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. 

Open Letter to Birth Makes Sense

I recently came across a post called Birth Boot Camp vs. Bradley Method over at Cory's blog and it saddened me. I may seem like I'm picking on her, but I'm not. I have written before about how sad I am about the 'us' vs 'them' that is coming about in our birthing communities across the globe. Those who should be supporting each other and finding the best fits for every woman's needs instead find ourselves feeling like (for whatever reason) we need to mark our own territories and discredit other methods, certifications, practices, practitioners, etc... I hope that she does change her original post to be less biased, but I pdfed it for anyone who wanted to see the original post... just email me.

At the time that I read her post, it was the only one that the comments had been disabled. I hope it was an accident, although it is the only post with comments turned off... so I wrote her a note instead. I hope she receives it and, if not, she might find it here through backlinks. *edited to add that she did receive my email.

Here was my response to that original post:

I like how you can't post any comments... lol! I will comment here then. This is a VERY inaccurate post. BBC came from a former AAHCC instructor who wanted more updated materials and options to teach their students, so the story goes. Which is a big part of why BBC goes out of their way to discredit AAHCC. As a former Bradley instructor, I can tell you this with confidence:

• Requirements for my training, and a friend who just completed the course include over a dozen books to read, not just 4 like you said (or any instructor I have met). So, in that way BBC and AAHCC are the same. 

• 'Husband' is the word they use for the partner/sister/mother/other support ONLY because the program was conceived in the 1940's/50's. Any support person can take that same role. The main thing is to have support, regardless of what form it comes in, as long as the support person is emotionally connected to the mama on that level. So, in that way BBC and AAHCC are the same.

• AAHCC encourages mom to go 'to bed' when/if she feels the urge to do so. If you were to watch the videos they present during classes, and if you were to read the materials for classes (the actual workbook), you would know that they teach that not every woman finds this to be the most productive, and is only one tool that they teach. In fact, they teach a total of 18 different tools and relaxation methods for birth, including positive position changes, guided relaxation, imagery, color therapy, breathing and vocalization, etc... Many Bradley moms find upright 'sleep' positions and noise to be better relaxation tools - and they teach both of those during classes. So BBC and AAHCC are the same in that way as well.

• AAHCC encourages mom to be knowledgeable and gain the intuitive, emotional, physical, and mental information/knowledge/wisdom needed to birth in confidence in our culture, and 'coaches' role (aka husband) is there to remind her. They also talk about the benefits of doulas and other support people synonymously with 'husband'. The main reason they teach it like they do is because 'husband' has an emotional connection and is able to help mom make those choices in birth, unlike any professional in the room.

All of that to say that some of the drawbacks of AAHCC:

• The material (pictures/verbiage) is antiquated and needs to be updated. Thankfully, your instructor will work around that. They all have the same complaint and have become very adept at modernizing the information. 

• The requirements to become an instructor are very stringent, even unfairly so. Although there are ways around it. 

• BBC has better bfing material

• Those running AAHCC have dissuaded many an instructor from recertifying, we'll leave it at that.

Some of the drawbacks of BBC:

• It's a newer method and, whether or not they say they are a method, they are. As much as Hypnobabies, BFW, AAHCC, Hypnobirthing, or any of the other methods are. Method is defined as: a particular form of procedure for accomplishing or approaching something. Because you have a workbook, you are a method :)

• The requirements to become an instructor are very stringent, even unfairly so.

• They are so hell bent on discrediting AAHCC and pick on them more than any other method that it puts a bad taste in my mouth.

I'm saying this all in love as a loving rebuke - Bradley picks on Lamaze, Hypnobabies picks on Bradley and Hypnobirthing, and BBC picks on AAHCC. Your business will thrive much better for not making broad opinions on partial information or biased reviews (that sounded mean, I'm sorry). You will find allies in the birthing and general community where others have failed because of this reason. Trust me, having BTDT and been in this industry for over 13 years I can say that with confidence.

Your post, whether you meant it to or not, comes off very 'my method is better than yours' and, as a capstone in your community, you cannot afford that and neither can your community. We are in the same industry, all of us (MWs, CBEs, Doulas, IBCLCs of ALL trainings and methods) are striving for the best for the women we serve. We deserve and should strive for community and camaraderie, rather than us vs them.
So, there's my dollar, keep the change ;-) And sorry if I come off as harsh.

