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Students becoming educators

Lately my childbirth students have been teaching medical professionals all about birthing positions.

1)  A first time mama was her OB’s first natural birth.  Seriously, first natural birth EVER witnessed.  And my student gave birth standing up!  Providing her own counter-pressure while her husband sat on the bed and held her from behind.  She gave birth to an 8lb+ baby without any tearing.  She said she felt her OB and nurse believed her to be a giant liability disaster waiting to happen! 

The next day, her OB had lots of questions about the birth.  The OB was surprised the woman did not “blow out her vagina.”  OB:  I’ve always supported the use of epidurals so I can control pushing and you don’t blow out your vagina.  But you didn’t seem to have a problem.  Mom:  I had instant feedback from my body about how fast/slow to push.  

2)  This mom was a VBAC who never got to active labor during her induction with her first baby.  And she wasn’t “allowed” to get out of bed.  This time, she stayed at home and birthed 17 minutes after arriving at the hospital.  She chose a hands/knees position.  There was no doctor on the floor so three nurses assisted.  The one catching had never done a hands/knees births.  I could pick up on some anxiety about the position but mom did all the work.  She made it easy for the nurses.  And thankfully, they were supportive of her choice–not that I think she would have willingly changed positions at that point!  The nurse passed the baby straight to mama where she snuggled skin-to-skin for over an hour. 

3)  A resident had only done back births.  Her words:  “I see that you’re pushing well on your knees.  But what I like to do for natural births is break down the bottom of the bed, scootch you down and have you pull your legs back.”  I wanted to ask, “Um, how is that different from medicated births?”  Mom was tricked onto her back “so we can check you.”  But she rolled to her side.  And instinctively gave herself her own counter-pressure.  This clearly made the resident uncomfortable but the mom ignored the nurse’s attempts to move her hand.  I heard the attending whisper to the resident “the manuevers are the same for a side birth as a back birth.”  When the resident gave me some instruction I can’t remember now, I replied, “Oh, ok.  I haven’t done a back birth in a long time.  The last birth I attended the mom was standing up.”  Wide-eyed resident shook her head in disapproval.  Sigh.  I hope that one moves on to a hospital far far away. 

I’m so proud of my students and other families who are changing the way birth is “managed” in the hospital.  It can be a tricky place to navigate and the balance of power can be overwhelming.  I think of my client who had a breech baby.  While she knew cesarean was her only option in the hospital, she also insisted on delayed cord clamping and skin-to-skin contact.  She made a path that other women can more easily trek. 

These amazing families inform and change one birth at a time.

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Preparing for a Smooth Hospital Birth

Each hospital birth I attend is a learning experience.  Here are some common characteristics of the most positive hospital births I’ve attended:

Before Your Birthing Time:

Early communication with care provider:  There shouldn’t be any surprises between the couple and the care provider.  Communicate your desires and expectations early in your pregnancy.  I understand that more and more OB groups are now including multiple care providers and each OB may support different practices.  This challenge is even more reason for you to communicate clearly and ask the question, “Will the other OBs in the group also support ______?”   

Hire an independent doula:  You knew that was coming, right?  An independent doula (one who does not work for the hospital) knows the way hospitals work.  I cannot imagine laboring without the continuous support of a woman who is there only for my physical and emotional support.  Especially for a hospital birth.  Please don’t let financial concerns stop you from interviewing a few doulas.  Find a student doula, barter services, or use your flexible spending account.

Take an independent childbirth class:  By independent I mean a childbirth class that is not offered by the hospital.  I don’t think it really matters which class you take.  Pick one and stick with it.  Childbirth classes are as important for the birth partner as for the mom. 

Pack only one bag:  For the initial admission into the hospital, try to condense everything into one bag.  Triage rooms are tiny.  Leave all the postpartum supplies in the car.  Bring only what is needed for the labor and birth.  You don’t want your nurse rolling her eyes at the first-time couple bringing 5 bags into the room. 

During Your Birthing Time:

Stay home:  The couples I work with who report the most satisfaction in their births are the ones spend most of their labor at home.  Even more reason to hire a doula–she can help you feel comfortable about deciding when to go to the hospital.  At home you have privacy, hydrotherapy, familiarity, nourishment, and power.  My recommendation is once you feel it is time to go to the hospital (unless you are arriving very late in the game), take a moment to take a shower/bath or freshen up.  Use this time to gather your focus and repeat your affirmations.  This can also remove you from your birth partner’s fluster of loading the car!

Stay hydrated and nourished:  Your birth partner and doula should be on top of this task.  I’ve noticed that most of the time, if a confident mom is drinking or eating at the hospital, the nurse usually turns her head.  I remember during one birth, I simply blocked the nurse’s view and told her the mom was drinking some water.  The nurse replied, “Yeah, I can’t see that or I’ll lose my job.”  And that was that.  In this case, it is easier to ask forgiveness than permission. 

