Tips for Achieving an Unmedicated Birth: Strategies for Labor and Delivery (Part 3)

If you're just joining, check out Part 1: Preparing Your Mind and Part 2: Preparing Your Body.There are so many different strategies you can adopt to help ease discomfort during labor. An acronym that's helpful in organizing these techniques is PURE:

Positions. The desire to move around during labor was one of the reasons that I wanted to avoid an epidural. I think it's a good idea to familiarize yourself with different positions that can be helpful in reducing the pain of contractions, but I also believe that your body will guide you during labor. Taking a cheat sheet with you to the hospital in case you do end up needing different ideas during labor is still a good idea. An example can be found here.

Urinate. A full bladder can put additional pressure on your uterus, making contractions challenging. Go to the bathroom often.

Relax. A few ideas to help you relax during labor:

• Visualization. This is the practice of using visual imagery of what is happening in your body to help the progression of labor and keep your body relaxed. All of my experience with visualization was through the HypnoBirthing course I took, and if this is something that you think you may find useful, I'd highly recommend reading the book and looking into taking the course because there's way too much information to discuss here.

• Deep breathing. This was a lifesaver for me and was a huge part in helping me stay in control during labor. I'd recommend practicing deep breathing daily during your pregnancy. Simply take a few minutes to inhale and exhale, counting to 8 for each, while also focusing you filling your abdomen so that it rises on the inhale. A snippit on this from the HynoBirthing book: "When your uterus surges (contracts), it rises. Slow breathing helps you to work in concert with that upward movement of the uterus as you breathe your abdomen up to the highest possible height- like filling an inner balloon. This maximizes the wave of the vertical muscles (the outer longitudinal muscle fibers of the uterus that contract to help push the baby out), causing them to work more efficiently in drawing up the lower circular muscles (the muscles that are concentrated near the cervix that need to be relaxed in order for it to open for birth), and thinning and opening the cervix. The assist that this gives to both sets of muscles shortens the length of the surge (contraction) as well as the length of labor."

• Massage

• Birth ball. This is good not only for relaxation, but can also help to open up the pelvis, allowing the baby to move down. 

• Bathtub

• Heating pad (generally provided by the hospital)

Environment. A calm, comfortable environment is so important to staying relaxed during labor. A few ideas to creating a tranquil environment:

• Choose a supportive doctor and birth partner. I cannot emphasize enough how important it is to choose a care provider who supports your birth preferences. Choose your doctor carefully and discuss your birth plan fully. You obviously don't have control over which nurses will be working when you're in labor, but (at least in the hospital where I had Noah) you can share your desire for an unmedicated birth while in triage and they try to assign you a nurse who prefers to work with and/or has a lot of experience with unmedicated birth. It's also important that you have a supportive birth partner. For many women, this is the father of the child, but you may also opt to hire a doula.

• Specify your preferences for lighting and bring music you find soothing. Some women find that dim lights and relaxing music have a calming effect during labor and birth.

• Use aromatherapy. My thought on using aromatherapy is that it will be most effective during labor if it is used in conjunction with relaxing activities during your pregnancy (meditation, yoga, a warm bath) so that there's a positive association. Lavender is an obvious favorite.

• Bring things from home to make yourself more comfortable. This may include pillows, blankets, comfortable clothes, etc. Just make sure you're ok with them getting dirty/stained.

• Post a sign on the door so that any staff member that enters the room is aware of the type of environment you're trying to create. We got a sign in our HypnoBirthing class that simply said, "We are a HypnoBirthing family", but yours could say something like. "Our goal is to achieve a calm, unmedicated birth". 

A few additional tips:

Make educated decisions regarding interventions. Modern medicine is amazing and sometimes so necessary. But too often, interventions are used unnecessarily and just lead to complications that require additional interventions. If an intervention is suggested, ask these questions (or have your birth partner do so. You obviously may not be in any state to be having full-blown conversations. This is another reason why it's so important to have a supportive birth partner who understands your desires exactly). Just remember the acronyn BRAIN:

• Benefits. What are the benefits of the procedure?
• Risks. What are the risks?
• Alternatives. What are the alternatives?
• Intuition. What is your intuition telling you?
• No/Not now. What would happen if declined or said, "Not now"?

