experience and research many sadly do.

If a car salesman tried to sell you a car and actually insisted you purchase the specific color, make and model he/she decides for you, would you buy it? You would hopefully say no thank you and leave. How dare some one make such a huge decision for you. How long do you research a piece of electronics or a computer, even a cell phone plane before deciding? Even the pair of shoes you are wearing. Did you have to try on several before finding the right pair?

So why not think outside the big box, one size fits all class? Every mom, baby and partner deserve to know the wisdom of birth, understand what is normal and how to stay that way, when the abnormal happens what to do and be a skilled consumer.

There is no re-do here. This time is too important to leave to chance and inadequate education.

This is at the essence of why I teach my own childbirth classes at a location outside the hospital. I am able to freely give full spectrum information without restriction, bias or without the fear of losing my position.

Your birth matters to both you and your baby, to your future fertility, to your confidence as a mother

Below is a list of options available to families all across the US and variations in other countries as well (if if any class types have been overlooked, please let me know and I will add it).

• Independent - philosophy based (CAPPA, Lamaze post-2000, ICEA, CBI, ALACE, Birth Works, Birthing From Within)
• Independent - method based (Bradley, HypnoBirthing, Hypnobabies
• Self education

There are many other great ways to find a class that suits you.

• Ask around in your community
• Attend birth circles, Birth Network, La Leche League and/or ICAN meetings
• Seek out local doula groups and information nights
• Check out sites like Independent Childbirth

Here's to finding the perfect fit and gestating in peace.

Desirre

Individual fit: Who and where you choose during pregnancy and childbirth matter.

Picture this: An expectant mother is preparing for the birth of her baby. She chooses the care provider her friend, co-worker or family member recommended, she is reading the most popular books on pregnancy and birth (she doesn't know there are any others to choose from - everyone is reading these), she cannot help herself as she watches hour upon hour of those baby and birth shows on t.v., people tell her their birth stories and to just get the epidural (after watching those birth shows and hearing THOSE stories she is beginning to think it might just be a good idea). Right now, she is pretty sure she doesn't want to be induced (she heard it hurts more, but knowing when the baby will come is appealing) or have a cesarean but other than that she is leaving it up to her care provider.

Now she starts her childbirth class. This class is based on normal birth and evidence-based practices. Hm those books she was given are SO different than what the instructor says during class. The instructor doesn't even recommend those books but a host of other books and websites. She begins to wonder what her care provider really thinks and believes about birth. Also, what birth philosophy and practices her chosen birth location has.

I have written a list on choosing a care provider and birth location that is right for you. This is too important to make decisions without extra thoughtfulness and investigation. The key to this information is remembering you are the one purchasing a service. Essentially you are hiring a catcher with medical expertise and renting a room to birth your baby (if you are going to the hospital or birth center).

Choosing the place of birth for your baby - It is incredibly important that you understand where you fit best prior to choosing where to birth your baby. Take hospital and/or birth center tour, call and talk to L&D floor, get facts on home birth by talking to home birth midwives, other moms who have had home births, online and in books.

• Does the location offer what is most important to you (tubs, birth balls, wearing own clothing, intermittent monitoring, etc.)?
• What are standard protocols that are followed?
• Does location routinely use methods that turn a low risk mom and baby into high risk patients?
• Are waterbirths available?
• Are birthing stools or non-reclined pushing and delivery positions encouraged?
• What is the no/low intervention rate?
• What is the epidural rate?
• What is the cesarean rate? Does the hospital support VBAC’s?
• Are mom and baby friendly practices used? (no routine interventions, no separation of mom and baby, breastfeeding is the norm, movement in labor is utilized, etc.)

Points to Ponder afterward -

• Will I be able to have the type of birth I truly desire?
• What location will I ultimately feel most comfortable in?
• What location is ultimately safest for my specific needs (I am currently low-risk or high risk)?
• Is insurance or lack of it the reason I am choosing the location?
• Do I have realistic expectations for the location?
• Am I willing to take responsibility for my birth in the location?
• Is staff open to working with a doula?
• Is staff willing to work with natural childbirth practices?
• Are there any compelling reasons to choose one location over another?

Choosing your care provider - Use this as a template for the interview process or to be certain you are of the same philosophy and belief system.

