Posts Tagged ‘labor’

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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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!

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Laughter is the best medicine . Such a cliché that we don’t even take it seriously. But what about bringing it into the birth experience? While birth is amazing and beautiful and holy, there is also a bit of the ridiculous involved. God created us to have our babies come out of WHERE? Sometimes we can help our bodies to accept the amazing and fantastic things and accept the flow if we relax and find the funny in it. It’s not a marathon after all, it’s a joyous thing. So here’s a tip for early labor: Bring out the laptop, or your dvd player, and bring the best stand-up and comedy clips you can find.

Pick something that brings out good belly laughs! They massage the uterus, which can tip a ripe and ready uterus right over the edge into proper labor. Laughing releases endorphins and oxytocin which are both hormones that are key in the birthing process! If you go to hospital to be induced, they’ll give you synthetic forms of oxytocin to stimulate contractions – wouldn’t you rather first have a try a more fun way of getting those hormones naturally?

Not only that, but beginning the process of labor and becoming parents by laughing with your partner is a good bonding experience for the two of you. You are enjoying this experience, together, both involved, feeling good, enjoying yourselves.

So what should you watch? I have a good friend who went into labor over My Big Fat Greek Wedding, although she was British so for people who are used to stiff, formal weddings this would really funny. If you are used to a loud, raucous family event like a Jewish wedding, then you won’t understand what the big deal is. I’ve added  a list of YouTube clips that make me roll about laughing over on the sidebar, but make sure that you’re watching these clips for the first time, because that’s when you tend to laugh the hardest! Another idea is to incorporate your friends: ask people to send you links to their favorite funniest videos, obviously letting them know if you are language sensitive or not. I’m sure they will be more than happy to play their little part in this event!

So, if you have a favorite comedy clip, go on, share it in the comments…….x

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

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

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

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

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

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

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

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

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

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

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