Feeds:
Posts
Comments

Ceridwen Morris summarizes my book for Babble. So, here is the VERY QUICK version of my book in case you don’t have time to read the whole thing or just went into labor and need a condensed version ASAP. :) https://www.babble.com/pregnancy/7-tips-for-having-a-natural-hospital-birth/

Morris writes: I just finished reading  “Natural Hospital Birth: The Best of Both Worlds” and I loved it! It’s written by medical anthropologist and doula, Cynthia Gabriel and it’s solidly helpful for women hoping for this kind of birth.

Home birth is not for everyone for a whole host of reasons, but some women feel they’d like to have something close to it in a hospital setting. And for those women there are strategies. This book is dedicated to that concept.

Here are seven really smart tips I got from the book:

1. Plan it. Absolutely have a dream birth and write it all out if you want to. While so many well-meaning friends, docs, and childbirth educators tell women to “stay open” she says there’s still a place for being very clear about what you want.”To the call for flexibility I say, ‘Let the hospital be flexible!’” Her most important advice: “Make a birth plan, and get attached to it!” She says you don’t have to hand this long document over to everyone you encounter– the headlines will suffice– but for your own process, writing it down can help you.

2. Get a great birth team together. Think about who will be with you to support you in labor. You really want to have a midwife or doctor who supports your wishes. This might mean you need to switch care providers mid-pregnancy (don’t worry, they’ll have plenty of other patients), hiring a labor support doula and taking a childbirth class “Taking charge of creating a positive birth team is a vital step in preparation for a natural birth.”

3. Learn about what happens in labor and what it feels like. Her sections on this topic are outstanding. She describes different kinds of labor but throws in amazingly accurate descriptions of what a woman looks like and acts like (for the partners) and feels like (for the moms who’ve never given birth before).  She writes about particularly challenging moments: the car to the hospital, triage, mid-active labor (at around 5-6 centimeters dilation) and transition.

NHB

4. Learn lots of coping strategies. Investigate all the ways you can cope without pain medication and practice a bunch of them with a partner beforehand. Gabriel gives a list of ways to help cope (she is a very big fan of getting in the water– a tub or shower) but also describes in detail how these things play out and help at various stages.

5. Wait an hour. When a medication or a medical procedure is proposed ask, “what if we wait an hour?” How this is answered will give you a lot of information. Sometimes you say, “What if we wait an hour” and the doctor says, “Oh, OK.” Now you know this is not an emergency but a suggestion.

6. Stay home in early labor. And while you’re at it? Ignore it! Ignore it until you can’t ignore it anymore.

7. Eat, cry or move. Often if a woman reaches a plateau in labor and it seems to slow down– often eating (for energy), crying (to release stress) or moving (to enable better positioning for the opening of pelvis/descent of baby and/or reducing pain) will likely help!

Gabriel also offers so much great, easy-to-follow advice for partners I can’t sum it up in a bullet point. But I will say, if you’re hoping for a non-medical birth in a medical setting, this book has a ton of good advice and info you can use.

NHB

 

Not everyone who is having their first baby had a wedding first. If you did, though, you have a natural window through which to peek at your relatives’ likely behavior — and your likely feelings about their behavior — at the birth of your baby. If you did not have a wedding, you may be able to think of another emotionally-heightened event at which family play a big role that will act as this window.

Mothers, mother-in-laws, sisters, and close friends are all likely to want to play a role at the time you give birth. I will focus mostly on mothers here, although for any mom-to-be it may be a sister or friend who lives nearby who is the focus of your attention. The question that pregnant women often ask their doulas is, “Should I invite her to the birth?”

If the woman had a wedding, this is where I usually start my questioning. Because it’s not about whether the relationship itself is good or bad. If you are considering inviting this person to your birth, I will assume the relationship is at least pretty positive. It’s about how the woman feels when she is doing something meaningful, stressful, and full of rapid decision-making in the presence of this other person.

