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 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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The Birth Nazi

I am continuously amazed at the way people twist my words all around.  I have a friend that said that to me the other day.  She said the comments I get on my blog are consistently 50/50 -- some supportive, some thinking I'm void of any compassion whatsoever and have totally lost my marbles.

Most of you don't know me in real life, but suffice it to say, I am very much the same sitting here at the computer as I am in person.  I will tell you what I think, and I'm OK with you telling me what you think, as long as it is kept respectful.  That's why I do not delete comments from my blog, even the ones that more or less call me a Birth Nazi.  You have the right to your opinion, just as I have the right to mine.

Before I go any further, I want to address my use of the word "Nazi" in this post.  I am using this word because I have heard myself referred to in this manner.  The "Soup Nazi" episode of Seinfeld has been laughed about for years, but when used in this manner, it's not funny.  At least I don't think it's funny.  I, personally, am quite offended by the use of the word, especially in reference to myself.  

Let's address a very interesting topic that I read several blog posts and Facebook statuses about this week:  Is it OK, even good, to expect a good birth experience?  According to most of them, no!  At least this is my interpretation:  You shouldn't get your hopes up because you might be let down.

A very fast recap of my birth experiences:  I have had 4 different births.  My first was an epidural birth where I narrowly escaped a c-section.  My second was my most emotional where I definitely experienced that "birth high." My third sucked and was my hardest (no one's fault but my own), and my fourth was the "easiest" but emotionally hard knowing it was my last and my son would never have a brother.  The only birth I cried tears of joy was my second.  The others, I was just mostly glad they were over.  Does that mean they were bad births because I didn't weep with joy?  Of course not.  They were all just different.  I learned very different things from each experience.  I hope those things I learned, I am able to pass on to my students.  Sometimes it's a case of "Do as I say, not as I did!"

There is this idea that Donna Ryan is an unforgiving natural childbirth educator.  If you have an epidural, I will make you feel awful about it.  And a c-section, forget it!  You might-as-well crawl into a hole!

OK, this is what Donna Ryan teaches.  Pay attention, Donna-haters!  I believe that there are some really awful OBs out there that are happiest when they are performing surgery.  They know nothing about natural childbirth and frankly, don't want to know.  They will scare you into an induction or make you beg for an epidural ("haha, let's keep her pit turned high and strap her to a monitor!"), or they will give you an episiotomy so long you will wish you had a c-section.  (Yes, I've heard a nurse say she heard an OB say this.) Are all OBs like this?  Of course not.  They do exist.  I think that the majority of them have not attended natural, intervention-free births enough to know what that looks like, sounds like, or how to help and encourage a couple on this journey.  Most of them will find a way to put you on their turf, where they are comfortable -- in a bed, strapped to a monitor, legs in stirrups, epidural, pitocin, etc.  See past blog post.

There are other resources in your community.  You may have to dig around to find them, but they likely exist.  Resources that support and encourage natural normal birth.  In Fort Worth, Texas there are so many resources available to families -- amazing midwives, in and out of the hospital.  With choices available, you need to use them.  These are the people who will help you have the birth you want -- or in some cases avoid the birth you don't want!  They encourage you to do the opposite of the (bad) OBs;  things like walking, intermittent monitoring, light food and drink throughout labor, choice of pushing positions, and just plain ole encouragement!  What a difference between a nurse (or midwife) saying, "You got this!  You sound wonderful.  Keep making those low, slow sounds," and "Oh, honey, if you think this is hard now, just wait till you're an 8!  Are you sure you don't want an epidural?"  Well, when you put it that way, of course I want an epidural!

I expect my couples to make the appropriate changes if necessary.  Don't ignore the red flags!  Nearly everyone that sits through my class does change their care provider and/or hospital if they see those red flags.  If you ignore them -- now, this does sound harsh, but it's true -- you have no one to blame but yourself for a "bad" birth if you do not make the necessary changes during the pregnancy.  It's not much fun to be left wondering if that c-section really was necessary. 

