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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Sounding Your Labor: Are you In or Out of Control?

If you are a "birth junkie" you've probably watched dozens of birth videos.  Or maybe you are pregnant for the first time and are pretty freaked out to watch them!  So many of the birth videos out there seem to play serene music as the baby is born, dubbing over the sounds the mother may be making.  The viewer is left with this impression that the birthing woman peacefully -- and quietly -- pushed her baby out.

When I was pregnant with my second baby -- first unmedicated birth though -- my friend Janet told me that "sounding" her labor helped her so much.  I don't know that we spent much time talking about it, but I must have remembered her telling me that because I was definitely "sounding" out that labor!  At one point, my midwife could tell that this was helping me so much and she calmly said, "Donna, you sound fabulous.  Keep doing exactly what you are doing."  This was huge for me because in my head I thought I sounded like a lunatic, and yet, I didn't want to stop doing it because it was helping me stay calm and focused and relaxed.

As the baby descended and was coming through the birth canal, I got a little panicked and wild.  I screamed "IT BURNS!" when the baby's head crowned.  The whole scene was followed by lots of euphoric crying, "I did it!  You're here!"  Needless to say, my first birth video looks nothing like the pretty ones I show in class!

Despite my midwife's words, I spent years feeling bad for sounding out my labor and especially for screaming the way I did when her head was crowning.  I felt that I should have been quiet and turned inward, welcoming my baby into a quiet dark room -- just like the women in the videos.

To this day, that birth video is still the most emotional to watch and listen to.  I just love it.  I love the way I sound when I hold my baby skin to skin, fresh from my womb.  I went from the most intense and painful thing I'd ever experienced to absolute euphoria and joy!  And I can hear every bit of it!

My 3rd baby, if you've read my birth stories, was the hardest of them all, simply because I didn't prepare on any level.  I was a know-it-all.  I hollered so loud when that baby came through, I scared the mailman right off our porch!  I yelled because it hurt, but looking back on it 10 years later, I think it's also because I was so angry at myself for letting myself  begin labor without even preparing for it.  I hate listening to that video.  I sound awful.  It is so obvious that I was struggling.  There was no euphoric "You're here!" when the baby was out.  I was just so unbelievably grateful that it was over.  Completely exhausted.

By the 4th baby, I was fairly comfortable with the fact that I am a what-I-call "vocal birther".  I had been teaching childbirth classes for a couple of years by the time I had her and talked about this in class.  I had attended a handful of births as well and learned quite a bit about this "sounding".

Several days ago, I asked on my Facebook page if anyone had any topics they'd like me to write about, and one of the midwives I work a lot with, Melody, asked me to write on this topic of sounding out your labor:  

"... Making noise and being "open" in labor! So many mommies think they didn't "birth well" because they thought they were loud or " out of control" when they are comparing with birth videos etc. It's not uncommon for women to apologize for how they responded or the noise they made. I would love to see a post on this topic!"

I could relate to this sentiment because I felt the same way with two of my babies.  The truth is actually quite the opposite.  I spend 12 weeks teaching relaxation - physical, mental, and emotional.  Sounding is so closely tied to physical relaxation.  When a dad calls me when they are in labor, if I can hear the laboring woman, I can tell how well she is handling contractions.  How?

OK, from your computer, do this with me.  Reading this on your phone in Walmart at the check-out?  You might wait till you are in the car!

Take a regular breath and let out a high-pitched "aaahhh".  This is the sound that many women make on TV when they are in labor.  It's high-pitched and obvious that she is in pain.  In fact, we are all in pain from listening to her!

Now take a good deep breath from the abdomen, open your throat, and let out a low-pitched "aaahhh".  Let your shoulders drop.  As the laboring woman peeks in her contractions, this sound will like get louder and longer, and hopefully lower.  The lower the sound, the more open her throat, the more relaxed and deep her breathing, the more her shoulders and jaw drop.  Without the noise, she simply cannot be this relaxed.

