I know that many people are anti-birth-plan because you “cannot plan birth”, so I’ll just repeat it here: you are not planning the birth. You are communicating (a good thing!) to staff about what kind of birthing mother you are and what you value at your birth, and if things change, then we agree beforehand that it’s is okay! Motherhood, like birth, is full of surprises and changes that are unexpected. But it can be beautiful and oh so rewarding – just like birth.

Importantly, a birth plan doesn’t have to be a very long document, full of polite paragraphs. You can be respectful and gentle when discussing the plan with your OB before the birth, but the document that staff will glance over at your birth can be short and bullet pointed, with just the 5 most important things that you hope for at this birth.

How do you decide what those 5 things are? Write a list of everything you want (using one of those comprehensive pre-formatted examples found online) and then prioritize them numerically. Read over the entire list with your birth partner, so they are aware of all your hopes and can remember to respect the wishes such as dimming the lights and massaging your back, for you. The top 5 make it onto your list. If fear of an episiotomy will make you tense up and close your legs to giving birth, then that fear will HINDER the birthing progress and your tense muscles will make you ripe for a need to cut. If you have that fear, then the sentence “Please do not perform an episiotomy; I would rather tear than be cut” should be on your birth plan. If you do not want to be offered pain relief, then state, “Please do not offer me an epidural; if I need one, I will ask.” If you have a fear of blood, then requesting that the baby be rubbed clean and wrapped up before being given to you may be the thing you decide to prioritize.


Then, draw a line, and under those 5 things you wish for your birth, write in detail EVERY SINGLE thing that you want done (or not done) with your baby. Leave nothing out, from skin-on-skin to letting the cord pulsate to bathing and pacifiers and immunizations – everything you want them to know is on the second half of the page! Leave nothing to chance. This is your baby, and no one else’s!

Make two copies of your birth plan. One should be on the top of any paperwork you bring with you to the birth, and the second should be taped next to the computer keyboard in the birthing room. Believe me, any medical staff who walk into that room WILL look at that keyboard, sometimes even before having a good look at the mother.

Now you have done your best to communicate, and can put your focus on letting go, and embrace birth!

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!

I am not a food blog. Yet during pregnancy and the postpartum months food plays a very important role, both in providing nutrients where they’ve been lost and in boosting energy, milk production, and very importantly, mood! I’ve put together here a collection of my favorite go-to recipes that I bring to mothers post-birth, when some feeding of the soul and body are needed.

(They are also family-taste-tested, my kids eat most of them too! 

And that’s not a small feat.)

And I apologize in advance for my feeble attempts at food photography….


Now, I’ve always loved smoothies, after a brief and terribly random stint as a dishwasher for a vegan resturaunt while a University of Alaska freshman. At that time I had no idea what vegan eating was, much less healthy eating, as I was your average teenager! But a hungry student supporting herself through university on scholarships will eat what comes her way, and the free smoothie lunch I was given was a revelation.

After moving to Israel where fresh fruit is abundant, I began freezing kilos of fresh chopped fruit when it is in season, and these frozen ‘ice cream’ smoothies helped air-condition my body during the summer months. At any time of the year you may find in my freezer great quantities of banannas, strawberries, peaches, apricots, dates, plums and shesek (loquat, apparently, in English).

Since Asher’s birth I’ve learned more about nutrition and breastfeeding, and have been packing my smoothies out with extra ingredients: ground flax seeds (rich in mood boosting Omega 3) almond butter (excellent for boosting lactation) and date syrup or black strap molasses (iron). Often there will be pumpkin seeds (magnesium, potassium and more Omega 3) and lately, I’ve gotten brave and started adding green leafy veg (iron! salad!) to my smoothies. This video showed me how to do it: How to make a green smoothie

