A friend of mine is having her first baby in a couple of months and has been asking for my advice. I figure I might as well put it down here and let other moms benefit from it (or be annoyed by it). So warning: this blog contains my opinions and advice. I am not a medical professional, but I've birthed 5 babies, and in my opinion that makes me more qualified than any male obstetrician, and a good deal of other health professionals to speak on the subject. Second warning: I'm talking about my experiences of giving birth here, so if you know me, and you think that might be too much information for comfort, then just stop reading, OK? I really don't care who reads this, but if you get grossed out, it is not my fault.
This friend has told me that so many others have told her there's no way to prepare for the first experience of giving birth, and, while I understand what they're saying, I disagree wholeheartedly. While you can never be 100% prepared for a new and unique experience, there is much you can do to prepare for labor and delivery. And, while a first labor is generally longer and more difficult than subsequent labors, that doesn't mean you can't have a natural one. It does mean however, that you need to be as prepared as possible.
Choosing Fewer Interventions:
First off, decide whether you want pain meds or not. If you know you want them no matter what, I'm not judging you. I chose that with my first two babies too. Just know that the epidural can and does often cause other complications including a serious drop in blood pressure which can cause serious nausea as it did with my second baby, Hannah. I found the added nausea to be far worse than just dealing with the pain and opted for natural labor after that experience. The rest of this blog is really dedicated to coping with a labor that is as natural as possible.
Second, keep in mind that labor is extremely unpredictable. It can be fast and hard, or slow and dragging, or even slow and hard as it was with my first, Naomi. There are myriad complications you can run into and myriad ways of dealing with those complications: slow labor, baby with an "unreassuring" heartbeat, fetal distress, failure to progress, etc. There are generally two ways of dealing with any complication: the "medical" intervention, and the "natural" intervention. OB's are often more quick to jump to medical interventions including drugs and C-sections. Midwifes and doulas are usually slower to reach those conclusions, opting to try more natural ways of remedying the problem first. The first thing you can do when an intervention is called for is ask the question, "Is this an emergency or do we have time to discuss our options?"
If it's a true emergency, by all means do what your doctor says, but often you will find that no one is going to die in the next 15 minutes and you have time to discuss other possible interventions before leaping into drugs or C-sections. Realize that your OB is human: he wants to go home and have dinner with his family, and sadly enough, some OB's will jump to do a C-section when it might not actually be necessary because they're home two hours later instead of waiting 15 hours for you to finish natural labor. OB's also jump to C-sections because they are less likely to get sued over doing a "just-in-case" C-section than if they wait and something goes wrong with labor. One article I read quoted a doctor whose mentor had taught him, "Just section them, they can never sue you for sectioning them." Unfortunately, there ARE risks involved with a C-section including hemorrhage and infection, and it's recovery from major surgery instead of being up and around in a couple hours after a vaginal delivery.
So arm yourself with the knowledge of what options you might have for each possible complication, there are lots of books on this subject. Or take someone with you, such as a doula, who knows these options and will help inform and support your decisions, but won't be overly pushy and obnoxious with her own opinions. Making a birth plan is a good exercise for you to think through these issues, but I've heard that most nurses and doctors don't read them, and the truth is you can't make a lot of these decisions until you know exactly what the issues are, and that won't come until you're in the thick of labor.
For example: you might experience "back labor" where the baby is trying to come out with his face up toward your tummy, instead of down toward your bottom. The back of his head pushes on the tip of your spine, creating severe pain. Doctor or nurse might recommend an epidural. Midwife or doula might help you get into a position that encourages the baby to rotate, or might show your husband how to apply counter pressure by pushing against your back during contractions. Or, if you have informed yourself, you can change positions or coach your husband on how to help you.
Another example: if labor slows to a crawl or stops progressing, often termed "failure to progress" an OB might recommend a C-section, whereas a midwife might be more patient and recommend that you get up and walk to speed labor along or that you just take a rest and enjoy the break. Arm yourself with knowledge to make these decisions when you meet them. However, keep in mind that there are true emergencies, and if you end up needing medical intervention because of one just thank God that pitocin, vacuum extractors, or a C-section is available and take it. I've given birth to all 5 babies with the aid of pitocin, and I don't find it to be the horror of horrors that some natural birthing idealists would make it out to be. In my book it beats 5 days of hard labor like I had with Naomi.
