Comfort at Any Stage
Recently for the Bakersfield BirthNetwork, I was presenting on comfort measures for birth. Expectant families, as well as doulas, come to these gatherings, and I love being able to offer information that is not only helpful to parents, but also information other professionals can take to their clients! As a Lamaze-certified Childbirth Educator, I am always putting together ideas in an unusual way to help make learning about birth fun!
The inspiration for this started when I had a few ideas I wanted to squish together into an activity:
1. Update the stages of labor to reflect an additional pre-labor phase at the onset of the first stage
2. Scaffold the stages/phases of labor by choosing and practicing supports meant to intertwine with the key emotional and physical events occurring
3. Provide a handout which not only helps visualize the opening of first stage, but also serves as a cheat sheet to labor happenings, timing, and ways to cope
What I came up with, I call the "Spinning Circles of Womb." Just kidding, I don't. But I think it works, and it's pretty simple, and that's all that counts -- no frilly title needed. Basically, here are the supplies:
I can't remember a time when I sat participants at a table, but for this activity we did, indeed, sit at a table. Surrounded by Mr. Sketch Markers, paper circles, and stickers, I began to share the stages of labor by tacking three sheets of (laminated) paper onto the wall. There is relief when an expectant parent realizes there are only three stages of labor (I did have a dad once who suggested there were 14, but that was his lucky number, and I asked him to take a guess!).
Three. That's not hard to remember, right?
Then I tack up two more papers, which you can see below, right. I share how some genius decided to break the first stage of labor up into phases, which is another word for, let's just insert more stages into this stage and call it good.
On the front of the circles we write things like average length of that phase, approximate cervical dilation achieved, contraction action, and more (note: I don't show all of that in the picture). The pinnacle of this is affixing the face sticker to the appropriate phase, as a handy visual reminder of what a laboring person might be feeling in that moment.
While we are moving through the phases with markers and stickers, we are also brainstorming what comfort measures might be beneficial at what time, and those are added to the back of that circle. We practice these comfort measures as we go. If we expect people to feel comfortable with different physical ways to counter the strong sensations of labor, we can't expect them to get there from a picture alone! Would you step into a ballroom, ready to dance in front of judges, simply from pictures you saw in a book? We need to actually show families what these positions and movements look like, how they feel, and when they help -- or they are of no help at all.
At the close of this activity, families walk away with their concentric circles of information, a piece of pool noodle, and an information sheet which shows about 20 different physical positions of a laboring person and partner working together.
Not a bad way to merge my three goals! A handy takeaway that can be utilized easily during birth.
One other thing about me: I love things that nest. Whether they are baby toys that stack together, measuring cups, boxes, or even Matryoshka dolls -- if it nests, it's the best. I have three different nesting toys that I actually don't let my kids play with...I keep them in the closet with all my childbirth education supplies.
One shopping trip, probably 8 years ago (I could look in a catalog to see for certain!), I found these boxes. I was attracted to the nesting, of course. But as I looked closer, I wondered the measurements? Might they be in centimeters, oh maybe, 2ish to 10ish? I went to a handy pencil/map/paper-tape-measure station to check it out. The smallest box was about 2ish centimeters, the next box was 3, 4, 5, and so on, until finally the last box was 10ish. Woo-hoo! I bought about 6 sets!
The bad news is, IKEA doesn't make these boxes anymore. The good news is, maybe you have an affinity for things that nest and there is a set in your possession? Maybe unlikely. But it gets the wheel turning, doesn't it? To be on the look out for what might work? If you are truly motivated, you could make your own, perhaps out of duct tape? I would love to hear your ideas -- let me know what you come up with! And don't forget to "Like" my Facebook page to keep getting ideas!
ACOG Statements in Pictures
I finished another project I am so excited about! I wanted to put to pictures these 20 ACOG statements that came out in March with the goal to avoid a woman's first cesarean. Now some asked why the images didn't exactly match the recommendations. All I could reply back with was, some of these things, you wouldn't want to see in pictures, either because they would be boring, or because they would be graphic. But more to the truth is, I wanted the pictures to represent patience...we need to be more patient with labor. We need to give moms and babies more time to perform this task.
