Posts Tagged ‘birth’

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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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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Words easily trigger painful memories, according to this recent report in Science Daily. I read the article just before I took my 4 1/2 year old daughter to get some blood tests done yesterday, and decided to see if I could apply this with her. Last summer she had some immunizations; She screamed and cried, and for months after said “Please don’t take me to get another immunization, Mama, please promise?”

So she has a history with needles, and I was certain she’d get into histrionics with this one. When we arrived there was another little girl screaming over blood being drawn. But I spoke to Ana in positive tones, telling her and her brother that it doesn’t really hurt, it’s like a little tiny pinch that isn’t hard. I showed them both a little pinch on the arm and they agreed it didn’t really hurt. When she went in I showed her the needle. It had a little blue bow shape on top – I said, ‘look at the little blue butterfly! It’s going to kiss you now, like it’s drinking nectar from a flower’ I told the staff: ‘Ana’s not scared, she knows it’s just a pinch and doesn’t hurt.’

As the nurse took the blood, Ana watched in fascination, and didn’t cry, not even a peep. Nurses crowded around in amazement and praised Ana, amazed that a four-year old wasn’t crying. Afterwards, she reported proudly to her teacher at kindergarten that it didn’t hurt at all.

Pain IS suggestible. Changing our vocabulary,  like in the Hypnobirthing method by calling contractions ‘surges’ or ‘expansions’ does make a huge difference in our perception of what we’re feeling! I’ve seen a mother coping well with labor and enjoying the strength in her body, using vocalization and making healthy noise….but the staff thought she wasn’t coping because they’re used to quiet women on epidurals. So the doctor came in and suggested that she might be needing an epidural because it sounded to him like she wasn’t coping, and he thought she might not be able to make it without pain relief. Instantly, under that barrage of unbelief and doubt, she wilted before my eyes, and the contractions got visibly much more painful. She said that an epidural hadn’t even crossed her mind before he said that, but after those words she got scared about the length of labor and couldn’t do it anymore. We had the epidural. The birth was still beautiful, with a joyous outcome, but I was left amazed at the power of those sentences spoken by one doctor. Now, I agree that there are situations where a mother does need an epidural, and for her it is a right and good choice. But in this case the possible complications were not worth it: she could have kept going as she was, NOT suffering, but experiencing the power of labor, without the risks that come with an epidural. It was not necessary. Words that made it necessary.

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It’s the magic question weighing on most laboring mothers’ minds: (as well as the minds of her partner or birth attendants!) How much longer? Is there any way to tell how far along I am in the birthing process? I’ve seen mothers beg for an internal exam and then be gutted about the answer (What? ONLY 4cm STILL!?) and suddenly *poof* she looses her resolve. It’s akin to having a test and finding out you’ve failed it, in front of your loved ones as well as complete strangers. Everyone knows this feeling is not conducive to labor – suddenly doubt and fear slide in and the laboring mother feels tense. Her oxytocin levels (our body’s natural pain-killer and labor inducer) take a nose dive and immediately she feels much more pain and she starts to run away from the contractions.

Happily, there are a number of external cues that can help you and birth partners get clued in to how much labor is advancing. Some are more subtle than others, but if you are ignoring the clock and keeping focused on staying in tune with your body, you will see them. Listen, embrace, wait.  Enjoy the way it responds! It is amazing what it can do, this body that God gave you.

1. Sound. The way you talk changes from stage to stage in labor. With the first contractions, you can speak during them if you try, or if something surprises you, or if someone says something you strongly disagree with. You may be getting into breathing and moving and ignoring people – but if you really want to you can raise your head and speak in a normal voice. When the contraction disappears you can chat and laugh at people’s jokes and move about getting preparations done. During established labor, There is very little you can do to speak during a contraction. You feel like resting in between, you are not bothered what people are doing around you. As you near transition and birth, you seem to go to ‘another’ level of awareness – it’s almost like a spiritual hideaway. You may share this with someone else, staring into their eyes with each surge, or you may close them and go into yourself. In between surges you stay in this place. It is imperative for birth assistants and partners to stay quiet and support the sanctity of this space: there are no more jokes, and should be as little small talk as possible. Suddenly, the sounds start to change involuntarily: you may have been vocalizing before (moaning, talking and expressing your discomfort, singing, etc) or you may have been silent. Listen – there are deep gutteral sounds along with everything you have heard before, just slipping in there. You are about to start pushing.

