Thursday, May 19, 2011

How to Prepare for Birth

The sensations of labour vary for every woman. Not only from woman to woman, but from labour to labour. I have had births that felt virtually painless for most of the labour, to having sensations that kicked my ass leaving me breathless and begging for mercy.

I honour whatever approach people take for their births. We all have different personalities and make-ups, and everyone has a different relationship to strong sensation. For me, while labour pain can be extreme, I can handle it. Unless there were a really good reason to do so, my choice is to not take epidurals or other forms of pain relief to manage the sensations. It hurts a lot, yeah, but having been through it, the endorphin and oxytocin reward at the end of the journey is so worth it. It is the most intense high I have ever had. I can draw the memory of that high into my being far more easily than I can the body memory of the pain. But the sensation of nausea? Youch. If I had the kind of nauseated labour I see some women have, or if labour felt anything like my first trimesters, I would seriously question whether or not I would want to have natural births. The sensation of nausea is so odious to me, that given the choice between a 36 hour posterior labour and a 12 hour stomach flu, I would absolutely, without any misgiving, choose the 36 hour labour. Because of my intensely difficult relationship with the sensation of nausea, I have compassion for women who have a feeling the sensation of labour might be something they absolutely abhor. Some people can handle achy pain but not sharp pain, or some breeze through a terrible bout of food poisoning cramps, while a migraine may traumatize them. It is such a subjective thing that it is important not to pile women all into one group, give them one method to prepare for labour, then send them off promising if they do it correctly they'll "be just fine". One may argue, "But labour pain is normal and natural, something good is happening in our bodies, therefore it can be done...it's not like the stomach flu or migraine, which are pathologies and trigger a stress response, thus exacerbating pain." True. But nausea and vomiting in labour are totally normal and natural as the body makes room and purges what it doesn't need..it doesn't mean I'd like it or be okay with it. Despite its normalness, it would trigger great anxiety in me. Luckily, I don't have pukey labours.

The challenge with birthing is that, if you've never done it before, you're not aware of how intense it's going to feel or how you're going to cope....whether the sensation is one of those types that's "safe" for you or challenging on a deeper level. This creates anxiety in women. When I work prenatally with my ladies and they invariably tell me they are nervous about their upcoming births, I say, "Great!" This is an opportunity to explore where she's coming from. I reassure the lady in front of me that it is perfectly appropriate to be anxious when teetering upon the precipice of the complete unknown. Using that energy usefully aids women in gathering to them what they need: resources, both external (support, primary care, knowledge of ways to help them cope) and internal (emotional exploration, cultivating an ability to relax and breathe deeply, maintaining presence with challenging sensations or emotions). A doula's job is to help a woman build up her resources.

Part of my prenatal care is to ask a woman what kind of approach she'd like to take with her birth. This helps me to figure out whether or not she's interested in having a natural birth. Contrary to popular belief, it is not only the flowery skirted ladies with a stockpile of incense to last through the Age of Aquarius, or whatever age we happen to be in, who hire doulas. In fact, those who procure the services of doulas in my neck of the woods are usually urban professionals in their mid to late thirties who are highly educated and well read about the birth process, with a lot of concrete ideas as to how they'd like to approach their birthing sensations. They've found whom their friends and relatives have told them are the best obstetricians in town. Their belief is that the combination of good obstetric care and the nurturing supportive care of a doula creates the best of both worlds for them. While many of them really do want to "go natural", there are those who are not that interested, and want their doula there to help assuage their fears and hold their hands through the epidural and just be a friendly face to hang out and make them and their partners comfortable. Fair enough. I serve whomever wants me at their birth, and my mandate is for them to feel like rock stars no matter what their approach. But I do have a few guidelines I feel are important for all of them to consider.

1) Prepare for anything and know you're great no matter what. Just about the only thing I can guarantee about birth is that it is unpredictable. I guide my clients into getting their heads around all contingencies. While I absolutely believe that the VAST majority of healthy women with good heads on their shoulders, if well surrounded but undisturbed in a cozy environment they felt safe and supported in, could have their babies with little to no intervention, birth, especially hospital birth, takes some preparation and knowledge. The whole, "Do nothing, have no fear, and you'll just open like a flower" approach is not useful or realistic in an environment that tends to make sphincters shrink rather than blossom. Neither is the, "I'm going to have an epidural the second I have pain, and my doctor will 'get the baby out' at some point and then it will be done" approach. Both extremes have the potential to leave one feeling disappointed at best, to downright traumatized at worst.

