Living in Denial – Three Reasons to Ignore Early Labor

This is where I am today – living in denial. I’m due with my third baby tomorrow, and while the contractions are taking my breath away, to be honest they haven’t organized themselves into a definite pattern yet, and I really can cope, and they really are not that bad. – Febuary 1st, 2011.

The above quote is from a post I started writing in early labor. I didn’t finish the post. I decided instead to go for a walk around the forest behind my house and through the neighborhood, a walk that takes 20 minutes on a normal day, but took an hour that day. I kept having to stop, and hold onto a tree or lamp post, and breath through the contraction, gazing on the beauty of the world around me that misty wintery day. By the time I’d circled back homewards, I phoned my husband to come back from work and called my midwife  – I could no longer live in denial, I knew I was in labor! My son was born by 5pm, that same day, at home. You can read the full birth story here.

 

I often talk to expectant mothers about the benefits of living in denial, and here’s why:

1: You end up focusing on the pain later, so your threshold is reached later. When I walk into a birth space and find the mother focused inward and breathing deeply through contractions, yet find that the contractions are either far apart, lasting much less than a minute or still unevenly spaced, then she might be using her coping strategies too early. I adore Hypnobirthing, but even using Hypnobirthing too early can mean exhaustion is reached after X number of hours, and that the techniques for coping with pain are sometimes “used up” by the time real, intense labor hits. Mom has tapped those resources, and reached the end of her rope before that rope was even needed. If you save your coping techniques and use them later on in labor, when things are so intense you can’t deny them anymore, then you still have those cards to play when you need them!

2: That old adage, a watched pot never boils? It is so true. Tension and anxiety produce the cortisol hormones that are not beneficial for labor. I know, the moment we tell you to “relax” and “enjoy yourself” and “don’t let yourself get stressed”, that just causes more stress! Man, how hard it is to convince yourself to not be stressed! Impossible. Instead, I encourage moms to look away; to plan a fun date or dinner or event to attend for their due date, and another for the day after. If you are looking forward to hanging out with friends or seeing that great movie, or going swimming with a girlfriend, or getting a pedicure with that cute niece who idolizes you – then you will be looking outwards and not meditating on inward frustrations. Bonding with other people encourages oxytocin – an essential labor hormone. There is an excellent idea in the comments section of this bringbirthhome post, where the mother looked over wedding photos and read old letters with her husband in early labor. The mother got a great dose of natural oxytocin through that beautiful bonding experience, which enhanced their labor process.

3: Lying to yourself WORKS. I was listening to a podcast about lying by Radiolab the other day (the third story on the podcast, the most interesting bit starting at minute 8) and I got so excited! I’ve used this method for such a long time, and never realized that researchers have identified the benefits of living in denial. Apparently, the happiest people in the world are the ones that lie to themselves, rather than focusing on the negative side of things. This approach works for many aspects of life: a simple example is how I coped with living for years in a hot country like Israel, after growing up in Alaska. We didn’t have any air conditioning for most of the time we lived there, and even our car was air-con-free. To cope, I would first: cross the street in order to walk on the side with the most tree shade (taking practical steps!) Two, I would tell myself, “Wow, it’s not nearly as hot as I expected today. I thought it would be worse! I’m just fine. Easy.” I find that these same words work well in labor as well. The language we choose to use, even aimed at ourselves, is a powerful weapon.

Let me assure you; when you are in active, full blown labor, you CANNOT POSSIBLY deny it any longer. You will know. Full on active labor takes all your concentration, all your focus. It cannot be ignored. So when you reach that point, forget living in denial – welcome to labor land. And you will be meeting your baby soon!

Does the thought of living in denial make you feel nervous? How can you know that you are not staying home too long, and want to know when to go into hospital? Read How Dilated Am I?

Will knowing how to catch your own baby just in case you do stay home too long put your mind at ease? For some, the practical tools put their minds at ease just a little bit. Read The Four Rules of Precipitous Labor

Many labor blessings-

Sarah Vine, doula

 

 

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Eight Ways To Avoid an Episiotomy (And Even Reduce Your Chances of Tearing!)

Ah, the ‘E’ word that every makes every mother-to-be tremble in her boots.

Of course, tension and fear is not the best way to help a baby come out! Birth is complex and mysterious and beautiful, and driven by hormones. These hormones are strongly connected to your thought processes: for example, take oxytocin, aptly nick-named named the love hormone. Those feelings of warm affection, vulnerability, acceptance, enjoyment – are they present in the face of  fear? No.