2. Smell. There is a smell to birth, that hits towards the end of dilation, during intense labor, just before birth. It is a cross between mown hay and semen and dampness. It has a fresh, yet enclosed quality, and is pervasive. The Navelgazing Midwife has also observed this scent and writes about it here.

3. Irrationality. I love this clue – it often is a sign of transition. It always makes me smile, and I always warn women about this phenomenon so that when we hit it during labor I can remind them that what they’ve just said is irrational, and that I told her this would happen, and here it is! Relax, it means we’re nearing the end. Sometimes a mother will say she wants to go home, she is done now she’ll come back and do this later, she wants to put on her trousers and coat and go out the door. A mother who wants a natural birth and has been coping brilliantly will suddenly say she was crazy and needs pain killers right now, or that she didn’t want another baby anyways, who said they wanted a baby? Some will just curl up and say they’re going to sleep now. If she does this, that’s okay. The contractions may die down, get farther apart, and maybe she (and the baby) will get a few minutes of sleep. This slowed down transition sometimes freaks out doctors or hospital midwives and pitocin is offered – try to see if you can put them off for half an hour. Send every one out, lie on your left side propped up by pillows and have a little nap before pushing; it is such a wonderful gift.

4. Feel. Here come some of the more fun tools that you might not have heard of before! Think about the shape of the uterus. Before labor, the muscle of the uterus is thick evenly around all sides, above, below, behind. As the cervix starts thinning and dilating, all that muscle has to go somewhere – it bunches up at that top. The top of the uterus thickens dramatically the more the cervix opens. During a contraction, at the beginning of labor, check how many fingers you can fit between the fundus (top of your bump) and the bra line – you will be able to fit 5 fingers. As the top of the fundus rises higher during labor, you will fit fewer and fewer fingers. When you can fit 3 fingers, I usually tell mothers they can think about going into hospital as they will find they are around 5cm dilated. At 1 finger, you are fully dilated. (Awesome, huh! Here is a blog post by a woman who describes in great detail checking her own cervix just before she went into labor.)

5. Look. There is something called the ‘bottom line’, which is shadow that extends from the anus up towards the back along the crease of the buttocks. It begins as 1cm and lengthens to 10cm, and it’s length correlates with cervical dilation. Why not look down there before inviting a stranger to put their fingers up inside you? It makes sense to me. Here is current research verifying the existence of the bottom line, and in their trial it was measurable and had acceptable accuracy for 76% of women checked.

6. Gooey Stuff. Also known as bloody show; there is usually one at around 2-3 cm dilation, and it can happen during the beginning of labor or a few days before hand. Sometimes it’s hard to know what is or isn’t a show, since during the days before labor the amount of vaginal mucus increases in preparation and this can be confusing. A show is up to a couple of tablespoons in quantity, so quite a lot. It can be clear, but is usually streaked with pink, brown, or bright blood. If there is more than a couple of tablespoons of blood then you do need to go straight into hospital to make sure the placenta is not detaching, but if there is just a bit and then it stops, then it is just show. There is a SECOND show at around 8cm dilation. This second show means that birth is near.

7. Opening of the Back. This is just at the spot where your birth partner has been doing lower back massage, at the area above the tailbone. It is a little smaller than palm sized, rather kite-shaped area that bulges out during pushing. At this point you’ve waited too long to go into hospital, and you need to refer to my last post, 4 rules of what to do when delivering a baby!

8. Check yourself. Okay, so technically this one is an internal check, but it done by YOU. You don’t have to announce the results or write them down: it is not an exam. To me it’s obvious that as the owner of your body, you have more of a right than anyone else to feel comfortable with it and understand how it works. It is best to get to know what your own cervix feels like from early on in your pregnancy, if not before, and then to keep a regular check on what feels normal. If you do this through out your pregnancy you will keep your flexibility into the 9th month. This is also an excellent time to remind you to not neglect perineal massage since you’re already down there! Check out the website My Beautiful Cervix to see photos and descriptions of what a cervix should feel like. At 1 cm you can fit the tip of one finger inside. Use a ruler to practice discerning how many centimeters dilation feels like, measuring with your pointer and middle finger. This visual aid is also a cute way to imagine dilation. NOTE: Always, always, always wash your hands thoroughly beforehand, up to the elbows, for 4 minutes at least. Do not assess your own dilation after your waters have gone.

