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Archive for August, 2011

I recently read Born in the USA by Marsden Wagner, who is the former director of women and children’s health for the World Health Organization. He made a great observation on the essential difference between midwives and the majority of doctors when it comes to childbirth.

Doctors view birth as something that happens to a woman.

Midwives see birth as something a woman does.

Seemingly a minor difference, but it means everything for how women in labor are treated.

Midwives assist a laboring woman give birth. Everything they do is to provide support for the woman while she works to birth her baby, and they are there in case something should go wrong. Women are considered “clients,” not “patients” because they are not sick. They are simply pregnant.

On the other hand, doctors deliver a baby. They see women as patients with a condition that must be fixed. Namely, she is pregnant and she should not be pregnant anymore. The goal is to get the baby out as quickly as possible, generally through medical methods and by their own expertise. It is rare to see a doctor who is willing to allow a healthy labor to happen naturally without attempting to meddle. Doctors are expert meddlers. It’s really all about control. But labor cannot be controlled, and when doctors (or nurse-midwives) attempt to control the uncontrollable, they tend to end up doing things that are not necessary or beneficial for the mother or her baby.

Doctors should be backup for when a woman actually does need assistance, not the default option for every woman in every birth. We need support during pregnancy and birth. Not always a medical degree.

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Less than three weeks ago I gave birth to my third daughter. Exciting, right?! Well, I’m excited. She’s adorable and it was literally the perfect birth. Absolutely perfect. Once I finish writing my birth story I’ll post it for anyone who wants to read about a home birth. Anyway, since I’ve now had three natural births, one in a hospital and two at home, I think it’s time to write about pain management during labor.

Although the majority of women in the U.S. choose to get an epidural to block feeling, there are definite risks to the procedure, both for the mother and her baby. I don’t think anyone would disagree that a drug-free vaginal birth is by far the safest. Unfortunately, not many women believe that they are capable of a drug-free birth. Most, if not all of this is due to our cultural opinion of birth. Nearly everyone, from doctors to the media, treats labor and birth as a medical condition that requires medical intervention and a highly-specialized doctor present to “get the baby out.” However, a healthy woman, left to herself or with a trusted labor assistant, will also give birth, and generally much more quickly and peacefully.

With all that being said, let’s talk about labor pains.

Now, labor is a lot of work. It is hard work. And for good reason. During labor our bodies go through incredible physical and hormonal changes as the baby moves down the birth canal to be born. How many are in awe that a baby is able to fit through an opening that is so small? I know I am! With all the changes occurring within a laboring woman’s body, there is also a level of discomfort. Each woman experiences it differently; some refer to the sensation as an intense ache on her pubic bone, some women describe extreme pain.

Whatever experience you’ve had or heard stories about, there are ways to alleviate painful sensations during each contraction (also called a surge or rush by many natural childbirth books – I like those terms much better, don’t you? They describe labor much more accurately than contraction does. What a distant, medical word) – without drugs. Here are some ways to handle the surges:

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1. Relax

Seems counterintuitive, right? When we experience pain or discomfort our natural reaction is to tense up in a “fight or flight” mentality. Our adrenaline kicks in and we’re ready to react. Normally, this is a good thing. However, labor is not something we can escape from, and it is not something to fear. We are bringing new life into the world, and that is a wonderful thing! Tensing muscles during a surge will only make the pain worse. Our tendency is to tense up, then when that makes it more painful we tense up more, which creates even more pain. It turns into a vicious cycle in which a woman even begins to tense up in anticipation of the next contraction.

In order to break free of that cycle, it helps to relax our muscles, especially in the abdomen, butt/vaginal area, and jaw. If you’re having trouble relaxing those muscles, allowing your mouth to fall open in a “duh” expression helps open up the birth canal as it lessens tension in your vaginal muscles. I know, it sounds weird, but those two sets of muscles are connected. It is possible to relax all these muscles even while you’re using others, such as while standing or kneeling.