Your labor should be a wonderful, yet challenging, time in your life.  Your birth team is critical.  I've said that a million times here over the last three years.  Birth is probably the hardest thing you will ever do.  I never paint a rosy picture.  We don't get to pick the way your birth is going to play out, but you will have a very good idea of what normal birth looks like.  We go through lots of variations of normal too.

This is what I teach about an epidural:  You know what normal birth looks like.  You know what to do, what not to do, you have prepared in every way possible (birth team, relaxation, exercise, nutrition, hired a doula), and you know when you are out of the "normal" range, which can mean a lot of different things.  You have the education to know when you are on the path to a c-section.  Many an epidural has saved a mom from a c-section.  We all hope that an epidural is not a part of the birth equation, but sometimes it is, and sometimes it's even a good thing, a necessary intervention that saves a mom from a c-section.

I have never -- not even once -- told a mom that she failed when she had that epidural.  Or a c-section.  I would never do that.  In many instances, I've put myself in their shoes, and have no doubt that I would have made the exact same decision.  Now, I can't say that a mom won't beat herself up over it, but it's not because I made her feel bad. 

Here's the reality:  When people sit through my class and do all the "right" things and their birth does not go as they had hoped (epidural, transfer, c-section), rarely do I have someone seem to dwell on it and have a hard time getting over it.  Most people know that there are things in birth that are not within our control, but you do your part, roll with the punches, understand why those things became necessary in your birth, and move on!  Learn from them.  Don't become a victim of your birth!  I am seeing this all the time.  It's exhausting.  Your birth does not define who you are as a person.  How you deal with things that happen in your life is more important than the actual things that happen. 

There are some midwives that have told me that the reason they refer to my classes is not necessarily because they love The Bradley Method®, but because my couples seem to bounce back easier when things go differently from their original plans.  My couples also know that they can trust them to help them on this road and if they say they need intervention or medication, it's OK to trust them.  Attitude is everything.

I simply want to see women believe in themselves enough to give birth their all.  Sometimes, that may not mean an unmedicated birth.  It might even mean a c-section in the end.  But if you do your part -- not just become a victim of a very broken maternity system -- you will have a good birth!  Does that make me a Birth Nazi?  Then so be it.

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Is This C-Section Rate For Real?

This week I went to the American Girl store in Dallas with my middle daughter (9) and a friend of hers.  We had a great time and went to lunch afterwards.  While we were waiting for a table, Abby's friend was telling about how she was born in the same hospital as a friend of hers, they have the same pediatrician, and born the same year.  I leaned over and told her that Abby was born at home in a big pool of water in our living room.  She was in total shock!  She said, "Did a doctor come to your house to get her out of your stomach?!"  (Abby seemed equally shocked by her reaction, which I must admit, made this mama proud.)

This is what girls growing up in America believe is normal -- babies being cut out of their mothers. 

I am certain that we are all aware that the rate of women having c-sections in the United States is about 1 in 3.  In North Texas, where I live, it's about 50%.  I have a friend that is a labor and delivery nurse at an area hospital and another that works postpartum at the same hospital.  They have both said there are days/nights that they do not tend to or witness a single woman that has a vaginal birth.  They are at a hospital that has a 60% c-section rate, but they have both told me they believe the rate is even higher.

I have another friend that works as a lactation consultant at another area hospital.  This is a portion of an email I received from her this weekend:

Out of 12 patients on the floor, 6 were c-sections.  Today's breakdown looked like this:

1 induction for "post dates" - mom was 40 weeks.  Ended in C/S

1 induction for "large for gestational age" at 39 weeks - baby weighed 7lb 9oz and ended up on antibiotics because mom ran a fever during labor.  Baby will spend an extra 2 nights in the hospital without mom for antibiotic therapy

1 induction at 39 weeks for "suspected ployhydramnios" - mom managed to deliver vaginally but baby is feeding poorly

1 induction for "post dates" at 40+6 - resulted in maternal fever, Failure to Progress, C/S and baby on antibiotics

