Sunday, January 17, 2010

The Birth That's Right for Me

Last night I finished reading a book called The Birth That's Right For You: A Doctor and a Doula Help You Choose and Customize the Best Birth Option to Fit Your Needs by Amen Ness, Lisa Gould Rubin, and Jackie Frederick-Berner. I have to say--I loved this book!

Everyone has an opinion about childbirth. People who have given birth before are adamant that others should (or should not) have experiences like theirs. It seems that the web is full of natural-birth advocates, whereas real life is full of medicated-birth advocates. Doulas and midwives say that the best place to give birth is at home or in a stand-alone birthing center. Doctors and disbelieving lay people insist that the only safe place to give birth is at a hospital. Many people assume that birth will happen in a hospital, with a doctor in attendance, and anything else occurs only if you wait too long to head for the hospital. Others assume that if you go to the hospital, you'll end up with a Cesarian or a cookie-cutter vaginal birth that you weren't really present for anyway, because of the drugs. Even if you go natural, people will push Lamaze, or Bradley, or waterbirth, or hypnobirth ... No matter what the opinion is, it seems like everyone has one, or at least an assumption about what childbirth will look like.

That's what I loved about this book--they didn't.

This quote from the introduction pretty well sums up the philosophy of this book: "The best and most satisfying birth experiences happen when you're able to make choices in labor and delivery that are based on who you are, not someone some childbirth expert tells you that you should be." So if you feel most comfortable giving birth at home, go for it! If a homey birth center is more up your alley, feel free. And if you feel most protected and comfortable in a hospital setting, that's exactly where you should be. Narcotics, epidural, natural pain management strategies--you'll know what methods will work best for you based on how you handle stress and pain in your normal, not-giving-birth-at-the-moment life.

I started this book feeling pretty confident that I wanted a natural birth in a stand-alone birthing center, with a midwife to catch the baby and my husband and a doula to help coach me through it. I wanted a natural birth because I truly do believe that a medication-free birth is best for the baby--narcotics can cause a baby to born sleepy, so sleepy in some cases that the child can't even breathe without help; an epidural is difficult to dose right, and if you're given too high a dose, you may not feel your body's cues to push or be able to push effectively when you try, resulting in the need for an emergency Cesarian, which is major abdominal surgery. I figured that the best way to have a natural birth was to birth in a location where that was the only option--there would be no pressure, no repeated offers, and a major relocation to the hospital if I changed my mind. But I also have to admit--I was pretty scared of the whole notion of natural childbirth. By the time I get back to the States, I may or may not have time for a natural childbirth course. Even if I take one, they often seem to rely on one's ability to relax using visualization, which is not my strong point. And the more I read about birth, the more I am told that fear, anxiety, and an inability to manage the pain of contractions combine to stall labor, resulting in a Cesarian ... which I absolutely do not want unless it's necessary to save the life of my baby.

As I read this book, I started thinking about my natural coping strategies. What do I do when I'm afraid, stressed out, and in pain? My first response, at least to pain: Go to the medicine cabinet. Uh-oh, Houston, we have a problem. Because I really do want to avoid medication during childbirth, yet I also really do have a notoriously low tolerance for pain. And the natural coping strategies that I've read about so far really don't fit my personality all that well, either. I can't visualize to save my life. I do eventually relax in a hot tub or pool, but never until I can be confident that everyone else is engaged somewhere else, and no one is paying attention to me--unlikely if I'm using a birth pool to take the edge off of contractions during labor, with my attentive husband and doula hovering over me. When I'm in pain, I don't "walk it off." I tend to freeze, sink into the couch or bed, and maybe rock back and forth just a little. My main coping strategy is prayer, combined when possible with a generous dose of medication. I haven't seen either of those strategies listed in any natural childbirth books!

So where does that leave me? Someone who wants a natural birth but who seriously doubts her ability to have one? This book helped me realize that it really doesn't have to be an all-or-nothing proposition. I can give birth in a hospital, with a doctor or nurse midwife who is supportive of my preference for natural birth. But if my labor stalls and it starts looking like a Cesarian is in my future, or I just can't handle it, I'm exhausted, and I need to sleep--to remove myself from my body so that I stop fighting the work my contractions are trying to do--I can request an epidural. And the knowledge that I can request an epidural, that I don't have to handle the pain indefinitely if I feel like I can't do it, will allow me to focus on one contraction at a time, which I think I can handle. And if I can't, there's the epidural. After all, if I can't relax enough for my contractions to fulfill their function, I'm headed for a Cesarian. As much as I shudder to think of a needle going that close to my spine, a catheter staying there, an IV pumping me full of fluids to avoid a sudden drop in blood pressure--all of those things will happen by necessity if I have to have a Cesarian. Why not try everything possible to avoid one?

