Finding Your Voice

I was at a networking meeting for birth professionals recently and in small group discussions we asked a question: “What do you wish more people knew about pregnancy, birth, postpartum or breastfeeding?”

There are a lot of answers to that question, but immediately one doula said (and I paraphrase), “I wish more women knew… that they had options.”  Options*. Yes. You have tons of them. But often people don’t know about them–well, you can’t ask questions about something you don’t know exists–so they get swept along with the status quo.

Here’s how it so often goes: You already have an OB/GYN that you see for your annual Pap test and any other “feminine issues”. When you get pregnant you’re a jumble of emotions and new physical sensations.  The birth is, like, forever away.  You call your OB/GYN to see what to do next and you’re told that they don’t see you until you’re about 12 weeks along. And so you wait. And hopefully you’re not too nauseous as you’re waiting.

When you do go in for your first visit, you’ll spend short visit being weighed, measured and listening to the heartbeat (♥). You may do some tests to screen for Down Syndrome and Spina Bifida. (Do you have to do these tests? No. But then again, you probably don’t know that’s option. And you don’t know that the screening test is only about 60% accurate. The other 40% of the time, it gives you a false positive or a false negative, yielding either a lot of anxiety and more tests or a false sense of security).  And then… you make an appointment for the next visit in another month. Maybe you had some questions, but your doctor seemed pretty busy. Besides you’ve got tons of time before you have to talk about all this stuff (remember, the birth is forever away). You can cover it in the next visit. Or can you? (For an illuminating view on the differing amounts of time you spend with an OB vs. a Midwife, watch this 2 1/2 minute video)

Maybe you have a vague concept that there are other childbirth choices, but they all seem kind of out there, odd, or um, crunchy. You can’t really relate.

I can relate.

You might be the ‘respect authority’ type, or the laid back ‘I-don’t-want-to-trouble-anyone’ type. I know I was. Only because my interest in birth goes back pretty far, did I go for the “crunchy” option right away.  But I don’t like to inconvenience people, especially not doctors. They’re important and they’re busy. I’m not a diva. I don’t feel like my needs have the be the highest priority. No big deal, right?

Wrong-o.

There are all kinds of choices that need to be made in your pregnancy and birth (in your life for that matter) and if you are not making those choices, it doesn’t mean that there wasn’t a choice, it just means that someone else is making it for you.  Sometimes that’s nice. I hate making decisions. If it’s of little consequence, I’m only too happy to hand that responsibility off to someone else! (Thai food? Burgers and fries? I don’t care! Pick for me.) But the key word here is “consequence.” Who has to live with them?  You do.

Wrenching as it sometimes is to make big decisions (or little ones, even) there’s something immensely satisfying about being in the drivers seat when it comes to your care.

Women should be making decisions together with their doctors or midwives. Your doctor or midwife should know enough about you to understand your hopes, fears and peculiarities. He or she should listen, answer your questions fully and should have a genuine interest in you and your well being.

If you have a nagging feeling about whether your choice of provider or birth place is really right, my advice is not to push it away. Take that nagging feeling and look it in the eye. Are you confident that you will get all the support you might need? If not, it’s time to start researching your options. There’s that word again! Options. Research them. Ask questions. Read books. Read blogs!  It doesn’t mean you have to change your mind or your plans. In fact all your research might show you that, in fact, your first choice was the right one for you. But whatever you choose, it will feel better–more purposeful–now. And, really, one less nagging worry is always a good thing!

Congratulations. You’ve found your voice.

*Obviously, this post isn’t about specific options (too much to cover in one blog entry!), but about the value of exercising your freedom of choice. 🙂

Epidural: Friend or Foe?

Well, I asked for suggestions for a new blog entry and someone helpfully suggested one of the most controversial topics in maternity care: THE EPIDURAL. Is this too much for one blog entry?

I guess we’ll find out because I’m going to take it on. But don’t expect me to come down on one side or the other. I’ve never seen this stuff as black and white and I don’t support arguing over it.

What I do support is knowing what you’re getting into (as much as possible considering we’re talking about labor here, the essence of unpredictable), whether we’re talking about getting an epidural or “going natural.”

So let’s break it down.

Pros of an epidural:

  • Takes the pain away, but leaves you mentally still “with it”
  • Allows you to rest if needed (sometimes desperately)
  • Relatively little medication gets to the baby
  • The amount  of medication can be adjusted so that you can have some sensation and motor control in order to push and change positions (while remaining in the bed, of course). I have been able to help some moms maneuver into a squatting position (with a squat bar) or onto hands and knees all while under the effects of epidural anesthesia. 