Minimize the number of cervical checks you get. I can tell you from experience that nothing is more frustrating than feeling like your body is working hard for a long time, but you're checked and haven't progressed. It took me seven hours to dilate one centimeter, and less than an hour to dilate an additional FOUR! When I was checked after that seven hours and learned that almost nothing had happened, it was so defeating and made me want to give up on my goal to have an unmedicated birth. Every body progresses at a different speed, and the information gained from a cervical check is not always an accurate representation of what's going on in your body or how much longer your labor will last. So, do yourself a favor and have as few of these as possible.

One thing that I have to emphasize is that these ideas are good for your labor toolbox, but you probably won't use all of them. You'll know what your body needs and you'll figure our very quickly what doesn't work for you. Thank you so much for reading and best of luck in achieving your birth goals! If you have any questions about anything you've read in this series, I'd love to hear from you at luckytwentyeight@gmail.com.

Why I'll Hire a Doula for My Next Birth

I always knew that I wanted to have an unmedicated birth, I just wasn't sure how I would go about achieving it. One thing I knew I definitely didn't want was a doula. It seemed like an unnecessary expense, and I preferred to have as few people in the room as possible anyway.

Josh was totally supportive of my goal and birth plan. He was familiar with the Hypnobirthing method. He had learned about the birth process right along side me and shared my enthusiasm for avoiding certain interventions. We practiced the techniques we thought we may want to use. He should have been a fantastic birth partner. But he wasn't, because he's a boy. And because of that he didn't understand what I was feeling or what I needed.

I was fantastically lucky to have a nurse who had used the same method I was using to give birth to her own child. She helped me in a way that only a woman who had experience with unmedicated birth could. She helped me in ways that my husband could not. She knew what to say, what suggestions to make. Having her as my L & D nurse was an amazing stroke of luck and she was an integral part of Noah's birth. Next time, I won't leave it up to chance and hope that I have a nurse with similar beliefs about birth and knowledge about achieving the process naturally. I'll seek her out because now I realize what an asset an educated, supportive, sensitive woman can be to achieving the birth you want.

Tips for Achieving an Unmedicated Birth: Preparing Your Body (Part 2)

I can't emphasize enough how important confidence, education, and the ability to relax your body and mind are to achieving a natural birth. If you missed it, check out the first segment in this series, Preparing Your Mind. Your body is designed to give birth, so you can do it without being in great physical shape. There are a few things you can do, though, that can help you prepare for the process. 

Eat dates daily during the last month of your pregnancy .
A study published in the Journal of Obstetrics and Gynecology (read more about it here) found that women who ate dates daily during their last month of pregnancy were less likely to need medication to start labor, were more dilated upon arriving at the hospital, and labored seven hours less on average! There's a compound in dates that mimics the effect of oxytocin, one of the key hormones involved in labor (pitocin is the artificial version of it.) I ate six or seven dates every night starting at 36 weeks and my labor and delivery were quick! There are so many variables that go into this type of thing, but research backs it up, and it can only help!

Do these exercises daily.
There are a number of different stretches/exercises that can help prepare your body for birth. I did these regularly (except for squatting due to the activity restrictions I had).

• Tailor sitting-Sit with your back against a wall in a butterfly stretch and gently push your knees to the floor for 10-15 seconds. Repeat 5-10 times. This stretch improves blood flow to the lower body and stretches the pelvic joints, which can make baby's descent easier.
• Squatting-Squatting is an awesome position to use during labor because it can create extra room in the pelvis, allowing the baby to descend more easily. It can be tiring though, so the purpose of doing squats during pregnancy is to build up your strength so that you can do them during labor. 
• Pelvic tilts- You yogi's out there are probably familiar with this one (also known as cat-cow). Get on your hands and knees, keeping your head in line with your back. Slowly push your back upward, creating an arch, and hold for a few seconds. Then, relax your ab muscles and let your belly fall slowly towards the ground, creating an arch. Repeat a few times. This exercise helps with lower back pain and abdominal strength and is beneficial to preparing for labor because it may help a posterior ("sunny side up") baby move to the anterior position. An anterior-facing baby's head is going to put more pressure on the mother's cervix than a posterior-facing baby, which makes contractions more effective and labor and delivery quicker and easier.