I have reviewed the materials for both classes and can say that they are both great options as childbirth classes. Putting my doula hat on for a moment, a great way to find out which class might fit your needs would be to listen to unbiased reviews from people who have nothing to profit from your choice (i.e. a doula who doesn't teach a specific method of childbirth class, your midwife, etc..). No one method of preparation is going to be the method for all women.

As supporters of the women in our communities, it is best for birth workers to know that and have good, unbiased, information on hand for every woman. Ladies - we are called to bring accurate and unbiased information to the public - let's make sure that, especially when talking about others IN OUR COMMUNITY that we are showing community to our community. We can do that while also encouraging them to make sound decisions.

The Tortoise and the Hare

Average first-time mamas will labor around 18 hours, with an average first-time 2nd stage (pushing) lasting around 2 hours. For some reason, though, our bodies didn't read the textbooks and might  not necessarily know that they are 'supposed to be' 18 hours of gradual labor, resulting in averagely, 2 cm dilation every few hours... 

(note the sarcasm)

Some women (read most women) fall somewhere on either side of these averages... 

Some women have what we call marathon labors. These are the slow and steadies, the tortoise labors, the long and languorous, the gradually tiresomes. Other women have speedy births, short and sweets, the hares of the bunch, the fast and furious, the giddy-up and git er done. 

Both types of labors have their benefits and their drawbacks. And I would like to talk to you about both, and tips on how to manage both, because you never know which type you will be, the tortoise or the hare, until you are in the midst of it. 

The Tortoise

Why might a labor be long and lengthy? Oftentimes, there are underlying physical factors, such as babies position, mom's body, or maternal hereditary precursors... Other times, it is the emotional side of things, such as relationship upsets, distrust in your birth team or birth place, fears of becoming a parent or of the process itself.

Slow and steady labors have their benefits. Many women say that their slow and steadies were much more manageable and easier to stay on top of the contractions. Many women even consider their tortoise births as 'pain free'. Drawbacks? Often times these are the labors that hasty care providers deem 'failure to progress'. These also tend to be the labors where moms forget to stay hydrated and nourished and their bodies tire too soon because of it. Positive outlook and healthy habits/good support are so important for tortoises.

Best odds are to encourage body and mind health until your birthing time begins.

• Encourage your baby to be in alignment as much as possible by working on positions that encourage optimal fetal positioning. 
• Consider chiropractic care to ensure the best odds that your body will be in alignment as much as possible
• Keep yourself mentally healthy by voicing concerns, talking through relationship issues, enlist the help of a close and trusted friend or professional to listen, and ensuring that you have a healthy outlook on pregnancy, birth, and parenting by protecting your space.

If you happen to be the Tortoise in labor and birth, here are some great tips on how to bide your time wisely during labor/birth:

• Stay on Schedule! One of the easiest tools for early or long labors is to simply ignore that you are in labor. I know, easy for me to say. A good rule of thumb is this: whatever you would normally be doing at that time of the day/night, stay true to schedule and do those things. Did you have plans to have lunch with a friend? Still have lunch with a friend. Would you normally be taking a midday nap or is it the middle of the night? Go to sleep! Did you want to get some last minute shopping done for the baby or wanted to grab some snacks from the store for your birth team? Now's the best time to shop! The less you pay attention to it, until your labor demands you pay attention to it, the less apt it is to seem quite so long.
• Keep Stoked! The fire that is... keep your fire stoked... get it? FUEL yourself. You will need fuel (good, nutritious snacks) and hydration (water, labor-aid, gatorade, etc..) to keep your body energized/hydrated and give your uterus the fuel it needs to remain active for any length of time.
• Cover That Clock! Put something over the faces of the clocks in your home and resist the urge to look at your watch/phone (partners this means you too!). Ever hear the term 'a watched pot never boils'? Well, a long labor never benefits from staring at the clock. It will only give you a tangible/visual confirmation of just how long you have been at it. Likewise... 
• Timing, Smiming! This is a hard one to retrain partners about. Timing can be a helpful tool or a repetitious bane on labor! When you think you might be in labor, sure, time a set of around 3-5 contractions to get a good base line for how far apart they are, how you are feeling during them, and how long they are lasting. Then, put the stopwatch and pad of paper up and away. When your labor changes (i.e. getting stronger, making you slow down or stop mid-stride, making you breath/make noise through it, etc...) time another set of 3-5. Whenever you do this, update your birth team. When you are done, put the list and the watch away! 
• Stay Home! Stay where you are most comfortable. Home is a great suggestion (wink). Eat at your own table, poo on your own toilet, wash in your own tub, and sleep in your own bed.. This is so much better than this. Use the former as much as possible. Don't just the gun and run to your place of birth until things are really hot and heavy. You will be more comfortable and once you go to your place of birth (especially if it is a hospital) points one through three on this list are nearly impossible to be adhered to... you will be reminded of just how long you have been in labor and exactly where you are at.
• Go With the Flow! It is not uncommon for slow and steady labors to ebb and flow... some contractions might be closer together and stronger, some less strong (although they may or may not space out)... If your body needs a break, it may actually give it to you, sometimes actually stopping for a short while for you to take a nap, regroup, have a snack, and refill your energy tank. Tune in to that body wisdom and do what your body says to do. 
• Keep Your Fingers Out! When you decide that it is time to go to your place of birth or call your midwife to be with you at home, consider keeping cervical checks to a bare minimum. Cervix' are shy as it is and don't like to be messed with/watched. Plus, rather than encourage a woman with the news of how far along she is, more often than not, cervical checks only discourage mom, her birth team, and yes, even her care provider. Trust your body to know how long it needs to open the best and trust your baby to know what he/she needs will be given to him... in their own timing. 
• Tune In! And finally, when you can see the finish line and your body is opened completely, don't expect it to be downhill from there and start exerting all of your energy to roar that baby out... unless your body is doing it for you! It's not uncommon for mamas to take between 2-4 hours to bring their babies from 10cm to born. If your body is not giving you that 'urge to push', just hang out, relax, recuperate, eat something, drink something, and take this time to reiterate your 'immediately after birth' plans. When you get the urge to push, tune in to the urge and push when the feeling comes, and don't when the feeling leaves. Conserve your energy and realize that baby is edging down with each urge.

The Hare

Why might a labor be a race to the finish? Again, oftentimes, there are underlying physical factors, such as babies position, mom's body, where mom starts her labor (i.e. if she has been walking around at 5cm before labor starts OR a small/premature baby), or maternal hereditary precursors... Other times, it is the emotional side of things, such as complete trust in the process or an undisturbed birth.

Short and sweet labors have their benefits. I have heard so many times that women 'would give anything' for a speedy birth. It starts fast and ends fast... as one woman said 'I can do anything for 4 hours or less!'. It means that when it starts, it starts in a sprint and all many women need to do is hang on for the ride... Drawbacks though? I have heard many women who have had fast births say 'I wish I could have been more present for it' or 'I wish I could have had more time to get on top of the labor, it just went from 0-100 with no warm up/no gentle progression'. Again, healthy habits/good support are so important for hares, and a chance to reflect on the flip side are so important.

To ensure that you are prepared for the possibility of being a hare:

• Practice relaxation and make sure your partner is part of it. If you have a fast birth you will want to know how to achieve as much deep relaxation as possible so as to be able to get on top of things/be present. 
• Read Emergency Childbirth. Just in case.
• Be sure that your birth team knows your desires for birth so that, if you ask for medication during a fast birth, they know how to encourage you to stay the path.

