Doing the Next Best Thing

When someone asks if Birthing From Within is natural childbirth preparation, I have a hard time answering that. Certainly most of my students plan to attempt a medication free birth experience. But BFW is birthing in awareness. If you are making an informed decision, and are choosing your next approach based on what is the next best thing to do in our situation, then you are making a decision in awareness and thus birthing in awareness.

Each birth is different and you have not idea what may be truly needed in that particular birth. That is why birth planning is difficult if not impossible. Certainly you can fantasize about your birth and make your wishes known, but to truly plan it is not conceivable having no idea how it may unfold.

In a birthing in awareness childbirth class you will learn to develop a pain coping mindset. You will learn at least 20 things that will help with pain coping. For instance think in terms of a few you already know that work when you have pain now. In class you will learn how to decide what things to choose and when the timing may be more beneficial. But here is a list of 20 things to try in labor :

1. Bath or shower
2. Walking or movement
3. Birth ball
4. Encouragement
5. Co-chanting
6. Rice Sock for heat therapy
7. Ice hands for cold therapy
8. Aromatherapy
9. Non focused Awareness
10. Breath Awareness
11. Coyote Howling or vocalizations
12. Quaker listening
13. Massage
14. Edges, Centering, Spiraling
15. Candle Gazing
16. Bellydancing
17. Reflexology
18. Doula support
19. Narcotics
20. Epidural

Fear & Fatigue

the Two Big Factors in Labor and Birth

As a labor doula there are two factors that I think make the most difference in labors. The first one is fear. Pam England says that the work of pregnancy is worry. We need to get all our fears out on the table and address them one by one. That way when labor begins, we have gotten the fear factor out of the way and we can labor. When a woman is holding onto some hidden fears she does not allow her body to unfold and birth. This truly inhibits the mind-body connection that is so essential for birth to flow more easily.

Some of the greatest fears are not unique to most women. There is a fear of loosing control. The concern about pooping when they are pushing out their baby. There is concern that their behavior will be such that they will be embarrassed by it later. There is the issue of trust for their provider and the location where they will birth. Will their partner be supportive enough? Will this experience enhance their relationship or hurt it? Will their body "fail" them- not opening properly or not being able to withstand the pain? Will they have to fight for what they want? Will they allow something to happen that they will later regret? These are just a few of the concerns most women share with me. The answers or solutions are as varied and individual as the concerns. I do know that these concerns need to be addressed long before labor begins so that these same concerns won't inhibit the natural process of labor.

You mind has a lot of control over your body. Sometimes we don't even know some fears are lying just under the surface of our conscious mind. Some people find the use of journaling to help then get in touch with what they are feeling. Some use birth art to help them discover what is going on inside their heart. When you feel something don't squish it down, open it up and let it out. It is essential for you to have your mind and heart open to your birth experience. You can't plan it but you need to allow it to happen without fear being a controlling factor.

I think one way of addressing fears is to begin to talk about them. You need to talk about them to your partner. You need to talk to your provider about them. If you feel like you are having to defend or fight now with your provider on some issues, then you may want to consider if this is a relationship that needs to change now. If you don't feel comfortable addressing your concerns with the person who will be your care provider in labor before your labor begins, perhaps you need to consider if you will be able to once labor makes you feel even more vunerable.

The other factor that I see play a huge role in the way labor happens is fatigue.It is essential in the last weeks before birth that you stay active and fit. But it is also essential that you rest when you are tired. Going to bed earlier than normal after a soothing bath is a good ritural to begin. If you are having problems sleeping talk to your care provider about some homeopathic or natural remedies that they can suggest. A warm bath with lavendar scents and a soothing massage will do the trick for many moms. But creating the ability to at least rest even if sleep is hard, is important.

When labor begins, if it is late in the evening, try to rest. Stay in bed if you can. Cuddle on the sofa in front of a good chick flick. Don't feel the need to go out for a power walk if you are tired. If it begins after you have had a good nights sleep, then go about your day, but don't over do it. Women who have lost a lot of sleep or try to work themselves into a good labor pattern find that they usually don't have the stamina for a long labor. Labor can be exhausting. Save your energy. Stay upright and active but only if you have rested. Listen to your body. If it says lie down and rest, then do it!

My suggestion to women in early labor is to rest and keep themselves well hydrated. Go about doing what you would naturally do at that hour. If it is 2 am- then crawl back in bed. You won't have a baby while you are sleeping. If it is 2 pm, go about doing what you need to do- but don't over do and rest when you need to. I believe if you listen to your heart and body and address your fears and take care to not over do in prelabor and early labor, two factors that can cause labor to not flow smoothly will be taken out of the equation!