Did you feel like your mother (sister/aunt/friend) understood exactly what you needed in the moment and was acting like an extension of yourself at all the wedding events? Or did you feel like she kept bringing you problems and issues to solve? Did she love your ideas and offer to help out anywhere? Or did she disapprove of your decisions (subtly or not so subtly)? Did she try to talk you out of ideas that meant a lot to you? Did you feel like her feelings enhanced and deepened the meaningfulness of your wedding for you? Or did her feelings about your wedding interfere with your own enjoyment?

 

Mothers can be just like us or very different from us and still be capable of offering genuine support. But not all mothers can offer genuine support. Their own needs get in the way of that.

Take a good look at how you felt about your mother (sister/aunt/friend)’s role at your wedding. If you have any lingering feelings of resentment or disappointment, I would strongly urge you to find a way to keep your laboring space free of their presence. Give her an important job to do away from your birthing space (making a birthday cake for the baby is a great job, for example). You do not get a re-do on your birth experience, so, like a wedding, it’s important to plan carefully. Don’t discount this treasure trove of information about how people are likely to act. Together with your gut instinct, this information about the past can usually tell you what you need to know about, “Should I invite her to the birth?”

man-person-cute-young-medium

POST-PARTUM SEX By Cynthia Gabriel, Ph.D.

No one talks about the sex life of new parents. I could make a joke here about how that’s because there is none, but that is not true at all. We would just rather gossip about a celebrity’s sex life than talk about real and challenging issues in an open, accepting way. Here in this land of individual freedom, we just let people figure things out (I mean struggle) by themselves. But it doesn’t have to be this way!

I, myself, have struggled with my sexuality in the wake of becoming a mother and I could have used some advice and reality checks. I feel lucky and privileged to have talked about this intimate subject with hundreds of women in interviews and in mother-baby groups. So, from the get-go, let me acknowledge that this is a one-sided piece. I have only heard from a handful of new fathers and even fewer lesbian mothers about this issue. But from these new mothers, I want to share some observations.

Friends, family, and medical professionals may assume you haven’t had sex in a LONG time – as if pregnancy and sex were incompatible.

Although pregnancy does slow down a sex life for some couples, for many couples pregnancy is a time of great sexual exploration. Still, birth has a way of changing the sexual dynamic, even if you were enjoying yourselves fully just a few days or weeks ago.

It takes longer to have sex after the baby is born for many couples than you think. Many people assume that the six-week mark is some magic date because there is usually a check-up at six weeks with a doctor or midwife. Yes, one of the topics of conversation at this check up is supposed to be birth control and, yes, the medical professional will examine the perineal area and the abdomen for healing. But this does not mean that a magic date has arrived. Do not think for a moment that MOST people have sex sometime around the six-week mark. Some do. But many, many, many do not.

The first time you have sex after having a baby is more of a “check in” than an act of passion. This may continue for a while.

A woman often wonders what sex will feel like after having a baby, even if she gave birth by cesarean. “Things” feel different in her body and it’s not clear ahead of time how these new sensations will affect sex. Lactating women are probably experiencing leaking and spraying as part of their everyday lives and they usually worry about how this will affect the sexual experience. She may have relied on nipple stimulation in the past to help get to arousal. What if her nipples are too sore from a baby’s mouth to be played with like they were in the past?

If you go into the first time – and, realistically, the first five or six times – as experiments, you will be less disappointed. These are occasions to figure out what is going to work for you, not occasions to measure something about your sexual success.

Women are often deeply worried about how their partner will “see” them now. They NEED reassurance, but part of that need is not wanting to ask for it.

The partner probably needs and wants reassurance, too. The partner wants reassurance that s/he is still desirable and that the new birth mother is not so wrapped up in the infant that there is no room for their “couple-ness.” The bad news is that the new birth mother is in NO POSITION to offer this reassurance. She will be able to do this better when the baby is one year old and she is feeling more confident herself. But right now, these first MONTHS (that’s right. Months. Not weeks) she is the one who needs reassurance. It’s part of the trade-off about growing the baby and giving birth to the baby. So, no matter how much you wish she would tear your clothes off and tell you how sexy you are, now is the time for you to tenderly reassure her that you find her attractive AS SHE IS.

Getting annoyed at the baby is a TURN-OFF. Being understanding of her attunement to the baby is a TURN-ON.