A person can lay perfectly still and quiet and be completely tense.  Noise is good.  It's good for mom.  It's good for baby.  If mom is taking these good, deep, long breaths during contractions, baby is getting good oxygen.  If she is chest-breathing and letting out short, high-pitched sounds, baby is not getting good oxygen and mom is tensing up in the shoulders, the jaw, and the abdomen, and therefore the uterus.  Sounding is even good for your midwife!  It helps her know how you are doing and perhaps how she can help you.  It also helps her know where you are in your labor.  By the 3rd baby, David knew exactly when that baby was on it's way out by the sounds I was making!

Think O-P-E-N and L-O-W sounds.  Should the mom sounding out labor feel bad about the sounds she's making?  No way!  Giving birth is, in the words of my last midwife, Barb Pepper, "animalistic".  She'd tell me to make some noise, let it out!  It's normal, it's healthy, and it's expected.

So what about those birth videos?  What should we do about them?  They are great visually, but they do women a disservice by editing the audio.  Hearing birth is equally important.  This is one reason I strongly suggest my students watch Orgasmic Birth.  We get to hear birth and lots of it!  It's real.  Don't be afraid of the name, if you haven't seen it.  It's a fabulous film on many levels, but for the purpose of this post, we're just focusing on the sounds of a laboring woman.  Dads should watch this movie too.  Many men are uncomfortable with the sounds their wife might make in labor, and it is so important that they become acquainted with these sounds and welcome them.  Recognize the high and low pitches and help her stay low and open. 

Most importantly, this is your labor.  No one will ever give birth exactly like you.  You can't do it wrong.  You may not be a "vocal birther" like me.  You may be very quiet and do all your relaxing through your breath.  That is OK too.  Find your ritual and run with it.  If sounding is a part of that ritual that helps your through labor and birth, great!  "Sound" loud and proud, Mama!

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The Gift of Days-Long Labor

Having a baby is such an exciting time, not just for the new parents, but for the grandparents, aunts, uncles, cousins, friends, sisters and brothers.  There are so many people that are invested in this new little person.  They all want to be called the minute you start labor so they can rush to the hospital and wait.

But what if labor isn't like the movies?  We know how often that happens, right?  First contraction and the baby's practically falling out.  Regardless, everyone is rushing around to get out the door and races to the hospital.  There is this idea, even subconsciously,  that if we head to the hospital, the baby will come. 

I recently had a couple start good contractions on a Sunday.  We thought for sure she'd have her baby and would not be in class Tuesday night.  We'd text or talk every several hours.  I knew her mom was nervous and wanted her to head to the hospital.  This woman knew it wasn't time.   She visited her chiropractor, and while it didn't seem to necessarily help speed things up, she didn't have back labor after that.  A success, for sure! 

I finally talked with her husband who had been a fun guy to have in class.  He said everyone was asking if this was normal -- labor taking so long.  All their comments were getting to him and he was starting to doubt their decision to stay home as well.  The pressure from family and friends can often lead to going to the hospital too early, which can lead to interventions that the couple didn't want in the first place.  Most people have never seen labor "take so long" because women don't labor outside the hospital very often.  And in the hospital, time limits are enforced.  So two days is unbelievable!  Surely, something must be wrong!

I believe that we'd see this so much more often if women:  a) waited until labor was very well established to go to the hospital, even if it meant days, not hours; b) were not dying to get an epidural, and thus, rushing to the hospital; and c) were not induced and simply allowed labor to start spontaneously.   If this couple were to go to the hospital, labor would likely be augmented either with pitocin or breaking water.  Were they ready to interfere with the natural process? 

Needless to say, they made it to class Tuesday night.  It sure was fun watching her contract all through class!  Some were super intense and she handled them beautifully.

This type of labor continued for a couple more days.  Baby B was born on Black Friday in the early morning.  I got news while I was in a line at Staples, or was it Sports Authority?  No drugs, no augmenting labor.  Just trusting that this labor was just what mom, baby, and even an emotional new father needed.  They are on cloud nine.

Another one of the couples from the same class has had a very similar week.  Contracting every 3 minutes, lasting about 60 seconds.  Still getting some good sleep.  Eating, resting, walking.  The story from the first couple has bolstered their confidence that this is normal.  They have had to remove "the family" periodically as well for the same reasons.  Both these women have amazing husband-coaches.