Coping with Pain:
I think of giving birth a lot like any physically demanding sport: part training, part mental toughness, with the bigger part being the metal toughness. I think my years of running cross-country and track prepared me for natural labor better than anything else.
Stay focused. Have you noticed how athletes prepare mentally before a big competition? The gymnast quietly visualizes her routine, the runner paces and stretches his muscles. There is a look in their eye that says, "don't bother me, I'm concentrating on the task ahead." Indeed none of us would dream of walking up to a gymnast five minutes before her competition and asking what her favorite TV show is. It never ceases to amaze me how many nurses will do just that! Are you kidding me?! I'm about to perform the most demanding physical task of my lifetime, this is not the time for chit-chat. Don't answer them. Coach your husband ahead of time to answer questions for you and to ask chatty nurses to leave you alone. Yes, contractions come in waves, with breaks in between. At first you might feel chatty and excited between contractions, but try to maintain a quiet, calm, focused atmosphere. I've come to realize that I have to be practically in a trance to focus all my mental energy on the challenge ahead. Chatting in between contractions breaks your focus on relaxing, and the increasing strength of the contractions may catch you off guard and mentally unprepared: that's where panic sets in and people call for pain meds. Stay calm, stay quiet, stay relaxed, stay confident, stay focused.
Inform yourself about the process of labor so that you can correctly interpret the incredibly strong signals your body is sending you. In the first stage of labor ccontractions are the uterus pulling open the cervix to a width of 10 cms so the baby can pass out of your womb and into the birth canal. Your job is to stay as relaxed and calm as possible. Be confident: you can do this, your body knows what it is doing. Fear and panic release stress hormones that can slow labor and compromise oxygen supply to the baby. Tensing your muscles creates more pain and wastes valuable energy.
Create a soothing atmosphere. As soon as you arrive at the hospital turn off the harsh florescent lights and use a dim lamp. Ask the nurse to use a quiet, calm voice. Put on scented lotion if you find it calming. Some people like massage, I never did. I listen to soothing piano or "new age" type music and breathe as slowly and deeply as possible while consciously relaxing every muscle in my body. Picture your body opening up to let a baby out, it will help you fight the impulse to tense your muscles up against the pain.
Create a rhythm. Contractions come in a rhythm, and a rhythmic way of dealing with them is soothing. It says, "I've done this before, I can do this again." Take a deep, relaxing breath as you feel a contraction come on and give a signal to your husband like a squeeze of his hand to let him know you're having a contraction. Don't say it, it breaks your focus. Matt got to where he knew if I closed my eyes and took a deep breath in he would let the nurse know I was having a contraction and tell her to be quiet. Often rocking or swaying feels good through a contraction and helps the baby's head to shift into the correct position in your pelvis. I love sitting on a birth ball with the hospital bed in front of me and Matt behind me, that way I can lean forward or backward as needed. Lying in a hospital bed during contractions was the absolute most painful position for me. A deep low moan on the out-breath will help you to relax your muscles and release tension. Screaming does the opposite.
My rhythm looked like this: deep in-breath, close my eyes and picture opening up to let a baby out; low, soft moan on the out-breath; slow sway or rock to the quiet music while continuing slow breathing and moaning, all the time focusing all of my attention on keeping every muscle in my body relaxed and fighting the urge to tense; finally opening my eyes at the end of the contraction, talking quietly with Matt if I needed to. As things progressed I stopped opening my eyes or talking between contractions at all, just breathing and focusing and saving energy. You are a marathon runner, the contractions are the running up-hill challenges, the breaks in-between are down-hill "rests," but don't ever break your focus or your rhythm. If you try to run alongside a marathon runner and ask him what his favorite restaurant is he'll either ignore you or deck you. Keep that same attitude toward all distractions.