If you manage to get all the things in order to have a sexual encounter (you are rested enough, had a shower, the baby is asleep, the bed is not full of baby poop or throw up, you are not mad at each other about who got up in the middle of the night for burping, etc.) and the baby wakes up and interrupts you…

If you can be understanding and caring toward your partner if she needs to take care of the baby (or if she asks you to do so) you are more likely to get another shot at this the next time the opportunity arises. It might be in five minutes, when the baby is calm or it may be another day.

If you groan and complain, you are less likely to get that second shot.

The choice is yours.

Figuring out WHEN and WHERE is more complicated than you think.

Some babies sleep enough that it’s possible to have a good sex life in your own bed. But many babies do not sleep enough and couples have to figure out where to go to have sex. The problem is that most babysitters come to YOUR house. If you can afford it, think of a hotel room for an afternoon as the same price as dinner and a movie. Once a month, this may be worth it.

Sex can hurt more after having a baby.

Although this is not true for all women, for a certain percentage of women sex after giving birth is more painful than it was before. Generally, the first thing to try is more lubrication. If that does not fix the issue, an estrogen cream can be helpful. This is a topical cream, not an estrogen pill that you take internally, so it does not have the same effects on your body that hormone pills do. In studies of “women’s sexual health after childbirth” about half of women report vaginal dryness as an issue. You are not alone!

Feeling “Touched Out” is a real problem for new mothers.

 Many new mothers who spend their days and nights caring for needy newborns want to spend their non-baby time not being touched. It’s a serious mismatch for new mothers and their partners who, likely, are feeling less touched than they were before the baby arrived.

There is not an easy answer to this problem; however, if you are the partner reading this essay, I would take away that providing down time without the baby is likely to be helpful to the new mother’s receptiveness to touch. Otherwise, this is an issue that just requires patience and understanding.

For you science geeks out there I am going to copy some information from a 2000 British Journal of Obstetrics and Gynecology about this issue. What I find fascinating is that the medical professionals write it this way “Sexual morbidity increased significantly after the birth: in the first three months after delivery 83% of women experienced sexual problems, declining to 64% at six months, although not reaching pre-pregnancy levels of 38%.”

I would reframe it this way:

Most of us hope that we will return to our pre-pregnancy sex life by about six weeks after our babies are born because this is what we are led to believe by birth books and doctors. The reality is that this expectation is not realistic, but no one talks about it openly. The truth: 38% of us have sexual difficulties even before we have babies and 83% of us are not having the same kind of sex life we used to have for THREE MONTHS and 64% for SIX MONTHS after our babies are born.

In other words, it is NORMAL to have a very different kind of sex life for a LONG TIME after our babies are born. It is UNUSUAL to return to an easy-peasy sex life within six months post-partum.

INFO FROM THAT STUDY:

BJOG. 2000 Feb;107(2):186-95.

Women’s sexual health after childbirth.

Barrett G1, Pendry E, Peacock J, Victor C, Thakar R, Manyonda I.

Author information

 Abstract

OBJECTIVE:

To investigate the impact of childbirth on the sexual health of primiparous women and identify factors associated with dyspareunia.

DESIGN:

Cross-sectional study using obstetric records, and postal survey six months after delivery.

SETTING:

Department of Obstetrics and Gynaecology, St George’s Hospital, London.

POPULATION:

All primiparous women (n = 796) delivered of a live birth in a six month period.

METHODS:

Quantitative analysis of obstetric and survey data.

MAIN OUTCOME MEASURES:

Self reported sexual behaviour and sexual problems (e.g. vaginal dryness, painful penetration, pain during sexual intercourse, pain on orgasm, vaginal tightness, vaginal looseness, bleeding/irritation after sex, and loss of sexual desire); consultation for postnatal sexual problems.

