Monday, November 29, 2010

When to Reign In Your Birth Team

As most of you know, I teach a 10-week course on natural childbirth.  The first night of class, the number one question is, "When do we go to the hospital?"  Line-upon-line here.  We don't hit that until Class 5!

Over the years, I've learned that this question is really asking, "When can the professionals take over?"  It usually is asked by a dad-to-be.  It's interesting to watch these expectant parents learn and grow.  Education and information is unbelievably empowering!  Several years ago, I was teaching "emergency" (ie. unattended) childbirth.  By the time we get to that point, we've spent countless hours together, watched more than a dozen birth videos, and everyone has a very good idea of what normal childbirth involves and what to do -- or not do!  I asked this particular father-to-be how he felt about the possibility of this happening.  I should preface his answer with the fact that he didn't speak to me until Class 5 and was totally depending on his mother-in-law to help his wife at the birth.  He despised that he was forced into attending this class.  So, when asked this question, I was amazed at his cool reply:  "On the one hand, totally terrified, but on the other -- bring it on!"  I should also mention that the mother-in-law didn't make it to the birth and they were only at the hospital for 22 minutes before the baby was born!

The answer to the question "When do we go to the hospital?" often changes as you get more information.  Let's back up for a minute.  You know how I feel about hiring a doula.  Do it.  Who are the people you are inviting to your birth?  A sister?  Mom?  Mother-in-law?  Other children?  Your best friend?  Do you call them all the minute you have your first "real" contraction?  Of course not.

There is nothing like being pregnant with your first baby.  Not that the other pregnancies and labors aren't exciting, but they are undeniably different.  You've done it before.  You have distractions now that you didn't have the first time around.  Regardless of what baby number this is, enjoy early labor with your spouse.  I love early labor!  Get into a rhythm together.  Figure out what works, what doesn't.  Practice different positions.  Nap.  Eat.  See a movie.  Enjoy this time together.

Everyone's labor is different.  You may have several hours of early labor -- this week I had a mom that did this for several days! -- or it may not exist at all.  You may jump right into active labor and need your doula right away.  There is no way to know beforehand. 

But let's assume that you do have early labor -- you are contracting regularly but are able to talk, walk, or sleep during and/or between contractions.  If your husband is sleeping, and it's 2:00 a.m., let him keep sleeping.  A lot of moms don't like it when I say that.  Here's the thing -- yes, labor is exhausting, but it's also exhausting for your birth team.  This often doesn't get a lot of sympathy from moms, but if your labor is on the longer side, you are going to need your birth team to be able to step it up, and they may not be able to if they are utterly exhausted.  If you don't need his help, let him keep sleeping.  You'll both be glad later.  You may find yourself enjoying those early contractions, just you and the baby.

As things progressively get harder -- and you feel like you need some extra help -- think about who you want to reign in.  Maybe it's your sister or mom or maybe it is your doula.  Whoever it is, be sure that you are ready for the help.  And perhaps even more importantly, be sure they will be a positive influence on your labor.  For example, the mom who is freaking out that you didn't go to the hospital with the first contraction or the minute your water broke may not be the best person to be with you and your husband.  She may not be someone you want at your birth at all!  In the end, if you don't need help yet, you may feel like a watched pot, which won't be good for your labor.

There's not a set time that is right for all couples.  I hate it when couples are told to head to the hospital when contractions are 5 minutes apart lasting 60 seconds.  You could do that for hours!  It's really hard to explain, but there will come a time in your labor that you will know who you need.  With my 2nd baby, I had no early labor and wanted my friend there immediately.  It was a very fast labor.  But with my 3rd and 4th babies, no one was there until about an hour before the birth, including our midwives.  But I knew when I needed them.

Again, it's hard to explain, but there will be an urgency felt to be with your birth team as labor progresses, whether you are in the hospital or at home.  This will be different for each woman.  Some women feel this urgency earlier than others.  This is their emotional relaxation -- how they feel about where they are giving birth, who is there, are their wishes being honored?  I remember with my first homebirth -- 3rd baby -- the minute the midwife walked through the door, I felt like crying.  I felt such a release.  She wasn't there more than an hour and my baby was born.  My body held back until my birth team was in place.

