The Questions to Ask

Last night at the Natural Birth Meetup in Fayetteville, we talked about different topics.  The main topic of the night was Placenta Encapsulation, but it morphed into many other subtopics, as these meetings always do.  I am always so refreshed to hear other women’s experiences, and to share some of my own.  I felt compelled to share the experience I had with our OB when I was pregnant with Sydney, and during my birth.  I stated that often, women do not ask the right questions, so this post is going to be a guide, of sorts, in dialogue form, to help you with the right questions to ask your provider.

The Wrong Questions:

Sally:  I need to ask you some questions, do you have time?

Provider:  Sure, (glances at watch).

Sally (feeling rushed and embarrassed for even asking):  My partner/husband and I would like to do a natural birth, are you okay with this?

Provider:  Of course.

Sally (feeling more confident, now):  We would like to remain pregnant until 42 weeks, do you see any problems with this?

Provider:  No, not really.

Sally:  We would like to avoid induction, unless medically necessary, will you suggest medically unnecessary induction?

Provider:  No, we do inductions that are necessary.

Sally:  We would like to avoid c-section at all costs, do you have ways to help us do that?

Provider:  Yes, we have many ways.

Sally:  I would like to push in a different position than on my back, is this okay?

Provider:  Sure, why not?

Sally:  We request skin-to-skin bonding, where the baby is placed on my belly/chest immediately after birth, will you do this for us?

Provider:  Yes.

Sally:  We would like for the cord to stop pulsating before clamped or cut, will you honor this request?

Provider:  Um, sure.

Sally:  (Feeling peppy and like she’s chosen the right provider)  Thank you so much!!! We know we have chosen the right provider for us!

This line of questioning could go on forever, I could list so many more, but this line of questioning is all wrong.  Notice how the provider does not say much, provides no detail, and really is not answering the questions.  This is no indication of how the doctor might respond during birth.  The questions Sally is asking are the right questions, but need much more detailed answers.  She asks closed ended questions, or questions that do not require much more than a one or 2 word answer.  So I will outline the correct line of questioning.  This puts the ball in your court, and you can make a much more educated decision about your baby, your birth, and your provider or your place of birth.

The Right Questions

Sally:  Dr. Moe, my pregnancy and birth experience are very important to me, so I would like to ask you some questions quickly (pulls out a sheet of paper and pen).

Provider:  Um, Ok.  (Sits)

Sally (feeling empowered and confident.):  My husband/partner and I are preparing for a normal physiological birth (expound as much as needed: intervention free, few interventions, pain meds free, whatever you want to say), how many of the births that you’ve attended have been this way?  And, how will you help me to achieve this?

Provider:  (Slightly taken aback with this open ended question) Most of the births I attend at Candy Hill Hospital are medicated with epidural or some other form of pain management.  I have only attended maybe 10 unmedicated births.  I am willing to help you achieve this by allowing you to labor for as long as possible without intervention.

Sally:  Okay… We would like to remain pregnant until 42 weeks, unless it is medically necessary to take action before hand.  How many of your mothers have you allowed to continue being pregnant until 42 weeks?  And what are your reasons as a provider for requesting birth sooner?

Provider:  We generally don’t allow women to remain pregnant until 42 weeks, our cut off is 41 weeks.  We don’t like women to continue pregnancy until 42 weeks because the risks of a larger baby/aging placenta/elevated blood pressure/etc go up.

Sally:  (Red flags going up, immediately, she’s done her research):  Okay, I understand your reasoning, and I’d love to see some written research to support this reasoning.  But, in our case, we would like to request a non-stress test following 41 weeks to ensure everything is fine with baby and me, and to ensure that everything is going smoothly in my pregnancy so we can go until 42 weeks.

Provider:  I guess we could do that, we will talk about it more as time gets nearer.

Sally:  Sounds pretty good.  Since we would like a normal physiological birth, we would like to avoid induction, unless medically necessary.  What is your induction rate? And what are the reasons you induce?

Provider:  Our induction rate is pretty high.  We induce because the baby is too big, the baby is late, there are medical problems with the mom such as high blood pressure, diabetes, other issues, and to help the mother to be more comfortable.

Sally:  Oh, ok.  (Increasingly more uncomfortable with the answers her provider is giving)  We would like to avoid c-section, unless medically necessary, first, what is your c-section rate? And, how would you help us to avoid c-section?

Provider:  Our c-section rate is right along with the national average of 32-33%.  We would monitor you and baby, to make sure that both are okay, and allow you your trial of labor, until it is deemed that c-section may be the best option.

Sally:  (Thinks she may want to switch providers, at this point)  All right… I would like to push in a position other than semi-sitting or flat on my back.  How many births have you attended in which the mother was in an alternate position for pushing?

Provider:  Since most of the patients I attend have had an epidural, we require the mother to lie flat during birth.  I have not attended many births where the mother wanted to push in a different position, but I guess I’d be okay with it.

Sally:  Okay.  We would like our baby to come directly to my belly/chest following birth for immediate skin-to-skin bonding.  Are there reasons you would not allow this? If so, what are they?

Provider:  We generally take the baby directly to the warmer to do the assessments of the baby.  While we understand skin-to-skin bonding is beneficial, we like to get the assessments done as quickly as possible so you can have your baby following.  We could maybe do skin-to-skin bonding for a few minutes.