Sharing with nearby toddler optional

  • a handful of one kind of green, such as chopped kale, spinach, lettuce, coriander, beet greens
  • a soft fruit, such as half a papaya, half a mango, 5-6 strawberries, peaches, or any other frozen berries
  • 1 frozen bannana (if it is frozen it adds that smooth, ice-cream like quality to your smoothie, and ensures it’s chilled and tasty.)
  • sweetener: 1 or two chopped dates, or 1 TBS date syrup (silan), or 1 TBS honey or blackstrap molasses
  • 1 tablespoon almond butter or raw tehina (ground sesame)
  • nuts or seeds, such as pumpkin seeds, chopped almonds or brazil nuts
  • 1 teaspoon milled flax seeds (“subin pashdan” in Hebrew) which is actually really cheep to buy. The one in my cupboard cost 7 NIS, and I’ve been adding it liberally to smoothies and breads for a few months already.
  • 1 cup of water. You can use fruit juice or part yogurt if you prefer, but it already tastes good so it’s up to you!

Blend, pulsing first until the frozen banana is broken up, and then allow to run for 30 seconds on low, until a smooth consistency is attained. Taste, and adjust if needed.

Feel free to share part of your smoothie with your children or other visiting mothers, but make sure you eat plenty of it yourself! Enjoy with the knowledge that you’re feeding your body well.


This last winter I discovered that not only are beets full of beta-carotene and iron, but their greens are even more so! So now I know what to do with all those leaves that Israeli beets often come still connected to: In this recipe you roast the vegetables which brings out the richness of their flavor, and then add the greens to the soup just before blending. Tada!! You have a rich, tasty, full of pro-lactogenic vitamins, and is a hearty, filling soup for any new mama. I often bring this soup to mothers a day or two after birth and they swear there has never been a tastier soup.

preheat oven to a high temperature, about 250 celsius (just under 500 Fahrenheit)

chop and toss together on a baking sheet: 

  • 1-2 beets (also add if you want: turnips, kohlrabi, etc)
  • 2 potatoes
  • 1 onion
  • 2 carrots or sweet potatoes 
  • 1/2 cup celery or fennel 
  • 3 cloves of garlic, still in their skins
  • 1 teaspoon of coarse sea salt, pepper to taste
  • 2 tablespoons olive oil
  • Beet green, or a big handful of some other iron-rich leafy green like spinach

Roast for 30 min, or until nice and golden, softened and smelling wonderful. Tip into a cooking pot, making sure you squeeze the roasted garlic cloves out of their skin first. Fragrant and yummy already! Add:

  • Hot water to cover
  • 2 cubes of beef stock, or vegetable stock
  • 2 tablespoons tomato paste
  • 1 teaspoon brown sugar
  • 1 bay leaf
  • the washed, chopped beet greens, around 1 cup (or any other dark green leafy vegetable)
  • optional: 1 can chopped tomatoes or 2 fresh chopped toms

Heat to boiling. Taste and adjust seasoning. Remove the bay leaf, and blend with a hand blender. You can leave a few chunky bits for texture, if you desire. Serve with crusty dark bread and a dollop of yogurt. *


Okay, so every now and again (or, often) a mother doesn’t have time to warm up a bowl of soup. Or sit down and make a proper breakfast for herself. These breakfast cookies are packed with goodness, it’s like a healthy granola in your hand. I’ve added oats and flax for boosting milk production.  The up side of these cookies is that they don’t taste like cardboard – they are YUM. Especially if you add a handful of dark chocolate chips….

Mix together:

  • 2 c. oats
  • 1 1/4 c. whole wheat flour
  • 1 c. white flour
  • 1 c. cereal (whatever you have on hand, from corn flakes to grape nuts )
  • 1/2 c. wheat germ
  • 1/4 c. ground flax seed
  • 1 1/2 tsp. baking soda
  • 1 tsp. baking powder
  • 1 tsp. cinnamon
  • 1/2 c. of seeds: sunflour, pumpkin, sesame, flax – whatever you have 
With a hand mixer, in a separate bowl, blend:
  • 1 cup butter
  • 1/2 cup applesauce
  • 1/3 cup raw tehina or peanut butter
  • 2 eggs
  • 1/2 c. brown sugar
  • 1/2 c. white sugar (can be replaced with molasses or agave nectar)
  • 1 TBS vanilla
  • 1/2 c. chopped almonds
  • 1 c. raisins or dried cranberries
  • 1 c. dates  (Or use dark chocolate chips if you want/need them!)