We want to create a birthing situation where you have done your utmost to set fears aside and know that you are ready to be open, wide, soft, accepting and ready to welcome that baby into your arms! Closing your eyes and hoping that if you don’t look and wish hard enough things will go away is not going to improve the chances, either. Here are practical steps you can take to making yourself ready.

1. Have a dad or other close family member with you in the birthing room! That doesn’t negate a doula, and a good doula with a calming presence who can switch out coping ideas, provide warm encouragement and a wealth of options is priceless. However, as much as many women hire a doula to be your advocate, in reality there is a limit to the amount of voice that she can use in the delivery room. Yes there are appropriate times when a doula will be vocal and stand up for your rights, but we walk a fine line. Plenty of doctors, nurses and midwives are wary of a doula who is ‘pushy’, and we are well aware that a doctor or midwife who is annoyed is NOT one you want to be looking at your soft parts when a baby is coming out! Talk about feeling tense down there. Therefore, when I work with a mama, I try to foster a warm, welcoming, inclusive atmosphere in a birthing room. I may make gentle suggestions, I may successfully help make staff aware of the mama’s desires, but I will be non-confrontational. I find that this approach works best, because when hospital staff feel lovingly welcomed into the mother-doula bond in that birthing room, they are MORE likely to be flexible when it comes to birthing position/waiting the baby down/cutting the cord late etc. However, when it comes to using the scissors on a perineum, in actuality the best person to advocate for the mom (who is feeling very vulnerable and word-less at this stage) is her Birth Partner: the dad, or even another close family member. That Birth Partner should be given the authority beforehand by the mom, (almost an edict!) that even if they are queasy about birth and feel out of place, their job can be to be as involved as they want or even just stand by the mom and love and compliment and cherish her throughout the birth – but – if they see scissors, their job is to firmly say ‘No’. There is no need to be aggressive, no need to shout, but to feel confident and take this one task of standing up for the mother and own those words. The father of the baby (or another close family member) who gently but firmly reminds staff that the mother would rather tear than be cut* will usually be much more readily listened to than a doula at this one particular moment.

2. Only hire a practitioner that has a low episiotomy rate in your area, make that one of your hiring criteria! A good example of a low episiotomy rate is in the testimony of CPM Pamala Hunt in More Business of Being Born, Conversations With Ina May Gaskin, where the well experienced midwife quietly states that she has not done an episiotmy in 25 years. And this is a woman who has attended over 1,000 births. The video (also found on Netflix) is excellent to watch, if only for the part where both Ina May and Pamela speak confidently and simply about waiting for the baby to slowly crown, and how this slow back and forth progress of the head gently stretches the perineum, naturally. Truly inspiring.

For mothers who read this in Israel: when you arrive at the hospital the first thing you ask for is to please have a midwife who believes in and enjoys natural birth, or is a native English speaker, before you even hand over your forms, in the same breath as ‘Hi.’ This doesn’t ensure that you will have someone that doesn’t do episiotomies, but it does heighten the chances that you will have someone who will give you more leeway to do things your way and birth in a position other than flat on your back, or who will be gentle, or with whom you can build a good rapport! Those are all things that will help take you one more step away from the scissors.

3. Write a birth plan that will be paid attention to. A birth plan can be short and to the point, highlighting the things that are MOST important to you. Of course we are not ‘planning’ the birth, we are simply communicating to your birth team what kind of a birthing mother you are and how you wish to be treated. Here is how to write an effective birth plan. It is an important element of being heard and understood.

4. Put positive words in your mouth! As you approach the end of your pregnancy make sure that you practice the belief that you will be wide, that you will be soft and stretch, that the opening will be huge! Repeat those words to yourself, make it something that you hear/say/think so often that you believe it with all your heart. If you take a Hypnobirthing course, then that is wonderful, because those words are used on tracks which you will listen to daily. Otherwise, find a relaxation or affirming birth track you can listen to, or read ONLY encouraging stories (such as are in the first half of Ina May’s Guide to Childbirth) or write those words on a sticky note and say them to yourself ever time you look in the mirror! Say it to yourself so often that it’s written indelibly in the deepest parts of your brain. Words we practice grow physical ‘branches’ of memory in our brain, almost like deep wagon ruts in a homeward path. Make this belief your path, and as the baby’s head is moving down and out of your birth canal say to yourself that you are big and wide and soft down there, and believe it in your heart. Have your birth partner whisper those words of belief to you. Remember, it is your brain that sends messages to your body to complete functions and actions – make those communications be soft and wide and your body will respond in that direction! It is very interesting to note, that even the rate of tearing is far less with hypnobirthing mothers. Your body does respond to what you believe.

