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From the Publisher"The beginning of the love affair with your child starts here. This book makes planning your birth fun and easy. A must read for every expectant parent."
— Louann Brizendine, M.D. Author, THE FEMALE BRAIN
With their groundbreaking film The Business of Being Born, Ricki Lake and Abby Epstein changed the way we view childbirth in the U.S. Now their empowering book will change how you view your own child's upcoming birth.
The national C-section rate is at an all-time high of 31 percent. Are all these procedures necessary, or are some of them done for the sake of convenience? Inductions seem to be the norm, but are they always needed? You are about to learn that you have a choice and...
With their groundbreaking film The Business of Being Born, Ricki Lake and Abby Epstein changed the way we view childbirth in the U.S. Now their empowering book will change how you view your own child's upcoming birth.
The national C-section rate is at an all-time high of 31 percent. Are all these procedures necessary, or are some of them done for the sake of convenience? Inductions seem to be the norm, but are they always needed? You are about to learn that you have a choice and the power to plan the kind of birth that's right for you—whether it is at a birth center, a hospital, or at home. Packed with crucial advice from childbirth professionals and delivered in a down-to-earth, engaging voice, Your Best Birth will inspire you to take back control of your birth experience. Discover essential advice on:
Positive and negative effects of epidurals, Pitocin, and other drugs and interventions
Inducing vs. allowing your labor to progress naturally
The truth behind our country's staggering C-section rate
Assembling your birth team and creating your birth plan.
Former talk show host Lake, producer of the documentary The Business of Being Born, joins with Epstein, the film's director, to further probe the subject of birth in America. Asserting that the "high tech, low touch" trend in medicalized births has usurped parents' sense of power and choice, the authors present a detailed examination of the birthing experience, beginning with their own personal accounts. Employing the premise that although one can't predict what will happen during birth, one can prepare, they present options that women should consider, including home birth and the use of a midwife or doula. Lake and Epstein point out that while 99% percent of births in the U.S. take place in hospitals and one-third are cesareans, the vast majority of births are not high risk and may not require medical intervention. But the fear of pain combined with unnecessary hospital protocols cause many couples to narrow or relinquish their options. The authors discuss the pros and cons of such interventions as episiotomies, epidurals and electronic monitors, and encourage women to carefully question their practitioners and hospital personnel. Above all, the authors advocate a safe and empowered birth, whether one chooses a hospital, home or birth center. (May)Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
TV talk-show host Lake and Epstein, executive producer and director, respectively, of the 2007 documentary The Business of Being Born, present an accessible starting point for learning about the approaches that constitute a natural birth. They list the different options that exist outside of a hospital labor ward and include many checklists about what to ask and look for when visiting each place. Sections cover doulas, midwives (and their different designations), birthing centers, home birth, inductions, and cesarean sections and vaginal birth after cesarean (VBAC). Giving clear explanations of jargon and drawing on the advice of experts, the authors hope their book will empower prospective parents to take control and make informed choices. One gets the sense that the authors believe that hospitals regard patients' wishes as somewhat lower priority than policy and lawsuit avoidance; therefore, for balance, make sure this is not the only title on the subject in a collection.
—Elizabeth J. Eastwood
Foreword Jacques Moritz, OB-GYN ix
Preface Ricki and Abby: Our Best Births xiii
Introduction Your Birth Is Your Business xxvii
Section 1 Know Your Options 1
Chapter 1 Not Your Mama's Birth Plan 7
Chapter 2 Your Best Birth Place 34
Section 2 Putting Your Dream Team Together 61
Chapter 3 Obstetricians: Finding Dr. Right 64
Chapter 4 Midwives: Not Just for Hippies Anymore 76
Chapter 5 Doulas: Labor's Love 93
Chapter 6 The Guest List: Birth as a Private Party 101
Chapter 7 For Sexual Abuse Survivors, a Healing 109
Section 3 Interventions: The Slippery Slope 115
Chapter 8 Epidurals: You Haven't Got Time for the Pain 119
Chapter 9 Inductions and Pitocin: Let's Get This Party Started 124
Chapter 10 Electronic Monitors: Reading between the Lines 138
Chapter 11 Episiotomies, Vacuums, and Forceps: The (Un)Kindest Cut 143
Chapter 12 Cesarean Sections and VBAC: To C or Not to C 148
Section 4 Take Back Your Birth 167
Chapter 13 Loving Your Labor 174
Chapter 14 Bonding with Baby 194
Resources for Your Best Birth 217
What kind of birth do you want?
Dare to think, just for a moment, that you could actually get the kind of birth that exactly suits your needs, the needs of your baby, and your desires. What would it look like? Where would you be? Who would you have around to support you when things got tough? Would you want something for the pain right away? Or would you like to give birth without drugs? And in those precious moments after your baby takes his or her first breath, is that child resting on your chest? Or being examined by a doctor to make sure that everything is okay? If you close your eyes and piece together all the different elements, what sequence of events would make you happiest and most secure?
Considering how unquestioning most of us are about the inevitability of giving birth the American way, it’s hard to know where to start in creating a birth of your own design. Where do you start to ask questions? Who do you ask them of? The place to start is with you.
For generations back everybody in your family has had their babies in the hospital, most likely. When your friends and your relatives go to the hospital to give birth, you don’t see what happens there. (For many decades, even fathers weren’t allowed in maternity wards.) You only see the result: your loved one propped up in bed holding that scrunchy-faced little newborn. The baby is the focus of most of the anxiety and most of the attention after the birth, so your experience of the hospital recedes quickly into the background. We’re going to tell you what the typical hospital birth is like for the mom because we expect no one has ever described it to you.
We need to say up front that we’re talking in a general way and trying to go right down the middle in terms of what most hospitals offer. You might live in a place where the hospital is extremely accommodating and caters to even the most fussy demands of pregnant moms. Or you might have as your advocate a very powerful doctor or midwife who, by force of personality and reputation, gets great treatment for all of her patients. It’s even more likely that your hospital offers a lot of good things, some flexible policies and practices, and some routine procedures that are not very friendly to the way you want to deliver your child.
Any description we offer here will miss some of the specifics of the hospitals in your area because every one, every state, every staff is different. So why bother describing? There are some things that are generally true and knowing them now, before we get to the finer points of the decisions you will be making for yourself and your baby, will give you a working knowledge of the way birth is managed in America. So we’ll start with you, the general you, as you enter the hospital in labor.