If you happen to be the Hare in labor and birth, here are some great tips on how to ride the wave of labor/birth:

• Early Contact! Be sure to clue your birth team in as soon as there is a rhythm that might mean that this is it. Partner, stay put, until/unless there is someone else that mom wants to be there in addition to you, you are her anchor to help her stay rooted. 
• Timing is Everything! Many whirlwind labors start with contractions close together (5 minutes apart) but contractions are short. Unlike with Tortoise births, if yours start close together, but are short, keep an eye on them. If they quickly turn into 1 minute long or longer and become uncomfortable quickly, again, let your birth team know. 
• In and Out! Reminders to use the bathroom often (once every 30-45 minutes) will decrease the chance of baby hanging out on top of your bladder more than necessary. Also, since you are sprinting on down labor land lane, you need water and food just as much as the tortoise. Your choices should be quick energy though!
• Rotation and Dilation! Even though most fast labors mean baby is just gliding down into the pelvis, it doesn't negate the need to be up and moving. To ensure that baby has ample room to rotate through the pelvis as your cervix melts away, be sure to remain as upright as possible, or as hip-OPEN as possible. 
• Listen To Your Body! If your body says to go to your place of birth earlier than what you had planned, listen to that intuition. If your body says that you won't make it, consider that it very well could be right (most times is right). If you get to your place of birth, only to be checked and told you are not very dilated, consider that it really has no bearing on how close you are to being done - patience and peace will help you to open right along with your contractions! It's not uncommon to 'slow and steady' dilate to a certain point and then open wide rapidly.
• Stay The Path! If it looks like you might have changed your mind about birthing without medication, chances are, you are probably really close to the end. Hang in there and ride each wave, leaving it behind and enjoying the calm between each wave. 
• Be Hands On! With rapid labors oftentimes comes rapid births. When you feel the urge to push, consider putting your own hands on your vulva/perineum/baby as baby begins to crown. This will allow you to really check in with your body, regulate your breathing/pushing, and provider your own perineal/vulvae support to minimize the chances of tearing and really ease baby out nice and slow. 

Regardless of if you are a tortoise or a hare in labor, remember that it is not a race to the finish line, and we all get a 'medal'. Staying the path, regardless of where the journey takes us in the end, is the measure of motherhood. Remember, whether it's fast or slow, your baby and body know the way to go!

It's All In The Method

Throughout the history of mankind, women have passed on wisdom and experience from generation to generation... the older and/or more experienced women teaching the younger and/or less experienced through story, words of encouragement, apprenticeship, and being present at birth or inviting the younger generation to view birth as it unfolds.

We have lost that woman-to-woman wisdom and candid form of education in our modern day, busy, non-communal, nucleic lives. Thus, the birth of childbirth classes. That's right, childbirth classes are a new invention, but the wisdom that independent childbirth classes transfer and convey is not.

I am often asked about the differences between the different childbirth education methods. There are 5 major methods of childbirth education, although there are many more available. I will take you through each one, the history of each, and my personal experience with each.

HypnoBIRTHING is: Self-hypnosis by 'distraction' (focusing away) for, what you can hope is, a pain-free birth. They teach the physical make-up of labor and birth, and do teach a lot on the postpartum period as well. Some find the birth affirmations as very helpful and relaxing, giving them the ability to achieve a deep state of relaxation during labor and birth. Others find the affirmations a little to 'hippie' and the wording distracting. More 'new age' than Hypnobabies. Started by Marie Mongan, a professional hypnotherapist. I have a few experiences with Hypnobirthing. I am not sure how much is a reflection of the method vs a reflection of the parent's commitment to practicing, so take it with a grain of salt but I found this method to be not as successful in it's goal as Hypnobabies. (check out their website HERE)

HypnoBABIES is: Again, using self-hypnosis techniques for, what you can hope is, a pain-free birth. Between the two hypno's, this one seems to have more success, whether it is from method teachings or parent's commitment, I am not sure. This method teaches lots of physiology of pregnancy, labor, and birth... not as much postpartum as hypnobirthing, but it is still a complete and comprehensive childbirth class that balances intuition, discipline, and mother-centeredness very well. Created based on master hypnotist Gerald Klein's teachings for introverted self-hypnosis (focusing IN rather than AWAY). Started by Kerry Tuschhoff, a previous Bradley student/teacher. Medical-grade hypnoanesthesia. (check out their website HERE)