Bishop Scores... and warning about Cytotec

The Bishop Score is a method to help determine how favorable your body is for an induction. The less favorable, the more likely your induction will fail and thus lead to a cesarean birth. The more favorable your score is the more likely your induction will lead to a vaginal outcome. There are several reasons to induce. This is a question for you and your care provider. But determining how favorable you are is something you should know so you can make an informed decision regarding the likely outcome.

Points you earn / 0 / 1 / 2 / 3 /

Dilation (cm) / 0 / 1-2 / 3-4 / 5-6 /

Effacement (%) / 0-30 / 40-50 / 60-70 / 80 /

Station / -3 / -2 / -1/0 / +1/+2 /

Cervix / firm / medium / soft / /

Cervix Position /posterior/ meidan / anterior/ /

Ask the care provider these questions: How far dilated am i? How effaced? What station is the baby located? How does my cervix feel? Is it soft or firm? Did the provider upon the exam have to reach way back, making it uncomfortable to do the exam? Ask if your cervix is posterior or anterior. Then take that information and give each item a value based on the chart above. The add up your score. This gives you a predictive value for your inductions success.

A predictive value:

0-4 45-50% failure

5-9 10% failure

10-13 1% failure

Understanding your rate of success for induction is just gathering information in order for you to make an informed decision.

Doctors can improve your bishop score chemically. They can insert Cervidil into your cervix and it can often bring your dilation to 3 cm and increase your effacement. There are other methods like using a bulb syringe from a catheter to stretch the cervix to prepare you for an induction. There is another method that is considered quite controversial- misoprostil of Cytotec. I do not feel a women should consider this method until she read what the manufacturers say about its use for induction, "

Misoprostol , given as a 1/4 of a small tablet placed in the vagina.
Misoprostol is an ulcer drug that is contra-indicated in pregnant women, not approved for induction of labor, associated with increased uterine rupture and maternal/fetal/neonatal death.

Known complications include:

Uterine hyperstimulation / tetonic contractions -- less than 2 1/2 minutes between contractions or lasting longer than 75 seconds, can occur up to 12 hours later;

fetal distress or amniotic embolism due to prolonged hyperstim;

uterine rupture, hemorrhage, emergency hysterectomy, maternal or fetal death/disability,

neonatal brain damage at birth, admission to NICU, cerebral palsy.

And another authortiy on birth, Marsden Wagner writes, "

The June 1999 issue of the American Journal of Obstetrics and Gynecology published the article "Uterine rupture associated with the use of misoprostol in the gravid patient with a previous cesarean section." The data in this article are truly frightening. "Uterine rupture occurred in 5 of 89 patients with previous cesarean delivery who had labor induced with misoprostol. The uterine rupture rate for patients attempting vaginal birth after cesarean was significantly higher in those who received misoprostol, 5.6 percent, than in those who did not, 0.2 percent or 1 in 423, p=0.0001)." Furthermore, a medical records review turned up several more cases of uterine rupture associated with using Cytotec with VBAC not included in their calculations.

Be clear on what this says. Over five percent of women given Cytotec for VBAC had a ruptured uterus, a 28-fold increase over those who did not have Cytotec induction for VBAC. This is a truly shocking rate of uterine rupture. And one of the five women with uterine rupture ended up with a dead baby as a result of the rupture. Just in case you think this paper reports an aberration, the same issue of this journal has a second paper in which three of eighty-one women receiving Cytotec for a VBAC had uterine rupture--a still shocking rate of 3.7 percent. And one of the three babies died in the NICU after the rupture. Both these papers were retrospective which means that none of the women given Cytotec were part of a research project. Thus, none had received the protection of research subjects, including information on the experimental nature of the drug given to them.

So in these two papers, of 170 women given Cytotec for induction with VBAC, eight have lost their uterus and two lost a baby as well. It is my educated guess that to this day none of them has been told that they were given a drug for a purpose not approved by the FDA nor has been told their case is described in published papers saying this drug should not be used in this way. These women and babies paid a very big price because their practitioners were willing to use a very powerful drug before it has been approved by the FDA for this purpose and before it was adequately evaluated by prospective, controlled research.

Marsden Wagner MD, MSPH

Do I Need a Doula if I Plan to get an Epidural?

Sometimes women think if they are considering an epidural they don't need a doula.