5. Don’t tell anyone you are pushing. Now that I’ve shocked you, let me explain. If this is your first baby, then it may take you 2-3 hours or more to birth the baby after you are fully dilated. If it is your second or more, then it may take much less, but it will still take some pushing. After you are fully dilated, the baby needs to slide past your cervix, and come a few inches down the birth canal to where it will slowly dilate the vaginal opening and perineum and finally the rest will follow. Slowly is good! Slowly means that there is time for the exchange of fluids necessary for your skin and muscle cells to expand and grow without tearing or bunching up and cause injury. Make it part of your birth plan to use Mother-Led-Pushing. With mother led pushing, there is no “Okay! You are at 10 cm, now give me a really big push!” No. When a mom is allowed to push as her body requires her to, (such as is usually done at a homebirth) then there is often no need to check and ascertain every time that she is at 10 cm. She will start making different noises, with little grunts at the end of contractions. Her breath will catch a little, ending in a grunt, and her body will move involuntarily as if someone were pulling on her ‘tail’. Bit by bit these signs start to become more pronounced, as the pressure builds and the ‘need’ to push become more urgent. Is okay to feel with her own fingers (or someone else can peek) and be sure that the baby’s head isn’t pressing against the opening, just to feel safe. If you feel the urge is very strong and you are pushing hard, then it is time to let everyone know. The next time you see hospital staff, state that the mother is feeling pushy during contractions, without alarm in your voice. Pushing in this way is much more gentle on the mother, and on the baby, thus possibly avoiding a situation of foetal distress and maternal exhaustion after hours of ‘purple pushing’. I am not suggesting that you birth the baby without the presence of medical staff- I’m only suggesting that there is no need to panic when 10 cm is reached. When a mother is already pushing according to her body’s direction, then she has more of a chance of continuing with Mother-Led-Pushing. Once purple pushing is begun, it is nearly impossible to go back and follow your own instincts.

It is interesting to note that with an epidural it is much more common for hospital staff to give the mother an hour to ‘wait the baby down’ after reaching 10 cm, and let her body work the baby past the cervix on the power of it’s own contractions, without purple pushing. Why not wait with un-medicated births too, before jumping to instructing hard pushes straight away?

6. Use an EPI-NO. There are plenty of devices out there to help tighten a woman up ‘down there’, and finally here is one that helps to relax you in preparation for birth. The official site for the EPI-NO gives more information and distributes to the US. In Israel, experienced midwife Ilana Shemesh is a direct distributor for the company. The reason I suggest using this product rather than perineal massage, is that there is controversy over whether or not perineal massage actually works. I have a suspicion the reason for this is that with perineal massage you have little control over the actual dilation you achieve during practice; there will only be benefit if you stretch to 10 cm. With the EPI-NO, you can see your progress, and every couple of days you will be able to stretch a little bit further, with the aim of achieving 10 cm before giving birth. I have heard a midwife criticize the tool, and the reason she disproved was that with women who used the EPI-NO, their vagina looked like a woman who had given birth two times already even if she had not. I cannot figure out how this is a negative thing – in the end, the first time mother is the one at greatest risk for an episiotomy, and after she gives birth she will have to stretch to accommodate the baby, why not have the advantage of gaining the shape of a woman who has birthed before? It is worth considering. Here is a link to a conversation between number of pregnant moms about the EPI-NO. It is also recommended to use if you have torn badly or had an episiotomy previously, to help the scar tissue learn to stretch  One more thing: If you purchase the more expensive model, you can also use it for pelvic floor strengthening exercises post birth, which is excellent.

7. Keep changing position. The baby has to move a lot, and flex her head, then make a quarter turn in the process of being born, so it makes sense that you should move your body to help your baby along! Many times a mama will seem to feel ‘stuck’ in one position, often because she was told to stay put, and when all the blood in the body is focusing on the uterus and birthing this baby, the brain lacks a little bit of decision making room. But when I ask her to listen to her body and see if it would like to change position, often times after a moment’s reflection she is emphatic that she definitely wants to assume another particular position. We so often forget to ‘listen’ to what our bodies are whispering when there is so much business and adrenalin going on in the room around us, when in fact, the actual process of birthing is going on INSIDE. That is where we really should be focused. So, right now, I am giving you permission, as the birthing mom, to take any position that your body asks you to. When told to move onto your back etc, you can firmly and quietly decline with a shake of your head. Listen closely to what your baby and your body are asking you to do; you are the ones giving birth.