Preheat oven to 350f/180c. Line baking pans with baking paper or lightly grease. Combine dry ingredients. Beat butter, eggs, sugars and vanilla. Add dry ingredients, mix until blended. Mix in almonds, raisins or cranberries and dates. Shape into balls and flatten on cookie sheets. Bake 13/15 minutes, until lightly golden.

And lastly, some link love to some tasty, healthy, give-able recipes I’ve used and fallen in love with this year:

The Yummiest Easiest Roast Veg Soup Ever (my name for it) By JCasa

A Famous Plum Tart  from The Kitchn

Chorizo and Chickpea Soup from Claudia at Aux Petit Oiseaux

Swiss Chard and Sweet Potato Gratin from Smitten Kitchen (In Israel, “margold” stalks are sweet and don’t need removing.)

Black Bean and Pumpkin Soup** from The Kitchn

Mediterranean Chickpea Salad  from Cooking With My Kid

Whole Wheat Banana Bread by Creative Jewish Mom

Simple Crustless Spinach Quiche  by Kahakai Kitchen (iron and protein, good warm or eaten cold with one hand…)

Maklooba the ultimate dinner to bring over! From the Middle Eastern Food Blog

Please if you have any more recipes that you love for breastfeeding and post-birth, do share! x

*As always, the color of beets passes through the system, so do not be alarmed at the color of your child’s next diaper change.

** Yes there are a lot of bean recipes in this list. If beans make you very gassy, they may make your child gassy too, and often they are on the ‘avoid’ list for breastfeeding mothers. But cutting them out completely deprives you both of a very use-able, healthy, inexpensive protein, and so the BETTER rule of thumb is to include beans, but to do so with moderation. Do not over do it, but eat beans regularly so that your system, and hence your baby’s system, tolerates them normally.

My husband is an animator:

Hence the very cartoon-y quality of his illustrations! 

Dear Husband, Partner, Boyfriend.

My wife asked me to write some advice for you, as someone who’s been a partner of a woman suffering post natal depression.

As if I know what I’m talking about. I may not be a certified professional expert source, but I have lived it.

Frankly, I’d like to just look you in the eye and say I know how bad it is. And I’m sorry. But: it really will get better. Your woman will return to you.

When I think back on that period of our life six years ago, my mind settles on one image: a snapshot of emotions taken over a bleak Christmas holiday. One night, out of frustration with this passive, dark creature that my wife had become, I vented my feelings. I knew I needed to be the support, the calm centre, a touchstone for her to hold on to- but I was tired. And I had had enough. Later I found her upstairs, cutting small slashes into her forearm with my craft knife.

I won’t forget that. You don’t really prepare for moments like that in a relationship, do you? You start in a rush of excitement and coiled potential, which plays out hopefully in a full and rich partnership. But- and here is where I will sound selfish- You will feel betrayed and abandoned by a partner with depression. You will be amazed that you, a pretty decent guy, are not able to fix this.

Hmmm…. where is the ‘reset’ button?

1.You can not fix her.

Face it. As a man, in an argument, your overriding need for process and parameters and a clear bottom line means that you think you can and must fix things now. I’m talking to the average guy; guys like me. If you’re a superstar listener and a rock solid support you’ll be fine. But for the rest of you: You can’t fix her. She is fighting with thoughts that make no sense, overwhelming dread, numbness. This cannot be fixed by what you say.  It will be healed over time. Resist the temptation to take control and straighten her thoughts out for her.

2.Carry her burden.