So here's what I'm currently thinking I want in childbirth. Keep in mind, though, that as I do more research on natural childbirth methods, gather information about classes that may be available once I'm back home, and come into more information in general, I may change my mind. And that's okay. But here's what I'm currently thinking:

  1. I intend to deliver in a hospital, with my husband and a doula by my side, using natural coping strategies. However, it will give me peace of mind to know that medication is available if I need it. (I'm still going to have to get myself okay with the idea that I'll probably have to have an IV, or at least a hep-lock, soon after I arrive at the hospital, but that's a compromise I think I can make.)
  2. There is a women's center 30-45 minutes from my hometown that is staffed by two female obstetricians and one female midwife. Seeing as how I've never had a pelvic exam from a male doctor, and the very thought makes me tense up like crazy, I think I need to give them a call on Tuesday (after the holiday), ask a few questions, and see if they could be a good match for me. I don't want a male doctor doing a routine exam to cause me to tense up and stall my labor on the big day--and I know myself well enough to know that I will never be comfortable with a man who is not my husband doing anything "down there." This women's center was recommended by a doula who is a firm advocate of natural childbirth, so I'm pretty sure that they will be supportive of my desires for a natural childbirth. But they also deliver in a hospital, and the doula who recommended them knows that I want the option of pain medication, so I'm thinking that will be an option too. I'll confirm all of this when I talk to them. And I already know that these practitioners are preferred providers for my insurance, which is a big financial plus!
  3. I want to hire a doula who is very experienced in natural childbirth, but who also can function well within a medicated childbirth situation. I have referrals for two women--one a newly certified midwife who still does doula work while building her midwife practice, and one who is in training to be a midwife. I'm thinking they will be comfortable functioning as doulas in any birth situation, but their midwife training will be particularly useful when it comes to helping me keep the birth natural. I've already sent emails to these women, so I'm waiting to see if they're available and how much they charge before I start trying to figure out which of them is the better match for us.
  4. I'm still hoping to find a natural childbirth class that will work for me, and maybe even a last-minute "crash course" for my husband.
  5. My ultimate goal at the end of the day--or the beginning of the day, depending on when the baby decides to arrive--is a healthy baby and a healthy mama. My secondary goal is vaginal birth, as opposed to a Cesarian. (Cesarians are fine for those who need or want them--please don't think I'm saying anything other than that--but I'd really rather avoid surgery if at all possible.) My tertiary goal is a natural vaginal birth, as opposed to a medicated vaginal birth.
So there you have it. The birth that's right for me. At least, the birth that I think is right for me at the moment. Any comments or suggestions? I'm still exploring natural birth options in particular, so if there's something that worked really well (or really not-so-well) for you, I'd love to hear about it.


  1. That's great to see something that pushes for women making their own choices. I'm decidedly pro natural birth (lol), but I had a hospital medicated one last time & it influenced my feelings on that greatly. Won't tell anyone else what to do though, its an important decision and no one else has to agree with you.

    Now... having had a hospital birth (I wanted natural there mind you) a few pieces of advice for that. 1) Make sure your dr or midwife (and don't assume its a given w/ a midwife, some that work out of the hospital are more like dr's in mindset) is 100% on board with what you want. Don't feel like you have to stick w/ the one you start out w/ either if it becomes clear she isn't. 2) Seriously hire a doula. If you can't, then get a close friend or family member who you trust to do the same job. In my experience.. Husband thought he could stand up for me if need be and he was lost. 3) Tour the hospital and make sure they will be on board with your wishes. Find out policies and all that. 4)You can refuse things if you don't want them. Obviously if there's a real need that's a whole diff story. But... They can't (or shouldn't) force things on you that you don't need. But.. they will give you grief in most cases if you do this. My first trip in I refused the iv and.. well.. that was fun lol. They were cussing me out in Spanish across the room the rest of the time we were there. 5)Goes along w/ 1 and 3 I guess... find out what positions they will let you deliver in and how much mobility you'll have. The rocking you mentioned could help, but freezing up and/or laying in a hospital bed very easily can delay labour... Even if you don't like to move when in pain (if you have any, some women truly don't) its pretty important to keep things moving along. Same when pushing.. sometimes its necessary to try different positions, and flat on back is the worst one for delivering.