Imagine this: What if you are planning to have an epidural as soon as you feel pain and it doesn't work out that way? For instance, what if you have one of those types of labours in which you're having a huge amount of pain at 1cm? Some women just have a lot of pain in early labour. This doesn't mean they're wimpy...we have to get out of the mind set that a number of dilation equals an expected sensation. This isn't true. So what if you're having 2 minute apart contractions that you consider rate an 8 on the pain scale, you're planning an epidural, and lo and behold, nobody wants to give you one because doctors don't really like to give epidurals to people at 1cm (for good reasons)? You would be offered other kinds of medications like narcotics, but anyone who's taken those during labour knows they don't really do the job that well if you're truly hurting.

What if you were planning an epidural, you get to the hospital and the pain starts, you ask for the Epidural Man, and lo and behold, there are 3 Cesareans in a row he must be present for? I have seen women have to wait 4 hours for an epidural. Sometimes they give birth before it comes. It is not the norm, certainly. But it can happen. Or, what if you have the epidural, and you are one of those ladies it doesn't work for, or it's all weird and makes you feel numb everywhere except for a two inch patch of excruciating pain in one little area on one side of your belly? What if you planned and epidural and you give birth too fast to get one? You can begin to see where having skipped the chapters on pain coping techniques in your books or caught up with text messaging during that part of your childbirth education class might not have been the smartest of ideas.

If you are going to plan an epidural, that's fine. But always prepare for natural birth too, because you never know. The last thing you want is to be faced with pain you never expected or prepared for because you decided to give all your power and jurisdiction over your sensations to an external source. Give over all your power, and the potential for birth trauma here is enormous. Do yourself a favour and get some tools to help you cope.

Conversely, what if you're planning a natural birth, you've done all the preparing and totally believe in yourself, that you can do it and everything feels like it's going to be great...but it doesn't end up this way? This is not a bad approach at all, and I believe very much in the power of positive thinking and visualization, trusting that the bodies who made these babies know how, without a lot of instruction, to birth them normally. Childbirth preparation truly comes more from the work we do on the inside than reading a bunch of intellectual information. However, having an understanding of what might happen IF something comes up and you find yourself in a position needing to make some hard choices about things like pain relief or you end up having that Cesarean you NEVER expected would ever happen to you, is important.

I don't think it's a bad thing to at least skim the info on what goes on when things don't go the way you'd hoped. I know this sounds silly, but it bears keeping in mind: reading or talking about a Cesarean will not make it happen. As logical and rational as a culture we are, superstitions linger. One day I was talking to a group of OB residents about birth plans. You know what their number one reason for not liking them was (for this group, anyway)? They believed they "jinxed" labour, that if a woman commits her deepest wishes on paper, it basically evokes the wrath of the evil eye.

Deep down, I think a lot of people believe that if they read the chapter of their favourite birth book on Cesarean and invite that knowledge into their minds, it might "make" it happen, and it is better to be blissfully ignorant. Saying all the magic words and doing everything right goes a long way to co creating a wonderful experience, sure, but again, there are no guarantees. Having a basic understanding of what it might be like to switch plans is a resource, not a hex, and will lend well to the situation if it ever comes up. For example, "I'm lying on the operating table shaking as if I'm having convulsions..oh, phew, that's normal, I remember reading that...it seems hard to breathe, am I dying? No, wait, it's just the muscles that are a little numb, I actually can move air into my lungs...breathe, breathe, breathe, I will be meeting my baby soon." You can see how not having a little knowledge here about the Cesarean process could make this a more terrifying experience than it already is.

