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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.

stay calm and deny everything

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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This just spotted on the Berkeley Parent’s Network e-list, and it’s really worth knowing if you are pregnant or have a newborn in the East Bay area!

Breastfeeding Support Group with Happy Milk——————————————-

Please join our weekly breastfeeding support group, facilitated a Happy Milk board certified lactation consultant. We meet EVERY WEDNESDAY from 10:30 am to 12 pm at Birthways, 1600 Shattuck Ave. Suite 122, Berkeley. No RSVP required, just $10 a visit; the first half hour is for arrivals, weighing your baby and informal chatting, then we’ll begin group introductions at 11 am.

Come meet other new moms in the East Bay area – isn’t it great to know you’re not alone? Pregnant mamas are also encouraged to attend – why not start gathering your support before your baby arrives!Thank you, please pass along the word, email me with any questions and see you there! 

http://www.happymilk.us/lactationservices/support-groups/
Submitted by: Ellen H. Schwerin, MPH, IBCLC (ellen@happymilk.us)

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I wish the whole world would see this birth! (Even though it starts out sideways. Just tilt your head to the left.) This mama gives birth in a hospital, squatting on the bed, unassisted because the doctor is busy in the OR. She calmly unwraps the cord herself, the baby comes to without being taken away or suctioned. He is just fine. The cord can be wrapped around the baby’s neck and that is not a danger in itself. Cord compression can be and often is unrelated to wrappage around the neck! Very good to be aware of. Enjoy the video.x

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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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TED talk about letting the umbilical cord pulsate out before clamping and cutting. Immediate cord clamping and cutting is the norm – if you want the doctor to wait and allow your baby to regain their normal volume of blood, you must put this on your birth plan. Otherwise, the cord will be cut within a few seconds after birth. This is so important, Mamas!

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Birth Story

I always write up a birth story to read together with new parents at our post-birth visit. I find it’s amazing to re-live the experience, helps put into order events and it adds to the joy of the birth. When I went into labour 3 days ago, I didn’t expect to take notes on my own birth, but then I found I just couldn’t help myself! It is so ingrained in me to record milestones and their times, feelings and thoughts during the birth, I couldn’t resist grabbing my notebook and a pen and recording what I was experiencing too. So here is the birth of my third child, who is sleeping peacefully next to me as I type.

 

Asher Kobi Vine

Born Tuesday, 1/2/2011 at 5:04pm

At home, Moshav Ramat Raziel, Israel

3.870 kilos, 8lbs 8 oz

31.1.2011 Monday morning I have my first bit of show, very exciting! All day I have painless tightenings, at varying intervals. They feel just like the braxton hicks contractions I’ve been having ever since week 14 (they come earlier with each pregnancy) but today they are coming much more often, every time I get up, move, sneeze, etc. I play around with contraction master while doing other things online, and sometimes they come every 3 minutes but other times there are spaces of 7 or 10 or so minutes between. I clean the house and do loads of laundry, and hang it all out on the line in the rain (it’ll have to stop raining sometime. It will smell nice. That’s a heavily pregnant nesting woman’s logic for you.) I finish re-reading Spiritual Midwifery, and go away inspired by the loving attitude of the wives towards their husbands and birthing companions. I plan on adopting that attitude during labor too.  After I pick up the children from school and gan we make lemon bars together with organic lemons off a neighbor’s tree – I’d wanted to bake these for the baby’s birthday cake! Recipe here. I’d planned on offering them to anyone who came to visit us after the birth, but we ended up eating them all instead… at least the midwife enjoyed some too before they were gone! I text my midwife to give her a heads up about the show and painless un-ordered contractions, letting her know that I may go into labour in the next day or so.

In the evening I make my favorite vegetable soup and couscous dinner, light and nourishing, and Jean-Philippe and I have a fun evening playing Settlers and enjoying eachother’s company. I do an enema supository just to clear out and possibly encourage contractions, go to bed with an Evening Primrose Oil capsule to soften the cervix, and measure my fundus during a contraction to be sure that we have time. I can still fit nearly 5 fingers, but am loosing more show throughout the evening. Sleep is hard to find, so I practice relaxing with my hypnobirthing and hypnobabies recordings.  Finally, at around 4am I fall deep asleep for 3 solid hours.