I felt that Sarah really withdrew from me when she sensed my own withdrawal, my frustration with the months of waiting for her to be well- for her spark of vitality to return. She felt judged, another layer of failure to add to the tomb of thought she was struggling to climb out of. Depression is exhausting. Fighting it is a battle that needs reinforcements and nourishment. What can you do to stand beside her, carry her burden, like the strong ox that you are? You can take the kids off her hands. You can cook dinner. You can sit and read next to her. You can find the youtube video of that comedian that she likes. You can take her out, and not talk about ‘it’. You can let her lie in. You show her that you stand next to her, with her, carry the burden that she is carrying.

3. Don’t judge her.

This is vital. She will do, say things that will make you feel like trash and the relationship feel like a sinking ship. The house will be empty of her life giving charisma. You, feeling tired and hassled, frustrated, will start to compare her to other, maybe fictional, women and she will not match up well. No. That route is the wrong one. Don’t judge her. Forgo judgment completely. It’s a tough route to walk, but you can do it and she needs you to. It is not a case of seeing her at her worst.  It’s more a case that she is not herself at all. But she will be back.

Date night brownie points?! Kerching!

4. Surprise her.

The pattern of the days for someone with PND can be overwhelmingly repetitive and void of joy. You might be tempted to hunker down and wait, allowing that pattern to stay the same until its finished and the stormclouds have moved on. Actually, this is the perfect time to surprise her and keep her on her toes. You are reminding her that the day can be something that brings life and new things, however small.  A note in the cutlery drawer, maybe. Or bigger surprises: That Christmas I mentioned earlier was followed by a three day trip to a bed and breakfast on a welsh beach. Sarah and I had for those three days a beautiful respite from the illness, discovering a new place together. That memory is much more powerful than the bad ones.

5. This time, read the manual.

I don’t read the manual, do you? I prefer my expensive purchases assembled by instinct and impatience rather than thoughtful absorption of the instructions. If you are this type, then I suggest that you do read the manual on PND. Find out how it makes other mothers feel, and you’ll realize that this isn’t the great unknown after all. Talk to your family doctor. Speak to the health care professionals who are working with her. Look at online resources, especially those written from a dad’s perspective.

 6. Take care of yourself.

When she returns, she’ll be wanting to find that you are the same guy you were. You must recognize that this thing that has touched your family is really, really tough. And you can’t carry the load of it all on your shoulders. You are part of the healing, as are the right doctor, the right meds, and healthy food, and walks in the park. Youneed to be well- that means sharing your burden with a good friend, keeping physically active, it means finding some time each week for yourself. If that means dropping the baby off at grandmas, and going fishing (whatever that is), then it must be done as part the plan for recovery. Do it to come back ready to share her burden again. Recognize the cracks of stress in your life, and back away from high pressure work, deadlines, business, drinking hard, or all-consuming hobbies that take you away from home. This is necessary, to realize that this period is a time for saving your strength. This storm will soon pass, and you’ll both emerge stronger.

I failed at most of these things. I learned slow, and with difficulty, but we are through. Sarah is entirely, utterly different now. She returned, as your partner will. Together, you’ll have some scars that a lot of relationships don’t experience. And you can be proud of them. You’re stronger than you were before.

Hello again, long time no see! I’m finally, finally coming back to this space.

It has taken me a long time to get my head around this blog post, because the topic is postnatal depression. There’s a lot of fear to overcome when admitting to having suffered from such an experience: the question of whether publicly discussing my illness will de-legitimize my abilities as a doula was a huge one. In the end I’ve decided that if it does stop a few prospective mothers from hiring me, that’s not too high a price to pay in order to reach those that are struggling and really do need help. So, if you’ve googled this topic because you or a loved one of yours is suffering and you’re trying to understand why and how to help, this post is for you. And from the bottom of my heart I am cheering you on, having walked through the fire and come out stronger.