Sally:  (Disheartened)  Wow.  Okay.  We would like for the cord to stop pulsating before it is cut or clamped.  Will you honor this for us? If so, why not?

Provider:  We like to clamp the cord and cut it immediately, so the assessments can be done on the baby, and with the baby attached to the cord, we cannot do that.  I guess we could do that so you could have a few minutes with your baby before we have to do the assessments.

Sally: (Feeling disheartened, discouraged, and frustrated, yet she knows she can switch providers) Thank you so much for answering these very important questions, we have some decisions to make.

Like I said, the questions are endless, and they all depend on what is important to you.  In this line of questioning, Sally receives the complete picture of what her provider is like during labor and birth, and is able to make more educated decisions about whether she would like to switch providers.

Let me say something else, if you decide to switch providers, it is YOUR decision.  You will not hurt feelings or step on toes, and if you do (Say this out loud to yourself), “IT IS MY BIRTH”.  What happens at your birth should be the well thought out plans you’ve decided on, not that your provider has decided on.

My personal experience with this was much more like the first line of questioning.  I can blame it on being a first time mom, being uninformed, or whatever I’d like it to be about, but what it came down to was I chose my provider for the wrong reasons.  My neighbor at the time wanted a fully medicated birth, and said her provider was “really nice”.  Well, most providers are really nice, they wouldn’t have much of a practice if they were ogres.  So my decision was made because my neighbor, who wanted a totally different birthing experience than I did, suggested the doctor to me.  If you want an intervention free birth, unmedicated birth, natural birth, normal physiological birth, however you want to describe it, DO NOT CHOOSE YOUR PROVIDER BASED ON THE CRITERIA OF “NICE”.  Ask open ended, detailed questions that will require thought, words, and an indication of the actions your provider will take.

Also, remember that you may always decline any procedure.  Simply say no, stand firm, and ask to sign a document saying you declined, if necessary.  Again, I will say this, and again, I want you to say this out loud (let this be your mantra), “THIS IS MY BIRTH.”

Please share comments, experiences, input, whatever you want to say, myself and my readers would love to read it.

Thank you so much for reading. Have a beautiful day!

The Truth About (Medicated) Birth

I read an article today that really lit a fire under my butt, made me extremely frustrated, and wanting to say a lot.  The article was about how a member of the media “delivered” his baby at home, and how it was made to be so dramatic.  This spurred me to think about my passion for birth, how much birth is made out to be an emergency, a medical event, or something that needs to be managed or fixed, and about how little truth women tell other women about how they gave birth.  The natural birthing community is often shunned because of how people who had medicated births perceive the natural birthers’ stories as bragging.  Come on, now, people!  We need to hear more of the natural birthing stories, they often have so much more vivid detail than the medicated birth stories.  Wonder why?!  Because the women who give birth without the use of medication actually remember their births.  That’s one reason, but I think that women who have given birth with the use of medication don’t necessarily want to tell the WHOLE story.  I know that after I had my epidural (after not planning or foreseeing such a thing taking place in my labor), that I didn’t want to tell the details.

Now, please, don’t get me wrong, I know there is a time and a place for interventions such as medication to be used during labor.  Sadly, though, these interventions have been so overused that now it’s a problem, a BIG problem.  Women and babies are suffering, and some are dying, because of the overuse.  Babies are being forced out of their mothers’ wombs because they are “too big”, “too late”, and for many other reasons that are not medically related, and this has affected their health, growth, and has caused some of them to die.  Mothers are not being given time and patience to labor and birth, instead, they are put on hospital clocks, and often hurried along with the use of induction and augmentation drugs, which ends in cesarean sections.  While cesarean sections are sometimes very much needed, they also have MAJOR risks, and repeat cesareans put women at further risks.  Women are dying because of the overuse of cesarean sections.  Yes, interventions are sometimes needed, I know that, but not routinely.

What we need to do, as a society, is expose women to what birth is intended to be.  Make birth this glorious event, instead of an event that’s shrouded in dark mystery, with hints of disaster and doom.  So here is what birth is, to me.

Like all mammals, humans are designed to give birth, and in most cases, women are able to give birth, with little or no intervention.  There are many things that must happen within the body for labor to begin, one of which is that the baby must be ready.  Because the woman’s body is so perfectly designed, with a flexible pelvis, that moves to accommodate her baby, birth is entirely possible.  If a woman is able to let go of all fear, the muscles in her birthing body should work correctly, and a sort of birth dance happens, where muscles work together in perfect harmony, to help the baby move down, turn, maneuver to a perfect position for birth, and finally be born.  The mother’s perineum, which is strong and muscular, if it has been massaged adequately in the weeks leading up to birth will stretch perfectly for the baby to make his entrance.  The baby is so perfectly designed for birth, the skeletal structure is pliable, and the bone plates in the head (fontanels) are able to overlap each other to make descent into the vaginal canal, and out of the body possible.  Much more happens in the body, cervical changes that include so much more than dilation and effacement, and oh how I WISH providers would teach this to their expectant couples!  Hormones (specifically oxytocin, the love hormone) work in the body to drive off stress and fear, and make birthing easier, help the cervix to open, help the labor to progress, help the baby to be born, help the mother to BOND with the baby, and help the mother to feel protective toward her baby.  Many other things in life produce oxytocin (love, like-minded women communing, intercourse, breastfeeding, etc).  As I said before, this is the watered down version of what birth truly is, what it’s meant to be.

