This is a curious phrase.. Active Labor...
When you ask moms when their labors started it is funny when they think they were in active labor. Some think it is when their water broke although it was not accompanied by contractions. Others think it was when they felt the first contraction- but others would say they had felt contractions for days before they were regular. Some would say it was when they began to have to concentrate and work during their labors.
Recently I had a mom who was contracting regularly and working with many of the contractions- having to concentrate and stay focused. But her cervix was not changing at all. The doctor came in and did an exam and said that active labor was, "when you are contracting regularly and it is making a change to your cervix." This mom was not happy when he said she was not yet in "active labor" as she felt she was working hard already. He in fact suggested she either go home or allow him to get her in active labor by either breaking her water or starting Pitocin.
Recently I had a mom who entered the hospital at the direction of the nurse at her doctors office since she had a list of regular contractions on a piece of paper documenting her labor. She was chatty and her demeanor was light and engaging. She entered the hospital and the nurse even said she was probably going to go home as she did not appear to be in labor. But the doctor came over to check her and found her to be 3-4 centimeters dilated. He said she was in "active labor" and they would be keeping her at the hospital.
Now often times we hear stories of women who walked around 3-4 centimeter or even more for weeks- obviously not in "active labor" but definitely contracting some and making changes in their cervix. But this mom stayed at the hospital and over several hours her contractions came in a gentle but irregular fashion and never made any change to her cervix. They even discussed going home but did not do so. Eventually the doctor broke her water and her labor became active.
Women are confused when they go in and hear differing opinions- do I go home? Am I in active labor? If I am not in active labor, how will I know when I am if this is not it? Is this a dysfunctional labor or is this not really labor at all? Is this prodromal labor or early labor?
I wish I could offer a definitive answer. The truth is no one really knows. Moms have had babies in the car or at home when their labor patterns were so irregular everyone listening to their dialogue of what is happening said- it is too early to come in. And moms have sounded like they were in active labor on the phone with their care providers only to get to the hospital and be told they were 1cm dilated.
Labor and labor patterns remain a mystery. For care providers to say it must be regular and painful to be active labor is proven every now and then to not be so. And for care providers to push a woman into active labor when her body is warming up but not quite ready may not be fair either. In fact so much of a woman's labor pattern has been misunderstood today because so many labors are not allowed to unfold naturally- they are so over managed by intervention that normal, natural labor is being lost.
Here is what others define "active labor" as:
Birthing Naturally says, "Eventually, the contractions that you have been experiencing will become stronger and more intense. You will also find that as time progresses the contractions are getting closer together and lasting longer. When this happens, you will have moved into active labor. You will find that as active labor progresses, you will become more serious or "focused" during your contractions. You may find yourself slowly moving from not talking during the peak of a contraction - to not talking during a contraction - to barely talking even between contractions. You may also find that your movements become slower and more deliberate as you progress through active labor. Eventually you may even be at the point that moving between contractions is uncomfortable and difficult to manage."
Baby Center says, "During active labor, your cervix begins to dilate more rapidly and contractions are longer, stronger, and closer together. People often refer to the last part of active labor as "transition."
Transition to Parenthood says, "What’s happening: Cervix is completely effaced, goes from 4-8 cm dilation. Contractions 3-5 minutes apart, lasting 40-70 seconds. Contractions become more painful. Duration: 30 minutes to 10 hours. The physician’s expectation for progress during this time is 1 cm dilation per hour; if you’re dilating at less than half that rate, a physician may prescribe Pitocin.
However, a recent study indicates that at non-augmented births, the average / normal amount of time between 4 cm and 10 cm is 7½ hours, and that abnormal progress shouldn’t be declared unless it has taken over 19½ hours for first-time moms (that’s less than 1 cm for every three hours). Abnormal progress shouldn’t be declared until 13½ hours for a woman who has given birth before. (Albers) If mom is doing fine, and baby is doing fine, then parents can ask the caregiver whether Pitocin is essential or whether it is possible to let labor proceed at its own pace.
Mom’s Mood. One of the biggest indicators that active labor has begun is a big change in mom’s mood: she becomes much more serious. During a contraction, the contraction takes all of her energy and concentration: she can’t walk and talk during a contraction. She doesn’t like distractions in between contractions; just wants to focus on labor. This can be a good time to go to the hospital."
Women Heath Care Topics shares, "Active labor is characterized by three distinct phases:* Stage One - The cervix dilates and effaces, * Stage Two - The baby is born
* Stage Three - The placenta is delivered.
Giving Birth Naturally offers, "Active labor is when birthing becomes more serious. As you become more serious with each contraction, relaxation and breathing become very important. Tuning out distraction and creating a positive environment will be important. You may feel the desire to have your birth companion present but may not want to be touched or bothered at this point. WHAT & HOW YOU MAY FEEL:
* Contractions that are Closer Together and Require Your Attention
* Need for Physical Support
* Need for Emotional Support
* Less Interest in Eating/Drinking
* Desire for Quiet so You can Focus
BEHAVIOR & ATTITUDE:
* Turning Inward
* More Focused
* Averse to Distractions
* Restlessness
OTHER SIGNS & SYMPTOMS:
* Bloody Show
* Diarrhea
* Rupture of Membranes
* Increased Pressure
* Lightening
* Nausea"
So you can see it can be confusing. It is not the same for every woman. It is not easily defined. I share what someone once told me- "You know she is in active labor by her demeanor. The meaner she gets the more active she is in labor!"
I tell my students three things will happen: The contractions get longer- lasting more than a full minute. The contractions get closer together- not all over the place but a regular pattern that is closer together. If you plan to get medication then 511 is a good time to go- five minutes apart, lasting one minute for at least one hour. If you are looking for a less interventive birth experience, then 411 is a better time to go. But all three things need to be in play USUALLY. If you are talking through contractions, laughing and walking around easily and they are 3 minutes apart, you may not be in active labor. If they are 6 minutes apart but lasting 90 seconds and are kicking your butt, you could be. See? This is confusing at best!
