Last Minute Tips for a Natural Birth in a Hospital

My good friend is going to be giving birth any day now and is planning a natural birth in a hospital. I've been thinking about her lots and can't wait to hear how everything goes. I thought I'd jot down a quick list of tips she can use as she goes into this transformative experience. In my experience, being in a hospital makes it more difficult to have a natural birth (but by no means impossible - I know many women who have labored with pitocin and have gone on to give birth without pain medication) simply because the option for medication is there...that is why I thought I'd give these tips.

1. Remember everything you've studied and learned. Remember to trust your body and the process. Remember that the pain will not last and that it will be over before you know it. While you're laboring and it is getting intense, tell yourself you can do anything for one minute. Count to 10 as you have a contraction and tell yourself you can get to 10. Remember to breathe...slow down your breathing to give your body oxygen - feel the energy rush back into you as you become grounded again.

2. When you feel like giving up or when you feel like the pain is so intense that you want to die (hah!), it'll be over right after. Everyone told me this and I had no comprehension of what they meant until I experienced it myself...I literally could not bear it any longer and in that moment, it was over. And then the joy was indescribable.

3. Make sure you have support - either your partner, mother, doula, friend, etc. Make sure they will stand by you and help you get through it while reminding you of the type of birth you desire. Make sure they'll stand up for you and be your voice with the nurses and doctor.

4. Enjoy the process. Let go of the fears and savor these moments. Think positive thoughts. I love this quote by Grantly Dick-Read, "Many women have described their experiences of childbirth as being associated with a spiritual uplifting, the power of which they have never previously been aware...To such a woman childbirth is a monument of joy within her memory. She turns to it in thought to seek again an ecstasy which passed too soon." Incredibly, after you give birth, you may feel too that it passed to soon. Savor it.

5. Move around! Change positions. Do not stay flat on your back in the bed. Be upright! It will move your baby down and your pain will be more manageable.

6. Overall, just be present. Embrace the laboring, the pushing, the delivering. Don't let yourself get down by thoughts of "How much longer is this going to take?" Those thoughts will come, but push them away and fill it with a positive thought instead. Tell yourself it's a beautiful day for your baby's birth and practice patience.

Here's all of the warm wishes and luck in the world to my beautiful friend!

Husbands and Out of Hospital Birth

I have received a few emails lately asking me about the journey that my husband and I took as we made the decision to have an out of hospital birth. I figure that there are probably more women wondering about this very subject, so I decided to write about it on this blog for the benefit of any who are in a position of thinking about having an out of hospital birth.

First, I must say, that this decision is going to be different for everyone. Relationships vary greatly, so the journey my husband and I took may look completely different from your individual journey. The most important thing to remember is that education and knowledge are keys to empowerment and good decision-making. Faith and prayer also go a long way with helping to ease fear and find peace.

When I brought up the idea of having a home birth to my husband, the first thing he said was "Why? What's wrong with just having the baby in the hospital?" I had to think about my answer for awhile and simply told him "Please let me just share the things I've learned with you and after that, tell me how you feel." Over a few weeks of discussion, he gradually realized that a lot of times the complications that happen in hospitals are due to interventions that do not happen at home or in a birth center. He learned that home or birth center births are statistically just as safe, if not safer for mother and baby, than hospital births. He learned that there is a "business of birth" and a lot of money is involved. There's a lot of fear of litigation and malpractice. There are time tables. He realized that birth was a natural process. After learning these things, we discussed birth - a lot. Was a home birth right for us? We prayed, we studied, we read, we learned. I knew, in my heart, that home birth was right, but I had to dispel a lot of fears. I had to deal with negativity from family members and close friends. I had to take a leap of faith and trust the feelings I was having that were driving me towards having an out of hospital birth. My husband had to do the same. Ultimately, he told me that he supported me in whatever I wanted to do. I told him that I needed him behind me 100% on having a home birth, or I would not do it. I needed him behind me. We met with the midwife I was considering using and after our meeting with her, we both felt very excited and better about having a home birth. Meeting with the midwife helped to ease fears we had as we asked questions and found answers. After that meeting, he told me that he supported me 100% and although we both had occasional fears, we had both felt peaceful and excited about the decision. We didn't tell people about our decision to have a home birth until after the fact because we are both very sensitive people and don't handle confrontation or negativity very well. We relied on each other and on the confirmations we had received through prayer to continue on with our decision.