So let’s look at what happens when women do not go this route (for whatever reason).  And let’s address that many women are told (by media, friends, culture, family, doctors, language, their own experiences, etc) that they are not capable of giving birth without the use of interventions/medications.  Women who give birth with the use of interventions are mammals, still, there is no denying that, but different things happen in the body once medication and other interventions are introduced.  The lovely love hormone, oxytocin, that I talked about above, when pitocin (artificial oxytocin), epidurals, and other drugs are introduced is cut off.  This means that the lovey, floaty, euphoric feeling that some women feel during labor, that counteracts pain, is gone.  What I didn’t say about the hormones in the body, above, is that these also help the baby, because what a mother experiences, so does the baby (if a mother is experiencing a comfortable labor, so is the baby, and conversely, is a mother is experiencing a painful pitocin driven labor, the baby no longer has a hormonal love cushion to protect him).  Epidurals also cut off the oxytocin, and cause the baby to feel a much more painful labor and birth.  And when mothers feel threatened in labor, their bodies stop working in perfect harmony, the cervix will not want to open (a protective instinctual mechanism to keep baby from harm), and labor stalls.  The mother’s pelvis and baby’s fontanels still function, but once an epidural is introduced, babies often have to be born when their mothers are on their backs (the least conducive birthing position, because baby has to go against gravity to be born).   This is the version of interventive/medicated birth that people often describe, without the “what happens in the body” mumbo jumbo.  I will tell you more… Here is the part we often do not hear.

With pitocin, contractions, or surges as HypnoBirthing calls them, often feel like they never end.  I’ve heard pitocin contractions described as one big one that never let the mother regain composure, catch her breath, and was extremely painful.  So when we hear about inductions and augmentations, the whole truth is not being told, I fear.  And with pitocin, epidurals are often right behind, because labor is so traumatic with pitocin, that it’s like cruel and unusual punishment to have pitocin WITHOUT an epidural.  And with pitocin and epidural, especially combined, cesarean section rates rise.

With epidurals, tearing is a lot more prevalent, as is malposition of the baby (baby’s face not facing his mother’s back).  Episiotomy (cutting of the perineal tissue) is more common as well.  And here’s the kicker, because the mother is numbed, many things can be done, without her knowing anything is wrong (legs being cranked back so far that hip damage is possible, episiotomy, breaking of the bag of waters, or release of membranes as HypnoBirthing calls it, etc.)

Cesarean section is a major surgery that has a long and painful healing course.  The art of VBAC (Vaginal Birth After Cesarean) is being lost among obstetricians, and so women who have primary cesareans are often put under the knife for no medical reason, other than the primary cesarean, for subsequent babies.  And the hard truth about cesarean sections, though some of them are truly needed, is that some mothers die following surgery.

My own experience was not what I expected it would be, partly because of Sydney being turned “sunny side up”, with her head resting on my tailbone, which made my labor much longer than I’m sure it would have been.  After 20 hours of unmedicated, unmessed with labor, I asked for an epidural, after having researched the risks and benefits.  What I never anticipated was how it would affect me, how it still affects me now.  Because I could not feel anything, my OB was getting my perineum ready for birth (which we had explicitly asked not be done (perineal massage) during labor, in our birth plan), and she tore me.  My legs were cranked back to my ears when I was pushing, to “make more room for the baby”, and I still have hip issues today (stiffness, pain, loss of flexibility).  After Sydney was born, I felt emotionally dead, all of my protective instincts I thought I would have were deadened by the narcotics present in the epidural.  Bonding with Sydney was near impossible, and took at least a month, if not more.  She had a poor latch to begin with, because of the drugs in her system from the epidural.  Sydney cried incessantly for about the first month, and I’m convinced that she had some sort of birth trauma from not being cushioned by my cocktail of love hormones during labor and birth.  I felt distant from her, and did not want to hold her, comfort her, and be with her, nor did I make an effort to learn how to.  I could probably go on, but you might imagine that this tore at me as a mother, and still does.  I don’t view myself as a failure at all, because at hour 20 of my labor, my body had reached a level of exhaustion it had never reached, and was ready to give up, and I was quickly heading for a cesarean.  So as a mother, I look back on my experience, and want desperately to do better, do more, educate other mothers, help mothers, help babies, just speak about this.

My point in saying all of this is that birth is not supposed to be scary, dramatized, medical, or an emergency.  When it is made to be these things, women lose their ability to think about what their babies might need, and instead think of simply getting through it.  With interventions come risks and consequences (lower rates of bonding, harder times bonding, lowered protective instincts in mothers to protect their babies, lower breastfeeding rates, higher infant and maternal mortality rates, higher infant and maternal morbidity rates, birth defects, emotional trauma, physical trauma, and the list goes on).  So here is my challenge for you.  Research everything, if you’re having a baby, research everything (your provider, hospital, interventions, alternatives, birth plans, having a doula, how your partner can better support you, etc).  And for those of you who have had beautiful experiences, PLEASE share your story (post it online, share it on Facebook, I’ll share it too!)!!!!

As always, thank you so much for reading this, and your input is always appreciated!

Preparation for Birth

There is so much talk about preparing for birth.  So I’d love for this post to be as interactive as possible.  Please feel free to comment, leave suggestions you might have for expectant mothers, and tell us how you prepared for your birth/s.