So PREPARE! The process of birth IS important to a woman's experience of motherhood, sexuality, feminine empowerment, all of that. This is what I'm all about. AND, it is unpredictable. It is so important, especially if birthing in a hospital, which, frankly, does tend to generate more need for intervention than you would expect, to prepare at least a little. AND, it is important to remember that the gold medal is the BABY, not the birth. All women get this somewhat patronizing message when faced with an intervention they didn't want, but there is truth to it. It is not uttered just to placate you into accepting something you never thought you'd want or need. It is the truth...absorb it, own it, breathe it...that you are amazing no matter what. You are noble and fierce for all the work you have done. This is not to say grief and disappointment are not warranted in a birth that didn't go the way you wanted. There is nothing selfish or unrealistic or stupid at all for having hoped and believed you could move mountains in labour. Normally you can. But sometimes it just doesn't work that way. We are not the only ones on the journey...sometimes the baby has his own ideas. It is vital to healing to emotionally process our births and it is important to recognize and deal with situations in which you felt less than empowered or honoured. But YOU are amazing. Dude, you had a BABY! No matter what, you are a hero

2) Manage your expectations. Preparing for natural birth is all about stretching...stretching your body, stretching your mind, stretching your heart to open to the magnificent love of and for a new being, and stretching your limitations. Expect it to be a challenge. Don't be cocky. Everything about you will open wide. When I get to the part of my prenatal meetings with my ladies where we talk about whether or not they're interested in birthing naturally, I often get the answer from well read, well informed women who are choosing to birth in a hospital, "I would like to do it as naturally as I can...but if it gets to be TOO much, then I'm open to taking an epidural." What this says to me is, "I have a secret wish to have a natural birth and reap all the amazing benefits for me and my baby as well as be like those tranced out women in the film Orgasmic Birth....but because this is unknown territory, I don't want to feel like I wimped out if they have to scrape me up off the floor in a quivering mess of pain induced insanity. I give myself permission to call time out to spare myself from entering into what I fear could be my worst nightmare."

There is also fear of judgement. "What if I share my precious dream of natural birth to the world, then I don't have it and everyone will say, 'ha ha, told you so!'?" We always feel like we need to qualify. Personally, if I stated I was intending to have a natural birth and resisted the temptation to give the pat disclaimer of "if everything goes well", but if it didn't happen and I got judged for it by certain people, well, I'd tell them to go jump in a lake and not associate with them anymore. A woman who's birth reality ends up not matching her expectations doesn't need judgement and messages like, "poor little woman, it was really cute for you to think you could do it...know now you're just like all those other people who yelled for their epidurals when the going got tough"..she needs SUPPORT.

Anyway, back to that "I want a natural birth but am open to an epidural if it gets to be too much" statement. I like to take this opportunity to ask women what "too much" means to them. Because quite honestly, there WILL be points where it is "too much". People rarely have natural births when they have a well padded "escape plan". If I were to say, "oh, sweetie, you'll be just fine. The pain isn't much. In fact, if you breath into point A while chanting phrase B, you shouldn't feel anything at all," I would be a liar and deceiver of the worst kind. Women may say, "why are you telling me it's going to be so hard? Won't that make me nervous and make it so, given that stress makes birth hurt more?" Ah, again with the superstition. I'm not personally so powerful that my words prenatally can make you hurt or not. If I tell you it's going to be hard, two things can happen..it ends up being hard and you are prepared with resources to cope with it, or you've expected it to be so long and hard that it sneaks up on you and we arrive at the hospital to find you're in way more advanced labour than you thought..woohoo (this happens frequently with my clients)! Don't ever think that if I DON'T tell you about the challenge it won't exist. Better to know.

Even those who never knew they were even pregnant and give birth birth after having thought they were just REALLY constipated feel a lot of pain. I don't buy that ignorance of pain is bliss in the case of birthing. But I do like to discuss how the pain can be transformed into power, and that it can be a total thrill ride.

When I ask ladies what "too much" means, they often don't know what to answer. I'm so curious to know what they think is going to happen to them. I ask them, "what are you afraid the sensations of birth are going to DO to you?" I get all kinds of interesting answers. Some say, "I'm afraid the pain is going to make me really mean to my husband or the staff, and they'll get mad at me." Interestingly, media paints the picture of women turning into these impossible hellions during labour, scratching their husbands' eyes out. My experience shows me that in normal birth, oxytocin tends to make women quite loving, trusting, and snuggly. Yeah, they're fierce too, but the ferocity is directed towards managing the energy of their sensations, not emotionally castrating their partners. There can be some irritation, but I rarely see a woman go rabid like Old Yellow. This is reassuring news for those who define themselves by their polite and good behaviour.

