the birthologist

It's all in how you look at it.

I set out tonight to write about our society's unnatural obsession with comfort and fear of any kind of pain, how that translates to a gross overuse of pain medications during labor, and how we are willing to overlook and rationalize myriad risks in order to satisfy our need to be comfortable, but everything I wrote sounded like a condemnation of pain medications. After several rewrites, I was left with just one point I can make and maintain some neutrality on the issue.

Pain is not always a bad thing. We choose to move through excruciating physical pain to finish marathons and climb mountains and we attend 8 years of intense schooling to receive advanced degrees. We push ourselves to do extraordinary things because we know that is the only way to experience extraordinary feelings. Why, when it comes to childbirth, are we as a society so focused on making it as painless and “easy” as possible?

There is a difference between pain and suffering, and not all women suffer during labor, despite the incredible amount of pain they feel. Labor can be an incredibly rewarding and even enjoyable experience with the right preparation and attitude, with or without medications. I recognize that not everybody wants to attempt an unmedicated labor. But it would be nice if people would stop assuming that nobody “should” want an unmedicated labor, and that anyone that does must either be crazy or a masochist. If a woman chooses to, she can accept the pain, work with her body, and achieve what is, in our culture, extraordinary.

Ain't Nothing Like the Real Thing, Baby!

How will I know when I'm in labor?  This is a very common question in my childbirth classes.  I myself remember being very nervous about knowing the exact moment labor would start when I was expecting my first daughter.  I envisioned all of those movies and TV shows where the woman would say to her partner "It's time," then the two of them would drive at about 90 mph to the hospital, and even then they would barely make it in time.  According to Hollywood, an average labor lasts about 25 minutes.  In reality, only a very small percentage of all births are precipitous (lasting less than 3 hours from onset of contractions to delivery), so the majority of us have ample time to realize we are in labor, prepare to leave, drive to where we are going to deliver (if we are leaving home to do that!), and labor some more before delivery.
So how do you know when labor has truly begun?  For about 90% of women, the beginning of labor is actually quite subtle.  It begins with short, mild contractions that are spaced pretty far apart.  I know, I know, this sounds a lot like the whole last three weeks of pregnancy for many women who have Braxton-Hicks (or practice) contractions.  The way you can tell "real" labor contractions is that they do not go away no matter what you do.  In fact, these contractions progress-- they get closer together, longer in duration, and more intense.  Most doctors and midwives want you to come to your chosen place of delivery during active labor, normally when your contractions are about 5 minutes apart.  You will want to check with your care provider for their preference and guidelines.
The other 10% or so of women have a more obvious start to their labor when their water breaks (the amniotic sac surrounding the baby and all the amniotic fluid breaks open and water leaks out). This causes women to experience anything from a slow trickle to a large gush of fluid.  If you even kind of, sort of think you might possibly, maybe be leaking something that could be amniotic fluid, it is a good idea to call your care provider.  Better safe than sorry!!
Have you ever met a woman who said "One minute I was standing there, and the next minute my baby fell out of me!"?  Me neither.  Labor starts slow for a reason-- so you have time to work up to those whopping contractions at the end, and you can psychologically prepare to give birth.  You will not miss it!  That being said-- there are always exceptions to every rule, and some labors do progress faster than expected.  The most important thing you can do as an expecting mother is to trust your instincts. Know that it is better to call or even go into see your care provider for ANY reason, than it is to wait because you don't want to be wrong.

Squeeze and hold.

One concern both men and women express about pregnancy and childbirth is how the experience will change their sex life.  Many factors will, in the end, contribute to a couple's return to intimacy, but there is one thing that women can do to help-- kegel exercises.  Ladies, they're not just for senior citizens!
Kegel exercises are contractions of the pelvic floor muscles.  These muscles not only support all your pelvic organs (i.e. your bladder, intestines, etc...), they are also responsible for continence and sexual sensation.  All women should practice these contractions daily, particularly before, during and after pregnancy.  Men can do them, too, but will not find them as life-altering as women will.  In case you haven't tried kegels before, let's try some together!!  There is no time like the present, and no one will even know you are exercising.
Get comfortable wherever you are, take a deep breath in and out, now squeeze the muscles between your legs, like you are holding in urine (not your buttocks muscles-- we're not trying to tone your butt!).  Hold for a count of ten, then release.  Be sure you relax completely before you try it again.  If you have never concentrated on these muscles before, it may take a few tries to master the proper contractions.
To help maintain continence and preserve sexual sensation, try doing 10 kegel exercises, 2-3 times per day.  Not only will your partner thank you, you will thank yourself when you are the only 84-year-old woman in your retirement community who does not wear Depends!