Pregnancy, for most women lasts from 37-42 weeks, and while that seems like a long time, it really is not.  In that time, couples/families become very involved in preparing for the birth, and I can’t help but wonder if families prepare enough.  We all know that couples, especially first time parents, go a little wacko on baby registries, and I’m sure stores are thrilled with this.  But are couples preparing adequately for the birth of their newest loves?

How did you prepare for your birth/s?  Do you think you prepared enough?  Do you think you could have ever been prepared enough?  So here are some questions I’d love for you to weigh in on.

1. Did you take childbirth classes?  (If so, where were they offered?  Do you feel like you learned enough to feel comfortable with giving birth?)
2. Did you interview multiple care providers, and shop around at several hospitals/birthing centers?
3. Did you take other classes?  (Breastfeeding, Newborn Care, Etc)
4. Did you research routine interventions that are used in hospitals?
5. Did you research newborn care procedures in hospitals?
6. Did you prepare a birth plan?  If so, did anyone help you with this?
7. Did you have all of your questions answered by your care provider?  (Questions to Ask your Care Provider)
8. Were you satisfied with the prenatal care your received?
9. Were you comfortable with your care provider/hospital?
10. Did you feel prepared to give birth?

I know that right now, in my community, there are two hospitals.  I have attended births at both, and each has its own policies and procedures, some the same, and some very different.  I cannot say that one hospital is better than the other, simply because I am not a woman who is preparing to give birth in either.  Each woman preparing for birth, prepares in her own way.  And the consensus I hear around my area is that women are not necessarily feeling prepared adequately.

The sad truth is that there is over-crowding in the hospitals, and the time that women receive with their care providers is little.  I always encourage women to ask tons of questions, and ensure that her questions are answered before she leaves her doctors office – whether she feels good about the answers or not.  I went to a Homebirth Meetup Group in Fayetteville a couple weeks ago, and heard a woman say that she felt like cattle in the system that is caring for pregnant mothers.  No mother should feel that way, ever, but especially by the providers who will help her to birth her baby.

Preparing to give birth is HUGE.  I believe that couples should research until they are blue in the face.  Here are the things I think should be researched by every expectant couple:

1. Proper nutrition during pregnancy
2. Advantages of hiring a Doula/Labor Support
3. Childbirth Classes – Which one is the best fit for you?
4. Routine interventions – imposed by care provider, and by hospital
5. Medical reasons for induction & augmentation of labor (when it is appropriate to do so)
6. Medical reasons for Cesarean section
7. Routine newborn procedures – who does them, when are they done, which are mandatory
8. Circumcision – Do you want this done?  (Here is a guide for you to look at if you’re curious about why or why not to have this done.)
9. Vaccinations – Will you vaccinate, will you delay?

Another sad truth is that many people research what car to buy, what TV to buy, what cable service to use, where to have their dog groomed more than they do how to give birth, where to give birth, who to have in attendance, and what the process will be like for them.  Some women do not feel confident with the care they receive, but do not switch providers.  So, if I can make one suggestion, it would be to prepare for your birth, and this includes switching providers if you do not feel comfortable with them. Prepare for birth, for you and your baby.

Make this interactive:  COMMENTS PLEASE.

Talking Birth

Talking to my friend online about her birth reminds me that there are different views of birth.  There are the people who go to medical school to attend very medicalized births of frightened women who may or may not be prepared for the challenges of childbirth.  These same people attend births that are largely medicated in one form or another, and because of this, they see this as “normal”. The women who give birth in this setting often have to fight for their birth wishes.  Even if women don’t come armed with birth plans, some have desires that they would like met, but in the face of having to defend their wishes in the presence of staff, they give up.

The normal that the other group of people see is totally and completely different.  We see birth as nothing short of a miracle.  Birth is normal, it is natural, and it is healthy.  Birth is meant to happen to women, and women were built to give birth.  We grow babies that are the perfect size for our bodies.  The normal birth that this group sees has every confidence in birth.  Birth is not a medical event, and it certainly is not an emergency.  The women who give birth among this group of attendees often simply drift through birth  without a fight.  These births are peaceful, calm, quiet (sometimes eerily so), and have a sacred feel to them.  Women feel loved, at peace, protected, nurtured, and surrender to their birthing energy.

I love talking birth, probably more than anything else in this world (except for sharing stories about Sydney, of couse!).  My passion comes out, I get fired up, and I want for others to feel what I feel about this subject.  There are certain things about birth that anger me, some that make me so proud to be a woman, and some that just sadden me.

I think back to my own labor, when I felt totally in control.  And even upon arrival at the hospital, in San Ramon, CA, I felt the same.  The team of people I had supporting me was incredible.  Never did anyone treat the impending birth of Sydney like it was an emergency, or even a medical event.  I self hydrated, walked, did many position changes, had intermittent monitoring, and never heard a mention of my pain.  Going through labor was a time in my life when I felt the most vulnerable, but knew I was so loved and supported.  Sydney’s birth was at the very least challenging.  But it was also a time that defined much of my life now, it was a time that empowered me, and bonded us together as a family.

Birth is a time when women must feel supported, loved, and vulnerable.  Our birthing energy must be focused, intent, and committed.  We must labor with conviction, with a knowledge that we can do this.  Women who lose this energy, this conviction become easily steered in directions they may not want to go.  This does not make them weak at all, it just makes their path to birth different, and sometimes a bit more challenging, and sometimes still, more dangerous.