So guess what? You need to be the judge! If you think it is time to call your care provider to come to the house for your home birth, or go to the hospital for your birth- then go. You do not have to stay! The studies show if you go to the hospital and you are 3cm or less and your water is intact, you should go home. Otherwise you are at a 50% increase of having a surgical birth- why? Because you are probably not in active labor and the care provider will push your labor to get you there- by breaking your water or adding Pitocin to the situation to help "move you along." And if your body or baby is not ready- well then you may end up with a cesarean.
If you are wondering, "Is this the real deal?" it probably is not. Most moms will tell you, you will know when it is the real deal.
Friday, March 19, 2010
Monday, March 15, 2010
CIMS posting of Cesarean Guidelines
NEW from CIMS! “The Risks of Cesarean Section” and “A Checklist for Expectant Mothers”
CIMS’ newest fact sheet was released on Feb. 26 at the 2010 CIMS Forum
CIMS proudly announces the availability of a recently updated fact sheet “The Risks of Cesarean Section,” (PDF) which also includes “About the Risks of Cesarean Section: A Checklist for Expectant Mothers to Read During Pregnancy.”
Birth is a normal, natural, process and the vast majority of women can have safe, normal, vaginal births. While there are health conditions where a cesarean birth is necessary for the well-being of the mother or her baby, more and more mothers these days are giving birth by cesarean section for non-medical reasons. CIMS along with 20 endorsing organizations recommend that cesarean surgery be reserved for situations when potential benefits clearly outweigh potential harms. This educational material is provided by CIMS to help healthcare providers and expectant parents learn about the risks of cesarean section.
Take Action:
* Download the new Cesarean Section Fact Sheet & Mother’s Checklist (PDF)
* Purchase CDs of recorded sessions from the 2010 CIMS Forum through our A/V partner Network Communications
* Download slide presentations of select 2010 CIMS Forum sessions
CIMS’ newest fact sheet was released on Feb. 26 at the 2010 CIMS Forum
CIMS proudly announces the availability of a recently updated fact sheet “The Risks of Cesarean Section,” (PDF) which also includes “About the Risks of Cesarean Section: A Checklist for Expectant Mothers to Read During Pregnancy.”
Birth is a normal, natural, process and the vast majority of women can have safe, normal, vaginal births. While there are health conditions where a cesarean birth is necessary for the well-being of the mother or her baby, more and more mothers these days are giving birth by cesarean section for non-medical reasons. CIMS along with 20 endorsing organizations recommend that cesarean surgery be reserved for situations when potential benefits clearly outweigh potential harms. This educational material is provided by CIMS to help healthcare providers and expectant parents learn about the risks of cesarean section.
Take Action:
* Download the new Cesarean Section Fact Sheet & Mother’s Checklist (PDF)
* Purchase CDs of recorded sessions from the 2010 CIMS Forum through our A/V partner Network Communications
* Download slide presentations of select 2010 CIMS Forum sessions
Sunday, March 14, 2010
Atlanta Parent Magazine Editorial
In the March 2010 Atlanta Parent Magazine there was an article entitled "Mom to Mom: The Practical Side of Breastfeeding" by Kimberly Kennedy. I have no idea who she is and what her credentials are as the article does not say. But I was sooooo disappointed in the article. I thought I would share my dislike with you- I have already left the editorial staff a message on their voice mail.
The first paragraph was about how hard can it be. The suggestion is that they need to start by consulting a lactation consultant. And although I like using a lactation consultant if there is a problem- it is not the first course of action that is recommended. The studies actually show that the first thing- the most beneficial thing to preventing nipple trauma is taking a good lactation class prenatally. The writer does suggest consulting La Leche League- but there is no mention of attending a class or going to a LLL meeting prior to having the baby. Both of these things would make a huge difference- you know- prevention is worth a pound of cure!
The writer goes on to say wearing a sexy bra with a nursing pad after pumping first is ideal if you are going to have sex due to having a let down when having sex. I thought - what? Pump before having sex... there goes anything spontaneous- or one more thing to deter someone from having sex. Why not say, "You may have a let down if you are lucky enough to have an orgasm during sex... and I certainly hope you are. So, keep a small towel handy to press against your breasts when this happens." Now isn't that easier than putting the pressure on the mom to wear a sexy bra and pump beforehand? Come on we are talking what breasts were really made for here- nursing!
Then for the new mom who is already a bit neurotic about having enough milk- she puts in this comment, " babies have suffered brain damage, even death, from insufficient milk supply. Fortunately, this is rarely a problem." Rarely a problem- but now you have given that mom one more thing to worry about and perhaps even deter her from breastfeeding. Come on- if it is so rare- and it is- then why not give practicals about counting wet and poopy diapers- and encourage the mom that more nursing brings in more milk- so warn her about not scheduling a baby in the first few weeks!
And then she pops in one more negative piece, "Breast reduction surgery can affect supply." Why not then refer her to Defining Your Own Success, a great book regarding how to assist a mom with this issue. And why not say this is usually only a problem if the nipple was removed and then reattached. Again, yes this happens- but let's help this mom not offer a reason to not try.
Then this part about made me scream, "How long will the baby eat? She says they drink for 5-10 minutes for the first few weeks and then will work up to 10-20 minutes each side when well established. But if the baby drinks for 30-40 minutes there could be a problem." Hello??? This is not true at all. Every baby is different- every baby has different sucking needs. And it is not about drinking milk alone- it is about sucking needs as well. So giving rigid guidelines like this is a recipe for disaster for many moms.
Then the question is posed how often will he eat? And she says at first, "every 3 to 4 hours." She goes on to say that "demand feeding" many moms find "impractical and instead schedule feedings." She goes on to say if the baby is acting hungry after 1 1/2 to 2 hours and isn't sated with a pacifier or other distractions, feed him" And I had to scream out loud for a minute! Who is this article for? For the mom who does not want to breastfeed but does in a very token way to say she tried? Is breastfeeding all about her? I am sorry- I am a baby advocate here. Demand feeding is best- the studies show it is best for a mom's milk supply to be well established and for the baby's needs. Period. Scheduling in the first few months is a recipe for low milk supply, gassy babies who are full of gas due to pacifiers and crying, and nipple trauma from nipple confusion due to the pacifier. And everyone knows that most babies in the first few weeks if not a bit longer- nurse ever 2 to 2 1/2 hours from the start of a nursing to the start of the next nursing.