Like I always say, the baby will come out!  Labor will not last forever, although you may get to a point that you can't imagine it ending.  It will.  Enjoy your labor.  Take it as it comes.  Don't rush through it.  You'll treasure these hours -- or days! -- down the road.  Do something memorable with your labor.  Get creative.  Stay in a hotel, see a movie, take some long walks, build a fire, enjoy a warm bath, eat a yummy candlelight dinner, get a pedicure, eat chocolate, get a massage.  All these things can release endorphins that encourage oxytocin to get flowing.  Remember, oxytocin is a feel-good hormone.  It's hard to feel good when you feel rushed or watched.  So when I say enjoy your labor, I really mean ENJOY YOUR LABOR!

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"Standing Outside the Fire"

So, I'm cutting onions and jalapenos this morning. No one is home. I have a Garth Brooks box set playing (sorry Tim!) with videos, concert clips, and interviews. I've had it for years but never watched it until this morning. It made the time go so much faster.

They showed the video for "Standing Outside the Fire". I love the song, but had never seen the video. I am such a sucker for sap! I want you to watch the video and then come back to me... (Yes, I have put videos on the blog before, but I can't remember how to do it, but if you click on the song, it'll take you right to the video.)

OK, did you love it? Are you bawling your eyes out? I was really a mess with all the onions!

Everything in my life relates back to birth. But before I went there, I couldn't help but be in awe of this mother's support for her child. The love was so evident and he had so much confidence because of her love and support. It made me think of my own children -- do I support them in their talents and ambitions? Some yes, some, not-so-much. It was a good moment for me as a mom.

Next, I couldn't stop thinking of a woman who plans and prepares for an unmedicated birth. She doesn't want to take the "easy" way out. Nearly all women will "stumble" in labor -- even if it's not obvious, maybe it's thoughts in her own head. What happens from there depends so much on her support team. Do they run to her? Do they cheer her on? Do they tell her, "Get up! You can do it!" Do they tell the doctors to "back off! Let her finish the race!"

What if this young man's parents had just sat in the stand? What would that boy have done? Do you think he would have finished the race? I do not believe he would have. It was his dad's encouragement -- the one who thought he would fail or get hurt -- who was at his side telling him he could do it! The look in the boys eyes -- my dad believes in me! -- was priceless.

And then to finish the race, running into his mother's arms, so proud. The prize at the end of labor, to hold your baby, knowing you did it!

Moms and Dads, it is not just about what mom is able to do. It is so much about her support team (doulas, nurses, midwives, doctors, mothers, mother-in-laws, sisters), cheering her to the finish line. Who would have thought that a Garth Brooks song would lead to such as inspirational birth song and post this morning! Sorry for all the crying. I hope you'll ponder this video and it's meaning in so many areas of our lives. Gotta love Garth! Now get on with your day.

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Benefits & Stimulants of Oxytocin

This month I had the opportunity to attend the International Childbirth Educators Association (ICEA) Conference in Oklahoma City. I actually had to take a test for another certification (I passed!). The conference ran for three days and there are lots of things I'd like to share with you here.

In honor of all the women that I have due right now and in the next few weeks, I decided the first thing I wanted to write about is oxytocin - its benefits and how to make it flow!

Let's review for a moment: We hear so much about pitocin, but rarely oxytocin. Pitocin is the synthetic form of oxytocin. Oxytocin is what causes the uterus to contract. Released are also endorphins that help mom to cope -- even feel good. In other words, when oxytocin is released naturally, it crosses a blood-brain barrier to release those endorphins. When labor is started artificially with pitocin, or "pit", the uterus contracts without all these extra benefits I'm about to share.

Benefits of Oxytocin that you may not be aware of:
Mom experiences lower blood pressure and fewer stress hormones.
Her pain threshold increases.
Her sleepiness, even laziness, increases, causing relaxation.
Her muscle tension will decrease.
She will feel more calm and even more curious.
She will become more trusting and possible more daring.
She is more open to touch and be touched.
Oxytocin facilitates learning.