There will be critics from any side. If you birth in a hospital, you will have a critic somewhere. If you birth at home, there will be a critic. If you go to a birth center, I'm sure you'll find a critic. Ultimately, I've learned, you must find some way to push those critics aside and find your own self. You have to be true to yourself, no matter what area it is in. Even if those critics or negative voices are yourself (aren't we ever so hard on ourselves? I know I am.) you must find a way to silence them and move forward. That doesn't mean ignoring gut feelings - you must always follow your instinct, your guide, The Spirit (if you are religious). For me, in every area of my life, my biggest fault is not getting over what the critics might say. It was a big one for me in my home birth decision, but ultimately, I had to do what I knew was right for me and disregard those negative voices.

My advice for husbands and an out of hospital birth decision is simple. Talk to him, educate him, tell him your feelings. Tell him how strongly you feel about things and help him to see things from your angle. Then, listen to him. Listen to how he feels. Listen to his concerns. Pray together and study together. Read about birth together. How do you feel at the end of the day? Do you feel happy about things? Excited? Then your out of hospital birth decision is probably right. At the end of the day, do you feel scared or that something's not right? Then it's probably wrong for you. Go with your gut. Branch out - learn new things, try to embrace new concepts (like the fact that hospitals are not the only safe place to give birth) - and then make your decision. Keep an open mind and ask your husband to keep his mind open as well. In the end, I know you'll be able to make the best decision for your personal situation and I hope, whatever decision that is, that you've got your husband 100% behind you.

*I have to say that now, after having had a home birth, my husband actually advocates for natural child birth as well as home birth :) He's been known to talk birth to a few friends and classmates and that has made me very giddy to hear!

Here's a post on the preparation and decision making for home birth.
Here's another post about home births and dads.
And, one more here.

What are you interested in?

So, part of my goal for this blog is to be a sort of "entry-level" blog into natural birth. Once you dive into researching birth, it is amazing the complexity that you'll find. But, I don't necessarily want to dive into complex areas of pregnancy and birth...after all, I'm not a birth professional (yet) so I technically don't have all of the scientific knowledge, etc. I mostly want to educate women on the choices they have. We have a choice in everything we do...everything!

Doctors and midwives have so much knowledge, thankfully, but ultimately, our care rests in our hands. It is so important to be educated and to work with your care provider so that you attain the best care possible. Many care providers are very busy and unfortunately, that may mean that you are not always in their best interest. That doesn't mean they don't care about you, or that you aren't important to them, but it may mean that often times, things are done simply as a routine. This is where choices come in. Research things and educate yourself so that you know when you have a choice about something and when you don't. For example, you might discuss IV placement (if birthing in a hospital) with your doctor or midwife. IV's are not medically necessary for birth, but they are routine. If you do not wish to have an IV, you do not have to have one (based on the discussion with your doctor). Obviously, if you are planning to have an epidural or other pain medication, you will need that IV. If you are desiring a natural, intervention free birth, you don't need that IV. Many doctors say you need at least a Hep Lock, in case of an emergency situation, but to that I say: if there is an emergency situation, I think you could put an IV in my arm fast enough that everything would be just fine (after all, if an EMT can place an IV in someone injured in a car wreck in the dark, one will most likely be able to be placed in me in a brightly lit room). That is one area where you do have a choice. Again, you research it, you weigh the pros and cons, and then you make a choice. If you feel more comfortable having an IV in your arm, by all means, have that IV. If you feel it would interfere with your ability to cope with the intensity of a natural birth, then decline the IV placement. Doctors and midwives vary on this practice. My second OB (before I switched to a home birth midwife) told me that I did not have to have an IV, but that she would prefer that I have a Hep Lock. When I told her I'd rather not have either, she was supportive of that. She is a great doctor who is understanding of how natural birth differs from medicalized births, so for me, she was a great choice as a care provider. The most important thing to remember is that you do have a choice in care providers, so if you are not happy with the way your doctor or midwife handles things or if you do not agree with the way they view birth, then you are free to make the choice to switch. You are the one paying them, so you are free to find someone who is a good fit for you. If you are not satisfied with their care, by all means, switch! It is your health, your birth, and you need to be with someone who will work with you, support you, and include you as part of your care. Informed consent...means you are educated, you work with your care provider to make decisions, and you make choices based on the information you have been given and learned.