As doulas it is not about us and what type of birth we want. Or what kind of birth we had personally. We are there to support women and help them to make informed decisions that are right for them as individuals. But, I tell moms if they would be sorely disappointed if they don't get an epidural then I am probably not a good doula choice for them. The reason I say that is that many women who have considered an epidural an option, find that they don't need one once I am there offering many other options in pain relief. It is not the doula's roll to insure you get your epidural if you are not asking for pain relief and are coping well with the contractions. Many moms are wonderfully surprised when they find that they can manage without an epidural after all. Much of the pain experienced in childbirth is related to fear. The doulas support and presence can enable a mom to let go of her fears and enter a safe haven to birth.

If you have a doula, does that insure that your labor will be one that an epidural won't be used?

Definately not, although the statistics state that it decreases the request for epidurals by 60%. But there may a time and a place for an epidural in some births. Are they overused today? Yes. Are there negative aspects to an epidural that you need to know about before deciding on using one? Yes. But if your labor is excessively long and fatigue sets in, or if you have a labor where you are failing to progress, sometimes it can be useful. If you have a non-natural labor, where you have to be induced, many times epidurals become neccessary. If you have to have a cesarean birth, you most likely would prefer an epidual over general anesthesia. For some women who have experienced abuse in their background, epidurals can ease the pain of labor. A doula is there to support the informed decisions you make.

What can a doula do once you have an epidural?

A doula may have arrived earlier in your home or met you at the hospital in earlier labor. She could have offered pain coping techniques that helped you get to the active stage of labor. This is the best time to wait to get the epidural if that is your plan. She can offer support in your decision. Many times women are disappointed if they had not planned on getting an epidural and end up making the next best thing decision and decide to have one. And yet by having a doula there you have knowledge that you have exhausted other alternatives before choosing to have one. There is the ability to delay the epidural until you are in active labor and therefore limit some of the negative side effects that epidurals can offer. She can assure that you get turned frequently so that malposition of the baby is limited. She can offer some massage techniques to help keep your contractions regular and not slow down after getting an epidural and therefore limit the need for pitocin. She is there to offer information and companionship during what can be a scary time. She can help when it comes time to push by offering some techniques for helping the mom to push more effectively. She is still there for photo taking and help with breastfeeding afterwards. And for the moms who have negative reactions to the anesthesia, shaking, nausea, windows of pain that the epidural missed, and itching, she is there to help.

So remember this is your birth experience.

But before making some of your decisions set in stone before the first contraction, know what other options are for pain coping methods, delay the use of an epidural until you are in active labor, and have a companion that is knowledgeable about birth there to act as a birthguide. Learn about labor and what to expect in labor. And understand that there are many unknowns in any labor. Having a doula by your side can decrease the use of forceps and vacuum by 40%, decrease cesarean births by 50%, decrease Pitocin use by 40% and shorten your labor by 25% as well as decrease the requests for an epidural by 60%.

Here is an article by another doula that explains why that is a misconception.

Doulas and Epidurals

By Kelli Way, ICCE, CD(DONA)

Your doula’s role is to assist you during birth. With or without pain medications, you are giving birth, and your doula will be there to comfort and support you.

Giving birth to your baby is much more than a medical procedure. It is an emotional as well as a physical journey, and having a doula with you can help smooth the crucial transition from pregnancy into parenthood. Both parents will benefit from the nurturing care a doula provides.

Epidurals do not usually take all the pain away. You will still be required to use some other forms of comfort measures at times.

Although good to excellent pain relief is obtained in 90% of epidurals, few epidurals take away all the pain. Some hospitals advertise "painless childbirth," but few women experience it that way. There are several reasons why an expectation of "painless childbirth" may be unrealistic. Often you must wait for the anesthesiologist to become available. You may need to wait while you receive 1-2 liters of i.v. fluid. The procedure itself can take up to 30 minutes, and you may not have complete pain relief for another 20 minutes. Once you are close to complete dilation, the epidural may need to wear off, or you may experience breakthrough pain. Rarely, the epidural gives only patchy pain relief, or doesn’t give pain relief at all.

If you experience any of these situations, or if you prefer to avoid using the epidural until you are 5cm to reduce your chances of needing a cesarean, your doula will be invaluable in helping you use breathing and relaxation techniques, suggesting position changes, and using non-medical forms of comfort measures.

Epidurals often (over 70%) come with mild side effects, which are unpleasant although not medically serious, such as itching, nausea, and shaking. Your doula will stay at your side, helping you cope with any side effects you have, and giving you information about your options.

While an epidural relieves most of the physical pain, it does not affect your need for reassurance.