Then the next section of the article is subtitled; Meeting Your Needs. I thought the first section sounded like that- after all it did not sound like it was in the best interest of the baby at all! She then goes on to say how you have to plan when you are breastfeeding- for appointments and such. Hmmm- why? Because she also discusses later where to nurse- she suggests your car! Well why not explain the law regarding breastfeeding publicly. Why not discuss how you can learn to breastfeed publicly in a way that is comfortable for you. That may be the car. But that may be in the chair in the waiting room at the doctor's office. Why do we need to try to plan our nursing times in such a way to not have to nurse when we are out. The feeling that breastfeeding moms are banished to the bathrooms or cars makes me get out my soap box for sure!
Then she says, "after baby is a few months old and is able to sleep six hours at a time, you may choose to wean him from nighttime feedings." Well what is a few months old? And six hours? Come on! I thought the accepted term "sleeping through the night" was five hours. And the studies again show that usually occurs at 15 pounds and/or 3 months of age. She again suggests offering a pacifier. Augh!
And then the big push to offer a bottle begins. Does she realize that often times a mom can actually have a nursing dyad with her baby without a bottle or pacifier coming into play? She suggests starting too soon may cause nipple confusion- thank you! And then suggests waiting til 6 weeks could cause bottle rejection- "a nightmare for any mom who'd like an occasional break!" She then suggests "offering a bottle within the first month, after breastfeeding is well established. Keep her accustomed to bottles by offering them once every day or two." Well let me say- I wonder how long she was successful nursing her baby. This is the recipe for early weaning- in fact it is weaning a baby from the breasts. There is that not so subtle way of also implying that a mom needs a break from her baby and must bottle feed in order to do so. There are many moms who enjoy their breaks with their babies. And many who can find time to slip away for a few hours to grab dessert with their friends or hubby and not leave a bottle. And most moms are still establishing their milk supplies in the first month!
The pump advise is ludicrous. If you miss a feeding you do not need to necessarily pump to keep yourself from getting a plugged duct. You can massage your breasts and express a bit off while away from your baby- and nurse well when you are back with your baby.
The what do you need section sounds like you need a basket of stuff in two locations in your home... hmmm not true. You may not need any of these things she suggests- they may be helpful. But again to nurse you need a baby and a breast... not much else. It is really quite simple- in fact minimal things are even helpful to be honest- we make it sound like you have to have a bunch of stuff to make this work. I do not believe history or third world countries with nursing moms will agree with you!
The advice regarding what to wear is ludicrous as well. "Loose fitting tunics... bunched up around the breasts..." Hmm how about a camisole and a shirt that buttons down the front- unbuttoned from the bottom. You pull up the camisole or light weight tank and unbutton the shirt from the bottom- thus keeping your breast fairly concealed and nursing easily?
And I already addressed her "where do I nurse in public?" comments. But let me say- wherever YOU are comfortable. I have nursed while walking down the mall- wearing a baby in the sling- so discretely that my husband was not even aware I was doing so! I have nursed on benches, sitting on the floor, in booths at restaurants, on the curb at a street fair, in the stands at a fire works display on the fourth of July, in my car, on the swings at the playground, in church on the pew... you get my drift... but I have never nursed in the bathroom... or in a special nursing area in all my years of nursing three children.
So, Parent magazine... please tell me who this chick who wrote this is- what her background is- what made her an authority on breastfeeding? She certainly is not indicative of the places she refers to for web breastfeeding help. I am glad she at least put those resources in the article. Perhaps folks will forgo her advice and head there to get correct information.
The first paragraph was about how hard can it be. The suggestion is that they need to start by consulting a lactation consultant. And although I like using a lactation consultant if there is a problem- it is not the first course of action that is recommended. The studies actually show that the first thing- the most beneficial thing to preventing nipple trauma is taking a good lactation class prenatally. The writer does suggest consulting La Leche League- but there is no mention of attending a class or going to a LLL meeting prior to having the baby. Both of these things would make a huge difference- you know- prevention is worth a pound of cure!
The writer goes on to say wearing a sexy bra with a nursing pad after pumping first is ideal if you are going to have sex due to having a let down when having sex. I thought - what? Pump before having sex... there goes anything spontaneous- or one more thing to deter someone from having sex. Why not say, "You may have a let down if you are lucky enough to have an orgasm during sex... and I certainly hope you are. So, keep a small towel handy to press against your breasts when this happens." Now isn't that easier than putting the pressure on the mom to wear a sexy bra and pump beforehand? Come on we are talking what breasts were really made for here- nursing!
Then for the new mom who is already a bit neurotic about having enough milk- she puts in this comment, " babies have suffered brain damage, even death, from insufficient milk supply. Fortunately, this is rarely a problem." Rarely a problem- but now you have given that mom one more thing to worry about and perhaps even deter her from breastfeeding. Come on- if it is so rare- and it is- then why not give practicals about counting wet and poopy diapers- and encourage the mom that more nursing brings in more milk- so warn her about not scheduling a baby in the first few weeks!
And then she pops in one more negative piece, "Breast reduction surgery can affect supply." Why not then refer her to Defining Your Own Success, a great book regarding how to assist a mom with this issue. And why not say this is usually only a problem if the nipple was removed and then reattached. Again, yes this happens- but let's help this mom not offer a reason to not try.
Then this part about made me scream, "How long will the baby eat? She says they drink for 5-10 minutes for the first few weeks and then will work up to 10-20 minutes each side when well established. But if the baby drinks for 30-40 minutes there could be a problem." Hello??? This is not true at all. Every baby is different- every baby has different sucking needs. And it is not about drinking milk alone- it is about sucking needs as well. So giving rigid guidelines like this is a recipe for disaster for many moms.