The births that OBs and L&D nurses see are dramatized because of the environment in which they are.  They are closely monitored, managed, and manipulated.  These births are mere fragments of what births should be.  Many of these births are not at all what the mothers or the babies want, but sometimes, mothers truly know no different.  Often times mothers are convinced of what they should want because of stories they have seen and heard from others (friends, family, media sources, etc), which creates fear in them, and they lose confidence and are convinced they need anesthetic assistance to get through birth.

Medicalized birth certainly has its place, it has its time, it has its necessity.  But it is not a majority of the time.  Healthy full-term mothers have a right to be fully apprised of how their bodies function, and how to work with their bodies and babies to have a birth with as few interventions as possible.

So here are some of my suggestions for a healthier birthing experience.

Take ownership for how you want to give birth.  Decide now, and follow through.

Eliminate the words “Delivery” and “Deliver” from your vocabulary.  They allow you no responsibility as a birthing mother.

Create a birth plan.

Research, research, research.

Consider options you may not have considered before (home birth, birthing center, water birth, different hospital etc).

Choose a care provider that is completely supportive of what you want.  If he/she is not, find another one.

Prepare for birth by taking a birthing class that fits well with you and your birth partner.

Believe in your abilities to give birth.

Hire a doula.

Be flexible about labor and birth, accept that some things in birth may shift a bit.

Envision your birth, just the way you want it to be.

Ask for positive birth stories only.  Walk away if people share anything less.

Do NOT watch shows like Maternity Ward or A Baby Story.

Arrange everything ahead of time so when birthing time nears, your life is free of undue stress.

When labor begins, stay at home as long as you are comfortable.

Have a happy, healthy, and safe birth.

Take time following birth to talk about your birth to a person who respects you and will not judge.

Do not feel like a failure if you chose to have interventions that you previously thought you would not.  You are NOT a failure.

Comments Welcome.

Doula Training

My goal for 2010 was to complete doula training.  This goal is under way, because of a suggestion from a lovely midwife I know who suggested toLabor, a doula training organization, previously known as ALACE.  So beginning this Friday, June 25 until June 27, I will be completing my doula training workshop in Virginia.  toLabor’s training allows me to use the two (soon to be three) previous births (prior to the workshop) that I have attended to count toward my total of six that I must attend to become certified as a birth doula.

I also have some fantastic books that I am in the process of reading.  To see this list of books and the other certification requirements, click here.

Since last posting, I had the opportunity to attend a birth at a local hospital.  This mother was one of my HypnoBirthing moms, and she was facing a deadline of 41 weeks (the hospital’s policy is to give birth before 41 weeks, or an induction will be ordered), and instead, went into labor the day before her induction date.  She did a fantastic job of getting all the way through her labor, while using the support of her husband, her friend and me.  Her baby boy was born early on the morning of the 9th, and was completely unmedicated.  Beautiful reason to want to be a doula.

I will be offering “in-training” doula rates as I complete my training, so if you’re interested in being one of my six births, please contact me!  I am not completely sure of how much the rate will be, but I will post that after I complete my workshop.

Malpositioned babies

Imagine planning and practicing for your gentle birth, and being told your baby is breech.  Such a thing happens to 3 to 4 percent of all pregnant women in the United States every year.  While most hospitals consider a breech baby an immediate surgical birth, there are ways to help turn a baby, through natural and non-invasive ways.

The same is true for many other positions the baby may assume before birth.  As pregnancy progresses, between 32 and 37 weeks, babies naturally turn head down in the uterus, into the vertex position.  Vertex position is the ideal way for a baby to be born, and more specifically, with the baby facing his/her mother’s back (anterior position, with his/her occiput (back of head) facing the front of mother’s body).  Sometimes, however, babies do not make this turn that nature intended, and malpositioning occurs.  The term malpositioned refers to a baby that is not in vertex anterior position (head down, occiput facing forward).

The most widely heard of malposition is breech, which means the baby presents butt first.   There are four types of breech presentation, to include:  complete breech,  footling breech, knee breech, and frank breech.  Complete breech occurs when a baby is sitting cross-legged, presenting butt first, footling breech is similar to complete breech, but one or both feet present, knee breech is similar to footling breech, but a knee instead of the foot or feet present first (knee breech is the rarest form of breech presentation), and finally, frank breech is a position in which the baby’s feet are near his/her face, and his/her legs are straight, with his/her butt presenting first.  I am sure that many people think that breech presentation occurs often, but breech only accounts for 3 to 4 percent of all births.

Malpositioning of the baby also includes OP (Occiput Posterior) or “Sunny Side Up”, this means the baby’s occiput is facing the back of the mother.  Such a position may cause tremendous discomfort, exhaustion, and cause difficulty with relaxation for a gentle birth.  (Sydney was OP, and her birth story follows.)  Another sort of malposition is transverse, which means the baby is lying horizontally or semi-horizontally with no particular body part presenting for birth.  Asynclitic position is another malposition, in which the baby’s head is tilted.  This may cause the cervix to not open evenly, and may make birthing more difficult.