1.2.2011 Tuesday morning – Tightenings have lengthened out to every 20 minutes, I have a feeling today is the day, and Jean-Philippe and I wonder if I might go into town to the mall to walk around and have a treat, or if he should take the car so he can get home again quickly. After listening to my body, I decide I’d rather stay at home and go for a walk in the woods at some point instead.  More show, so much I check with a Mei Test to see if my waters are leaking – no it’s just a lot of stuff! Finish knitting a green baby hat while watching Grey’s Anatomy online – yes I am a medical drama junkie. I have a sleep for an hour, waking every 10 minutes with tightenings, but feel really rested afterwards. Check fundus, 3 1/2 fingers. Decide if I’m going to have that walk in the forest I’d better have it now…. go below the house and walk through the woods – if I hang from a certain acorn tree

My acorn tree - with Ana in it, a day later

it feels really really good during a tightening. I am amazed at the soft spring beauty of the day, the greenness, the rolling hills below this place God’s planted us just a few weeks ago! I feel so thankful. It takes me 45 minutes to make the loop along the edge of the forest and back up the hill through the moshav to pick up Ana and Noah from the bus stop and gan – during that time the intense feelings start coming every 3 minutes and make me stop in my tracks and breath. I’m pondering calling the midwife when she phones me! Ilana Shemesh somehow knew something was up. She wonders if she should come straight away – mama with her 3rd baby having contractions every three minutes – but I reason that they’re not painful, and that perhaps they’re just a result of my walk. My fundus is still at a reasonable height. We agree that I will go home and lie down and if they don’t tail off or get more intense I will call her. I do ask Jean-Philippe to come home straight away, though, and warn my parents that they should come get the children that afternoon. Collect children, walk home, but don’t have the energy to make them lunch so they snack in front of a video while I veg on the sofa.

2:00 Jean-Philippe arrives home all happy and excited, kisses me, and I feel myself finally relax and let go. Ask him to do lunch, go into bedroom to lie down, phone Ilana and tell her I think she should come. Timing rushes: 2:10, 2:13, 2:17, 2:19 Go to the bathroom, am suprised I can actually find my own cervix and it’s low and about 5 cm dilated! Whenever I’d checked in pregnancy and the past few days the cervix was still high, posterior and pretty much out of reach. Things aren’t going back now. Fundus is at 3 fingers. Still getting thick pink discharge. Try hypnobirthing relaxation on MP3 but children are so loud I can’t relax. 2:25, 2:30 painful contraction, lasted 2 minutes. 2:34 strong. 2:37, 2:40 very strong.  My dad arrives to bring the children to their house, Ana wants to stay but when promised treats is easly bribed out the door. I can’t go out and say hello – dealing with rushes on my knees now.

I put on my birthing skirt that I’d sewn from an old dress earlier in the week, long with a stretchy waistband, and a vest top with a shawl to keep warm. I don’t feel comfortable taking everything off and had kept my skirt on all the way to the end with Ana’s homebirth 5 years earlier. I want to try using the birthing ball, so go into the kitchen and lean over a chair while rocking on the ball. I have Jean-Philippe put on my TENS machine, and then he’s all busy being told to fetch a pillow for padding the chair back, putting on music, lighting candles, getting me a drink, mopping up said spilled drink, and squeezing my hips with every contraction. It feels soooo good to have my hips squeezed! Hot water bottle is wonderful, little instant warming hand packs not warm enough.

3:00 Ilana arrives, with bags and equipment and birthing stool. I miss my husband’s hip squeezes while he helps her bring them in. I greet her by saying it’s gotten more intense for sure, but I’m fine. I find that when a new rush hits me I’m scared by it’s intensity and don’t want to feel pain – but if I manage to relax and let go and breath, the more relaxed I am the less pain I feel. I start out a contraction by making moaning sounds and getting scared, but when I let go and completely relax and focus on my breathing like I’d practiced in hypnobirthing, I really do not feel pain. I feel really intense sensations that require all my attention, but they don’t overwhelm me. I can let them go, thinking wide, open, soft, peaceful. I keep thanking Jean-Philippe and complimenting him for how perfectly he’s squeezing my hips, telling him I love him, that I’m enjoying myself at this birth. I comment that it’s a beautiful day to have a baby, that this is so much fun. I try singing along with a contraction, The Color Green by Rich Mullins, Wonderful Life by Hurt, and it feels so good to sing loudly during a contraction, words that I really feel in my gut.