There were three in the bed and the doctor said...

    For many new parents, where their baby sleeps is a more complicated decision than expected. I have talked to so many moms who, while expecting, spent countless hours and hundreds of dollars decorating and furnishing the nursery, only to find that their newborn will not sleep unless he or she is being held (myself included). Mom and Dad do what they have to do in order to get as much sleep as possible, and before they know it, the baby is not a baby any more! The nursery goes virtually untouched until the new family is ready to embark on the long and sometimes painful process of moving the baby (or child) into his or hew own room. I also know a few couples who have planned to co-sleep in a number of arrangements, only to discover that Mom and /or Dad cannot sleep well with the baby in the same room. This family has to quickly find a new sleep space for their baby in order to preserve their own sanity. Just like most aspects of parenting, it is rare that sleep is easy or even predictable.  
    Although many friends, family members, authors, and care providers will offer what seem like “rules” about your baby's sleep habits, I am here to assure you that there is no right way to get your baby to sleep. All you need to be concerned about is safety. The true experts on children's sleep (in general) is the American Academy of Pediatrics, THE resource for evidence-based advice on children's health issues. They have a great pamphlet called “A Parent's Guide to Safe Sleep,” available on their website. This pamphlet is as close as you will get to the real “rules” about sleep, and you might be surprised how many options and scenarios are available to you even after you make sure you are practicing “safe sleep.”
    The only expert on YOUR baby's sleep is YOU! No two family's sleep needs are the same at any stage of life, including when there is a newborn in the house. Anyone who tells you your baby “must be sleeping in a _____” or “should be sleeping __ hours at a time” had better have spent at least a week sleeping at your house and be familiar with the latest research to know what they are talking about! Following the AAP guidelines as closely as you feel comfortable, you can come up with a sleep solution that works for your family NOW. It doesn't have to-- and probably won't-- be the right solution forever. Trust your instincts and your baby, and continue to adapt as needed, and you will find a way to get enough sleep so you can enjoy your life!

So many choices, so little substance.

I recently added a list to my blog of my favorite magazines.  You will likely notice that the list is pretty short-- only three magazines.  And only one magazine about parenting!  This is not because I dislike magazines; quite the contrary.  I really enjoy magazines because the article lengths tend to be short enough for me to actually finish in less than a week.  

If there were more magazines published that I considered worth reading, my list would certainly be longer.  I am particularly ashamed by the lack of good parenting magazines available.  Every one I have ever laid my hands on have been nothing more than a beautified representation of trends that results in my feeling what can only be described as mass peer pressure to buy an expensive diaper bag or feed my baby the same baby food as Brooke Shields.  Not that I have anything against Brooke Shields-- she seems like a lovely person.  I just don't think she is qualified to tell me how to parent.  In fact, I don't think anyone is qualified to tell anyone else how to parent (not even me!).  

That is why I am such a fan of Brain, Child Magazine.  The articles are well-written, interesting and timely, objective when they need to be, enlighten me about different parenting styles within and out of our culture, and respect my right to make the choices I need to as a parent.  Fortunately, it only is published quarterly; it takes me about three months to get the whole thing read because I read it cover-to-cover.

Isadora's Birth, Conclusion.

