How to Have a Natural Birth

Recently, I had a conversation with someone about wanting a natural birth and how hard it is to get that without a fight on your hands.  She asked the question, "Why can't you just say 'I don't want the drugs.'?"  It was an interesting question, really.  Why is it so difficult in American obstetrics to have a natural birth?

I think there are many factors here.  Fear is at the top of the list.  Fear of pain, fear of lawsuits, fear of the time commitment.  I think loss of control is also a factor.  We like to control everything.

And as much as we glorify the "superhero," we hate her when it comes to birth.  We want her to fail.  Her natural birth makes me feel bad about my medicated birth.  It's easier to believe that no one can do it than it is to believe I couldn't do it. 

The media is at fault here too, but it's largely because they feed the fear.  I have a mom right now doing Birth Boot Camp online classes that was thinking about transferring to a natural-birth-friendly hospital but it's an hour away.  We get this idea from all the sitcoms that the minute labor begins - or water breaks - the baby is going to fall out.  Women and men are fearful of a birth place that is more than a few minutes away. In reality, they could probably cross state lines with plenty of time to kill!

And then there's the noise factor that I've been talking about for years - the majority of the people at the hospital want you to have the drugs because of the noises you might be making, be it moaning, grunting, or even screaming.  Those noises make people uncomfortable when they are not used to hearing them. Personally, I like to hear the noises a woman is making in labor because you can tell how well she is handling things. Those noises let her support team know what she needs. Who needs a vaginal exam?!  Just listen to her!

In addition to making the laboring woman be quiet, the control is now shifted to the medical staff.  They do not have to wait for your labor to progress.  Like magic, they can force your uterus to contract whenever they want it to with pitocin.  What power!  The laboring woman is powerless at this point.

Frankly, people just don't understand why someone would want an unmedicated birth.  I was that way with my first baby.  I couldn't believe it when people would ask me if I was having the drugs.  Of course I'm having the drugs!  I get it.  I've heard a million different reasons for wanting a drug-free birth over the years, but in the end, a couple has to be willing to do what it takes.

HOW TO INCREASE YOUR CHANCES OF GETTING A NATURAL BIRTH

1.  Believe that your body and baby will work together.

2.  Choose a care provider very carefully.  They may make or break this experience.  If you have chosen wisely and you do have a cesarean or are encouraged to induce, you will not second guess them EVER.

3.  Take a thorough childbirth class.  As the founder of Birth Boot Camp®, I believe our 10-week curriculum is the best program out there, preparing both partners for an empowering birth experience. If there is not an instructor in your area, take the online course. After you have an amazing birth, become an instructor!

4.  Communicate with your partner.  This is an opportunity to grow closer together.  It's not every day you bring a baby into this world.

5.  Hire a doula.  She will help you achieve a drug-free birth.

6.  Know your options.  If your chosen birth place is not natural-birth-friendly, RUN.  If you take the attitude of  "I'll stay with my OB this time and switch to a midwife next time," they may set you on a path of cesareans that will make it harder next time around.

7.  Practice relaxation on a regular basis.  Eat well.  Stay fit.  If you become high-risk because you eat junk food and have a sedentary lifestyle, your plans for an intervention-free birth may go out the window.

8.  Surround yourself with people that believe in YOU!

9.  Don't be afraid to ask the hard questions and read between the lines with your care provider.  If you feel like you are jumping over red flags, you probably are.  As long as the baby is still inside of you, you have options.  Regardless of what you may have heard, it's never too late to switch care providers.

10. Read positive birth stories.  Read - and believe - affirmations that you can do this.  You are strong and capable.  Embrace this experience.  It is yours and yours alone.

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The Perfect Birth - Does it Exist?

I received these thoughts from a former student - turning Birth Boot Camp Instructor - and wanted to share it here.  I think many women can identify with her point of view.  I'd have a dozen babies if it was all about the birth and breastfeeding.  Those little ones become big ones with opinions and attitudes!  While my 4th birth was my favorite, there are still things I would change or do differently if I could.  For example, I wish I wouldn't have said "Make him come out!" when I was pushing.  (We were convinced Darcy would be a boy.)  Thanks, Jennifer, for sharing your thoughts.  You are not alone, my friend.

