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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?”

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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.

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Brazil ImageBrazil has a cesarean rate that is, depending on the year, the highest in the world. Their rivals include Taiwan and China, but not the United States. Here we hover around the 33% mark, but in Brazil about half of all babies are born by surgery and in some urban, private hospitals the rates are in 70-90% range.

To put this in perspective, if we took a 20% cesarean rate as “normal” (and I do not think that is normal!) as a 2010 World Health Organization report did, several million Brazilian women are having unnecessary cesareans every year. That report calculated a world-wide excess of 6.2 million cesareans annually and half of those are in China and Brazil.

(http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf, p. 8).

Why is the cesarean rate in Brazil so high?

If you ask Americans, they tend to blame Brazilian women.  Almost invariably, the first ideas we Americans have are about how the WOMEN must want more cesareans, how the women must be more used to surgeries (since they have so many more plastic surgeries than American women), how the women must be more concerned with keeping their vaginas tight and beautiful, how the women must not be willing to undergo labor.

But when I ask Brazilians in the United States, they tell me the same things that American women tell me. They say things like, “My doctor told me I didn’t have enough amniotic fluid” or “My baby was too big to be born vaginally” or “My baby was in distress.” In other words, Brazilian women understand their own cesareans as medically-necessary, even though statistically it can’t be true for most of them. (The same phenomenon occurs in the United States, I find.)

A 2014 article in the Atlantic confirms this. That article concluded that the medical system is not set up to support laboring women who are aiming for vaginal births (much less unmedicated vaginal births!). In hospitals where 70% or more of births are by cesarean, women who aim for vaginal birth are nuisances to the schedules of doctors and nurses. And it is a self-fulfilling prophecy that doctors and nurses who are skilled at cesarean birth become less and less skilled at managing natural labors.

All of this adds up to a fascinating cultural picture that I am eager to learn more about. So I am headed to Brazil at the end of May for a two-week crash course in all things birth in Brazil. I will be in Florianapolis with Ana Paula Markel, doula trainer extraordinaire, and in Belo Horizonte with my Portuguese teacher, who has promised to introduce me to young women and their families who are in the thick of this childbearing conundrum.

I’m so excited! If you are Brazilian, Brazilian-American, or an American who has given birth in Brazil, I want your stories!

Here are two articles if you’re interested in more.

http://www.theatlantic.com/health/archive/2014/04/why-most-brazilian-women-get-c-sections/360589/

http://www.pri.org/stories/2014-05-14/brazil-half-all-mothers-have-c-sections-whether-they-want-it-or-not

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A group called The Unnecesarean pointed out today that anesthesiologists, themselves, are aware that WALKING in labor (“ambulating” in medical terms) reduces cesarean rates. Though I am an advocate of natural hospital birth, I share the goal of reducing unnecessary cesareans. It seems to me that if “walking epidurals” are known to reduce the risk of cesarean in women who want epidural anesthesia, we should be offering these more often. (Please know that I say that with the belief that no woman should be offered anesthesia in labor that she does not want. Women who want a natural birth deserve FULL support for this!) As “The Unnecessarean” points out, the anesthesiologist quoted in this article is blunt in admitting that it is “easier” to manage laboring women in bed. But labor is not about ease. It is about birthing the next generation. It is worth the hard work of women AND hospital staff!

Here are some excerpts and a link to the article. Thank you to The Unnecesarean for pointing this out.

Most notably, only four of the patients who received a walking epidural experienced hypotension compared with 44 patients in the nonambulatory group. Only 113 in the walking group required bladder catheterization compared with 187 in the nonambulatory group. Motor block was seen far less frequently in the ambulatory group (14 vs. 145 patients in the nonambulatory group), and cesarean delivery was less common as well (53 vs. 65, respectively).

On the other hand, patients who received walking epidurals reported more pruritus and required more interventions, as demonstrated by higher total PCA volume and use of rescue doses of ropivacaine. The duration of labor was unaffected.

“Even with the benefits to the patient, walking epidurals are not used very often because they are more time-consuming in terms of patient management,” said study leader Shaul Cohen, MD, professor of anesthesiology at UMDNJ, in New Brunswick. “It’s much easier to keep them in bed with a Foley catheter. And it’s an insurance issue. Insurance companies pay for care not quality of care, and they won’t pay for the additional time and staff required by walking epidural.”

Dr. Cohen added that the increased use of cesarean delivery—nearly 45% of laboring women in New Jersey now undergo the surgery, he said—makes it more difficult, if not impossible, for obstetric anesthesiologists to offer patients the walking epidural approach.