Wow! Who knew! Oxytocin levels are at their highest in a woman right after she gives birth. If you have given birth without medication, think back to how you felt right afterwards.

And did you know that women being together will also produce high levels of oxytocin. In comes the doula. Why is it that women are more able to relax and have fewer interventions and medications with another woman by her side in labor? We often assume that it is because she is more sympathetic or has been through this experience before. While these are often true, it's more than that. Think of when you have a girls night out. Oxytocin is flowing! Men will often report that their wives are in the mood for sex they come home from a girls night out. Oxytocin is often called "the love hormone" and makes us feel good!

So how do we get it flowing? There are many different ways. I always talk about nipple stimulation and sex as the number one way. This weekend, another educator reported that some serious kissing can often get oxytocin flowing more than nipple stimulation. If you have read anything by Ina Mae Gaskin, she'll probably say the same thing. Following is a list of several contributing factors to the natural production of oxytocin:

Ways to get oxytocin stimulated:
Warmth
Sex
Stroking
Descent of the fetus
Good food
Doulas/Companions
Low light
Mediation
Visualization
Positive thought
Movement
Suckling
Pleasant smells

Adrenalin is the opposite of oxytocin. If a woman in labor, or one who is trying to start labor, is under too much stress (ie. the threat of induction!), the production of oxytocin is squelched. Too much stress can actually stop labor. We've heard of the "fight or flight" response. It applies to labor as well. You can sometimes tell if a woman is under too much stress by looking at her eyes. Her pupils will likely be dilated instead of her cervix. Her digestion will slow, while her heart rate and blood pressure will increase. When this occurs, not enough blood will get to her vital organs and muscles, including the uterus.

The mind is a powerful, powerful thing. I was talking with one of my moms-to-be this week who was due about a week-and-a-half ago. I found out she was still working because she feels great. Better than sitting around waiting for baby to get here, right?! Wrong! I told her, no matter how the baby comes out, she will be a mother by the weekend. Her brain knows, when she's still working, that she has someplace to be tomorrow. Her focus needs to be on getting oxytocin to flow.

Relax. Take some time for you. Gather your girlfriends for some plain ol' fun. Go see a movie. Take a warm bath. Close your eyes. Take some good deep breaths. Enjoy the end of your pregnancy. Burn a favorite candle. Get a pedicure or foot massage. Wrap yourself in a warm blanket and read a book. Nap. Make out with your hubby and have some great candlelit sex. Let the oxytocin flow. Don't fight it. I feel good just writing all this!

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Beta-Endorphins and Their Affects on Pain Perception in Labor

I have come across the most fascinating graph dealing with beta-endorphin levels at different times in a woman's life. I want to share it with you.

This made me think back to the "Is Labor About How Tough You Are?" post I wrote several weeks ago. Interestingly, we all agreed that labor is NOT about how tough you are.

I have previously mentioned that the body produces endorphins in labor -- when drugs do not interfere with the natural process -- to help a laboring woman "deal with" the intensity of labor. When an epidural is introduced, those endorphins are squelched. It used to be advised that women let the epidural wear off when it's time to push, but most women found this too difficult. (I was one of them with my epidural birth.) A big part of the problem is that her body is not producing those endorphins at an increasing rate to coincide with her labor. Being flat on her back is a pain-inducing position to a woman about to push her baby out, so it is a double-whammy!

Beta-Endorphin Changes During Pregnancy and Labor:

Non-pregnant: 58
First trimester: 58
Second trimester: 33 +/- 1.9
Third trimester: 49 +/- 2.7
Early labor (cx < 4 cm.): 202 +/- 32
Advanced labor (cx > 4 cm.): 389 +/- 78
Postpartum: 177 +/- 22
Awaiting cesarean birth (not in labor): 151 +/- 23

This, to me, is proof that our body knows what to do. "Pain tolerance" is a moot point when looking at these numbers.