"While playing on the beach in Daytona during our Florida vacation, I was taking pictures of the kids.  I took dozens of the same activities- playing in the sand, wave jumping, boogie boarding- looking for that “perfect” shot.  You know, the one that looks like it came in a new picture frame, or that you would see in a magazine ad for a beach resort.  Later, when talking with my husband in the pool, he said that he didn’t know why I wanted a perfect picture instead of a real one. One that shows the personalities of our four kids: their movements, their expressions, their quirks; one that shows what the moment was actually like.

It dawned on me, at that moment, that I have had that same view of my births.  You see, I have been struggling with not having another birth experience.  Partly because I want to do it all again (Ok, not really.  The four months of morning all-day sickness and early breastfeeding struggles are not necessarily moments that I wish to relive).  But when it comes to birth, I am consumed with wanting another birth.  A big reason for this is that I still want, and feel like I have missed out on, my “perfect” birth.  I have had (mostly) wonderful experiences delivering my three sons and daughter, and was blessed to have finally accomplished my natural water birth with my 4^th child.  But, I tell myself, it wasn’t a home birth… I went to the birth center too soon, and didn’t labor at home as long as I’d liked… the midwife was more hands-on during delivery than I would have preferred (we had planned on my husband catching the baby, but when her shoulders got a bit ‘stuck’, the midwife was quick to push him out of the way and take over).  Don’t get me wrong, it was a wonderful, life-changing experience- all of my births were- but it wasn’t perfect.  I find myself dwelling on that instead of relishing the amazing experience that it was.  I fondly remember the way my husband was my rock and encouraged me every step of the way.  I love remembering the way my three sons rubbed my back in between contractions, and how excited we all were to learn that they had a baby sister.  I am still amazed at what my body was capable of doing with the proper preparation and the resolve to succeed in my quest for a natural birth.

Was I perfectly poised throughout my labor?  Much like my squinty-eyed, goofy-grinned children, no.  But, just as my camera captured who my children were in the moment, my birth captured who I was at the time- all of them did, actually.

Were there things I would do differently if given the chance?  At the beach, as well as during my labors, yes!  But that does not take away from the amazing experience we had.  I will forever look back fondly at our Daytona vacation, and am glad I have pictures that show who my family really is.   I have decided to look at my birth experience in the same way.  It wasn’t perfect, but it was real, and it was perfectly mine."

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The Effects of a Crowded Room

For years I've been talking about emotional relaxation.  Emotional relaxation is how you feel about your laboring environment.  For example:

Are you confident in your care provider?  

Do you feel that your nurse is supportive of natural birth?  

Is the on-call doctor respectful of your birth plan? 

How is the temperature in the room?  

Are people talking during your contractions?  

Do you feel supported not only during contractions, but between them as well?  

Are your needs anticipated by those around you?  

Do the people at your birth really know how to help you?

How is the lighting?

What does the room smell like?

Are you hungry?  Are you encouraged to eat/drink?

The answers to these questions will impact your labor.  Someone posted on my Banned From Baby Showers Facebook page wanting to talk about prodromal labor and someone else about "longer than normal" labors.  When I hear about a woman having a very long labor, there are some things that pop into my mind, the first one being how many people were in the room?  What did she do in early labor?  Did she watch the clock and wait for contractions to get closer?  Or did she announce it on Facebook and deal with phone calls for the next 3 days?  Did she feel like a watched pot?

My two bits of advice for all my couples in early labor are:  1) Depending on the time of day you realize contractions are regular, SLEEP.  2) Depending on the last time you ate, EAT.  Eventually, you may want to do both of these things and will likely not be able to.  

The 4 top things that women worry about for their labor:  

1) The sounds they will make during labor and birth

2) Modesty and being/feeling exposed

3) Fear of tearing

4) Fear of pooping during the pushing phase

Let's look at this list further.  The only one that is actually a physical fear is #3, the fear of tearing.  The other 3 have more to do with how she is perceived by others in the room.  There are few times in a woman's life where she is more vulnerable than when she is in labor.  She may act like a wild animal, making sounds that might be embarrassing otherwise.   Or, her sounds might be low and sexy -- and she may stop when her mother or mother-in-law comes into the labor, even though those sounds were her "rhythm" and helping her through contractions.  