You might expect that with pain relief, all your worries will go away. Interestingly, this does not seem to happen. Women experience the same emotions during labor whether they use epidurals or not. Many times, the medical staff feel that if a woman has pain relief, she doesn’t need the same type of gentle emotional support. Women often feel even more frightened and worried when they sense this emotional withdrawal. Your doula will continue to focus on what you are feeling, and will give you the reassurance and comfort you need.

Help in coping with pain is only one small part of your doula’s role.

Epidurals do not hold your hand, rub your shoulders, explain what is happening or help you make decisions. Epidurals do not get you ice chips or remind you to urinate. Epidurals cannot suggest position changes to help labor progress. Epidurals will never advocate for you or help you get what you need from the hospital staff.

Epidural or doula?

You may want both. If you are considering using an epidural for pain relief, make sure that you choose a doula who will support that decision. Talking about your options and feelings in advance will make your labor much smoother, leaving you free to concentrate on the birth of your baby.

Benefit of labor- even for planned cesareans

Babies born by cesarean section before labor are more likely to have breathing problems and to need special care in the early days of life,compared to babies born after labor. Sometimes the obstetrician thinks the baby is older than he or she actually is, perhaps even ignoring the mother's opinion of when she conceived. Other cases seem to reflect the normal human variation which leads some babies to mature sooner than others, just as they roll over, sit and walk at different times. None of the tests are 100% accurate in dating a pregnancy or in assuring fetal maturity. However, even when the baby is definitely mature, a certain number of born before labor suffer from lung disease, particularly complications from excess fluid in the lungs.

A recent article in Scientific American documents why labor benefits,including their lung functioning. ("The 'Stress' of Being Born," Hugo Lagercrantz and Theodore A. Slotkin, Scientific American, April 1986, pp.100-107). Hormones called catecholamines are released in the baby in response to the stress of experiencing contractions, being pushed through the birth canal, and the intermittent oxygen deprivation which occurs in normal labor. Twenty years of research indicates that these hormones not only protect the baby from a lack of oxygen, but also prepare him or her to adapt to life outside the womb.

Adults also produce catecholamines in response to physical or emotional stress. The heart rate increases, while blood is redirected away from many organs and sent to the heart, brain, arms, and legs, all needed for the so-called "flight or flight" response. This is the reason for a mother's fear and anxiety can lead to prolonged labor and fetal distress. (See C/SEC Newsletter, Vol.12(2), 1986). With the immature nervous system of the fetus, however, catecholamines work somewhat differently. Blood is kept in the brain and heart rather than the limbs, and the heart rate shows rather than rises. This allows the brain to survive without damage at much lower oxygen levels, similar to the way people can survive for hours in very cold temperatures under ice or buried in snow. The discovery of this different response to stress in the fetus means two things: 1) Babies are well protected from reduced oxygen in labor; and 2) When the fetal heart rate slows in labor, rather than meaning the baby is in danger, it may mean the baby is being protected from damage. This process explains why over 50% of babies delivered by emergency cesarean after monitor tracings indicate fetal distress are in fact not short of oxygen at birth. The authors recommend that only when fetal scalp blood sampling shows the baby is truly short of oxygen should he or she be delivered quickly.

Catecholamines appear to help the baby adapt to life outside the womb in several ways. First, a surge of catecholamines in labor facilitates breathing by causing fluid to be absorbed from the lungs and surfactant to be released. (Surfactant allows the lungs to remain open once they are expanded with the first breaths.) Lung compliance, the ability of the lung to stretch and fill with air, is partially dependant on lung liquid absorption. In research at the Karolinska Institute in Sweden, lung compliance was correlated with catecholamine levels at birth. Two hours after birth, vaginally delivered babies had significantly better lung compliance compared to cesarean babies. This helps explain why even mature babies born by elective cesarean are more likely to have breathing problems.

A second benefit of catecholamine surge at birth is to speed up the baby's metabolism, so energy stores in the liver and fat cells are made available until the baby begins to nurse. Cesarean stored fuel, and were more likely to have low blood-sugar levels. The burning of stored fuel also helps the newborn maintain body temperature.

A third effect of catecholamines is to alter blood flow so more blood is sent to the vital organs. Blood flow in vaginally delivered babies was lower in the legs and higher through the lungs during the first two hours of life. This effect is particularly important for babies experiencing breathing difficulties right after birth. In general, the higher the catecholamine surge, the better the baby can withstand oxygen deprivation. Babies who were moderately deprived of oxygen during birth had good Apgar scores if they had high catecholamine levels and lower Apgar scores if they had low catecholamine levels.