3:25 Ilana asks if I want to check dilation, I agree and she finds I’m 8 cm, and is very pleased. I pass one contraction lying down on my back, not nearly as comfortable but if I do relax my body completely and smile, it’s not unbearable. I tell myself it feels so good to lie fully supported on the bed, and enjoy not having to hold myself upright. After the bed I want to try the rocking chair – this reclining position puts more pressure on my weak sciatic nerve and I have to have the hot water bottle at my back, and can’t bear the rushes without a hip squeeze. It’s harder to relax, but really nice to rock while listening to music. He tells me stories of how we met, wonderful times we’ve had together at a B&B in Wales, what fun we had cycling for 2 weeks before our first child was born, a magical town we stumbled across and how enchanted I was listening to the locals conversing in Welsh. I murmur back little additions to these memories even in the middle of contractions, it’s so lovely to share the memories.

I decide I want to try a few contractions in the shower, aware that I’m close and this is my last chance to try water therapy! We don’t have a bath in this house, one thing that I’d really, really wanted for this birth was to get in the bath, but I’ve reconciled myself to not having one just because our new little home (we moved in 1st of January) is really wonderful and perfect in every other way. It’s a peaceful home. I am scared to walk (my legs don’t work so well when I’m in labour) and so Jean-Philippe and Ilana pull me up and help me make it to the bathroom. Ilana helps me undress really fast – no time for socks before the next contraction so I get in with them on =0) and oh the hot water is so nice! I experiment with where it feels good – there’s no room in the shower for anyone to be with me so I can’t focus it on my back, and during a contraction it seems to feel best on the top of my bump, moving slightly but not in big circles. Between I like it all over just keeping me warm. We keep the bathroom light off, with just a nightlight illuminating the room gently, warm. I end up crouching on the floor of the shower, on my knees sitting upright. I feel for the baby – there’s a bag of waters bulging down my birth canal. Still time. Three more rushes and I check again, and the bag of waters right there. One more contraction and I feel pressure in my bottom, so I call Ilana that it’s time to get out I need to push! Do I want to push in the shower? No, I want to go to the bedroom. Towels are wrapped around me, unfortunately not the old natty ones that are set up in the bedroom but my mom’s white ones that are in a neat stack in the bathroom; I should have spread the old ones around the house a bit better!

4:55 Race to the bedroom, Ilana gives me the option of pushing on the bed or using the birthing stool – I’ve never tried a birthing stool so I think it’d be nice to give that a go. A contraction hits and I lean over the bed with one knee on and one foot on the floor, Jean-Philippe squeezing my hips, trying not to push. Finally make it onto the birthing stool, Ilana has Jean-Philippe sit behind me and I lean back against him and try to let go and relax and be held. That totally helps. Because of the sciatica this position isn’t the most comfortable and if I couldn’t lean back and be held it wouldn’t have worked at all. Jean-Philippe is a bit dissapointed because he had wanted to film the birth itself. Ilana has warm oily water ready and together we apply hot compresses. I gently stretch myself and I can feel the bulging bag of waters emerging already. I relax and listen to my body and breath J-breaths down and out, thinking open, loose, let go. At the end of a pushing contraction a huge urge hits me and I push harder – the bag of waters pops all over the place and Ilana giggles “I knew that was going to happen!” Breathing the baby down is nice, but then when a huge pushing sensation hits me I loose it, because pushing means movement and it hurts! Birthing hasn’t hurt so far and I don’t want it to now, but I have no choice, my body wants to push. I shout “No, no!” which makes Jean-Philippe stop providing counter pressure which then hurts even worse – I was voicing how I was feeling about the contractions, not expressing a wish for anyone to do anything. Then I get a leg cramp – just like at Ana’s birth except this time in my upper right thigh – and have both of them jumping trying to figure out which muscle to rub out for me. Then one more big push and Ilana tells me to pant, the head is crowning! I pant and blow my lips, trying to relax the baby out, the head stings anyway. It’s out! I reach down and run my fingers all over the slippery little roundness, feel it lean away and there is no shoulder dystocia, the neck is free and no cord. I reach down and it feels so far away, Ilana supports the baby too as one hand comes free and I can reach under the armpit and oops the rest of the baby slides out.

