Hurricanes and Babies

“To describe my mother would be to write about a hurricane in its perfect power.” - Maya Angelou

As a doula, I can't think of any better way to describe the great storm that is labor - growing and encompassing, opening and clearing the way for a new life.

As Tropical Storm Harvey gears up to shake, rattle, and roll Texas, I thought it might be prudent to get some Pregnancy Hurricane Preparation into my clients hands.

If you aren't planning to evacuate for the storm, here's a best odds for staying safe in the storm: 

• If your plan had been to labor at home for as long as possible, know that that plan should change and travel should probably be considered earlier in labor. 
• This website will help people in the Houston area to know which roads are closed for high water. This will enable you to map the best route more efficiently. https://traffic.houstontranstar.org/roadclosures/roadclosures.aspx?typ=hw
• Map out where your nearest hospital with L&D, your local ems, and fire departments are, just in case it's needed, and post it on your fridge. 
• Stock up on snacks and especially water, as water in general, and especially clean water can be scarce. 

Supplies Checklist for Pregnant Mothers:

• Comfortable traveling clothes, including closed toe shoes
• Food (nutritious snacks like protein bars, nuts, dried fruit, and granola) and water for 1 week and 1 week supply of medications
• Printed medical records, in case you need to go to another hospital
• Phone and Chargers
• Full tank of gas
• Emergency birth supplies, such as clean towels, sharp scissors, infant bulb syringe, medical gloves, two white shoelaces, sheets and sanitary pads

In case of an emergency, exclusive breastfeeding will provide the best protection for your baby. It doesn't require water, sterilization of any equipment or water, and doesn't require a heat source - lowering risk for baby during emergency. If you cannot breastfeeding, you should try to get single serve, already prepared formula. If you are a mom who relies on pumped milk, learn to express your milk by hand and have a few syringes and/or disposable cups on hand that you can feed your baby with.

Additional Resources:

http://www.marchofdimes.com/pregnancy/stayingsafe_disaster.html

http://www.marchofdimes.com/baby/environment_disaster.html

http://www.nhc.noaa.gov/

http://www.mymidwife.org/Guide-to-Emergency-Childbirth

Coping At All Stages - Immediately Postpartum

"For my first, I didn't get to hold him or nurse him until 1 in the morning. I had a bad reaction to the medication. We spent two days in the hospital where I didn't get much help breastfeeding. I was told I had to supplement with formula because of blood sugar. I didn't know about LCs or LLL. I struggled greatly and, at 3 months, stopped breastfeeding. The recovery from a cesarean was very difficult and I had issues doing anything for about a week and a half. 

For my second, after I birthed the placenta, I started to hemorrhage. So I was given some herbs and a shot of pitocin in my leg. I was taken out of the birth pool and onto the floor where they massaged my uterus. It finally slowed when my baby was brought to my chest. They cleaned me up, and I started to nurse. The next day the soreness and pain settled in and I couldn't lay down for a couple of months without being in pain. For about 10 weeks I camped in the living room with my rocking chair. I never went out and smiled and said I was fine. I was really horribly depressed. If it wasn't for a visit to my house by an LC, I don't think I would have kept nursing. It took me till 6 months out to crawl out of my depression. I got a part time job. I wish I would have known about ppd and known to work to process this birth, which was more traumatic in some ways than my cesarean. 

For my third, 6th hours after giving birth, we went to the chiropractor for adjustments. That night I was up and cooking dinner. No postpartum depression, no baby blues, just awesomeness." ~ Allison

"I had a small tear that they stitched up, I didn't even know the placenta was born. Nursing went fine. The anesthesiologist came in and had me sit up to pull out the epidural. That felt weird. I thought I'd be staying in that room - with all the equipment and stuff. I was pleasantly surprised when they came in with a wheelchair a few hours after M was born and said we were moving rooms. I was also wary of my ability to get up.  My butt felt like someone put a cue ball in it and my legs felt like velour. We got up though, and surprisingly I peed. My least favorite thing about postpartum was that I  had a nurse, lactation consultant, doctor, nursery nurse, pediatrician, or food delivery person in my room every. single. hour. Literally, day or night, every hour, someone was coming in. I didn't sleep well until I got home." ~ Amili

"After birth I was not prepared for all the blood and the pressing on the uterus and the stitching up. I used ibuprofen for awhile after birth and went home about 4 hours after he was born. I had one 2nd degree tear and even with it being minor, it wasn't fun for those first weeks. I spent a lot of time preparing for birth but not postpartum recovery, so a lot of it was a shock to me. I was sleep deprived as well and was so grateful for the help of my parents. I did do herbal baths though to help with healing. But yeah, the whole soreness and bleeding and emotional roller coaster, no sleep, and constant breastfeeding was veerrrrryyyy shocking." ~ Chelsea

"It ends up he pooped while I was pushing and they wanted to suction him. When he was back in my arms, he started nursing right away. It hurt. Some observations: no one told me about your legs staying up in stirrups and 30 minutes of strangers staring at your vagina. No one told me about your free postpartum massage; Fundal Massage my ass. No one tells you that birthing your placenta feels like birthing an octopus. No one told me that your tailbone can hurt for a long time after. No one told me that you would feel like your vagina was just in a boxing match with Mike Tyson.... But, also no one told me that I might change my mind about an early discharge and want to stay the full two days so I had 24/7 help. No one told me that I might really need and appreciate the nursery nurse coming in so often to assess his latch (and diagnose a posterior tongue tie a few hours before we left the hospital). Final thoughts, never underestimate the power of sitz baths and boppy pillows to sit on." ~ Liv

Read the rest of Holly's story on her blog, including her postpartum blog post and her cord burning post~ Holly

"We stayed this way with Cole only slipping in to give us a blanket (our request) so we could hold him. Our midwife only slipped in to check his heart rate and his breathing. About 15 minutes later they helped us out of the tub and to the bed. On the way to the bed my placenta fell out. They knew it was coming (we didn't) and caught it in a bowl. They took our food order and did one more once over on baby and I. I appreciated that they didn't bother us. My midwife and doula helped me get him latched, my midwife checked my bottom out and helped me get cleaned up, but then they both left the room to make us breakfast and chart. The placenta stayed in the bowl beside us with a chux over it. A little while later, my midwife came in and helped us with the newborn assessments and asked if I was ok taking an after-birth smoothie to help with my contracting (I wasn't bleeding heavy, just a little more than what she wanted to see). We cut the cord and our doula made cubes out of the placenta for smoothies (and brought one to me right then). My doula did the dishes, cleaned up the birth pool, and did a load of laundry. We just hung out in the bedroom and, after breakfast, nodded off. When we woke, our doula was gone, my sister had arrived and my midwife was packing to leave. My mom came the next day (and my midwife to do the 24 hour assessment), and my postpartum doula came the third. I felt cared for and checked in on." ~ Trinity

"My doctor pushed on my fundus (holy owie) and pulled on my placenta to get it 'unstuck' (owie owie owie). He then gave me pitocin in my IV, cytotec in my bum, and methergine in my thigh. I bled a lot. Things finally settled down and he said I had a tiny tear that didn't need a stitch. The tech started washing me off but I told her I wanted to do that myself. My doula and nurse helped me to the shower and I rinsed off. Postpartum wasn't what I hoped for, they bothered me all the time and told me everything I did was wrong (breastfeeding, sleeping with babies cot right up against my bed and my hand on her, hubbies swaddling technique and diapering technique). We felt we were doing good, but they made us feel inept. That, along with the long line of well meaning visitors.. and we never slept or rested. We requested an early discharge and left 24 hours after baby was born. We did a follow up the day after at the hospital nursery." ~ Kelly

After baby is born, if your hospital does LDRP rooms (Labor, Delivery, Recovery, Postpartum combined), you won't need to worry about moving rooms. Common practice, though, is to have LD rooms and postpartum in another section.