Another effect of high catecholamine concentrations is to produce a state of alert arousal. It is possible that the catecholamine surge leads to the extended quite alert state which usually occurs in a healthy baby in the first hour of life, and which may contribute to the beginning of parent-infant bonding right after birth.

The Karolinjska Institute studies also found that babies born by elective cesarean without labor had markedly lower catecholamine levels compared to those born vaginally, while those born by cesarean after labor had begun had only slightly lower levels. The message seems clear: A mother who wants a VBAC is not putting her own experience ahead of her baby's well-being. Babies benefit from a vaginal birth whenever possible. When it is not possible, they benefit from experiencing labor before a cesarean birth. The authors conclude, "Taken together, the weight of the evidence indicates that the elevation of 'stress' hormones in the normally delivered newborn reflects not only a response to acute stress but also an attempt by the body to enhance the chances for survival at birth. Such findings suggest that infants delivered by elective cesarean section before the mother begins labor may be at some disadvantage."

How Labor Benefits Babies:
Adaptational Effects of a Catecholamine Surge

Improves Breathing
Increases lung surfactant
Increases lung-liquid absorption
Improves lung compliance
Dilates bronchioles

Protects Heart and Brain
Increases blood flow to vital organs

Mobilizes Fuel
Breaks down normal fat into fatty acids
Breaks down glycogen (in liver) to glucose
Stimulates new production of glucose by liver
Activates heart-producing brown fat in response to cold

Facilitates Bonding
Dilates pupils
Appears to increase alertness

(From "The 'Stress' of Being Born," by H. Lagercrantz and T.A. Slotkin, Scientific American, Apr.'86, p.106.)

The Value of Labor Support

Having a doula be with a mom in labor has many values. The initial value, if you are able to do so prior to the labor, begins during pregnancy with a relationship building that will encourage the mom's ability to relax with the doulas help based on a relationship of trust that has been built and established during this time .During this time, the doula can point the mother in the direction for obtaining more information in order to better educate herself as to what her options will be for this upcoming birth. I am available via the phone to answer questions that arise during the pregnancy. In labor the doula can act as an advocate for the couple. She can also be the clear mind that will help the couple achieve the birth that has been planned for, if at all possible. The woman will need mothering during labor and birth, a doula can act as this mother without the emotional entanglements that sometimes occur when it is actually your own mother. After the birth, a doula can assist in helping the bonding time to go smoothly and offer assistance with breastfeeding, if it is needed.

Women don't need to be "delivered" if they are allowed to give birth. Birth needs to be reconsidered as a natural process- not a medical procedure. A doula can support a woman in this, in a natural non- intervening way. She can support her ability to give birth, and thus helping to empower a woman in the process. Many times this medical interventions are the way that the medical community copes with attempting to meet this mom's needs. And many times she falls prey to interventions that will increase her chances of the unnecessary need for drugs and possibly a cesarean section. All she may need is comfort and reassurance.

Doulas act as the support a woman needs emotionally, assisting in carrying out the birth plan that the parents have selected to provide them with the "right" birth for them. She does not replace the role of the father, but enhances it. Many times a couple does not know all of their options. I initially meet with the mother or couple to offer assistance in determining the birth plan that best fits her needs and desires. A doula can point this couple in the right direction to gain this much needed additional information if they so desire. I try to educate and encourage everyone to take the responsibility for exploring their options for their birth experience, choosing the one that is right for them.

As a doula, I stay by a woman's side throughout labor, providing the emotional support, physical measures and an objective viewpoint to help her make the decisions that will enable her to have the birth experience she desires. Many times she can get caught up in the moment and not have the ability to make rational decisions. Having a doula can help to keep her grounded emotionally and a doula can be the stability to assure her the birth experience will go as she has planned, unless medical emergencies arise.

The role of a doula is multifaceted. I will attend a prenatal visit to meet the doctor or midwife you have selected. Sometimes a doula can assist the mom in planning out the questions to ask her provider. Many women feel intimidated by the medical community. A doula can be there to offer moral support. She can help give emotional support and aid in building the confidence the woman has in asking difficult questions to her provider. I can become a liaison between the medical staff and help with communication between mom and her partner. Although we do not speak for the mom, we can help her formulate the questions to find her answers needed before making a decision. A doula does not offer medical advice, but can help with the questions a couple may need to ask before complying with advice they may not understand facilitating a decision based on knowledge.

I stay with the laboring mother throughout labor offering comfort measures- encouragement, massage, relaxation techniques, making suggestions along the way to aid in helping the mother stay comfortable. Having a third party there- not he emotionally connected family member, but someone with knowledge of laboring techniques, can speed labor along and help the mom to stay more comfortable. Many times, a husband just needs some guidance in order to best meet his wife's needs during this time. A doula can provide that guidance and reassurance.