Spend some time on a physio ball.
After I was released from strict bedrest at 36 weeks, I spent some time every day sitting on an exercise ball. Doing this opens up your hips and allows the baby to move down, putting pressure on your cervix and aiding dilation.

Follow along for part 3, Strategies for Labor and Delivery.

Tips for Achieving an Unmedicated Birth: Preparing Your Mind (Part 1)

When I was pregnant with Noah, I spent a lot of time reading about natural childbirth. What could I do to prepare my body for birth? What about my mind? What could I do to ensure that labor and delivery were quick and as complication-free as possible? Preparing yourself for something you've never experienced is as challenging as it sounds, so I'd like to share what I learned from my natural birth in hopes that it will help others in achieving their goal of having an unmedicated childbirth. Because there's so much information I'd like to share, I'm going to divide this into 3 separate posts. Part 1: Preparing Your Mind, Part 2: Preparing Your Body, Part 3: Strategies for Labor and Delivery

Let me just say, pregnancy and birth are a BFD no matter how they happen. This isn't meant to make anyone feel like there's one right way and that everything else is inferior. The "right thing" is different for different people. This is simply information about what I found helpful in the process of preparing for birth.

The psychology major in me knows how much power your brain has over your body, which is why I decided to make this the first part of the series. Take phantom pregnancy, for example. Despite the fact that a woman is not carrying a child, her periods stops, her abdomen swells, and she begins lactating. Her brain is so convinced that she's pregnant that her body starts acting like it is. Another example of the power of the mind is a study from the Cleveland Clinic Foundation that found that just visualizing a specific muscle being strengthened (without even working the muscle) actually makes it stronger. Bottom line? Your mind controls your body. This concept is crucial for achieving an unmedicated birth. So, what helped me prepare my mind for a natural birth?

Education

Read every (positive) thing you can about birth. I think that learning about the process of birth and everything it entails makes it less scary. It also empowers you to make informed decisions throughout your pregnancy and birth.  Too frequently in obstetrics, common practice is not research-based. Act like becoming informed about evidence-based practice is your job. If you read only one thing to help prepare you for birth, let it be What to Reject When You're Expecting: 10 Procedures to Think Twice About During Your Pregnancy from Consumer Reports. It discusses in great detail how overuse of unnecessary procedures and regular use of practices not rooted in research have caused the US to have one of the highest infant and maternal mortality rates in the industrialized world.  Many doctors will still induce (without medical reason) between 37 and 39 weeks, even though research shows us that a baby is still experiencing significant development during this time period. Artificial rupture of membranes is also common practice, despite the fact that research tells us that, on average, breaking a woman's water doesn't decrease the length of labor. You and your baby deserve to recieve medical care based on sound research. Be informed.

If you have time, check out 'More Business of Being Born'. I particularly enjoyed the interview with Ina May Gaskin in the segment entitled 'Down on the Farm' and the birth stories in 'Special Deliveries'. Watching these segments provided me with useful, interesting information that solidified my decision to have a natural birth. It's also interesting to hear about other women's birth stories and what worked for them. 

Hypnobirthing

This method appealed to me because, like I said, my education taught me the power of the mind. Hypnobirthing consists of guided relaxation, visualization, and positive affirmations. The classes and book were full of useful information, but one concept that really resonated with me was the Fear-Tension-Pain cycle. It's the idea that fear (of birth or pain associated with birth) causes physical tension in your body, which leads to additional pain. If you can eliminate fear and tension, it will help to minimize pain. Believing that birth is a natural process that your body was built for and understanding exactly what is happening during the process can help to eliminate fear. The guided relaxation component of Hypnobirthing also helped me to learn how to relax my body and mind, which is an integral part of mastering the Fear-Tension-Pain Cycle.

Confidence

I think that so much of birth (and life generally, really) is a confidence game. You need to believe in your body's ability to give birth. Part of the Hypnobirthing program was listening to and repeating positive affirmations like, 'I am focused on a smooth, easy birth', 'My mind is relaxed, my body is relaxed', 'I trust my body and follow its lead', and 'My baby's birth will be easy because I am so relaxed'. Believe that you are capable. Have faith that it will go well.