Others say, "I'm afraid I will lose control of myself." "What does that mean?" I ask. "What does being out of control look like to you?" What they usually mean is that they will be in such a state that they will lose all semblance of who they are. I tell them that they will change, yes, but they will still be themselves within that pain/endorphin haze, able to take in, process, and communicate what is needed in the moment. Yes, they may lose their modesty in front of strangers, find themselves nude with blood, amniotic fluid and mucus running down their legs, little rivulets of barf drooling from the corners of their mouths from time to time, and that they will be making uncontrollable noises they never thought they'd make. To some, this animalistic image is deeply disconcerting. But really, if you're willing even a little bit to go there, what you will find is freedom and even possibly a level of intimacy you never knew could exist with your partner and those in attendance. There is nothing more liberating than being in that space of pain and mess, looking up in your misery and finding eyes that meet yours in total acceptance of your experience, eyes that mirror back absolute approval and praise for what holy work you are doing, giving you energy, and even having those messes tended to with love and honour. You are safe, and everything is okay. You have "hit bottom" in terms of what our culture deems ladylike behaviour, but having gotten there and found strength in yourself and awe from your attendants, you have found your rawest nature, the one that gets you through to the end of the journey. You have found ultimate surrender in pushing away all cultural expectations of your femininity which believes having it all together is the sign of an accomplished woman; now you learn that where you find your truest power is not in keeping your shit together, but in letting it all go. Sometimes literally. What you have been afraid of all this time is becoming the birthing animal you actually are and have been programmed to be since your DNA decided to light up as "girl". You will come back...I promise. But you will come back having witnessed and activated a deep part of your Self that we are meant to bring to motherhood. You will come back feeling like you've been through a very important rite of passage. And so you have. It is a biological blueprint we fail to honour as a whole, and we must begin to work to reclaim it rather than do dumb things like have women birth in machines while a gaggle of pimply students oggles them with clip boards clutched in their hands, trying to figure out why women can't give birth properly anymore (duh).

We all read the birth books with the secret hope we will make it unscathed and maybe avoid that scary animal place. There is no chant or prayer to spare you from that. It is meant to be. Whether it is painful or not for you, you will go to that growly, trance-y place whether your expression of it is outward or more internalized. You will temporarily lose that intellect we cling so fiercely to and go into an incredibly dreamy place inside you...Labourland. It's the best place to fall in love from.

I dare you to make a commitment to natural birth without a disclaimer. We already know it. You will not have to go around wearing some scarlet letter if you don't reach your goal. Be willing. Be willing to get down and dirty, to open up your THANG, in every sense of the word. If you can't figure out how to "do" a hard contraction, yell your head off if you can't breathe through it. It's okay. What you can always choose to do is use the spaces between. Choose not to waste your in between times negotiating with yourself how much longer you're going to do it for, or how much more you can take. Sink down into what you will find is a deep, beautiful, profound space of rest and quiet. Trust that as the pain cranks up, so will your ability to cope. You will say "I CANNOT do it anymore" only to find three hours later you still are and are just fine. As I mentioned, you stretch in every way...your resources too. Be willing to ride the sensation even when it hurts, be willing to have those huge waves crash down over you, knocking you down. Be willing to get up again tearing at your clothing with your nails, bearing year chest and yelling, MORE! I CAN! Trust that strong contractions are GOOD contractions, and that each one brings you one step closer to meeting your baby...and in between, soften, soften...soften.

I will never candy coat labour pain to a woman. That is not love. That is disempowerment. I just talked to someone who used a method of pain "control" in labour. When I asked her if it worked, she said, "well, I DID feel pain at some points, so I guess we just can't get away from those cultural expectations...the idea of birthing pain is so imbedded in us that we'll always believe it's there even if it's not meant to hurt because it's natural." This broke my heart, because what these methods teach us is that if we do hurt, it's our fault, that the stain and stigma of normal pain must be attributed to the woman's failing the method, not the method failing the woman. I like to see the strong sensations as conducting the hormonal flow. It's a good thing. And perhaps the more we dive in, embrace it, open to it, accept it, work WITH it instead of against it and trust it, the less it may actually "hurt" us.