I am so grateful to all the families, doulas, and photographers who shared pictures with me -- the response was overwhelming. Because the focus is on preventing the initial cesarean birth, I am pleased that some of these moms are shown laboring toward what ended up being successful VBACs!
Patience is the key. Many of these are based on evidence that shows with more time, a woman can birth vaginally. And speaking of time -- research shows it can take 10-17 years before new evidence is implemented into practice. If we familiarize ourselves with these new recommendations, we can be the driving force behind ensuring the care we receive is current when our caregiver might still be doing things out of habit, comfort, or custom. Let's spread the word!
Pin these! Help raise awareness and get this information out there into the hands of the families that need it. The goal is to educate families, so they can enter into their providers' offices knowing what ACOG now recommends.
Stay tuned for August's adventures in celebrating World Breastfeeding Week and Breastfeeding Awareness Month. Like my Facebook page for resources that can be used by educators, doulas, and of course, breastfeeding mothers!
Have you heard "6 is the new 4"? When looking at the stages of labor, it was taught that 0-4ish was latent or early labor, 4ish-7ish was active labor, and 7ish to complete (what we call "10") was transition. After seeing that we misjudged the amount of time in active phase, it is possible many women received cesarean births simply due to what was thought of as non-progressing labor, when in reality, with 4-6 more hours in that phase, birth would have happened on its own. Patience is not only a virtue, but it is also the safer way to birth for moms and babies.
My First Baby's Birth
I must preface this by stating, it is not an uplifting tale of birth. I know in our culture we hear more birth horror stories, and it is not my intention to perpetuate that. This is the beginning of my birth experiences, and although I take credit for my missteps, I hope 1-it can serve to help get you thinking about your birth options, and 2-you will read my other experiences of birth to see the evolution which came through my personal education and faith.
When I was pregnant for the first time, I fit the typical American mom-to-be stereotype. My older sister was three months behind me pregnant with her first, and she was planning a homebirth with a midwife. Not me, I wanted a hospital birth, and the cherry on top was, I chose a female obstetrician just knowing she would "get me."
My appointments were a lot of waiting, waiting, waiting for her to show up, and then her rushing me out in important-doctor fashion. One time I was made to wait so long, naked bottom on the papered-table (in a very hot, windowless room) that I sweated through the paper -- how terrible was that? But I was a good girl, and I did as I was told. "Take off your pants and sit here, she will be here soon." How humiliating. (Please, if it is not too late for you, keep your pants on until you practitioner arrives, and just sit in the chair while you wait -- it's allowed!).
This is long! Be warned!
I think when a person in is a position to serve a woman while she is in labor, that person should have required training every few years, like a recertification, on what it feels like to have a baby. I am not certain how this certification could be obtained, virtual reality plus some sort of pregnancy suit? Actually having a baby? I haven’t figured out the logistics, but I have recently had a recertification of my own, and that is called, my fourth child.
This fourth pregnancy was a surprise. Technically, I got pregnant at a time when no one would be able to get pregnant – only I guess more like I got pregnant at a time I felt I was highly, highly unlikely to get pregnant. My last menstrual period was June 10th. I did not get pregnant until July 13th at the earliest (a time when I was waiting for my period to start), to July 20-ish at the latest; looking at the date he was born now (April 6th), July 13th seems closer to the target date…we were on vacation.
I had lots of irritable contractions combined with irritable baby movements (probably more of the latter versus the former) that would happen around 10 pm to 1 am. The week before labor began I pretty much experienced these every night and I hated them. During these times, I would have waves of panic and anxiety about the reality of actually having to go through the birth process again, and I was always grateful when they were over and I could finally climb into bed.
Friday the 5th of April was pretty normal except I had two very serious bouts of grumpiness that made me feel deeply in touch with someone who was (hopefully!) going to start labor soon -- it was like total,
irrational, not-triggered-by-much anger that switched on so fast, I knew it was something else with some other root than just me being moody.