If your postpartum unit is in another area of the hospital, generally you will recover in your LD room for around 2 hours. During that time, a number of things will be happening.

If you have a home birth, your midwife will normally stay for about 2-12 hours afterward, depending on your needs and birth experience, and will perform a lot of the following postpartum care practices. If you are at a birth center, generally you will stay there for 4-12 hours, again depending on the time or day, your needs, and your birth experience, before you head home.

PLACENTA
While you are bonding with your baby and getting to know them, generally your provider will bring

your bottom down to the end of the bed and wait for your placenta. When it's time for your placenta to be born, they may ask you to cough or push to help deliver it and to aid in separating it from your uterus. Usually the provider will give light traction on the cord while you bear down to birth your placenta. Heavy traction or pulling on the cord correlates with an increase of bleeding.

To minimize bleeding, they will most likely provide fundal pressure (aka massage or pushing on the top of your uterus). This helps your uterus to contract. This is very crampy and painful for some women. Other women, it is minimally crampy and painful, and more annoying. Some women feel it is less painful if they place their hand on top of the nurses' hands while they're doing it. Likewise, some women ask the nurse to show them how to do the massage to check their own uterus.

Most women in the hospital setting will receive postpartum pitocin or cytotec for the same reason unless they have a prior agreed upon arrangement with their provider. The postpartum pitocin can be administered via IV or through the muscle as a single shot. Postpartum cytotec is administered rectally. Midwives in most states can carry pitocin or cytotec for this same reason.

REPAIR
Some providers will begin any stitching that needs to be done before the placenta is birthed. Most prefer to start repairs after the placenta is born. If you haven't had an epidural, they will provide lidocaine, a local anesthetic, to the tissue through injection prior to any repairs being done. The stitches that they use are dissolvable. It's important to tell your provider if you have any sharp pain during the repair, although dull pressure is expected. Midwives at home and birth centers can provide lidocaine for repairs as well.

CLEAN UP
After repairs are done and your placenta is birthed, the tech will generally clean you off with warm water, soap, and a washcloth, change out your padding, change the sheets of the bed, and, if the bed was broken down for birth, they will put the bed back together. After you are able to move up in the bed and sit up, they will generally give you an ice pack for your bottom and help you change out your clothing/gown before covering you with blankets.

If you have a home or birth center birth - generally your midwife and/or doula will help you get cleaned up and take a shower or bath, clean up the birth pool and any bed messes, and get you into bed with a pad and soothing compresses.

RECOVERY MISC.

@laughing.moon via Instagram

• If you had an epidural for a vaginal birth, they will turn off the epidural and remove it. 
• If you had an epidural and don't have a lot of feeling in your legs, they might empty your bladder with a straight catheter (one that doesn't stay in) once more before leaving for postpartum. 
• If you had an unmedicated birth or have good mobility, they may have you use the restroom and try to empty your bladder before you head to postpartum. Your midwife at a homebirth would like to see you empty your bladder before she leaves as well.
• They will offer you something to drink (juice, water, ice) and sometimes a light meal. At home or the birth center, you can eat whatever you'd like. They normally encourage a high protein food and juice for energy. 
• You will need to have someone (father, partner, doula, other support person) pack up your belongings for changing rooms if you are in the hospital. 
• Sometime during this time, baby is normally taken to the warmer for any newborn procedures you have agreed to, such as eye erythromycin, vitamin K, and sometimes Hepatitis B. Baby will also be weighed, measured, have a physical assessment, and newborn reflexes checked. If you are at home or the birth center - these all happen in your room and in your presence, oftentimes at the end of your bed so that you and partner can take part in it. 
• Normally your blood pressure cuff, whether you had an epidural or not, will go off around every 15-30 minutes. Also, you may have a pulse ox on your finger. In home and birth center births, they will check your blood pressure and listen to your respiration before they leave to make sure you are doing well. 
• Some hospitals remove the saline/hep-lock prior to moving to recovery - others remove it after 12-24 hours in postpartum. 

POSTPARTUM (24-72 HOURS)

Once you are moved to your postpartum room, your hospital will expect you to stay anywhere from 24 - 72 hours after birth. If you would like to be considered for early discharge, let your provider and nursery staff know that. 

When you arrive at postpartum, normally your postpartum nurse will assess you for her own records (another set of vitals, another fundal massage, etc.) and your babies nursery nurse will do another set of vitals on baby (usually in the warmer, but many women request it be done with baby in their arms). If you're at home or a birth center - your midwife will continue to monitor you intermittently before leaving/sending you home. They will provide a list of things to be looking for, what to expect, and when to call them.

Around the time that you arrive in your postpartum room, your  baby will probably be getting very sleepy. This is usually babies longest nap for the coming weeks. Pro Tip: consider not having any visitors until you have taken advantage of babies first nap and napped yourself at the same time. 

If you haven't yet been offered food or to use the restroom, this is usually when they would offer or ask that of you. Pro Tip: since you don't know when you'll birth, consider packing an actual microwaveable meal - otherwise you might get whatever is in the fridge - which is oftentimes cold cut sandwiches. Your nurse should also help you become familiar with any/all of these items that your hospital might have handy: 

• Peri bottle - this is your bathroom time best friend. Spraying warm water (and sometimes witch hazel) from this bottle onto your bottom before you start to urinate helps dilute the urine, making it less stingy on your stitches, and confuses the tissue in your bottom/urethra, making it easier to 'convince' your body to relax and allow you to urinate. Pro Tip: put a Tucks pad in the peri bottle with the warm water and shake it up. Also, a few drops of peppermint in the toilet bowl can help stimulate the first pee. 
• Witch Hazel/Tucks pads - these are wonderful to stuff in your pad to help sooth your bottom and bring down swelling/hemorrhoids. 
• PADS - the pads at the hospital are thick, bulky, and leaky and are kept in place with strange undergarments. They're free, and you go through a lot of them usually - so that's a bonus... Pro Tip: consider using Depends - which are just as absorbent but don't leak nearly as bad - and they keep those soothing cold packs in place better. 
• COLD PACKS - some hospitals offer ice in a glove, others have the perineal cold packs. Just like with other times icing, it's best to do 20 minutes of cold, then a break. Thankfully the perineal cold packs only stay cold for 20 minutes. Pro Tip: have someone make you some padsicles for when you get home
• Medicine and Stool Softeners - your nurse will tell you what pain medication options you have on your chart, but your provider should order ibuprofen or other light pain medication for your discomfort. Also, the stool softeners are to help you with your first bowel movements; and labor makes the system reset, which, in turns means a more difficult time with the first bowel movement most of the time. 

After you've settled into your postpartum room, you will normally have a nurse check on you every 2-3 hours and on baby every 2-3 hours. They also, usually, stagger this care - which results in someone coming into your room every 1-1.5 hours, day and night. Pro Tip: see if they can coordinate both coming in at the same time so that you can rest more without interruption. 

Pro Tip: while at the hospital, take advantage of the nurse staff... when you change diapers, swaddle, bath, or nurse baby - ask for confirmation everything is ok and right. More confident parents from reinforcement means easier adjustment when you get home. 

You should expect your bleeding to taper off dramatically during your stay. Take your time adjusting to baby and nursing and call for help with nursing if/whenever it's pinchy painful. Discharge takes time and is a great opportunity for partner to pack everything in the car so that the only thing left to take out to the car is you and baby. 

I hope this overview of what to expect in every stage has been helpful for women choosing to birth in the hospital. What did your hospital stay include that you weren't expecting/prepared for?  What were you glad for? What worked and what didn't?  

Coping At All Stages - 2nd Stage (Pushing)

"For my first, n/a - but my anesthesiologist was warm and so kind....

For my second, when the lip was gone and I could push, I pushed for 20 minutes. 