The car ride to the birth center was nothing short of horrible. Bryce was driving our van with Janet in the back to help me stay calm. We were leading a caravan of people who did not know how to get there, so Bryce had to drive reasonably slow and make sure everyone made it through all the lights together. I used all my will power to keep myself from yelling at him more than once to go faster. We walked into the empty birth center at 3:09 pm. The girls immediately situated themselves in the family room with their new DVD's and coloring projects. My sisters, Dori and Abby, and my friend Tina arrived shortly after we did. I was so happy to be there, and asked to fill the tub, because I was ready to try these giant tubs I had heard so much about. I went to the bathroom again, which was really painful because every time I stood up I would have a contraction and they hurt even more when I was squatting. With my bikini top on, I slid into the tub, and immediately felt more relaxed. I tried several positions in the tub, but really just wanted to lay on my back, stare out the window and moan.
Although I was curious about how far along I was, I did not ask the midwives to check me. I could tell by the intensity of the contractions that I was close. Sydney and Ivy came in and out of the room to check on me, but did not like the sounds I was making. We had talked a lot about those sounds for months before the birth, and I had even shown them several videos of unmedicated births so they would know what to expect and be less scared. It worked-- while they didn't like the sounds, they weren't bothered. They just went in to the family room to play while I worked. It was so nice to have the whole birth center to ourselves; we could roam around and felt totally at home. All of our friends and family who were there for the birth also made sure the kids were taken care of. I had nothing to preoccupy me-- my job was to labor as comfortably as I could.
As I stared at a leaf blowing in the breeze outside, I started to get desperate. I kept repeated two phrases over and over again: “I just want this to be over” and “I am never doing this again.” My contractions were hard enough to make me moan so loud I was almost screaming, but still not less than five minutes apart, so I got a decent break in-between. Just when I was ready to ask them to check me, I felt myself begin to bear-down during a contraction. I did not realize that I was doing it at first, and when I could tell I was pushing, my midwives, doula, husband and audience all agreed that I looked and sounded like I was pushing. It did not feel totally right, and I know that pushing should not hurt that way, so I asked my midwives to help me. The student midwife checked me, and told me that I was completely dilated, but I did still have a small anterior lip left, which was probably why I was feeling pain when I pushed.
Then she did something I was not familiar with. She held the lip of my cervix back so I could push the baby past. As soon as she did that, the baby moved down very quickly and I started screaming even louder. My audience was summoned as close to the tub and they could get, and the girls were brought in. They chose to leave for the loud part, and asked to be called in as soon as the baby was out. I remember feeling my hips parting and the baby moving through me as I pushed through two or three more contractions, still with 2-3 minute breaks. Bryce was behind me holding my hands while I pushed and screamed, pushed and screamed. My midwives reminded me to concentrate on pushing with my mouth closed, and not to scream so much-- it was taking too much energy. I was working so hard, I felt limp at the same time as I felt positively electrified. My body was exhausted, but could not stop the process-- all I had to do was go with it. I kept thinking about Baby's face, that I would finally get to see her face. I pushed with the pain and let my body do what it was built to do. Even as I cried and panted with pain, I was not afraid. I was thrilled.
I felt the stretching that I knew meant she was almost born, and Nicki took over holding my hands so Bryce could move down to the other end of the tub to catch Baby. My eyes closed, I concentrated on the sensation of my baby moving through my body as I screamed her head out. I knew this was probably going to be my last baby, so I'd better make the most of it, and even at that intense moment, I was overwhelmed by the wonder of what I was doing. One of the midwives encouraged me to touch her head, a feeling I will never forget. I ran my fingers over her soft hair, wrinkly scalp and hard skull, and then my body around it. As soon as I knew her head was out, a surge of energy took over, and there was no stopping me. I was going to get her out NOW. I did not stop pushing until she was born. As her whole body emerged, I felt what I can only describe as an orgasmic energy radiate from my excruciatingly sensitive birth canal to every part of my body. Every part of me, including my brain, felt positively magnetic.