Certainly the results are in for the way that a doula can decrease the chance of a cesarean, decrease the length of labor, reduce the needs for pain medication, and facilitate a normal, natural, non-intervening birth experience. There is no other job as rewarding. I find being a doula both exhilarating and fascinating. It is hard work but the rewards outweigh the work every time! A doula is certainly an extra pair of hands and another heart, helping each birth be a labor of love!

I have been a doula for almost 17 years (first birth 5/6/92) and 380 babies ago. There is nothing like seeing a woman become empowered through the birthing experience.

I consider myself a birthguide--only there if she ventures from the path and needs help returning to it. I give her my heart, my ears to listen to her fears, my hands to touch, and my eyes to help her refocus.

I don't mind the long hours, the sleepless days and nights. The gift of the birth is what makes it so wonderful! Most of my clients stay in touch forever! I am beginning to really do a lot of repeat clients now--it's such a compliment to be invited back again!

I waited till my kids were all grown to become involved in this and that has been a blessing too--I am not splitting my attention. This is wonderfully rewarding work!

What influenced the way you have raised your children the most?

This is an article I wrote in 1997

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When I give thought to this question, beyond the religious influences that have had a great deal of impact on my family, I believe it is the influence that La Leche League had on me. I became pregnant at the age of 19, just after I was married. The pregnancy was something that did not figure into my plans- a newlywed entering a sophomore year of college. After all, due to severe endometriosis, I was told children would probably not be a part of my future. But all of a sudden, I found my plans turned upside down. At one of my office visits to the OB, it was strongly suggested that I consider Breastfeeding. My family history included both my mother and maternal aunt having had breast cancer, so my doctor felt it favorable for me to breastfeed since evidence was showing the decrease of breast cancer having done so. So, since I had no friends who were pregnant and no background that would support me in this adventure, I sought out the local LLLeague group that was advertised in the brochures at his office.

I started attending meetings finding this whole attitude toward Breastfeeding very a la natural and therefore a little intriguing. But the idea of nursing past 6 months was something that I found distasteful. But as time wore on and the pregnancy came to a conclusion, I found myself excited about the aspect of doing something so intimate yet so earthy. I was not really excited about the aspect of being pregnant or having a baby as much as doing something new and different. Once Julie was born, I found myself quite adept at this new venture.

I had changed pediatricians when the previous one had not been supportive during a bout with a stomach disorder. I don't think I could've done this without the support of my LLL leader. The women in my league group became my friends and support peer group. The older moms were helpful in teaching me to listen to my instincts and inner voice.

The library was filled with information on child rearing and such novel concepts as the family bed. I would chatter away with women who had the same common interests and who were empowered by their instincts, having listened to their inner voices. I found this whole process of turning into a woman and a mother almost instantaneously exciting! I found inner strengths that I never knew I had. I found myself exploring options that I did not know I would've even considered. Not only did I nurse past 6 months, but I planned to nurse at least one year!

At the one year mark, my LLL leader asked me to consider becoming a leader too. I nursed Julie into the third month of my pregnancy with my son. She weaned at 22 months with little encouragement due to my sore nipples. When John was born, I planned to let him nurse till he weaned on his own. He was born with some birth anomalies that caused him to have numerous surgeries. There were battles with the anesthesiologist when NPO was required- encouraging him to understand that breast milk was digested more quickly than formula but after 20 months- and two surgeries, I gave birth to my third child, Jami.

John had been interested in nursing through out the pregnancy and continued to tandem nurse with his sister for a year and a half longer. Jami nursed till she was 3 ½ years old.

When I look back on the experiences I had through these years, I am sure without the support of the friends I had made in those early years, and continued to build, I would not have had the confidence to try new things. I would not have gone against the system of our society that encouraged bottle feeding and schedules. I would not have ever welcomed our children into our bed. And I certainly would not have ever nursed a toddler much less two non twins at the same time!

The library of books available to me within LLL, The women who would listen to my concerns and share theirs, but mostly the friendships shared influenced the way I continued to mother my children throughout their lives thus far.

My oldest daughter will be 21 soon, a senior in college and in love herself these days. My son entered his freshman year in college this year, John is 18. And Jami is my baby. The one who would empty one breast and twirl around in my lap and say"empty, oder side". She is almost 17 and is in her next to last year of high school. No, they are all weaned. They are normal, well adjusted kids. They don't sleep with us anymore. They can spend time away without negative repercussions!