For my third, baby was born at 2:25am after 2 hours and 10 minutes of labor." ~ Allison

"I was so angry at myself. My husband and Cole came back in and I told him I wanted he and my nurse to leave me alone. Cole suggested he go get some coffee. When they left I cried. Cole let me. She then helped me to 'unpack my baggage' as she called it. She told me about laboring down. She told me about sleeping before pushing and how that could help me. She talked to me about options like turning down the epidural, turning it off, or abstaining from pushing the medication button. She talked about what pushing might feel like. We waited an hour and half for me to feel butt pressure and called everyone back at that time. My doctor checked me and baby was sitting so low that I only needed to push for 4 contractions and M slipped out. She was born in the wee hours of morning and didn't leave my arms for 2 hours." ~ Amili

"By the time it was time to push, I got out and onto the bed and pushed on my back until he was under my pubic bone. Then I got back into the tub and pushed there, alternating between bites of fig and sips of water. He was born after a few more pushes..." ~ Chelsea

"My nurse came in and asked to check me. I hopped up on the bed and she said I was 9cm with a lip of cervix. I turned on my side for a contraction and it was miserable. We flipped to the other side and did it on the other side for the next contraction. My doctor came in and checked me and said I was 10 cm and could push whenever I wanted. I wanted to be on all fours but couldn't move. My doctor didn't want me to be in that position either, so I drew my legs back and pushed hard. My contractions had spaced out to about 6 minutes apart and I didn't really feel like I had to push, but I wanted to be done. I pushed and pushed, resting between, with water sips and cold washclothes. It took me 2 hours to feel the urge to push, and another 45 minutes to push him out. 4 billion people came in the room for baby, the doctor, and me. Everyone showed up for the big finale and I took forever to do it. He came out turned to one side and his shoulders didn't come out easy. I tore, but not a lot. I didn't feel it either. When he came out, they unwrapped a cord around his neck, they cut his cord, and took him to the warmer...." ~ Liv

"I got in the tub... One contraction caused me to involuntarily spring forward into a splay-legged position on all fours. (I remained in this position until Julep was nearly born). I could’ve done the splits and still wouldn’t have felt I was open nearly enough. I wanted so badly to stretch my whole pelvis even wider. This compulsion didn’t intend to relieve pain (I wasn’t experiencing any), it was to enhance what already felt good. After my water broke, Julep’s head was in the birth canal. The whole round thing, all of it so suddenly. Cole arrived (ten minutes before Julep would be born). In one moment, I felt Julep kick me from the inside. His whole body, from shoulders to toes, wiggled inside the birth canal right before the contraction that would bring his head out completely. It was a wild, incredible feeling..." ~ Holly

"My midwife showed up and asked if I wanted to get in the tub. It had been about 15 minutes or more since my last contraction. I had totally forgotten about the birth pool. Thankfully my husband had set it up while Cole and I were moving back and forth between the bedroom and bathroom. I hopped in the tub during that long break between expansions (because that's what they really were) and again asked if this huge lull was normal. My husband climbed in with me and I intuitively got into a squat, facing him, with my hands on his shoulders. The next expansion rolled over me and I threw down (like throwing up, involuntary and all-body like) with so much intensity that I howled at the ceiling. My husband matched my howl and it made me feel so primal and sensual. I put one hand between my legs and felt my babies head. My husband put his hand on top of mine and our eyes met. I don't remember a real break in the expansion, as my body just opened, then opened more, then opened more. His head came out into our hands, then he spun on our hands and slipped out effortlessly. I sat back and our four hands drew him up to the surface, where we let him float between us. I was still riding this euphoric wave and our howls had turned into moaning, keening, post orgasmic joyful tears. " ~ Trinity

"... I popped up to work through a contraction, right around when we noticed the blood, and I started moaning through a contraction before suddenly yelping as my water popped, then grunting. Cole asked if I was pushing and I said I didn't know. She asked if I felt like I was pooping and I said yes. She asked if I thought it was time to have a baby and I said 'no, I'm only 4cm'. My nurse came in and asked the same series of questions. I was irritated at them, of course it wasn't time for me to have a baby, I was only 4cm. They were so stupid in my mind. With my next one I sank to my knees and started really pushing. Even between pushes though, I would pant 'just pooping, just pooping'. I know that things got chaotic but I was only focusing on pooping, which was so vastly important and satisfying. Next thing I know, my butt felt totally stretched out and I remember thinking 'oh, it's not a piece of crap, it's a baby', and then I was holding her. I was holding my baby. Total time between my 4cm check and my baby in my arms was 50 minutes. My doctor didn't make it, my nurse and I caught my baby, kneeling on the floor beside the bed. Cole and my nurse helped me into the bed. My doctor came in and proclaimed 'now that was interesting', while the nursery staff came in and saw she was a little floppy. They wanted to take her to the warmer to get her to get more pink and to start crying, but my doctor asked them to do the oxygen with her in my arms, so they did. We clamped and cut the cord a short time later and sat around waiting on the placenta. Baby latched on about 40 minutes after birth, but my placenta wouldn't come out. I kept nodding off to sleep between little crampy contractions..." ~ Kelly

Pushing can be an interesting sensation. Some women say it is like throwing up, in reverse: the involuntary nature of throwing up, that intense pressure moving everything in your core upward... but instead downward. They call that 'throwing down'. Other women say it is like the most intense constipated pressure you will ever feel. Other women say it is an involuntary urge to poop - similar to when you have diarrhea.

Pro Tip: all about pushing and positions here. 

Pro Tip: when preparing for second stage during pregnancy, practice pushing gently and controlled while going #2 on the toilet. 

Many providers will encourage you to purple push, or hold your breath and push for a count of 10. If you aren't wanting to do that, there are other ways to push.

You can push while envisioning your pelvic floor like an elevator car. Picture your elevator car in the lobby/main floor (not high rise) of a building with many basements. "Take a deep breath in the lobby, now drop your baby lower and lower all the way to the basement - like an elevator".

Pro Tip: when preparing for second stage during pregnancy, you and partner can have a spit bubble making contest. Pay attention to how gentle you have to be with your lips and the pressure you press out with to make a successful spit bubble. 

In pregnancy, I explain that their vagina and butt needs to be as soft as their lips need to be to blow spit bubbles, with just the right amount of pressure. In labor, some partners will say 'blow spit bubbles with your bottom'. It's a great analogy. if they feel tight or scared, tension or burning, it's time to back up and blow more gently so their spit doesn't pop.

Speaking of burning, many women say that, as baby comes to crowning, they feel burning or heat on their perineum. That is their perineum stretching. Being mindful of this stage can minimize the chances of tearing. When mom's feel the burn or the pressure or the stretching or the fire, support teams can say 'that's good, you're stretching, stretchy bottom, soft bottom, relaxed bottom, push when you need, breath when you can.". Say all this really close to their ear and quietly. The tone reflecting what she wants her bottom to achieve. Pro Tip, more on minimizing tearing here. 

What did your experience of pushing include that you weren't expecting/prepared for? What were you glad for? What worked and what didn't?  

Coping At All Stages - Transition

"For my first, not applicable.

For my second, my midwife had me lay on my left side to help me keep dilating. It was very painful. My doula curled up face to face with me and never left my side... once I was 9cm, I was in the birth pool and my body began pushing on it's own. I had a large cervical lip though, and I had to learn to not push when my body wanted to so that she could push the lip back.

