Monday, August 29, 2011

Birth Plans

Birth plans have been a hot topic in my neck of the woods lately and I just wanted to throw my two cents in to the mix. 

When I start talking birth plans with some people, I see them roll their eyes -- even on the phone, I can actually hear some people rolling their eyes!  Especially Labor & Delivery nurses.  The comment I've heard most often is, "The lady that brings in a birth plan is always the one that ends up with a c-section!" 

My approach to birth plans has always been this:  A woman needs to know her options before she can think about a birth plan.  In class, we play an "Options" game where we talk about all types of things that will likely be brought up during your birth -- some positive, some negative.  The point is just to get people talking and learning about various interventions, when they are actually necessary, and finally how they feel about them.  We go over all these options and then I encourage them to go home and print out the 22 page birth plan online (you know what I'm talking about!) and check off all the little boxes.  Again, just to get the two of you talking about how you feel about these options.

From there, it gets significantly whittled down to a simple one page document that is unique to the two of you and your wishes.  My favorite is the "Yes, Please" and the "No, Thank You" columns.  Polite, and not a list of demands by any means, which I think sometimes the L&D nurses envision when handed the dreaded Birth Plan.  

When I was pregnant with my 4th baby, I had imagined myself laboring in my bathroom with the big garden tub.  I don't think I had ever said that out loud and it certainly wasn't on a piece of paper.  I loved that bathroom.  I had been contracting all day long -- it was such a great day, really -- but it was not until I got to that bathroom around 8:30 that night that contractions really picked up.  By the time David came in the bathroom about 30 or 45 minutes later, I was telling him to call the midwife.  He couldn't believe it.  After timing a couple of contractions and listening to me sound out my contractions, he agreed to call her.

I strongly believe in Emotional Relaxation.  I believe that the mind is a very powerful thing, possibly the most powerful tool in labor.  I've known many women in various labor situations that without a doubt, Emotional Relaxation played a huge role in how their labor played out -- good and bad.  I believe that imagining your birth -- imagining yourself remaining calm and relaxed, imagining the smells you want to smell, the food you might want to eat, the music you might want to listen to -- are all good things. 

Labor is a funny thing, as we all know.  We don't get to choose our labor, which I believe, is what makes it so exciting.  Hindsight is always 20-20 and you can always look back and think or wish you had done something different.  It's hard to just roll with the punches and enjoy the journey, but that is my best advice.  Take it one contraction at a time.  It's like I always say in class, if we knew exactly what your labor would be like, that's what we'd prepare for, but since we don't, we'll prepare for all sorts of situations that labor is likely to throw at you.  Hopefully you will feel prepared to deal with them as they come. 

Back to the birth plans:  Go ahead and make one.  Making a birth plan doesn't mean that you are married to one kind of birth and you are going to be unhappy with your birth if it doesn't look like it does on paper.  It just means that you have talked about all the options and have decided what is important to you.  You have a right to have those wishes heard and honored. 

We makes plans every single day of our life.  I live by my list every day, every week, every month.  Sometimes I get it all done, exactly like I plan, and other days, life happens and the list doesn't.  I understand that obstacles are in the middle of the road occasionally, and I may have to go around them or just deal with them head on.  Laundry is a weekly obstacle that gets in the way of my plans! 

You don't stop planning your life just because it might not happen the way you want it to. Go ahead, plan your lovely birth.  Pay close attention, when you imagine your birth, to the details -- the people in the room, the lighting, the temperature.  Keep the things you like and dump the rest.  Enjoy your labor.  It's yours and only yours, no matter what it looks like on paper.  Enjoy the journey, speed bumps and all. 

Finally, honor your labor and your birth.  I've had several people over the years that have had "necesareans" and some of those have rolled a little easier with the punches than others.  I think mourning the loss of something you didn't have or get is a tough place to be.  Talking to people who understand is so important, and at some point, acceptance is necessary.  Knowing you did everything within your power to carry out your birth plan seems to be an important step to accepting the outcome. My friend, Abbey, writes a blog called The Road to VBAMC and she just wrote a fabulous post this week titled When Your Birth Doesn't Go As Planned.  If you are in this situation, I suggest you head over there and check out what she had to say.  I think you'll find it extremely helpful. 

Birth Plans?  Don't be afraid of what might happen.  Go ahead and plan what you hope will happen.