Seconds after the birth

5:04pm I pull the baby to my tummy, it’s a boy! Ilana gives me a towel and I rub him, holding him upright talking to him to breath, he’s gurgly for a minute but then gives a strong cry. I start to cry too. “Oh baby, it’s a baby!” Jean-Philippe tried to film the birth, but in the excitement pressed the wrong button – so we have the following pictures instead. Ilana comments a couple of times at how thick the cord is, and that it already stops pulsating after just a couple of minutes! She has me feel it and confirm this. I comment that his cheeks are dusky but she points out that his chest is pink so he’s okay. Jean Philippe cuts the cord, Ilana leaves a long tail on it so as not to have to mess with the baby yet.

5:14 I wanted to move to the bed and try a breast crawl, but Ilana asks that I stay on the stool as it’s the best way to birth a placenta, so I have Jean-Philippe fetch the strong, sweetened Red Rasberry Leaf tea that I’d prepared earlier to create uterine contractions for birthing the placenta, and I offer the baby to have a go at breastfeeding. He has a strong suck and latches on straight away! After 10 minutes I feel a good push and the placenta comes right out. Make it to the bed, I’m cold, so all the blankets and duvets in the vicinity are fetched and we’re bundled up together with a cup of tea. Baby boy continues to feed for another hour and a half solid!

When we finally weigh him he is a big boy – good thing I’d followed a gestational diabetes diet for the second half of the pregnancy, just as a precaution. (I don’t have GD, I simply had a feeling this was going to be a boy and my first was 8pounds 4oz.) This child is my largest yet, at 8lbs 8oz or 3.87 kilos, and his head is round and 36cm, 3cm larger than normal, just like my first born son! But instead of pushing on my back with an epidural for 3 hours, I was upright and relaxed.

Ilana Shemesh making sure the placenta is complete

As Ilana is leaving she comments that this was a beautiful birth to attend, one of the most beautiful she’d ever been at. Which is quite the compliment for someone who has attended thousands of births over the last 40 years, hospital, birthing center, and home births! “And so social – I get to go home for dinner and bed.” Happy to oblige.

I learned:

1. I like TENS, still!

2. Living in Denial works

3. Hypnobirthing works

4. Hot water bottles work, little hand held hot packs don’t

5. Relaxing makes the pain go away, it really does

6. Hanging from a tree feels really, really good

7. I like hot water, especially on the top of the bump during a contraction

8. Hip squeezes, wonderful

9. Reflexology pointed pressure at the base of the spine, also really feels great

10. Measuring your fundus by finger widths really does correlate with dilation (See my External Assessment of Dilation post)

Day 5 – As I finish typing this story, Asher Kobi Vine is a laid back, easily settled little guy. My milk came in at day 3, and he has turned into a super efficient milk processing machine. We have him sleeping with us in bed, and from the first night of milk (Thursday night) he has been feeding only 3 or 4x a night, and he goes right back to sleep as soon as he’s fed. He loves to be in bodily contact, so doesn’t get put down very much, but I have a couple of different slings so we’re allright. I tried to offer him a pacifier but he gets all agitated and angry – he prefers my finger if it’s just a need to suck and not hunger. So I have a feeling I may be attached to this little man for a while. That’s okay. I have one birth planned for April, and after that I’m on sebatical for the rest of the year. I am training for my IBCLC (breastfeeding consultant), although when I manage to do the mentoring and exam I don’t know. No pressure. I may do some more education this year, but mostly I’m going to rest, be a mother, and enjoy my last baby’s first year.x

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The following is a comparative list of the natural birth facilities at hospitals in Israel. It’s far from comprehensive, but gives an exact rundown of basic amenities and availability of natural birthing suites and costs! It was published in Ha Aretz newspaper this weekend 8/10/10 – I thought an English version might be helpful to someone out there. (p.s. I’d love it if WordPress would have an option to create an easily readable grid, but until I figure that out, this will have to do, bear with me!)

