Childbirth - To My Expectant Girlfriend - Part II
If you were my girlfriend and you told me you were pregnant with your first, this is the conversation I would have with you. If you missed the first post in this series, I covered sleep. Childbirth is a complicated, information overloaded and sometimes controversial topic. There is more than enough information out there for the expectant mom, so I will be brief. I won't even fill this up with a bunch of resource cited research. I will just give you my straight opinion based on the reading I've done, the real life conversations I've had with moms, the personal birth trauma processing I have done with various professionals, a little of my own experience and the information I have gleaned through conversations with many birth partners (doctors and midwives).
1) Birth position greatly influences labor and childbirth. I honestly think this is the number one influencing factor for how your labor will present itself. The optimal birth position for your baby in the womb at the onset of labor is anterior, which is head down, chin tucked, back to belly (I repeated that mantra over and over again while pregnant, visualizing this optimal position).
It seems to be common knowledge in the community that anterior labors progress more easily than posterior presenting labors. Simply put, if your baby is posterior ("sunny side up") you will most likely have a prolonged and more intense labor than if baby is in the anterior position. You will also most likely experience back labor. There is no question, some women just simply have an easier time giving birth than others. Some women push for much longer than others. Some women experience a much more extreme amount of pain than others. I feel that a lot of the reasoning for these differences gets attributed to the shape of the mother's body, how she mentally and emotionally prepared herself for labor, potential fears she may have been subconsciously carrying, the fitness level she was in by the time labor commenced, the quality of her diet, or how hard she worked during pushing.
My main conclusion for all these differences in labor experience is simply "what was the position of the baby?" While all those other factors may have an influence, and I believe they do, I think the presentation of the baby is quite possibly the greatest influence on how labor progresses.
2) Interventions easily lead to more interventions. Epidurals frequently lead to the need for other interventions, across the board. A woman that has an epidural cannot get up and move around, so if the baby is not in a good position, there is little the mother can do to encourage a better position to help the labor progress.
Pitocin is frequently used to increase the intensity of contractions in an epidural labor, particularly in a slow progressing labor. The increase in intensity sometimes puts stress on the baby, causing distress, which can lead to Cesarean. Having a Cesarean carries varying degrees of risk, and also necessitates the use of an antibiotic, which will then expose the baby to antibiotics. I have come across some studies that link early exposure to antibiotics to the development of allergies and asthma in children.
Even if Cesarean is not necessary, vacuum or forceps assistance to get the baby out is also more common in epidural labors, necessitating an episiotomy (cutting of the vaginal opening) to allow for the tools to reach the baby's head to assist delivery. An episiotomy many times ends up damaging the perineum more so than a natural tear potentially would have, therefore causing a much more painful post birth recovery. Certainly many women tear naturally, some greater than others, but tearing is not always a given and it is possible to give birth and have the entire perineum remain intact.
There are risks to the baby when the use of instruments to assist in delivery are undertaken. Manual rupturing of the membranes too early in labor can also increase the risk of infection, particularly in a woman that has Group B Strep (GBS). The longer the amniotic sac is exposed to the birth canal, the higher the chance that bacteria will travel into the uterus.
3) Contractions will happen after child birth. These are typically referred to as "After pains." I was told this in birth prep class, but greatly underestimated how painful they would be. Doing my research, it appears that women's experiences vary widely in this area, as some women are completely oblivious to them, while others feel some discomfort, and still others experience a great deal of pain (this was me). I would describe mine as worse than any period cramps I have ever experienced in my life, and I have had some painful ones.
On my third day post birth I shared with my son's doctor the pain I was experiencing, and being a homeopathic practitioner as well as regular M.D., she recommended two homeopathic remedies: Cimicifuga racemosa 30c and Caulophyllum Thalictroides 30c, both common menstrual cramp remedies. I would say they helped, and are worth having on hand before giving birth in the event you struggle with this discomfort. It is also more commonly experienced during nursing sessions, as nursing stimulates oxytocin which in turn causes the uterus to contract. This contracting of the uterus after birth is very important as it helps to shrink the uterus and minimize bleeding.
I discovered AfterEase from Wish Garden while pregnant with my second, and I found it to be extremely effective in easing the after pains. I highly recommend all expecting moms have this on hand in preparation for the postpartum recovery period. Unless you know you are having a C-section and expect to be on pain meds in the days following surgery.