Others in the field have a more tempered view of its benefits, however. “There is no ‘ideal’ epidural infusion regimen for labor analgesia,” said David Wlody, MD, chief of anesthesiology at the State University of New York-Downstate Medical Center, in New York City, and a specialist in obstetric anesthesiology. “Different patients, anesthesiologists and obstetric providers will have different expectations regarding pain relief in labor,” said Dr. Wlody, a member of the editorial board of Anesthesiology News, who was not involved in the latest research.

“Some patients may be willing to tolerate a greater amount of discomfort if it means enhanced ability to ambulate, while others will desire more pain relief at the expense of increased motor block,” Dr. Wlody added. “It is the responsibility of the anesthesiologist to balance these often conflicting goals in order to provide the best outcomes and the highest degree of patient satisfaction.”

http://www.anesthesiologynews.com/ViewArticle.aspx?d=Clinical%2BAnesthesiology&d_id=1&i=May+2013&i_id=956&a_id=23112#.UaSyPv1c7Q0.facebook

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Reposting my all-time favorite post. Because I love my job! Every so often I get a bug to become a better-paid birth professional. Doulas are just not the top earners in the birth field, sad to say.

And part of me is a real midwifery geek. I know I would love learning to become an obstetrician or a midwife or a labor and delivery nurse. I love learning about blood vessels leading to the placenta, about how to guide a breech baby out, about how to diagnose an ectopic pregnancy. Really. GEEK is the only word for the thrill I get from reading about such topics.

But when I am at a birth (as I was a few days ago) I have this fabulous role. This birth brought it home. Everyone else in the room at this hospital VBAC birth was focused on getting a recalcitrant baby out of a woman’s body as fast as possible: cutting her vagina open, attaching vacuum suction cups to the baby’s head, and adjusting various accoutrements to keep track of the baby’s heart rate (which was low and not coming up in between contractions… thus the drama and concern).

In contrast to the midwife, the L&D nurse, the obstetrician, the resident, and the neonatal team, my job was to remain full of trust in birth. My job was to help the mother stay connected to her calmest, most trusting place inside herself. I was allowed to smile and tell the mother that we could all see dark, curly hair as her baby’s head crowned. Everyone else was 100% focused on getting this baby’s head OUT. Fast. The mother and I were able to concentrate on this baby’s individuality. (Her previous babies had blonde hair.)

When the baby was born, the neonatal team whisked him away because of the heavy meconium. (Yet he was FINE immediately. At one minute he had an Apgar of 8. So much for all the panic!) No one but me noticed that the mother was panicked without being able to see or or hear or touch her baby.Of course, after all that drama when she didn’t hear a cry right away, she was afraid her baby was not OK. I was able to stand in the middle of the room and relay news about how her baby was waving his arms and legs and his skin was a beautiful, healthy pink color. All the birth professionals were busy, with important jobs for which they went to school for many years and for which they get paid fair salaries.

But would I rather learn how to measure a cervix or help a mother find her inner power? I am so, so glad that there are birth professionals out there who answer, “I want to measure the cervix.” Without these professionals, birth would not be as safe as it is today. Yet I am happy when I remember that my greatest joy is not measuring blood pressure or fetal heart tones, it is in aiding a woman have the experience that makes her feel like she is a powerful, amazing mother who can do anything. This is a feeling she gets to keep for the rest of her life.

Helping women smile when they remember giving birth. That is a doula’s job.

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I just read a blog by a woman who was trying to decide whether to hire a doula in her second pregnancy. She eloquently captures that inner dialogue that I bet a lot of women have about this question: Is a doula a luxury or a necessity? In her blog post, she talks about her unease with consumerism. Do we need to buy things to be happy? Do we need to spend money to regain our confidence in our own birthing bodies? You can check out her blog here: http://mothershavefeelingstoo.wordpress.com/2012/08/29/doulas-necessities-or-luxuries/

In this post, I want to offer one idea in response to the Mastercard-buy-more-to-be-happy-consumerist problem we all live with in the First World. One of the problems with consumerist culture is that we mistakenly believe that the THINGS we buy are what gives us pleasure. In fact, the things we buy are things that real humans made, transported, sold. It is their WORK that gives us pleasure. When we buy services (massage, health care appointments, a haircut, or doula services) this is more evident than when we buy objects.