We had pizza for dinner, and like I had for the last week, I restrained myself from eating too much (“If labor starts tonight I don’t want to be too full,” was my rationale). I had two pieces and then cut myself
off. I took a little nap in bed, which I hoped would actually be “going to bed,” but I woke up at about midnight when I couldn’t ignore the antics of Wild Baby any longer. I watched TV a little and sat on the ball to try and bounce my guy into a calmer state. At 1 am I decided to watch the last episode of Mad Men on Netflix so I would be ready for the new season, with the intention of going to bed after that.
At 2 am, just when I was settling into sleep, I realized I was contracting, and these contractions felt different. They came 5-6 minutes apart, were totally manageable, and lasted about 40 seconds. I tried to sleep, but I was also mindful of needing to recognize true labor so I could get my sister and my mom on the road from two and a half hours away if this really were it.
Everyone was asleep, and as long as I was okay, I felt no need to wake them. I was feeling hungry, so I ate half a lemon Chobani (again, not wanting to eat a lot) in the morning quiet. I did call my sister at 3 am to let her know it was go-time. I labored longer, in the quiet of my living room, tending to small errands and tasks between contractions. At 4 am I woke Brad up to tell him I was in labor. He came out to the living room and asked, “What can I do?” and I immediately answered, “Take the recycling out, it’s driving me crazy and I have contemplated doing it myself for the last 2 hours.” I was hoping he would just lie back down on the couch and snooze a little, but he was up and ready to go.
I thought I would wait to call my midwife until 5 am, but at 4:30 my contractions began to get stronger and longer and closer together, just as they should, and I finally had some show. I phoned Linda to let her know I was in labor. She asked me a few questions, and then said she would be over soon. She lives about 40 minutes from us.
At 6 am, Linda arrived, and things were beginning to feel real. We had our tub set up in the dining room and I was feeling a pull to climb in, but I didn’t want to stall labor if I wasn’t that far along. I asked Linda to check me and she said I was 3 centimeters (“Not quite active labor!” I thought with a little disappointment), about 90% effaced, baby maybe at -2 station? I can’t remember that part. I mentioned I wanted to get in the tub, but I should probably try the shower instead (so gravity could keep helping my labor), and Linda agreed.
I got in the shower, and I really don’t know how long I was in there. The water felt great on my belly and during contractions I would swing from side to side so the water could fan over me. In between contractions I alternated putting my foot up on the side of the shower to lunge, in case my baby was posterior like his two brothers before him. Soon I found I had to vocalize during the contractions. I was in the bathroom alone and I had a lot of time to think. The thought that kept coming back to me was, “All is as it should be,” which was part of a prayer Brad had said earlier in the week when I was feeling really overcome with fear. I rubbed my belly and talked to the baby and told him to hurry, it all felt like it was happening in slow motion.
When I got out of the shower it was about 7 am and Linda checked me again. I was 5 centimeters. I went straight for the tub at that point, dropped my towel, and climbed in.
Jacob and Jonas were awake and had been for a while. Soon Isaac woke up and came straggling out of his bedroom in his standard sleeping attire – undies and a t-shirt. Brad told him we had company and he might want to put clothes on. Before Isaac woke up I remember Brad asking Jonas if he knew why Linda was at our house so early? Jonas admitted he didn’t, and we made a joke about Linda just coming for an early-morning visit. Brad then said, “Your mom is going to have the baby today.”
I looked to the tub for the relief it had brought in the past; with both Isaac and Jonas I got into the Jacuzzi tub at 5ish centimeters and after an hour was at 9ish centimeters, and I was hoping for the same, with the addition of having the baby in the water. After 30 or 40 minutes it seemed the tub wasn’t going to work as I had planned. I had intense pain in my lower abdomen to the point of not being able to sit in a relaxing position, so the whole time I was in the water I had to be on my hands and knees, and I didn’t want to stay that way much longer. Also, Brad started making pancakes in the kitchen.