While all of the causes of malpositioning may not be known, some of the causes may include:

• Stress or Fear
• Upsetting situation
• Tense uterus
• Poor posture

It is important to know, however, that if your baby is breech, there are things that can be done to help turn the baby, without resorting to pain causing medical procedures.  Here are some things you can do to help your baby turn:

• Breech turn script with HypnoBirthing Childbirth Educator
• Webster Method (Chiropractor)
• Seek help from a doula, who can help with exercises to help turn baby
• Acupuncture
• Acupressure
• Pelvic tilts
• Positive attitude, coupled with visualizing baby head down
• Shining flashlight toward vagina while playing music at vagina

It is so important to remember that nature, your baby, and your body do not make mistakes, and if your baby does not turn, keep a positive attitude.  You may still have a gentle birth, because your mind dictates how your body will follow through.  If you only allow positive words and actions to happen, your body will follow suit, and you will have a gentle birth, as one of my HypnoBirthing Moms did.  I taught Ashley and Dan in the fall of 2009, with the anticipated birth in March of 2010.  They were really the model couple for HypnoBirthing, and I held every confidence they would approach their birth with such positivity, I had no idea exactly how much.  I am still amazed and overjoyed at their journey, though it did not go as they would have planned.  Here is Ashley’s story:

“When I first found out that Ava was breech I was crushed to say the least because of the road that I knew this was going to take us down. My doctor told us when we were about 34 weeks along and generally you’re told that babies have a significantly smaller chance of flipping after 32 weeks. I was told that having a vaginal birth was basically out of the question but that we could consider doing an external version or just plan to have a c-section. Both of the options they gave me were out the question in my mind at the time and in my opinion I felt even worse about having an external version than a c-section.

Having taken Hypnobirthing classes early on in our pregnancy and practicing Hypnobirthing during the months leading up to this it felt like everything was being turned on its head and there wasn’t much I could do about it at this point. I felt very helpless, sad and guilty (for being so upset about the situation despite that we still had a perfectly healthy baby girl) in the beginning. After a couple of days though the line from the Hypnobirthing CD about meeting any problems that may arise during the pregnancy or birth with calm and confidence started running through my head. The CD also mentions being an educated parent and making informed decisions, these thoughts also started running through my head. I knew that I was fully capable of giving birth naturally but now it came down to making the best choices I could with the opportunities and information  that I had in front of me. At this point I figured I had a few options 1.) Be upset and worried about the whole thing, 2.) Accept the situation and move on, 3.) Accept the situation at the moment but try my best to provide an environment for Ava to flip if that’s what she wanted to do.

I chose option #3 and I am so glad that I did. I educated myself on ways to help a breech baby to flip without using any force at all. I tried many different positions, headstands, I had a chiropractor perform the Webster Maneuver 4 times and tried to maintain as much of a relaxed frame of mind as I could. All of this was going on while my husband was deployed to Haiti which made everything a lot more difficult but praying a lot, having faith in God’s plan for our family and staying relaxed using my HypnoBirthing CDs helped me to maintain a positive attitude during this stressful time. After trying many different things to help Ava flip we were told at 39 weeks that she was still in the breech position which I was actually pretty surprised about but my husband and I were able to take the news very well because we knew that we had done everything that we felt comfortable with doing to help her flip.

If she hadn’t flipped at this point we felt pretty confident that she would not flip at all and we were ready to look into the other options. Since the 39 week appointment was my last appointment before Ava’s due date we needed to move things along quickly. Generally at this hospital breech c-sections are scheduled sometime between 38 and 39 weeks, rarely do they schedule them for 40 weeks or later. Ever since we found out Ava was breech I thought that as long as I could give Ava the longest amount of time possible to flip on her own that I would feel much better about any decisions regarding c-sections that we would have to make. I was very hopeful that we would be able to push any possible c-section out to her due date. Thankfully since I had declined scheduling the c-section at my 34 week appointment as they had wanted me to we were able to have the c-section scheduled exactly on her due date (March 5^th) due to a full c-section schedule during my 39^th week. I felt at ease with having a c-section in the end knowing that Ava had had a full 40 weeks in utero and we had tried as many things as we could to increase our chances of being able to have a natural birth. I am very happy with how the c-section went. Of course I would have loved to have had a natural birth but it was not in the cards for us given where we were giving birth, how far we wanted to push the medical boundaries and Ava seemed to be quite happy in the position she was in. I was alert throughout the entire procedure and I have very good memories from the day Ava was born.

I was able to begin breastfeeding her about an hour after the procedure which helped a lot with bonding and making up for the things we were unable to do due to the c-section. Her Dad was able to see and touch her right when she came out. He then was able to bring her over so I could meet her a few minutes later. We had a great moment there right in the operating room where the 3 of us were finally together as a family. At that moment when I finally knew that she was going to be ok, that Dan and I were ok and that we were all together everything came into perspective and I realized that nothing is more important than that. No matter how Ava was going to come into this world it was going to be an amazing moment and it was… one that I’ll never forget.

Here are some ideas that helped me during this experience:

1.) Do your own research and use the information you find to help make your experience what you would like it to be

2.) Be open minded

3.) Stay positive… either way the outcome is going to be great

4.) When the big plans fall through, set small achievable goals that you’ll feel good about reaching (mine were to try different exercises each day to encourage Ava to flip and to make it to her due date)

5.) Come to terms with what is happening… denying it is only going to work for so long

6.) You don’t always need to settle with what you’re told and it’s ok to say no.

I look forward to trying to have a natural birth in the future and seeing what my body is capable of… but for now I’m going to go enjoy my healthy, happy breech baby!”

Attitude is everything, and HypnoBirthing was able to help Ashley, Dan and Ava tremendously.  They clearly wanted to achieve a gentle birth they knew their daughter deserved, and they worked toward it with goals that were reachable.  I can honestly say that I have seen many babies in my life, and few are as peaceful and calm as Ava.