RESULTS:

Of the 484 respondents (61% response rate), 89% had resumed sexual activity within six months of the birth. Sexual morbidity increased significantly after the birth: in the first three months after delivery 83% of women experienced sexual problems, declining to 64% at six months, although not reaching pre-pregnancy levels of 38% . Dyspareunia in the first three months after delivery was, after adjustment, significantly associated with vaginal deliveries (P = 0 x 01) and previous experience of dyspareunia (P = 0 x 03). At six months the association with type of delivery was not significant (P = 0 x 4); only experience of dyspareunia before pregnancy (P < 0 x 0001) and current breastfeeding were significant (P = 0 x 0006). Only 15% of women who had a postnatal sexual problem reported discussing it with a health professional.

Book Review

Just found this on the web. Thank you, Sarah Luk!

http://www.michiganbirthandbeyond.com/book-review-natural-hospital-birth/

Control Photo

This is a quick reflection on how birth is about “the unexpected” and about how important it is that women be in control of decision-making in birth precisely BECAUSE so much in birth is unexpected.

I think there is nothing worse than expecting one thing, having something entirely different happen, and feeling like the decisions were not in my control. Yet, this is what happens in birth across America every day.

We all have some vision in our mind of how our “perfect birth” will go. And I have yet to meet the woman who achieved her vision 100%, although I’ve definitely met a lot of women who are happy with their experiences. I’m always amazed at how even women with seemingly perfect births can obsess about the things that did not go right! (That’s a post for another day, because, come on! Let’s start talking about what went RIGHT at our births!) But this post is not about those seemingly “perfect” births.

It’s about the births in which we’ve planned really well, we’ve hired just the right support team, we’ve done everything we can to ensure that our vision has the best chance to succeed…

and then the baby decides to turn her head sideways or come out foot-first

or there is a flood/tornado/hurricane/outbreak of SARS (that last one happened to friends of mine who gave birth in Toronto!)

or our midwife is sick

or our blood pressure gets dangerously high during labor

or whatever….

And we have to improvise. We have to make decisions that we wish we didn’t have to make. We accept interventions because we know they are the right thing to do in the moment, but we also know that we researched and planned for HOURS and WEEKS and MONTHS to try to avoid them.

It’s just so important that women have as much decision-making control (and support) in birth because when these scenarios arise we will feel so differently about them when WE said, “Yes, it’s time for that intervention” than when we felt like it “happened to us.” Our healing for the days, weeks, and months after the birth will hinge in many ways on whether we feel like we had no choice or whether we chose.

We may be sad and angry that we did not have the perfect birth we envisioned, but we will not feel tricked, disempowered, or trampled upon. We can be sad and angry and also, simultaneously, grateful and empowered. These do not have to be mutually exclusive.

Childbirth Classes: Necessity or Luxury? Redundant in the Internet Age?

(reposted from last year with a new graph below!)

Hello pregnant women!

Fewer of us than ever before are signing up for traditional childbirth education classes. You know, those old-fashioned classes that meet in person. With a teacher. And maybe a textbook. Perhaps “class” reminds you of high school. Or college. And you do not want to be in SCHOOL any longer.

Besides, everything you need to know about birth is on youtube. Right? OK, well, then. Maybe it’s on Parenting.com? Or Childbirth.org? Or the American Pregnancy Association? Or WhatToExpect.com?

Oh, dear. There’s a lot of websites that offer “childbirth information.” And the information they offer conflicts. A lot. More importantly, the information is not well-tailored to your unique situation.

No, problem, says the modern mama-to-be. I know how to get information tailored for me! I will jump into some chat rooms or join a website and ask my specific, individualized questions. Then the magic of the Internet will quickly provide me with the answers I need.

Check out this graph from the “Listening to Mothers-III” survey about how we judge the trustworthiness of information on-line about pregnancy and birth:

Screen Shot 2015-05-12 at 9.40.15 PM

This is, indeed, how the majority of American women are preparing for childbirth. But childbirth is a very different process than researching what car to buy or whether or not to cut bangs this week (Michelle says, “Yes!”). Preparing for childbirth on-line is sort of like preparing for a triathalon on-line. There are good tips out there, but we all know that the REAL preparation is occuring off-line in what I would call “real life.”

Childbirth is a unique life event and probably nothing you have ever done in your life (except give birth previously!) can serve as a good model for how to prepare. I don’t know of any other event that requires the combination of social (how to interact with hospital staff and birthing professionals well), emotional, relational (negotiating the needs/wants of partners and parents and siblings), intellectual, and physical that birth requires. Many people compare birth to endurance sports events like marathons, but the fact is that few marathoners have to negotiate important medical decisions with doctors while they are running.

