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 - 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. 

Bathrooms or Birthrooms

It happens - mama is laboring along and someone, whether it's mom herself, her partner, her doula, or her provider, suggests she go to the bathroom for awhile. I get a little happy flutter in my belly, I love when mom labors in the bathroom... or, as many of us birth workers consider it, the birth room.

Yes bathrooms are where we relieve our bladders and our bottoms, or where we wash up... but, it's also where we have been conditioned to completely let go. We let go and urinate. We let go and pass gas and poo. We let go and sing in the shower. We let go and have a good cry when we need to be alone and find some solitude. Birthrooms, err, I mean BATHrooms, are a great place to let go.... and labor and birth is all about letting go.

The bathroom is full of great tools to use during labor and birth. It's no coincidence that women progress so well when they are in the bathroom. And here, in this post, we're going to break down all of these lovely tools, one by one.


THE TOILET, aka the magical birthing throne

The toilet is one of the most powerful labor and birthing tools in the bathroom. And no doubt the reason why: we have been conditioned to relax our pelvic floor when sitting on it! So if a mama needs to get her baby deeper in the pelvis, or  needs help relaxing and completely letting go, or getting a stronger or better labor pattern going, or simply emptying her bladder - this is the place to do it. It also allows mom to rest while allowing her physiology and natural law (gravity) work in her favor. 

"OK. So we have you on the toilet and now you’re pretty comfy. You can rest your upper body and head on the pillows. You can close your eyes and sleep (between contractions). We’ll get your partner on a stool or the birth ball behind you ready with a back massage during your rests and double hip squeeze or direct pressure during the contraction. And we’ll likely ask you to stay here 20-30 minutes. Maybe longer. Yep. Because it makes a difference. 

It’s probably clear that the toilet is a similar shape, size and height to a birth stool. So it makes sense that this is good place to hang out. But we’re here not because you are ready to push, we’re here to either get contractions longer, stronger, and closer together or baby to move down or both. And it seems to work. Here’s why: in addition to harnessing gravity, and getting you into a position that opens your pelvis while supporting you to rest, the open space in the toilet seat allows you freedom of movement to rock and sway your pelvis during your contractions. This movement makes a huge difference and can be just what is needed between lovely spells of resting to bring your baby down and progress your labor.  And let’s talk (for just a second) about how psycho-somatically, this the perfect place for your body to remember how to let your lower sphincters open. ‘Nuff said? Thought so."

- Baby Bump Services, Laboring on the Loo (an EXCELLENT article, go read the whole thing)

THE DRAIN, aka what happens in the bathroom stays in the bathroom

The drain is a great tool that is oftentimes overlooked... But let's not forget that birth oftentimes means that there is going to be a great amount of body fluids involved. And for this reason, the drain is so very helpful. 

Ok, so truth be told, some women have a really hard time going potty on the potty during labor. Sometimes, it's because there are other people around (performance anxiety), and for other women it's because sitting 'disallows' for her bladder to release, for positional reasons. In both of these cases, I'll sometimes encourage mom to stand over the bathroom drain, or in the shower/tub to urinate. Some moms find that standing, or standing and leaning, or even squatting, allows for her to completely release her bladder through swaying and swinging during contractions. 

Drains allow for that freedom and quick clean up. 

Likewise, if a mom is feeling very nauseous and has 'emesis basin retraction' (as soon as you offer her the place to vomit she swallows it back again, only to repeat with the next contraction), some women are given 'permission' if they are allowed to just 'let it go' (yeah, there are a number of you who started singing right then). 

It might not be pretty, but it gets the job done when other tools have failed; and for that, I am eternally grateful to the almighty drain!

THE SHOWER, aka the fount of oxytocin

Since we're still in the shower/tub and talking about the almighty drain, let's just stay here a moment and transition into our next tool, the shower. The shower is a helpful tool throughout all of labor. If your shower has a stationary head, the shower stream can provide excellent nipple stimulation if you place a washcloth over your breasts and aim the stream at your chest and belly. It can also provide a great distraction from back labor if it is directed at your back. 

If your shower has a removable shower head, you can focus the heat and rhythm of the shower stream to your aches. This can mean that you direct the shower stream to your lower back, your belly, or even against your perineum/inner thighs. 