Then the question is posed how often will he eat? And she says at first, "every 3 to 4 hours." She goes on to say that "demand feeding" many moms find "impractical and instead schedule feedings." She goes on to say if the baby is acting hungry after 1 1/2 to 2 hours and isn't sated with a pacifier or other distractions, feed him" And I had to scream out loud for a minute! Who is this article for? For the mom who does not want to breastfeed but does in a very token way to say she tried? Is breastfeeding all about her? I am sorry- I am a baby advocate here. Demand feeding is best- the studies show it is best for a mom's milk supply to be well established and for the baby's needs. Period. Scheduling in the first few months is a recipe for low milk supply, gassy babies who are full of gas due to pacifiers and crying, and nipple trauma from nipple confusion due to the pacifier. And everyone knows that most babies in the first few weeks if not a bit longer- nurse ever 2 to 2 1/2 hours from the start of a nursing to the start of the next nursing.
Then the next section of the article is subtitled; Meeting Your Needs. I thought the first section sounded like that- after all it did not sound like it was in the best interest of the baby at all! She then goes on to say how you have to plan when you are breastfeeding- for appointments and such. Hmmm- why? Because she also discusses later where to nurse- she suggests your car! Well why not explain the law regarding breastfeeding publicly. Why not discuss how you can learn to breastfeed publicly in a way that is comfortable for you. That may be the car. But that may be in the chair in the waiting room at the doctor's office. Why do we need to try to plan our nursing times in such a way to not have to nurse when we are out. The feeling that breastfeeding moms are banished to the bathrooms or cars makes me get out my soap box for sure!
Then she says, "after baby is a few months old and is able to sleep six hours at a time, you may choose to wean him from nighttime feedings." Well what is a few months old? And six hours? Come on! I thought the accepted term "sleeping through the night" was five hours. And the studies again show that usually occurs at 15 pounds and/or 3 months of age. She again suggests offering a pacifier. Augh!
And then the big push to offer a bottle begins. Does she realize that often times a mom can actually have a nursing dyad with her baby without a bottle or pacifier coming into play? She suggests starting too soon may cause nipple confusion- thank you! And then suggests waiting til 6 weeks could cause bottle rejection- "a nightmare for any mom who'd like an occasional break!" She then suggests "offering a bottle within the first month, after breastfeeding is well established. Keep her accustomed to bottles by offering them once every day or two." Well let me say- I wonder how long she was successful nursing her baby. This is the recipe for early weaning- in fact it is weaning a baby from the breasts. There is that not so subtle way of also implying that a mom needs a break from her baby and must bottle feed in order to do so. There are many moms who enjoy their breaks with their babies. And many who can find time to slip away for a few hours to grab dessert with their friends or hubby and not leave a bottle. And most moms are still establishing their milk supplies in the first month!
The pump advise is ludicrous. If you miss a feeding you do not need to necessarily pump to keep yourself from getting a plugged duct. You can massage your breasts and express a bit off while away from your baby- and nurse well when you are back with your baby.
The what do you need section sounds like you need a basket of stuff in two locations in your home... hmmm not true. You may not need any of these things she suggests- they may be helpful. But again to nurse you need a baby and a breast... not much else. It is really quite simple- in fact minimal things are even helpful to be honest- we make it sound like you have to have a bunch of stuff to make this work. I do not believe history or third world countries with nursing moms will agree with you!
The advice regarding what to wear is ludicrous as well. "Loose fitting tunics... bunched up around the breasts..." Hmm how about a camisole and a shirt that buttons down the front- unbuttoned from the bottom. You pull up the camisole or light weight tank and unbutton the shirt from the bottom- thus keeping your breast fairly concealed and nursing easily?
And I already addressed her "where do I nurse in public?" comments. But let me say- wherever YOU are comfortable. I have nursed while walking down the mall- wearing a baby in the sling- so discretely that my husband was not even aware I was doing so! I have nursed on benches, sitting on the floor, in booths at restaurants, on the curb at a street fair, in the stands at a fire works display on the fourth of July, in my car, on the swings at the playground, in church on the pew... you get my drift... but I have never nursed in the bathroom... or in a special nursing area in all my years of nursing three children.
So, Parent magazine... please tell me who this chick who wrote this is- what her background is- what made her an authority on breastfeeding? She certainly is not indicative of the places she refers to for web breastfeeding help. I am glad she at least put those resources in the article. Perhaps folks will forgo her advice and head there to get correct information.
Thursday, February 25, 2010
Tips to Avoid Induction
Tips for Clients
(Ana Hill's CAPPA training topic)
No complaining about normal discomforts to your care provider- complain to your doula or your friends- but the care provider often feels the need to "fix" it for you with an induction.
Adjusting your expectations about your due date- first time moms are usually pregnant for 41 weeks and a few days, and moms who have given birth before usually go 40 weeks and five days... so remember your due date is a guess date based on a 28 day cycle. Only 4% of moms go into labor on their due date.
Correcting suspect due dates with caregiver- do this early if you do not have a 28 day cycle- advocate for yourself if you know how long your cycle is- share it early on so that is taken into consideration.
No horror stories told or listened to... they affect your mind body connection as well as how your care provider sees you. Don't listen to the stories and don't offer up any for him or her to project onto you.
Chiropractor care and prenatal massage is great for helping the baby to be lined up properly. Gail Tully's website www.spinningbabies.com also offers some great guidelines for aligning your baby for optimal fetal positioning. We also offer a great Line Up Your Baby for Labor class.
Sexual activity- those who stayed sexually active tended to not go postdates. The oxytocin and prostaglandins are wonderful ways to get things going.
Prodromal labor is a problem for many moms who have a malpositioned baby- so optimal fetal positioning is important. But often times it is also some issues that are causing fear that will delay labor beginning and sometimes cause labor to become dysfunctional once it does begin.
Some studies are showing perhaps these things can help:
Vitamin D supplementation- 4000 IU daily is recently been linked to more cesareans and malpositioned babies when the Vitamin D is too low... perhaps considered in the way the pelvis is lubed by doing so...
Fish oil- 400 mg DHA daily...matures baby's brain and helps the mom prevent PPD.
