Guest Post by Elizabeth McKeown - Author of "In Search of the Perfect Birth"

So many women end up reeling from their births, with something empty inside or a “why me” attitude. It’s not always easy to explain or define. Some cover it up and go along with life anyway, convinced that the problem is themselves. They chastise themselves and don’t question the way things are. Afraid to be ungrateful, some are ashamed to confide their feelings and they keep it inside. And then for those, like me, for whom that is not good enough… we go searching for more.

What was I “in search of”? Answers. Answers why my body didn't work like I thought it would. Why wasn't I a pain warrior in the hospital? Why didn't my baby latch well or take to breastfeeding? Why did I feel so void of raw emotion the instant I became a mother? Why wasn't that the happiest moment in my life? Logically I knew it should be. In my heart, I was like a conductor with no orchestra. Cue the teardrops, I urged. All I felt was hungry (not eating for almost 24 hours) and tired. Some natural birth goddess I turned out to be.

Years later I had still not given up on myself. I believed in myself so much that I decided that if only I weren't strapped down to that hospital bed I could have handled everything well. I was older and wiser, and maybe even tougher than that 21 year old girl I used to be. Homebirth midwives were going to help me have the birth I needed. Only it didn't work out that way. I was overdue. Pressure was on. I experienced a non-consensual membrane sweep. The following day I would give birth. Intense, increased pain in their presence, meconium, and an ambulance ride to the hospital created for me what was my most horrifying life experience yet. My baby and I were alive, but I was shaken. I knew I was not made for this. 

My disappointment and disillusionment surfaced. Bitterness in “natural birth” took the place where confidence in myself once was. I knew I could never give birth again. I wanted no one to give birth again, ever. When I thought of birth, I thought of tsunamis wiping out populations, and tigers tearing animals apart in the jungle. Nature was harsh and cruel and did not care about any of us. I felt like some lonely star wandering the cold, desolate universe. I was on God’s torture table subject only to his whims, suffering comedy and tragedy at random and completely out of my control. 

I was not content to let it end there. Not like that.

My epiphany came and hit me during my third pregnancy. Something was always getting in my way in the other births. What would happen if nothing was standing in my way? There were things I had no say in, people who didn't honor my requests or needs, with the feeling of being vulnerable magnifying every pain. Yes, I do like to be in control of everything. Yes, I do like the idea of going with the flow. There is some balance, or harmony to be stricken, between the randomness of nature and the power in my own hand. I was going to find that balance. My epiphany was that I needed to birth unassisted.

I began researching my needs and found, shockingly, that everything I felt was so specific to me was supported in science. Scientific observation of mammals, the primal birth space, the nature of birth physiology… these were all in tune with what I suspected were my own “preferences“. I flung myself deeper and deeper into research and gave birth undisturbed and unassisted in 2011. Shortly thereafter my book In Search of the Perfect Birth was published. It describes all my birth experiences in detail, the “errors” in each, and the triumph of learning how to trust yourself again after life’s hard lessons. 

I am so glad I never gave up on myself, never subscribed permanently to my own bitterness, and never stopped asking questions. The obsessive pursuit of truth will lead you to scientific and spiritual revelations about yourself of proportions you could never imagine. It is “perfect”. I tell my story so others can find their way out of the suffering, too. 

The Facebook page In Search of the Perfect Birth is dedicated to discussing these topics. The book of the same name is available (among other places) at Amazon and for Kindle.

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POOP

That's right, you read the title right. Let's talk about poop for a few minutes. Did you know that you might poop when you push your baby out? Most people never think about this, and others are completely obsessed with the possibility of this happening. I've even had one of my couples have a c-section over this topic. She made it to a 7, everything was going great, and she opted for a c-section. She just could never let go of the fear.

Approximately 30% of women poop when they push their baby out. There is a trend I'm starting to see pop up of offering/pushing enemas to women when they are in labor. I got an email from a friend this week and here is a portion of it: "They gave her an enema before starting pitocin because the doctor didn't want to be pooped on. Yes, he personally told the mom this."  Gotta love the OB that does things for his comfort and not the mom's. 

At any rate, the body, typically at the beginning of labor, will naturally get rid of waste.  She'll usually have loose bowels, sometimes even diarrhea.  She should eat and drink throughout her labor though, which means more waste.  And that's ok!  So, along with all the questions I've given you over the years to ask your care provider, here's another one:

"How do you feel about poop?"