Stay Confident. The marathon runner who loses focus and is suddenly confronted with an agonizing hill begins to doubt himself: can I really do this? How many more hills are ahead? If he lets himself entertain thoughts of quitting, the race is already lost. The same for the laboring woman. In high school I had a track coach who normally coached football. His name was JB. How the school assigned him to girls track I do not know. He was a huge man, and relentlessly tough on us. I clearly remember sinking into despair in the middle of a mile-long race. JB saw the change in my demeanor and yelled as loud as he could from the side-lines, "Buck...It...UP, Johnson!" (my maiden name). This angered me and I found reserves of strength I hadn't known I had before he yelled at me. He caught me up in a huge hug after the race and told me what a good job I'd done. He had yelled at me because he knew if I lost my confidence, I lost the race. Physical endurance demands mental toughness. You can do this. Millions of women have done it before you. You can too. Don't let yourself think otherwise.
Transition is the last phase of the first stage of labor. It is where your cervix dilates from about 7 to 10 cms, and is by far the most challenging part of labor for most women. It is a time of intense physical sensations including: pain (contractions are longer, stronger, and have very little break between them, if any), extreme pressure as the contractions push the baby's head against the cervix, shaking and trembling, sometimes nausea, and a strong urge to push. This is where even a strong, confident woman who's been handling labor well can lose control and panic. You know what helps in transition? Knowing that it's transition, and that it doesn't last long--often 10-30 minutes (I've read up to two hours, but I think that's less common).
When transition hit after only 40 minutes of labor with my third baby, Emma, I didn't recognize it as transition because I wasn't expecting it yet. I panicked, imagining hours more of this agony, and was completely taken aback when Emma came flying out only minutes later. I thought to myself that if I'd known I only had a matter of minutes to go, it wouldn't have seemed as bad. So when I began to shake and tremble with baby number 4 I looked at the clock and told myself this would all be over within 20 minutes. He was out in 15. Granted, it will probably not go quite that quickly with a first labor, but knowing that what you're experiencing is normal and not a problem, and that it is for a limited time will help you stay confident and calm(er).
Many women find their previous soothing ritual of deep breathing and quiet music doesn't fit the tremendous pressure and shaking of transition. This is the time to switch to light, fast breathing if you've practiced it and it seems to help. Do practice it ahead of time though--I tried it with baby number 4 and hyperventilated so badly all four of my limbs went numb. I also prepared a CD ahead of time with baby number 5 of more fast-paced, upbeat music for Matt to play. When he put in that music it renewed my energy and excitement and helped me focus on the home stretch. Pay attention to what you're feeling--instead of just "OWWW!" think "OK, that's the baby's head pressing on the cervix, it's going to slip through the hole soon and I'll be able to push, almost there."
This is the part I was most afraid of when I thought of natural labor, but I was surprised to find that it is actually a great relief to be able to work with those strong sensations after transition. Yes, it hurts, but you don't much care anymore by this point. It's when the runner, exhausted and weary, rounds a bend and sees the finish line--suddenly he bursts forth with renewed energy, he knows he's almost got the prize. As soon as the doctor or midwife declares you 10 centimeters dilated and gives you the OK to push, go for it! Don't hold back, don't fear the pain. If ever there was a time to visualize opening up and letting the baby out, this is it.
If you don't have an epidural in, you ought to be able to choose an unconventional position to push in. Some OBs will strong-arm you into lying on your back with your feet up because it's the easiest way for them to catch the baby. That's how I delivered my first four babies. But with Elijah, the midwife let me choose the position, so I went with what felt natural. They dropped the end of the bed down and I knelt on the lowered end of the bed and rested my arms on the raised portion. The midwife caught Elijah from behind. There are pluses and minuses to this, it felt much more natural and a lot easier to push him out, but didn't provide a great view for me. I think most women are most concerned with the easiest route at this point, though, and not the view. You get to see the baby soon enough.
The head's the hardest part, then one push for the shoulders and that kid comes slipping out into the world. After that you get to hold him, take lots of pictures, and learn the art of breastfeeding. I'm hoping that will be the subject of my next "Mom Advice" post.
What can you do to prepare for labor and delivery:
--Read books on natural labor
--Collect CD's of music you want to listen to (or make a playlist on your Ipod or whatever you have) Slow, calm music for active labor, faster, more inspiring music for transition.
--Practice deep breathing and relaxation techniques
--Practice light breathing for transition
--Visualize youself going through labor the way you want to (on a birth ball, in a warm tub, whatever)
--Practice reassuring yourself that you can do this, because you can.