Protein 80 to 100 grams a day.
Rest and hydration go together... don't over do in the last week as to go into labor and be exhausted. Some say take your current body weight divided by 2 is the number of ounces you may want to drink of water daily.
Consider your expectations and determine if they are realistic with the birth care you have selected. Perhaps a change of venue and care provider will get you the birth you desire.
Keep in mind induction is not the same as labor. Our bodies being pushed into labor is not the same as our body going into labor on its own. Oxytocin and endorphins work very differently than the drugs used for induction- it does not pass the blood brain barrier. It can be more challenging since it brings on a different labor pattern- contractions much closer a lot sooner- transition lasting longer.
Remember what is controllable and what is not. The method of pain relief may not be as effective. The method of birth may be different. Failed inductions does not mean your body failed. The body's job is to protect the baby from being born too early. So if your body does not think this baby is really ready to be born, your body will try to work against the induction medicine. Some studies show it may increase your cesarean rate by 50% over the normal rate. So understand what happens if it does not work- you may have a cesarean birth.
Find out what your Bishop score is before you go in so you know what your chances are of an induction that may be smoother.
You can consider acupuncture, a competent herbalist, a chiropractor and a massage therapist. There may be some risks to consider when doing herbal or homeopathic or kitchen sink inductions. It is an oxymoron to say "natural induction." (these are my therapists- my acupuncturist, chiropractor and massage therapist.)
The bottom line is know what to expect and be a great advocate for yourself prior to going to the hospital for your induction.
Consider these sites if your induction does not go as you had hoped. Solace for Mothers and ICAN.
(Ana Hill's CAPPA training topic)
No complaining about normal discomforts to your care provider- complain to your doula or your friends- but the care provider often feels the need to "fix" it for you with an induction.
Adjusting your expectations about your due date- first time moms are usually pregnant for 41 weeks and a few days, and moms who have given birth before usually go 40 weeks and five days... so remember your due date is a guess date based on a 28 day cycle. Only 4% of moms go into labor on their due date.
Correcting suspect due dates with caregiver- do this early if you do not have a 28 day cycle- advocate for yourself if you know how long your cycle is- share it early on so that is taken into consideration.
No horror stories told or listened to... they affect your mind body connection as well as how your care provider sees you. Don't listen to the stories and don't offer up any for him or her to project onto you.
Chiropractor care and prenatal massage is great for helping the baby to be lined up properly. Gail Tully's website www.spinningbabies.com also offers some great guidelines for aligning your baby for optimal fetal positioning. We also offer a great Line Up Your Baby for Labor class.
Sexual activity- those who stayed sexually active tended to not go postdates. The oxytocin and prostaglandins are wonderful ways to get things going.
Prodromal labor is a problem for many moms who have a malpositioned baby- so optimal fetal positioning is important. But often times it is also some issues that are causing fear that will delay labor beginning and sometimes cause labor to become dysfunctional once it does begin.
Some studies are showing perhaps these things can help:
Vitamin D supplementation- 4000 IU daily is recently been linked to more cesareans and malpositioned babies when the Vitamin D is too low... perhaps considered in the way the pelvis is lubed by doing so...
Fish oil- 400 mg DHA daily...matures baby's brain and helps the mom prevent PPD.
Protein 80 to 100 grams a day.
Rest and hydration go together... don't over do in the last week as to go into labor and be exhausted. Some say take your current body weight divided by 2 is the number of ounces you may want to drink of water daily.
Consider your expectations and determine if they are realistic with the birth care you have selected. Perhaps a change of venue and care provider will get you the birth you desire.
Keep in mind induction is not the same as labor. Our bodies being pushed into labor is not the same as our body going into labor on its own. Oxytocin and endorphins work very differently than the drugs used for induction- it does not pass the blood brain barrier. It can be more challenging since it brings on a different labor pattern- contractions much closer a lot sooner- transition lasting longer.
Remember what is controllable and what is not. The method of pain relief may not be as effective. The method of birth may be different. Failed inductions does not mean your body failed. The body's job is to protect the baby from being born too early. So if your body does not think this baby is really ready to be born, your body will try to work against the induction medicine. Some studies show it may increase your cesarean rate by 50% over the normal rate. So understand what happens if it does not work- you may have a cesarean birth.
Find out what your Bishop score is before you go in so you know what your chances are of an induction that may be smoother.
You can consider acupuncture, a competent herbalist, a chiropractor and a massage therapist. There may be some risks to consider when doing herbal or homeopathic or kitchen sink inductions. It is an oxymoron to say "natural induction." (these are my therapists- my acupuncturist, chiropractor and massage therapist.)
The bottom line is know what to expect and be a great advocate for yourself prior to going to the hospital for your induction.
Consider these sites if your induction does not go as you had hoped. Solace for Mothers and ICAN.
Infant Massage
Do you enjoy a good massage? I have a massage therapist who I find provides me with a little slice of heaven (www.kmiatlanta.com). And if you have experienced a great massage you must also understand how much a baby who has been so used to being constantly touched by his mother's body while in utero would love to be massaged once out.
2 Wonderful Breastfeeding Videos
The studies show hands down that the best way to avoid nipple trauma is a class BEFORE you have your baby. So, please consider a great class to help you avoid problems. But here are two videos that may assist you if you have any problems.
Maximizing Milk Production
Hand Expression of Breastmilk
And if in doubt of a medication passing into your breastmilk- try this link LactMed.
Maximizing Milk Production
Hand Expression of Breastmilk
And if in doubt of a medication passing into your breastmilk- try this link LactMed.
Thursday, February 4, 2010
poems for labor
In the midst of the chaos
When the wind is howling I hear
the ancient song
Of the ones who went before
And know that peace will come
-Susan Stauter
May the sun bring you new energy by day,
May the moon softly restore you by night,
May the rain wash away your worries,
May the breeze blow new strength into your being,
May you walk gently through the world and know its beauty all the days of your life. –Apache blessing
For as long as it lasts let the singer be the song.
For as much as it’s worth let the truth outweigh the lies.
For this single moment in time let my own voice be heard.