2. Breathe, Breathe

“Breathing” does not mean the short, “hee hee hoo hoo” breaths that classes like Lamaze teach (well, they used to, at least; maybe they’ve changed). Patterned breathing techniques like that are only used to try to distract a woman from her contractions. When I say “breathe,” I mean deep, full, belly breathing. The kind we all used to do as children, before our culture taught us to never let our bellies stick out. Breathe like an opera singer or a baby. With each breath use as much lung space as possible. If you do it correctly, your belly should rise with each breath, but your chest barely moves. Try to visualize sending air down into your vagina instead of your chest. Deep breathing takes more oxygen into your body, which alleviates pain. Focusing on the breathing is also calming and brings your focus inward as you “give in” to what your body is doing.

3. Set the Mood

Just as there is a certain ambience that creates a romantic mood, there is an ambience that is good for labor. There are exceptions, of course, but most women need dim lighting, a peaceful atmosphere, and a very few trusted people in the room with her. If laboring at home, you can set up candles, play music, and hand-pick who is allowed to be there. If at a hospital, it will probably take a little more effort, but it is possible. Some hospitals provide cd players and bedside lamps, but others don’t. Find out beforehand and, if they don’t, you can bring your own stereo or light if you desire. Having only a few trusted people is also nearly impossible at a hospital, but you can limit who enters the room and when. In this case, a spouse or friend may have to keep unwanted people out. Also, if a nurse is rude or makes you uncomfortable, you can tell them to leave. Remember: you are paying them to help you during labor. Don’t be afraid to request a different nurse.

4. Move Around

I’ve written before that lying flat on your back is the worst position to labor and birth in. It not only closes the pelvic opening so that the baby has a hard time getting out, but it also makes contractions much worse for the vast majority of women. Early in labor, walking is great because it helps the baby move down and into a good position for birth. Later in labor, moving around to find the most comfortable position will help alleviate pain. Also, your body will tell you if you’re in a bad position for the baby as she moves down toward birth. Listen to your body, and if you don’t feel like being in a certain position, move (between contractions!) to a different one. Here are a few positions women find comfortable during late labor:

-standing, leaning forward against someone
-kneeling on all fours
-kneeling and resting upper body on a couch or bed
-sitting on the toilet, an exercise ball, or a birth stool
-resting in a tub of warm water
-lying in a side-relaxation position (on your side, slightly leaned forward, with top leg propped on a pillow and another pillow under chest and head)

5. Visualization and Listening

Many women find exercises such as visualization or self-hypnosis to be very helpful for labor. Hypnobirthing is an entire childbirth class that helps a woman learn self-hypnosis. There is also a good book on Hypnobirthing if you are unable to find or afford a class. Other classes, such as for the Bradley Method, teach visualization exercises. One popular one is called The Rainbow Visualization. Have your birth support read it to you in a calm, low voice in the months leading up to the birth, and then during labor they can read the whole thing or just the parts you find most soothing. A familiar voice is a very calming thing to listen to during labor. Have someone tell you a story, or read poetry or passages in Scripture to you. You can even recite favorites to yourself.

6. Massage

Nearly every woman loves some type of massage. During labor there are certain places that, if massaged, make labor easier. A skilled doula or labor assistant will be able to try various things to discover if one feels particularly nice. But, you don’t have to have a trained professional do it. Whoever you choose to be with you during labor can do it. One of the universal labor massage areas is the sacrum. This is the part of the lower back that lies roughly between the hipbones, just above the tailbone. Many women find that pressure on this area during contractions and even during pushing feels good. If your birth partner is unsure, have them start out firm but not too hard, then if you want more pressure, ask for it. Other good places to massage are the hands (especially between the thumb and index finger), feet, and ankles.

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So, there you have it! During labor remember: relax and give in to labor – you can’t escape it so work with it!; breathe into your pelvis; set the mood; don’t be afraid to move around; listen to a soothing, calm voice; and utilize the hands of whoever is in the room with you!

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