Most of those pros are common knowledge. The cons of epidurals are less well known:

  • Getting an epidural means lots of other medical things have to be done also. You will need IV fluids, your BP will be checked regularly, you will have continuous fetal monitoring, and you will probably have a catheter and a pulse oximeter (measures your blood oxygen levels).  You will not be able to leave the bed (although, as mentioned, you may be able to change positions in the bed).
  • Sometimes an epidural doesn’t work. Or it only works on one side (if you don’t believe me, just Google “epidural only worked on one side” and you’ll come up with hundreds of thousands of hits). Or it leaves a “hot spot” where you can still feel pain.
  • An epidural can slow down your labor. (note: sometimes it can also speed up labor and sometimes labor stays at a steady pace). If your labor slows, you will likely receive Pitocin augmentation and it may be increased more quickly because providers are not as concerned about your pain since you are receiving pain medication.
  • Epidurals can cause fever in the mom, which means that she may be treated with antibiotics in case of infection. Baby may also be subjected to an invasive septic work-up to rule out infection and/or will be treated with antibiotics.
  • Epidurals can affect the initial breastfeeding. I’m not sure how much stock to put into this because some epidural babies latch just fine and some medication-free babies have trouble with the initial latch (and vice versa), but studies show that there is an increased risk of initial breastfeeding difficulty in babies whose mothers had epidurals.
  • Epidurals anesthesia can make your BP suddenly drop, which is risky for mom and baby. The IV fluids are given to head off this potential complication.
  • Reactions to the medication can range from the very common itchiness (usually starting at the chest and neck) to the much rarer severe allergic reaction to the anesthesia.
  • These actually aren’t all the cons, but I think you get the picture.  Getting an epidural isn’t always easy and breezy, although for many women it is. 

And you know what else is not always (or even often) easy and breezy? Yeah, you guessed it; unmedicated childbirth. I’m all for it, and I could list several items that were pros for me (but I can also see why someone would not relish this particular mode of birthing):

  • Allows your body to follow the hormonal “blueprint” that helps prime you for motherhood and your baby for life outside of the womb. 
  • Increased the bond  between my sweetie and I. Being able to trust that I could “lose control” and still have him there by me, supporting me was an immeasurable feeling and made me fall in love with him all over again.
  • Made me feel incredibly powerful. It’s incredibly powerful just to carry and grow a baby inside your body. Giving birth can intensify that feeling.
  • It was like a rite of passage. I came up against some big fears and I had to face them in order to move forward in labor. Though it was hard, it was also rewarding. 

But the cons are many as well:

  • It hurts (for many or most women).
  • You don’t know how it will feel or how you will cope. You may worry if you will be able to cope.
  • You may come up against some big fears that you are not ready or able to face (this could be especially true for survivors of abuse).
  • “Losing control” or surrendering to the process can be difficult and/or terrifying to do.
  • You may cope well at first, but if labor is long, it can severely deplete your ability to handle the rest of labor.

In the end though, it comes down to this: What are your needs? What can you do to help you meet those needs? Whatever that happens to be is A-OK.

One big piece of advice, though: Make sure you are not making decisions based on fear. Fear is fine and normal, but it is not your friend when making big decisions. Take these steps during your pregnancy:

  • Think about your fears. Are you terrified of tearing during birth? Are you scared of how you will act in labor and what people around you will think? Are you scared about being a parent?
  • Talk with someone you can trust about these fears (your partner, your childbirth educator, your doula, your friend, your counselor) or write them down. Often there actions you can take that will address your fears. Sometimes even, just getting them out can make you realize that maybe it’s nothing much to worry about after all.
  • Having your fears addressed and your priorities in order will help you proudly chose how you want to birth. And it will help you make choices during labor, too, if (when) unexpected things pop up.

Many blessings for your birth.

“There is a secret in our culture and it is not that birth is painful but that women are strong.” -Linda Stavoe

You’ve entered the judgement-free zone

Everybody has opinions. Everybody has biases. I’m no different. Lets just get that out of the way right here.

Something else to get out of the way: I am a birth junkie. It’s what I geek out on. When I had my two babies, I had not one second of doubt about whether I would be able to give birth at home without drugs. Don’t ask me why. I just…knew. But I’m not on some high horse. It’s just a little insight into what was important to me.

And the key word here is “me.”  I did what was important to me. And my choices, unique to me, don’t belong in anyone else’s birth.

Duh.

Most women have huge doubts about whether they can achieve a drug-free birth and, more importantly, whether they want to.  This is a perfectly valid question to have: “Do I want to have a pain-medication-free birth?”

While I never waffled about what I wanted for my own births, and always respected the decisions of others, I was really able to understand this on a personal level through an activity that I’m far less confident in. Bicycling.

My husband loves bicycling. I, on the other hand, rode a bike when I was, like, 8 and then never again until I was in my 20s. Riding in traffic scared the pants off of me and I was so out of shape that I thought I would collapse after just short trips. I’ve come a looooooong way, but I still wouldn’t identify myself as a cyclist. So when my husband and a friend hatched a plan to ride 40 miles (with children) to camp in cabins, I was leery. Very leery. The saving grace was that other friends would be driving a car that could carry the cargo and they could ‘rescue’ anyone who needed to quit. So I committed. And we did training rides. And I felt pretty confident. But I knew that if push came to shove I could opt for the ride. And if I did I wouldn’t feel disappointed or like I’d failed. My identity just wasn’t all that tied up in whether I made it all the way on my own power.*

People, this is more than fine.