For more labor tips and information about external assessment of dilation, I recommend finding a copy of Anada Lowe’s book, The Doula Guide to Birth, Secrets Every Pregnant Woman Should Know.  This is one book packed with practical and useful information!

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So, you’ve been doing everything you can to help this baby turn over and get into their optimal position: you’ve been on all fours and in the knee-to-chest position for so long you’ve picked all the lint off the carpet. You’ve been sitting on a birthing ball at the dinner table, computer, and while watching late-night TV. And STILL your baby is stubbornly posterior.  How are you going to face this labor?

OP labor is what is commonly called ‘back labor’. The baby’s spine is lined up with your spine and in this position it is harder for him to tuck his chin into his chest and come out at the smallest circumference: the crown of the head. Instead, his chin stays up and the larger circumference, the forehead enters the pelvis first – an awkward fit. The back of his head presses against your tailbone, causing that exquisite back pain.  Sometimes, when an OP positioning is diagnosed, the mother is advised at the outsed have an epidural, and if the decent is prolonged she may have an assisted birth.

There is a potential problem with accepting this epidural: your pelvic circumference. When lying on your back, your pelvis compacts into it’s narrowest shape. OP means that a larger shape of the baby’s head is presenting, so if the pelvis shape is also at it’s smallest, you may have more difficulty getting the head to pass through. This could lead to assisted delivery or Cesarean on the pretext that your pelvis is ‘too small’ to have your baby (also known as cephalo-pelvic disproportion, or CPD).

You actually want the exact opposite to happen! Rather than constricting your pelvis, you should aim to help yoru pelvis have its most open shape. More space is created in the pelvis by leaning forward, or being on your hands and knees. This also has the benefit of lessening the pressure of the head on your tailbone (lying down means gravity adds more pressure in that area). If you go into labor and the baby is still posterior, I would advise you to ask for a natural birthing room if there is one in your hospital, or let the staff know your goal is to labor in a way that comes natural to you. Then they are more likely to be generous with allowing you to adopt the position you desire.  You could even request for your initial 20 minutes of monitor time to be done while you are still on your hands and knees. A mother I assisted whose baby was OP did just that instinctively, and simply refused to lie down or even sit. The midwife managed to apply the monitor and get the required inital 20 minute printout while the mother was in this position just fine.

Another way to help the pelvis to widen is to have someone do hip presses – that means they stand behind you, placing one hand on either hip just below your hipbone where you can feel the outer edge of your pelvis sticking out and press together very firmly during contractions. You may find this feels soooo good. Then, at the end of the contraction it may feel better for as much pressure as possible to be applied against your tailbone, providing counter-pressure to the baby’s head on the other side and relieving the strain you feel there. Bring a sock filled with rice, or containing two tennis balls, or even a rolling pin to help apply this pressure. Remember, the kind of pressure you will find helpful does change during the course of labor – what felt good at first may irritate you later. Make sure your birth partner is aware of this and that you agree to feel free to direct them to do something else instead. These presses and lower back massage can be done while you’re leaning against a counter, on all fours, or holding onto your partner’s neck, swaying to music. Gyrating your pelvis in circular movements and figure 8s can help your baby turn into the easier anterior position during labor, so move plenty to help him find freedom to flex and turn.

During contractions, try lunging forward when on hands and knees, bring one foot up beside your chest. Rock during the contraction. This lunge provides a twisting sensation in the pelvis that may help the baby turn. You may also do this while standing, with one foot up on a chair and someone behind you to help you keep your balance. Go to spinningbabies website for more illustrations of positions to adopt during labor to help your baby turn.

For pain relief I would recommend looking into using a TENS machine. It is much better to try to use a small machine over which you have control, before giving yourself over to others to make decisions for you! Some women don’t like the sensation of a TENS, while others have called it their ‘friendly little buzzing bee’ and swear by it. A TENS machine can be rented from Yad Sarah in Israel for a small fee. The electrodes are applied to your back, exactly where your pain is in a back-to-back labor. I recently spoke to a midwife who swore by her TENS machine for her OP labor with her first baby. There are no side effects, either for you or the baby, no drugs to be flushed out of your system.