In this hypothetical scenario, you’ve been in labor since early in the morning but the contractions are weak and disorganized. You call your doctor’s office when it opens and the nurse tells you to call back when the contractions are consistently five minutes apart and much stronger. Some time after dinner, the pace starts to pick up and they get stronger. When you page your doctor around eight in the evening, the doctor on call, a doctor unfamiliar to you, tells you to go to the hospital.
The hospital’s main entrance is closed, so you enter through the emergency room. The staff directs you to the elevators that will take you to the maternity ward. When you enter the maternity ward, they put you in the triage room, a big room with four beds, two of which have other women in different stages of labor. All of you are being evaluated to see if you should be admitted, and your partner is told to wait in the hallway. Suddenly alone, you are separated by curtains and can hear the other women clearly as the nurses look you over. The nurses hand you a big pile of documents to fill out.
Before you get on the bed to be examined, you see the fetal heart rate monitor, with its stretchy wide belt made of fabric that is much like a girdle but shaped like a tube top. Monitoring in triage is a hospital requirement to get an initial reading on the baby’s heart rate. The nurse points you to the bathroom and tells you to give them a urine sample, after which you have to put on the fetal heart rate girdle.
The nurse places a glove on her hand and inserts her fingers in your vagina to determine how soft and wide your cervix is and how far your baby has progressed. Her assessment of these two things determines that you are three centimeters dilated, far enough along to stay. For a first-time mom, few hospitals will admit you unless you are at least that dilated. As the heart rate monitor gives out its readings, the lab is testing your urine to see if you have any kidney problems. The nurse also checks your vital signs: temperature, blood pressure, pulse, and breathing.
It is a busy night in the maternity ward and you have to stay in the triage room for a while waiting for a room to open up and be cleaned. While you wait, you address all the forms that need your signature. There are a lot of things to specify including allergies and drug sensitivities as well as consent forms for different procedures including anesthesiology. This is a very hurried and stressful time as you absorb this new atmosphere, the demands of the hospital’s legal and bureaucratic rules, in addition to whatever is going on in your body.
Soon after you enter the room where you expect to deliver your baby, a nurse takes some blood to make sure your blood is clotting effectively in case you want an epidural pain block. And, since they are sticking you with a needle anyway, they use that same puncture to start the IV. She places a cuff on your arm that inflates every fifteen minutes to check your blood pressure. You also have a little cap on your finger too, a pulse oximeter, that feeds the nurses a reading on your heart rate and the amount of oxygen in your blood.
The anesthesiologist visits you in the birth room. The assumption is that any patient might suddenly need general anesthesia, even though few need it. In order to determine if you can be intubated—meaning have a tube stuck down your throat—the anesthesiologist has you open your mouth wide to check to see if your teeth are loose, has you stick out your tongue to assess how far it extends, and asks you to swivel your head around to ensure you have full neck mobility.
Then they ask you if you want an epidural. First the nurse asks you. Then the anesthesiologist pops by again and says, “When you’re ready for your epidural, let me know.”
This is a question you are asked frequently, even though you have explained to the staff that you don’t want one.
We’re talking about the average birth here, so most likely after a time you will be hooked up to the monitor and you will have agreed to an epidural.
Because of the epidural, you are connected to a drip that adds saline to your system so that your blood pressure won’t drop dramatically. Attached to your back is the tube to the epidural pump, which feeds a continuous drip of anesthesia into a space around your spinal column. For the average hospital birth, you are hooked up to five machines (blood pressure cuff, electronic fetal monitor, epidural pump, pulse oximeter, and IV) and a catheter has been inserted in your bladder because, with the epidural numbing you, you won’t know that you need to pee and you are no longer mobile. Most women on epidurals also end up with Pitocin, a synthetic hormone delivered through an IV drip that accelerates and intensifies your contractions. So at some point after you have entered the birthing room, the nurse will hang a second bag, with Pitocin, on the IV pole.
The arrival at the hospital, with its unfamiliar atmosphere and all the demands of being admitted, plus the epidural slows down your labor. After an initial flurry of noise and activity, the staff leaves you and your birth companion or companions alone, monitoring you remotely from a bank of screens at the nurses’ station.
If this is your first child and you didn’t hire a doula or a midwife, it gets a little lonely in there trying to figure out what is supposed to happen and if your labor is progressing as it should. The nurse comes in about once an hour to make sure you are not too stressed out, which is not something she can pick up on the screen at the nurses’ station and which could stall your labor. Every hour or two, she examines you vaginally to see how dilated you are. If you are not dilating a centimeter every two hours over the course of six or seven hours, they might increase the Pitocin or start saying that your labor has stalled or is failing to progress. If they decide this, you will be getting a C-section, like nearly a third of the women in the hospital.
Before they prep you for the operating room, they suggest a number of things to get labor moving. If your bag of waters, the amniotic sac that surrounds the baby, has not yet broken, a midwife or doctor might suggest nicking it with a device that looks like a crochet hook. This causes a release of prostaglandins and more direct pressure of the baby’s head against the cervix, helping the uterus focus the contractions better and speed up the labor. Another technique is stripping the membranes, in which the nurse or midwife or doctor inserts a finger in your vagina and sweeps around under the lip of your cervix to irritate it. This irritation, which hurts, releases a hormone that helps the cervix soften.
When you are fully dilated, the staff tells you it is time to push that baby out. Your epidural is turned down so that you can regain some sensation to push effectively.
After about two hours of pushing, the nurse summons the doctor on call from your doctor’s practice. Part of the nurse’s job is to alert the doctor of a half-hour window in which the baby will be born so he or she can be there to catch the baby. Your baby isn’t coming out as quickly as the doctor thinks she should and the doctor wants to help her along. Although you told your doctor that you don’t want him to cut an episiotomy, this doctor is not the one you discussed this with. She grabs a pair of surgical scissors to cut a line from the edge of your vagina toward your anus. She doesn’t ask you if you want an episiotomy, and because you are drugged with the epidural, you don’t feel the cut until later when the anesthetic wears off.
After your baby is born, the hospital policy is to take the baby to be examined immediately. While the baby is being examined, a nurse gives you a shot of Pitocin to help you push the placenta out. At this point, the active management of your hospital labor is complete.