Heat relaxes your muscles and melts away tension, while the invigorating rhythms of the shower get blood flowing and wake the body and mind up. Standing, or sitting on a stool or birth ball, while in the shower allows the woman to remain upright, giving gravity a chance to work in her favor throughout early and active labor. And finally, the shower itself provides enough distraction to the nerve endings that many women find showers to make contractions both stronger (because of the oxytocin produced from tactile stimulation) and easier.


THE TUB, aka the aquadural

Yes, it's been called the aquadural for good reason. The birth pool is oftentimes considered the best method of pain management during labor and birth.

Complete immersion in a tub or birthing pool is best reserved for when labor is active, unlike the shower, which can be used at nearly any time during labor. The reason for this is because the tub can sometimes space out contractions if used too early in labor - because mom isn't using gravity for progress and she relaxes a little too much for the uterus to be as effective as other positions.

That said, if the laboring mama is having a long early stage of labor, or if she is looking for a way to slow things down or stop them to get some rest during the early stage, the tub can help mom to achieve that.

"The warmth of the water on the mother's body can be very mentally and physically relaxing. The water pressure can help alleviate muscle tension and back pain. The effects of immersion in water may be summarized as the following: bathing provides buoyancy and warmth, both of which often bring immediate pain relief, relaxation, lowering of catecholamines, increases oxytocin, and more rapid active labor progress."

- The Labor Progress Handbook, by Penny Simkins and Ruth Ancheta

THE DOOR, aka the support that just won't stop

The door to the bathroom is a powerful thing. It gives mom power over whom is invited into a small and intimate space for her birthing journey. If she feels she has too many people watching her, or she feels the need to have some completely alone time, she simply invites those people she wants into her little cave of birthing energy and shuts out the rest.

So yes, the door is a tool when used how a door was actually intended to be used.

But, there are other ways that a door is tool for labor. One of these is for body work by using the door and door frame itself. If you happen to experience round ligament or hip tightness during labor, between contractions simply put your hip against the door frame and twist until the stretch releases that tension. Be sure to repeat on the other side so that you are balanced.

This stretching is great because, oftentimes, tension on one side of the pelvis/hip/thigh and not the other can be a sign that baby is coming down a little asynclitic. Stretching not only feels great, but can actually encourage baby to rotate and straighten out as it balances out the inner workings, tendons, and ligaments of the pelvis and pelvic floor.

http://eliteathletic.com/

Another exercise that can be done with the bathroom door frame is to do posterior pelvic tilts (aka, lift and tucks) against the door jamb. This exercise is perfect for posterior bubs, or any labor, in which mama is experiencing back discomfort. To do this, simply place a towel between mama's rump/lower back and the door frame. Then, at the start of a contraction, mama should press her lower back flat against the frame/towel, tucking her tailbone under, and lifting her belly to tuck it into her body.

Some women enjoy doing this as a continuous motion (tuck/tilt, release, tuck/tilt, release) whereas other women prefer to tuck/tilt and hold throughout the contraction. This can help get a baby lower in the pelvis, tuck their chin to their chest, or rotate. It can help mom by providing comfort and pain relief, along with give them a great tool that they can provide for themselves - which is a very powerful and positive thing to give mom.

And our final use for the bathroom door is to use the door itself as an addition to the rebozo. You can make a knot in the top of a rebozo, other long scarf (think baby wrap) or sheet, hang it over the top of the door, then shut the door to anchor it in place. Voila! You have an anchored laboring tool that mom can pull on, hang from, squat with, etc... This gives mom confidence and security to be able to get into many positions that she might feel a little wary of otherwise getting into.

If possible though, and unlike the picture linked, TRY to have the rebozo hanging down from the opposite direction that the door opens toward. This will ensure that someone on the outside of the door doesn't accidentally unlatch the door, loosening the anchor, and sending mama onto the floor!

IN CONCLUSION

I hope that our little trip into the bathroom has helped you see how a truly great birthroom the water closet can be! I didn't even touch on the acoustics of the tiled walls/floor and how it helps mama to open up her glottis. I didn't even get to talking about the usefulness of the sink. There are still so many more tools to be found in the bathroom that help make labor and birth a more fluid, efficient, and comfortable event.

But tell me, did you labor in the bathroom? If so, tell me your story (or link it) below!

Chiropractic Care In Pregnancy

I am a firm believer in Chiropractic care. Most women don’t know, or don’t see the rationale that chiropractic care is nearly as important as seeing your care giver for prenatal assessment and care.

Strong claim, I know. But, if you consider the average lifestyle choices, activity levels, and personal birth experiences, you will see that chiropractic care is vital to a healthier, easier pregnancy and labor/birth.