Bradley Method is: A method started by the Dr. Robert Bradley, a contemporary of Dr. Lamaze. He created the method with the understanding that, to stay healthy and low risk, diet and exercise was necessary. The method teaches diet, exercise, A&P of pregnancy, labor and birth, the signposts of labor mapping, and relaxation techniques. These are intended to alleviate unnecessary pain, although proponents of Bradley don't have a goal of a painless birth, only a comfortable one.  The focus of the method is breaking pain/tension cycle by negating fear through education/understanding, teaching S/Os how to help a laboring woman, and positive consumerism... as well as lots of postpartum and b/f education. (check out their website HERE)

Birthing From Within is: more of a free-method - taught through the bias of whatever teacher you happen to work with. They teach mainly through dialogues and exercises, not much 'formal education'. Lots of hands on and working through fear/tension cycle. Acceptance and embracing of birth process is a central focus. Lots of creative (drawing, painting, writing) exercises designed to help you through this. They teach breath awareness, mindfulness, self-hypnosis, and visualizations while also being open to the use of drugs and epidurals. Teach active birthing (moving, yelling, accepting pain, etc...) and good nutrition. Very loose in terms of a 'method' of natural birth. They teach from the POV that the only thing a woman needs to be able to achieve the birth she wants is dedication and trust... not an actual 'relaxation method'. Some consider it New Age or hippie - but it gleans from Native American practices oftentimes. I find it a great method for women working through birth/sexual trauma. Founded by Pam England. (check out their website HERE)


Lamaze is: Different from it's inception. Dr. Ferdinand Lamaze's original design was incorporating nutrition, exercise, and psychoprophylaxis to counteract acute pain in labor and birth. Current Lamaze teachings focus less on the altered breathing patterns of the original Lamaze, and instead focus on healthy birth practices. Lamaze classes are often the 'mainstream' childbirth class taught in many hospital settings (which focus primarily on hospital policy and procedures), although it does not reflect the education that you would find if you were to take an independent (non-hospital affiliated) Lamaze class. Current independent classes teach anatomy, exercises, positions for birth, and a wide range of relaxation techniques. (check out their website HERE)

All of these courses are considered complete and comprehensive - meaning that they cover pregnancy, labor, birth, postpartum, and baby care. All can be found as independent childbirth classes (meaning that they are not affiliated with a hospital).

Beyond these childbirth methods, there are many many independent childbirth classes that are not taught as a 'method'. This means that the information within the class will be greatly influenced by the individual teaching it. These include:

• Doula-formulated childbirth classes - these will vary greatly by doula, philosophy, scope of practice their certifying organization allows, their experience, and their 'specialty' (any type of birthing situation or circumstance that they specialize in or have a great amount of experience in). These are great because of the amount of experience doulas have attending birth, unlike the average childbirth educator 'only'.
• ICEA - a neat concept, providing educators with the education and tools necessary to design their own class. Usually covers diet, exercise, A&P, relaxation techniques, positions for labor and birth, medications, interventions, breastfeeding, and postpartum options.
• CBI - The same as ICEA, but, additionally, they train their educators in dynamic teaching skills.
• CAPPA - much of the same as ICEA and CBI, with an additional focus on supporting young families through their HUG Your Baby program.
• Birthworks - from their website "each woman finds her own way through birth and labors in her own unique way. Our childbirth classes and doula services honor each woman’s wholeness and individuality and encourage integration of the mind, body, and spirit through the human values of truth, right action, peace, love, and nonviolence. "
• And many more...

Benefits to an independent childbirth course:

• you will not be limited in your education to what the hospital wants you to adhere to (i.e. policy and procedure)
• you will learn a variety of coping techniques that have a focus on natural, active, and autonomous
• you will learn about nutrition and exercise, staying healthy and low-risk for your pregnancy. Something that hospitals rarely do.
• you will learn about parenting options and how to do them (i.e. baby wearing, cloth diapering, alternative vaccination schedules, intact penis care for the newborn male, breastfeeding, and more)
• you have the possibility/opportunity of having your course tailored for you, individually, and your needs

A limitation of independent childbirth classes is that you need to be sure that you agree with the educators philosophies and ideals, as it often colors the course/classes. Interviewing a childbirth educator is very important when you choose to take an independent childbirth course. For more information on how to interview a childbirth educator, see here. And to see if your childbirth class is mother and baby-friendly, see here.