For the sake of your confidence, I would also recommend keeping your plans for a natural birth to yourself unless you're being asked or you know that the person you're talking to will be supportive. Josh and I followed this piece of advice, and I'm so glad we did. Comments I got from the people who asked what our birth plan was: "Ha! Good luck with that!" "I said I'd have a natural birth too. You'll change your mind when the contractions start", and "You think you're going to have a natural birth?! I bet you'll be begging for the epidural at 4 cm". Equally as important as avoiding/ignoring negativity is sharing your plans with people who will encourage and support you. Giving birth without pain meds is a crazy hard thing, but you're totally capable and you don't need people telling you otherwise!

Check out Part 2: Preparing Your Body, and Part 3: Strategies for Labor and Delivery

Noah's Birth Story

After being monitored for a short cervix from 20 weeks and then being hospitalized for preterm labor at 33 weeks, we were pretty sure Noah would make his arrival before his due date. I was put on strict bedrest for two weeks after getting out of the hospital and was put on nifedipine to stop the contractions. I was actually surprised that I didn't go into labor immediately after coming off bedrest and the medication and told Josh I would be shocked if we made it past 38 weeks. 

We went to my 38 week checkup on November 14th and the first thing my nurse, Benny, said to me is that she was shocked I was still pregnant. I went to the bathroom to do my urine sample and heard a sort of popping sound. Something started leaking so I ran back to the exam room to tell Benny. The doctor came in to check me and verified that my water had indeed broken and I was dilated to 5 CM! We were all so excited!

We were admitted to L & D and my doctor told us that we would start talking about pitocin if contractions hadn't started by 6 pm. We had taken Hypnobirthing (childbirth classes that focus on preparing for a natural birth) and our goal was to have an unmedicated birth, so from about 2 to 4:30 we tried a few different things to get contractions started, including walking and rolling around on a birth ball. The contractions started in a normal pattern around 5 o'clock, about a minute long and a few minutes apart and that probably lasted for about an hour. They quickly picked up and got to 2-3 minutes long with very short breaks in between. Sometimes a new contraction would start just as the last one was starting to die down and they were strong. It was definitely overwhelming. 

Around 7, Dr. Arhcibald asked if he could check my cervix because the contractions were so close together and so intense. I was devastated when he told me I was only at a 6. I felt like my body had been doing WAY more work than that and I couldn't imagine doing what I had just done for hours and hours. He said that I was 90% effaced and that I would probably progress more quickly from that point on. After that I got in the tub and things just got more intense. My nurse Chetan had given birth to her child naturally using hypnobirthing techniques and she was incredible! She kept reminding me to breathe and relax and told me that she rarely saw moms as in control as I was, which definitely made me feel better. At some point I started crying and told her I didn't know if I could do it and she reminded that I was doing it.  I started to feel an overwhelming urge to push around that time so Chetan decided to see if I had made any progress. She checked me and immediately pulled the emergency cord in the bathroom. Then she said, "Breanne, look at me. The baby is right there and you NEED to stop pushing so we can get you to the bed". I told her I couldn't stop pushing and she assured me that I could, I just needed to breathe through it. She helped me breathe through the rest of the contraction and we quickly moved to the bed before the next one started. I had progressed from 6 CM to 10 in less than an hour.

Things got a little chaotic at this point. My doctor was on a conference call because he thought he had enough time. Because of how quickly everything happened, the doctor on call took a few minutes to get to the room, so we had another doctor and multiple residents and nurses rush into the room. I thought that having so many people in the room would bother me but I didn't care about anything else at that point. I pushed for about 10 minutes and he was born at exactly 8 pm with his arm next to his head! Meeting Noah for the first time was the most incredible experience! He came out crying but quickly calmed down and just hung out and looked around. He was so alert! He was seven pounds even and 19.5 inches long. Giving birth was a challenging but incredible experience and I'm so grateful that things went so smoothly and that Noah is in perfect health!

On a side note, I would highly recommend Hypnobirthing classes to anyone looking to have a natural birth. The reading, classes, and exercises taught me to relax my body completely and gave me confidence in my ability to give birth without medical intervention. You can visit here for more information or to find a class in your area.