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Is Labor About How Tough You Are, Part 2

Sarah, a former student, brought up an excellent point which she posted as a comment under the "Is Labor About How 'Tough' You Are?" post. I want to share her comments before I comment:

"I'm glad you addressed this issue, Donna. Funny. It seems many women get told they must be "tough" to have handled NCB. I can't remember *one* time I've been told that. But most people who don't know me well don't know that I do NCB, either. I don't exactly advertise it! (Perhaps that makes a difference?)

Most of the time, if it does get brought up, women will think I must have had really easy labors. (Especially because I'm so positive about it--I'd love to do it again!) Some will even reply that *their* labors were **hard,** so *they* **couldn't** go natural; essentially cheapening all the hard work that went into my "easy" births.
I've said it before, but these responses remind me of a Napoleon Dynamite favorite quote of mine: "Lucky." Like I just *happen* to have NCB! It's annoying and a little demoralizing. I know I'm not alone in this, because I've had this conversation with my sister. But it seems like it's common with your commenters that people assume they're tough.

Like you say, it isn't about being tough. And, like you say, it isn't about labor being easy, either. I feel like all the education and preparation I did is completely overlooked when people assume that it was easy. (I think this may be why I don't advertise that I "do" NCB to general acquaintances.) It feels like a slap in my face, whatever it is they assume about me. And, no, it never has been that I must be "tough." I almost wish it were! At least that would be a compliment, right? The "easy" assumption is by far the usual response I get. Am I alone among your readers? Please address this issue, if you have anything to say about it! Thank you!"

My friend, Janet, after having a 3-hour labor with her second baby, routinely heard other women say to her, "Well, if I had a 3-hour labor, I could do it without an epidural too!" This totally undermines the work of that mother. Sarah has heard me say a number of times that a longer labor is "easier" than a shorter one. Your body builds up to the longer and harder contractions. Fast labors are usually one contraction on top of another, while the cervix dilates very fast.

I rarely have students go through my class who just decide that labor is too hard, give up, and have an epidural. But a few years ago, I had this woman go through my class who had an epidural when she was dilated to 4 cm. I was so surprised, and disappointed. I'll never forget what she said to me: she said that she thought her labor must have been harder than most women's labors. Aaarrhh!

Deep down, I believe that women know what is the right thing to do -- for themselves and their baby -- but they CHOOSE to ignore that intuition or instinct, and make excuses (my labor was too long, too short, too painful; I have a low pain tolerance, etc.) so they do not have to take responsibility for their actions.

I also liked your commentary, Sarah, on the fact that people believe that if you actually ENJOYED labor, it must have been easy. Part of why I enjoyed my labors was because it was HARD, and I did it! You cannot beat that feeling of accomplishment.

Comments such as these are meant to lessen what you have done. When my friend, Alisa, the one I wished would fail at NCB, had her baby without drugs, I easily could have made up reasons as to why she was able to do it and I wasn't. My reaction was different though, for some reason. I thought, "If Alisa could do it, I could do it!" I wish those of us who choose NCB could inspire that sort of confidence instead of these ridiculous comments that people make.

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Is Labor About How "Tough" You Are?

Just a quick observation: I have several friends and acquaintances that are avid runners and train for marathons and triathlons. I cannot emphasize enough how awful and painful this sounds to me. I was a two-pack a day smoker for more than 10 years -- smoke-free for 15 years now -- so I never developed a love of exercise, unfortunately.

I routinely have people comment on how high my pain tolerance must be, or how "strong" I must be to give birth without medication. I have to just laugh! This is coming from people who run for three hours straight! I would rather give birth several times over than run to the end of my street!

This is the misconception about labor and birth -- that it is about the pain -- how much you can take. It is about education, as I have said over and over. I truly believe that with conviction, education, and a supportive birth team, ALL women can give birth without medication.

I am pretty sure, however, that I could not run a marathon! Labor "pain" serves a purpose and when a woman understands that, she does not fight it, but works with her body to help her baby out. Labor is hard. I never try to fool women into thinking birth is painless, but it is the most joyful experience in a couple's life.

Anything that is difficult in life ultimately challenges our will and our mind, and often our bodies. I guess I am simply pointing out that women do hard things all the time -- don't miss this opportunity to truly bring your baby into this world with your own awesome power! You CAN do it!

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