A Gentle Birth Pie

I wrote this initially in 2013 but feel it needs to be back at the top of our blog. So often folks come to our Mingles to meet us and say that they want to avoid a cesarean. Yet they are choosing a hospital where the cesarean rate is over 40%. They do not plan to take classes or they plan for a hospital based class or a one day abbreviated one. Please realize that today with the high levels of intervention, you have to do a lot of things to avoid the interventions that lead you to the OR. There are lots of ingredients that go into making a gentle birth pie:

  1. Provider
    1. Your gynecologist may not be the best one for your pregnancy care- well woman care vs pregnancy and birth care
    2. Communication goes both ways- can you discuss things and be heard and feel listened to now?
    3. Back up is important- who covers what- do they share call- will you get to meet them beforehand?
    4. Midwifery model vs the medical model of care=What do most women choose? Obstetricians are by far the most common choice in the United States, although certified nurse-midwives are becoming more popular: In 2006, CNMs attended almost 8 percent of deliveries in the United States and over 11 percent of vaginal births. provide handout
    5. CIMS questions to ask
    6. Marriage – then date- can lead to divorce- when is it too late? Don’t stay where the rules of the games are different than the game you want to play.

“Midwives see birth as a miracle and only mess with it if there’s a problem; doctors see birth as a problem and if they don’t mess with it, it’s a miracle!” Barbara Harper in Gentle Birth Choices

“Unfortunately, the role of obstetrics has never been to help women give birth. There is a big difference between the medical discipline we call “obstetrics’ and something completely different, the art of midwifery. If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving back childbirth to women. And imagine the future if surgical teams were at the service of the midwives and the women instead of controlling them.” Michel Odent, MD

“When meeting with my OB, I described—in a light way—the feeling I had about the baby telling me he was coming out vaginally. Unfortunately, this kind of thing does not provide confidence to everyone in the medical community! And much to my dismay, they wanted to schedule me for a C-Section, just like that. Thankfully, at least one very important local midwife did believe me and believe in me (and my baby). She encouraged me to do what I needed and go where I needed to get my try at a VBAC. “– Jenna’s story

“Switching practices mid-pregnancy was perhaps the best decision we have made. Last week I was so fed up with being pregnant that I just about begged her to induce me. Had I stayed with my old practice, they would have scheduled a date right then. But not Janet. She just calmly reminded me that no one stays pregnant forever and that my baby would come when she was ready. She talked through natural things we could do to help get labor started and walked us through what would happen if she doesn’t come by 41 weeks.

As we left her office I turned to D and said, “We picked her for a reason. I don’t really want to be induced. But I was desperate. And instead of letting me cave to my uncomfortableness, she talked me out of it. Gently. I’m thankful for that.” She has been a rock for me during the last half of my pregnancy. I’d recommend her to anyone. {This is Janet Fedullo with Alpharetta Women’s Specialists}”- Chrystal Rowe from the blog

  1. Location
    1. Sometimes a drive is only a drive- will it be worth it in the end?
    2. The most options give you the most choices- ask for what you want – keep asking- sometimes they are willing to offer you something that is not on the menu ordinarily
    3. Where do you feel safe and secure- home is not the right place for everyone- just like your hospital may not be the right place for you
    4. What type of things are most important- discharge time, nursery care, pediatrician coverage, mother baby friendly, lactation help, water birth, laboring in tub, telemetry, nicu level, etc

The distance between the hospital on the north side of atlanta with the 40+ cesarean rate vs driving less than 13 miles away from a hospital that offers water birth and true midwifery care.

“Every [hospital] intervention is a lesson in who really owns your body and your baby’s body.” Jock Doubleday

Why is choosing a place of birth one of the most important maternity decisions I will make? Early in your pregnancy, when you are deciding about your maternity caregiver, it is also important to make a thoughtful decision about where you plan to give birth, or your place of birth. These major decisions can influence:

• the care that you receive and the effects of that care

• the quality of your relationship with your main and other caregivers

• the amount of information you receive

• the choices & options you will have, particularly during your labor & birth

• the degree to which you are involved with decisions about your care.

If you are a well and healthy childbearing woman (as are most pregnant women in the U.S.), you can consider giving birth in a hospital, an out-of-hospital birth center, or in your home. This link from Childbirth Connection entitled Your Options for Choosing a Place of Birth will help you learn about these three choices, and learn about differences that you may find from hospital to hospital or birth center to birth center. This and other pages in this section can help you find the birth setting that is right for you.

It may take some time and energy to find the right place of birth and caregiver. These important decisions are well worth the effort.

How is my choice of a place of birth related to my choice of caregiver?

