Friday, March 14, 2008

Should I try for a natural birth?

The first questions you may ask yourself when you are deciding whether you want a natural birth or not, is likely to be,
Can I handle the pain?

Another question is, Is the baby positioned so he/she will fit? Or, simply, Will the baby fit?
(You may be wondering, how can an entire baby fit out that little hole, and what will it do to me?)

The answer to whether you can handle childbirth pain and whether the baby will fit is often the same, single answer. A well-positioned baby leads to a do-able labor and almost always fits the mother's pelvis.

What fetal position is good? Facing the mother's right hip (left occiput transverse, or left occiput lateral) or her back (occiput anterior).

A baby whose chin is tucked before labor will be able to rotate into a good position during labor, if they aren't already in one.

Most posterior babies, in which the baby faces the mother's front (and in my opinion, her left hip, too) will rotate to the anterior during strong labor contractions and then be born vaginally. A few posterior babies will be born posterior, and a few will need medical interventions, like Pitocin or a cesarean, to finish the birth. By far, most babies who start labor in a posterior position will rotate and be born in the anterior position.

For some women with a posterior baby labor will be longer than with an anterior baby. There may be challenges in the labor, such as starts and stops in contractions, clusters of very strongs contractions followed by almost no contractions, and subsequent emotional disppointments due to the confusion such a labor pattern can cause in the parents AND the birth attendants.
See more on posterior labor.

Is that a reason to skip labor and have major abdominal surgery for the birth of your baby?
Here are some other questions to ask:

What do you want for your baby? How do you want your first minutes and hours of your life with your baby? If you knew your second birth would be do-able would you go for it again?

What do you want for yourself? When you look back, what do you want to have learned about yourself? Where do you want to have taken yourself, spiritually, emotionally and physically, with this birth? Is that the place you want to live in?

A doula (doo-la) is a trained woman who will listen to your answers, help you find the truth in your journey and if you want to go with a vaginal birth, or even a drug free birth, she will help you gain confidence and comfort in preparing for and going through labor. I highly recommend finding a calm doula for your upcoming birth.

Wednesday, March 12, 2008

The New York Times doula article rebutal by Susan Lane

Pamela Paul's article in the Sunday, March 2 Times ("And the Doula Makes Four") left out key points. One is that it's very easy to find out if a doula is certified, because the agencies such as DONA International that certify doulas offer an on-line listing. DONA and the Coalition for Improved Maternity Services also offer a guide for interviewing doulas. Parents should get current references and contact recent clients of a doula they are considering. Ms. Sacher's comment at the end of the article is most appropriate- parents should be conscientious about selecting a doula as well as a physician. Most doulas will meet for an interview at the parents' convenience, making the process easier still.

Minneapolis and the state of Minnesota have more certified doulas per capita than any city or state in the country, and we have wonderful relationships with medical staff in hospitals around the state. The Childbirth Collective is a Minnesota nonprofit organization of doulas, homebirth and hospital midwives, psychologists specializing in perinatal issues, massage therapists and chiropractors with special certifications related to pregnancy, birth and postpartum. Doulas in Minnesota can register with the state, which confirms their certification and conducts a background check for doulas who are then listed on the Health Department website. Most major metropolitan areas have birth networks that can help with doula selection.

I wish Ms Paul had indicated if the doula who disappointed those parents was certified, and if the parents have contacted her certifying agency with their concerns. That would be most helpful to all doulas and future clients in her area.

Finally, given that our cesarean rate is an astounding 31% and rising nationally, and that our maternal mortality rate is rising in direct proportion, and that our infant mortality rate is worse than most industrialized nations, is it really the 1-2% of doula supported births we should be concerned about?

Susan Lane, CD DONA, LCCE, CLC

Minneapolis, Minnesota

Sunday, March 9, 2008

Birthing in the Field

Hi Gail,
I thought I'd send you a link to my blog where the birth story for Adeline Louise is located
The Inversion worked to turn her from breech to vertex but like her sister before her, AddyLou decided to present in the persistent ROT-Posterior presentation, then oddly, she rotated on the perineum so that her face was then fully looking at my right thigh. We had about 45 seconds of shoulder dystocia and then both her shoulders birthed at once. Miraculously my perineum was intact but for skid marks.
...I especially appreciated your website with this pregnancy for all the information and inspiration I found there. Knowing I had an anterior placenta, a transverse baby who moved to breech before vertex, then a persistently "mal" positioned baby was stressful but I took comfort and strength from the information and stories on your site.
While this third labor and birth was longer and more physically/emotionally challenging for me 7 hours to get an 8lbs 10 ounce, interestingly positioned baby out is really pretty good. Not a cake walk, for sure, but doable.
Thanks for all you do!
Brenda Sutherland-Field