What It Is
Some of you might be wondering what, exactly, is chiropractic care. Chiropractic is a branch of holistic medicine which is based upon the understanding that optimal health depends, in part, upon a normally functioning nervous system. The term“Chiropractic” comes from the Greek word Chiropraktikos, meaning “effective treatment by hand.” Chiropractic practitioners understand that distresses, emotional, mental, and physical upsets, begins with the body’s inability to adapt to its environment. (definition information )

Why it Makes Sense
Ever have a neck ache that ended up giving you a headache that ended up making your whole face feel like it was stuffed with cotton? Well, we would think, by the time we got to the stuffy stage, ‘allergies are acting up again’, instead of looking back to the start of it all, that pain in the neck.
That type of situation is compounded, pressed down, and overflowing in pregnancy. Women experience so many changes during their pregnancy, and here is a short list of those changes:

• Hormones –
  • Relaxin causes muscle and ligament relaxation
  • This allows joints to hyperextend and more easily become misaligned
• Center of Gravity –
  • As your center changes, strains are put on joints that are not used to carrying the center
  • Postural adaptations equate more stresses and increase chance of subluxations to different joints and ligaments
• Weight Distribution –
  • Increased demand on spinal and pelvic muscles and ligaments
  • Joint stress, as stated previously, which increases the occurrence of joint misalignments
  • Increase in lumbar and thoracic spinal curves
• Rapid Weight Gain –
  • Demand and fatigue on spinal and pelvic muscles and ligaments

Chiropractic care during pregnancy can help alleviate all of the above strains, pains, discomforts, and stresses. Commonly, women who have chiropractic care during pregnancy can benefit by experiencing:

• Healthier pregnancies
• Less discomfort during pregnancy
• Less nausea during pregnancy
• Prevention of cesarean or aggressively controlled delivery because of fetal or pelvic misalignment
• Shorter, easier labor and birth

During Pregnancy

“Pregnancy is a natural physiological function of the woman. She should feel little discomfort during the pregnancy. You often hear of the person who has little or no discomfort during pregnancy, one who has had mild labor pains and relatively easy delivery. This is the way delivery will be if there is the proper separation of the articulations (Sacro-Iliac Joints)” - Chiropractic Care During Pregnancy, Today’s Chiropractic, September/October 1991

Yes, many women have aches and pains during pregnancy. No matter how much we love being pregnant, sometimes it can be a pain in the butt, or side, or back…

The sacroiliac joints are joints that are frequently adjusted by chiropractors. They are also the joints responsible for the majority of lower back pain during pregnancy.

Likewise, sciatica is a common complaint in pregnancy. Sciatica is caused by pressure on the sciatic nerve. Its symptoms include: pain radiating from the lower back, buttocks, and/or down the back of one leg, and sometimes into the foot, ‘seizing up’ of that appendage (an inability to move or manipulate it), aching or burning, tingling or zinging. It usually occurs only in one side. It makes sense for it to intensify with pregnancy weight gain and hormonal fluctuations.

Round ligament pain is another common complaint in pregnancy and is marked by a stretching, aching, or downright painful radiance like a girdle on the underside of your growing belly. Again, chiropractic adjustments throughout pregnancy can reduce the incidence of this occurring, or can keep it from ever occurring.

Finally, a less reported but equally as uncomfortable complaint of pregnancy is symphysis pubis dysfunction. Because of the hormones women release during pregnancy, the added weight and girth of the uterus setting upon the pelvis, and the over compensation of her posture, some women experience an intense pain of the pubic arch (the mons pubis area), popping of the hip joints, groin discomfort, and lower abdominal issues. Unfortunately, many women continue to suffer from this postpartum. The best remedy? Getting your spine and pelvis aligned properly so that it can accommodate the changing dynamics of your body more easily.

Bottom line, regular chiropractic care before any of these issues crop up are your best bet for an easier, more comfortable pregnancy!

Labor and Birth

"Chiropractic care during pregnancy greatly facilitates the delivery process. Chiropractic care during this time becomes increasingly valuable when one studies Towbin. He states, “Much of the neurological damage at birth is caused by precipitous delivery techniques-i.e. unnecessary pulling forceful traction during deliver.” He further states that most of the signs of neonatal injury observed in the delivery room are neurological and that the apgar score, now widely used in appraising respiratory action, cardiac function, muscle tone, reflex irritability, and other elementary signs of the presence of absence of neurological injury. Subluxations (spinal misalignments) can also occur due to precipitous delivery techniques.