That term, “active management,” is at the heart of the different approaches to giving birth. The hospitals and most doctors approach labor as a crisis. Note how they start you off in the triage, often in a wheelchair too. Are they serious with this triage thing? Triage is a term from the battlefield, an emergency hospital set up so the medical staff can decide which of the wounded can benefit from treatment and who won’t survive, a method for allocating scarce resources.
Seems pretty over the top, but it’s a window into the medical model of childbirth, the kind that is practiced in most hospitals, the place where 99 percent of women give birth in an atmosphere of crisis. It’s a place where pitched battles are fought and American women feel they must come with a defensive birth plan in hand and a small army of supporters to help defend them against the maneuvers of a wily staff who are operating under orders from on high about how birth should be conducted.
What if it didn’t have to be this way?
This section will explore the important points you should consider in determining what you believe will be the best birth for you and your child, where you would feel most comfortable, who you want around you, and how you will deal with pain. Most important is not to be afraid. Or at least to face your fears in a way that shrinks them down to a more manageable size and reinforces your confidence about your body and your natural ability to give birth.
Few first babies arrive on their due dates, Jennifer Jilani had heard, so on the day her baby was scheduled to meet the world, she sent her mom and her mother-in-law, who were visiting for the birth, off on a tourist jaunt to the country and made an appointment for a late afternoon manicure and pedicure. Beautiful toes and fingers for the birth, she thought. The manicurist was brushing the finishing coat of hot pink on her toes when Jenn felt water between her legs. Her water had broken.
She called her husband, Asif, who was working from home, to ask him to join her at the salon and suggested he bring their dog, Senna, who probably could use a walk. Asif was suspicious. Was anything wrong? Had anything happened? Everything was fine, Jenn assured him. She just wanted to walk, and she didn’t feel like dragging her bicycle back. Jenn told the manicurist to proceed to paint the fingernails pale pink but not to bother with the cuticles.
This calm and casual attitude about birth was not the way Jenn first approached her birth, but being pregnant in the Netherlands had completely transformed her point of view from the anxiety she naturally felt as an American preparing to give birth. When she discovered she was pregnant, one of her American friends, who had recently had a baby in Amsterdam, referred her to her midwife. “A midwife?” Jenn thought. “Wasn’t that some hippie idea from the sixties?” Jenn told her she wanted to find a real doctor.
Her friend said that in the Netherlands all healthy women see midwives. Only those with dangerous or difficult pregnancies go to doctors. Anyway, Jenn decided, she had to get down to the clinic right away and get checked out. Her friend gave her a phone number for a midwife.
At that first appointment, Jenn was struck by the decidedly unmedical feel of the entire experience. Amsterdam has blocked cars from De Genestetstraat, what Jenn refers to as “the birthing block,” a street completely devoted to pregnancy and babies. A midwife practice has offices there, along with an acupuncturist who specializes in the discomforts of pregnancy, one of the state-run well child clinics, and a day care center. De Genestetstraat also has a children’s shop devoted to pregnancy, birth, and babies with a café that caters to moms and offers a special play area for children.
In the midwifery office, instead of chairs lined up stiffly against the walls, there was a big wooden table in the center of the waiting area scattered with information on pregnancy and childbirth, a setup designed to encourage conversation between the couples that gathered around. In brightly colored ink, a mirrored door had a list of the names of the babies the Het Geboortecentrum midwives had helped enter the world that week. Facing the street was a big picture window, and women waved to each other as they passed by.
Jenn was charmed, but Asif was alarmed. He called his dad, a pediatrician, to ask him about the Dutch health care system. His father told him that the Dutch system is highly regarded, one of the best in the world. “Maybe I should just allow it to be very low stress,” he said. That old familiar stress rushed back when Asif entered the salon and Jenn mouthed to him, “My water broke.”
Jenn was grateful she was wearing a long sweater that hid the dampness on her pants. As she and Asif walked, they had to pause when she was overcome by a contraction. When they arrived home, they called their doula, Jennifer Walker (who would provide labor support), and the midwife on call, Mary-Elliz Sheridan, whom Jenn adored.
While Jenn was moving around the living room, sometimes on the couch and other times leaning against the wall to yield to the contractions, Asif was quietly freaking out. He wanted to be at the hospital, which they had decided would be the best thing for a first pregnancy. In the Dutch system, you don’t have to decide until the day of the birth where you will have your baby. The midwife calls your first-choice hospital to see if they have a bed available. If not, she continues down the list until she finds an open maternity bed.
Jenn and Asif’s moms returned from the tulip fields, and Asif handed them a bottle of wine and two glasses. They set themselves up in the kitchen to wait. Jenn was having heavy back labor. Jennifer Walker used counterpressure and acupressure to help her cope. When Asif came in to the bedroom, he took over digging his thumbs into her hip indentations, while Jenn leaned into the wall. Around 8 p.m., when the contractions were coming faster and harder, the doula suggested that Jenn take a shower and recommended that Asif go in with her to continue to help her.
Around 9 p.m. Jenn entered the bath because Jennifer Walker suggested that probably would help her with the pain. Asif joined her there, holding her from behind as she rode the waves of her contractions. By the time they got out of the tub at around 11 p.m., Jenn had made incredible progress. She was nine centimeters dilated. As Jenn sat in the bath, she had gone through another transition. She realized that she didn’t want to go to the hospital. “I couldn’t imagine getting dressed, getting in a car,” she said. “I couldn’t think of how that would separate me from Asif.”
When Jenn describes the birth, her mood is light and she focuses on the happy specifics. She remembers the candles Jennifer Walker had placed all around their bedroom and the beautiful soft light they provided. She recalls the mellow and cheerful music of Jack Johnson she had chosen to play in the background. For Asif, as it turned out, the experience was profound.
“I don’t think I could have been any more close with her. She was sitting on this birthing stool resting her arms on my legs. I held her arms and rubbed her shoulders. Opposite our bed is a closet with a full-length mirror. We could look each other in the eye. I could see everything. I could see the baby crowning. That was incredible. Quiet and so peaceful and the immediacy of the moment. Jenn gave that last push and immediately the midwife brought our baby to her chest and I could put my arms around them and hold us as a family. Honestly, looking back on it, I could not imagine a better experience,” he said. “Within twenty minutes, they had cleaned up the whole place and Jenn and Aleisander and I were in our own bed with our moms at our sides.”
