I was chatting with another doula today about VBACs and CBACs. There are so many factors to a woman who has had a previous cesarean to getting a vaginal birth the next time. Factors include the choice of care provider, the reason for her first cesarean (I do believe most of my clients have either had failed inductions- ie- their baby was not ready to be born and was being forced out, or had impatient care providers), the team she has with her and how deeply they believe in her ability to have this vaginal birth, and the preparation she puts into this birth being a different outcome.
She called me the “Statistics Queen” when I shared that I think in the 75 women who have taken our BOLD/Fear to Freedom Method Childbirth class, we had 2 or 3 primary cesareans and I think maybe 1 cbac in our whole group. And we have a lot of VBAC moms attend our weekends. Now I am not going to say it was just our class- that would be too BOLD for sure to make that statement. But I do think that they were more careful about those factors I mentioned earlier. And I do think that the type of preparation we offer is so different, that women really process their fears and the baggage we could all take to our births.
Sometimes there are hidden fears deep inside of us that do not come out until someone or we ourselves probe deeply to find them- to bring them to the surface and process them. If they are not brought to the surface, then they are likely to come out during labor and inhibit a woman from being able to release and open up to giving birth. That is why when I hear a mom who had a previous cesarean tell me she took classes before and does not need to do so again, I cringe.
All classes are not equal. Some classes teach you how to be a compliant patient and others are great at conveying information and even allowing some hidden concerns to come out. But you need to have more than those concerns and fears revealed, you need to have to have tools to process them and tools to develop a plan to resolve them.
I went through my most current stats spreadsheet when I started being even more detailed- since 2009, 116 births later, I have had 18 women attempt a VBAC- vaginal birth after a previous cesarean. Of those 18, 16 went on to have vaginal births. What has made the most difference in helping women get those vaginal births- choosing wisely where they are birthing and who they are birthing with- but yes I do think the way I help them process things does make a difference. And those factors keep those primary cesareans reduced as well. I have an 87% vaginal birth rate- that means a 13% cesarean rate overall in my 600 births. 10% is optimal per the World Health Organization. And keep in mind our area has more like a 40% rate in our metro area at the larger, busier hospitals.
So make sure you really do the work prior to your labor so you improve your chances to have the birth you desire.
If you were going to build a house and only had a saw, you would be in bad shape. Thus the reason why a childbirth method that puts all your pain coping skills in one basket may not serve you well. Our recommendation is to have a lot of tools in your tool box. In our comprehensive childbirth classes it will not be unusual to leave with three dozen or so ideas for helping manage pain in pregnancy, labor and birth. I would want the construction team building my house to have a lot of tools. We want you to as well.
But are too many tools dangerous? I was at a labor recently where the mom in labor had a tribe of friends. They wanted to assist her so badly they were offering her things she did not seem to need at times. She loved the support and hands on, but we prefer to use a tool when it is actually needed and called for. The best advice my first childbirth educator, when I was pregnant decades ago told me after teaching me a ton of tools, was to not use them until they were needed. Otherwise by using them randomly and without real purpose, they can lose their effectiveness. They can also mislead the mom into thinking they will not work later if she did not find them effective early on.
And how about the doula’s tool box? Sometimes I use very few things in my birth bag. I almost always use lotion, my rebozo, some peppermint essential oil and of course my hands. But I have a lot of things in my bag that rarely get pulled out to be used. I have heard it said that if you have a full toolbox as a birth professional you are tempted to use things that are not needed. What does this mean? For instance if someone has been trained in fetal monitoring but you are using a skilled birth professional, your doula should not be using this skill unless she is an assistant to a midwife. And things like neonatal resuscitation skills, vaginal exams, and other medical procedures are not within the scope of a doula. But skills like acupressure, reflexology, essential oils, massage therapy, aromatherapy and similar skills could come in handy and if she is properly trained could be very resourceful.
And how about your care provider’s tool box? If you need a great surgeon, you want him or her to have excellent surgical skills. But if you want a non interventive birth, have you considered asking your provider how they plan to help you achieve that? Tools like patience and belief in birth are essential. If 95% of their moms end up with an epidural, why do you expect they will not recommend that to you? If 40% of their moms end up with an induction, do you think you can dodge that bullet? If breaking your water is their go to tool for getting your laboring moving, perhaps you should ask a few more questions about the risk to that procedure. If they are asking you what you desire instead of sharing their agenda for how your birth should go, they may indeed have the right tools for you. But if their cesarean rate is the local average of over 35%, you may want to change providers.
So pack your tool box full of pain coping skills and hire a doula who has the correct tools packed for the skills that are within her scope.
What does this mean to you? Fortitude means ” courage in pain or adversity.” Synonyms are courage, bravery, endurance and resilience. So in order to have fortitude of spirit it means you do not lose hope in the midst of the pain or struggle.
For me as a doula one of my jobs is to help women find their fortitude. It does not mean she is unable to make decisions that are right for her- although perhaps not what she planned or desired, but to persevere regardless. It means facing her fears before labor ever begins. It means listening to her intuitive spirit early on in her life but especially in the pregnancy.
For me personally it means moving forward with strength that I am unsure where the origin of that strength can be found at the time. I can affirm that my God is with me giving me strength and that encourages me. I can remind myself of those things I have come through in my life- death of mom, dad and sister, cancer surgery with complications, etc… but it means having to put myself back out there again and again, trusting.