Tis The Season

I love Christmas. I love the snow (which we don't get here in TX), building snow forts in the dazzling night sky, the scent of the pine tree, the roaring fire, the baking and cooking, the family and friends visiting, the warm cups of joy clutched in cold fists... I love it all. Except one thing: when I'm asked to make a Christmas list for myself.

Maybe it's my nature, maybe I feel shy about saying 'I want' something, maybe its

because I am happy with all of the above, that gifts are an afterthought... whatever the reason, I am inevitably asked to send out a gift list for myself after the kids have sent out theirs.

For that reason, and in case you are considering giving your midwife, doula, or childbirth educator a gift this season, consider this doula's "open Christmas list".

If you are shopping for a childbirth educator, I can tell you that, unless she works through a hospital, CBE work doesn't make a lot of money. She has expenses and some of her items are either consumable/perishable or will wear out over time.

• Budget Friendly - a gift card to her favorite bookstore for her latest wishlist book. Or a copy of the Business of Being Born
• Moderate Cost - A knitted uterus is a great choice, especially for newer childbirth educators.
• No Expense too Great - a flip chart of childbirth graphics. This is an awesome one that I am personally in love with.

If you are shopping for a doula, I can suggest items that will help her to be the best that she can be for the future women that she attends. Although the number one most precious and perfect gift you can give her is word-of-mouth advertising and referrals, there are other, more tangible, gifts that will help her on her way.

• Budget Friendly - a necklace to inspire her, or a set of childbirth education booklets for her and her clients would be perfect.
• Moderate Cost - the hypnodoula packet would give her excellent continued education and help her expand her bag of tools, or a homeopathy starter kit, or, if she is newer and wants a wonderful educational item, a Rebozo and DVD is a great idea.
• No Expense too Great - if she is interested in becoming a placenta encapsulationist, a dehydrator would get her on her way nicely, and a birth stool would go wonderfully with any doula to any birth.

Midwives are a little more difficult, unless you know specifically what she doesn't have that she would like or needs.

• Budget Friendly - if you know her assistant or any of her peers, ask them what her favorite restaurant is, a giftcard is a great way to tell her how much you appreciate her, as is buying a second of any book in her lending library (in the event one is not returned).
• Moderate - Again, jewelry is always appreciated, as is a copy of any DVD in her lending library, or a hand-painted (placenta) bowl. 
• No Expense Too Great - a shrine is a beautiful piece of artwork to add to her office, or an antique for her collection.

 And finally, if you really don't mind the cost, a wonderful gift to any midwife, doula, or childbirth educator is to gift her services to someone who cannot afford them. This allows the birthworker to give back, in turn.

Other items that all doulas, midwives, and CBE educators can always use are gift cards to bookstores or gift certificates to places like Doula Shop and Birth with Love.

In fact, we like to recycle, and places such as Ebay have resale and items at great prices.

So, if you are thinking of giving a gift to your birthworker this season, consider some of the ideas above. And have a Merry Christmas!

Mmmmm, Hormones!

I am such a birth geek. I prefer that term to birth junkie because I am not necessarily addicted to birth, but I am definitely completely geeky about it - insatiably learning and researching and assisting with it at every possible moment.

I love reading about the event; our anatomy and physiology, the hormones of labor and birth, our emotional and mental and spiritual selves during the event - it's amazing.

Which is why I wanted to link you up to some great reads about the lovely and intoxicating hormones of labor and birth:

• Oxytocin - the love hormone. You know, kiss me deeply and make me feel all purry inside.
• Melatonin - yep, dark room and sleepy mama? this even helps! 
• Beta Endorphins - you know, the painless high that athletes get? yep, laboring women get it too, but not if you have an epidural!
• Adrenaline - not so good in first stage, awesome in second stage.

And for further reading on the subject:

• A great PDF of Sarah Buckley's Ecstatic Birth - Hormonal Blueprint of Labor, the most popular article on this subject.
• Natural Childbirth III: Why Undisturbed Birth and Natural Childbirth IV: the Hormones of Birth - a really neat read.
• Childbirth Connections quick reference of the hormones of labor and birth.
• A great slideshow presentation on the Hormones of Birth