If you are super concerned with pooping when you are pushing your baby out, do the enema.  If it makes you feel more confident, by all means.  Know that I am not advocating the enema whatsoever!  In fact, I'd really just like to see women comfortable with their bodies and not afraid to eat and possibly poop in labor.  But, like all interventions, I believe there is a time and place. 

Let's go back to the mom who just can't let it go, no matter how much her husband and care provider tells her it's ok, it's normal.  They don't care if she poops.  There are some other issues associated with this fear.  At the top of this list is sexual abuse.  Pooping during pushing is not about vanity.  I strongly suggest counseling in this situation.  To most, this topic is funny and only slightly embarrassing.  To others, it's completely paralyzing.  

Last I read, approximately 1 in 4 women have been sexually abused or molested.  Poop has the potential to be a big issue for many women -- even one million per year -- about to give birth.  I can't help but wonder about the women who elect to have a c-section and never experience any labor.  It's a question that simply cannot be asked, and yet, I can't help but wonder.  Is sexual abuse a part of their history?  Labor and birth is an extremely vulnerable time in a woman's life.  She is exposed in every way possible.  It's a lot for a woman who has not been abused or molested to come to grips with.  But for a woman who has endured abuse or molestation, vaginal birth  may be much too overwhelming.  

If you have seen Orgasmic Birth, they address sexual abuse and birth in a very tender story.  The woman is terrified to surrender to the power of her birth.  When she does, she comes out stronger on the other side.  If you have not seen the movie, check it out.  It's about much more than just "orgasmic" birth!

What started out as a funny post, took a very serious turn.  You know me, I can't end like this.  So, in class, the mamas planning a water birth always want to know about pooping in the water.  (My water birth is the only birth I didn't poop!)  I tell them that if they are really worried about it, if the dad will just throw a bunch of tootsie rolls in the water at the time of birth, she'll never know if she pooped or not.  (I've never had anyone actually do it, but it would be a very funny trick to play on a midwife.)

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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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Vaginal Tearing -- What You Should Know For Your Next Birth

When couples show up for the first night of childbirth classes, they want to know 3 things:  1) When do we go to the hospital?  2) What if my water breaks?, and 3) My mom says an episiotomy is better than tearing.  I don't want either.  Of course, I make them sit through 4 weeks of classes before we get to "the good stuff."  By the time we get there, they have a really good foundation.  For this post, we'll concentrate on item number 3.  (Yes, I've been inspired by my good friend, Sarah Clark, aka Mama Birth, with the humorous photos.)

Obviously, the tearing of the vagina as the baby is crowing does not sound enjoyable.  There is a lot of fear surrounding the possibility of this occurring.  The good news and bad news is all rolled into one sentence concerning this fear:  You'll think you tore, even if you didn't.  Some women feel better after learning this and some don't.  The skin typically burns (thus, the "ring of fire") as it stretches over the baby's head.  Once it is stretched, the skin is pretty numb, but before this, you will likely think that you tore.   I thought that with every baby and I've never torn. 

So what can you do to prevent tearing?

I live in the Fort Worth area now, but I lived in Albuquerque before moving here.  NM has almost the lowest  c-section rate in the country.  No coincidence that one in every three births is attended by a midwife.  When I taught Bradley® classes in Albuquerque, I had a number of students participate in a study that the midwives were conducting at UNMH (University of New Mexico Hospital).  The study was trying to find out what method at the time of birth was the most effective at protecting the perineum.  If you chose to participate, you were given one of three envelopes at the time of birth with one of the following options written on it:  1.) Do nothing as the baby emerges; 2.) Use perineal massage; or 3.) Use warm compresses on the perineum as the woman is pushing.

I always like to share a funny story in class from my third -- and hardest -- birth.  As I was pushing, my midwife was applying pressure to the perineum. She asked me if I wanted her to keep doing that -- actually, her exact words were, "Do you feel like your butt is going to blow out?"  Yes, that's exactly how I feel, and yes, please keep doing that!  Emotionally and physically I felt like I had something to push against.  I think women are always surprised at how hard they are pushing.  I have always been a big fan of warm compresses or support of the perineum, much more so than perineal massage.  I must admit, I thought warm compresses would be the big winner of the UNMH study.

