Tuesday, March 19, 2013

Pregnancy and Birth: The Fear Factor

Because I know sooner or later it will come up, I want to say now that this post is strictly from the standpoint of non-emergent situations. I could argue that even in dire emergencies, fear shouldn't be a motivator, but hormones run much higher in emergencies, heightening many emotions and senses.

Our culture as a whole uses fear as a weapon to keep a pregnant woman or laboring woman compliant. From the moment a woman decides to share her pregnancy with others the advise and horror stories pour in. Decide to share a plan alternate to that of the standard medical system and you are sure to be told what a risk you are taking, followed by scare tactics designed to scare women straight.

It all really does begin early. From the start, our trust in not only our bodies, but our decision making is undermined. Immediately a pregnant woman's world is a of world don't. Don't eat this, don't drink that. Don't run, jump, skip or play?  If she is wondering about sexual activity, the answer is often shrouded in ambivalence.  Our media plays up the fear factor even more with shows like One Born Every Minute and books like Participatory Care sounds Scary! Listen to your Doctor! Better known by it's formal title,  "What to Expect When You're Expecting".   What is rarely addressed in all this is damaging impact fear can have on pregnancy and birth. It can have a negative impact on outcomes, lead to stress that can be dangerous in and of itself and take an emotional toll on the pregnant and laboring woman.  Decisions being made out of fear aren't really decisions at all. Choice is eliminated when fear is the only motivating factor and so many women are left with feeling either cheated or denied the experiences and outcomes they wanted during their pregnancy and birth.  When faced with an onslaught of negativity in a culture of fear that promotes doubt and mistrust how can a woman balance respecting the often times unpredictable nature of birth with trusting her on instincts and ability to make decisions?

One of the first steps would be eliminating unchecked fears and putting them in perspective. Doing this can come in many forms. Taking childbirth classes, hiring a doula, hiring a care provider that is supportive, and professional and balanced in their approach to maternity care are all positive steps. Educating yourself on the process of birth is key, but so is asking yourself hard questions. How do you want to birth and why? What are your greatest fears and how do you check them? What are the risks and benefits to any choices you might make and how do you apply them to yourself?  Just as you try hard to feed yourself with good food and drink; you should be nurturing your pregnant soul with good information, positive reinforcement, and practicing how to achieve peace with your pregnancy and being at peace with the decisions you make for your upcoming birth. Surrounding yourself with people who will inspire, uplift, but also be honest with you. Birth can be many things and it's important to not only know this fact, but understand how and why it can be. Embrace the good with the bad, and not only own your choices but be at peace with them.

Lastly, I want to address the fact that fear has it's place. Fear can warn of us danger, heighten our instincts and motivate us to make prompt and decisive decisions. What is important is to address fears, especially before labor and birth and learn to check what I call, fear run amok.  Balance is the goal when it comes to fear.

Friday, November 30, 2012

Confessions of a doula who....

...doesn't like Call the Midwife. I tried everybody.  I tried really hard. But there are so very few "period" dramas I like. That era, the language. None of it speaks to me or moves me. I just don't get into it. I feel like I betrayed my sisters. :-(

Tell me I'm not alone in my guilt. Although I suspect there are very, very few who can. It's a great hit. I'm happy that it is too. Very happy to see anything midwifery related be portrayed in a positive and realistic manner. Now if we can only get one done set in this century. That would be great!

Monday, November 26, 2012

If I'm getting an epidural why would I need a childbirth class?

How many of us doulas, midwives, and educators have heard this question asked. Sometimes it's not just asked, it's a statement: I'm getting an epidural, I don't need a childbirth class.  Either way, it's not entirely true is it?  Allow me to outline some points that may shed light on the subject:

1. You may not get an epidural:  Now before you get riled up thinking I'm trying to talk you out of it that's not what I mean. What I mean is that labor can be very unpredictable. You may have a fast labor or what we sometimes call a precipitous labor, in which there is actually no time to get the epidural placed before the baby is born. Another scenario is that you may be surprised by how manageable your labor is, opting to labor at home until the you feel the need to go to the hospital. And then your labor may pick up quickly, leaving you no time to get your epidural placed.  In both instances, having knowledge of what's going on, how to deal with it, and tools to manage your stages of labor can be taught in a good, independent childbirth class.

2. The anesthesiologist may be unavailable:  Many women request an epidural early in their labor and others wait until they feel they are in active labor or when the pain of labor becomes unmanageable. In any scenario, the anesthesiologist on-call may have other patients he or she is tending. The Doctor may even be out of the hospital altogether (depending on where you birth), and you may need to wait a length of time before you can be seen. This can be especially troubling to women who do not have other pain management tools to fall back on. Or women who didn't realize waiting was something that could happen. Again you can be taught valuable information about labor coping techniques in a quality class.