When we remember that it is human’s work that we are paying for, not just “things,” we can make wholly different choices about spending money. We can spend money and stop being a “consumer” if that makes sense. We can USE money to connect with other humans. So often we do the opposite. We use the fact that we are paying someone money for something like a haircut or cleaning our house or taking care of our children as an excuse to treat them differently than we would a friend or relative. We all do it. (Be warned: Sometimes when I try to treat someone I am paying for a service more humanely than they expect, they act as if I am crazy.)

As a doula and as a woman, I value so-called women’s work — no matter who does it, men or women. Long ago as a teenager learning about women’s work in history I vowed that I would pay childcare workers fairly even if they themselves did not charge a fair amount (which is true in our area. Our babysitter charges an absurdly low hourly rate and doesn’t charge for sick days: hers or ours!). A more accurate term I learned in graduate school is “reproductive work” — which is all the work that is (usually) unpaid if it happens within a family. It is the work that is necessary to reproduce ourselves everyday (taking a shower, mending clothes, cooking, doing dishes, gardening, etc.) and to reproduce another generation (childcare, etc.)

Because of larger cultural and global forces outside of any one person’s control, we are not able to do all the reproductive work inside families anymore. In my case, a big factor is that my parents, my husband’s parents, and all our siblings (eight in all) live far, far away from us. The closest is a ten-hour drive; many of them live across the globe. Many of my friends rely on their extended family for SOOO much help. My best friend here sends her two kids to her in-laws overnight every Saturday. [An aside: I can’t imagine having a night off of children to spend with my husband free of charge every week. When we do hire a babysitter, we have to go out of the house. I would love to stay at home and sleep at home with my husband with no kids in the house!] Just because I would prefer to have much of this reproductive work done inside my family networks doesn’t mean that is the best way to do it in 2012.

In general, I try hard to be thoughtful about using money and when I pay for reproductive tasks I find I am even more thoughtful than when I am buying plain-old commodities like new running shoes. I want to be thoughtful when I am buying running shoes, too, but I find it is easier to be thoughtful when I actually meet and interact with the human who is doing the work. Because when I pay for reproductive work (cooking, cleaning, childcare, doula work) I am asking someone to step into the shoes of my relatives. I am asking someone to care for me/my loved ones. Money is just the vehicle that allows someone else to have the time to do this work that I do wish my sister, my mother, my grandmother could do for me. But they can’t. So I am using money as a tool — not a substitute — for connecting to real humans.

It’s not a perfect solution to our consumerist culture. But being clear that money is really a metaphor for human time and that what we buy is human work — not “things” — makes me more thoughtful about my choices. And the surprising conclusion I come to when I think this way is that I want to spend MORE of my money on things like doula services and home-cooked meals and less of my money on things like technological gadgets.

What about you?

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I got to speak at University of Michigan on Saturday to a packed room of what looked like 100 people or more. Wow! There were nurses, midwives, doctors, doulas, and pregnant women conversing together. Again, wow! It’s so great to be HAVING these conversations. Here’s an article from the University of Michigan website:

Hospital can provide safety net without pushing interventions; expert panel discussion planned at U-M March 24

Nadine Naber labored with a midwife, who guided her through her pain. Her husband was at her side, holding her hand, as she gave birth to her youngest son in a water-filled tub.

It was everything she dreamed a natural childbirth could be. But it didn’t happen at home — her son was born in the hospital.

Naber is one of many women who find that a natural hospital birth — a childbirth without medication or other intervention — is possible at Von Voigtlander Women’s Hospital at the University of Michigan. U-M has eight nurse midwives on staff and encourages women to set a natural birth plan that still offers the advantages of being in a hospital setting.

“I truly and deeply experienced what I would dream of with a natural birth, in every way possible, without any sense of it being medicalized,” says Naber, a 42-year-old mother of two and Ann Arbor, Mich. resident.

Naber says the natural hospital birth offers the best of both worlds: a birth plan without unnecessary medical intervention but also the safety net of the hospital setting.

U-M and Douglas Care will host a panel discussion, “Supporting Natural Birth in Hospital Settings,” on March 24, featuring author and professional doula, Cynthia Gabriel. Gabriel’s book, “Natural Hospital Birth: The Best of Both Worlds,” features a forward written by U-M’s Timothy R.B. Johnson, M.D. , who is professor and chair of the U-M Department of Obstetrics and Gynecology.

 http://umhsheadlines.org/20/natural-births-possible-encouraged-in-hospital-setting-at-university-of-michigan/

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