Take Nothing for Granted: What it Feels Like to Come Home from a Birth

What do you feel like when you come home from a day of work? Tired? Energized? Cranky? Cuddly?

When I come home from a day (or more) of being with a laboring mom I feel like I’ve been in another world. A world where life and death hang in the balance. A world where lives are changed dramatically and forever. A world where women and their partners exhibit amazing feats of endurance and remain exquisitely beautiful as they negotiate decisions in the throes of great physical and emotional strain. I bond with these people as if we’ve been in a war zone together, hanging on to each other for dear life.

That may sound awfully dramatic, but in those moments it sometimes feels that real.

And given all of that drama, it’s impossible to just reintegrate to normal life.  I know that birth happens every day–it’s mundane in that sense–but when you have just witnessed The Miracle of Life it doesn’t shake off easily.

I was talking to a doula friend who said that she’s uncomfortable with this transition period. She wants to be able to flip a switch and go back to her normal routine. But she can’t. She’s working on how to reconcile this emotional dilemma of how she thinks she should feel versus how she actually feels. In the mean time, she just lives with that uncomfortable feeling until it fades away and things start to feel normal again.

For me, after 4 years of doing this work, the post-birth “syndrome” is predictable and recognizable. It has two sides. On one side I am in love with the world and everyone in it and truly grateful for the most important things in my life–my family. I live in the moment and take joy in things like baking a big batch of granola for the family or cleaning the kitchen. But on the other side I am incredibly vulnerable. I have a hard time tolerating grouchiness or bickering, especially if it is directed at me. Sometimes little things will make me break into tears. And I look around at people honking at a bad driver or venting about a co-worker and I think, “Why? Why spend your energy on this when there is so much to be happy for?” I appreciate this feeling. Sure, it makes me a little moodier (this is where I apologize to my husband), but it routinely humbles me, reminding me to take nothing for granted.

Death has the same effect on people that are close to it. Two bombs exploded yesterday near the finish line of the Boston marathon. Three are dead and many others are wounded. My heart goes out to the victims, their families, and those who just narrowly missed being in the path of the blast. I often feel powerless after events such as these. What can you do? But where I find my power is knowing that in the face of great pain we often find great strength. Those who survive will be reminded not to take their lives and their loved ones for granted. Those who have lost loved ones will hopefully find healing by finding ways every day to love, honor and remember the one they lost. Boston, pull your loved ones in close, give kindness, compassion and casseroles. Take nothing for granted.

And to all my doula clients past, present and yet to come, I thank you. I thank you for the chance to support you, for the chance to be a part of your life at such a critical time, and most of all, for the consistent reminder that life is amazing, fragile and beautiful.

Ripe for the Picking

Ripe for the Picking

It’s late summer now. Middays are hot, but the mornings are chilly. And the blackberries–my favorite berries of all– so ripe a few weeks ago, are starting to shrivel and go dormant until next year. Sure I have some guilt for loving this invasive plant, but somehow I can’t help myself. Ahhh… blackberries.

And the picking of berries makes me think of–what else?–pregnancy and birth, of course. Why, you ask? Because I’m an impossible birth nerd and I nearly always have labor on the brain. And also because they are both about nature, about the mystery of why one berry on the vine is ripe for the picking and releases easily with a gentle tug and others on the same branch resist the traction you place on them. The unripe berry might have good size, it might be nice and black (although if you turn it, you may find it’s still pale on the underside), but still it tells you, “Not yet. Give me another day.”

But while most people seem to understand and accept that not all berries ripen at the same time, they do not always feel the same about pregnant women and labor. Sometimes I think they view it more like baking a cake. When the timer goes “ding” the cake needs to come out soon or it will end up dry, or worse, burnt. Though any good baker knows to check the cake for doneness, in the baking world it’s always better to pull the cake out early (and put it back if underdone) than to wait too long. Often, this thinking pervades in the labor and delivery world even though you can’t check a baby for doneness without getting him/her out and you certainly can’t put the baby back in to “cook” for longer if s/he was born too early.

We just like to know when the baby is supposed to be done and in this day and age it seems impossible that we still cannot pinpoint a normal healthy delivery date to any smaller range than 4 weeks. But such is life. As annoying as it is, there are some good reasons to learn to live with it.

Consider:

a) When women are induced or scheduled for cesarean births prior to 39 or 40 weeks, providers sometimes discover that the due date was wrong and that the baby hadn’t yet reached “term” resulting in an accidental premature birth with all the resulting health risks (known as “accidental iatrogenic prematurity”).

b) Though we consider 40 weeks the average end-point to a normal pregnancy, a 1990 study by the Harvard School of Public Health showed that the average (median) length of gestation for uncomplicated first pregnancies (in which the mother goes into labor spontaneously) is actually 41 weeks + 1 day. For subsequent pregnancies the average length of gestation was 40 weeks + 3 days. (Note: This study applies to white women only. Weird, huh? There’s a lot to explain about this which I can’t get into here, but for those who are curious, here’s a short explanation: For reasons that aren’t completely understood [but may be related to the stress of institutional racism, not just in the woman’s lifetime but in the lifetime of her mother and grandmother] black women have a much higher rate of premature delivery even when they are highly educated, get good prenatal care and have higher incomes).

c) By studying other mammals, such as the mice in this study, we know that the presence of lung surfactant protein (which is key in making the lungs work after birth) acts to trigger the hormones which lead to labor. Though this has not been studied in humans, it has been studied in other mammals so it’s reasonable to guess that something similar occurs in humans. If this hypothesis is correct, it means that babies signal their mother’s bodies to go into labor when when they are ready to survive outside of the womb.

Everything seems to flow more easily when babies are ripe and ready to be born–while it might look early or late based on the calendar, often when labor happens on its own, it is right on time for the baby.

In my own experience, I’ve seen babies born at 38 weeks at 7.5 lbs and babes born at 42 weeks at 8 lbs and everything in between.  My own two little monkeys had quite different gestational times. My first child was born at 41 weeks exactly and my second was born at 39 weeks +1 day, weighing just a few ounces less than my first (they were 8 lbs 2 oz and 7 lbs 14 oz, respectively). For whatever reason, my younger child needed nearly 2 weeks less gestational time than my older child did.

Of course, nature does make mistakes sometimes. I would be a fool not to recognize that. Women do go into labor prematurely and some women do get to a point at which it is safer to induce labor. But this ought to be the exception, not the rule. Having a great care practitioner that you trust is key–one that recommends induction only if it is truly needed, not just because the clock is ticking.

Good things are worth the wait. Here’s to babies born ripe, healthy, plump and delicious!

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.