At about 7:45 my mom, sister Shiela, and her two boys arrived. I headed to my bedroom, finished with the tub. Linda had set things up around the pool in preparation of a water birth, so some rearranging was in order, moving things to my room, getting equipment ready if needed. Once in my room it was just Linda, my mom, Shiela, and I. Brad had the boys going with pancakes and if they were making any noise, I sure didn’t hear it.
I asked someone to bring the piano bench into my room as I was laboring standing up, and I wanted to continue to lunge in case I had a malpositioned baby (which I don’t think he was, but I was a little gun
I think I had Linda check me again, and I think I was 7 centimeters? I am not really clear on this part. I wasn’t ready to sit down, so I continued to labor standing up. Shiela was a super doula – she would squeeze my hips during my contractions, and it brought so much relief! One thing I know about that double-hip squeeze is, it is hard to do when you have to press your arms together at the height of a woman’s hips – you get tired fast, and the laboring woman usually doesn’t want you to stop. If the
mom can get on her hands and knees on the floor, you can squeeze her hips with your own inner knees by straddling over her back, but I didn’t even want to try or offer that as I didn’t feel good in that position.
Over and over, a contraction would come, and I would tell Shiela, “Hips, hips, hips,” and she would start
In reality I have no idea what kind of time span this all happened in, I say over and over, but maybe it was only about 5 contractions? Or maybe it was 10?
I did finally sit on the bed for a bit. I remember taking my watch off and handing it to Shiela with the feeling that this was taking too long. I know for a fact I wasn’t looking at my watch or paying attention to how long it was taking in a linear fashion, but it was more some sort of symbolic resignation that I
would try to just flow with the timetable my body and baby presented even though I am as impatient as they come; in the last picture of me with my watch on, I see the time is 8:55 am.
I decided to visit the toilet. I spent a couple of contractions there, and Shiela was with me. She said my noises changed and she knew I was getting closer. As I sat laboring on the toilet, I opened the shower door next to me and contemplated getting back in -- I was looking for anything to comfort me at this point. Then I decided to see if I could feel anything inside of me, so with one finger about one knuckle in I was shocked to find something! “Is that a head?” I asked. But then I realized it was a bulging bag of water, with a head behind it. After all the years of hearing practitioners say, “I feel a bulging bag of water” (which I did remember Linda saying when she checked me last), I finally knew what that felt like and what it meant. I think I almost gingerly hopped off the toilet at that point, feeling remotivated.
I had one contraction standing up, with Shiela at my hips. Then I had another, and my water exploded all over the floor. There was a little meconium but Linda said it looked old and there was no reason for concern. I finally climbed into bed.
At this point I knew it would soon be time to push. I suddenly had the need for Brad to come and be with me, so I called to him and patted the side of the bed next to me, I just wanted him to sit with me and be near. Shiela was on the other side of me, and Linda was at the foot of the bed. My mom was by the door, ready with the camera, and the boys were in the living room playing Legos (again, I never heard anything from the boys, and there were 5 of them. Actually, I think after they ate pancakes they walked to the park with the dog to play for a bit. But I do know when the baby was born, they were playing Legos in the living room).
I did begin pushing at some point, and Linda said I still had a rim of cervix and she was going to try and move it, and I was totally fine with that because if anything was holding this baby up, I wanted it gone. So for a couple of contractions she worked on that and I guess it went away. I was pushing with such intensity but it felt fruitless. I truly felt nothing moving or changing and I imagined pushing forever
and not making any progress. It was at this point that I remember thinking, “I should have gone to the hospital so I could have the drugs!” (Interestingly enough, when I had my babies in the hospital, I never thought to ask for drugs, because I know if I had had the thought, I would have asked; maybe at home when it is not an option, my brain safely went there, just as a way to cope and vent.) Brad and Shiela were helping me pull my legs back during the pushing. Instead of rolling my chin to my chest, which I have helped women remember who-knows-how-many-times, I arched my head back against my pillows. I also had my body twisted in some way, crooked a little. Linda gently reminded me to get better aligned (with words and heart I could understand at that point), while giving me positive encouragement for this task I had to undertake.