So my question is, what things are you interested in learning about on this blog? What things would you like to know more about? Is there any particular aspect of pregnancy and/or birth that you would like to broaden your knowledge on?

My response to Tianna

Tianna commented on the post below about my breastfeeding story. She had some questions for me, and my response was too long to post in the comments section. If anyone else has any other advice to offer on this subject (the logistics of nursing an older baby), please do contribute!

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Tianna, thank you :) I have been inspired by many, many women, so I am so happy to do the same.

(Nursing my two month old at the Grand Canyon...can't even tell, right?)

I do not, regularly, use a breastfeeding cover. I have gotten good enough at it where I can nurse very discreetly. I always have on a tank top underneath my shirt, so I will pull up my shirt and then pull my tank top down underneath my breast. I'll cover my breast with my hand while the baby latches on, then my shirt will cover the rest of it while she nurses (I realize that I am a small-chested woman, so this works for me, but it may not work if you have a large chest...I don't know about that because I don't have a large chest!). When she gets distracted and pulls off, I quickly pull my shirt down. That means I am always very self aware and never show anything. Most people don't even realize I'm nursing. There are times when I do use a cover. Often it is in a social situation where I feel uncomfortable because I know others feel uncomfortable with me nursing, like around lots of guy friends, etc. Sometimes, I do leave and go to another room because being around people is just too distracting. When the baby was small, I would nurse in Sacrament meeting without a problem. More often now, I go to the lounge because it is less distracting for her.

I am not perfect at nursing on demand. She still uses a binky and I like that. But I have tried to be more aware this time and offer her my breast when she cries, rather than offering her a binky. She will nurse anywhere and in any position. She nurses while I chase the toddler around, getting him off tables, etc. She nurses while I clean up toys. She nurses while I hold her brother. She is really adaptable because she loves it so much.

Max was not difficult to wean, but I think it is because I never really, really nursed him for more than just feedings. By the end, he was nursing three times a day. Gradually, we stopped nursing before his nap - I just would lay him down with his binky instead of nursing him. Then, instead of nursing him in the morning, I'd take him right out of his crib and we'd go eat breakfast. At night, I just didn't nurse him one night and that was that. It was really easy to wean him (easy logistically but not easy emotionally), but again, I feel that it is probably because I never really nursed him for much more than nourishment. I do not know how it will be with Maude, since I've approached the whole thing much differently this time around. However, I'm not worried about it. I am quite comfortable with nursing her as long as she needs it. Yes, even if she is 2 years old. I know that is not culturally acceptable, but it feels right to me and I believe that relationship is very important...even past one year old.

Max never drank milk. He doesn't like it. I don't like milk either. At first, I was concerned about it. But after a lot of research and prayer, I decided it wasn't a big deal. We are made to think that dairy is where we get all of our nourishment, but that's simply not true. In fact, too much dairy can cause problems like inflammation and over-production of mucous. He eats a very well balanced diet and he eats other dairy products like cheese and yogurt very well. If you are concerned about liquid intake, you could offer almond milk, whole milk or raw cow's milk, or rice milk. I don't recommend soy milk.

As for the babysitter goes...here are my thoughts, and I realize that this may not be how everyone thinks, but it is how I feel. When I am a nursing mother, I try to remember what a privilege and blessing it is to be a nursing mother and to be the only one who can provide that nourishment for my baby. That means that I may have to sacrifice things while I am nursing. For example, I cannot leave my baby overnight or for more than a few hours at a time. But, to me, that never feels like a sacrifice, because honestly, I do not wish to be away from my baby or toddler for that amount of time. For me personally, if I need to get away and have time to myself, an hour or two is enough for me to feel rejuvenated. If we go on a date, that is trickier. I will make sure to nurse the baby right before we leave, and we will go on a short date. Or, if needed, we'll come home and feed the baby, then go back out. I have not had success with pumping after the first few weeks of the baby's birth. I don't pump more than just an ounce or so, so I don't even try. I just realize that a bottle is not an option for me, and leaving them for a long time is not an option either. As long as I realize that it isn't an option for me, it doesn't feel hard or annoying. Honestly, it doesn't bother me, though I know, for some women, it is very important for them to be able to not feel "attached" in that way. Or for others, who work, it is a necessity to be away. I don't have any advice on that front because I have not been in the situation where I've had to leave my baby for work.