I suffered from severe clinical postnatal depression after the birth of my second child. Therefore for this third birth we planned meticulously. One of the steps I took was to dedicate the entire first year of my son’s life to lying low, and I planned a whole year of maternity leave (ha, being self employed of course, the pay is symbolic!) and focus on my health and stability. I am happy to say that this time things have gone well and I’m very thankful that there was no repeat experience of last time, even though my psychiatrist said that I had a 98% chance of the illness coming back as bad, or worse. And here I am standing in the 2%! There were some tricky times a few months in ,where I was close to sliding into that hole, but thankfully we pulled through and I’ve grown stronger and stronger, and in the end I’ve returned to the birthing world earlier than I had planned, and I’m well. Thank God, I’m well!

A list of self-care steps we took when facing this third pregnancy and birth will be published shortly. 

Here’s a myth about PND* that I’d like to bust: Post Natal Depression doesn’t necessarily go hand in hand with sadness.

Now that he's crawling, the game changes! Look out, big brother's Lego...

Before it happened to me, after my second birth, I have to be honest, I didn’t really believe in depression, full stop. I was in that snap-out-it, pull-yourself-up-by-your-own-bootstraps, just-pray-harder category.  PND sneaked up on me when I was in a time of my life when I thought I had no reason to be struggling! I was (am) married to a handsome, talented man, my children are healthy and cute, I loved my home, and my work as a doula is so satisfying. I’ve had a safe childhood and never self harmed or suffered from mental illness or trauma in my past. Just because circumstantial and historical issues place you in the risk category for PND, doesn’t mean that you must be already off your rocker to have intrusive thoughts. I didn’t have all the classic signs one thinks of with depression: I wasn’t crying all the time, my house was spotless (too tidy) my children and myself were well dressed, and I smiled. A lot. What I didn’t realize is that there are a host of other risk factors and symptoms. PND is sneaky. I got blindsided.

By the time it was diagnosed in 2006, my daughter was seven months old. I was unable to leave the house to attend functions, because of panic attacks that would start three hours before an event and last for three more after we returned home – not worth the effort. I couldn’t drive our car, because I couldn’t concentrate on all the visual input and decision proccesses it takes to drive (too fast, dangerous corners, urges to crash into walls.) I often couldn’t make dinner for my children, because I couldn’t decide what to make, or focus long enough to make anything. I couldn’t concentrate to watch a movie or read a book . I was terrified of taking a shower (have you ever thought of how many steps it takes to complete that task?) and at one point went three weeks without washing my hair. Speaking of hair, one night at 2am I used the kitchen scissors to cut it all off. A few years later when Brittany Spears did the same thing just after the birth of her second child, I was like, hey! She’s copying me!

Sleep. Disturbed sleep patterns always accompany PND. While I mastered the motherly art of falling asleep in the instant after finishing a breastfeeding session, I would awaken 20 times a night to check the kids blankets/windows/oven/I have no idea what else. I was obsessive compulsive about the cleanliness of my own home, and could not sit still and chat to a guest (my health visitor) if there was a piece of lint on the carpet across the room, I would have to pick it up immediately. If I couldn’t feed my family, at least the home would be clean.

Among the worst things that happened (and the hardest to admit): I was perscribed co-codimal for a breast abcess and recurrent deep tissue pain, and was introduced into the world of abusing prescription drugs. I bought a bottle of vodka and hid it. (All this from a woman who had never been drunk, never smoked a cigarette, never abused anything!) I was self harming on a regular basis. I felt like if I cut myself and drew blood, that would satisfy the terrifyingly painful urge in my chest to harm my children, to kill myself. It was only a little blood. My children never saw, there was no ‘real’ injury. I had to plan how I would get myself and my baby away from my balcony, where the cement walkway below looked so terribly inviting.

Even more terrifying than that, I felt like I’d lost God. My sense of the divine was gone, like heaven became cement, there was no one looking and no one hearing. Right and wrong, good and evil were all mixed up and I didn’t know who to believe anymore. I felt like I was to blame, and at the same time, that it was so unfair that the one time when I needed help most in my entire life, that I was abandoned. Desolate. Afraid of life, afraid of the world I’d brought my kids into.