Linda! What else could you want from a midwife? Really, not one thing. As a doula, I get really uncomfortable when people say, “Stacie, I couldn’t have done it without you.” Because, come on, you could have, and you would have. I don’t want anyone’s birth experience to have me entangled as an
essential ingredient; it should be all about the mom and her family, not me. But I have to concede that
when the right person is helping you with the right words and attitude and presence and spirit, it helps make the experience even more amazing, if that is possible. When you have the right midwife, the feeling is similar to being in your own home – the comforts of being in your own bed, using your own bathroom, lunging on your own piano bench – Linda was a natural extension of that. It felt right that she be here, in our home, unobtrusively watching over the birth of our baby.
The support Shiela gave me was also invaluable. Family members don’t always make the best doulas.
Shiela actually has taken a DONA-doula training, and that coupled with what she knows about me (just about everything), made her perfect for the job. She stayed by my side, she gave me verbal encouragement, she wished she could help me more. The truth of the matter is, only the mother can have the baby, but she doesn’t have to be alone while she is having her baby. I will forever treasure that my sister was there to support me during one of the most intense experiences of my life.
Pushing was hard, it was really hard – it seemed harder than it ever had been. I know I was lost in my head, and in there, the storm was raging. Every push came with screams, I hate to say it. I have never screamed with any of my other babies. And also, I cried, which was something new for me. In hindsight I probably could have pushed more effectively keeping those screams to myself, but they just came out. I know the boys didn’t appreciate the noise (although they all later admitted they weren’t scared), I am thankful my neighbors didn’t call the police, and the screaming is not my favorite thing about the birth video – oh well!
After so much pushing (again my sense of time is really off here), finally his head emerged. I felt his head with my hand, but it really didn’t mean anything to me, I just wanted the rest of him out! I pushed for one or two more contractions, maybe three, and then his shoulders popped and he tumbled out on a
wave of fluid and tons of baby poop. Linda helped bring him to my chest, all the while rubbing him and talking to him and watching him carefully. I was so relieved and instantly went from that person experiencing the very hard work of pushing toward a goal, to that mother experiencing her baby
for the first time. I was rubbing him and toweling him off and just taking him in, my body relieved of the burden with the prize in my arms. He was born at 9:42 am.
We all watched as he turned from purple-y to pink. His apgars were 8 and 9. Very soon after birth he wanted to nurse and he seemed to know just what he was doing. The boys peeked in one by one, only appearing mildy interested (we had two 13 year olds, two 11 year olds, and one 7 year old), and then backing out of the room again.
There were lots of things in the birth kit we didn’t use. My perineum didn’t need massaging, which Linda was prepared to do. We didn’t need the bulb syringe to suction the baby’s airways. There are lots of Chux pads that didn’t get used. Everything just happened easily and well, as it so often can when left to its own devices. I am sure the level of comfort and security factored into that for me as well. I am still struck by how ordinary things were and how extraordinary they were. Within a couple hours I was back in my shower. A little while later I threw a load of laundry in. My mom bought donuts and I happily ate three. Our new (nameless) baby was being admired and touched and held by his cousins and brothers and dad and aunt and grandma, while also nursing and visually taking in all he could. In many ways it was like a normal Saturday morning at home, but then, it was also like some rare, high holy day, calm with introspection, peace and joy.
Ezra Christian was 8 pounds, 1 ounce. There was much debate about his name – the other choices were Benjamin, Ruben, and Abraham. He was born on what we in the LDS religion believe to be Christ’s birthday, and also the day the LDS religion was restored; Christian is my brother’s middle name, and we
felt it appropriate for Ezra as well.
Moving through that birth, I didn’t feel alone. I remembered so many births and situations and strong mamas moving gracefully through this work. I could name each and every one that came to mind, but hey, this one’s my story. Just know if I have been with you for the birth of your baby, you were with me during mine in spirit and endurance and admiration. This has brought me so much more appreciation and compassion for birth and women while experiencing it – that’s why I feel there should be something birth workers can do every few years to get back in touch with what it can really be like to physically grow and have a baby. It changes you, and sometimes we forget that.
When Do I Push?
♥ four young boys and a boy dog (offspring)