For my third, two minutes later, another contraction... then another... I woke in full active labor and immediately moved through transition. Contractions continued to be a full minute long, intense, and 2 minutes apart."~ Allison

"They kept telling me I was almost done - but I felt they were lying to me. It took me a long time to get from 6-7 to 7cm. I felt like I needed a break and wasn't getting it, but I was actually getting a minute break, then had a minute contraction. I used my breaks to worry about the next one. I made the mistake of looking at the clock and feeling like it should have been two hours since they last checked me (they said I was in transition and should be ready to push within a few hours) but it had only been 15 minutes since my last check. My nurse again asked if I was sure I didn't want an epidural. I asked for another cervical check. I was 7 at my last check (15 minutes prior) and was 8cm at this one. I felt like it had taken hours to make that change. It was only 15 minutes. I got the epidural at that time. The epidural took about 30 minutes to finish everything and another 15 minutes to feel completely numb. When they checked me after those 45 minutes, I was 10cm and ready to push. I 'epiduraled' my way through transition." ~ Amili

"The birth assistant did some acupressure and I got in the birthing tub for the next several hours, squatting and shifting weight from one leg to the other..." ~ Chelsea

"Around the time that my contractions were about 3 minutes apart and were lasting for 90 seconds, I started to feel nauseous with each one. I would start to shiver, and that's when I knew another one was coming. My doula would see me throw off my sheet, stand up on my toes and shiver. In response, she would rest her hands on my hips and say 'sink into it, let the wave lift you up and over the top. All you have to do is go limp and breath.'. I threw up into my husband's hands. I still feel bad about that one. The pressure in my butt was huge. I felt like I was constipated and started to dread the next one. I started shaking my head 'no' when I felt them come on. My husband looked me in the eye and said 'yeeeessss baby, yeeeessss.' I nodded and started 'yeahing' my way through them. I think if I stayed in that negativity I wouldn't have made it. Things were really intense, but doable until transition. Transition was the hardest part. It only took an hour and half though. I kept asking how long it had been and how much longer. My doula and husband kept replying 'just long enough and only as much time as you need..' I know I was checked a few times but can't remember how far open I was..." ~ Liv

"Midwife arrived an hour and twenty minutes before J was born. Photographer arrived (forty minutes before J was born. She was startled to see me upon entering because the lights were dimmed and I was crawling around on the living room floor wrapped in TDD’s oversized, dark navy bathrobe like a drunken bum.... A contraction would move through me and I’d think, Wow! This is so interesting! " ~ Holly

" I had had enough of all fours and just wanted to go back to the toilet. We got back there and, as soon as I sat down, my water popped with a huge splash. I remember my doula checking her phone often and it irritating me. I thought she was checking the time and I thought, 'if they tell me what time it is or how long I've been doing this I swear I'll deck them.' I learned later she was worried my midwife wouldn't make it and was updating her. With my next contraction, I was sitting on the toilet and moaning like I was having the hugest orgasm ever. My husband took that cue to kiss me after every contraction and rub my breasts and brush my hair with his fingertips. My doula was giving me this counterpressure throughout, but I acutely remember thinking 'my god, she's got her fist in my butthole'. She didn't really, but she was giving me counterpressure on my lower sacrum and the baby was sitting in my bum, making it feel like one giant pressure. With my husband making out with my top half and my doula pressing on my bottom half, it was erotic and sensual but not sexual. The contractions were strong, but the pressure was stronger. Every contraction felt like an expansion and I needed to make a huge amount of space by opening my legs and mouth and butt. I pooped again, then rested, no contractions, for a long time. I kept asking if this was normal. Cole said yes, that it's usually the calm before the baby and then text updated our midwife for the last time." ~ Trinity

" I started shaking and throwing up with every contraction. My butt and hips hurt and I was miserable. I opted for some IV pain medicine, which did nothing but make me feel drunk. My doula grabbed my attention during one of my contractions and said 'you're almost done. you are doing this.' When that contraction was done, she would say, 'you never have to do that one again.' That became my mantra. I didn't really have a moment where I was like 'I can't do this' probably because of the Demerol. I did notice, though, that I wasn't getting as much of a break. My hubby noticed I had a bunch of blood when I stood up for one of the contractions. He asked if that was normal. My doula said, 'it's even more than 'oh that's normal', that's 'ooh, exciting''. All of this happened in about 40 minutes that passed since they checked me and said I was 4cm..." ~ Kelly

Transition is usually the shortest stage in labor. It is tucked in an (average) 45 min - 2 hour gap between active labor and pushing. Around 1/3 of women experience a very intense transition, 1/3 experience a moderate transition, and the remaining 1/3 don't realize that they are going through transition. In the event that it is intense, some symptoms include:

• nausea and vomiting
• hot and cold flashes, the shakes, and goosebumps
• short temperedness, introversion, and doubt
• emotionally feeling anxious,  fearful, or requesting to be done/get medication/have other help
• loss of time or ability to reconnect with those around her
• raising up on heels to cope with pressure

In addition to any or all of the above, and even in the absence of the above, physiologically, transition generally is marked by: 

• contractions 2-3 minutes apart
• cervix 7-9cm
• contractions lasting 60-90 seconds
• sometimes double peaking
• pressure in the sacrum, vagina, or buttocks

In addition to these symptoms, if your water hasn't yet broken, it commonly will around this time and be followed by an urge to push. It's also not uncommon for women, even those who haven't had any bloody show to this point, to have bloody show at 7-9cm. 

Some women begin having the urge to push at this stage, or increased pressure. With pressure, as stated earlier, some women become fearful of making themselves more 'open' by keeping heels on the floor, bending knees, or sitting on the toilet. Pro tip: make that pressure bigger by relaxing your bum like your passing gas. Good reminders that the pressure you're feeling is baby and a good indication of progress can allow a woman to relax her bum. All else fails, the toilet will help with that conditioned response to relax around the pressure. 

Women who may have been coping brilliantly well throughout labor, oftentimes request for pain medication, for something (else), or for help at this stage. If you are planning and hoping for an unmedicated birth, here are some Pro tips to forge through the transition stage: 

• Connect - If you've been closing your eyes and internalizing, and you feel the sensations of transition are becoming overwhelming, try opening your eyes and making eye contact with someone in your birth team. Research shows that closing your eyes amplifies sensations. 
• Stay Positive - If your mantra becomes 'oh no' or 'not another' or other negative words, having someone change your head shakes to head nods, your "no"s to "let goooo"s and your "that was BAD" to "that was PROGRESS" can help refocus your energy.
• Cocoon In - If you're intimate partner is there, having them come in close and speak affirmations to you, touch you purposefully (no petting, patting, or tapping), and cheer you on gently and quietly can help quiet any fears in your mind. 
• Keep The Goal In Mind - If your goal was an unmedicated birth, you are almost there. This stage is usually the shortest and means you can almost see the checkered flag. If your goal was an unmedicated birth, your mini goals are acceptance and surrender. If you haven't done either of those, work on that - communicate your needs to your team so that they can help you too. 
• Stay Present - Many women worry about 'if it's this big now, how much bigger will it be an hour from now' or 'I can't do this much longer' or other such projection into the future. Don't worry about the future - stay present and do what you can right in this moment. 

What did your experience of transition include that you weren't expecting/prepared for? What were you glad for? What worked and what didn't?

Up next, pushing... .

Coping At All Stages - Active Labor

"For my first, I received an epidural around 4cm and no one told me the risks associated with it. I continued to labor, but could rest because of the epidural. I got to 5cm, but didn't got past 5cm on the clock that they expected. At 7pm they recommended a cesarean, which I declined. At 8 pm they said the baby was in distress and i needed a cesarean for his life. At 9:16, he was born by cesarean. 

For my second, by 10:30am I was in active labor My midwife had to work my cervix through some scar tissue, but I went from 4-6 within moments. My doula did a lot of work with me but I wasn't prepared for the intensity of active labor because I didn't do childbirth class. She helped me through a lot of mental blocks.