Bryce placed her soft, warm body on my chest as I cried with relief and joy. Baby and I took our first looks at each other. Her dark eyes gazed and blinked, and she stared directly into my eyes, as if she knew already that I was her mother. As I panted and my body shook from the new freedom it felt, I smiled and cuddled Baby and told her it was okay, it was all over and she could rest now. I was instantly and profoundly changed, a new woman entirely from the one I had been just a moment ago, just as I had been after Sydney and Ivy's birth. Baby stayed quiet for a while after her birth because her cord was still attached, so she was still receiving oxygen from the placenta. When the cord stopped pulsing, Bryce and Sydney cut it together, and Baby was officially free. I looked over my right shoulder, to see Bryce and both girls also staring at Baby. We worked hard to make sure the girls were ready to attend the birth, and it all paid off at that moment. Sydney and Ivy had come into the room just as Baby was born, and were right there to share an irreplaceable family moment together, which is what Bryce and I had hoped for. The girls got to see their sister in her first seconds of life, and were a big part of her entrance into the world and our family.
Even as I was enjoying the end of labor, my labor was not actually over yet. I could feel the cord still between my legs, and I remembered I had one more job to do. My midwife was holding the cord tight, but could not yet feel it moving. This kind of situation is when it is better to NOT know what is going on. I am well aware of the complications from a placenta that will not detach, so I momentarily had to think about something other than the sweet new baby and the awesome relief. It appeared that the placenta was stuck somewhere in my birth canal, and I was asked to stand to help the process. Bryce's shirt was off in a nanosecond as he took our new baby to the bed to have some skin-to-skin time together. I remember telling my midwives that I was scared about what was happening. I was so preoccupied with my placenta, I did not mind giving Baby to my husband for a few minutes. In fact, now that I have seen the pictures from that time, I am so glad they got to be together! Once I got out of the tub and sat on a birthing stool, I was able to easily “cough” the placenta out (literally, I coughed hard, and it slid out).
My labor finally complete, I hobbled over to the bed that Bryce and Baby were snuggling in, and joined them. A blue waterproof pad was on my side of the bed, and I received my first pair of the lovely, one-size-fits-all gauze underwear to hold my giant pad in place. Isn't postpartum fun? I gently lay down in bed and removed my cold, wet bikini top. It felt really good to be naked. Although I was far from it, I felt really clean and light. My whole body felt empty, but empty in a good way-- I was without pain, without fear, without anything attached to me, and without Baby. I was strangely unencumbered and light. I can understand why this sensation causes so many women to grieve; for the first time in 40 weeks they are truly alone. For me, at that moment, I felt so free, I was ecstatic. We took some new family pictures and before long Baby was already rooting. Fortunately, breastfeeding came easily to her (the next week or so would not be so easy on my nipples, though). I started hearing everyone asking what her name was, and Bryce looked stressed. It was his job to name this baby, a right I had jokingly promised him when he agreed to have another child. He took me to my word, though, and by the time I went into labor, he had a LONG list of favorites to choose from. In the first hour after her birth, he narrowed the list to three full names, but could not bring himself to choose one.
Bryce finally resorted to asking the girls what they would like to name Baby, and it was a consensus between the three of them. He asked me what my favorite was, but I refused to be the one to choose-- I liked all three, and this was his big decision. After a while of hemming and hawing, we announced to those left in the room that her name was Isadora Ruth. Isadora was a name Bryce liked, and Ruth is a family name on my side (and, of course, my name!). Bryce, Sydney, Ivy and I all marveled over our gorgeous new Isadora-- her perfect fingers, her kissable lips, her round head and dark hair, her soft tummy, and her riveting charcoal eyes. Newborn babies are magic. The rest of our time at the birth center was spent getting evaluated and debriefed by the midwives and preparing to go home. Oh, and eating!! What a workout labor is. The meal I eat after giving birth is always the best I have ever eaten, no matter what it is. This was my first out-of-hospital birth, so my first meal was not hospital food, and it was even better than usual! Four cheese baked pasta with chicken. Mmmm... I left the birth center two hours after delivery.
I hope you have enjoyed reading the story of Isadora's birth. I cannot tell you how difficult and invaluable the process has been for me. When Bryce reads this I am sure he will want to make some amendments, as my recollection of the experience is probably skewed, but I do not plan on changing anything, because I want a record of MY memories. All new mothers should write their birth stories down as soon as possible afterwards. Think of how appreciative you and your children will be when they are grown and you can still recall so many details of their birth! Parenthood messes with our memory-- the more we write down about our experiences, the better. If you want to see pictures of the birth and my family, please see my flickr page.