In earlier studies Duncan found that it takes about 120 pounds per pull pressure to initiate spinal damage with this injury (cord subluxations) occurring most often in the cervical spine. Towbin states that he feels 120 pounds pull pressure is not uncommon in a normal delivery. The normal delivery process herein is described as the doctor pulling on the fetus. This pull now can see the need for chiropractic care during pregnancy. Chiropractic care aids in maintaining the integrity of the lumbar-pelvic area. Therefore, chiropractic care facilitates delivery, lessens intervention, lessens the need for pulling on the fetus and, according to Towbin’s Less Precipitous Deliver Technique, lessens neurological damage to the newborn child." -Chiropractic Care During Pregnancy, Today’s Chiropractic, September/October 1991

"There are two things quite apparent for a “normal” birth—one is chiropractic care during the pregnancy for correction of subluxation to allow the pelvic outlet to be at its maximum and a proper birthing position (squatting) to allow gravity to do its job. Chiropractic is always a value during the birth process, but it is even more during or after a supine (lying on the back) delivery. It would seem logical that chiropractic care during pregnancy, chiropractic care for the child and the squatting position for birth are all logical. Let’s be logical for a change." - Modern Day Birthing Techniques Can Produce Subluxations in Both the Mother and The Baby, Webster, L., D.C., International Chiropractic Pediatric Association January 1993

Misalignments can:

• Cause unnecessary pain and discomfort in labor and birth
• Cause a woman’s body to not go into labor at the right time for her body (indicative by start and stop labor or prodromal labor)
• Cause baby to be in a malpresentation or malposition
• Cause a disrupted or inconsistent labor pattern
• Cause slow decent of baby during 2nd stage

Yes, we childbirth professionals tout that, basically, any position except the supine position facilitates an easier birth. Add to that the caring of your spine and pelvis to ensure that everything points directly and easily to the straightest path out of your body, and you have a great chance for an easier, shorter birth.

Additionally, looking at the physiology of labor and birth, the mechanics of the uterus, spine, and pelvis, how they are all interconnected and interrelated, it is easy to understand how even a minor subluxation can be disruptive to the natural process and biological timing of labor and birth.

Baby’s who are carried in uterus’ supported by misaligned spines and tipped pelvis’ tend to favor positions that are not optimal (breech, transverse, posterior, cranial hyperextension, shoulder dystocia, or asynclitic positions). Baby’s who are carried well supported uterus’ by well aligned spines and proportionately stable pelvis’ tend to favor optimal positions for their exit strategy.

Ideally, the well aligned spine, pelvis, and uterus will give optimal room for a well positioned, well supported baby to move easily down the birth canal. It will mean less aches and pains that are not related to physiological labor, meaning less physical and hormonal distraction from the work at hand – resulting in an easier labor and birth.

What About After Birth
Don’t stop going to the chiropractor just because you have given birth! Your body is constantly in a state of motion, shift, and change. Also, immediately following birth, as your body attempts to move back into its pre-pregnancy state, chiropractic care can prevent muscle tension, headaches, rib discomfort, and shoulder problems. This means that your body can continue to benefit from adjustments with a skilled provider.

Likewise, just because you didn’t get care during your pregnancy, it doesn’t mean you can’t start now! If you didn’t get care, or had a large baby, chiropractic care can help get you back on the road to healthier living. Oftentimes, pregnancy and birth can cause long-term neuromusculoskeletal problems if not corrected.

In Closing
Pregnancy, labor, and birth are wonderful and beautiful times in a woman’s life. Natural, physiological pregnancy, labor, and birth should be relatively free of aches, pains, detours, and disruptions. Our lifestyles, the way that we were born, and our daily habits influence how far we have deviated from natural and normal. Chiropractic care can help set right that which is wrong, set straight that which is crooked, and make normal that which has gone awry.  



