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!

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.

Compassionate Care

Does every woman need a doula?

I’m a doula, so I’m pretty sure I’m supposed to answer this question with an unequivocal “yes.”  But that wouldn’t be quite honest, would it? Because, like most things, it’s more complicated than that.

I can’t answer “yes” to that question because here’s my little confession: I had two children and I didn’t have a doula, nor did I feel like I needed one at any point in my labors. And that little tidbit is why I occasionally feel a little guilty about hocking my services to expecting parents. What if they don’t *really* need me? I think at them: ‘You’re good enough! You’re strong enough! And gosh darnit, deep down you already know how to give birth!’

And it’s true!

But then I remember. Usually while laboring, even if deep down you know how to give birth, you still need a lot of reminders. A lot of reminders. And patience. And warm, soothing touch. And the feeling that everyone around you cares about you and they are giving you all the support you need.

That’s compassionate care.

Sometimes you can get it without a doula. For my first birth, I had a homebirth midwife, my sweetie, my mom and my two sisters around me and no shortage of calm, compassionate care. My second birth had fewer relatives, but still plenty of love and support.

But often times, a doula is just what you need to complete the circle of care. You have a midwife or an OB to provide medical care, you have a supportive partner or family member that you love and who loves you and you have a doula that knows you and supports you and your partner, helps explain procedures and options, offers warm, soothing touch and massage and calmly guides you into trusting yourself.

The birth will be what it will be: wild and unpredictable. I’m never attached to a particulars when it comes to the birth, because who are we kidding? Nobody can control all the aspects of labor. If the parents come through their experience feeling compassionately cared for and supported, then I’ve done my job. Everyone deserves that for their birth. Do you need a doula? Maybe not, but it’s one great way to increase your chances of having a happily memorable birth day.