3. Your hospital may require you to be in active labor before being admitted:  There are variations of labor in which you feel strong contractions long before active labor. They may not last long, but they vary in pain and manageability. Often this is when a woman has a baby in a malposition, or feels back labor. In this instance, you may not be admitted early in labor, but rather when your labor reaches a more predictable pattern or when you reach a certain dilation. You can be checked for dilation and sent home to manage your labor for a few hours. In this case a childbirth class (and truth be told a doula or very knowledgeable support person) comes in great service. First, you learn that this is a labor variation in the range of normal for birth and second you can learn exercises and position changes to help turn your baby into a better position, relieve pain and pressure and make your labor more efficient.

4. You may want to wait until active labor before going to the hospital:  I've had many clients tell me they were either on the fence about getting the epidural or they knew they wanted one, but they were absolutely adamant about declining many other interventions and strongly desired a vaginal birth. In those cases, taking classes (or having a doula) is very valuable. You may be feeling some strong contractions and sensations long before you decide to make the trip to the hospital and in that case you will need the labor coping techniques and a good understanding of the variations of normal as in labor.

5. Childbirth classes help you learn options, give you an understanding of the process, eliminate fear, and educate you so you can make an informed decision:  Labor isn't just about coping or not. Pain meds or not. There is a lot in this day and age that goes on in the labor and birth room, and a lot has been lost over the years in terms of allowing a woman to birth intuitively. In a good childbirth class preparation series, you can learn about the birthing process from an emotional standpoint, physiological standpoint and a procedural standpoint. You can learn to weigh your options, get a better understanding of the risks and benefits of different interventions and evidence-based practices, and make better informed decisions. This includes not only the decision on whether or not to use an epidural, but when to use one if you decide you want one.  Lastly, a childbirth class can help you ask and answer questions within yourself. It's not enough to make a decision based on fear. Fear of pain, fear of hospitals, fear of bad outcomes. You can explore within yourself why you have chosen an epidural and make sure that you've eliminated fear as a motivator (if it was one) and made a better informed decision for you and your baby. Whatever that may be.

Wednesday, November 7, 2012

How do we obtain choices in childbirth?

I've talked a lot about choices in childbirth in this blog. I've encourage women to choose paths for themselves and own those choices.  Right now though,  I want to talk about how we exercise our rights and give voice to our choices. More than that, how we keep choice from being just a buzz word and a mere illusion that is really system of control to placate us.  

Now the childbirth educator in me says that the key is education. Get as much evidence-based information as you can. Really educate yourself on pregnancy, labor, and birth. Educate yourself on hospital procedures. Educate yourself on postpartum topics like baby care, breastfeeding, and vaccination. However, the warrior in me knows it's not that simple.  Yes, knowing your options is by far the best way to be able to know what choices you want to make and how to make them, but it does very little in preparing you for intricate system that seeks to narrow your choices by simply removing them. So what if you learned there is a such thing as hotdogs and decide you definitely want hotdogs if the chef has completely taken them off the menu. In that scenario lets just say hotdogs are VBACS (vaginal birth after cesareans) and the chef would be insurance companies, hospital policies, your doctor, etc. Are you getting my point?

So what does the warrior in me say? Fight. Advocate. Talk. TAKE ACTION. (Sorry, I really didn't mean to shout. That was the warrior in me) How do we take action? You may ask? Well voting comes to mind, but really that's another blog post. For now lets stick with consumer advocacy.  Many years ago there was shift in what birth looked like in hospitals. Women and families rebelled against protocals such as twilight sleep, separation of family members from the birthing room (in particular husbands), routine drugs and pain medication, and more. We can affect change again by demanding it. Demanding that the standard of care practiced by the people we hire, our doctors, midwives, and their staff,  is evidence-based medicine. Demanding transparency in maternity care data reporting. Demanding an overhaul of the insurance system. We can affect change in policy and procedures by putting our money, time, and efforts where our mouths are. Writing our congress person. Joining grassroots efforts. By signing petitions and organizing and/or participating in demonstrations. Sharing our stories and donating money to efforts that support our causes. The list goes on and on.

I really hope this post didn't come off as preachy. It's just that I've had this idea rattling off in my head for a while and our recent elections have really awaken something within me. There is a huge difference between knowing your rights and exercising them. In the same vein, knowing your options and keeping them on the table are two different things as well. Although many women equip themselves to fight for their choices in birth while in labor, I'm thinking that if we fight collectively for them now we could spend that energy in labor concentrating on something really radical: Birthing our babies. Our way.