The next morning, Jenn’s kraamzorg (maternity nurse), Grietje, came around 8:30, even though she had been present for the midnight birth. Although Grietje is a private nurse whom the Jilanis hired because they wanted to choose the person, the state pays for a kraamzorg to provide care for all moms and babies for two weeks after the birth.
A year later, Jenn’s mom, Gail, still cannot get over the beauty of that birth, an event that had her terrified pretty much the entire night. “I have to say it was like going on a journey with her. When she told me she was riding her bicycle at seven months, I wanted to tell her to stop,” she said. “Then she was riding that bicycle on her due date! But when I saw her at that birth, it was all so beautiful. My daughter was very, very blessed with everything.”
Jennifer Walker agreed with Gail’s description of pregnancy as a journey. “You can’t have a child without going on a journey, whatever that journey will be,” she said. “A woman has to get to know her body, get to know her baby, start to understand her fears, and experience how her hormones change and how what she learns from the people she speaks with along the way affect her ideas about the birth. What she decides at week ten might be the opposite of what she’s confident of at week thirty-five. This is a process that puts the woman at the center, and we go on the journey with her. But we don’t lead. She does.”
Maybe you’re hating us right now for describing this beautiful birth story. Oh yeah, you’re thinking, everything is beautiful in the Netherlands, thousands of miles away from the United States, where the whole friggin’ country basically welcomes each new citizen into the world. Just try getting anything like that here. Even if you wanted to give birth like Jenn did, how could you afford it? You might have to pay out-of-pocket for everything!
We present Jenn’s story as a way to open your mind to this alternate reality of childbirth, a world where the mother’s sense of herself and what she and her baby need drives the process, not the rules of the hospital and the doctor’s fear of getting sued. Although this was the Netherlands, you too can have the peace, empowerment, and joy that Jenn experienced even though you are in the United States by doing your homework and assembling the right people around you.
Yes, ours is a system in which we are taught to believe that wisdom and experience reside with the professionals. Our idea of wisdom is a head-centered, brain-focused intelligence that professionals acquire through years of study and training. With that point of view as the starting place, it’s difficult to fathom that there is any wisdom residing in the body of someone who has never given birth before. By contrast, in the Netherlands the system is constructed around the wisdom inherent in a woman’s body. And yet you can have the best birth for you—despite our system. It’s just up to you to advocate for it and by the end of this book, you will know how.
According to a 2008 report released by the Centers for Disease Control (CDC), the U.S. infant mortality rate barely budged between 2000 and 2005, causing the U.S. to slip further behind other developed countries despite spending more on health care. War-torn Bosnia and Croatia have better maternal outcomes than we do. So don’t let anyone chide you for being a spoiled, entitled American woman if you go to great lengths to get the kind of birth you want for your family. In fact, you might be saving your life by taking yourself and everyone around you on your journey. This is the first step. Don’t look back!
Most pregnant American women do what the Jilanis expected to do: go to their doctors and let the doctors tell them what is going on in their bodies. That’s what their mothers did and all of their friends do. After the obstetrician examines her, she goes to the hospital the doctor recommends. Ninety-nine percent of American babies are born in the hospital and only 8 percent of babies are delivered by midwives. It’s one-size-fits-all maternity. A woman who wants a birth that reflects her values can arrange for one, but she will have to do her homework.
Unfortunately the burden is on you to arrange all the different circumstances and anticipate the variables as well as think through a plan that clearly describes your preferences. Most women simply walk into the office of the doctor that is covered under their health plan and follow directions from that moment on. Even if that’s what you’ve done, you might consider hiring a doula early on to help guide your journey and accompany you to the hospital. There are always choices!
Sure you can eat right, not drink alcohol, and make sure you do a moderate amount of exercise as a way of believing you have control over your birth. In some ways, that is a bit of control. But the moment you go into the hospital to have your baby, many vital decisions are in the hands of people you’ve never met. If you want to give birth in a way that reflects your personality and your values, you’re going to need to do some homework.
Does that sound like too much of a burden right now? Do you feel like all of this is too much? Geez, can’t you just go with the flow and do it the way your mom and your doctor say is the best and the safest? Those are opinions you should consider, but what about your opinion? You know your body and will know your baby better than anyone. You have the power to do this. You can prepare, even though you’re not in the Netherlands!
Three basic elements to initially consider when you’re pregnant are your body, the baby or babies, and your level of anxiety. Of course, sometimes physical conditions limit the choices of where and how you can have your baby. If you are having more than one baby or if your baby is breech, some midwives will direct you to the hospital and to the care of a physician. For many caregivers, a woman who has a breech baby or is carrying more than one baby is an automatic indication for a C-section. Some midwives and doctors who are experienced in delivering breech babies or multiples vaginally might take you on as a client, but you will have to look hard to find them. Women who have previously delivered children through cesarean section are under a lot of pressure to have their next child through cesarean as well.
A small percentage of pregnancies present dangerous conditions that require the mom to be carefully monitored at the hospital. Like a lot of things related to birth and childbearing, there isn’t a uniform consensus on what constitutes a risk. A condition that one doctor might define as high risk might not be seen the same way by a different doctor or a midwife. Many birth professionals don’t use the label “high risk” because they see the term as fear-based and subjective.
If a medical professional classifies you as high risk, look further into what these conditions mean, where you fall in the range of risk, and how you might be able to counteract the condition. In some cases, a different caregiver might take a completely different attitude toward your health. In many of these conditions, a midwife can co-manage your care with the help of a physician. Although the pregnancy might need extra monitoring, the delivery of the baby frequently is normal.
The conditions that should concern you are:
If you, luckily, don’t fit into any of these categories, then you are likely free and clear to pursue the complete spectrum of choices in childbirth.
We’ll get into those subjects in greater detail a bit later. For now, let’s talk about the worrisome stuff that pretty much every pregnant woman experiences—fear.