I have someone in my current class that recently looked up the study.  Yes, I'm embarrassed to admit that I never looked it up to see the results.  Let me give you a few more details about the study before the exciting results.

Data was collected from 1211 births over a 3 year period.  There were several bits of data collected including maternal age, parity, race, years completed of education, body mass index, weight gain in pregnancy, and use of antepartum perineal massage (during the pregnancy).  Variables included use of pitocin and epidural, length of 2nd stage, style of pushing (coached or self-paced without prolonged breath-holding), position of the baby (compound presentation or posterior), and complications or unexpected birth events.

The most interesting thing about this entire study is the probably the c-section rate:  Of 1211 births, 98%, or 1187 had a spontaneous vaginal birth.  Only 25 of these women -- 2% -- had an operative delivery!  Nine cesareans occurred in late labor, and 16 women had vaginal operative births (3 by forceps and 13 by vacuum).  ONLY 9 CESAREANS IN 1211 BIRTHS WITH THE MIDWIVES! 

Take a minute to recover from that and let's move on.  There are a number of other items I found interesting within the study.  The first one is that 13% of the women that were receiving perineal massage requested that the midwife "stop."  With the other two methods, it was 2.2% (warm compresses) and 1.7% (hands off).  Again, I'm not a fan of perineal massage (I think I've said that a time or two!) and neither were 54 of the 400 women who drew this envelope.

*Less than 40% of the women in each group had an epidural and the use of pitocin was between 32-36%. 

*At least 77% from each group gave birth sitting upright.  About 10% were flat on their backs with stirrups.  Less than 1% in each group gave birth in a squatting, hands and knees, or standing position.

*The vast majority (each group over 77%) did not participate in Valsalva pushing (holding breath excessively long causing capillaries to burst, etc.) and between 30-34% of the mothers delivered the head between contractions.

*Approximately 94% of the babies was born in an occiput anterior position, while about 10% were born with a compound presentation (hand by the baby's head).

Other things that should be noted:  40% of the participants were first-time mothers.  There was a wide range of ethnic diversity as well.

Some interestingly low numbers include:

*92 births with nuchal cord
*42 births had meconium
*34 with extreme fetal heart rate abnormalities
*10 with postpartum hemorrhage
*9 with shoulder dystocia (.7%)  -- Side note -- I hear this all the time for a reason for c-section or induction.  True shoulder dystocia is rare!
*2 with manual removal of placenta

The Results:

*Only 10 episiotomies were performed, due to severe fetal heart rate abnormalities.

*23% off all women experienced no trauma at all to the genital tract, regardless of which envelope they drew.

*20% had major trauma, defined as 2nd, 3rd, or 4th degree tearing.

*57% had minor trauma, defined as 1st degree tearing, affecting the external genitalia, or the outer vagina.

Other studies have defined an intact genital tract as "no trauma, or minor and unsutured trauma."  If this definition was applied to this study, the midwives' rate of "intact" would be a whopping 73%!  In all fairness, too, these 12 midwives who were involved in this study already had a high degree of expertise at minimizing trauma in vaginal birth.  I met with a couple of them when I was teaching in Albuquerque and was extremely impressed.  In fact, the obstetric culture at UNM teaching hospital is patient, calm and controlled, and emphasizes slow expulsion of the baby. 

Ultimately, there were 2 care measures that were associated with a lower risk of genital tract trauma.  1.) "A sitting position allows the mother greater comfort and autonomy at delivery.  It allows face-to-face proximity and direct visual contact between the mother and midwife."  2.) "Delivery of the head between contractions requires communication, synchrony, and shared responsibility for a slow and gentle expulsion of the infant."  


So ladies, be patient at the time of birth.  Ban the cheerleaders!  Don't let anyone count to 10 for you like they do in the movies.  Just let the baby come.

As for the 3 methods?  It's really up to the woman and her midwife.  The results were all similar in findings.  If you'd like to read more about the study, you can find it here.

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The "Big" Baby

Contrary to everything you may have been told, a big baby is a good thing!  Women have become afraid of giving birth to a big baby because their doctors, and even some midwives, have instilled fear into these mothers.  When a woman hears the phrase "birth trauma," do you think she's excited to start labor and give birth?  Of course not.  A woman's body is less likely to start labor when she is fearful.