Maybe I don’t need to be an accomplished bicyclist in order to feel like my life is complete. Many women out there feel the same way about birth. Like, it’d be kinda cool to have a drug-free birth, but they’re not willing to be pushed to the limits of what they can endure for the sake of a drug-free birth. I get it.

I work with lots of women that want to try for a drug-free labor, but they have a threshold after which they would want medication. Some women know they want an epidural, but they want a doula for emotional support, information and lots physical support during labor prior to an epidural (and the massages don’t have to stop when the epidural arrives, for sure!). Some women really, really do not want an epidural, but end up getting one because they desperately need rest after several days of labor. And let me tell you, it can be incredibly empowering to stand up and say, “This is what I need right now, even though it doesn’t fit the plan I had for my labor.” Some women know that they don’t want drugs in labor and they do it–sometimes with ease and sometimes with a lot of effort and resolve.

When I’m with a woman/couple in labor, I stay flexible and responsive, checking-in as things morph and change. There are no absolutes when it comes to labor. And there is just no room for judgment. When my clients come to me, they are safe (emotionally speaking). There are no “right” answers. They’ve entered the “Judgment Free Zone” where making choices isn’t easy, but it’s free.

*For those that are curious, we made it almost the whole way, but the last 3/4 of a mile was a steep uphill, so I took my kids (sparing my exhausted husband from hauling their dead weight up the hill) in the car.

Wonder Woman for a Day

It’s kind of a funny story.

I was listening to Fresh Air on NPR on the way to pick up my daughter from school and Terry Gross was talking with Jimmy Fallon about how he came to be on Saturday Night Live. It turns out that Jimmy Fallon wanted to be on SNL almost as far back as he can remember. He said that when he would blow out birthday candles, he would wish to one day be on SNL. I was thinking, “How crazy is that?” that such an unlikely wish would come true…

And that made me think about my own crazy childhood wish, which was–get this–to be Wonder Woman.  I wished that on a lot of stars before my age made me cynical. I knew the wish would never come true.

But while I never donned a patriotic swimsuit-like uniform with tall red boots and I never swung the Golden Lasso around anyone’s torso and I never, ever drove an invisible, flying jet, I did sorta get my wish.

I gave birth at home with my first child (it was a planned home birth) and while I didn’t know what to expect any more than anyone else, I felt confident and prepared for this particular challenge. I was excited for my baby and my birth. It wasn’t particularly easy or hard. It was labor. It was scary in parts–I was afraid I would tear–but I surrendered to the process. I let my primal brain take over and once my daughter emerged I felt that I was the strongest, most capable woman in the world.

I felt like Wonder Woman.

It wasn’t that I felt physically strong. Heck no! I was laid up in bed for a week having lost more blood than is usual. But I felt, as many other women have described before, that if I could do that I could do anything. I know it was the hormones talking, but what wonderful hormones they were! Over time the feeling faded away, but I was glad to experience it all over again when I had my son 4 years later. (And that birth was downright lovely. I would have done it all over again the next day if you asked me.)

But I’m well aware that not everyone has the desire or opportunity to birth the way I did. That’s not really what I’m getting at. What I’m getting at is that every woman deserves to feel this way at some point in her life.  Birth (in all its forms) can be wonderfully empowering and exhilarating, but so can skydiving.  So birth may or may not be your portal into the super hero world but, gosh, it wouldn’t be so bad if every new mom could start off motherhood feeling like Wonder Woman for a day.

Eeny meeny miney mo

Life is about decision-making. Some decisions are small (Do I wear the rainbow-striped socks or the green argyle ones?).  And, of course, some decisions are BIG, like, “Where should I have my baby?” And you would never make that kind of decision based on a child’s game like ‘Eeny, meeny, miney, mo,’ right?

Or would you?

It seems ridiculous. And yet… there are times when all the research is done. The pro and con charts have been made. You’ve chatted with all your friends and you still can’t decide.  This happened to a friend of mine when she was trying to decide whether to have a home birth or a hospital birth.

Growing up, she didn’t know you could have a home birth. But then she’d encountered friends and relatives who had had home births. She was intrigued, but still preoccupied with the question of: “What if something happens?”

I told her that I’d seen plenty of people have great birth experiences in the hospital–it makes sense for a lot of people. Having had home births myself, I also told her what I’d learned about that, namely that though complications do happen, most often they happen slowly. There is generally plenty of time for an experienced midwife to make an assessment that things are not going well and have time to transfer to the hospital.

She still wasn’t sure. So I told her something that I probably wouldn’t remember telling her if she hadn’t reminded me. I said, “Just do ‘eeny meeny miney mo’. If you land on the “wrong” one you’ll know, because your heart will sink a little as you realize you’d actually been ‘rooting’ for the other one.

Of course, you don’t have to do what the ‘eeny meeny’ tells you to. But it’s a surprisingly effective way of deciphering what your gut is telling you. When you realize you’re pulling for one answer over the other, you know that you’re not as undecided as you thought you were.

My friend did the ‘eeny meeny’ trick and it’s what helped her settle on what she really wanted for her birth.

Don’t expect it to solve all your decision-making woes, but pull it out in a time of real indecision. “…My best friend told me to pick the very best one and you are it!”

You probably already know what the “right” answer is.