    As for classes... I don't recommend going without them. That was my first mistake. I really recommend HypnoBirthing, is the route I'm going now lol.. There's a book (if you can find it there) you can read called HypnoBirthing the Mongan method that is absolutely wonderful. She also doesn't push for home over hospital and the method is even recommended for section mama's (in addition to meds of course). It deals a lot with the fear/pain issue... The classes can be hard to find.. but there's also a home course similar called Hypnobabies. That one can even be downloaded online, so there's an upside to that lol. I know you said the visualization is not your strong point, but even if you decide on using meds at some point, the tips it gives can help out.

    Oh and just because prayer isn't listed in those books doesn't mean it shouldn't be.

    Ok - I'll be nice now & stop giving advice :-) You did ask though!

    Oh btw, not sure if you got my reply... but I have not gained 60 lbs this pg! LOL I need to make sure I didn't write a typo... what I did was gain 10 lbs this last month. Doesn't put me anywhere near 60 yet... hopefully I won't. I did gain 50 with Kalila though. Looking back I'm glad because it fell off so fast I probably needed the extra.

  2. Mama Kalila has good feedback. I would only add that you should prepare yourself for ANYTHING - prepare for not being in control. Yes, you want to control anything you can going in (hosp/home, doc/midwife, drug-free/drugs, etc.) but "the best laid plans of mice and men...". I wanted to go drug-free, but changed my mind the second they blew a valve putting in my IV. I didn't want an episiotomy, and had to scream my head off not to have one (had discussed it with doc, he said he agreed not to and didn't generally, but it was taking a bit too long for his liking and he had the scissors in hand when Whitaker's head finally popped out). I have a friend who wanted a home waterbirth and after 30 hours in labor, she wound up in a hospital with an epidural. Anyway, I just wish I had prepared more for 'other' possibilities as I really felt out of control once I started pushing. But maybe there's no real way to prepare yourself for that kind of pain and drama. The best news is this: In the end, when you have a beautiful healthy baby, it just won't matter as much how you got there.

  3. For my 2nd birth, I was determined NOT to have a hep-lock, but that's because it made it too "easy" for me to accept pain relief. I also specified that they are not to offer pain medication - if I wanted it, I could ask for it. Both of these were based on my first birth experience, in which I "gave in." But you know - I don't regret accepting medication with the first birth either. I just wanted to do without the 2nd time around because by then I knew I could.
    I avoided an epidural because the procedure terrifies me. That's me, personally - most people consider it safe, and that's fine for them.
    I will say, during my 2nd labor, there was a point where I actually said "WHY did I want to go without drugs this time??" because the pain was rough. But at that moment, since I was still in the car, drugs were not an option. By the time I arrived at the hospital, my body had moved past that point. The pain of labor, while intense, was relatively brief. THAT is what I wish I had known in my first birth. If I knew it would be over soon, I would have had the fortitude to forge through.
    I've heard of one person who requested that her husband say to her, if she requested medication, "Let's get through this contraction, and see if you still want it." Her nurses were ready to kill him! But it was what she needed in order to take the birth in small steps, and she got through without drugs!

  4. That's a good point.... Being prepared for the unexpected is important, or at least understanding that it could happen... and that it will be ok. I wouldn't dwell on the negatives, worry, or come to expect them... but childbirth is childbirth and you never really know. Sorry I missed that earlier but glad someone jumped in lol.

  5. You might see if you can find something online for the classes you want to take. They would probably not take the place of the in-person class you want but might be a nice supplement. I googled, "natural childbirth class online" and got a couple of interesting hits that might be worth checking out.

  6. I would just "second" the "Be Prepared for the Unexpected" bit. discuss with your doctor/midwife what various scenarios there could be, and "under what circumstance would you offer me drugs? want to do an episiotomy? suggest c-section? etc, etc, etc?" Find out if you can, and realize that there are more "out of your control" decisions than just the "life or death" ones. At least, in my experience.