I was hospitalized in a Mother and Baby Mental Health Unit for nine weeks. I tried seven different antidepressants and other drugs before we found something that finally, finally, helped me feel like ‘me’ again.

Recovery took years. Hence the age gaps: Ana and Noah are 22 months apart – and then there are five and a half years until Asher.

Ana 5, Noah 7, Asher 5 months. Aren't they lovely!?

The first glimmer of hope that spoke to me came from a nurse in the Mother and Baby Unit of my local mental health unit. Being a naturally smiley person, people were often surprised that I was one of the patients. Well, I certainly wasn’t going to erase the smile and look glum, just to fit their expectations. I still struck up conversations with staff, just to be polite. Trying to be friendly, I asked her how working on the Mother and Baby Unit was different from the other mental health wards she’d worked on over the years, and why she chose this unit in particular. (I was a very articulate kind of patient.) Her answer has echoed in my mind all this time. She said,

“I like to work in this ward because mothers suffering from PND get better.

They recover, they go home.

Not like the patients in the regular mental health wards.

And like that, a ray of hope peirced my darkness. We get better. It is a mental illness with a very high recovery rate; I was going to recover.

I did recover.

The following are very painful lessons I’ve learned:

1. Children are scarred for life if their mother didn’t love them enough to stay around and chose to kill herself. No one recovers from that kind of hurt.

2. Children are resilient. They love their mama, they forgive their mama, they need you.

3. “If I confess what I’m feeling then ‘They’ will take my children away from me” – that fear is false. Health professionals want to help you heal and the end goal is to keep the family together. If you have these thoughts, someone needs to know so that they can heal the source of those thoughts.

4. While it does not happen to everyone, it happens to enough women so that you can know that you are not alone! And those thoughts and feelings that make you feel alone have been felt exactly the same way by so many others. This helped me understand that the awful thoughts and urges must not be true or from me; they belong to the illness. Find a support group – there are some excellent online ones, including the mothers at Postpartum Progress. So many of us do get better.

5. It is an illness. It passes. You do emerge again, changed perhaps, but truely you. I am far more me, honestly, after the re-building of my spirit.

6. So many women are scared of taking medication, whether because of the very real stigma surrounding depression (I personally have spent years avoiding writing this post) or because they are worried about taking something that might be addictive. At some point the benifits start outweighing the cons. Getting well is so very worth it.

7. Breastfeeding – is it a benefit or does it cause more hormonal upheaval? There is a lot of debate about this one, in both directions. For me, I finally needed help myself if I were to remain alive for my daughter. Yes, breastmilk is magic juice and I loved giving it to her, but she needed her Mama living, attached, loving her.

8. It is important to keep looking your kids in the eyes, hug them, and tell them you love them. Daily.

9. For a simple, preliminary online test for PND try the Edinburgh Postnatal Depression Scale.

10. There are survivors who are on call daily, and would like to talk to you. If you live in Israel, phone NITZA, the Israel Center for Maternal Health at 02-5332810, or email them at nitzappd@013.net

11. Dads and family members need help too! It is totally bewildering to see your wife turn into someone you don’t recognize. My husband has written a post about what he would like to say to any dad whose loved one is suffering, which I will post next week.

I am on the other side, a stronger, more humble woman; more appreciative of life than before.

Baby wearing: ticks the bonding box as well as providing exercise! *phew*

*otherwise known as PPD. Since I suffered the illness when I lived in the UK, I refer to it as PND in this article.

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

Yes I’m a doula, and I obviously I support natural birth, homebirths, breastfeeding – the whole nine yards. But that doesn’t mean that only births that go according to the perfect plan are beautiful. A beautiful, connected birth can happen no matter what the circumstances are, and sometimes that means a joyful birth for a mother who chooses an epidural, or has every complication under the sun. Sometimes the well prepared, well versed mother who had planned a natural birth, has a Cesearean birth.