Ziv Hospital, Tsfat. Number of beds: 7. Private midwife: no. Private doula: yes.Private doctor: no. Cost: agreed privately between doula and client. Special pain relief options: Jacuzzi in the natural birthing suite, massage, reflexology, aromatherapy etc. Anesthesiologist on call for delivery suite: no. Number of private rooms: 4, free, subject to availability. *

Ha Emek Hospital, Afula. Number of beds: 7. Private midwife: no. Private doula: yes. Private doctor: no. Cost: agreed privately between doula and client. Special pain relief: shiatsu and massage by a certified midwife. Anesthesiologist on call for delivery suite: yes. Number of private rooms: 4, free.

Rambam Hospital, Haifa. Number of beds: 9. Private midwife: no. Private doula: yes. Private doctor: no. Cost: agreed privately between doula and client. Special pain relief options: Jacuzzi in the natural birthing suite, oil for massage, birth ball, no extra cost. Anesthesiologist on call for delivery suite: yes. Number of private rooms: 4, free subject to availability.

Carmel Hospital, Haifa. Number of beds: 8. Private midwife: no. Private doula: yes. Private doctor, no. Cost: agreed privately between doula and client. Special pain relief options: Massage and Reiki by a trained midwife, free. Anesthesiologist on call for delivery suite: yes. Number of private rooms: 4, free.

Halel Yafet Hosptial, Hadera. Number of beds: 8. Private midwife: no. Private doula: yes. Private doctor: no.Cost: Either private hire agreement between doula and client, or through the “B’reshit” program: 900 NIS per birth, or birth plus 3 treatments 1,500 NIS. Special pain relief options: Birth ball, aromatherapy massage and reflexology by a certified midwife. Anesthesiologist on call for delivery suite: yes, during the day only. Number of private rooms: none.

Laniado Hospital, Netanya. Number of beds: 10. Private midwife: yes, from the list of Laniado midwives. Private doula, yes. Private doctor, yes. Cost: Private midwife- 3,400 NIS, For one on one midwifery care in the natural birthing suite – 1,050 NIS, Private doctor – $300 to Laniado hospital and the remainder payable to the private doctor’s agreement, Doula – agreed privately. Special pain relief options: water therapy in the natural birthing center, birthing balls and other props for aiding active birth. Anesthesiologist on call for delivery suite: yes. Number of private rooms: 6, at the cost of 450 NIS. Shvil Ha Leida website (There is no English website option, but you can use google translate, and they do often provide English translation on a hospital tour if requested.)

Meir Hosptial, Kefar Saba. Number of beds: 9. Private midwife, no. Private doula: yes. Private doctor: no. Cost: agreed privately between doula and client. Special pain relief options: Jacuzzi in the natural birthing rooms, most of the certified midwives are trained to provide alternative therapies such as shiatsu, massage etc for free, as well as availability of TENS machines for pain relief. Anesthesiologist on call for delivery suite: yes. Number of private rooms: none. Virtual tour of natural birthing room found here; there is also information on birthing classes in the Meir For You page.

Liss Hospital (also known as Sourasky or Ichilov), Tel Aviv. Number of beds: 16. Private midwife, no. Private doula, yes. Private doctor, no. Cost: agreed privately between doula and client. Special pain relief options: A variety, from water therapy and massage with oils, to use of  a Dutch chair and ball pit, free. Anesthesiologist on call for delivery suite: yes. Number of private rooms: 12, free. **

Sheba Hosptial, Tel Hashomer, Tel Aviv. Number of beds: 12. Private midwife: yes. Private doula: yes. Private doctor: no. Cost: midwife- 3,300/4,300 NIS, Hospital doula – 2,300 NIS, Private doula – agreed privately. Special pain relief options: Jacuzzi (in some of the rooms), acupressure, free. Anesthesiologist on call for delivery suite: yes. Number of private rooms: None. **

Ma’ayanei Yeshua Hospital, Bnei Barak. Number of beds: 11. Private midwife: yes. Private doula: yes. Private doctor: yes. Cost: Private doctor – 8,000-9,200 NIS, Private anesthesiologist – 1,200 NIS, Private midwife – 2,900 NIS, doula – agreed privately. Special pain relief options: Massage with essential oils, birthing ball, volunteer support from the hospital’s Tamar project. Anesthesiologist on call for delivery suite: yes. Private rooms: 2, $80 per night.

Rabin Hospital (also known as Bellingson), Petach Tikva. Number of beds: 11. Private midwife: no. Private doula: yes. Private doctor: no. Cost: agreed individually between doula and client. Special pain relif options: Shiatsu, Reiki, essential oils, free depending on how busy the delivery suite is. Anesthesiologist on call for delivery suite: yes. Number of private rooms: 8, free.