1. 'Definition of Twilight Sleep". MedicineNet.com. http://www.medterms.com/script/main/art.asp?articlekey=10221(November 7, 2012)

Wednesday, October 24, 2012

So you want a Natural Birth. Now what?

You're pregnant and have decided to have a natural birth. It's the first trimester and while you may think you have plenty of time to prepare there is NO time like the present! So in that vein I've decided to put together some helpful tips that I sincerely hope you all find useful. 

1. Explore the reasons why you want a natural birth, examining your fears, expectations, and influence:  So many times when I ask a potential doula client or clients in childbirth preparation class why they want a natural birth I get the same basic answer: Fear. You may think that's strange. How could fear motivate anyone to have a natural birth? But I assure you, it can and it does. I hear; "I'm afraid of needles". "I'm afraid of being numb".  "I'm afraid the risks of epidurals". "I'm afraid of getting a cesarean section?"  Fears like these can wreck havoc on the best laid plans because if you've made your birth choices with fear as the motivator you've already given power to negativity. I truly believe the only way to make a true decision in life is do so freely. Otherwise the fear has made the decision for you. Address your fears and motives. Place importance on the positives. Educate yourself and see what your desires truly are after you've done so.
 It is also good to take time to explore any triggers of your past. Did you have a traumatic experience? A history of depression or abuse? Pregnancy, not just labor and birth, can trigger the memories and pain of these past events. Speak to your care provider, a therapist, your partner/husband, family member, friend, or doula about it. Choose someone you can trust and someone who will actively listen, having your best interest and goals in birth in mind. It's not a good idea to live alone with these feelings and let them fester. 

2. Properly educate yourself and limit negative influences:  Right now, in 2012, properly educating yourself on natural birth, hell on childbirth in general, goes beyond the $150 hospital birthing course we sometimes so eagerly sign up for. It can be unsettling to learn the last place you can gain true perspective on birthing choices would be at your hospital, but it's true. If your goals are to birth your baby without medication, vaginally (whether medicated or not), or with minimal intervention and augmentation then picking an independent childbirth preparation course is really the best way to go. You can pick an educator who specializes in specific methods (bradley, hypnobabies, lamaze) or one who doesn't have any of those specific affiliations. I would urge you to speak to more than one, interviewing them if you will, and ask specific questions; does your course cover comfort measures, relaxation exercises, variations of labor and birth? Do you cover hospital procedures, unexpected outcomes like cesarean section, etc? 
Now, as for limiting negative influences, this can be tricky. Once you start showing everyone has an opinion. Many people share that opinion with you whether you've asked for it or not. There are some who will throw so much salt in your game about your plan to birth without medication or even vaginally, that it can be extremely overwhelming. There are a few things you can do. One is to limit who you share your plans with. Some women who find all the "poo poo'ing" too overwhelming try this. Another way is to simply ignore them. The my body, my baby, my birth so fuck off approach. Choose a way to deal with this negativity that is conducive with your personality, but also try to put yourself in situations where exposure to those negative nelly's is minimal.
Keep in mind that the negativity you take in isn't just by what people say to you in person. The web is teeming with people itching to tell you how crazy you are for deciding against epidural or birthing vaginally. Visit only natural birth friendly webpages, threads, and groups/pages in social media. Read positive books, watch NON-maintstream movies and documentaries on birth that are informative and positive. If you watch videos on Youtube, for the love of god do not read the comments! That last bit is an order :-).
 Lastly, there is a wealth of resources on the web. Finding good ones can be hard, but I will gladly list a few of them here for you:
  •  Science and Sensibility - A great blog from Lamaze.org. There are articles and posts on various pregnancy, birth , and labor related topics. Well researched and well cited.  http://www.scienceandsensibility.org/
  • Childbirth Connection - Another great resource with many studies and citations. Topics include helping women to understand risks and benefits many pregnancy, labor, and birth related topics. http://www.childbirthconnection.org/
  • VBACFacts.com - The name speaks for itself. If you are looking to have a VBAC this is an awesome resource! www.vbacfacts.com

3.  Hire a doula: Doulas are an invaluable resource for women no matter what your birth plans are and this is especially true for those wishing to achieve a natural birth. Doulas take on a wide variety of duties from helping you write out your birth vision (plan), teaching and practicing comfort measures and relaxation techniques before birth, examining those pesky fears I talked about earlier as well as any anxiety, and helping you examine any previous life experiences that factor into either impeding or helping your birth. Doulas offer you a specialized kind of support that you can rarely find in another type of support person and their objective is to help you reach your objectives, whatever they are, and help you obtain on overall optimal and satisfying experience, no matter what arises in birth. Interview at least 2-3 doulas when you search for one, remembering to ask key questions. Here are few resources for finding doulas:
  • Capital City Doulas - A great doula collective with many doulas of varying experiences serving many greater Sacramento and surrounding area cities in Northern California.  www.capitalcitydoulas.org
  • Doulamatch.net - A good tool for finding doulas in your area and matching up your EDD to their availbility. www.doulamatch.net
  • BabyProFinder - Another good resources for finding doulas (and other birth professionals) in your area.  www.babyprofinder.com