When the baby is older, they can go longer between feedings. I find that it is much easier to leave the baby as they get older. Before the baby is 6 months old, I rarely leave. If I do, it is for only an hour and a half. Or else, I am rushing home feeling stressed that the baby is hungry. Once they can eat solids, you can distract them with that until you return.

Do you have any other questions? Did I answer everything you were wondering?

How to have a natural birth in a hospital

I asked my friend, Rachel, who blogs at The Beginning of Motherhood, to share some thoughts about how to achieve a natural birth in a hospital setting. Rachel has a lot of experience with this, as she has had five children naturally and works as a nurse in Labor and Delivery. Thank you so much for sharing your wonderful tips!

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I have seen all sorts of births and all sorts of birth plans. I have seen women do fabulous going natural on pitocin, laying in bed, and in all sorts of other situations. I have also seen some women who have been doing great soaking in a tub, but ask for an epidural. I have seen some who I would have thought regretted not getting an epidural, but when asked, said they appreciated the experience. Any way it happens, a natural birth(going without pain medication) is something that you need to have a reason for wanting. To me, that has been the key ingredient. Also, your desire may change further down the road through labor, and that's OK. So, I would say the first step in having a natural birth in the hospital, is to decide if you really want to and why. These are not questions that anyone can really give you an answer too, but yourself, but I'll attempt to start you on your path.

First off, you can do a natural birth. Women have been doing them forever. So the real question is do you want to. The main reason for getting an epidural is the obvious: pain relief. Labor is hard work, and can be very painful. But, pain tolerance is not really an indicator of whether or not you will want an epidural. What you need to decide is if your reason for wanting one is greater than your reason for not wanting one. A few case examples. Many women are afraid of the needle in an epidural, or the pain of the epidural itself. I have had one woman tell me that when her contractions are so intense that she no longer is afraid of the needle then she gets the epidural. She always gets them. Therefore, for her, the labor is worse than the epidural. On the other hand, another woman I took care of felt like her fear of the epidural was greater than her fear of labor. Therefore, she always went natural. Some other factors to think about when it comes to reasons for/against getting epidurals: 1)you ability to move is greatly reduced when you have an epidural. Once you have one you are in bed, with a tube to drain your urine, and the nurses have to help with movement of the legs. This may be OK with you, and may be worth it, but again, it's just something to think about. Many people are worried about drugs being introduced. From what I have researched, the drugs given in epidurals will not cross into your babies body, but it does effect immediate breastfeeding(though not long term). It does tend to slow down labor, and there is an increased use of forceps or vacuums with them. For those who are experiencing exhaustion or can not relax, though, it may be useful. These are just some of the factors involved, and I would suggest thoroughly researching them.

So onto how to work through a natural labor in the hospital.

Request a hep-lock(where the iv is in you, but not connected to any tubing), or no iv at all if you feel comfortable with that. If you are not receiving iv fluids, make sure you are eating and drinking. If your hospital only allows ice chips, eat as many ice chips as possible and add sugar:) I would even bring some Gatorade pre frozen just for you to suck on. As long as it's ice, it fits in the policy. Some research I have read suggests that a woman needs at least 125-250 ml of water and hour. That's 1L of fluids every 4-8 hours. If you have to have an iv, you are still capable of moving. Request that you have an iv pole for the fluids to hang on so that you can walk around with it. If you do have any fluids running in, keep in mind that you can also get too much. Especially if you are on pitocin as that tends to increase water retention. One bag of iv fluid equals a liter, so keep that in mind when gaging how much you are drinking. Make sure you are going to the bathroom often, at least every one or two hours. An empty bladder will facilitate labor. Sitting on the toilet is also a comfortable position:) An iv pole can actually be very useful to hold onto during contractions. When you are feeling weaker, but still want to stand, an iv pole makes a good brace to pull down on. It is also useful during pushing. If you are wanting to squat, the pole can be used to hold onto.