Julie has traveled to Africa, to Soweto, to work in orphanages for AIDS babies. John had worked with children coming from main land China into Hong Kong and inner city kids in Philadelphia. And Jami plans to have a home birth for her future children and wants to teach special needs children, she works as a teachers aid now as part of her curriculum in high school.

Do I feel blessed. Indeed. But I do think I owe a great deal of appreciation to LLL for the way they influenced a young 19 year old girl who began her journey as a new mom.

(In the last ten years a lot has changed... Jami did have her home birth almost six years ago and nursed her son well into toddlerhood. Julie has also given birth to two (almost six and fours years old) and soon to her third child. She also allowed her children to gradually wean into their toddler years. Our son is an architect in St Louis and was married a year ago- no children yet!)

Only a nursling for a short while

I am amazed at the pressure women still feel today regarding nursing an older child. Twenty years ago it was a very hush hush thing, but somehow I thought with more time passing, it would become something that was considered more the norm. I wish people would view the breast as a natural element of comforting a child, as do many other cultures, rather than a sex object.

I guess everyone may have the fears running through their heads when they nurse a toddler. Will they go off to school still nursing?, will they ever wean?, will I make my child overly dependent on me?, will my child be normal- what we really mean is like every other child? I am not sure we come up with these questions on our own, or if these are the questions others place into our minds.

There is something very special about nursing an older child. when an infant nurses, they look very angelic. Nestled in to the breast and dozing on and off. But when there is a toddler sitting in your lap, holding a cookie with one hand and wanting to nurse with that mouth full of cookie, there is some unpleasantness. But with time and tenderness, these can be worked around with a few rules.

There is nothing so special as to have a child crawl into your lap and ask you if they could please nurse. And then at the completion of one breast let you know it is empty and they would like the other. There is nothing so satisfying as for that sweet child to then let you know how warm and good it tastes, how special they feel and how much they love your milk.

I wish that others could experience this without the haughty comments from others who have no clue what this relationship is like. Don't let others opinions rob you of the joy that having an older nursling can bring.

Remember what your grandmother told you, they only stay little for a little time! My children are all weaned now and only one is left at home for a short while longer. Hopefully I will have nursing grandchildren to cuddle in a few years. But I hope that my children will remember to let a little one be little for that short while. And also that the nursling will be off in running quicker than they think.

Sleeping Alone

The reason why we tucked a little baby into the bed with us... the motives were purely selfish. I was 20 years old and mothering was a completely new horizon for me. I had not babysat very much and I was the baby in my family. experience was certainly lacking! This new baby in the house was mixed up and slept all day and was wakeful at night. Now I know how this happens when you first bring them home, but his was happening into the 5th month. I was able to rest some during the day, as I was told to do. but in the morning when I would get up I was irritable and resentful for not having slept much the night before.

Benefits, rewards and challenges of experiencing the physical process of birth

Here are excerpts from the speech that Teresa gave at the La Leche League Annual Conference 2001 in Atlanta, GA

Labor of Love

A loving look at the benefits, rewards and challenges of experiencing the physical process of birth.

"The view of labour pain as an affliction seems most prevalent among western women. In many cultures pain in labor is accepted as necessary. Perhaps the fact that these women are usually cared for by other women, who understand birth and it’s mysterious benefits for the female psyche, is the central reason why pain is not feared but accepted.”- A. Robertson

“Pain in labor is seen as a blight, an unnecessary imposition, an affliction we must bear as the price for bearing children. This view bolstered by the perception that pain is a symptom of disease and illness has enabled men to convince us that pain is indispensable during birth and is of no value, an evil to be cured with modern treatments and technology.” –A. Robertson

“ Many western women have never been physically tested until we go through labor and birth …haven’t gone 18 or 24 hours without food or sleep…allowed ourselves to go a day or 2 without a bath or shower, without brushing our teeth and doing our hair and makeup. Even fewer of us would allow anyone else to see, smell or touch us, unwashed, sweat-soaked, naked, oozing mucus, blood, and feces from our nether regions. When faced with the forces of labor, we can’t hide the fear, the anxiety, the responses to pain…All the inhibitions and trappings of our social selves are peeled away as our bodies thrust and heave, vomit and grunt, cry and leak. The animal is there for everyone to see”- S. Diamond