Changing position regularly is especially important when having an epidural! After an epidural, the mother will often get comfortable and take a nap, and even though her position may be shifted a couple of times, she is much less mobile than a mother without an epidural. She is also pumped full of bags of fluids, to counteract the drop in blood pressure (a side effect of the epidural) which just compounds the situation – this mama is FULL of fluids. And since she is not moving, they pool on the lower half of her body. After the longer hours of pushing, this usually means that the perineum (on the lower side of her body since she is on her back) is completely saturated with fluids. It is puffy and thick, and has already stretched so much that it cannot accommodate a baby’s head, hence the need for an episiotomy to make more room. Key word for epidurals: rotissary**. Keep her turning, from side to side, to back, to supported kneeling or all fours if possible. (There must be two birth partners to actively help with these last two positions. Never let her chest drop lower than her abdomen, or the epidural could possibly flow upwards.) Turn, ever 15-20 minutes, to keep those fluids from pooling, and avoid birth path oedema!

8. Give birth in a birth pool. When immersed in the water, your tissues are soaked and warm, so they are soft and pliable. It is uncommon for a mother who gives birth in a pool to tear badly, and obviously you is not going to be given an unnecessary episiotomy underwater – which circles back to point number two. If you are birthing at home or at a Birth Center, then you have already made your caregiver choices very carefully, haven’t you!

It is important to note that yes, there are occasional situations when an episiotomy is needed. But once you’ve made choices that lessen the chances of finding yourself in that situation, you can eradicate some of that fear. Embrace the stretching, opening, widening, of your body, gently and at the perfect time, releasing your precious baby. Many of us have been there before you, and birthed with joy! You can, too.

*As a general rule, a ragged tear grows more organically back together than straight cut cells, with less pain. Also, cuts may sometimes extend beyond their bounds to become worse than a tear would have been in the first place. The cases where an episiotomy is the best option should be very rare, according to the practices of many midwives.

**Rotissary – it is an unflattering word, I know. But I find that it sticks in the mind, which means it is more likely to be followed!

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The Due Date Myth

Most mothers carefully count down the weeks, days, even hours (I’ve seen this, it’s true!) to their due date, looking forward to that magical day. What few prospective parents realize is that the due date is just the result of a scientific bell curve – half of women deliver before their due date and half afterwards. Here is a link to an in-depth description by Transition To Parenthood, including a graph which shows what percentages of women give birth in the weeks before and after their due date. As of week 37 your baby is no longer considered premature! And while as of the day you go over your due date you are considered ‘post dates’ or ‘overdue’, really, your baby is simply going to be among the half of babies who are born after their due date. When a baby is mature, he or she gives off hormones to signal to your body to begin labor. Your body and your baby are beautifully and wonderfully made – trust them.

For this reason, when I am hired as a doula, I am on call day and night for the 5 weeks around the due date, my cell phone is always on and within earshot!

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Natural Ways to Induce Labor

–Obviously, keep active. Walk, climb stairs, swim, gently bounce on an exercise ball. In addition, there are a few other activities you can try……

–Nipple Stimulation: Stimulation of the nipples is a very effective way for ripening the cervix and initiating labor. Have your partner suck continuously on the nipple, or rolle the nipple between the thumb and finger. This may need to be continued for many hours to establish regular labor. IT is fine to rest during a contraction and resume stimulation as it fades. (I know, it sounds really funny but it seriously works!)

–Sexual Activity and Intercourse: Sexual activity acts in the same fashion as stimulation of the nipples, if not more intense. If sexual orgasm is acheived, this may actually initaiate labor contreactions through the release of hormones that cause uterine and pelvic contractions found in orgasm. Semen contains a natural prostaglandin that will soften the cervix and help with labor initiation. Some midwives have actually suggested that oral ingestion of seminal fluid also may act just as well (not to mention relaxing a tense father-to-be!) it is wise to keep in mind that the act of loving put the baby there to begin with and it may be the remedy to helping the baby be born as well. Actually, when you are induced the injections and suppositories they give you to stimulate labor are a synthetic type of this exact same hormone!