–Susan Stauter
“Come to the edge,” he said.
They said, “We are afraid.”
“Come to the edge,” he said.
They came.
He pushed them and they flew.
-Apollinaire
What lies behind us and what lies
before us are tiny matters
compared to what lies within us.
-Ralph Waldo Emerson
I know nothing with any certainty, but the sight of the stars makes me dream. –Vincent Van Gogh
What Makes Women Warriors?
According to Wikipedia "A warrior is a person experienced in or capable of engaging in combat or warfare, especially within the context of a tribal or clan-based society that recognizes a separate warrior class. According to the Random House Dictionary, the term warrior has two meanings. The first literal use refers to "a man engaged or experienced in warfare." The second figurative use refers to "a person who shows or has shown great vigor, courage, or aggressiveness, as in politics or athletics."
So I want to consider when a woman is in labor- how does she become a warrior? I love the phrase "warrior woman." I feel the way we carry ourselves through our journeys of adversity we become warriors. But for the sake of this blog, I want to explore the aspect of labor and birth.
A woman who shows "great vigor, courage or aggressiveness" in labor and birth... hmmm. Does a woman have to birth naturally- without any pain medication to be a warrior? Nope, I don't think so. Is she more of a warrior if she goes natural while being induced with labor augmenting drugs? Perhaps she may think so, but nope I don't think it is a competition. But women make it a competitive arena. Just share with another woman that your intention is to try to go without pain medication and she will tell you how ridiculous that is- making you feel like it is an insurmountable feat to try to do so. But find a woman who did give birth without medication and she will tell you that you do get a prize for doing so... and she will explain how easy her recovery was, how well breastfeeding went, etc. But this is not always true.
We had a client who took our classes and hired a doula and planned an pain medication free birth. But due to some past issues, her labor as it unfolded brought up a lot of stuff she thought she had dealt with, but had not. Her labor was hard and unmanageable and she chose to get an epidural. Was she a warrior? By all means she was! With her second birth, she planned on getting an epidural in her labor and did so. She had a great second birth. Was she less of a warrior? Nope, I don't think so... She figured out what she needed and worked through that which she could, and chose the labor that was right for her.
My daughter chose a homebirth with her son. When people heard she was doing so, they commented on how brave she was. She then would ask where they were giving birth and when they named their hospital, she would tell them no they were brave! She did not feel comfortable giving birth in the medicalized birth arena. Was she more of a warrior? I feel her battle would have been more difficult if she had gone to a hospital. She was a warrior in her labor the same as the first mom.
I have written about doing the next best thing- when your options or choices change in your labor- it is about being flexible as things arise. But being a warrior to me is more about not allowing yourself to be bamboozled and manipulated. It is about asking questions and then finding the answers that are right for you.
I received a call recently from a woman who was seeking doula support for a hospital birth where her care providers were midwives. But in their prescribed birth plan- the only one you are allowed to have- where you check items... it stated that you should only choose natural birth if you could control yourself. Hmmm... what does that mean? I do not think a woman in labor needs to act in some prescribed way that is considered in control by those who are supporting her. She should feel free to move and make sounds that help her in her labor. This group also stated that they would be the ones who decided when you may need labor augmentation and they would decide how it is administered. Wow- so does the woman give up her autonomy in her decision making about her body and her birth? When did informed consent get thrown out of the door? This same practice does not "allow" a mom to go past her 41st week of pregnancy although the ACOG says that she is not past due until her 42nd week.
I do appreciate that this information is handed out early in your pregnancy so you can decide if this is the way you want your labor managed.
Warriors- what should our battles be? We do not need to fight with care providers when we are in labor. We need to battle our fears ahead of time- not in labor. We need to fight fatigue and do the work of labor , and those around us need to be on our team- our comrades in the battle!
I love the scripture in Exodus 17 "Moses' arms soon became so tired he could no longer hold them up. So Aaron and Hur found a stone for him to sit on. Then they stood on each side of Moses, holding up his hands. So his hands held steady until sunset." As a doula, as a friend, as the care provider, as the nurse...this is our role with a woman in labor.. to hold up her hands so she will be supported even when tired...
I love this quote by Laura Stavoe Harm,"There is a secret in our culture- it is not that birth is painful, it is that women are strong." We need to find that vigor and courage that we are made to have in labor. Being courageous is what makes us warriors. Having the courage to keep looking if the place and provider is not the right one for us; having the vigor to drive farther away to get those if they are not in our neighborhood. We need to have the courage to look within ourselves and determine the path we want to follow. But part of that determination must be with informed consent.
And we need to take ownership of our decisions.For instance you can not decide to get an epidural and then complain about the side effects you may have from them- as if someone made you get that epidural. You can not stay with your care provider and then in labor when they are not supportive complain that they are not on your team.
Warriors are made by battling through adversity- finding the truth for yourself- and having courage to move forward. It is not about a prescribed way to give birth- it is about making it your own!
Monday, February 1, 2010
It is in a relationship...
Relationships take time to develop. When you pick a doula it is best to hire her as soon as you can so you can develop a relationship with her. She needs to be someone you feel you can be honest with and share your inner most thoughts regarding your birth fears and ideals. It needs to be someone you can trust. This is a double road though- it is up to you to make this happen as well as the doula.
We had a client who hired a doula several months out. Although they discussed things and chatted along the way, some things were said or shared that made her question her decision in her selection of her doula. She did not address these concerns. She did not ask for clarification or share her thoughts about what was said or misunderstood. And just like when your partner does a bunch of little things that bother you and you do not address them, the group of them together makes for a sore spot between you. This did not make for a relationship that would foster a great doula-client relationship.
We see women select care providers and find out along their journey that this care provider was not going to be supportive of their ideal birth. But instead of addressing their concerns, they either dismiss them or they decide that perhaps it won't really make a difference. But this is a relationship that will not foster a great care provider-client relationship.