Monday, August 22, 2011

A Letter to Grandma-To-Be: All the Things You Want to Say But Can't

A few years ago, I took dinner to a dear friend who had just had her 4th baby.  It was the day she had gotten home from the hospital -- in fact, she had only been home a couple of hours -- and what did I find?  The Grandma sitting on the couch holding the new baby and the mom up, rushing around, helping the other kids get their dinner dished up.  When I left, she walked me to my car, and we had a heart to heart.  She didn't want her mother-in-law to be the one to hold the baby, but she felt so awkward about asking her to trade places.

As so it is with many new moms.  As a childbirth educator, I see so many pregnant women worried about their mother or mother-in-law coming to help after the baby is born.  Since it is so hard for many of these women to say what's in their heart, allow me:

Dear Mom-

I am so excited you will be spending some precious time with us after our baby arrives.  We are committed to letting the baby come on his/her own time, so we hope that waiting time is enjoyable for us all.  Let's make the most of these last few days together before our world is turned upside-down!

We have prepared for the birth by taking classes and we have talked a lot about our hopes for after our baby is here.  Breastfeeding is so important to us both.  In order to establish a good milk supply, I plan on holding my baby and feeding her a lot!  I am so excited for this experience.  I know that you will also want to get in some good bonding time with your new grandbaby, and there will be plenty of times that I'll need your help with that, including when I shower or nap. 

We have discussed what we hope to be able to do ourselves, but also made a list of things that we would happily accept your help with.  Among that list is cooking, shopping, dishes, and general pick-up.  Everyone has told me to "sleep when the baby sleeps", but I know that will be hard for me to look around and see the mess.  I would be so grateful for your help in those early days of helping to keep things straightened around the house so I can enjoy and get to know my new baby.  

Everyone tells me how much the baby will change in the first month and I don't want to miss a thing!  Thank you so much for coming to help us and for respecting our wishes as we embark on this new journey called parenthood.  I love you.

If you have not made a list of how people can help you after the baby is born, do so.  Have a talk between you and your husband too.  Decide who will do what in the first couple of weeks postpartum.  You may not be comfortable with other people doing certain things for you.  For example, I don't want anyone doing my family's laundry.  Weird?  Maybe.  But cook for me, shop for me, do my dishes, mow my lawn -- I can make a list!

Their job in coming to help you when you have a baby is not to actually help with the baby -- it's to help you with housework so you can bond with your baby and recover adequately.  Your emotions will be in overdrive and being able to just focus on the baby will help you transition from pregnancy to being this baby's mother.  Let your mother help you do that, but give her a road map.

You want to cry when she leaves because she was that helpful around your house -- not because your relationship is damaged due to her lack of help at your time of need.  Communication is the key.  I hope this letter is a starting point if this is a difficult topic for you or your husband to approach with your family.  Enjoy your Babymoon!

Monday, August 15, 2011

Hoping for a Fast Labor? Think again!

There is a list I give out in Class 8 titled "Variations of Labor" and we spend the entire class discussing this list.  Some of the things listed include Premature Rupture of Membranes (PROM), Breech, Failure to Progress, etc.  Also on this list is "Fast Labor".  I always start out this class by telling everyone they will have something from this list, but you don't get to pick which one it'll be.  There's always someone in the room that shouts out, "I get the fast labor!" to which everyone laughs and they fight over who gets that one!

My friend, Janet, who I referred to in last weeks post, had a very fast labor with her 2nd baby -- 3 hours to be exact -- and she received so many comments along the lines of, "Well, if my labor was that fast, I could do it without drugs too!"  Comments like that total negate the incredibly hard work she did in those turbulent 3 hours.

Now, if you had a very long labor, I know we aren't getting any sympathy from you!  It's great if there is a balance between fast and hard and long and slow.  While there are things that will sometimes work to speed things up or slow things down, we still don't get to choose.

I don't know how many times I've heard, "Who cares how the baby gets here as long as they are healthy."   We just want labor to be as fast as possible so we can get it over with. 

Any time a mom is dilating quickly, contractions are right on top of another.  She gets very little break, if any.  Now, hindsight is always 20/20.  A mom having a fast labor doesn't know she's having a fast labor -  especially if her last labor was 30 hours.  She's thinking "I can't do this for 28 more hours!" 