For most women pregnancy is a beautiful time filled with happy anticipation and punctuated by stark moments of terror. Feeling yourself fluctuate between these extremes is exhausting. You’re picturing the wallpaper of the perfect nursery and swooning over the most adorable little clothes. Just the sounds you make looking through those itty-bitty socks can make you feel like a hormone-stoked fool. The fear isn’t that you are shedding so many brain cells standing in the children’s clothing department that you might not have enough left to properly care for your child. The discomforting undercurrent is the fear of the unknown and the uncontrollable during childbirth.
Despite your careful preparation, your baby might get stuck someplace in labor, or the pain might become unbearable. Nearly every happy anticipation also presents its opposite. There’s the wonderful knowledge that once this baby is born your life will be changed forever. And there’s the terrible knowledge that once this baby is born your life will be changed forever. You’re vulnerable and dependent. In that state, you have to trust your partner completely. Yikes! When fear spikes, it knocks all those lovely mommy feelings right out of your mind.
There are two sources of fear. There’s the externally produced fear you get from talking to other people about their birth experiences and seeing the way television dramatizes birth, and there’s the fear you generate on your own.
The way we see birth depicted on television and in the movies is a truly frightening experience. We see none of the softness and peace of the Jilanis’ birth. That doesn’t make for very good television. The scenes that stay in our minds begin with the maternity ward doors flying apart as the gurney that holds the panicked pregnant woman rushes toward us with doctors and nurses jogging alongside holding an IV bag aloft. Birth in crisis! The disbelieving husband tries to hold his wife’s hand, reassuring her that, “It’s going to be okay. You’re going to be fine. You’re doing great.” You can see in his eyes that he doesn’t believe a word he’s saying, and so neither do we. The hero of this scene is not the mom but the doctor. He is saving her and the baby from the perils of her malfunctioning body.
The second kind of fear, the internal kind, takes place within the mysterious inner workings of your body in labor. No matter how many times you hear the elegant choreography of birth described, the hospital scene you’ve viewed so many times feeds that undercurrent of fear. The horror stories of birth you’ve heard focus the mind more on what can go wrong than on all the things that usually go right. Yes, labor is a beautiful sequence with one powerful step leading to the next. But each step of the process might stall if your body doesn’t work as it is supposed to, and you can’t do anything about it.
What they don’t tell you is that the first image of birth in some ways prefigures the second. So much of what we think about, yet refuse to really talk about, related to birth in America focuses on fear and the fear of pain. This can influence the stalling of labor, particularly for first-time moms who don’t know the rhythm of their bodies in childbirth and, as a result, believe that each pause in the progress of labor is a sign of disaster. And since everyone around them is familiar with the disaster scenario, women have their fears validated by the looks in their companions’ eyes.
Fear stalls labor. If you’re schooled from the beginning of your pregnancy to focus on fear of all the things that can possibly go wrong, you’ve got a higher chance of them going wrong at birth. Here is a brief body chemistry lesson to explain how images of scene one affect the internal reality of scene two.
When most other mammals give birth, they retreat to dark, private, protected places where they can labor in peace and safety. (Think of dogs and cats going under the bed to have their litters.) Americans go to the bright lights, bustle, chaos, and strangers of the hospital. We might rationally believe that the hospital is a safe place because, if disaster strikes, there are professionals and equipment to save mom and baby, but our mammalian brain may believe otherwise.
Under stress, mammals produce stress hormones called catecholamines such as adrenaline and cortisol. These are great hormones to have in your system if you need to fight or flee. If a predator comes upon a laboring deer, a surge of these hormones can stop her labor cold and enable her to jump up and get the hell out of there. If you want labor to progress, these hormones are not so good for you.
When they spike, they reroute blood away from the uterus and placenta to the other major organs. This diminishes oxygen to the baby and slows or stops contractions. Catecholamines also inhibit the production of oxytocin, the hormone that stimulates the progress of labor. When they surge, the uterus stiffens and resists contractions. The French obstetrician Michel Odent’s research into this showed that the atmosphere of most hospitals stimulates the part of the brain that produces stress hormones. The reason women rely on synthetic oxytocin (Pitocin) given to them at the hospital and fall victim to unnecessary C-sections, according to Odent, is that the lack of privacy and increased stress of a hospital setting inhibit their ability to produce oxytocin on their own.
For most of their time in the womb, babies float freely in the amniotic fluid, flipping around, sticking their little feet and hands out for a stretch as they grow. Sometime around the eighth month gravity and the pressures of the uterus maneuver them into the head-down birth position. Babies at this stage who look like they will present feet first, butt first, or knees first are breech babies; about 3 to 4 percent of all births are breech.
Although midwives and physicians delivered many breech babies successfully for centuries, the common practice for breech babies these days is a cesarean birth, especially if this is a first baby. The American College of Obstetricians and Gynecologists (ACOG) standard is a C-section for breech babies. Generally speaking, the only babies that are delivered vaginally are the ones who are already too advanced in labor for a C-section.
In part this is because many obstetrical schools no longer teach their students how to deliver breech babies vaginally. Midwives who have a lot of experience in delivering breech babies would disagree that a C-section is automatically called for, particularly if a woman has successfully delivered other babies vaginally and has a “tested” pelvis.
There are old and new ways to try to turn your baby into the head-down position. As Abby recalled earlier, when she found out Matteo was breech, she researched moxibustion, a traditional medicine technique in which the practitioner holds a cone of slow-burning herbs, such as moxa or wormwood, as close to your toe as possible without burning you or causing pain. This is a counterirritant, designed to stimulate blood flow and turn the baby around. There is also a chiropractic adjustment used to turn breeches, as well as a procedure involving acupuncture points.
Another technique for turning the baby is version, a method where the practitioner tries to turn the baby by grabbing hold from outside the mother’s belly and manually adjusting the baby. A version needs to be done while carefully monitoring the baby for any signs of distress, as there is the possibility that the cord can get caught during the version and create decreased blood flow to the baby as the cord is pinched. Some practitioners feel that attempting a version is a lower-risk procedure than scheduling a cesarean surgery.
Midwives have passed down a number of techniques for turning a breech baby including:
Doctors and many others might laugh at these tricks, but they are worth trying—they are unlikely to carry significant risks and they don’t cost a dime.
Chiropractors have a trick called the Webster Technique for repositioning the baby. Your midwife should be able to recommend a chiropractor in your area if you don’t already have one.