Resources:

• Fallon J. International Chiropractic Association. 1994 – Arlington, Virginia.
• Bery G, Hammar M, Moller-Nielsen J et al. Obstet and Gynecol, 72:71-75, 1988.
• http://www.chiroweb.com/find/whatischiro.html
• http://en.wikipedia.org/wiki/Symphysis_pubis_dysfunction
• Lisi AJ. Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series. J Midwifery Womens Health. 2006 Jan-Feb;51(1):e7-10.
• http://www.americanpregnancy.org/pregnancyhealth/chiropracticcare.html
• http://www.planetc1.com/chiropractic-articles/pregnancy-chiropractic.html
• Östgaard HC, et al. Prevalence of Back Pain in Pregnancy. Spine 1991;16:549-52.
• Berg G, et al. Low back pain during pregnancy. Obstet Gynecol 1988;71:71-5.
• Mantle MJ, et al. Backache in pregnancy. Rheumatology Rehabilitation 1977;16:95-101.
• http://www.acatoday.org/pdf/jacaonline/Jan07/107Pregnant.pdf

Dancing For Birth - Review

Dancing for Birth is an innovative pregnancy and postpartum exercise and labor preparation DVD.

From their website:

Dancing For Birth TM prenatal/postpartum dance classes incorporate dance moves from around the world that best prepare you to give birth. Birth can be like a marathon, and Dancing for BirthTM classes prepare you for the challenge. You'll become stronger, more agile, more at ease with your body and both mentally and physically ready to embrace your unique birth experience. 

Weekly classes are offered to keep you dancing thru pregnancy, and postpartum with your baby. Dancing for BirthTM prenatal/postpartum dance class participants report experiencing low levels of discomfort, few or no interventions, brief labors and high levels of satisfaction during their births. 

You'll learn birth dancing moves inspired by Belly dance, African dance, Latin dance and Caribbean dance. At the same time you'll be learning valuable childbirth preparation skills and natural pain coping techniques that will build your confidence in your own birthing ability and wisdom. Birth can be active, ecstatic, orgasmic, transformative, empowering! Did you know that there is an optimal position for your baby to be in when labor begins, and you can help assure that position? You'll gain knowledge to help you have the birth that you envision for your baby. 

Babies whose moms take Dancing for BirthTM prenatal/postpartum dance classes love the motion of dancing and are easily soothed after birth by being held while you dance.

I received my copy of Dance for Birth in the mail and immediately popped it into my DVD player.

I have to admit, I didn't watch it in order, I skipped around a lot. But I loved it.

There are many segments, of course, on dance and movement, but there is so much more to this DVD as well. This doesn't surprise me, given the founder's background!

Stephanie Larson, DFB, CD(DONA), CBE, BFA, is a former professional dancer with three decades of dance training and experience and the creative genius behind Dancing For Birth. She has been a DONA International certified birth doula since 2000, and was the Managing Editor of DONA's International Doula magazine from 2005-2007. 

Within the DVD, she has a marvelous segment on Birth Wisdom vs. Myths. This is a wonderful tool for women who are battling what society tells us versus what our innate wisdom and bodies are telling us. My second favorite part is her Relaxation segment. She incorporates affirmations, how to personalize affirmations, and how to create a positive body and mind space for all things pregnancy and birth related.

The dance segments are broken down into Warm Ups, Belly Dance 1 and 2, Baby Welcoming Dance, African Dance, Latin Dance, Caribbean Dance, and the Pelvic Floor. Throughout all of the birth dance exercises, I was struck by one profound thought: globally, we have the movements already integrated into our culture and dance movements for both baby making and baby birthing. It was beautiful to watch the womb-movements through different dance styles; as a doula, I had seen so many women intuitively use these same movements to bring their babies into the world.

I am so excited to be able to add this to my lending library as a resource for women during their pregnancies.

Doulas Do It Anywhere - pt 3

Doulas help women give birth anywhere. We offer support in a home birth setting, hospital birth setting, birth center birth setting, medicated birth setting, and even cesareans.

Again, the definition of a doula:

A doula is not a midwife (unless, of course, she’s certified as both), in that she has no authority to make medical decisions, nor is she credentialed to deliver a baby. She’s not considered on the level of a nurse, either; doulas cannot administer or regulate medicine, operate monitoring devices, et cetera. In fact, a reputable doula will tell you that she doesn’t even have the authority to speak on behalf of the mother should a complication or other medical surprise surface.

But sometimes it’s the unnameable, intangible aspects of the conclusion of a pregnancy that require the most help and planning. And that’s where a doula is indispensable. In addition to the priceless knowledge and experience she brings to the laboring phase and to newborn-care assistance, she’s a wellspring of intimate emotional and physical support. A doula educates the family ahead of time; keeps the laboring mama focused and lucid; instinctively retrieves things she needs, like water or compresses; supports her body while walking through contractions; suggests different laboring positions; initiates massage and breathing patterns; reassures other labor partners; works alongside hospital staff; advocates for the mother; and, afterward, ensures that the new mommy is getting enough rest, is recovering well, and is bonding with the baby.  - Divine Caroline

That said, a doula is definitely a soothing presence in all birth settings, including MEDICATED HOSPITAL BIRTH.