How does your doctor know the size of you baby?  Ultrasound?  While ultrasound can be a useful device in estimating a number of things, when it comes to the size of the baby, it can be off by more than 2 pounds, either way!  So if you have a doctor telling you that you are carrying a 10-pound baby and a C-section is the way to go, you likely are NOT really having a baby that big.  Do not allow a doctor to conveniently (for him/her) cut you open because he/she is afraid of your "big" baby. They do not trust your body to give birth if they are recommending a C-section.  I have a lot of confidence in a woman's body being able to give to birth to the baby that her body allowed her to grow.

And what if you are carrying a 10-pound baby?  Congratulations!  My dad was 10 pounds, born at home.  So was his brother.  My grandma, who I lovingly call a "hillbilly," lived on the land. She ate the food she grew.  She knew where her food came from.  And she grew healthy, big babies.  

Most women are afraid to birth a big baby because they are afraid they will tear at the time of birth.  You are actually more likely to tear with a smaller baby than a bigger one.  How can this be?  A small baby tends to come through the birth canal faster and the skin, or perineum, doesn't have as much time to stretch.  A bigger baby allows the skin more time to stretch over the baby's head.  I've seen women be fearful of a bigger baby, because, surely if they tore with a 6-pound baby, an 8-pound baby would be dreadful.  Just the opposite is true.  

I have a lot more to say on the subject of tearing, episiotomies, etc., but I'll reserve that information for those lucky enough to take my class!  Wink, wink. 

I would also like to point out a very important statistic:  The #3 reason for a C-section in America is for CPD, or cephalopelvic disproportion, but only 1/2500 women actually has this very rare condition.  This is when a doctor says that your baby is too big to fit through your pelvis.  The only way for a doctor to truly diagnose this condition is when a woman is in labor and has spent a considerable amount of time pushing or has had an X-ray.  No one is going to do an X-ray on a pregnant woman, let alone in labor!  

We all know the tiniest women who have birthed 9 and 10-pound babies.  You cannot tell by looking at woman's hips whether or not her baby will fit through them.  During labor, there are hormones released to help soften the cartilidge within the pelvis.  It shifts with the baby, allowing more room for him or her to pass through.  The baby's head will also mold to fit through. Understanding the process of birth instills confidence in this natural process of the baby passing through the pelvis.  

True CPD was more common in the 19th century when a lot of women had suffered from rickets, causing the pelvis to be misshapen. Very rarely does a mismatch occur with the baby's size and the mother's pelvis, but there is no way for a doctor to prove it, so it is used as a diagnosis very often, even in pregnancy when a woman has never even experienced labor!  Give me a break!

Let's talk about that "birth trauma" we hear so much about.  Specifically, shoulder dystocia, is seen more often with bigger babies, but certainly not as common as the doctors make it sound. This is when the head is born, but the shoulders are "stuck."  Honestly, the baby doesn't have to be huge for this to happen -- just to have really wide shoulders.   A doctor will usually deal with this by giving the mom an episiotomy and then by breaking the baby's collarbone.  Ina Mae Gaskin, who I consider to be the nation's leading midwife, has a different approach, called The Gaskin Manuever:  have the mom get on all fours and lift a leg.  This will release the baby's shoulders. I have done this with one of our births.  It's amazing.  

Briefly, let's contemplate what is believed to be a "big baby."  What do you believe to be a big baby?  If 7 1/2 pounds is average, does that mean anything over that is "big."  I don't believe so. I do not consider a baby in the 8 pound range to be "big" -- just healthy.  We want this!  I, personally, think that once a baby is over 9 pounds, they are "bigger."  I love asking moms that have "big" babies if they tore, and I am constantly amazed by the amount of moms that say no, or very little.  

I had a mom in my class a few years ago that gave birth to a 12-pound baby with a 1st degree tear.   She gave birth in a hospital with a midwife.  Her family and friends couldn't believe that no one knew the baby was going to be so big.  They insisted that if she'd had a doctor instead of a midwife, they would have known.  I made the point that if she'd had a doctor who was expecting a 12-pound baby, she would have had a scheduled C-section and not the wonderful birth experience that she did.  

 

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