Most of the time, moms-to-be in the United States are told not to worry about their fears and let the medical establishment handle that part of it. They’ve got drugs and machines that will save you from agony and uncertainty. Birth is portrayed as an out-of-body experience. However, the way we want to look at it here is through the mind–body connection.
Birth is automatic and involuntary, no matter how much your doctor or the hospital may tell you that it needs to be managed. It is as automatic as digesting your food. You can’t control it. If you are not numbed below the waist, you will know when to push without anyone yelling “PUSH!” at you. But fears, expectations, and beliefs can definitely affect its progress. The emotions you experience in labor signal your body, if you are in a safe place, to have a baby, which affects the limbic system, the part of the body that governs the hormones that influence labor.
If you’re in a safe place and a calm state of mind, your body will naturally produce the hormones and neurochemicals that help labor progress. The pituitary gland will bathe your system with oxytocin to stimulate contractions, and prostaglandins will pour from the hypothalamus to ripen the cervix.
This is a very big deal, becoming a mom. You’ve got every reason to be afraid that it won’t go as well as you planned or that you or those around you are not up to the task. If you’re frightened by your surroundings or by some emotional issue you haven’t resolved before labor begins, this onslaught of hormones will stall and so will your labor. That said, what can you do about your fear?
Start to see fear as your friend. This is counterintuitive, of course. Who wants friends they’re frightened of? Fear is not the endpoint, but the starting point. What you’re frightened of shows you where and how you need to be supported.
The fears are as individual as the women giving birth. Gayle Peterson, a therapist practicing in northern California, has been working on ways to identify and address these fears since the birth of her first child in 1973. She developed a specialty in birth counseling and hypnosis, a four-session model of defining a woman’s fears and giving her ways to cope effectively with them.
When birth counselor Gayle Peterson meets with clients for the first time, she takes them through what she calls “a birth inventory.” The following are the fourteen basic questions she asks her clients to help them explore the fears that might stall labor. If you want to go deeper into this area of birth preparation, pick up her book An Easier Childbirth or find a birth counselor or doula in your area to help you cope with these issues.
1. Was this a planned pregnancy?
2. What was your initial response when you realized you were pregnant? Have there been any changes in your attitude or feelings since then?
3. How has this pregnancy affected your relationships with your partner and your family members?
4. How will a baby fit into your current lifestyle and plans?
5. Will a baby alter your lifestyle significantly or change your long-term plans? If so, how?
6. What are your impressions and expectations of a newborn?
7. How will you and your partner share responsibilities for the baby during the first year?
8. What do you know about your own birth? What is your impression of your mother’s experience of childbirth?
9. If you have given birth previously, what was it like for you? Is there anything you would change if you could? Is there anything you would do similarly the next time you give birth?
10. Do you feel satisfied with your current plans for this child?
11. How do you envision the birth of this baby? What is important to you? Who will be present at the birth?
12. How do you think you will cope with pain during labor? How do you want to prepare for labor?
13. Do you like your body? Do you trust your body’s changes during pregnancy and childbirth?
14. Do you have any particular concerns about this baby? About childbirth? About the postpartum period?
Telling a woman that anxiety has an impact on labor but not giving her some way to cope with it only makes her more anxious. These fourteen questions really focus on the way life changes and how you might change once you bring a new member into the family. They are simple questions about practical things. Answered thoughtfully, they can help you explore the places in your relationships that will be tested during and after the birth. Those candid answers can expose the weak spots in the way you have prepared for this child.
By working with those answers, Gayle helps her clients deal with the four or five issues that have the biggest emotional charge and uses counseling and hypnosis to guide them to reframe their attitudes about the things they fear.
For example, if a woman fears she will become just like her mother, whom she doesn’t think was a very good parent, Gayle will guide her to focus on the ways she’s not like her mom. Or, if she’s afraid she’ll lose her identity in motherhood, their work will focus on practical things she can do that will shore up her identity once the baby is born.
By addressing those anxieties, Gayle’s work shows, labor doesn’t have to be a battle. Those who do this exercise honestly battle their fear before labor begins. In this way, the baby can be an opportunity for an incredible amount of growth for you, healing for the family, and getting closer to your partner.
Of course Gayle has tons of examples of this specialty, since she’s been practicing for more than thirty years. When we met, she was just back from a final session with a patient who had a frightening recurring dream that she would give birth and the baby would be taken away from her for a long time, then returned to her much older and significantly disconnected from her. In the baby’s absence, she was anxious and alone. Gayle suggested she speak to her mother about what had happened at the woman’s own birth.
The woman went to visit her mom to discuss this dream and was shocked to find out that she had been taken away from her mother after birth. Her mother sobbed as she recounted her postpartum nervous breakdown for which she had to be hospitalized for six months. This was so shameful for her mother—she felt so guilty about how indifferent she had been to her daughter when they were reunited—that she had kept this secret for more than thirty years. Being able to release the secret at last was cathartic for the woman’s mom. When her client related the story to Gayle, she was calm. Her dream made sense to her once this part of her history was explained. She didn’t have the dream after that.
If you understand your fears and plan accordingly, you may be able to manage them on your own—without needing certain drugs during childbirth—by using the power of the mind–body connection.
The aspect of labor that women seem to focus on the most is how they will handle the pain. Pain is frightening and, thankfully, most of the time we experience it, it comes as a surprise. If you slam your hand in a car door or pick up the handle of a pot without a potholder, you’ll jump around swearing and waving that hand in the air to compensate for the searing discomfort. With that as the idea of pain, few would sign up for twenty-four hours of it in labor. Some women who’ve had epidurals and caregivers who push epidurals often compare using one for childbirth to getting a tooth pulled with an anesthetic, as in, why would you get a tooth pulled without the Novocain? Why would you put yourself through unnecessary discomfort when instead you could just have the shot, relax, and explore the playlists on your iPod?
We believe this is an inept analogy. Don’t you think comparing your beautiful little baby to a rotten tooth is just a teensy bit insulting? There is nothing empowering or transformative about having your tooth yanked. Birth equals create. Extract equals discard. The two just don’t line up well. Besides, not all women experience childbirth as pain.
Ina May Gaskin, one of the most respected midwives in the world, says that when she surveyed 151 women, most of whom had given birth at The Farm midwifery center in Tennessee, one-fifth of these women said they had had an orgasm at some point during labor or birth!