Places of birth and caregivers usually go hand in hand. As you explore your different options, you will want to decide on a place of birth that has caregivers that will meet your needs – in pregnancy, during labor and birth, and after birth.

For example, if you decide to give birth in a hospital, you must choose as your caregiver a physician or, if available, a midwife who practices there. Most caregivers who work in out-of-hospital birth centers or who offer home birth services are midwives, and physicians occasionally attend births in these places of birth. When choosing a place of birth, it is also important to think about choosing a caregiver that is right for you.

What are important considerations when choosing a place of birth?

The following are signs of an excellent choice of a place of birth:

• place of birth offers care that is consistent with the best available research about safe and effective care

• the environment and practices in the birth setting enhance, rather than disrupt, the physiology of pregnancy and birth – your body is finely tuned to do this work; some things support this work, while others interfere with it

• the birth setting staff are committed and able to provide you with lots of support, including comfort and information

• the place of birth offers individualized care that considers the health needs of you and your baby and your personal preferences and values.

What are some insufficient reasons for choosing a place of birth?

It is not wise to select a place of birth solely because:

• it is near your home or workplace – convenience is nice, but you may need to travel further to find the right setting

• you know someone who used that place of birth – even if recommended by a friend or relative, you need to be sure that a place of birth will meet your needs and values and reflects the best available research

• your family has used a particular hospital for other types of care – you need to learn about a hospital’s maternity policies and practices, and about other maternity care options, before making your decision.

How do types of places of birth differ from one another?

In making your decision, keep in mind that places of birth can vary in important ways:

• philosophy of birth

• style of practice within the place of birth – this includes the amount of time caregivers spend with you, the amount of information you receive, your involvement in decision-making, and patterns of using interventions

• caregivers – a limited number of caregivers practice in any one place of birth

• whether specific places of birth are an option in your area – an out-of-hospital birth center or caregivers offering home birth services may not be available in some areas

• whether your insurance will cover the services of a particular setting.

What if I change my mind and want to switch to another place of birth?

As time goes on, you will learn more about your needs and about the place of birth and caregiver that you have chosen.

If you have concerns and have not been able to resolve them through open and respectful communication, you may begin to wonder if you have made the right choice(s). Do not hesitate to explore other options. Even if it is late in your pregnancy, you can switch if:

• you have enough time to explore options and find a situation that you believe will work better for you

• the new place of birth or caregiver has no policies that prevent you from making this change at that time in your pregnancy

• your insurance will cover the new arrangements, or you are willing and able to pay out of pocket.

You may have to change your place of birth and/or caregiver to get what you want. From Childbirth Connection

  1. Childbirth Preparation
    1. The more tools in your tool box the better- attend a class that is taught in the time frame you need- not a weekend if you need to absorb longer- etc, also take a class that offers more than one method of pain coping- you want to  have a lot to choose from that you may utlize.
    2. How do you learn best- classes need to offer lecture, hands on, reading, video- lots of ways to learn. Consider when you may want to take the class time frame wise too- early to mid-pregnancy vs late pregnancy.
    3. Exercise classes, mental – mind body connection classes, couple classes and women only classes
    4. Good compliant patient or informed consumer, who are you paying for the classes- who controls what is being said? Are there handouts for you to learn at home and review later?
    5. Practice makes perfect- Olympic athletes don’t just show up in uniform- can’t give birth in awareness if they are not living in awareness on a daily basis.

“The truth for women living in a modern world is that they must take increasing responsibility for the skills they bring into birth if they want their birth to be natural. Making choices of where and with whom to birth is not the same as bringing knowledge and skills into your birth regardless of where and with whom you birth.” Common Knowledge Trust

“You are constructing your own reality with the choices you make…or don’t make. If you really want a healthy pregnancy and joyful birth, and you truly understand that you are the one in control, then you must examine what you have or haven’t done so far to create the outcome you want.” Kim Wildner-Mother’s Intention: How Belief Shapes Birth

“Mothers need to know that their care and their choices won’t be compromised by birth politics.” Jennifer Rosenberg

“We did a lot of research about childbirth education. Once we decided on a class, I did more research on the educators themselves. We picked a class based not only on the content and the schedule, but the person who taught it. And we made an incredible choice. She equipped us not only with techniques, but with confidence and strength. She made an effort to get to know us as well as our parents. As we sit through the final days of our pregnancy, her voice rings in my head over and over again.I can do this. I was made for this. I am a strong warrior woman. {her instructor was Guina Bixler with A Labor of Love Doula and Childbirth Services, Inc.}” Chrystal Rowe from the blog

Why should I take childbirth classes?