As mentioned above, OP (occipital posterior) is another form of malposition.  This occurs when the back of the baby’s head is facing the mother’s back.  As we prepared for our HypnoBirth with Sydney, I grew more and more excited as her birthing day drew nearer.  Here is the story of Sydney’s birth:

I went into labor on July 16, 2007 at about 5:30 pm.  My husband was at work, and my mother in law was with me.  I timed my surges to establish the baseline, which at that time was 20 minutes apart.  When I felt changes, I paid attention, but for the most part, I relaxed.  I felt fine, relaxed, ready, excited.  We hung around the house, I ate, took a bath, and my husband arrived home from work.  I was upstairs in the bathtub resting, and his mother had told him I was upstairs in labor, with surges 10 minutes apart.  When he entered the bathroom, I informed him they were 3 minutes apart, and it would be time to go to the hospital soon.  Needless to say, he was shocked.

We arrived at the hospital at about 10:30, and I was given the choice of walking or being wheeled to the room.  I chose to walk.  The nurse started me on a blood pressure cuff, intermittent fetal heartrate monitors, and asked me for the birth plan.  I cheerfully handed it to her, and she exited to read it, then returned with questions.  I continued to labor comfortably, and was not asked about pain or discomfort (per my birth preferences), and was only asked how they could help me to be more comfortable.

As my labor progressed, my body continued to clean out, and I was free to move around.  I walked, sat on the toilet, sat on my birthing ball, rested in bed, and kept moving.  My labor was becoming progressively more tiring, and I was experiencing a lot of pressure in my back, and at hour 17 of having minimal intervention (no IV, only intermittent fetal heart rate monitoring, and blood pressure readings), I whispered I needed help.  Everyone in the room heard me, but further relaxation was encouraged, and I followed suit.

At hour 20, I had reached a point of physical and emotional exhaustion, and felt as if I could not continue with my labor as it was.  At this same time, I was informed that my baby was OP, and Nicole, my HypnoBirthing Childbirth Educator (she is also a chiropractor) encouraged me to assume polar bear pose to help baby to drop out of my pelvis so she could rotate.  I did this, and was impatient and exhausted, so at 10 cm opened, I chose to have an epidural.

It is useful to know that about 70% of all OP babies are born via cesarean section.  4 hours after getting the epidural, with a lot of forced pushing (which HypnoBirthing does not advocate for, but I had no choice, she was wedged), inspiration from looking in a mirror at my baby emerging, and just pure adrenaline and determination, Sydney Ava was born.  The lights were dimmed for her entrance into the world, and she was placed directly on my stomach for skin-to-skin bonding.

She remained with us for an hour or so, before they completed any assessments in which she had to be taken from us.  Considering the circumstances of Sydney’s birth, and knowing I had prepared myself for her birth, I am extremely proud of the lengths I went to to get her here, vaginally.

It is so important during pregnancy to care for your body and your baby.  It is important to eat well, exercise, and prepare mentally and physically for the birth you’d like to have.  As much as I prepared for our birth, I still needed assistance during my labor to reposition Sydney.  I later found out about the use of a rebozo for repositioning a baby in utero, during or before labor.  A rebozo is a large cloth that is used to gently reposition the baby.  These following links include pictures and video of different techniques that can be used.

Rebozo Video

Rebozo Technique in pictures

Rebozo explanation

Malpositioning happens.  And when it does, alternatives to medicine are viable and often useful options to consider.  Remember to always ask questions, if something doesn’t sit well with you, or fit in with your values or what you think is best for your baby, a wealth of information exists that may back you up.  Research what you want, and prepare yourself for any turn your birthing may take.  In the mean time, Happy Birthing.

As always, comments welcome.

*Special Thanks to Ashley, Dan, and Ava for sharing your inspiring birth story!  I love you all!

What would YOU like to read about?

I am always interested in reading new articles about birthing, helping people to understand HypnoBirthing, and helping my community to become more progressive toward birthing.

With this in mind, I am giving the floor to you, my readers!  Please write me a comment and tell me what kind of things interest you about birthing or what kinds of questions you have.  HypnoBirthing is not a medical birthing method, but we do help couples to achieve a gentle birth in medical settings (often, and with beautiful results).  So medical birthing questions are fair game (to include questions about breech babies, interventions, etc. )  Keep in mind, also that HypnoBirthing does not require that I am medically trained, because I do not assist my couples medically.

So here you go, the floor is yours!  Ask your questions, and I will answer as many of them as possible, in blog format! I look forward to reading them and answering them.

~Teva

La Leche League Baby Fair – I’ll be there!

On May 1, 2010, from 10am to 2pm, at the Holiday Inn Bordeaux in Fayetteville, the La Leche League is having a Baby Fair.  I will have a booth set up complete with brochures, the Kaya Birthing Stool (for you to try out), perhaps one of my HypnoBirthing moms, information, and my smiling face!

One of the door prizes to a lucky winner is a FREE group HypnoBirthing class valued at $300.  Come out to meet me, if you haven’t already.  Ask questions, try out the stool, sign up for classes, and learn more about HypnoBirthing. Come out in support of a beautiful organization aimed at helping moms to have high success rates, and find out what the vendors of Fayetteville have to offer to families.  Visit their website for more information about the La Leche League.

I look forward to seeing familiar and new faces at this awesome event!