How about a mobile epidural? This may depend on the anesthesiologist and hospital policy; I would call ahead and ask. If you do feel the need for an epidural don’t, whatever you do, feel guilty – you alone know what you are going through; you don’t need anyone’s permission. If your mobile epidural is successful (not always do they have the same effect on everyone) then you will be able to still move onto your hands and knees, as long as there is someone next to you at all times holding on and making sure you’re stable and supported. Epidurals have quite a few side effects, so read up on epidurals so you can make an informed choice. Most doctors and midwives do not fully explain them at births.

Monitoring is the same as in any other birth. To facillitate the desired mobility in OP deliveryies you can refuse the straps (except in the case of dips in heart rate or an epidural) and the heart rate will be checked every 1-4 hours. If the pushing stage of an OP labor is extended, the baby’s heartbeat will be monitored every five minutes to be sure the baby is coping well;  but even so you can ask that they the hand held monitor be used instead.

Finally, as the baby’s head is being born imagine your vagina relaxing and becoming HUGE, and repeat this to yourself over and over again as the baby crowns. Believing positive words with your head that you can open wide, relax, accept will cause more relaxation in the muscles. As is true during sex, engorgement of blood causes the tissues to expand and become more stretchy, and this is all connected to your frame of mind, the hormones your brain releases. Fear and tension make for painful intercourse. Fear and tension, then, must make for more lacerations in childbirth too. I really wish every mother could read a copy of Ina May Gaskin’s Guide to Childbirth before going into labor! The entire first half of the book is positive birthing story after positive birthing story – women giving birth OP or to big babies (10 lb) with no tearing, even for first babies. The goal of immersing yourself in other women’s positive experiences is to immerse yourself in the idea of the normality of birth, that things can go well. I believe it – I’ve seen it and experienced it myself. You can too!

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Everyone recommends doing this to encourage the elasticity of your skin and prevent tearing at the birth,

but not many explain exactly how to go about it…….

Appropriate oils: vegetable oils, such as almond oil, grapeseed oil, wheatgerm oil, or cold press olive oil.  Do not use: baby oil, mineral oil or petroleum jelly as they tend to dry the tissue.  Vegetable oils are much better absorbed. Alternatively, use a water-based jelly.

Two aromatherapy blends that are good: Blend 40 ml sweet almond oil and 10 ml of jojoba oil and massage in a few drops daily.  Or, 45 ml cold pressed olive oil and 5 ml wheat germ oil mixed.  Store in a plastic sealable bottle.

From 34 weeks practice perineal massage for 5 minutes once a day, to care that the tissue will be soft and pliable for birth, and reduce the likelihood of tearing or the need for and episiotomy.   Prenatal perineal massage lets the expectant mother experience the sensations that are similar to those she will feel as the baby emerges, and it gives you a chance to practice relaxing your perineum as you ought to during delivery.


Wash your hands and cut fingernails to prevent scratching.
Make yourself comfortable in a semi sitting position, with legs bent and relaxed.
1. Lubricate your fingers well with oil.  To avoid contaminating the oil, do not dip your fingers in, instead pour oil over your fingers.  Or, have a few drops already poured into a clean dish.
2.  Rub enough oil into the perineum (area between the vagina and the anus) to allow your fingers to move smoothly over the tissue and lower vaginal wall.
3. Starting with one finger and progressing to two, place your fingers well inside the vagina (up to second knuckle,) rotate your fingers in both directions while pulling down and outwards gently for about 3 minutes.  If your husband can do this for you, then he can use both forefingers to spread downwards in opposite directions.  Slide your fingers in a U shaped down the vaginal walls, across the perineum and up the other side. Do this for about 3 minutes.  The movement will stretch the muscles surrounding the vagina, and the skin of the perineum.
4. Finish the massage by rubbing the skin of the perineum between the thumb and forefinger (thumb on the outside, finger on the inside) for about one minute.  In the beginning the tissue feels tight, but with time and repeated massages it relaxes and stretches.
5. Try to concentrate on relaxing your perineum as you feel the pressure.  As it becomes more comfortable, increase the pressure just enough to make the perineum begin to sting from the stretching.  The same stinging sensation will occur as the baby’s head is being born.

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