Pain Coping Mindset

• No pain, no gain- why does this work in other areas of our life but not here, or does it?
• Preparation mentally, emotionally and physically is needed
• Surrounding yourself with examples- where do I find them today?
• Warriors stand up and fight- back up plans- doing the next best thing thinking
• Benefits to painTriggers the knowledge that labor has begun- time to find a safe place to retire while the process unfolds
• Feedback as to the stage of labor
• Alert mechanism for problems and special needs
• Releases endorphins
• Guides the mom in positions to choose
• Guides the feedback loops that tell nerves to transmit to other parts of the body

Endorphins

• Releases natural pain killers
• Creates a sense of well being and promotes positive feelings
• Link to mother baby attachment- increasing bonding ability
• Self esteem and confidence enhances with feelings of achievement and satisfaction
• Amnesic effect

Adrenalin

• Signals fight or flight mechanism
• Subconscious fears can trigger
• Raises blood pressure
• Causes a sense of panic
• Slows contractions
• Decreases oxytocin
• Increases pain
• Counteracts dilation of muscles

Why Natural or Unmedicated?

• Empowerment- labor is hard work, it hurts and you can do it – a willingness to try- I can do anything attitude
• Passing on a legacy to our daughters
• A rite of passage learned no other way

Rites of Passage

• Puberty
• Making Love
• Birthing
• Breastfeeding
• Menopause

Pros to Natural birth

• Less interventions mean less complications
• No catheter- less UTIs
• Let’s keep moving- a baby in a bad position- let’s move the mom
• No drug reactions
• No out of body experiences- birthing in awareness
• Recovery- ready to enjoy the new family

While pregnant we are told to avoid drug use and then in labor we are eagerly offered them. Many women will find that labor pain is bearable if it means better health for the baby. The desire to avoid drugs may necessitate women once again accepting that pain may be a necessary component to birth.

Advantages to Baby

• Alert and ready to nurse
• No drug reactions
• Less chance to have to go to NICU
• No sepsis workup for epidural fevers
• Less drugs mean less complications
• No delay in the labor/birth process
• Mom and baby alert together- bonding

Disadvantages of Natural

• An exception to the rule- what! - No drugs- why?
• It hurts and it is hard work- is there value to the pain?
• Do you have support?- Why do I feel so alone?
• My support can’t stand to see me in pain

What do you need to birth?

• To feel nurtured and protected
• To feel safe and have a safe place to birth

“The right place to give birth would be the right place to make love.” –Michel Odent

So How Do You Prepare?

• Books- how many and which ones?
• Birth plans- a help or a hindrance?
• A living birth plan
• Protecting your minds
• Learning to listen to your instinctive voice
• Childbirth classes- which ones?
• Pain coping techniques that work

Birthing Instinctively

• Trust your body
• Forget learned patterned breathing
• Follow instinctive behavior
• Get good labor support
• Avoid induction or augmentation

"Women are tricked into believing that a managed, predictable labour is not only desirable, but safer for themselves and their babies.” “Have we placed our faith in medical men when we should have had more faith in ourselves and found female companionship for labour and birth?” –A. Robertson

Protecting Your Birth Space

• Preparing the space- what makes me feel safe?
• Addressing the fears ahead of time
• Environmental controls, privacy
• Reduction of people, things and procedures
• No negative languages, behaviors or people with anxiety
• Avoid conversation- keep a woman in laborland

Virtually all women have the potential to give birth easily and safely and no special knowledge or learning is required.” –A. Robertson

Doulas

“Part of the increase (in using doulas) stems from the fact that the consumer is taking back birth into their own hands and wants to be a part of the decision process. Also, it is a natural instinct to gather the right kind of support around you.”-Ridd-Young

Doulas- Why do I need one?

Who can be my doula? Mothering the mother

Four women often unaccompanied by knowledgeable support people, and made vulnerable by their emotional and hormonal state are ripe for seductive messages conveyed by “experts? That labour pain has not benefit.”– A. Robertson

Doula Studies

Promises promises- what can she really do?

• 25% shorter labors
• 60% reduction in epidural requests
• 40% reduction in pitocin use
• 30% reduction in analgesic use
• 40% reduction in forceps use
• 50% reduction in cesarean births

“Your heart and hands are the most important. If someone’s not certified, they’re not necessarily less qualified.”-Guralnick

“Good doulas make fathers feel more involved and more useful at a stressful time.”-Guralnick

Dads- what help are they really?

Men have not experienced the innate birthing instincts since they don’t give birth- this may make them more uncomfortable with woman in labor.

What role do they feel comfortable with?

• The pitfalls of being a labor coach
• How do I help him to prepare?
• Find someone to help support him as well.

Doctors and midwives- are they really different?

Average doctor visit is 6 minutes- midwives on average are twice that.