So although we’re trained to think that childbirth is extremely painful, the truth is that some women do experience orgasm. This is a big revelation, as it hasn’t ever been mentioned in a medical text, as far as we know. Even imagining this possibility can take the curse off labor and birth to some extent, since many women have been raised to think that labor pain is some kind of religiously ordained punishment (historically referred to as “the Curse of Eve”).
Ina May first started asking women about this because many times it sounded like they were moaning in ecstasy instead of agony. She says that a good labor and birth often sound like the couple is making a baby, rather than having one. So what makes a woman capable of having an orgasmic birth? Ina May said, “It’s not so much about an innate capability as that the ecstatic hormones of birth aren’t easy to access in the conditions that we now find in most hospitals, with their bright lights and frequent interruptions. To access the hormones that can help create a sense of euphoria, it is necessary to open one’s body and to surrender to the powerful sensations of labor, a difficult thing to do unless it is possible to feel absolutely safe and secure. Women who would like to increase their chances of experiencing an orgasmic birth will need to do some research on the subject so that they understand that much will depend upon the choices they make about where and with whom they will give birth.”
The kind of woman who’s less likely to have it, Ina May said, is “a woman who is afraid she’s going to fart.”
That needs some explanation.
Ina May and her colleagues developed a principle of birth called the Sphincter Law. (This theory is described in much more detail in her book Ina May’s Guide to Childbirth.) The basic concept is that the vagina is a sphincter and so are the throat, urethra, and anus. The midwives have observed that when one sphincter opens, all of them do. And part of being completely open is opening yourself to all possibilities, including that of an orgasmic birth.
“You don’t need people around who make you feel inhibited,” Ina May said. “And being around people who are violators of sphincter law doesn’t help.”
And she advises that the baby must cooperate too. “I think that it has everything to do with circumstance,” Ina May said. “It’s much easier if your baby doesn’t try to suck both of his fists at the same time because then you have to deal with his elbows. Too many sharp corners would mess up the orgasm.”
Okay, I know you’re thinking we’re nuts right now. If childbirth isn’t painful, then why are all these women in labor asking for drugs? What we’re saying is that it’s not a slamming-your-hand-in-the-car-door kind of pain. The pain escalates and subsides, and there are periods of rest when you can recoup your energy for the next surge of feeling. Caregivers who are trained in ways to help you handle the pain have a number of inventive techniques to minimize the discomfort. The place to start when considering pain is to look at the ways we think or don’t think about it.
In Ina May’s classic Ina May’s Guide to Childbirth she cites a very interesting study that probed into the way American women think about pain in contrast to the way the rest of the women in the world consider it. In the study, researchers told a group of American women and a group of Dutch women (sorry, we’re back to those Dutch women again!) who were about to have their babies in hospitals that pain medication might stall their labor. Two-thirds of the Dutch women gave birth without pain medication while only one-sixth of the Americans did. Two days after their births, when the women were asked about their ideas of pain in childbirth, it was clear that even though both groups of women had gone through the same experience, the American women expected it to be more painful and expected pain relief. They just wanted to be knocked out and didn’t really want to think about the effect that would have on the baby. Our cultural schooling in anticipating pain is a big factor in how we perceive the pain of childbirth.
But hey, we’re Americans and we’re sort of stuck with our cultural expectations. We are trained to think of childbirth as painful, but many women in other countries think of pain as part of the process of giving birth and essentially manageable. This difference in attitude has a huge impact on women’s perception of pain. Knowing that these fearful expectations are not universal can make you a little curious though. If it isn’t certain that it’s going to be unbearably painful, what can you do to manage your expectations in a way that makes the pain bearable? You can’t control the pain, only your attitude toward it, as the saying goes. What if you could work on changing that attitude?
The automatic response to pain is to say you could do without it. That’s not subtle enough, not personal enough for the kind of questions we’re raising here. Not everyone has the same expectations when it comes to handling pain. See where you stand on Seattle childbirth educator and doula Penny Simkin’s pain scale, below, adapted from her book The Pain Medication Scale, co-authored with Ruth Ancheta. Penny has written several very insightful and compassionate books about childbirth as well as a great handbook on labor. Her pain scale is provocative because it allows you to compare your image of the kind of birth you want to a realistic expression of how much pain you feel you can manage. It’s a good starting point for discussing with your partner and your caregiver your expectations and tolerances in a concrete way rather than simply saying, “Pain? Do. Not. Want.” This scale is a great starting point for discussing with your caregivers how you would cope with labor pain.
+10 I want to be numb, to get anesthesia before labor begins. (An impossible extreme.)
+9 I have great fear of labor pain, and I believe I cannot cope. I have to depend on the staff to take away my pain.
+7 I want anesthesia as soon in labor as the doctor will allow or before labor becomes painful.
+5 I want epidural anesthesia in active labor (4–5 cm). I am willing to try to cope until then, perhaps with some narcotic medications.
+3 I want to use some medication, but as little as possible. I plan to use self-help comfort measures for part of labor.
0 I have no opinion or preference. I will wait and see. (A rare attitude among pregnant women.)
–3 I would like to avoid pain medications, if I can, but if coping becomes difficult, I’d feel like a “martyr” if I did not get them.
–5 I have a strong desire to avoid pain medications, mainly to avoid the side effects on me, my labor, or my baby. I will accept medications for difficult or long labor.
–7 I have a very strong desire for a natural birth, for personal gratification along with the benefits to my baby and my labor. I will be disappointed if I use medication.
–9 I want medication to be denied by my support team and the staff, even if I beg for it.
–10 I want no medication, even for a cesarean delivery. (An impossible extreme.)
(Adapted from Penny Simkin’s Pain Medication Preference Scale © 2001, 2008)
One important point to consider as you rethink labor pain is that it is actually helpful. The spikes of pain help release more oxytocin, a hormone that helps the progress of labor. Plus, coping with the discomfort of the baby moving through you causes you to move and shift the baby into a better position.
Let’s assume your baby is facing head down in the uterus, just as he should be, but his head is turned the wrong way for a smooth delivery. He’s facing to the side when he should be facing up toward your behind. This pain is hard to handle. The midwife or nurse attending you can coax him to rotate by helping you position your body asymmetrically. One foot up on a chair or one knee on the floor in a lunge will open your pelvis in that direction and give the baby more room to twist around. An experienced caregiver will be able to determine where the baby is in his journey and where he might be caught and guide you to positions that encourage his safe and relatively speedy passage.