Some of you have had a fast labor and you know it was out of your control.  It was like a roller coaster ride that you couldn't get off of and just had to hang on until the end.   When you get off the ride, it's all a blur -- the racing heart, the just wanting it to be over, the nausea, the fear.  Generally, when women have a baby super fast, they just can't believe it when it's over, also a blur.  Most of them will say that they wish it had been longer and they got to enjoy their labor more, to use some of the techniques they learned in class.  They missed out on enjoying the "putsy-putsy" stage, as Dr. Bradley called it, with their spouse.   The processing of a fast labor is unique.

It's hard to explain to a woman about to start labor all the reasons not to hope for a fast labor.  I've seen women hope for a slower labor, only to have a fast one!  Since you don't get to choose the pace of your labor, I don't want to scare anyone, I just am hoping to help some moms to see that maybe a fast labor isn't all that it's chalked up to be.  Let's show some respect to those that had super fast labors.  They were hard and intense. 

A side note about fast labors:  Mom is more likely to tear when the labor is fast because she doesn't have as much time to stretch.  This is also more common with smaller babies that have a tendency to shoot through the birth canal.  Big babies and longer labors ain't so bad after all, my friends.

Some quick tips if you are having a fast labor:

Labor on your hands and knees.  This takes the baby's head off your cervix and may help slow things down a bit.  

Get in the water.  Even if it doesn't slow contractions down, they will at least feel different and more tolerable in water than on land. 

If the baby is coming through the birth canal fast, lie on your side.  It lessens the tension on the perineum and makes you less likely to tear.  

Enjoy that labor.  It belongs to you and your baby.  You only get to experience it once.  Don't wish it away by hoping it goes by super fast. 

I have to end this post with the same picture I opened with, simply because it totally makes me laugh.  Labor is a roller coaster ride.  Embrace the thrill!

Still laughing...

Monday, August 8, 2011

Sounding Your Labor: Are you In or Out of Control?

If you are a "birth junkie" you've probably watched dozens of birth videos.  Or maybe you are pregnant for the first time and are pretty freaked out to watch them!  So many of the birth videos out there seem to play serene music as the baby is born, dubbing over the sounds the mother may be making.  The viewer is left with this impression that the birthing woman peacefully -- and quietly -- pushed her baby out.

When I was pregnant with my second baby -- first unmedicated birth though -- my friend Janet told me that "sounding" her labor helped her so much.  I don't know that we spent much time talking about it, but I must have remembered her telling me that because I was definitely "sounding" out that labor!  At one point, my midwife could tell that this was helping me so much and she calmly said, "Donna, you sound fabulous.  Keep doing exactly what you are doing."  This was huge for me because in my head I thought I sounded like a lunatic, and yet, I didn't want to stop doing it because it was helping me stay calm and focused and relaxed.

As the baby descended and was coming through the birth canal, I got a little panicked and wild.  I screamed "IT BURNS!" when the baby's head crowned.  The whole scene was followed by lots of euphoric crying, "I did it!  You're here!"  Needless to say, my first birth video looks nothing like the pretty ones I show in class!

Despite my midwife's words, I spent years feeling bad for sounding out my labor and especially for screaming the way I did when her head was crowning.  I felt that I should have been quiet and turned inward, welcoming my baby into a quiet dark room -- just like the women in the videos.

To this day, that birth video is still the most emotional to watch and listen to.  I just love it.  I love the way I sound when I hold my baby skin to skin, fresh from my womb.  I went from the most intense and painful thing I'd ever experienced to absolute euphoria and joy!  And I can hear every bit of it!

My 3rd baby, if you've read my birth stories, was the hardest of them all, simply because I didn't prepare on any level.  I was a know-it-all.  I hollered so loud when that baby came through, I scared the mailman right off our porch!  I yelled because it hurt, but looking back on it 10 years later, I think it's also because I was so angry at myself for letting myself  begin labor without even preparing for it.  I hate listening to that video.  I sound awful.  It is so obvious that I was struggling.  There was no euphoric "You're here!" when the baby was out.  I was just so unbelievably grateful that it was over.  Completely exhausted.

By the 4th baby, I was fairly comfortable with the fact that I am a what-I-call "vocal birther".  I had been teaching childbirth classes for a couple of years by the time I had her and talked about this in class.  I had attended a handful of births as well and learned quite a bit about this "sounding".