Thursday, March 6, 2008

Fear of second birth after previous long labor

"I am almost 36 weeks pregnant with my second baby. My first son was born naturally, with no pain relief, no intervention and no instruments, after a 30 hour labour. It was very difficult but we pulled through and he was a very healthy newborn. He was average size (3.7kg). He had been LOA throughout the final months of pregnancy and was born LOA. I did a lot of positioning work then.

I would like to repeat that experience but am disheartened by the fact that the current baby has been completely posterior since week 33/34. He was LOA at the 33 week check, then in the following days I noticed he had shifted and I was having constant back pain that I had never had before in either pregnancy (pressure in the back). Then at the 34 week check he was confirmed posterior.

I stand or walk for most of the day. I don’t slouch on the sofa. When I sit my bump hangs forward.

I am concerned that when I go on all fours I am effectively doing an inversion and risk turning the baby breech. I feel that if I remain upright, the shape of my bump should by itself facilitate an anterior position. I don’t understand why the baby has turned posterior. I haven’t had back pain again so it doesn’t seem like he is trying to turn back at all.

I am terrified of a posterior labour. I don’t think I can handle anything worse than what I had last time, and that was with LOA. I have lost all confidence in my ability to have a natural birth. I would be very grateful for your advice."

You are facing a common dilemma. The second labor after a first, long labor.

Remember, most women having posterior labors have progressing and do-able labors. First of all, babies come out. You've done it before and you can do it again. There is an illusion that medicated birth is painless, shorter, etc. Its just different, it may be easier, but of course, most 2nd births are going to be easier anyway.

There are common mistakes about what to do to help a baby into a good starting position for labor.
Maternal positioning is only the second of 3 Principles, please visit the discussion of the Three Principles on my Pregnancy page.

You are not at all doing an Inversion when you are on all-fours.
The Inversion is a wonderful tool when used as shown in the video in this blog, search Inversion. Limiting the time you do the inversion will prevent the baby going breech. But you can do it daily for a short period of time, as shown in the video. Do not do the Inversion if your doctor or midwife has said that there is more amniotic fluid than usual (for instance, you measure 3 or more cms over dates).

The shape of your abdomen, your bump, as you call it, is not a reliable indicator of fetal position. Nor will it make your baby be anterior. You can try adding a pregnancy belt to see if that helps baby rotate, but I suggest body work. Myofascial work on your broad and round ligaments. Meanwhile, repeated Inversions will eventually help the broad and round ligaments as your pelvis comes into symmetry over time and repetition.

Do you have a doula who is mature and calm?

I've helped many women, as a doula and as a midwife, with just your situation. Very often their labors are delightfully shorter than the first, in spite of having a posterior baby the second time.

You don't have to start with an anterior baby, you have to start with a tucked chin.
It also helps to have a relaxed pelvis, pelvic floor muscles, and uterine ligaments and be moving with your labor, in positions that help the uterus line up with your pelvis. You can do that with the Inversion, Chiropractic and the Pelvic Floor Release.

You may have to face the fear of a 30-hour labor again so you can get past that and get on with a second labor. The real labor. Not the labor in your mind. There is only room for one head in your pelvis, and it isn't yours.
Look at When Should I Worry?

Once you do that, you can enjoy the wonder of this child and this remarkable journey you are on.

How do you want to remember this pregnancy? Let go and find some joy here. I will try and follow this advice in my day today while I hold you in my heart and trust that you will find your way. I know you can.

Have a brave and wonderful birth.

CIMS congress in session

The Coalition for Improving Maternity Services (CIMS) is now in session, March 6, 2008.

There will be the release the International MotherBaby Childbirth Initiative on Saturday, International Women's Day. If you have time check out the MotherBaby web site

The purpose of the IMBCI 10 Steps is to improve care throughout the childbearing continuum in order to save lives, prevent illness and harm from the overuse of obstetric technologies, and promote health for mothers and babies around the world.

A consumer version of the Initiative, "Having a Baby? Ten Questions to Ask" is available.

Changing the Earth by supporting Birth

Mothers bring forth life; medical corporations do not. Birth can be simple, powerful and loving. Fetal positioning, natural birthing and practical help for normal birth.