Your body is a wonderful guide too. There are some positions that just feel better. Some women report that every contraction is different than the one before and informs their body what position to move into next.
Many women feel great when they spread out over a big birth ball, with the pressure of its forgiving surface relieving the strong sensations and helping to massage the baby down with each contraction. By shifting the body into a more comfortable position, expanding the room for the baby to adjust, the baby wriggles down a bit more, moves a bit closer to being born. With the next contraction, the uterus squeezes in a little tighter, nudging the baby forward. You feel that pain and shift some more. The baby twists a little more and so it goes until you’re holding your newborn in your arms.
Some of the doctors we talked to about natural childbirth when we were working on our film dismissed the idea of giving birth without pain medication as a “macho mom” fixation. These doctors inferred that natural childbirth was an elitist experience, a way of separating yourself from the other moms at the playground by claiming bragging rights over those whom you judge as too weak to go all the way. The doctors who said that don’t understand that when you tell some mothers that you gave birth without pain killers, they don’t envy you. They think you’re crazy. Besides, the women who give birth without pain medication would never describe the experience as macho.
“Macho mom is a terrible characterization because it implies pompousness and arrogance and this was the least arrogant thing I’ve ever done,” said Jorie Walker, an Alabama mom who, during the first stage of labor, drove forty-five minutes into Tennessee to give birth to her second baby naturally. She couldn’t find a doctor in her small Alabama town who would pledge not to give her an epidural. “Every woman I’ve ever talked to who has had this experience has a profound humility. It’s the experiential equivalent of an archeological dig. I felt powerful and very feminine and connected to all the women who had done this before.”
We’ll return to fear when we get to the section about putting together your support team, wherein we will deal with fear of your mother. No, we’re kidding. Fear of your mother needs its own book. There are fears that come up during labor that are images and expectations from the past that should be dealt with in order for it to go more smoothly; many of them have to do with the people who are closest to you. But first we want to close off this part where we’re getting you pumped up to handle this, the birth that is your own creation, by addressing something unexpected, positive, and uplifting while having the additional benefit of being true.
Perhaps you don’t feel so much like a goddess right now. You’re nauseous and cranky and your body is cumbersome. Pregnancy pants with a big elastic front panel do not impress you as being standard-issue goddess wear. Nonetheless, what’s happening to you is nothing if not miraculous.
Creating life is goddess work. You are stronger, more powerful, and more focused than you’ve ever been. Life force is coursing through your body and you are living life in a heightened state of awareness. You are extremely sensitive to smell and taste and to the people, situations, and changes in the atmosphere that might do you or your baby harm. What might make you feel vulnerable also makes you fierce. People better watch out because you will do almost anything to protect your baby.
In this state, you are amazing. You are going to access parts of yourself that you didn’t know existed. You are going to face your fears. You have decided to face pain and handle it in a way that makes you most comfortable. Dealing with fear and facing pain are the kinds of things that most people run from as fast as they can, but not you. You are the birth goddess and you will do what needs to be done.
When you come out the other side of this experience, you will be a different woman than when you went in. You will know yourself better and have a much broader sense of what you are capable of doing. You will be smarter and stronger than you’ve ever been before. Each birth experience is extraordinary, yet at the same time birth is commonplace. Millions of women do this every year. After the birth of your child, you will be connected to all the women who have given birth across the centuries as well as deeply connected to your baby.
From time to time in this book we will highlight other birth goddesses so you can revel in their extraordinary experiences and perhaps take inspiration from what happened to them and how they handled it. Our first birth goddess is Cindy Crawford. Of course Cindy Crawford is a birth goddess. She was a goddess even before she gave birth. She’s Cindy Crawford: beautiful, smart, sexy, funny, and, just like you will be, she was transformed by the amazing way she birthed her babies. Cindy turned her baby around in the womb in one massive act of will!
Everybody told Cindy Crawford that the birth of the second baby is supposed to be much easier. After the home birth of her first child, son Presley, Cindy and her husband, Rande Gerber, were able to sit down for a relaxing dinner (albeit on one of those inflatable donuts) only hours later. She believed her daughter’s birth would be no problem. Kaia, it turned out, wasn’t having any of that.
Kaia was what the midwives call “sunny side up” or posterior—she was coming out face up, facing Cindy’s front, which meant that her spine was rubbing up against Cindy’s. “With Presley I never screamed out,” Cindy recalled. “With my daughter, I was standing on my bed screaming obscenities.”
Her contractions never fell into a rhythm during the thirty-three hours Cindy was in labor. Toward the end she was in such pain and so frustrated. Her midwife told her to stand up to give her baby more room to maneuver, but Cindy didn’t want to leave her bed and didn’t want to stand. She wasn’t certain how much longer this labor would go on seeing as she was ten centimeters dilated and still didn’t have the urge to push.
Rande got a birth ball and placed it on top of the bed so he could support Cindy as she focused on her next contraction. Cindy stood up and rested on the ball. With the weight off her legs, when the next contraction peaked, she let out a primal sound. As the contraction peaked, she felt her baby rotate inside her into the proper position to be born. “It was a very ET-like alien experience,” Cindy said. A few pushes later, Cindy held her daughter in her arms.
Hours afterwards, Cindy was a little disappointed that the second birth hadn’t gone as smoothly as the first, a peaceful birth where she had gone inward and meditated. She was surprised at how the second birth had exposed a different side of her personality, a much more raw and not-in-control aspect.
“I don’t let myself be that way in life. And so to have this experience that was so unedited in any word or action, that was very liberating as well,” she said. “My births both gave me something very different. I learned that’s okay and that’s a side of me. It makes sense that my daughter’s birth was so different from Presley’s; I believe that babies come out in a way that reflects who they are.”
Excerpted from Your Best Birth by Lake, Ricki Copyright © 2009 by Lake, Ricki. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Posted May 1, 2009
This is a good resource for those who are interested in finding alternatives to hospitals for childbirth. The birthing experience is vividly described and many options discussed. it's heavily slanted in favor of home childbirth.
I find one negative and that is when Ricki is describing her child's birth; she uses unnecessary profanity. Otherwise, it's a worthwhile resource.
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