Very carefully consider the people you invite into your birth.  Often, women feel the need to "perform" for their audience.  Maybe it's for your mother or best friend who never had a natural birth and has been very negative about you having a homebirth.  You feel like you have something to prove.  Maybe you have "media" at your birth, a photographer or are recording a video.  The pressure to "perform" can really hurt a labor.  I feel strongly about recording your birth, but not at the cost of not being able to give in to your labor.  It's just another thing to evaluate and be flexible during labor.

As hard as it may be, you may need to banish these people from your labor.  Most women labor best in dark, quiet, undisturbed places.  The more people involved in your labor, the harder these conditions are to achieve.  Mom needs to feel free to move and vocalize.  We have this idea that if we are vocal, we are not doing well.  This simply isn't the case.  In fact, the opposite may be true.

Of course, there may be physical reasons for a long labor, but the people in the room is something that each couple has direct control over.  Even in a hospital birth, if you don't like your nurse, request another one.  Have your doula or midwife do it if you can't.  If they suggest it, acknowledge that they may able to see something you can't see in the throngs of labor.  Many people don't want to believe that having their mom or sister in the room is slowing their labor, but I've seen it many times over the years.  Hindsight is always 20/20 too. Often, women can't see the effects of the "spectators" until after the birth.

If you feel self-conscious about how you will sound, act, or look, you might consider not having anyone not crucial to your birth team at your birth.  Birth is not a spectator sport!

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Pushed into Supine Pushing Positions

When I was thinking about getting pregnant with my second baby, I visited my OB, Dr. Brian Wolsey, that "delivered" my first baby.  I had been gathering lots of information and knew I would do things differently with the second baby.  One of the questions I asked him was how he felt about me pushing in a different position besides flat on my back.  He got down on the floor (in his very nice clothes), and on one knee, contorted his body, and while looking and reaching up, said, "Well, it's kind of hard to catch a baby in this position."  He was more concerned with his comfort than mine when it came to pushing my baby out.

I never returned to his office.  

This is an important question to ask your care provider. The answer should be a respectful "Let's see how you feel when it comes time to push.  The benefits to using gravity and an upright position are ...    An example of when you might not want to use gravity is ..."

I've had a number of people return to class saying things like, "My doctor said I can hang from the rafters for all he cares" or "I can squat on the floor like I'm in the jungle!"  They seem happy with these responses, but in reality, your doctor is making fun of you.  He thinks its undignified and foolish.

If I am an OB -- or even a Certified Nurse Midwife -- working in a hospital, chances are, approximately 90% of the births I attend is with an epidural.  The mom is mostly on her back.  Like it or not, this is how I get used to catching babies.  This is what I am comfortable with.  Even to have a mom on hands and knees, well, this looks different to me, and I am not as comfortable with this situation.  I will find a way to get this mom on her back.  I will give her lots of excuses that sound really good, such as, "The baby is caught on the pubic bone and I need you to lean back."

If a woman is left alone to choose her birthing position, very often she will use gravity in some form or another.  Rarely will she lay flat on her back to push her baby out.  Squatting, for example, is known to widen the pelvis up to 30%.  Many OBs will not suggest a mom get up and squat, but instead, will cut an episiotomy to get the baby out quicker.  Or worse, perform a c-section because her hips were "too small."

I simply wanted to let women know that what position you birth your baby in is your choice.  This seems common sense, right?  I routinely hear women talk about their doctor wanting them in a certain position when it comes time to push.  Pushing while flat on her back can cause more problems that it fixes.  The only person benefiting from this position is the OB. 

When you ask your care provider this important question, listen for silly answers that are really meant to make fun of you.  Listen for responses that put his/her comfort above your own.  The good answers are the ones that inform and respect you and your comfort.  Follow what your body is telling you to do.  Don't let them push you around when it comes to pushing your baby out!  

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Birth Plans

Birth plans have been a hot topic in my neck of the woods lately and I just wanted to throw my two cents in to the mix. 