Wolfson Hospital, Holon. Number of beds: 9. Private midwife: no. Private doula: yes. Private doctor: no. Cost: agreed individually between doula and client. Special pain relief options: Massage, Shiatsu, reflexology – free. Anesthesiologist on call for delivery suite: yes. Number of private rooms: 6, free.

Asaf Ha Rofe Hospital, Tzrifin, near Rishon Le Tsion. Number of beds: 11. Private midwife: yes. Private doula: yes. Private doctor: no. Cost: Private midwife – 3,300 NIS, Birth assistant – 2,300 NIS, Therapy given by an alternative medicine specialist – 2,300 NIS. Special pain relief options: Jacuzzi, water, warm compresses, birth ball etc. Alternative therapies in the birthing room by specially trained hospital staff. Anesthesiologist on call for delivery suite: yes. Number of private rooms: 4, free.

Hadassa Har Hatsofim, Jerusalem. Number of beds: 7. Private midwife: no. Private doula: yes. Private doctor: yes. Cost: Private doctor – 8,500 NIS-21,500 NIS, Private doula – agreed individually between doula and client. Anesthesiologist on call for birthing suite – no. Number of private rooms: none.

Hadassa Ein Kerem, Jerusalem. number of beds: 9. Private midwife: only in the natural birthing suite. Private doula – yes. Private doctor: yes. Cost: Private midwife – 3,500 NIS, Private doctor – 8,477-12,750 NIS. Special pain relief options: Jacuzzi in both natural birthing rooms, essential oils, wireless waterproof monitoring equipment, massage, guided meditation, TENS machine, birth ball and gas and air (nitrus oxide), free. Anesthesiologist on call for delivery suite: yes, until 11 pm. Number of private rooms: 2, free. **

Shaarei Tsedek, Jerusalem. Number of beds: 13 (+10 in triage). Private midwife: no. Private doula, yes. Private doctor: yes. Cost: Private doctor – 7,000-14,000 NIS, Private doula – agreed individually between doula and client. Special pain relief options: Showers, massage, free. Anesthesiologist on call for delivery suite: Yes. Number of private rooms: none.

Bikur Holim, Jerusalem. Number of beds: 6. Private midwife: no. Private doula, yes. Private doctor: yes. Cost: Private doula – agreed individually between doula and client, Private doctor 9,522-14,173 NIS, Epidural daytime – 2,500 NIS, Epidural nighttime – 3,500 NIS. Special pain relief options: none. Anesthesiologist on call for delivery suite: no. Number of private rooms: none.

Kaplan Hospital, Rehovot. Numberof beds: 9. Private midwife: no. Private doula: no. Private doctor: no. Special pain relief options: Alternative active birth practices that were developed at Kaplan hospital, free of charge. Anesthesiologist on call for delivery suite: yes. Number of private rooms: 8, free.

Souraka Hospital, Beer Sheva. Number of beds: 10. Private midwife: no. Private doula, yes. Private doctor: no. Cost: agreed individually between doula and client. Special pain relief options: Shiatsu, reflexology, guided meditation, offered by midwives for free. Anesthesiologist on call for delivery suite: yes. Private rooms: yes.

Yoseftal Hospital, Eilat. Number of beds: 2. Private midwife, no. Private doula: yes. Private doctor: no. Cost: agreed individually between doula and client. Special pain relief options: Water birth –  free, must be scheduled ahead of time. Anesthesiologist on call for delivery suite: yes. Private rooms: none.

Special notes: At Sheba (Tel Ha Shomer) Hospital there are two kinds of private midwife – the more expensive cost is for the natural birthing suite, and the lower cost is for a private midwife in the regular birthing rooms.  At Bikur Holim Hospital the cost is according to the type of birth – the least expensive is for a normal daytime birth, the more expensive is for a nighttime cesearean section. At Shaarei Tsedek the cost differs according to the time of day of the birth, the type of birth and the doctor’s standing. At Hadassa Ein Kerem the cost for doctor’s services is according to the type of birth.

*I’m assuming this refers to the postnatal ward. **These hospitals have a post-birth mother/baby/father Maternity Hotel option. Price not listed in this article.

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