4. Get in touch with your spiritual side: Perhaps spiritual might not be the right word, but the goal is to tap into your inner strength, your inner self, and to quiet your mind and cleanse negativity. When I teach or when I conduct prenatals with my clients we  practice some type of relaxation technique that includes visualization. I ask that all my clients practice the technique at least once everyday until the baby is born. Find a good relaxation exercise that you can do quietly once a day. Incorporate breathing, relaxation, stretching and visualization in this exercise.

In addition to visualization, it's important to understand the influence of energy in our lives and how it relates positively or negatively to pregnancy, labor, and birth.  Allowing yourself time to reflect, calming your mind, and seeking positive energy at least once a day in your pregnancy is good practice for birth and for postpartum. It helps cleanse the unwanted energy from your life. Remember that each person in your life brings their own energy and that it may be prudent to determine whether or not you want a certain persons energy in your birth space or during your pregnancy.
Another great tool is birth affirmations. Birth affirmations help you build positives attitudes about birth. You gain mental strength and trust in your body, your baby, and the birthing process. 

In closing please remember that your goals should be your own and that when you make informed, educated choices, it leaves little room for doubt. I hope that these tips are helpful and if you find them as such I hope you'll share this with others.

Happy Pregnancy, Happy Birthing! 

Tuesday, October 23, 2012

How to determine what matters most in birth.

What matters most in birth? A healthy baby? The experience? A healthy mom? Vaginal or Cesarean? Medicated or Natural? If you are reading this post now to find the answers I can tell you already that you are off to a VERY bad start.

What matters most in birth? Only you have the answer. So here is some advice: stop looking for it externally in blogs, threads on facebook, journals, and ANY other people and search internally. Ask yourself the question and answer honestly. Determine why you came up with answer and act accordingly.

Lastly, remember this; while it may be in the general nature of us human folk to seek validation in our choices, when we make them educated, fully aware, and from our hearts, validation becomes moot point.

Happy Birthing!

Saturday, April 14, 2012

Doulas and Advocacy: Are they mutally exclusive?

I hear time and time again. I'm sitting in an interview with potential clients and they tell me that one of the reasons they want to hire a doula is to have someone advocate for them in the birthing room. I'm constantly explaining to clients that while I do consider myself an advocate of choices in birth, natural birth, and natural postpartum choices; I do not advocate for you during birth, but rather help you to advocate for yourself. I also explain that if they hire me as their doula, the process of how I help them to advocate for themselves starts prenatally.

I use to always wonder where these women and couples got the idea that doulas are advocates for them during birth. That is, until I started listening to my fellow doulas. Again, I'd hear over and over about stories of doulas who would get into heated conversations with doctors and nurses about hospital policy, clients wishes, evidence-based practices and more. I'd hear doulas brag about arguments they felt they won, shouting matching, standoffs, and more. The worst to me are the stories of doulas who unhooked IV's, stopped the pit machine, and spent time interpreting fetal monitor readouts. It was quite horrifying to me. Who was serving the mother at that time? How did this truly make her feel? Did these doulas really feel they served their clients best this way?

Now I understand there is a type of doula for everyone. Some women benefit from doulas with a more no nonsense attitude, the ones that don't sugar coat things or come off more "militant".  Other women prefer a lighter touch or a more "middle of the road" doula. I respect the differences and the need for them. However, I believe there should be a separation of doula and advocate. Politics, in particular your own personal politics, have no business at the birth of your client. Once a client is in labor, any personal agendas should be checked at the door. There is a more appropriate time and venue to try and change faulty birth practices.

I think the same thing goes for the myth that we empower women through these actions at her birth. A woman's power to advocate for herself and birth in the way she wants isn't ours to give. It's her birth and it has to be her job to find the power and be empowered. We can help, we can guide, we can even lead, but we can give that to anyone. Sadly though, through our actions, just like the hospital staff, we can take it away.

So people, what do you think? Do you think there should be  separation? Perhaps there is another side I am not seeing. Maybe you are a mother who benefited from a doula doing some of the things I mentioned above or a doula who felt there was no other way. Share your thoughts with me. I'm open to them.