So, what you get in childbirth education classes that you CANNOT get on-line is the opportunity to practice in the presence of an experienced guide. When you READ information, it does not stick with you nearly the way it does when you have practiced what that information tells you to do. As Yogi Berra said, “In theory there is no difference between theory and practice. In practice there is.“

You learn SO much by getting to ask a question and having a personal INTERACTION about your question. You get to practice — try out — different ideas in this safe place that is not yet your labor or your baby’s birth. In this place, you get to practice thinking and feeling and relating different ways. You have a teacher, who has probably been at a number of births and seen some of those ways play out in real life, who can guide you in your thinking and feeling and relating.

Childbirth education classes are not really about information. The “facts” are readily available on-line. It is the practice of trying this idea and then this one or, hey, maybe this one that makes this information useful for you. When you are in labor you do not need theoretical knowledge. You need very, very practical knowledge.

ID-10020876

“I can’t afford a doula,” said a pregnant woman to me recently who was only a few weeks away from giving birth. “And, anyway, my husband is going to be there.” We chatted a while about the kind of birth she was envisioning. This was her first baby. She had a strong desire to avoid a cesarean and to give birth without drugs. She really didn’t want a “huge needle” in her spine.

This mother had clearly done her research and knew that many of the interventions that are so common in American childbirth are unnecessary. She had a lot of statistics at the tip of her tongue and we discussed many of them. I could tell she was determined to beat the odds, even though when you think about these odds, you probably would not bet against them in Vegas!

Eighty-three percent of American women receive pharmaceutical drugs for pain during labor (despite polls that show that most women say they would prefer NOT to do so). Ninety-one percent of American women lie on their backs or just a bit propped up when they are pushing out their babies. Forty-seven percent have bladder catheters during labor (which means they are NOT walking around). The list of interventions goes on and on. (These statistics come from the study “Listening to Mothers III.)

When I asked her how she thought she would avoid these common interventions, she said, “Well, I’m informed. I’ve done my homework.” She imagined herself just saying “no” to these interventions during labor.

This is when I asked whether she’d considered hiring a doula and she told me she couldn’t afford one. I asked how much the doulas she interviewed cost. She had not interviewed any doulas, but she’d “heard” that they cost $1,000.

In my town, only the most experienced doulas charge $1,000 as birth doulas and the real going rate is somewhere between $350-700. So her data on this point was inaccurate. But this woman’s tone indicated that this line of inquiry was closed. She was just not open to the idea of hiring a doula in these last weeks before giving birth and I could tell that continuing that conversation was not an option.

But if she had been open to the conversation, this is what I would have said to her:

It’s possible that you will have the kind of labor that never gets really hard. You might pay $1,000 and realize at the end of the day that you and your partner could have handled that birth without any outside help at all. It does happen. I have met such women before.

It’s possible that you will have the most amazing labor and delivery nurse who reads your birth plan and gives you a lot of labor coaching because she is a strong believer in natural birth. Even at the moment when you say, “I can’t do this anymore. Get me an epidural!”, this nurse will say back to you, “You’re doing great. Just focus on this contraction.” And you will focus on this contraction and the next one and after a few minutes that feeling like you can’t do it anymore fades away and you start to feel the urge to push. This also happens. I have met such women before.

It’s possible that your midwife will maintain a calm and protective aura in your room and never let you know that there is a resident just down the hallway who is watching your baby’s heart rate monitor and suggesting all kinds of interventions. This happens. I have watched it happen in hospitals in my town.