• What is his/her birth philosophy?
• What is philosophy of pregnancy?
• Has provider seen normal labor and birth? How often?
• What percentage of patients have medicalized births?
• How is the "due date" approached? When is “overdue”?
• Will you answer questions over the phone?
• How much time will you spend with me during each appointment?
• What if I hire a doula? Are there restrictions on the doula I may hire? If yes, why?
• Do I need a childbirth class? Breastfeeding class?
  o Are there restrictions on the type of childbirth or breastfeeding class? If so, what and why?
• What routine tests are utilized during pregnancy? What if I decline these tests?
• What are routine intervention rates? (IV, AROM, continuous monitoring, etc.) Cesarean rate? VBAC rate?
• Induction rate? What induction methods are used?
• Is natural, normal labor and birth supported?
• What positions is care provider comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing?
• If I choose an epidural, when can I get it or when is it too late?
• How often is episiotomy used?
• When would forceps/vacuum be used? Which method is CP comfortable with?
• What about a birth plan? Will desires be put into my file at the hospital so the nurse and/or back-up will know what has been agreed to?
• Are there any protocols that are non-negotiable?
• What if I choose to decline something after careful consideration?
• Is an on call rotation utilized or does CP attend all own patients? If there are partners or an on call rotation, do EACH of the others share in the same birth philosophy and approach to birth?

Points to ponder afterward-

• Did you feel immediately comfortable at the interview?
• Were or are questions specifically answered or is the answer “only when necessary” without additional information unless pressed?
• Was or is care provider willing to answer questions in detail without being annoyed?
• If already with a CP, do you feel comfortable and heard at each appointment?
• Is choosing your care provider based on your insurance or lack of insurance?
• What are you willing to do in order to have the birth you really desire? Birth location?
• How much responsibility are you willing to take for the health care decisions for you and your baby?

Cesarean Avoidance - Tips For Every Woman

Yes you DO want to avoid a cesarean whenever possible. Cesarean is MAJOR surgery. It is not just another way to give birth. Both women and babies are well designed to give birth often never needing intervention of any type.

Cesarean can be a life-saving technique and used well for some serious medical conditions, including but may not be limited to placenta previa, HELLP syndrome, uterine rupture, placental abruption, cord prolapse, some breech presentations, true fetal distress, vasa previa and high order multiples.

Approximately 50-67% or more of all cesarean surgeries performed in the U.S. are likely unnecessary or become "necessary" from iatrogenic influences (non-medical inductions, AROM, pitocin augmentation, epidural or spinal anesthesia, "fetal distress", suspected big baby, lack of mobility, continuous fetal monitoring, pushing positions and/or technique).

Here are some tips to help you avoid a cesarean and have a positive vaginal birth.

• Get educated: Book to start with - The Thinking Woman's Guide To A Better Birth by Henci Goer, Ina May's Guide to Childbirth by Ina May Gaskin, The Official Lamaze Guide. Giving Birth with Confidence by Lothian and DeVries. Seek out websites that use evidence-based information and normal birth practice information. TURN off the t.v. from the dramatic birthing shows unless you watch with a discerning eye to figure out what could be done differently and why. Seek out local resources such as La Leche League, Birth Network, Birth Circles and/or a local ICAN chapter to learn from other women. Take a childbirth class that is not a good patient preparation class. Take an independent evidence-based class that gives you tried and true techniques along with the communication skills to use your consumer voice. Study and learn about your rights as a pregnant woman, informed consent/refusal and all the usual interventions and medications (induction, augmentation, AROM, epidural, monitoring, etc.).
• Interview Several Care Providers: You want to find out what the raw data is for inductions, interventions, epidurals, episiotomy, cesareans, VBAC's and so on. It is important to get at the core philosophy of the care provider. Email me at desirre@birthingtouch.com to receive my handout on this.
• Interview several and hire a Doula: You want a doula who will fit into your philosophy of birth and labor/delivery needs. One size does not fit all.
• Use normal birth practices: Stay home as long as possible in labor (if having an away from home birth), choose a care provider who supports and believes in you, use a variety of natural coping techniques, opt out of routine induction, opt out of continuous monitoring unless high risk, opt out of routine augmentation, opt out of routine epidural or narcotic use, opt out of routine pushing position, limit vaginal exams, use mobility, TRUST yourself, LISTEN to your body and baby, accept responsibility for your decisions, BE confident that you are designed for this task.

I hope this has given you a jumping point to go out and birth!

Happy Thanksgiving.

Desirre

http://www.cdc.gov/nchs/data/hestat/prelimbirths05_tables.pdf#1

http://www.ican-online.org/

http://www.lamaze.org/Default.aspx?tabid=171

http://www.birthingtouch.com/

http://www.childbirthconnection.org/

http://www.hencigoer.com/