1 "Term Induction" (whatever that means!) at 39+2

3 repeat C/S (1 at 36+ wk, 1 at 38wks and 1 at 39wks)

4 spontaneous labors, one of which ended in C/S for "Failure to descend"

Also this week, at the same hospital, a woman was told that she would have to have her birth plan approved by the legal department.   It was 11:30 p.m. and they would not be available to do so until the morning.  Her doula reminded her that she had options.  Yadda, yadda, yadda, she drove across town and birthed with the UNT Midwives in Ft. Worth -- no pain medication, cord wrapped around baby's neck 3 times, and water broken for almost 48 hours.   This couple would certainly have had a c-section had they stayed at their original birth place.   If that story doesn't inspire you to hire a doula, I don't know what will!

One of my couples had their baby at 37 weeks right before Christmas.  She had started bleeding pretty heavily, but it would stop when she laid down.  They suspected a placental abruption, but the midwife (yes, one of the UNT Midwives) and back-up OB couldn't see anything on the ultrasound.  She had lost quite a bit of blood, but they decided to wait it out.  Her contractions were sporadic -- short and not very strong -- and this went on for over 6 hours.  Baby was fine.  The midwife finally decided to break her water and things progressed from there.  She was catheterized so that she would not get up and start the bleeding again.   Her baby was born, posterior and wrapped in his cord, about 12 hours after the midwife broke her water.  No epidural.  As it turns out, she had had an abruption, but she had a large blood clot on the placenta that had stopped the bleeding.   Had it broken free, she would have had an emergency c-section.    I believe she would have had a c-section had she walked into the majority of the DFW hospitals bleeding like that.  Baby is nursing well and everyone is doing great.

So, yes, the c-section rate is crazy.  But we don't have to leave it to chance.  Do not ignore red flags.  If they are popping up at your hospital tour or monthly/weekly appointments, do not put a blindfold on and keep walking, hoping things will work out in your favor.  Tear it off and RUN!  There are care providers who will support you -- not just go along with you -- in your decision to have a normal vaginal birth.

Let's face it though, if I was an OB, I would be all over the c-section thing.  No waiting around, twice as much money, I'm the hero saving the day, and dang it, no one ever sues an OB for performing a c-section!

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When to Reign In Your Birth Team

As most of you know, I teach a 10-week course on natural childbirth.  The first night of class, the number one question is, "When do we go to the hospital?"  Line-upon-line here.  We don't hit that until Class 5!

Over the years, I've learned that this question is really asking, "When can the professionals take over?"  It usually is asked by a dad-to-be.  It's interesting to watch these expectant parents learn and grow.  Education and information is unbelievably empowering!  Several years ago, I was teaching "emergency" (ie. unattended) childbirth.  By the time we get to that point, we've spent countless hours together, watched more than a dozen birth videos, and everyone has a very good idea of what normal childbirth involves and what to do -- or not do!  I asked this particular father-to-be how he felt about the possibility of this happening.  I should preface his answer with the fact that he didn't speak to me until Class 5 and was totally depending on his mother-in-law to help his wife at the birth.  He despised that he was forced into attending this class.  So, when asked this question, I was amazed at his cool reply:  "On the one hand, totally terrified, but on the other -- bring it on!"  I should also mention that the mother-in-law didn't make it to the birth and they were only at the hospital for 22 minutes before the baby was born!

The answer to the question "When do we go to the hospital?" often changes as you get more information.  Let's back up for a minute.  You know how I feel about hiring a doula.  Do it.  Who are the people you are inviting to your birth?  A sister?  Mom?  Mother-in-law?  Other children?  Your best friend?  Do you call them all the minute you have your first "real" contraction?  Of course not.

There is nothing like being pregnant with your first baby.  Not that the other pregnancies and labors aren't exciting, but they are undeniably different.  You've done it before.  You have distractions now that you didn't have the first time around.  Regardless of what baby number this is, enjoy early labor with your spouse.  I love early labor!  Get into a rhythm together.  Figure out what works, what doesn't.  Practice different positions.  Nap.  Eat.  See a movie.  Enjoy this time together.