Stay cooperative and positive during admission:  The admission process is ridiculous.  The number of consent forms keeps growing.  When you have a pressure wave, simply stop signing forms and focus your attention.  Hold your hand up or make a “shhhh” sign if a nurse continues to talk.  You do not have to be hurried.  Some hospitals allow you to come in before your birthing time to sign forms.  Ask if this is possible. 

Be confident and make the first move:  It is important to present a confident demeanor.  This task can fall on the birth partner if it suits his personality.  The birth partner should make the first move when the nurse arrives (once you’re in a room and know who your nurse will be).  He should introduce the birth team–calling mom and baby by name; introducing the doula.  I call this move “disarm by charm.”  The birth partner should also use every opportunity to brag on the mom.  “Isn’t she amazing?” 

Bring goodies:  Nothing like a little surprise to woo your birth team.  Bring at least three gifts for nurses (there could be shift changes or a student nurse).  One nurse told me she loved 5.00 starbucks gift cards since there was a starbucks in the hospital lobby.  This is not bribery.  Oh no, no, no. 

Do not stay in bed:  A great nurse will examine you or perform procedures in alternate positions.  However, if your nurse is not comfortable with this, use the bed for the duration of an exam/procedure only.  If you are being monitored, sit or stand by the bed, use the birth ball, or request a telemetry unit (if available).  Your partner or doula can volunteer to hold the monitor in place for wiggly babies.  In my experience, once you are in the bed, the monitors and blood pressure cuff stay on.  If you would like to lie down, consider using the couch!   

Stay unhooked:  Each time you are hooked up to a monitor, ask the nurse for a time frame.  She will likely leave.  If she has not returned by the time she gave you, unhook yourself. 

Control the mood:  Keep the lights low.  Keep the door closed.  Have music playing.  Massage mom with some lavender oil.  Use a low tone of voice.  If you create an atmosphere of serenity, your nurses and care providers will usually join in.  At a recent birth, the nurse commented on how much she loved coming into our room because it was so peaceful.  She automatically relaxed and lowered her voice.  If your nurse forgets to turn the lights down or shut the door when she leaves, the birth partner or doula should jump on it. 

No one should talk during pressure waves:  Maybe the hospital staff will join in the silent tribute if the birth partner and doula are quiet during mom’s pressure waves.  I’ve noticed that hospital staff can be quite chatty during labors.  Staying quiet during waves reminds everyone to keep their focus on the mom.  The birth partner may “shhh” someone if needed.

Memorize BRAIN:  What are the Benefits?  What are the Risks?  What are the Alternatives?  What does my Intuition tell me?  And what if we do Nothing?

Order a squat bar:  If your hospital has one (or more), request it.  Sometimes it takes a while to find it (and dust it off). 

Have a SHORT birth plan and/or baby care plan:  I think a birth plan can be a positive tool.  Include the names of everyone on the birth team and include the baby’s name.  Keep it short.  Do not include things that are easy to speak up for in the moment–like freedom of movement or minimal vaginal exams.  I recommend focusing on 2nd stage and 3rd stage birthing practices–birth position, routine 3rd stage pitocin, cord care, pushing, immediate skin-to-skin, etc.  These are the times that mom needs lots of support and focus.  Your nurse can help facilitate your birth plan at this point.  What is a baby care plan?  I’ve noticed that it is tough to communicate with the baby nurse in advance.  She often arrives as “delivery is imminent.”  She doesn’t know you.  Doesn’t know what you want.  You can create a simple baby plan and place it in the newborn warmer for her to find as she sets up.  Include the things that are important to you:  immediate skin-to-skin, procedures that should be delayed at least an hour, procedures you are declining, etc. 

When you feel “pushy,” wait:  This one might be controversial.  Things seem to get a little wild in the hospital when it is “time to push.”  If you’re laboring quietly and you feel some spontaneous pushing sensations, try to ignore them or bear down a little.  It is a great time to hang out in a dark bathroom with the door closed.  There is no need to rush the drama that will come.  Sometimes you begin feeling “pushy” before you are fully dilated and you’ll end up with several vaginal exams, instructions not to push, words tossed around like “anterior lip,” and “you’ll tear your cervix.”  You really don’t need multiple fingers messing with your sphincter when you’re trying to release a baby.  If you’re comfortable, lie low and wait until you have the absolutely-can’t-help-myself-hurling-pushing waves to call in the staff. 

Don’t give up the baby:  Finally, your little one is in your arms.  Barring medical concerns, keep the sweetling in arms.  If the well-meaning baby nurse says “let me just take him for…” understand that it could be 15-30 minutes before you get the babe back.  Delay, delay, delay.  Eye ointment, shots, footprints, tagging–these things can be delayed and they can also be done in mama’s arms.  Keep your newborn skin-to-skin as long as possible.  Just say “no” with a disarming smile, of course.

Midnight Arrival

Long Drive.

Strong Mama.

Great Music.

15 Minutes of Pushing.

Healthy Baby.

Immediate Breastfeeding.

Long Drive.

Tired Happy Doula.