I don’t talk about C-Sections much during prenatals. It is best to focus on believing in the ability of the female body to give birth easily and trust it to do so! Since I am accompanying this couple through the birth, what works best is for me to provide information as issues come up. But if you aren’t going to have a doula to support you in every eventuality, then it is a good idea to think through all eventualities and make a plan. This is not a birth plan for a Planned or Elective Cesarean Section – there are plenty of birth plans out there for planned Cesareans that are lovely, thought through, organized ahead of time with a supportive doctor. You can have classical music piped in, curtains drawn aside, births filmed. Here is one example of an Elective Cesarean Birth Plan.

This is also not a plan for a ‘Crash’ Cesarean Section. If the fetal heart-rate is dropping rapidly and the baby needs to come out NOW, then the mother will be put under general anesthetic (unless she already has an epidural) and the surgery will be done within a matter of minutes. There is no time for planning, for crafting an experience. At a Crash Cesarean Section, you are happy for medicine that can save lives. However, Crash Cesareans are the rarest kind of Cesarean Section. Usually there is time to prepare, and that takes us to the most common type of cesearean:

‘Emergency’ Cesarean Sections, in a class of their own. They are the most common type of Cesarean Section that couples experience with their first baby. Reasons are sometimes as follows:

Situation number1 – Mother is anxious about how to know when labor is really beginning, and with the first twinges of contractions she remains awake and counts every single one. She cannot or will not fall asleep, and since she is paying close attention to what she’s feeling, the level of pain she feels is at a higher level from the start. She goes into hospital, is told she’s not dilating and sent home, and ends up absolutely exhausted, dehydrated and sleep deprived by the onset of labor. An exhausted, dehydrated and sleep deprived body does not dilate well and this goes on for a very, very long labor. Dr’s decide she is not dilating enough, despite augmentation (induction) and a CS will eventually take place. Lesson: live in denial! When you are really in labor, you won’t be able to deny it anymore, you WILL know.  In the meantime eat, sleep, stay hydrated, relax. (I can’t believe I haven’t written anything about living in denial. Will do that asap.)

Situation number 2 – Baby is ill fitted in the pelvis, and does not move down. This is often because the baby is back to back, or the head is tilted at an angle that does not fit well. In this case, sometimes the mother ceases to dilate further at some point in labor, or the baby’s head simply does not descend in the pelvis. Often baby’s heart-rate does not respond well to pushing, because the fit is poor and baby is not happy with the sensations. In America this is often mis diagnosed as CPD, or Cephalo-Pelvic Disproportion. No, the baby was just in a poor position, and if the position were better the fit would have been just fine. Lesson: read up on optimal fetal positioning or see spinningbabies.com, and watch how you use your body in the weeks leading up to labor.

Situation number 3 – Dr’s have a great name for diagnosing things that they don’t understand in birth, and the term is ‘failure to progress’. They can’t explain why, there is no reason, but things aren’t happening so we might as well have a Cesarean Section.

Situation number 4 – Cord compression. This is not usually the cord around the neck, which in most cases is not a real cause for alarm. There’s a small space, a lot of cord, and it has to go somewhere. Baby is ‘breathing’ through the umbilical cord anyways, and not using air ways in the throat until after birth. Cord compression is where as the baby decends, the cord gets caught up in the way and with every contraction baby gets not quite enough oxygen. Often this can be resolved by getting mother into a different position that takes pressure off the cord or by amnio infusion (warm saline flushed inside the uterus),  but if not, and it is suggested that the cord compression will get worse during the pushing stage, then a cesearean section is required.

Situation number 5 – Failed induction. An induction has been going on for a long time, nothing is happening, baby and mother are tired, everyone wants things over and done with. Lesson: Do anything else you can before you go for a medical induction! CS rates are much higher for induction births than births that started on their own.

The Emergency Cesarean Plan

The above are a few reasons for an Emergency Cesarean Section. You know this kind of Cesarean because there is time to hang around before the surgery. Your midwife or doctor may hint at the possibitily of a C-Section, just to get you used to the idea, but tell you there is time to try a few more things first and no need to get worried yet. It will be hours before the surgery is done, because there is no immediate danger to the life of mother or child. Yet, because it is classed as ‘Emergency’, fathers are generally not allowed into the room during the surgery. In Israel, fathers are only allowed if it’s a planned Cesarean, and doulas never.