For my third, immediately I felt the need to go to the bathroom. As soon as I moved, my water broke everywhere. I got to the restroom and immediately had another intense contraction with more fluid gushing..." ~ Allison

"When the pressure got big enough and the discomfort got big enough that I needed help, I called Cole. She met me at our house and I worked through things in the shower. My contractions got closer and closer throughout the day, but it was slow going. I ate breakfast with my husband, lunch with Cole and my husband, and we got dinner on the way to the hospital. It was always very manageable. They were big and demanded my attention, but as long as I could mentally check out and just roll with it, I was good. We got to the hospital and checked in. Cole says my contractions were about 4 minutes apart at this time and big. My first nurse was awesome. She turned down the lights and left us alone except for an initial cervical check to tell me I was 6-7cm. I was given a hep-lock and they put me on the monitors. The monitors were really uncomfortable. My nurse had to leave though and my second nurse was rude. She flipped on all the lights and wouldn't leave my room. This change in staff happened around 10pm. She kept barking orders at me and making me feel like I was managing all wrong. I finally went to the shower to get away from her. This worked until sometime in the middle of the night. At that point, she told me I had to get out. When I got back in the room, I was so tired and annoyed. She asked me if I wanted my epidural. It really sounded good. I asked her to check my cervix. I was 7cm...." ~ Amili

"I went out for Mexican food and all the patrons were giving me concerned glances because, by that time, they were more like 4 minutes apart and I couldn't talk through them. Then I knew I was in 'real' labor. I called my midwife and she said to make my way to the birth center. I started walking around the birth center for what felt like 20 minutes but it was more like 2 hours, pausing periodically for black cohosh, which tasted like dirt. When a contraction would come, I would squat down and sway my hips while either my partner or my doula would hold under my arms..." ~ Chelsea

"We went to the chiropractor at 10am for my appointment and my chiropractor pointed out to me how my backache was making my belly hard. I was in labor. After my adjustment, we went to our local breakfast place and had brunch. Half way through our meal I took a huge gulp of OJ and, for one confusing moment, thought the juice dribbled down between my legs. But my water had broke. We finished eating as quick as possible and I hobbled out to the car. Thankfully I was wearing a black skirt and the only ones who knew was my husband and I. I decided I wanted to be in the hospital and we called Cole to us. She met us at the hospital, where they had changed from backache to BACKACHE.  I was 5 cm at check in. She recommended some belly shifty thingy and all fours. My back felt immediately better and I felt like I was on top of things. Contractions were now about 3-6 minutes apart - they would come in sets of three close, then one further away, then three closer together again. I was really getting into a rhythm and only really felt how tired I was. It was painful but manageable. We did this for about 8 hours." ~ Liv

"I was managing my contractions with the vibrator. I texted my birth team that my contractions were lasting a minute every 7-12 minutes. An hour later, My contractions were 6-10 minutes apart, lasting almost a minute. I was flipping through a breastfeeding book and sitting on the birth ball TDD started timing my contractions but he was in charge of various duties so only managed to record a few. The first was fifty-two seconds; three-ish minutes between this one and the next few. We were unable to time them religiously so he told my midwife they were about a minute long, every three minutes TDD and I cracked jokes between contractions, but the ache in my sacrum and hips was constant. I tried not to worry about it. I told TDD I thought I was probably still dilated at a two, so he reiterated to my doula that it was okay if she wanted to go home and shower before heading over..." ~ Holly

"Around 8am, the cervical tickles were starting to feel like licking a battery with my cervix. I remember Cole telling me this can be a good sign for dilation. I got up to use the restroom and noticed they were coming pretty close still, but felt longer and definitely stronger. I didn't really need help, but I wanted my people. So I called my doula to come to me, asked my midwife to start making her way over, and woke my husband up. I preferred laboring on all fours in the bedroom, but kept going back to sit on the toilet every few contractions. They stayed 'easy' and I only really needed to breath hard through them and shake my head to stay loose. I could talk through them, but it was like asking someone to talk during an orgasm - you can, but it's so distracting. Cole turned off all the lights and made it nice and dark by drawing the shades. The only noise I wanted was affirmations and the only thing I wanted was presence." ~ Trinity

"Things picked up slowly and steadily and sure enough, when I really wanted to rest I couldn't because my contractions demanded that I was up and moving, rocking and swaying. My contractions went from 10 min apart to 7 min apart to 5 min apart over about 15 hours. I would only really consider them INTENSE intense for the last 5 hours of that, when they went from 7 minutes apart to 5 minutes apart. When they got about 7 minutes apart I couldn't just change position to make them better, I had to make noise. My doula showed up when they were about 6 minutes apart and worked with me to make positive noises. When they were 5 minutes apart for a good hour I decided to go in to the hospital. I just wanted to sleep but lying down wasn't working. I hated that position the most. My contractions were 3 minutes apart by the time we got to the hospital. They checked my cervix and I was 4cm. I was frustrated." ~ Kelly

Active labor is when your labor/contractions actively require your help. This is usually when your contractions are closer, longer, and stronger than they had been prior... Again, ignoring your labor as long as possible will help it go smoother and feel shorter/more manageable. When you arrive at active labor, it is difficult or impossible for most women to ignore the sensations of labor, and contractions are easier to cope with when you adjust your body to the sensations.

Textbook active labor is 5-6 cm on through 7-8cm and when your contractions are between 7 - 4 minutes apart, and lasting between 45 seconds and a minute each. Pro Tip: again, try not to watch the contraction app all the time. 

I'll reiterate, our bodies don't necessarily follow the textbooks and it's important to listen to what sensations you are feeling, how your body is coping, what positions you prefer, and what else your body is telling us emotionally, mentally, and physically. If your water hasn't broken yet, there is a good chance it will break sometime during active labor. Pro Tip: keep note of your water when it breaks. What did it look like, smell like, color, big gush or little trickle, etc... 

You might also see bloody show if you haven't yet. If your water already broke, it will continue to leak in small trickles, normally with contractions. You might notice that you begin to feel contractions in your hips, back, or butt. Pressure in your vagina or butt is normal the more open your cervix gets and the lower your baby moves. Pro Tip: if you aren't sure if you'll like massage or counterpressure - give it a try. If they are pushing or massaging in the wrong place, tell them where you need it by pointing. Tell your birth team how hard you want it by saying 'more' or 'less' or 'stop'. 

Contractions don't normally feel any 'bigger' after you get to around 7cm, they just continue to get closer and longer, with more constipated pressure. It's not uncommon to lose your appetite around active labor. Remember to drink water often, though, and use the restroom often. Pro Tip: Keeping your bladder empty will ensure baby can move down and that your uterus doesn't get over stimulated. 

Movement, falling into a relaxing rhythm and ritual, will help make time go faster and labor go smoother. Find positions that work for you and ambiance that allows you minimal distractions. Whatever you would do to make a romantic or sleep inducing atmosphere is the perfect atmosphere for active labor. Pro Tip: do what you need to to let your body surrender to the sensations. If someone is causing you to feel inhibited, they should leave. If you want to moo, then moo. If you want to get on all fours, do it. 

Example of ritual: 

Contraction, I spread my legs and sway my hips while leaning on the bed. Doula pushes on my hips. Husband moans low with me to give me a vocal goal. At the end of the contraction, he reminds me to take a deep breath and as I finish blowing it out, he kisses me. Mom offers me a sip of water. I stand up and stretch. Contraction, I spread my legs and sway my hips while leaning on the bed. Doula pushes on my hips. Husband moans low with me to give me a vocal goal. At the end of the contraction, he reminds me to take a deep breath and as I finish blowing out, he kisses me. Mom offers me a sip of water. I stand up and stretch. At the end of each hour I go sit on the toilet for 3 contractions.

Speaking of positions, if you change a position and don't like it, (pro tip) give it 3 contractions before abandoning it. It will take your body that long to adjust to the new position. Resist the urge to raise up on your heels or clench your butt/pelvic floor/thighs and, instead, focus all of your attention on letting go of all tension in your body. 

Speaking of romantic - romantic things like kissing, nipple stimulation, nuzzling the neck, making out, even orgasm - these are great things for any time during labor but especially during active labor. Be mindful of your tone - vocalization is a powerful tool. It's ok, in fact it's downright good, to make noise. 