Do yourself and your doula a favor... in fact do everyone in your life a favor and share with them the thoughts that make you uncomfortable when they occur. Address them so they can either be resolved or so a decision can be made early on to switch doulas if the doula is not a good fit. Sharing early on may have been something that could have allowed the relationship to grow and flourish rather than falter. After all it is about the relationship. Every match is not one made in heaven. But being honest is the best way to maintain relationships that will bring the blessings to your life and your birth!
We had a client tell their doula they did not want a particular doula to be their back up. When questioned about it, they did not feel she would be a good fit since her personality when they met seemed different than what they felt they may need in their labor. We have enough back up options that we certainly are able to accommodate that request. But keep in mind, just as Paul states in the bible that he became all things to all people to win as many as possible, a doula can become what you need. For instance I have had clients want me to be gregarious and fun in their labors. I have had some ask for almost complete silence in their labors. I have had some who loved the casual conversations in the background that insured them all was normal. Doulas become what you need in your labor. But you need to let them know what you need. Since every woman has her own particular needs, your doula needs to know what you think you will need. But ironically that may change when you are actually in labor. She knows how to be flexible as your needs change.
A doula who is gregarious and funny at the Meet the Doula Tea may be the quiet, calm spirit who holds the sacred space of labor and birth for you. So, remember just as you may have a different personality at a party than at your labor, so she may as well. Ask questions that will enlighten you to her full personality before deciding she may not be who you are looking for to support you.
I often tell women not to lie to their care provider- don't expect them to be truthful if you are not willing to be truthful to them. I feel if you can't be vulnerable and honest with them, your relationship is not one of trust for your labor and birth. This is certainly true for your doula as well. Be honest, be vulnerable, be open- it will help your relationship become what will be most beneficial to you for your birth experience. Understand that misunderstandings occur, but share your feelings if they do so it can be cleared up. Communication is paramount for growth in this relationship.
I spoke to a friend who is a bit older than me. I said the bad thing and the good thing about getting older is you don't care what people think of you. But the truth is you should always care how others feel from your actions or words. But again, sharing how one makes you feel will help resolve any negative feelings you may have from someone else's actions. She said that sometimes when we get older we know things, we feel we need to speak the truth- even bluntly- and that those who are not in the same place are unwilling to hear the truth. I think about the phrase, "folks don't care how much you know, they need to know how much you care."
Sometimes I think in an effort to share what we know from our experience, we have our comments come across too emphatic and opinionated. I used to think that if you did not fully believe something, then you could not really have a strong opinion worth sharing. Now with age I realize everything is not so black and white. Fully supporting women sometimes means not sharing your opinion unless they really ask for it. As a doula that is often hard to not feel the need to share what you feel is truth that will protect them. But sometimes too much information can overwhelm a mom. It is a fine line in this relationship. We begin to feel responsible for them instead of to them.
Polly Perez a friend of mine- and an internationally known birth advocate shared this with me recently. "
I had to remind myself the difference between feeling responsible TO or FOR many times....
That is why I wrote the following handout and even put it in one of my books hoping it might be helpful to others.
Hope this will help your in some way in your current situation....
Here is the handout---
The Difference in Feeling Responsible TO and FOR
When you feel responsible TO others....
You show empathy, encourage, share, confront, level, are sensitive, listen.
You feel relaxed, free, aware, high self-esteem.
You are concerned with relating person to person, feelings, and the person.
You are helper/guide.
You expect the person to be responsible for themselves and their actions.
You trust and let go.
When you feel responsible FOR others....
You fix, rescue, control, carry their feelings, don’t listen.
You feel tired, anxious, fearful, liable.
You are concerned with the solution, answers, circumstances, being right, details.
You are a manipulator.You expect the person to live up to your expectations.
So, find a care provider and a doula who will feel responsible to you. And be responsible yourself and share your feelings- after all it is about developing a relationship. Be open and honest. Let her know what you think is important and will need. And then know you will be fully supported in your labor and birth!
We had a client who hired a doula several months out. Although they discussed things and chatted along the way, some things were said or shared that made her question her decision in her selection of her doula. She did not address these concerns. She did not ask for clarification or share her thoughts about what was said or misunderstood. And just like when your partner does a bunch of little things that bother you and you do not address them, the group of them together makes for a sore spot between you. This did not make for a relationship that would foster a great doula-client relationship.
We see women select care providers and find out along their journey that this care provider was not going to be supportive of their ideal birth. But instead of addressing their concerns, they either dismiss them or they decide that perhaps it won't really make a difference. But this is a relationship that will not foster a great care provider-client relationship.
Do yourself and your doula a favor... in fact do everyone in your life a favor and share with them the thoughts that make you uncomfortable when they occur. Address them so they can either be resolved or so a decision can be made early on to switch doulas if the doula is not a good fit. Sharing early on may have been something that could have allowed the relationship to grow and flourish rather than falter. After all it is about the relationship. Every match is not one made in heaven. But being honest is the best way to maintain relationships that will bring the blessings to your life and your birth!
We had a client tell their doula they did not want a particular doula to be their back up. When questioned about it, they did not feel she would be a good fit since her personality when they met seemed different than what they felt they may need in their labor. We have enough back up options that we certainly are able to accommodate that request. But keep in mind, just as Paul states in the bible that he became all things to all people to win as many as possible, a doula can become what you need. For instance I have had clients want me to be gregarious and fun in their labors. I have had some ask for almost complete silence in their labors. I have had some who loved the casual conversations in the background that insured them all was normal. Doulas become what you need in your labor. But you need to let them know what you need. Since every woman has her own particular needs, your doula needs to know what you think you will need. But ironically that may change when you are actually in labor. She knows how to be flexible as your needs change.
A doula who is gregarious and funny at the Meet the Doula Tea may be the quiet, calm spirit who holds the sacred space of labor and birth for you. So, remember just as you may have a different personality at a party than at your labor, so she may as well. Ask questions that will enlighten you to her full personality before deciding she may not be who you are looking for to support you.
I often tell women not to lie to their care provider- don't expect them to be truthful if you are not willing to be truthful to them. I feel if you can't be vulnerable and honest with them, your relationship is not one of trust for your labor and birth. This is certainly true for your doula as well. Be honest, be vulnerable, be open- it will help your relationship become what will be most beneficial to you for your birth experience. Understand that misunderstandings occur, but share your feelings if they do so it can be cleared up. Communication is paramount for growth in this relationship.