During those home visits, your doula can help prepare you for early labor, before pain medication is available or a good idea, through teaching you coping techniques and making suggestions for home labor. Your doula can also help you understand the different medications available and the interventions associated with them so that you can make the best choices for your circumstances and desires. Some of the things that a doula does during a  medicated hospital birth include all of the same stuff we do during an unmedicated hospital birth, plus:

• We 'better and best': we will make suggestions along the way in order to minimize risk. There are 'better times' to get an epidural vs. IV pain medication. Likewise, there are 'best' times to get the epidural that you are anticipating receiving.  
• We body work: after the medication is administered, we will still help your body into different positions to encourage baby to rotate through the birth canal. 
• We keep it mother-centered: we help to encourage the hormones of labor to continue, regardless of medication, by setting ambiance and preserving the 'sacred space' of birth. We also gauge the emotions of mom: disappointment, anger, happiness? If she needs to work through emotions, we have an impromptu emotional mapping session. 
• We move it along: we will watch your contractions. If they start to space out, which often happens with epidurals and spinals, we will encourage labor to pick back up through acupressure points, aromatherapy, and massage.
• We stay on task: if a medical emergency does arise, which more frequently does with medicated births, we can  help to prepare you prenatally and during the actual birth event, to be as involved as possible and to ensure this is still your babies birth story/time.
• Breast is still best: we still stay after the birth to help with breastfeeding, which may need more help than otherwise would have.

Anything the doula might do on this list is definitely interchangeable with your other support person (spouse/partner, etc..), so that we can  make a seamless team of support for you where none of your needs, or the needs of your other support person, go unmet.

Doulas do it at medicated hospital births!

Doulas Do It Anywhere - Pt 2

pdxdoulas.org

Doulas help women give birth anywhere. We offer support in a home birth setting, hospital birth setting, birth center birth setting, medicated birth setting, and even cesareans.

Again, the definition of a doula:

A doula is not a midwife (unless, of course, she’s certified as both), in that she has no authority to make medical decisions, nor is she credentialed to deliver a baby. She’s not considered on the level of a nurse, either; doulas cannot administer or regulate medicine, operate monitoring devices, et cetera. In fact, a reputable doula will tell you that she doesn’t even have the authority to speak on behalf of the mother should a complication or other medical surprise surface.

But sometimes it’s the unnameable, intangible aspects of the conclusion of a pregnancy that require the most help and planning. And that’s where a doula is indispensable. In addition to the priceless knowledge and experience she brings to the laboring phase and to newborn-care assistance, she’s a wellspring of intimate emotional and physical support. A doula educates the family ahead of time; keeps the laboring mama focused and lucid; instinctively retrieves things she needs, like water or compresses; supports her body while walking through contractions; suggests different laboring positions; initiates massage and breathing patterns; reassures other labor partners; works alongside hospital staff; advocates for the mother; and, afterward, ensures that the new mommy is getting enough rest, is recovering well, and is bonding with the baby.  - Divine Caroline

That said, a doula is definitely a soothing presence in all birth settings, including UNMEDICATED HOSPITAL BIRTH.


It's a really cool thing when a woman who might need or simply want a hospital birth can still benefit from the intimacy, emotional encouragement, and fortitude that home prenatals provide. During these prenatal appointments, we are establishing rapport with you, getting to know your idiosyncrasies, as well as your needs and wants for your birthing time. We might give your additional support people tips and tricks for early labor, and we definitely want a home walkthrough for if you are planning on laboring at home for any amount of time.


During labor, we normally will show up at your home, again if you are planning on laboring at home for any given time, unless we have reason to believe it might be a good idea to move to the hospital sooner rather than later. Some of the things that a doula does during an unmedicated hospital birth:

• Doula-y stuff. Yup, we still do the normal things like massage, counterpressure, acupressure, recommendations for position changes, relaxation exercises, body work, aromatherapy, encouraging you in word and actions, and overall caring for you emotionally and physically. 
• We make house-calls. Doulas normally like to labor with you a little at home, help you decide when you are reaching your 'I want to be at the hospital at this time' time, and help you get as much of the intimacy that home labor allows as possible. 
• We travel. When it is time to head to the hospital, we will go with you and offer continuity of care from the home to the hospital. This continuity of care is so helpful during admission and gives so much peace of mind knowing someone is going to be with you/your partner throughout both home and hospital care. 
• We nurse flirt. Flirting with your nurse is a great talent many doulas have. First off, we work hard to make sure that your nurse is on your side. If we can't win her to your side through compliments and hard work, we simply try to get you a cooler nurse. Some things we do to make her love you and us: change out your pads for you, get you another blanket, get you another drink, help you to and from the bathroom, help get through check-in faster by knowing you, help you fill out your admission paperwork faster so she can do other things, reaffixing the monitor or BP cuff if it falls off or isn't tracing correctly, and silencing those pesky alarms before finding her (quietly and non-demandingly (I know, it's not a word)) so she can fix whatever the alarm was for.
• We Med-translate. If we can explain it more thoroughly or more easily to digest, we will. If we can't, or you need further explanation, we will ask your care provider for clarity. We jump start informed consent/refusal by asking the tough questions and urging them to give you more information in a non-confrontational manner.
• We memorize and reiterate. Your birth plan? yep, we try to remind you and your birth team about that. We try to get you as close to that as possible. In the heat of the moment, we are keeping an extra eye out for deviations from that birth plan too (i.e. scissors in the hand of the doc when you clearly stated you don't want an episiotomy). 
• We watch your intake. We make sure that you are eating and drinking as much as you need to keep your energy and hydration up. We also make sure your partner/husband/other support person is eating and drinking. This is important - you wouldn't believe how easy (and common) it is for a birth team and laboring woman to forget to eat or drink during labor, resulting in low energy or a slowed labor. 
  
• We watch your output. We not only keep tabs on how much water you are taking in, but also how much you are urinating. This helps keep you off of an IV if you don't want one. We can 'report' your output to your provider. We also watch for other body fluids. Whenever we change a pad, we are sure to watch for bloody show or amniotic fluid, both of which give you more information with which to provide your doctor or hospital-midwife. The more information you have for them, the more confident they are in you!
  
• We take pictures. If there is a camera or video camera lying around, you bet we will take some birth pictures for you (if you want). 
• We burn the candle. Again, especially in longer labors, partner/spouses need to sleep so that they are fresh for the birth. You don't want a sleep-deprived partner to miss out on the birth either! Your doula will burn the candle with you. And sometimes they just need time to walk the halls, get some fresh air, and regroup.
  
• We Lady-Wait. After birth, while everyone is fussing over initial baby vitals and daddy is loving on the newborn or calling family, we can help mom get in and out of the shower, to the toilet, get into fresh clothes and pads, make her bed up nice and comfy, and get her hair brushed. She feels clean and shiny when she slips under the covers, ready to love on her baby and enjoy the fruits of her labors. If mama wants an herbal bath, we can make one up for her, even in a hospital setting.
• We assist. In the off chance you are a speedy birther, many of us are skilled in emergency childbirth. In the off chance you are a speedy birther but we made it to the hospital, and your nurse needs an extra set of hands in a sticky situation, we can definitely do that.
• We glue the bits together. I love this part of my job. We help the man of the group (usually the father of the child or the partner of the woman), the 'extraneous' member, to glue his place into the birth event. We help make sure he isn't stuck with all the grunt work, the contraction timing, the childbirth class remembering, or the gopher work. We ask for his expectations as much as the birthing woman's. And, on that note...
  

Anything the doula might do on this list is definitely interchangeable with your other support person (spouse/partner, etc..), so that we can  make a seamless team of support for you where none of your needs, or the needs of your other support person, go unmet.

Doulas do it at unmedicated hospital births!

Doulas Do It Anywhere - pt 1

prepforbirth.com

Doulas help women give birth anywhere. We offer support in a home birth setting, hospital birth setting, birth center birth setting, medicated birth setting, and even cesareans.

Again, the definition of a doula:

A doula is not a midwife (unless, of course, she’s certified as both), in that she has no authority to make medical decisions, nor is she credentialed to deliver a baby. She’s not considered on the level of a nurse, either; doulas cannot administer or regulate medicine, operate monitoring devices, et cetera. In fact, a reputable doula will tell you that she doesn’t even have the authority to speak on behalf of the mother should a complication or other medical surprise surface.