If you're not yet at your place of birth, this might be the time that you decided to head in. When you arrive, if you are at the hospital, they will likely: 

• draw your labs - a blood draw to check your blood type and your platelets. 
• put in a hep/saline-lock or an IV - they will normally put this through the same spot as your labs and don't require another poke. Pro tip: consider before hand where you might prefer the IV to be placed. If you have a lot of vein options, you might have a choice of where it goes.
• Ask you to give a urine sample at check in. 
• Ask you a series of questions about your health history.
• If your water broke, they might do a swab or speculum exam to check if your water did, indeed break. 
• Check your cervix to make sure that it is opening and your cervix is making change. Pro tip: cervical checks in labor can be VERY uncomfortable - a trick is to act like you're blowing their fingers out while they check you. This allows your cervix to come lower, making the exam easier on you and the person checking.
• Monitor babies heart rate, your contractions, your temperature, and your blood pressure. Pro tip: they usually have you in the bed to put on the monitors. Once they are on, you can get up and move around the cabin to the extent the wires will allow you to.
• Ask you to change into a gown. 

If your hospital has a triage or assessment center prior to moving you to labor and delivery, you will normally have all of this done in triage/assessment. If your cervix is not at least 5cm and your water hasn't yet broken, it's not uncommon that they would have you labor in assessment until you make another centimeter cervical change or your water breaks. Once you arrive in your birthing room, it's not uncommon for a second cervical check and set of vitals on baby and you to be done. 

Standard care in most hospitals is: 

• to at least intermittently monitor baby and your contractions (15-20 minutes out of every hour), and many times continous monitoring once you've reached active labor
• to give IV fluids, or at least have access in place should an IV be required (hep- or saline-lock)
• to check your cervix every 2-4 hours for change, depending on where you are at in labor and if your water has broken or not

If you are birthing at home or the birth center, the standards of practice are different, and you should ask your midwife what you should expect when they first come to you or you first arrive to them. This wraps up our active labor overview; up next: transition. 

Coping At All Stages - Early Labor

"For my first I was set for an induction at 7am. I woke at 2:30am with period like cramps. I didn't know what labor would feel like, my doctor didn't give me any information and I didn't know about childbirth classes. Around 4am, I figured out I was having mild contractions. We went in at 7am and I told my doctor this. I still got Pitocin, though, and he broke my water and away we went. They were fast, intense and back to back. 

For my second, I woke at 3:30am to go to the bathroom, when I sat up I felt a trickle. I went to the bathroom and there was more fluid leaking. I was so excited. I was having mild contractions. 

For my third, I woke at 12:15am. As I opened my eyes I couldn't move because I was having such an intense contraction my whole body felt paralyzed..."~ Allison

"I woke to a pop and a gush - so there was no mistaking that I was going to be in labor - although, from what I hear, only about 10% of women's labors start with the water breaking. When my contractions started about 30 minutes later, I was in the shower rinsing off and my husband was putting the laundry in the washer. They started out subtlety, like a nearly continuous menstrual cramp. It was all under my belly button and all dull and achy. Within a few hours, the continuous dull menstrual cramp had spaced out to full belly hugs that wrapped around from the sides, the top, and the bottom, lots of water balloon-like pressure the full size of my uterus; like this giant water balloon being blown up inside, at the same time that this flat wide band wrapped around the water balloon and tried to pop it from pressure alone. The dull menstrual cramp of my lower belly was still there. As the day went on, the menstrual cramps got bigger, and the pressure got stronger...." ~ Amili

"I first considered that I might be in labor when I started experiencing crampy-like contractions at regular 6-7 minute intervals...." ~ Chelsea

"My contractions were confusing - I think everyone else knew I was in labor before I did. I woke up about 4am to a backache. It would start as a pulling on my lower back that would intensify, last for awhile, then go away. I woke repeatedly in the night to this sensation and I thought it was just a muscle strain. After I got up, my husband asked how I slept and I told him. He noticed I said 'about every 15 minutes I woke with a nagging backache; so no, I slept like crap'. He kept that observation to himself, which I'm happy for. The backache waves got closer and closer - until about every 7 minutes apart, before he said 'Do you think this is labor'? Until then I had no idea. I thought I needed a massage or a chiropractor. Luckily I had a chiro appointment for that morning..." ~ Liv

"With my first birth, I woke up to brief light cramps every 10-15 minutes. It took 24 hours for them to meet the "every 5 minutes" criteria my OB had given me, and even then they were still light. 

With my second,  I was induced gently. Acupressure and nipple stimulation worked to bring a light contraction pattern to around 7 minutes apart. 

With my third birth, I was in a meeting at work and I started having period cramps. They were probably every 7-10 minutes at first and lasted that way until dinner..." ~ Terri

"With my first pregnancy, I never had cramps or Braxton Hicks. I felt my insides twist up all of tha sudden. Then ten minutes, again. I knew right away. For my second, I'd been feeling crampy since the morning. I didn't know if it was worthy of mention since I'd been crampy for a month. My mom picked up my three year old for her usual weekly babysitting gig. As soon as he was gone the cramps became what I'd most certainly call contractions. Purposeful, dynamic, big, moving. I felt my uterus lifting up like a skirt with each one. I felt relaxed knowing this was probably "it", and suddenly very feminine too..." ~ Holly

"I had a midwife appointment at my house at 38 weeks and I asked her to check my cervix. This was around 4pm. We went out to dinner and called it an early night; going to bed at 9:30. I was glad because I woke at midnight. I had contractions that felt like cervical tickles. They would come for about 20 second every 3 minutes. I woke my husband after a few hours of this. At that time I got up to go to the bathroom (diarrhea) and saw I had pink discharge and my mucous plug in my panties. I called my midwife because they were so close so soon. She said to wait until they felt more intense OR got longer OR they spaced out to match the intensity and length. I called my doula hoping she'd say it was going to be a fast birth. She said 'it might be or it could be [midwife] touching your cervix' and then told me the same thing my midwife did. So I put on a pad and went back to bed. I woke intermittently, never fully rousing, and slept for a good part of the night." ~ Trinity

"I started having mild cramps after a doctors appointment. He said to go on a walk. My doula mentioned eating dinner and heading home to settle in early for the night. I went on the walk. We went to dinner, then I walked more. I didn't want the cramps to stop and they only stopped or spaced out when I stopped moving. So I kept moving. I checked in with my doula and said they were getting stronger, but were still short and only picked up in frequency when I walked. She again suggested I go to sleep. I really didn't want them to stop though, so I kept walking. About midnight I was thoroughly exhausted and had to go to bed. So I got a shower and we tucked in for the night. I woke up to nothing the next day. That evening, we repeated the events of the prior evening and night. Again, I tuckered myself out and went to bed only to wake up to nothing. The third night, I didn't go walking, but instead just hung out at home and went to bed early. Around 2am I woke to a different contraction. I can't explain it but it was more... encompassing...." ~ Kelly

Early labor is a time when your body is working, but you usually don't need to actively adjust your activities to accommodate the sensations. A textbook early labor would last around 10 hours and start with contractions far apart (10 minutes or further apart), lasting for a short time (30-45 seconds each), and be crampy, light, and not very intense. Over time, these contractions would get CLOSER, LONGER, and STRONGER (all three). 

But we all know that our  bodies didn't read the medical textbooks and every body has a mind of it's own, so early labor can last a few hours (or less) or a few days. Some women have labors that skip early entirely, and others have early labor patterns that don't follow the 'early labor patterns'. 

Sometimes early labor contractions will start out close together, but the intensity (strength) isn't there and the duration (how long they're lasting) isn't there. In those cases, your birth team would be looking for the strength and duration to pick up to match the spacing...  or for the frequency to space out to match the other two. This pattern is very common when your cervix is checked or stretched/swept at a prenatal appointment and you have contractions afterward. 