Request intermittent monitoring. Keep in mind that this may only be possible if the nurses aren't busy, and your babies heart rate is looking OK. Intermittent monitoring has been shown to be safe and effective in monitoring the heart beat of the baby. ACOG guidelines suggest listening to the babies heart beat every 15-30 m while in active labor. This also needs to be done during a contraction and immediately after. This allows the nurse to check the heart rate while you are in different positions or different places. If you have to be connected to the monitors, you can still sit up and move around. You can stand, squat and walk. The difficulty in this comes from making sure that the heart rate stays on the monitor. It is helpful to have someone hold it on tighter during contractions, while sitting up, or squatting. Anyone can do this, it doesn't have to be a nurse. If you notice that the babies heart rate isn't picking up at different times during your labor, try having someone hand hold it. While I normally, don't like internal monitors, for someone who is going natural and having to be on the monitor, they can be useful. With internal monitors, the babies heart rate is picked up much easier and movement is not restricted as much. This would be something that I personally would like at on a case by case basis, and only if the mothers bag of water is already broken.

Which leads me to the bag of water. I would suggest not getting it broken as a matter of policy. Research shows that it does tend to decrease labor time, but only by about 20m. Once your water is broken, contractions tend to be stronger and harder. If you want to shave off time in labor, I would suggest having your water broken during transition or after(around8-10cm). At this point, your labor is already pretty intense, and shaving off time at this point is usually very welcomed. This really is just my opinion. Also, once the water is broken, it allows for germs to be introduced. So often the water is just broken, without a thought as to the individuals preference. Just make sure you at least think about it.

The bed in the hospital can actually be very useful. There are a lot of different positions that it can help you obtain. If you want to kneel, you can kneel over the top, bring the bottom down and kneel on that, or just be on your hands and knees on something soft. During pushing, you can bring the head all the way up and the feet all the way down to simulate a squat or birthing chair. I would play around with it and see how you might find it the most useful. It is also useful to use to kneel on, or put a birthing ball on and lean on.

Water....this has been shown to be one of the most effective pain relief measures for those who are going natural. If you find yourself getting tired, afraid you can't go on, or just needing to try something different, try a hot bath. Some hospitals do not allow this. If this is the case, bring a heating pad that you can use to sit on on the birthing ball, use with counter pressure, or just relax muscles and tension.

If you need to have pitocin, don't sell your selves short and feel like it's impossible to have a natural birht. I have seen many women do fantastic with pitocin. Some key things to remember...you can do it. You have to have a reason for wanting to do it, but it's OK if you don't want to. Ask your provider if you can do low dose pitocin. This will add the pitocin more gradually. You can also request that your pitocin be turned off once you have reached active labor. At this point, your body will sometimes take over and you will no longer need pitocin.

For some it is useful to try not to think about the contractions in terms of pain, but just intensity. If you prefer this, make sure you ask your nurse not to ask you your what level your pain is at. But let her know whether or not it is getting more intense. This is an important indicator of how your labor is progressing and how well a woman is coping.

One last point, when you first arrive at the hospital there is a whole admittance procedure. If you are not in too much pain, it's not that big of a deal. But if you are having to work hard through contractions, appoint someone else to answer the questions that are needed.

healthy birth practices and spirituality

new data shows that there is a connection between childbirth and spirituality. you can see what i've said about spirituality here.

“'Childbirth and motherhood provide many women with an ideal context in which to recognize the spiritual aspect of their lives,” said Lynn Clark Callister, R.N., Ph.D., FAAN, a professor of nursing at the Brigham Young University College of Nursing and study co-author.  “Our research illustrates that for most women, childbirth is a deeply spiritual experience.  As healthcare providers, we need to recognize and support this evidence, and listen to women’s voices to guide their care.'” 

The themes that emerged in the study included: childbirth as a time to grow closer to God, the use of religious beliefs and rituals as powerful coping mechanisms, childbirth as a time to make religiosity more meaningful, the significance of a Higher Power in influencing birth outcomes and childbirth as a spiritually transforming experience."

read the summary here.

at the end of the article, it lists Lamaze International's "Six Healthy Birth Practices" so i wanted to list them here. i truly believe that following these six practices will almost always lead to a wonderful outcome for mother and baby.

1. let labor begin on its own

2. walk, move around, and change positions during labor

3. bring a loved one, friend, or doula for continuous support

4. avoid interventions that are not medically necessary

5. avoid giving birth on your back and follow your body's urges to push

6. keep mother and baby together; it's best for mother, baby, and breastfeeding