4) There are natural, drug free, pain relief options. If you are interested in a drug free, natural birth, I highly suggest you investigate pain relief options. One interesting method that I wish I knew of was sterile water injections. I had severe back labor with #1 and had I known of this option I would have definitely tried it. TENS units have also been widely used for drug free labors, and many women report positive results with them.
Acupuncture can be used in a variety of ways in labor, and I plan to use this method with #2. Holistic Squid, my friend, fellow blogger and Acupuncturist compares labor acupuncture to first aid. Whatever the mother wants and needs is what is focused on in the moment, in the treatment. Whether it is relaxation, anxiety, fear, emotional, physical, an acupuncturist can provide a treatment that may have beneficial results for the laboring mother.
Homeopathic remedies are also very safe to use and may alleviate some of the intensity a woman experiences. I appreciated this resource which gives many of the remedy options for the individual circumstances in labor. While there are many options, and there is no way to know which circumstance you will experience, you cannot go wrong with using Arnica 200c, which can also be used after birth for recovery as well.
5) Take a childbirth prep class. Okay, so I want to preface this by saying that expecting any method to work in such a way that you're not even aware that you are in labor is unwise. I have seen so many beautiful, peaceful, joyful and seemingly painless and struggle free births caught on video that I absolutely believed this could be achieved with enough visualization, mental practice and meditation. I think the reality is that some people just have an easy time giving birth, and sometimes those births get caught on tape. I think the biggest takeaway you will get from a birth prep class is learning techniques to calm your mind and calm your body so you don't go into major freak-out mode when stuff starts to get real. Childbirth can be a very real mental battle with yourself just to maintain calmness and control, so practicing various relaxation methods and mantras ahead of time is probably your best bet at having something "work" for you to achieve the birth you are hoping for. There are so many childbirth education classes out there, I hesitate to recommend any one in particular. Do some research and decide based on what your personal preferences lean toward.
And assemble the resources that help you maintain calm. Essential oils? Ocean and nature sounds? Monks chanting? Classic rock? Yoga? Put together a playlist of all your favorite songs that make you happy and at peace. Prepare all the things you think will help you feel nurtured and relaxed.
6) Hire a doula. This should really be at the top. I recommend hiring a doula to every single pregnant mother I know, particularly if they are planning a drug-free birth. Their fees vary widely based on years in practice and experience. If you feel like you can't afford one, contact a local resource to find out if there are references for doulas in their training phase that need birth hours for certification. Their fees are typically much lower than one who has been certified. I had three different doulas for my three births, and the doula that was most experienced and the only one fully licensed was the worst out of the three. Don't judge based on experience or lack of certification! Sometimes the newbies are much better at supporting a laboring mom.
7) Don't let anyone into the birth room that you don't want to be there. This seems like a "no duh!" piece of advice, but it happens ALL the time that parents and well-meaning/intrusive family members assume they will be allowed at the birth. They may even guilt you into inviting them to show up when they are given notice you are heading to the hospital. When I was pregnant with my first, the midwives said for each additional person in the birthing room a laboring mother can expect to have 2 additional hours of labor added on to her birth. That is probably an underestimation. A dear friend of mine was progressing splendidly along until her mother showed up. She was at a 9 cm dilated and got stuck there for HOURS once her mother showed up and got all up in her business. Don't let that happen to you. Your birth is no one else's business but you and your husband's. And advise your husband to be your advocate, if you know you've got a pushy family member that will burst in uninvited, he is to man up and escort them out promptly! Get over feeling guilty. It ain't worth it and will only create obstacles for you birthing how you want.
With my first I thought for sure I would want my good friend, my Aunt AND my Mother-In-Law present, in addition to my doula, my husband, the midwife and her assistants. We even considered allowing a film crew and celebrity to be present, as they were in the midst of filming a documentary about happiness and wanted to include a birth. That's all really just crazy talk. Everyone got uninvited when I actually went into labor. You kind of go into a primal mode where you want to just be left alone, apart from the very few people that are knowledgable and capable of supporting your journey.
I love how my first midwife put it, "Birth is like sex, or going to the bathroom. We don't pretend we don't do it, but we don't invite an audience to watch, either." Enough said.
How about you, experienced moms? Any advice you want to add that you think would be helpful for the newbie walking into this for the first time? Comment below!
Check out the first post in this series - To My Expectant Girlfriend - Part I