-Clary Sage Oil shows high indications that it helps strengthen contractions. Mingle 1 TBS carrier oil (like grape seed) with 5 drops of Clary Sage and rub it gently onto your bump in wide, soothing strokes, or use as a hand massage oil if you are attached to a monitor. Then leave the rest of the oil in the room (over a burner if you prefer) so that you will continue to benefit from the fragrance, or dip a washcloth into the remaining oil and keep in a zip locked bag, which you will take out to sniff regularly to keep strengthening contractions. If your hands have been massaged, keep raising them to your face to sniff them. Do not sniff it straight from the bottle, and do not rub it directly onto your skin without a carrier oil, as undiluted it is too strong and can aggrivate your skin. Obviously, as with all oils and essences or even hair colorings, do a patch test on your underarm before applying any oil – if it itches or turns pink do not use the oil.

-Eat a fresh pineapple: Not juiced, cooked, or pre-sliced as the active ingredients perish quickly on contact wtih air. Pineapple has more of that prostaglandin that softens mucus tissue. If you’ve ever over indulged in fresh pineapple then you know what I mean, how your mouth and lips feel burned; that’s the juices affecting your tissues. It’s also a fun midnight run when you’re overdue and need something else to try!

-Hot spicy food: this works by stimulating your digestive system. Have you ever noticed that one might get the runs after very spicy food? The digestive system is very near the uterus, the activity can initiate contractions. The same with Castor Oil, which I do not recommend unless you are under the observation of a midwife who is familiar with using it. There have been some studies performed where it has been suggested that the oil is passed on to the baby, which can cause him to pass his first meconium early, which then leads to the danger of aspiration and breathing problems. It seems to me, that having problems with diarreah while you’re supposed to be pushing a baby out could cause a mother to feel uncomfortable and anxious, just when she ought to be totally present and focused on the beauty and magic of the moment of birth! That said, often just before labor the body does naturally have a clean-out, and during labor itself the change in blood flow causes the digestive system to slow down. And besides, midwives have seen it all before, they are not shocked at what the body does during labor. Don’t worry.

-Ask for an enema: As opposed to spicy food and Castor Oil, and enema cleans your system out in one go, rather than inducing diarrhea over a period of time. If you are going into hospital for an induction, or you arrive with early, light contractions, ask for a self-applied enema. It is a little wax-like capsul shape, and you go into the bathroom and insert it yourself. You can think of it as a moment of privacy, with your own body, before you enter a period where numerous people will be helping you out very intimately. After about 15 minutes your body will empty itself completely. There are two benifits: one, you aren’t afraid of pooing during pushing, which can make some women tense up and not push effectivly. Two, the sudden activity of the bowels massage the uterus and can do strengthen contractions.

-Watch a funny movie and laugh a lot! Laughter also jiggles and stimulates the abdomen, and there are no negative side effects. You’ll raise your feel-good hormones which are only good for you and the baby! I know of someone whose waters broke while laughing over My Big Fat Greek Wedding…

– Take Murphy’s Law into account: Babies are often born at the most inconvinient times. Book up the weeks around your due date with things you look forward to doing: dinners out, walks on the beach, theater, trips to shops, dates with close friends. While there’s no proof that Murphey has ever induced labor directly, enjoying every day of living is much better than moping around and watching the clock. Enjoy!

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Red Rasberry Leaf Tea

This is taken to tone the uterus and theoretically will shorten the second stage (pushing) of labor. Drink 1 cut pof red rasberry leaf tea from 34 weeks, increasing to 3 cups from 36 weeks gestation. It needs sweetening, so add honey. It is also very nice as a iced tea in summer – make a big jug of it and keep in the fridge. The tea works by causing small contractions, thus helping practice and tone the muscle of the uterus, making it more effective for the birth. RLT is not safe for earlier in the pregnancy, due to the theoretical possability of inducing early labor. However, it is not a proven labor inducer, do not expect it to induce your labor naturally after one cup of tea if you are overdue! The warning to early labor is just a precaution since it does exercise the uterus.

Make sure that you buy the LEAF tea and not the fruit tea. Buy as fresh as possible from a good health food store.

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Evening Primrose Oil

From 38 weeks, take orally up to 3 capsules a day for up to a week before birth in order to systemically soften tissues (including the cervix and perineum.) Also, direct application of the oil on the cervix is beneficial for encouraging the cervix to soften. Insert 1 or 2 gel capsules as far up as you can before bedtime, and they will melt with your body heat. Try to do this at a time when you will be lying down for a few hours, and wear a panty liner. (Note: Always wash your hands before inserting, and don’t insert anything if your membranes have already ruptured.)

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