I spoke to a friend who is a bit older than me. I said the bad thing and the good thing about getting older is you don't care what people think of you. But the truth is you should always care how others feel from your actions or words. But again, sharing how one makes you feel will help resolve any negative feelings you may have from someone else's actions. She said that sometimes when we get older we know things, we feel we need to speak the truth- even bluntly- and that those who are not in the same place are unwilling to hear the truth. I think about the phrase, "folks don't care how much you know, they need to know how much you care."
Sometimes I think in an effort to share what we know from our experience, we have our comments come across too emphatic and opinionated. I used to think that if you did not fully believe something, then you could not really have a strong opinion worth sharing. Now with age I realize everything is not so black and white. Fully supporting women sometimes means not sharing your opinion unless they really ask for it. As a doula that is often hard to not feel the need to share what you feel is truth that will protect them. But sometimes too much information can overwhelm a mom. It is a fine line in this relationship. We begin to feel responsible for them instead of to them.
Polly Perez a friend of mine- and an internationally known birth advocate shared this with me recently. "
I had to remind myself the difference between feeling responsible TO or FOR many times....
That is why I wrote the following handout and even put it in one of my books hoping it might be helpful to others.
Hope this will help your in some way in your current situation....
Here is the handout---
The Difference in Feeling Responsible TO and FOR
When you feel responsible TO others....
You show empathy, encourage, share, confront, level, are sensitive, listen.
You feel relaxed, free, aware, high self-esteem.
You are concerned with relating person to person, feelings, and the person.
You are helper/guide.
You expect the person to be responsible for themselves and their actions.
You trust and let go.
When you feel responsible FOR others....
You fix, rescue, control, carry their feelings, don’t listen.
You feel tired, anxious, fearful, liable.
You are concerned with the solution, answers, circumstances, being right, details.
You are a manipulator.You expect the person to live up to your expectations.
So, find a care provider and a doula who will feel responsible to you. And be responsible yourself and share your feelings- after all it is about developing a relationship. Be open and honest. Let her know what you think is important and will need. And then know you will be fully supported in your labor and birth!
Semantics....
Recently in a prenatal meeting I posed a number of phrases to get the couple's thoughts- it helps me to understand what is important to them. There was one "I gave birth, I was not delivered," that I posed to them. Usually it is met with how they feel giving birth is something they do- vs. being delivered is something that is done to them. But this mom did not share until much later what she felt about that phrase. She said, "I actually prefer the word "deliver" because it's more empowering to me; "birth" seems too passive, as if you're a bystander."
This response made me realize that different things provoke different feelings in folks. I have to say this was the very first time in years of using these phrases to promote understanding and dialogue, that a woman shared this thought. I realized that if she felt "deliver" had more power, than by all means I wanted to use the word "delivered" when talking to her about her experience.
But this made me realize that if words are powerful, who gives them the power? Individuals do! It is important to allow a woman to use the words that help her have more power. For instance the hypnobabies program have words they use... deliver is replaced with giving birth, the husband is the birth partner, contractions are pressure waves or sensations, labor is birthing time, pain is discomfort, labor room is birth room, transition is transformation, false labor is pre-birth waves, pushing is ahhhh pushing or breathing your baby out and due dates is guess dates. They want to replace all negative connotations to be positive words.
But wait- who makes words positive or negative? Shouldn't the mom be able to decide what works for her and what does not? I personally like the word birth more than deliver- but it is not my birth- or not my delivery- it is hers.
Hypnobirthing has their own words to use- some that are considered no nos that promote fear instead of correcting the years of negative subconscious belief. Well again- what if our subconscious belief has been full of positive birth beliefs? And what if we are not afraid of words like powerful contractions or labor is hard work- or labor hurts but I can do this? Shouldn't I be able to use those words or phrases?
I think women should use the words they want to use. I hate that my phrases that were to promote thought and discussion made this mom feel I was coercing her to believe my words... nope - I wanted it to help her discover what she felt. And it did. Words are only given power by the one using the words or finding the word has power for them. Please share the words you need with those who are there to meet your needs!
My youngest daughter uses words I am not comfortable with sometimes and when I say so to her- she reminds me that we give the power to the words- that words themselves have no power. So, if you want to have specific words used or not used in your labor- then tell those around you what words work and what words you want to have avoided. If you are surrounding yourself with folks to help you achieve the experience you want, help them to help you by sharing the words you desire to hear as well.
But, I think it is unrealistic to expect everyone in a hospital atmosphere to not use their "normal" phrases. At a home birth it may be easier to accomplish this. I think making some birth art or encouragement cards with the phrases would be a great reminder for those around you. I have tried in my years as a doula to help change some semantics by hospital staff thinking I was helping women. For instance I do not like referring to a mom as the cesarean section but instead she is the mom who had a cesarean birth... But much to my surprise, I was taught by some wonderful women in ICAN that they did not like the term cesarean birth- because they felt it softened the surgical experience that they so wanted to avoid in their future.
There are several other phrases- like the word circumcision vs genital mutilation- hmmm you know how one feels based on using that second phrase don't you? But some words hold less impact on their use- for instance I love the baby who is breastfeeding called a nursling- the mom nurses her baby- because I feel it is much more than just feeding a baby at the breasts. Lactivist call formula artificial breast milk. When a woman says the contraction she just had was a bad one, I do try to get her to use the word powerful instead because I think it helps her to re-identify it in a more positive way. I am not sure I will ever get women to embrace the word rush or surge for contractions... even though I do think labor can be a series of rushes and rhythmic surges... but some moms don't relate to those words. And who am I to try to make her use my words?
So, rather than forcing a woman to use words that she does not relate to or words that for her have no power- words that she has a hard time embracing- let's let women decide for themselves what they want to call their experiences... when we force them to embrace our words we dis-empower them by doing so. So, explore new phrases- ask yourself how the words make you feel- then share the ones that work for you with those who are there to help you!
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