I remember with my first kid believing with all my heart birth would be the worst pain ever, that I'd probably go crazy, that it would be horrible, but that I just would do it. I'm a paddy ass, so I planned a homebirth to keep myself away from the drugs. I just went with it, saying, "one foot in front of the other, one contraction at a time". And when my midwife came into my room asking me if I felt pushy because I was making some convincing sounds and she found me fully dilated, I said, "What? I did it? Already?" Because even though the sensations were the fiercest, craziest, most mind blowing sensations that made me yell so loudly I thought I was gonna bust, it was never actually bad...if that makes sense. All I'm saying is, if I can do it, wimp that I am who cries when my tummy is upset, you can too.

3) Own your choices. . When it comes to normal labour, I think it's really important for women to own their choices. "I had the epidural because I just couldn't do it anymore" (at 4cm five hours in) is not the truest of statements. This is not to be mean, but I have a hard time with that. We're not victims of our normal labours. Culturally and mentally unprepared maybe. Our physiologies profoundly effected by our modern psychological and emotional landscape perhaps. But what does that mean, "I couldn't do it?" Well, yah, technically, you probably couldda. If you had been walking around in the middle of nowhere and labour came upon you and there was nowhere else to go, you'd just do it....with nobody telling you how. There would be no opportunity to say "I can't do it", you would have to. If this same labour comes upon you in modern civilization, "I can't do it" is what many women say when the crunch is on. Actually, when given the choice and available epidural, and admittedly the much more challenging birthing environment to labour in, the truer statement is "I don't want to do it." And you know what? That's perfectly okay. You are in no way, shape, or form expected to have a natural birth you don't want just because you think you should. If you didn't in the end want a natural birth when you got to active labour, it's important for the sake of your friends and daughters and women everywhere not to blame your labour for your personal choice. This desacrates the brilliance of your body, of the brilliance of the bodies of your Grandmothers. I'm not talking about situations such as inductions, or you're at 9cm for years, or you have a permacontraction that doesn't let up,or hideous back labour, or you have a PTSD reaction to a trigger, or the staff is so challenged by your coping methods that they simply drive you to distraction so you lose your mojo, or it's really long and you're truly exhausted, or there's some kind of problem, or your in laws refuse to stop wandering in and out of the room causing a case of family dystocia...these scenarios are more about survival than personal choice. I'm just talking about regular labour you decided wasn't your thing.

I feel so sad that many women think they need to apologize for their choices for pain relief and perhaps even cover up unneccessary shame by trying to convince themselves and others that their bodies were lemons for not birthing "properly" when in fact there was no problem. Maybe it means they felt they failed themselves and didn't feel as strong as their friends who had natural births. It's not a competition. Or maybe, they just really don't know what normal labour means, which is kind of a societal failure. Shouldn't girls be taught this in detail from a young age instead of know more about what celebrity was "too posh to push"? Though this choice may often be made without the correct information on benefits vs. risks of elective Cesarean and is not one I'll ever feel good about as a doula, claiming to be too posh to push is at least really honest, and the choice is totally owned with emphasis on the woman's desires for her Cesarean rather than blame on the probable birthing excellence of her body. There are very sad and misguided aspects to this choice, for sure, and it does create collective harm definitely, but at least there is no blaming or creating victimization to justify a choice.

You know, there are other ways women can experience surrender and raw power. It doesn't HAVE to be in the realm of childbirth. It's not "for" everyone. I have seen a few incredibly beautiful births, which were intensely empowering, with women whose mandate it was, for personal reasons, to feel NO pain in labour. I learned a lot from these births, and came to an honest place of honour for these women, not just paid them a lip service because I have to be diplomatic as a doula. While I may not personally agree with some choices, meaning I wouldn't choose them myself, I can totally appreciate an informed choice and ownership for that choice. Personally, if my labours felt like intense nausea instead of the way they did, I'd probably be strutting around saying, "Yeah, I had them knock me unconscious the minute I felt sick. I was simply not interested in going there. There are no benefits to my feeling that way in any circumstance in or for anybody in my life. Wanna make something of it?" Well, no, I'd probably just deal with it anyway because I believe so strongly in the benefits of natural birth. I would do my very best to heal my issues surrounding nausea. But if I did in the end make the choice to end the discomfort, I wouldn't make any apologies for myself. It is what it is.