    Also -- for preparing. Consider how you handle stressful, "immediate action required, no time to think" decisions/situations. Pair that with how you handle pain, and that is a better indicator of how you'll handle labor, I think. Because if things are going smoothly, that's one thing, the labor is not so bad but for me, it was the stress that pushed me over the edge. Maybe that's just me, but....worth commenting about just in case.

    Most of all -- keep praying, and relax! Don't read so much that you start developing worst case scenarios in your head!

  7. Hi! I love to read Your blog.My husband and I are trying to have a baby but unfortunately yesterday we have got a news that I have a PCO. We have to pospone our wishes and start my treatment.

  8. Interesting to read. Congrats on the coming baby. I, too, am located in Maadi, and expecting baby #3. It seems my babies are too comfortable inside me, and just don't want to make any effort to come out. In the states, with baby #1, we went in for an induction after she was a week late. I didn't realize at the time, that a csection was to follow if the induction didn't work. But, after the baby was in distress and breaking my water didn't help labor progress, and 24 hours had elapsed (albeit it wasn't a painful 24 hours, just a frustrating one as we kept hoping that I had dilated more and more every time the doctor checked), they had no option but to do a csection. I was awake, although drugged, for it, but got to see my baby briefly before going to recovery. I'll be honest...both my husband and I were VERY disappointed...we hadn't considered csections at all...and to not be able to hold my baby immediately after birth...and to have to wait two hours to even really look at was hard for me. BUt, once I held her, I did forget a lot of that.
    Now onto baby Tunisia...the dr. was willing to let me try natural...but 10 days after my due date passed, she didn't want the baby to get any bigger, and once you've had a csection, no chance for induction, so another csection. Again, we were trying to avoid that. But, this time, as I lay on the table and they were prepping me for surgery, I started being thankful as one of my Tunisian friends said, Praise the Lord there are two ways to have a baby! And that is true. So, that was the end of my disappointment, and that time, I was very aware during surgery and as the dr. pushed on my stomach and pulled the baby out, I knew what was happening and kind of experienced it.

    Now, baby #3 in Egypt is a scheduled csection which works out well for parents coming over to help out. So, my advice, I hope you can have the experience you are looking forward to, but maybe for your own benefit, realize that there are unforeseen things, and the whole process may not go as planned. Either way, I hope you have a healthy baby in the end!

  9. We do understand that things may not go the way we want them to--that's part of the reason why we've decided to give birth in a hospital. It's certainly the reason why my husband is relieved that I made that decision! (He's being supportive of my birth choices, because he realizes that they impact me more than him, but he quietly hoped I'd choose a hospital birth.) One of the things I'm very grateful for is that we do have choices. I just want to have a plan first, because I'm the type of person who doesn't think quickly under stress. If I have a plan and have thought through my options already, I can quickly adapt the plan, but if I go in without a clear idea of what my options are and what I want, I'll just make a decision in a hurry and later regret it. So I'm thinking through now what I want and, if things don't go according to plan, what options I want to try first, all the while understanding that if it becomes medically necessary I will have a cesarian ... I just want to be sure that I know all that I can do first to try to avoid one.

  10. Hi! I just had baby #2 10 days ago. My first was an induction for preeclampsia so I the pitocin, AROM, stadol, epidural--the whole nine yards!

    For my second we had a homebirth. Let me tell you when I read your post on how you deal with pain I chuckled, cause I'm the same way! I don't "deal" with pain! I'm the biggest wimp--my husband and mother both thought we'd end up in the hospital cause I couldn't take the pain. But we were able to stay at home and the birth was utterly amazing. My husband and I prayed the whole time for the Lord's protection and guidance (and that He'd keep my 2 yr old asleep!).

    That being said, I write all this to encourage you that you CAN labor drug free! It is possible. (Though I understand super long labors and other crazy stuff happens.)

    Recommendations from a stranger(I know some of these are repeats):
    1. Take a birth class.
    2. Read many books on labor and delivery. Be informed!
    3. Find a care provider you really, really trust.
    4. Hire that doula. They provide so much.
    5. Be comfortable with the hospital you've chosen--and know you CAN refuse anything they try to give you or your baby.

    Hope you have a happy birth!


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