But sometimes it’s the unnameable, intangible aspects of the conclusion of a pregnancy that require the most help and planning. And that’s where a doula is indispensable. In addition to the priceless knowledge and experience she brings to the laboring phase and to newborn-care assistance, she’s a wellspring of intimate emotional and physical support. A doula educates the family ahead of time; keeps the laboring mama focused and lucid; instinctively retrieves things she needs, like water or compresses; supports her body while walking through contractions; suggests different laboring positions; initiates massage and breathing patterns; reassures other labor partners; works alongside hospital staff; advocates for the mother; and, afterward, ensures that the new mommy is getting enough rest, is recovering well, and is bonding with the baby.  - Divine Caroline

That said, a doula is definitely a soothing presence in all birth settings, including HOME BIRTH.

Doulas, like home birth midwives, will make home visits; or, as we call them, prenatal appointments. During these prenatal appointments, we are establishing rapport with you, getting to know your idiosyncrasies, as well as your needs and wants for your birthing time.

A planned home birth will also mean we get to know your living space: where your linens are, towels, washer and dryer, cleaning supplies, birth kit, foods and dishes, and more. We will get to know your other children, if you have already-birthed children, as well as their play/sleep spaces/routines and comfort level with attending the birth.

During labor, we normally will show up before your midwife, unless your midwife has reason to believe that you are moving toward birth quickly. Some of the things that a doula does during a homebirth:

• Doula-y stuff. Yup, we still do the normal things like massage, counterpressure, acupressure, recommendations for position changes, relaxation exercises, body work, aromatherapy, filling the birth pool, changing out your pads, cleaning up any 'oopses', encouraging you in word and actions, and overall caring for you emotionally and physically. 
• We Doul-ess. Sometimes homebirths are so chill and zen we 'do' less doulaing, so we might just be there for mom, brush her hair back from her eyes, take notes for her birthing journal, offer sips of water, or make ourselves scarce in other parts of the home to do the things below.
• We make food. Yes, you read that right. We will make food for you and your birth team. This is important - you wouldn't believe how easy (and common) it is for a birth team and laboring woman to forget to eat or drink during labor, resulting in low energy or a slowed labor. Also, if a mom has a honey-do list for us, it's not uncommon that she will put on there 'in down times, please prep a casserole for the fridge for dinner in the next 24 hours. Recipe below'.
• We do household chores. We will clean up around the home, do dishes, throw some dirty laundry into the washer, tidy up the kids play space, clean up the 'mess of birthing'... whatever needs to be done. What's nicer than getting down to the business of birthing, only to get tucked into your bed with your new baby and realize (for you and your partner/spouse) that the house is completely clean?
• We take pictures. If there is a camera or video camera lying around, you bet we will take some birth pictures for you (if you want). 
• We like children and pets. If you currently have either (children or pets) we can care for the pets (food, water, bathroom breaks, etc..), or your older children (play with them, help them get ready/off to school, feed them, help them know what is going on with the labor/birth, put them to bed, etc..). 
• We keep watch. Sometimes, especially in longer labors, partner/spouses and midwives need to sleep so that they are fresh for the birth. You don't want a sleepy midwife at birth, and you don't want a sleep-deprived partner to miss out on the birth either! Your doula will burn the candle with you.
• We travel. In the event of a transfer to the hospital, we will go with you and offer continuity of care from the home to the hospital. This can offer unimaginable relief to a stressful situation, knowing someone is going to be with you/your partner throughout both home and hospital care. 
• We Lady-Wait.  After birth, while midwife is doing some initial baby vitals and daddy is loving on the newborn or calling family, we can help mom get in and out of the shower, get into fresh clothes and pads, make her bed up nice and comfy, and get her hair brushed. She feels clean and shiny when she slips under the covers, ready to love on her baby and enjoy the fruits of her labors. 
• We assist. In the off chance your midwife needs an extra set of hands in a sticky situation, we can definitely do that. Midwives can be assured that many home birth doulas are well versed in how to assist a midwife with clamps, oxygen, syringes, bulbs, and more.
• We glue the bits together. I love this part of my job. We help the man of the group (usually the father of the child or the partner of the woman), the 'extraneous' member, to glue his place into the birth event. We help make sure he isn't stuck with all the grunt work, the house work, or the gopher work. We ask for his expectations as much as the birthing woman's. And, on that note...

Anything the doula might do on this list is definitely interchangeable with your other support person (spouse/partner, etc..), so that we can  make a seamless team of support for you where none of your needs, or the needs of your other support person, go unmet.

Doulas do it at homebirths!

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!