Everyone's labor is different.  You may have several hours of early labor -- this week I had a mom that did this for several days! -- or it may not exist at all.  You may jump right into active labor and need your doula right away.  There is no way to know beforehand. 

But let's assume that you do have early labor -- you are contracting regularly but are able to talk, walk, or sleep during and/or between contractions.  If your husband is sleeping, and it's 2:00 a.m., let him keep sleeping.  A lot of moms don't like it when I say that.  Here's the thing -- yes, labor is exhausting, but it's also exhausting for your birth team.  This often doesn't get a lot of sympathy from moms, but if your labor is on the longer side, you are going to need your birth team to be able to step it up, and they may not be able to if they are utterly exhausted.  If you don't need his help, let him keep sleeping.  You'll both be glad later.  You may find yourself enjoying those early contractions, just you and the baby.

As things progressively get harder -- and you feel like you need some extra help -- think about who you want to reign in.  Maybe it's your sister or mom or maybe it is your doula.  Whoever it is, be sure that you are ready for the help.  And perhaps even more importantly, be sure they will be a positive influence on your labor.  For example, the mom who is freaking out that you didn't go to the hospital with the first contraction or the minute your water broke may not be the best person to be with you and your husband.  She may not be someone you want at your birth at all!  In the end, if you don't need help yet, you may feel like a watched pot, which won't be good for your labor.

There's not a set time that is right for all couples.  I hate it when couples are told to head to the hospital when contractions are 5 minutes apart lasting 60 seconds.  You could do that for hours!  It's really hard to explain, but there will come a time in your labor that you will know who you need.  With my 2nd baby, I had no early labor and wanted my friend there immediately.  It was a very fast labor.  But with my 3rd and 4th babies, no one was there until about an hour before the birth, including our midwives.  But I knew when I needed them.

Again, it's hard to explain, but there will be an urgency felt to be with your birth team as labor progresses, whether you are in the hospital or at home.  This will be different for each woman.  Some women feel this urgency earlier than others.  This is their emotional relaxation -- how they feel about where they are giving birth, who is there, are their wishes being honored?  I remember with my first homebirth -- 3rd baby -- the minute the midwife walked through the door, I felt like crying.  I felt such a release.  She wasn't there more than an hour and my baby was born.  My body held back until my birth team was in place.

I often think of it as involving people according to their skill set:  my mom was needed because I needed help with the other kids (1st called).  She cleaned up, made food, changed sheets -- a good one to have around!  Anyone else helping out with the kids was next.  They'd usually help my mom too.  One of these people was usually on video duty.   As labor progressed, if I had a doula or doula-friend, they'd be called in to help me and David.  Your chiropractor is also a great person to call in for a period of time.  Eventually, you'll want someone to catch the baby, so either calling your midwife or heading to the hospital will be necessary!  You'll know when this time is.  You'll be very serious, eyes closed, not talking or smiling.  Some women will be sounding out contractions and others won't make a peep.  Either is fine.  One is not better than the other.

My ultimate answer to the question "When do we go to the hospital?"  Alright, here it is.  There will come a point when she (talking to dad because mom won't remember this or be thinking logically) will not want to walk anymore.  She will still get up and go to the bathroom when you encourage it, but she doesn't want to.  She has to wait till the end of a contraction to get up and she will move quickly so she doesn't get caught standing up during a contraction.  Contractions are stronger and longer when she stands up.  Still willing to move, but not wanting to.  This is usually a good time to mosey on down to your birth place or call in your midwife.  Labor is very well established at this point.

Most of all, enjoy your labor.  Choose your birth team carefully and reign them in as you need them.  So many women wish for a fast labor, not understanding how hard a fast labor is -- just to get it over with.  A longer labor is not a bad thing.  Like I always say, labor and birth serve as a bridge between pregnancy and becoming this baby's mother and father.  Enjoy it.  These hours are unlike any in your whole life.

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