~Teva

Comments Welcome.

International Cesarean Awareness Month

I was floating around Facebook, and saw this posted!  Avoiding the First C-Section :  An article on Birth Sense about what kinds of questions to ask your provider in order to avoid unnecessary interventions that have a high risk of leading to cesarean sections.  In HypnoBirthing, we teach awareness of how to avoid interventions, and how to advocate for a natural start of labor.

According to the National Center for Health Statistics, the C-section rate in the United States has risen 53% since 1996.  Scary! Cesarean birth is being overused, and VBAC (Vaginal Birth After Cesarean) is being grossly underused, at about 8%, because many hospitals are outlawing VBACs.  Because of bans on VBACs, women have been denied access in over 40% of hospitals in the United States .  The National Institutes of Health has found that VBACs are reasonably safe for women who had a previous cesarean birth and are low risk for uterine rupture.

Many hospitals and providers fail to disclose all of the risks associated with cesarean birth.  Some of the risks of cesarean birth include:

• Life-threatening risks to mother
• Long-term risk to reproductive health and future pregnancies
• Longer recovery time following birth
• More pain following birth
• Baby is often whisked away to the nursery or NICU
• Often no skin-to-skin bonding immediately
• Trouble with breastfeeding
• Bonding may be difficult for mother and baby (because of drugs, and separation time)
• Low Birth Weight in babies
• Respiratory problems in babies
• Infection in mother
• Risk of excessive bleeding in mother

So with all of these risks, what can YOU do to avoid having your first c-section?

• Take a birthing class that encourages you to speak up for yourself.
• Know your options about avoiding interventions and how to achieve a natural onset of labor.
• Know your provider, ask questions until you are blue in the face.
• Learn about the risks to all interventions you may be faced with.
• Speak up when you feel like something goes against what you want (don’t wait till next time).
• Ask for patience at all times from your providers while you are in labor (many c-sections and interventions happen because providers and/or hospitals expect birth to happen at their rate, not at the rate of the mother and baby).
• If interventions and/or c-section are not medically necessary, ask for more time.
• If membranes have released, ask for antibiotics after 24 hours, or whenever is standard practice at the hospital.

That’s all fine and dandy, but what about if you’ve already had a c-section and are faced with the possibility of another one?  The International Cesarean Awareness Network has provided a document for women whose providers or hospitals have banned VBACs.

The bottom line, with all of this is, KNOW YOUR RIGHTS!  Research what you want to know, and stand behind your wishes for you and your baby.  It is your birth, and you have every right to have a beautiful and gentle one.

~Teva

Comments welcome.

New Surge In Birthing

It seems that with the media attention that birthing is receiving, that women are becoming more aware of the problems that could face them as they enter the hospital to give birth.  Women, for years, now have taken the word of the medical community as the only truth that could possibly apply to them, and because of that and so many other factors, women believe their bodies are bound to malfunction during labor (thus the artificial induction, epidural, and cesarean section rates).  Women spread the word of the terrors, pains, and sheer agony of labor, and explain in plain detail how pain medications saved them from having to feel and experience what labor was like.  This, too, creates a barrier to women who will someday give birth; they begin to believe that they, too, will feel like they are being hit by a bus, and torn to shreds, and that they will need medication to just make it through.

Then there are the women who know their bodies were created to nurture, carry, and birth babies, and that all of these things are completely normal, natural, and healthy processes.  These same women have a vision of how labor should be, and the vision they experience is not one of terror and pain, instead, it is of endorphins flowing through their bodies, creating a beautiful birthing experience they want to feel, and will remember forever.  The experiences of these women are shared, too, but their voices are often drowned out by media outlets creating traumatic birth scenes and women sharing their terrifying stories.

Could our culture be turning toward the latter experience of birthing?  With methods such as HypnoBirthing, couples are very clearly saying, “yes”.  HypnoBirthing has been around for a little over 20 years, and was developed in the 1950s and 1960s by Marie Mongan, a woman who had the desire to experience birth for what it was.  She knew her body was designed so perfectly, to nurture, carry, and birth her babies, and it wasn’t until her fourth child, that her knowledge came into being.  HypnoBirthing believes that pregnancy and birth are normal, natural, and healthy processes, and so, focuses on knowing and understanding how the body and the baby function during labor and birthing, and working with the body and the baby, rather than against them.  HypnoBirthing employs three different breathing techniques, one for relaxtion (yes, I said relaxation), one to use during surges (HypnoBirthing’s word for contractions), and one to use when birthing.  HypnoBirthing also focuses on relaxation, conditioning pregnant mothers to become relaxed quickly, and on releasing fears and limiting thoughts that could stand in the way of a beautiful and gentle birth.

Because of my passion of HypnoBirthing, and the positive, beautiful, and empowering experience I had when birthing my daugther in 2007, I became a HypnoBirthing Childbirth Educator (HBCE), in 2009.  I have made a small impact in this community that seems to be almost resistant to a progressive move in birthing, and my true desire is to start a birthing revolution that focuses on better maternity care and newborns’ rights.  I firmly believe every woman has the right to know how her body works, and how to work with it for a beautiful birth, and that every baby deserves to be born peacefully and gently.  If I could say one phrase that would embed itself in women’s minds forever, it would be, “Trust your body, Believe in your abilities.”

I always welcome comments!  To learn more about HypnoBirthing or Teva, please visit www.mygentlebirthing.com