Sometimes early labor contractions are far apart, but the intensity is quite strong. This can sometimes be the result of baby being in a different position than on your left side or lined up with your belly button. If this is the case, call your doula or midwife to help you get some ideas for how to get the intensity to match the frequency and duration. 

Some Pro Tips from birth workers who have been around the block a few times with laboring mamas: 

• Make sure you're taken care of - sometimes practice labor, UTIs, bladder infections, and dehydration can look like early labor. Make sure you're well hydrated, if you were walking, try lying down (and vice versa), and make sure it doesn't hurt or burn to pee. If you've been spending a lot of time doing physical activities and that's what started everything, try getting on all fours and swaying your belly back and forth to make sure baby isn't playing with the braxton hicks button.
• Don't pay attention too soon - if you think you're in labor, let your team know, but then try to ignore the sensations and do what you would normally do during that time of day or night. If you'd normally be sleeping - SLEEP. You never know how long your labor will be and there will come a time you will probably want to sleep and can't. If you had plans for lunch, keep them - it's probably a good distraction, there will come a time when your labor won't let you be distracted from the work your body is doing. 
• Don't get hung up on timing contractions - try timing them in sets of 3-5 contractions, update your birth team, then put the app (or paper and pencil) away. When your labor sensations change (more intense, markedly closer, or markedly longer) time another set and send them to your birth team. 
• Don't try to walk your baby out during early labor - it rarely works and usually only serves to exhaust mama. Then when she really wants to sit or lie down, active labor kicks in and she can't sit or lie down. Walking your baby out is best reserved for active labor. 
• Eat and Drink - again, you have no way of knowing how long it will take. Eat when you're hungry or during your regular meal times. Drink water often. Pee often. 
• Greet labor with patience - you have been waiting for this moment for around 9 months. Remember it might be fast, but will probably take time and patience. Clocks have no place in the labor room and the more you can disconnect from worrying about how long it is taking or going to take, the more seamlessly it will evolve. 
• Change things when labor changes - when your labor says 'no more side lying, I don't like that' listen to your body. If you suddenly feel like you need to get rinsed off, take a shower. 

This is an overview of early labor.. next up is active labor, the time when we need to actively participate in the process. 

The Empowering Cesarean

Empowerment - making one stronger and more confident, especially in controlling their life and claiming their rights.

Let's get one thing straight from the start - noone can empower another person when it comes to the humanistic experience of empowerment. Empowerment is, by definition, one finding ones own strength. So, I cannot empower you... but, you making a choice that feels good and resonates within you can be empowering to you. It is your power of making that choice that feels good. 

I am a huge advocate of low intervention, no pain medication birth. In healthy and low risk birth, less intervention (medications, tools, equipment, etc..) means less inherent risk. But just because I believe in that truth does not mean that it is going to be true for every birthing journey. Every birthing journey doesn't stay healthy and low risk, not every birthing journey couldn't benefit from weighing the pros and cons of an intervention and erring on the side of the intervention. So, that is where we start.

Women can have very empowering births in whatever way that they birth. My years as a birth worker have taught me that truth. The number one deciding factor that makes or breaks the case for a woman's fulfillment of a birth experience and decreases her chances of seeing it as a trauma is choice. When a woman is provided with choices, and is given the space to be a partner in her healthcare and birth planning, she is able to look forward to her birthing time with joy and not fear, fulfillment and not trauma.

If you find yourself planning for an upcoming cesarean, here are some options that are specific to you:

• Feminist Breeder 
• ICAN’s Family Centered Options 

• Sample Cesarean Plan 
• Medical Paper on Facilitating a ‘Natural Cesarean’ 
• Best Cesarean Care Plan – most information is for a planned cesarean

• Gentle Cesarean 

• Kangaroo Care after Cesarean 

• Family-Centered Cesarean

 In addition, you can talk with your provider about using a clear drape or a drape with a window in it, see if your hospital offers the TAP block for post-operative pain management, and talk with them about having a photographer in the OR with you to document those first moments.

Knowing your options, and finding a provider who will have an open dialog about these options, helps to ensure a happy and healthy mom in all birth experiences. 

Cervical Espionage

 

Espionage - spying to obtain information that is considered secret or confidential without the permission of the holder of the information.

Not trying to be a rabble rouser or anything, but I hear this all. the. time! A mama comes back from her providers appointment (both OBs and MWs appointments) and I hear about how their provider gave them a cervical check that hurt badly. Sometimes there's bloody show afterwards, sometimes there's mild cramping.

Yes, sometimes that's just how our cervix' feel when we are fully pregnant... When you are around 36 weeks, oftentimes a provider will perform an exam a little different from ones prior. During this exam, they will be feeling for:

• your ischial spines
• your cervix (how open it is, how soft it is, and what direction it's pointing)
• your baby (how low or high they are and if it feels like they're head down

This can, at times, feel more invasive and uncomfortable... But more often than naught, especially if there is 'sharp' discomfort, the provider might be 'helping mom out' by stripping her membranes (also known as sweeping or stretching her membranes) in order to either get some of the dilation out of the way before labor begins, or to try to encourage labor.

A membrane strip/sweep/stretch is when the provider puts a digit (finger) or two inside the cervical opening and sweeps their fingers left and right, around the inside rim of the cervix. This stretches the cervix and breaks the seal that the mucosa has on the amniotic sac adhering it to the cervix. This can cause enough irritation and pressure on the cervix that it might put a woman into labor....

The problem is, both of these are often done without a woman's consent.

When most first time moms think 'cervical check' they're thinking it will be like prior exams... Providers assume the woman knows what will be happening and what to expect. But, when a woman is given a procedure without the provider discussing it or getting her consent, that's assault. There, I said it.

A routine exam can give provider and mom useful information prior to birthing, but it will not tell you how long your labor will be, how soon it will happen, or how short it will be. Some things to consider:

• It can give you a false sense of discouragement - feeling that your body isn't doing what it needs to, when in fact it's perfectly normal to not make cervical progress until you're in labor.. and it's perfectly normal to go into labor anytime between 38-42 weeks
• It can give you a false sense of impending labor - feeling that you are going to go into labor any moment can be daunting... a sense of excitement and anticipation, followed by let down if it doesn't happen (see point #1) within your providers projected time frame
• It can increase your risk for infection
• Sometimes your water is accidentally broken
• Sometimes it causes discomfort or bleeding
• Some women report a feeling of violation when you don't know what to expect

Sometimes a membrane sweep will work to bring on labor beautifully. Other times, it can:

• cause cramping for 12-24 hours without any dilation or labor starting
• cause cramping for 12-24 hours with dilation, but then stopping and no labor commencing
• cause maternal exhaustion (inability to sleep) to occur more commonly because of the 12-24 hours of cramping that occurs prior to labor fully commencing 
• cause bleeding
• introduce bacteria, increasing the risk for intrauterine infection
• accidentally break her water, with or without contractions
• cause a woman to question her ability to go into labor on her own

A better option: providers, tell the women that you are serving (because that's what you're doing, serving her during her time of pregnancy and birth) what you want to do, hope to find, and the risks and possible benefits - and let her decide what she wants you to do to her body.



Were you given a membrane sweep? Were you asked prior to it being performed? Did it 'work' (within 24 hours of the procedure)?

Additional reading:
Effect of Membrane Sweeping atTerm Pregnancy on Duration of Pregnancy andLabor Induction: A Randomized Trial 
MedScape's Guide To Membrane Sweeping

Rose of Jericho - Symbol and Midwife Medicine

I happened upon this older article from Baraka Birth today. It's beauty was worth sharing.