Several days ago, I asked on my Facebook page if anyone had any topics they'd like me to write about, and one of the midwives I work a lot with, Melody, asked me to write on this topic of sounding out your labor:  

"... Making noise and being "open" in labor! So many mommies think they didn't "birth well" because they thought they were loud or " out of control" when they are comparing with birth videos etc. It's not uncommon for women to apologize for how they responded or the noise they made. I would love to see a post on this topic!"

I could relate to this sentiment because I felt the same way with two of my babies.  The truth is actually quite the opposite.  I spend 12 weeks teaching relaxation - physical, mental, and emotional.  Sounding is so closely tied to physical relaxation.  When a dad calls me when they are in labor, if I can hear the laboring woman, I can tell how well she is handling contractions.  How?

OK, from your computer, do this with me.  Reading this on your phone in Walmart at the check-out?  You might wait till you are in the car!

Take a regular breath and let out a high-pitched "aaahhh".  This is the sound that many women make on TV when they are in labor.  It's high-pitched and obvious that she is in pain.  In fact, we are all in pain from listening to her!

Now take a good deep breath from the abdomen, open your throat, and let out a low-pitched "aaahhh".  Let your shoulders drop.  As the laboring woman peeks in her contractions, this sound will like get louder and longer, and hopefully lower.  The lower the sound, the more open her throat, the more relaxed and deep her breathing, the more her shoulders and jaw drop.  Without the noise, she simply cannot be this relaxed.

A person can lay perfectly still and quiet and be completely tense.  Noise is good.  It's good for mom.  It's good for baby.  If mom is taking these good, deep, long breaths during contractions, baby is getting good oxygen.  If she is chest-breathing and letting out short, high-pitched sounds, baby is not getting good oxygen and mom is tensing up in the shoulders, the jaw, and the abdomen, and therefore the uterus.  Sounding is even good for your midwife!  It helps her know how you are doing and perhaps how she can help you.  It also helps her know where you are in your labor.  By the 3rd baby, David knew exactly when that baby was on it's way out by the sounds I was making!

Think O-P-E-N and L-O-W sounds.  Should the mom sounding out labor feel bad about the sounds she's making?  No way!  Giving birth is, in the words of my last midwife, Barb Pepper, "animalistic".  She'd tell me to make some noise, let it out!  It's normal, it's healthy, and it's expected.

So what about those birth videos?  What should we do about them?  They are great visually, but they do women a disservice by editing the audio.  Hearing birth is equally important.  This is one reason I strongly suggest my students watch Orgasmic Birth.  We get to hear birth and lots of it!  It's real.  Don't be afraid of the name, if you haven't seen it.  It's a fabulous film on many levels, but for the purpose of this post, we're just focusing on the sounds of a laboring woman.  Dads should watch this movie too.  Many men are uncomfortable with the sounds their wife might make in labor, and it is so important that they become acquainted with these sounds and welcome them.  Recognize the high and low pitches and help her stay low and open. 

Most importantly, this is your labor.  No one will ever give birth exactly like you.  You can't do it wrong.  You may not be a "vocal birther" like me.  You may be very quiet and do all your relaxing through your breath.  That is OK too.  Find your ritual and run with it.  If sounding is a part of that ritual that helps your through labor and birth, great!  "Sound" loud and proud, Mama!

Monday, August 1, 2011

Transitioning from Co-Sleeping

This is a bittersweet topic for me.  Probably for you too if you are in the middle of transitioning baby/toddler from your bed.   I've got a couple of friends going through this right now, so this post is for them.

Let me clarify - I don't miss the days of having a toddler in my bed, but I really do miss having a small baby.  I loved the smell of that little one and feeling her little body mold to mine as she nursed throughout the night. 

I have talked about co-sleeping and bed-sharing in previous posts over the years.  Here's one, two, and three of my favorites.  But there does come a time when you -- and baby -- are done and just want your own sleeping space.  And that's OK.  Even exciting.  My number one bit of advice is to be patient.  I know this is easier said than done on some nights, but I promise that they will sleep in their own bed one day and it will be all night long. 

Everyone's circumstances are unique and all babies are unique.  Take what works and throw out the rest.  I'm going to tell you some things that worked for us with our 4 children -- who are fabulous sleepers now at ages 15, 12, 10, and 6.  They weren't always that way though...