It’s possible you will be able to speak calmly and rationally throughout your labor. It’s possible that you will be able to interact with your hospital staff very rationally and weigh pros and cons of interventions on the spot. It’s possible that when the obstetrician says something like, “I’m a bit worried about your baby and I’d like to get some more information. I’m going to break your bag of waters and put in this internal monitor,” you will be able to say, before the next contraction hits you, “Oh, thank you so much for your concern. Is my baby in real danger right now? Could you tell me the pros and cons of this procedure?” And the obstetrician will patiently wait at your bedside while you handle an intense contraction that lasts a minute and a half. When you’re back to yourself, the doctor will touch your arm gently and explain the particular situation with your baby (who is not in imminent danger) and the pros and cons of breaking your water and using an internal monitor. Except that the explanation will be interrupted by four more contractions. But you have the best obstetrician in town, who will patiently wait through all of these contractions. You will be able to ask specific questions about parts you don’t understand. You will ask about alternative ideas. And you will be the kind of woman who is still able, after all this, to say politely, “No, thank you. After considering your explanation, I don’t want to do this right now. Let’s wait a little while longer.” It’s possible.

Although I want to tell you that I have not really met more than a handful of women who can do this during an active, strong labor.

This is where women who want natural births without unnecessary interventions often end up “giving in” and later regretting it. They are deep in the physical work of labor and they can’t really (and shouldn’t really!) concentrate on logical conversations. All the intellectual information we have gathered during pregnancy really does us almost no good when we are in labor because we are not really able to access much of our intellectual knowledge during labor. It’s much easier to say, “Yes,” during labor than it is to articulately say, “No, thank you.”

We imagine ourselves as our everyday Self in labor. Our everyday Self may be a strong, educated, and even opinionated person who is able to advocate for herself. But our Labor Self is a different self. Our Labor Self is strong and educated in a very different way, in a sensual, physical way. Labor Selves rarely articulate themselves well in full sentences and well-considered arguments.

You don’t pay $1,000 (or, more often, $500) for the labors that are easy and that you could manage without help. You pay $1,000 (or, more often, $500) for the possible times that having a doula changes the game.

So, if we are playing the Vegas odds, let me tell you that while it’s possible you will have that easy kind of labor in which your doula is really unnecessary, the odds on it are not very good. Maybe 3 in a 100. But the chances that a doula has something to offer you in labor that turns out to be important? Well, those odds are worth betting on. I’m going to put that at about 89 out of 100 or even higher.

In case she is needed, what will she be needed for?

Maybe for fifteen hours of squeezing your hips because when she squeezes your hips during a contraction, the pain changes from unmanageable to just manageable. But.only.if.she.squeezes.your.hips.EVERY.TIME.

Maybe she will help you walk around the hallways when your labor seems “stalled” at six centimeters and the hospital staff say it is time to think about a cesarean for “failure to progress” and it turns out that getting moving helps your labor a lot and you are eternally grateful for your doula’s insistence on walking before agreeing to the cesarean.

Or back to our scenario of “rational decision-making” during labor. It might feel like you paid $1,000 for her to whisper to you, after the doctor explains the pros and cons of the intervention, “I know you’ve heard what this doctor has said. Do you want a minute to discuss this with your partner?” And you nod your head. The doctor leaves the room and your partner is able to ask you, without a lot of eyes and ears around, “I know how important doing this naturally is to you. Do you want me to tell them we don’t want to do this and we want to wait a few hours?” And you can nod your head. You don’t have to say any words. You have a team that knows what you want, a team that knows how to create a situation in which you are likely to get it, and that does not expect you to talk rationally.

Let’s be honest that most women in America will not pay even one penny for this kind of support. Around 94% of American women, in fact. Maybe for these women paying $1,000 (or $500!) is not worth it for these “moments.” They are happy enough to go along with the routines of the hospital and have the kind of birth that the hospital staff guides them toward. If their labor is medicated and no one suggests anything “hippie” like walking around or using a shower to manage labor pain, if they end up with an unnecessary cesarean, they are pretty OK with it. They choose the route of “going with the flow” and that route works well for them.

But if you are the kind of woman like the one I met at the park the other day, the kind of woman who has done her homework and knows the statistics, who wants to beat the hospital intervention childbirth odds, then I would roll my dice with a doula. Every time.

photo by Salvatore Vuono

If you want to read more about ‘Listening to Mothers III” you can find a report here:http://transform.childbirthconnection.org/wp-content/uploads/2013/06/LTM-III_Pregnancy-and-Birth.pdf