I often think of it as involving people according to their skill set:  my mom was needed because I needed help with the other kids (1st called).  She cleaned up, made food, changed sheets -- a good one to have around!  Anyone else helping out with the kids was next.  They'd usually help my mom too.  One of these people was usually on video duty.   As labor progressed, if I had a doula or doula-friend, they'd be called in to help me and David.  Your chiropractor is also a great person to call in for a period of time.  Eventually, you'll want someone to catch the baby, so either calling your midwife or heading to the hospital will be necessary!  You'll know when this time is.  You'll be very serious, eyes closed, not talking or smiling.  Some women will be sounding out contractions and others won't make a peep.  Either is fine.  One is not better than the other.

My ultimate answer to the question "When do we go to the hospital?"  Alright, here it is.  There will come a point when she (talking to dad because mom won't remember this or be thinking logically) will not want to walk anymore.  She will still get up and go to the bathroom when you encourage it, but she doesn't want to.  She has to wait till the end of a contraction to get up and she will move quickly so she doesn't get caught standing up during a contraction.  Contractions are stronger and longer when she stands up.  Still willing to move, but not wanting to.  This is usually a good time to mosey on down to your birth place or call in your midwife.  Labor is very well established at this point.

Most of all, enjoy your labor.  Choose your birth team carefully and reign them in as you need them.  So many women wish for a fast labor, not understanding how hard a fast labor is -- just to get it over with.  A longer labor is not a bad thing.  Like I always say, labor and birth serve as a bridge between pregnancy and becoming this baby's mother and father.  Enjoy it.  These hours are unlike any in your whole life.


Karen Joy said...

"Education and information is unbelievably empowering!" Much agreed!

I just commented on your previous post, about attachment parenting. And, while, with my first, I didn't feel a really strong mothering instinct, I did feel -- with all five of my children -- a strong birthing instinct. And, the more I learn, the more I understand that I have done things the "right" way, even before I really understood what I was doing.

I SO agree with enjoying pre-labor together. I tend to have long pre-labor. With my first, it was close to 3 days, and my husband was the only person who believed I was really in labor! With my last baby, it was still close to 24 hours, and my hubby and I had so many precious trips around the neighborhood and around the hospital corridors... I treasure those walks! We've done things like go out to lunch together, go to the chiropractor, just hanging out as a couple. :)

As I continue to study to be a doula, I will remember that guideline in that second-to-last paragraph, and also remember that the heart of "when do we go to the hospital" is really "when can the professionals take over"!!

Nonimor said...

This is really interesting. My mom, though I have never heard or used that term, is definately a doula. She had three out of her four kids at home and was there for my aunt and sister's births.

eulogos said...

I didn't really like the "talking to Dad at this point" business. And in fact I have never liked the "husband coached " thing. I didn't want to be coached, and I didn't want my husband doing it. And I didn't need him to tell me when to go to the hospital. (The right answer is never, in my opinion, unless something is going wrong.)
In the hospital labors I was glad he was there, but I certainly couldn't rely on him to fight my battles with the hospital staff for me. And when I was home, I needed him only as the person who loves me, but not to tell me when I was at what stage in my labor. In later labors he mostly ran interference with the older kids, cooked food to feed me afterwards and so on. For one labor he was dead tired from working 13 hours and he slept until I woke him up to catch.
I don't know if that first Bradley book has been revised, but even back in the 70's when I read it the tone of it was irritating. I remember one place where it tells the husband, if he sees his wife sleeping the wrong way to pick up her leg and move it to get her in the right position. I think maybe from her back to her side, so as not to compress the large blood vessels? But really, if my husband had done that to me, I would have been highly pissed. I hope they have edited that out of the book by now, or reworded it.

Sorry to sound so negative. Coach is probably a word a lot of the fathers understand, and it may well get some of them to commit to learning about birth, and to being involved at all. And if the women are fine with it, and it works for them, who am I to object? But it isn't for me.

Different subject. "Reign" means "rule" as in the reign of a king. The expression is "rein in,"
as in pulling on the reins of horses. But that usually means to restrain, to pull back in those who have been wandering and going too far.
That is clearly not what you meant. I think you mean something like "call in" or "bring together".

I have managed to say nothing but negative things here and I am sorry for that. There is a lot which I enjoy on your blog. And the title is really catchy!

Susan Peterson