Baby #1 was not exclusively co-slept.  He was back and forth all night long.  He stopped breastfeeding at 15 months, and while I hesitate to say this -- that is when he stopped waking all night.  Now don't go use that as an excuse to stop breastfeeding!  I wasn't trying to wean him, I just realized on Friday that he hadn't nursed since Tuesday.  He was still in a crib though until about 21 months. 

Moving out of a crib and into a "real" bed is really the same as moving out of mom and dad's bed and into their own bed.  The techniques we used were about the same. 

Baby #2 always slept in a crib and wanted to be left alone.  Ironically, she has been our worst sleeper since about the age of 6 -- hard time falling asleep and a light sleeper.  There was no transitioning with her.  She never nursed to sleep.  She always wanted us to put her in her crib and leave her alone.

Baby #3 was our hardest.  We had the crib and by the simple nature of having the crib set up, we felt obligated to use the crib.  If we had just been co-sleepers and not tried to force her into a crib, we probably wouldn't have had the difficulties that we did.  All night long, she rotated from the crib, to our bed, to a playpen.  That being said, I can appreciate that many of you are in this situation right now and you do not use a crib.  So how do you lovingly transition baby to his own bed?

 You've taken extreme care in helping your baby feel secure about sleep up to this point.  She's learned that sleep is pleasant, but like any change, it takes some getting use to a new bed and surroundings.  It can be exciting and scary for your baby.  Be patient.

Baby #4 never had a crib.  When she moved to her own bed, granted, she had two sisters in the room with her.  It was exciting for her.  She was one of the big kids.  She was 28 months old.  She had had her bed in our room, but she would never stay in it.  Moving it to the girls' room was best for her.  We had tried to move her at about 20 months to that bed (in our room), but she just wasn't ready.  It was too much work.  If it's that hard, they aren't ready!  She stayed in our bed another 8 months. Again, ironically, when she quit breastfeeding at 28 months, this is also when she transitioned, and slept through the night.

OK, there's a little about our experiences.  On to some of our tricks:

One of our tricks with baby #1 and #3 that helped was to sit outside their bedroom in the hallway.  This sounds crazy, but it gave them the security that I was there, but they needed to learn to sleep in their own bed.  Key advice here:  Have a good book and a book light!  I found myself looking forward to this time of night because I didn't feel like this was a time-suck, sitting in the hallway.  When I didn't have a book to read, I hated sitting there thinking of all the things I needed to get done.  "Hurry up and fall asleep!" was all I could think.  I became impatient and toddler felt that, cried, and became more clingy.  Fail.

They will come out of bed, likely, several times.  That's OK.  This is new and exciting to be able to get out of bed.  They feel independent.  And if they have mostly nursed to sleep up until now, this may be quite new for them.  We kept a sippy cup of water by their bed.  When they get out of bed and come look at you in the hallway, simply put your book down and tuck them back in.  I didn't talk to them at all, especially after several times of getting out of bed.  Initially, I would remind them that I would stay until they fell asleep, but eventually they get bored with the whole thing and fall asleep. 

I never did nightlights for any of the kids.  I felt like it kept them awake.  They had never slept with one in our room, so why start now?  I felt like knowing I was nearby is what made it all OK.

Some parents have a pallet on the floor in their room and try that initially.  It's all the same idea, really -- just letting toddler know that you are still nearby.  I never liked doing the falling-asleep-next-to-baby and then sneaking away, even if their new bed was big enough.  It was no different than what we had been doing.  Plus, I found myself feeling like my evening was shot.  Yes, I am selfish with my time.  If I was reading in the hallway, I was good with that. 

Whatever is going to make you the most patient parent, that is what I suggest!

I know the next question is "How long did it take?"  I sat in the hallway with #3 for probably 2 weeks.  She was 2 years old.  And stubborn.  Still is.  She's also the most organized and responsible, so I let it slide!

If transitioning is a really awful experience, just wait a few weeks or months and try again.  I promise, this will not last forever.  They will sleep in their own bed.  You want them to feel proud of themselves though, kind of like potty training.  If they aren't ready and you are making them do it, your whole family will be miserable.

 Roll with the punches (even the ones in the back in the middle of the night!).  Know this phase of co-sleeping with this baby is almost over.  You don't get that time back so enjoy every single minute.  It'll make getting your own bed back that much sweeter.