1. Ask: is my baby’s life in danger right now? If not, then there is time to suit up my husband to accompany me to surgery. I am scared. I do not agree to surgery if I have to go in by myself. *Note: if your life or your baby’s life is in immediate danger, do not argue. That is a ‘Crash Cesarean’, a whole different kind of situation. But if there is 5 minutes to spare, there is time to bother to get your husband dressed and take him with you. If you are Orthodox and husbands are not allowed for religious reasons, then insist that a female relative or doula will go in with you to hold your hand. Do not go into surgery alone.

2. Have the epidural. If it is an Emergency Cesarean Section, there is time to set things up, and there will be possibly a few more hours of labor before you get to surgery. Once a mother has given up and given into the the idea of the CS, she feels much more pain than when she has hope and fight, and that wait will feel like an eternity.

3. Dads: it is your job to make sure that mother gets to see her baby. Sometimes in the hustle and bustle of the surgery especially in Israeli hospitals, Dr’s and midwives forget to let the mother have a look in. If baby needs help breathing, as often happens (usually without mishap) at a CS, then as soon as baby is stable insist that the mother gets to be cheek to cheek with her baby, and sniff the top of her baby’s head. Take a photo of the two of them together.

4. Go with the baby. Usually the mother was looking forward to skin on skin contact and bonding right after birth – this can still be had with dad. Take the camera. Take lots of pictures and have a relative ferry the camera back and forth so the mother can see the photos of her baby still fresh and new. Follow the original birth plan for baby care already preplanned before the birth when it comes to bathing the baby, immunizations, creams and drops. There may be a need for antibiotics for the baby, about which you cannot argue.

5. Together with family members arrange to support breastfeeding from day one! A post-Cesearean Section mother cannot pick up her baby on her own for the first few days, so how is she to breastfeed? She may be feeling let down by her birth experience, but with full on support she can still realize her dreams of breastfeeding successfully. If separation from the baby is prolonged, have the nurses help her express colostrum and insist that it be given by spoon or dropper to the baby, NOT by bottle. Do not let a plastic teat touch the baby’s mouth. You want to help, not even possibly hinder by a little bit the chances this mother has at breastfeeding. Someone will have to be with the mother at all hours of the day on a rota, to bring the baby to her breast for feeding. Pester staff to send over the breastfeeding counselor for specific advice how to breastfeed a baby without hurting the mother’s tummy. I know of one family who became so endeared themselves to staff that they managed to have a female family member sleep in a chair at night by the mother’s bedside post-Cesearean Section, so that she had complete rooming-in from day one. It may officially be against the rules, but it is possible, and that baby never had any breastfeeding problems, and the mother and baby bonded beautifully, thanks to her family’s tenacity and dedication.

6. Listen to how the mother is feeling. Never, never, never say to her, “Well, at least you and the baby are alive and well! All that matters is a healthy baby. Get over it.” Yes, she knows that. She’s thought that already. She will hear that sentence a few more hundred times from well-meaning friends and family. That sentence will always shut her up effectively, but the emotions from processing the birth experience still need to come out or they will grow and cause harm inside. Let her talk. Let her feel. And nurture her with affection, affirmation, compliments, healthy food, enough sleep, and skin-on-skin time with her baby until she is through the mourning phase and the sad feelings fade on their own.

Cesarean women are Brave. Read this beautiful post by Avital Klein, a Canadian doula, who describes the sacrifice that it takes to lay down your body for your baby, how much strength it requires. That is, in the end, what every woman learns through childbirth.

If you have any more suggestions,  or experiences you could share, please do! An Emergency Cesarean Section does not need to be traumatic or horrible.  The good, the joy, the birth is still happening and both the mother and the baby can feel supported, loved, safe.