When I start talking birth plans with some people, I see them roll their eyes -- even on the phone, I can actually hear some people rolling their eyes!  Especially Labor & Delivery nurses.  The comment I've heard most often is, "The lady that brings in a birth plan is always the one that ends up with a c-section!" 

My approach to birth plans has always been this:  A woman needs to know her options before she can think about a birth plan.  In class, we play an "Options" game where we talk about all types of things that will likely be brought up during your birth -- some positive, some negative.  The point is just to get people talking and learning about various interventions, when they are actually necessary, and finally how they feel about them.  We go over all these options and then I encourage them to go home and print out the 22 page birth plan online (you know what I'm talking about!) and check off all the little boxes.  Again, just to get the two of you talking about how you feel about these options.

From there, it gets significantly whittled down to a simple one page document that is unique to the two of you and your wishes.  My favorite is the "Yes, Please" and the "No, Thank You" columns.  Polite, and not a list of demands by any means, which I think sometimes the L&D nurses envision when handed the dreaded Birth Plan.  

When I was pregnant with my 4th baby, I had imagined myself laboring in my bathroom with the big garden tub.  I don't think I had ever said that out loud and it certainly wasn't on a piece of paper.  I loved that bathroom.  I had been contracting all day long -- it was such a great day, really -- but it was not until I got to that bathroom around 8:30 that night that contractions really picked up.  By the time David came in the bathroom about 30 or 45 minutes later, I was telling him to call the midwife.  He couldn't believe it.  After timing a couple of contractions and listening to me sound out my contractions, he agreed to call her.

I strongly believe in Emotional Relaxation.  I believe that the mind is a very powerful thing, possibly the most powerful tool in labor.  I've known many women in various labor situations that without a doubt, Emotional Relaxation played a huge role in how their labor played out -- good and bad.  I believe that imagining your birth -- imagining yourself remaining calm and relaxed, imagining the smells you want to smell, the food you might want to eat, the music you might want to listen to -- are all good things. 

Labor is a funny thing, as we all know.  We don't get to choose our labor, which I believe, is what makes it so exciting.  Hindsight is always 20-20 and you can always look back and think or wish you had done something different.  It's hard to just roll with the punches and enjoy the journey, but that is my best advice.  Take it one contraction at a time.  It's like I always say in class, if we knew exactly what your labor would be like, that's what we'd prepare for, but since we don't, we'll prepare for all sorts of situations that labor is likely to throw at you.  Hopefully you will feel prepared to deal with them as they come. 

Back to the birth plans:  Go ahead and make one.  Making a birth plan doesn't mean that you are married to one kind of birth and you are going to be unhappy with your birth if it doesn't look like it does on paper.  It just means that you have talked about all the options and have decided what is important to you.  You have a right to have those wishes heard and honored. 

We makes plans every single day of our life.  I live by my list every day, every week, every month.  Sometimes I get it all done, exactly like I plan, and other days, life happens and the list doesn't.  I understand that obstacles are in the middle of the road occasionally, and I may have to go around them or just deal with them head on.  Laundry is a weekly obstacle that gets in the way of my plans! 

You don't stop planning your life just because it might not happen the way you want it to. Go ahead, plan your lovely birth.  Pay close attention, when you imagine your birth, to the details -- the people in the room, the lighting, the temperature.  Keep the things you like and dump the rest.  Enjoy your labor.  It's yours and only yours, no matter what it looks like on paper.  Enjoy the journey, speed bumps and all. 

Finally, honor your labor and your birth.  I've had several people over the years that have had "necesareans" and some of those have rolled a little easier with the punches than others.  I think mourning the loss of something you didn't have or get is a tough place to be.  Talking to people who understand is so important, and at some point, acceptance is necessary.  Knowing you did everything within your power to carry out your birth plan seems to be an important step to accepting the outcome. My friend, Abbey, writes a blog called The Road to VBAMC and she just wrote a fabulous post this week titled When Your Birth Doesn't Go As Planned.  If you are in this situation, I suggest you head over there and check out what she had to say.  I think you'll find it extremely helpful. 

Birth Plans?  Don't be afraid of what might happen.  Go ahead and plan what you hope will happen.

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