Whether you’re delivering your first child or fifth, childbirth classes can help you prepare to meet the challenges of labor and delivery. Consider the opportunities:

  • Learn things you never knew about labor, delivery and postpartum care. You’ll find out how to identify the signs of labor and what happens to your body as your baby makes his or her way into the world.
  • Address your fears. During childbirth classes, you’ll have the chance to talk about your fears with other women who probably share the same concerns. The instructor can dispel myths and help put your mind at ease.
  • Connect with your partner or labor coach. Childbirth classes offer your partner or labor coach the chance to understand childbirth, too — as well as how to support you during labor.
  • Discuss options for handling pain. You’ll practice various methods for coping with contractions, such as breathing techniques, relaxation and visualization. Most classes also cover the pros and cons of common medications, such as narcotic analgesics and epidural blocks.
  • Get the basics on medical interventions and possible complications. Find out how routine interventions can influence the course of labor.
  • Check out the facility. You might tour the facility where you’ll give birth and find out about its policies and resources.
  • Brush up on newborn care. In addition to labor and delivery, you’ll likely get a primer on newborns. Common topics include choosing a pediatrician, breast-feeding, diapering and bathing.
  • Create a social network. Meet other pregnant women and listen to their experiences. – Mayo Clinic

  1. Support
    1. Michel Odont’s article about partners- read this article  . Partner’s used to have to have a coach card- if we give women freedom in labor why not offer the same to the partner
    2. Doulas- Doula is a woman who helps women and their families through labor and birth. Here are some of the statistical changes in a birth that a doula makes. Benefits of having a trained Labor Doula:
  • 50% reduction in the cesarean rate
  • 25% shorter labor
  • 60% reduction in epidural requests
  • 40% reduction in oxytocin use
  • 30% reduction in analgesia use
  • 40% reduction in forceps delivery

“If a doula were a drug, it would be unethical not to use it.” John H. Kennell, MD

  1. Friends and family– audience or support- same tribe or skeptics?

Ina May Gaskin, “Basically, if you can’t poop and have a whole group of people watching, it might be a little difficult to have a baby in that same kind of atmosphere.”

  1. Guarding your heart and what you listen to-  Baby Story is not your friend.  Listen to what is helpful and step away from that which corrupts and grows fear… don’t listen to the horror stories

“Treating normal labors as though they were complicated can become a self-fulfilling prophecy.” Rooks

I would never want to labor without a Labor of Love doula! It was such a wonderful experience, and worth every single cent we paid for it. Melody Lee

Charlotte Sanchez- As a Professional Midwife and past Birthing Mother: ” I strongly feel all birthing moms need a mothering support during labor, a Doula! Please contact Labor of Love Doula and Childbirth Services Today!”

  1. Mind Body connection
    1. Address your fears and decide how to deal with them- taming the tiger. If you do not speak it does it make it not rumble around in your heart? If you dream it are you setting yourself up for failure?
    2. Listening to the intuitive voice- right brain/left brain- engaging the right brain
    3. Staying fit is not just about your body- spending time every day exercising a bit, bonding with your baby and connecting with your body- FEAR to FREEDOM Birth Fitness Routine: Preparing to give birth requires a pregnant mom make a commitment to herself. Comfort measures for labor and delivery like soft music and massage are nice, but ultimately the supreme comfort measure is the pregnant mom. The FEAR to FREEDOM class has a Birth Fitness Routine is ideally practiced every day at home until labor begins.

“When you have come to the edge of all the light you know and are about to step off into the darkness of the unknown, faith is knowing that one of two things will happen: there will be something solid to stand on or you will be taught how to fly.” Patrick Overter

‎”In order to change the culture of birth, we have to connect women to their own power” Karen Brody

“When I dare to be powerful, to use my strength in service of my vision, then it becomes less and less important whether I am afraid”  “When we speak we are afraid our words will not be heard or welcomed. But when we are silent we are still afraid. So it is better to speak. “Audre Lorde

“What happens next feels beyond words: I have this overwhelming thought-feeling that this baby is going to come out on his own. I instantly sit up and say, “Honey, this baby is going to come out.” Matt, unaware of my reverie, just laughs at the totally-out-of-context-comment and says, “Well I hope the baby stays in a bit longer, because we just got pregnant!” I laugh—he always makes me laugh—and reply, “Good one, but, I mean it. This baby is coming out this time. I am sure of it.” Jenna

“Remember this, for it is as true and true gets: Your body is not a lemon. You are not a machine. The Creator is not a careless mechanic. Human female bodies have the same potential to give birth well as aardvarks, lions, rhinoceri, elephants, moose, and water buffalo. Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.” ~ Ina May’s Guide to Childbirth

Skipping an ingredient is like baking a cake and leaving out the flour or eggs. You may get something in the end- it may even be able to be eaten- but it will not be what you were hoping for. Don’t skip a vital piece of the pie in your planning for a gentle birth.