"Labor begins, and the midwife places a small dry twiggy rosette in a bowl of warm water near the mother. Labor continues, the mother gently perspires, her cervix is softening and opening, and as it does, the ball of twigs begins to soften and expand into a woody flower. She takes a sip of the medicinal water, and, breathing deeply, she watches as the ball fully blossoms. Soon enough, she’s ready to push… 

The Flower of Maryam (Anastatica hierochuntica) is a small shrub collected across North Africa, Saudi Arabia, Iran, and Pakistan, and among its most popular medicinal uses is its application for childbirth. Whether its medicinal properties encourage dilation, or if it’s a powerful visualization tool for mothers, traditional midwives have used the Flower of Maryam with their laboring mothers for hundreds of years. A quick glance at its names (below) suggests its religious significance: it is referred to as the “leaf of Maryam” (mother of Jesus), the “hand of Fatima” (daughter of the Prophet), as well as simply “daughter of the Prophet,” and “resurrection plant.” It is referenced in the Bible in II Kings 19:34-36 and in Psalms 83:13, “make them like tumbleweed,” here referring to the dried twiggy balls of Anastatica that disperse in the wind, scattering its seeds."

- Baraka Birth 

According to birth workers and women in the Middle East, the Flower of Maryam (or Flower of Jericho) is a medicinal plant used during childbirth for women in labor. It is steeped as a tea by the midwife, and then taken as birth becomes imminent. 

Rose of Jericho from Sean Steininger on Vimeo.

This powerful image is ingrained into women of every culture regarding birth, every culture but Western culture. This opening, unfolding, spiraling full and wide - unveiling - it's universal. In addition, the tea itself is full of calcium, magnesium, potassium, iron, and alkaloids. 

I found it also interesting that the dried plant looks very much like the vessels of a placenta and umbilical cord. Nature is amazing, isn't it? 

To purchase one for yourself, see here. 

One Tough Mudder

This last month my husband and I completely our first Tough Mudder.

 While we were heading through the course, 3/4 of the way done, we spied this gal:

And I asked her if I could take her picture for my readers. She was such an amazing encouragement to me, and I was hoping she would be for you too! Her shirt read "Tough Mudder of Two".. .and that's the truth ladies - you are all Tough Mothers!

Remember, condition and train for your race. And run it well. Give it your all and look back on it with no regrets!

Thanks in Birth

I love the Greek language.  It is so expressive and complete. Whereas we might say 'love', the Greeks have different words for different types of love. And whereas we might say 'thanks', the Greeks have different types of thanks.

In my 13+ years of birth work, I can tell you that this one thing can make all the difference in the birthing room - whether you are thankful for the sensations of birth or not. If you're not, you might find yourself using these words:

• (at the beginning of a contraction) "NO!"
• (at the beginning of a contraction) "not another one..."
• (at the end of a contraction) "it's horrible, this is horrible".
• (between contractions) "I hate this, this is not good."

Think of it this way, if you have been asked to do a task that is very difficult, attitude will make all the difference. You still have to complete the task, but it's up to you if you do it grumbling and complaining or if you do it in thanksgiving and joy. Joy and thanksgiving doesn't mean it's not still going to be work, even hard work - it's just the difference between a dance and a dirge.

Ok - back to the Greek forms of Thanks. There are at least 7 forms that I am aware of. I am going to break down four of them for you here, and how they can apply to birth.

• YADAH - This form of thanks means to 'throw'. It literally means to thank with total surrender - like a child jumping into the arms of their parents in total surrender and gratitude.
• TEHILLAH - this form of thanks is audible - to sing or laud verbally. An unrehearsed and spontaneous new song or recitation from the heart. 
• TOWDAH - is physical thanks, such as extending your hands palm up in gratitude. This is also a form of adoration or agreeing with what has been done or what has been promised. 
• EUCHARISTIA - feminine form of giving thanks. This form means to actually feel thankful. 

Labor that is thankful is a change of mindset. When the mind changes, the heart follows. Practical ways to practice thankfulness in labor and birth can include: 

• YADAH - surrendering through your body language, completely letting go.
• TEHILLAH - using your voice positively and using positive words, such as 'yes', 'I am safe', 'this is good', and 'one step closer'. Nodding your head or rolling it in circles rather than shaking it 'no'. 
• TOWDAH - practicing deep surrender by releasing tension in your body. Keeping your mind set on the goal of birth - the baby. Being thankful for that baby and the work that comes with getting to baby. This would include keeping your mind set on the fact that labor is bringing you closer to baby. 
• EUCHARISTIA - if you are practicing the above thankfulness, eucharistia normally and naturally follows. 

Happy Thanksgiving everyone! 

Let It Go...

So, right about now, many of you have magically transformed into Elsa and are singing with gusto.

Yeah, that's kind of what I'm talking about. During labor and birth, your support team will be encouraging you to let it go... all of it. Physically, emotionally, and mentally. Labor and birth is an event unlike any other in your life - one which challenges you in all three of these areas, providing an intensity that brings you to a very primal place of reckoning within yourself.

For that reason, let's look at some practical and concise ways to encourage letting go during pregnancy, and in preparation for birth. 

First off, be sure to protect your bubble of peace during pregnancy by letting only positive and empowering stories and words into your heart and mind. Women love to give advice and tell 'big fish' birthing stories to each other. One simple thing you can say to stop negativity in it's tracks is, "please only share positivism with me, my baby is listening."

Read books that encourage education and preparation in a non-threatening and positive way. Books will give you education and tips/skills to help you through the labor and birth process. 

Practice physically letting go through conscious recognition of tension. An easy exercise for this is when you have to use the restroom, either #1 or #2.. .in fact, getting used to the sensations of both is actually helpful. When first sitting down on the toilet, remain in tension for a moment, notice how your pelvic floor is clenched. Then, take in a deep breath and, on the exhale, release the tension in your pelvic floor, allowing you to go to the bathroom... this exact sensation is what you need to accomplish during labor with every single contraction. You can do this as often as you like, and I recommend practicing this a ton in the last 6 weeks of pregnancy. 

Practicing progressive relaxation will condition you to physically release tension - which is a helpful tool for labor and birth. Find a good one, either through Hypnobabies, Hypnobirthing, or even YouTube, and practice it at least 3 times a week. 

And finally, practice being open and honest with your partner and birth team about any anxiety or worries that you have while preparing for birth. Two things are accomplished with this simple practice. One, you may be able to let go of some of these before your birthing time even begins. And two, if you can't, you are at least practicing honest self-evaluation - which will come in handy during your birthing time in the event any of these worries or anxieties come up during it. 

During labor and birth, there are some key tips and tricks to help you remember to let it all go...

First off, use words that help you let go. These words might be "limp and loose", "release and relax", "soft and open", or even "let go...". Your partner and birth team can help you by repeating these to you at the start of every contraction, and use reminders throughout the peak of each contraction as well. 

Now speaking of words (pun intended) let's touch on your own vocals. Prior posts have spoken extensively on the power of your labor sounds. More specifically, you can practice prenatally, and use in labor, the HA breath. Open your mouth and let your jaw hang throughout. Make what noises sound loose and limp, roll your head on your shoulders in broad sweeping circles. If you feel your jaw and neck muscles resisting, blow "horse lips". 

When you feel a contraction begin, shake out any tension in your hands, arms, hips, or knees before it climbs to it's peak. This will help you set your body into a state of 'no tension allowed' and wipe the slate clean during each contraction. 

Remember that toilet training from earlier? Practice that same 'letting go' during each and every contraction. Check in with your buttocks and pelvic floor and make sure it is in a state of looseness. If you pass gas or pee a little, that's fine. It means you are completely relaxed in the area it matters most. 

If you are in a position that you aren't using your hands to support you, place your hands palm up. This keeps you from referring tension to your hands. 

Remember to voice any negativity or anxiety/worry that comes into your mind and heart. Talking it out allows you to move over that hurdle instead of stepping onto a hamster wheel of negativity. Remember, your birth team can only help you as much as they know what you need. 

And that, my friends, is my list of practical ways to let go during labor!