And that is the key to me…trust. I trust birth. That is why I believe a woman can birth without a lot of interventions and pain medications. I also trust that medications usually are safe if they are needed. You do need to note I said usually. I do think more women could birth normally and naturally if they had been raised with the idea of birth being normal and natural and to trust their bodies. I am deeply sadden that we propagate more fear in women when they are pregnant than any other time.
I trust I do not stand alone. I have a force within me that is stronger than the forces outside of me. I also have some wonderful support from those around me who love me and trust me. I do think more women would birth normally and naturally if they had proper support. When their family and friends scoff at the idea of natural birth, it is hard to move forward with that trust. That is why women benefit from having a doula along side of them.
I do believe we need to encourage women daily from the time they are little girls to have fortitude of spirit. It is something we encourage in boys but not in girls. We need to teach women to not be afraid of birth from a very young age. It will change birth for them. And birth can change a woman forever.
What are you doing to instill courage and fortitude in yourself and others?
We teach several things in our classes regarding voice. But sometimes it is not the spoken that will derail you, but the heard and unspoken.
I ask couples to hold their hand up in a stop sign and repeat after me, “My childbirth educator said that if what you are about to say is not positive and affirming, I can not listen to it.” It keeps all those naysayers shut up. In fact if you have naysayers around you, I would shake them loose now. They are definitely not the ones you want to discuss your birth plans with or invite to be with you in your labor.
We teach women to create a mantra that will guide them in their pregnancy, labor and birth. It is best if the mantra is simple and perhaps can fit rhythm wise to your fingers. It needs to come from your soul. It needs to be a phrase that will guide you. For me, my mantra has been, “The warrior within me emerges and she knows just what to do.” It has been my guide for over a decade.
We encourage women to create a vision and within that vision to think of words each day that exemplify that vision. These affirming words help to plant a deep seed within her. These affirmations will speak to her mind and body. Those seeds will flourish and produce a lot of strength in labor and birth. The women who focus the time on these affirmations will be amazed at how these words form a song within them during the hard parts of labor.
This week I sat with a couple who had a long labor and birth. It began with her water breaking and after twelve hours she had to come into the hospital due to her GBS status. She was slowly induced over the night. And then she had a full day or work ahead of her before getting an epidural in the last few hours before she birthed with the help of a vacuum. She and her partner used the word traumatic to describe their births to others. The mom was also counting all of the hours from when her water broke as her labor length. It was like a fish story, it kept getting more traumatic the more she added to it. When we sat and talked about her labor and she saw the actual timeline of her labor, her feelings softened a bit. She wants more children and wanted to begin her preparation mentally and emotionally to make that happen.
What we hear, listening to the naysayers… when we do not address our deepest dreams daily and tell our body what we want… when we fill our minds with negative fears instead of positive affirmations… and when we allow our words to grow bigger like a fish story, we set ourselves up for even more baggage at our next birth. Be careful, your body is listening.
When we say something over and over in our minds and even with our voices, our body begins to believe it. It begins to take it on as truth and fully embrace the words as truth. Be careful what you are telling your body and mind. Tell it what you want it to do and become- it is listening. I find that women who prepare their mind for labor and birth in a positive way, often find that positiveness carries them through many a storm if it arises.
I love this article on Intact Perineums by Gloria Lemay… it is fabulous!
I don’t usually just post a blog article by linking another- but oh my – just such wonderful information!
My observations over 594 births is just this- and you will find I agree so totally with Lemay.
Perineal massage during pushing usually causes the tissue to abrade and swell. I usually have to turn away as the doctor says he is helping her to not tear. I have thought, “crap!, I don’t see it!”
I have been teaching for years that if you keep your hand on your own perineum you will not only protect that space, but you will feel immediately reaffirmed when you feel the bulge of the baby’s head. Why is it that women are afraid to put their own hand on the perineum? I think it goes back to the MontyPython Meaning of Life- they have come to believe that they do not know how to birth a baby without someone helping her!
I beg women to get to know their vaginas and how they stretch long before the labor begins. The exercises of allowing your breath to stretch a bit further helps a woman have confidence in her body’s ability to stretch without tearing.
I love in Gloria’s article when she talks about how quiet it needs to be when a mom is pushing. There should not be any yelling or counting to ten- that is one of the most ridiculous actions I have witnessed in labor and births. I think women need to resist the urge to blast her baby out- but instead eases the baby out gently. It makes all the difference in the birth experience and the healing afterwards.
So, read this article- shoot- print it out and make your partner read it- share it with your midwife… read it over and over. Thanks Gloria for the work you do!
I have had clients who when I share how fabulous making love is in pregnancy for preparing the womans’ body for birth, look at me like I have lost my mind. So, I thought I would share some information that may encourage you to have more sex!
Occasionally a woman tells me she no longer feels sexy when she begins to fully blossom into her pregnant body. This is often also true postnatally. So this lack of feeling sexy causes her to think her partner feels the same way. But when it is discussed, often the partner says the exact opposite. The partner talks about the curves, her round bottom and her full breasts as very erotic.
Although libido changes can occur during pregnancy with hormone fluctuations, sometimes a woman will actually have increased libido during pregnancy. This often causes the partner to be shocked. But with some pregnant women the sex drive diminishes. This is an opportunity to learn some wonderful foreplay techniques that can often to lead to orgasm without penetration. This is certainly one of the options a couple may find works for them.
Occasionally a male partner tells me he is concerned about hurting the baby. Or he may be shocked when the baby moves during sex and this throws him off his game immediately. When understanding the anatomy of a woman, you will see the idea of harming the baby by penetration would be difficult to do. But there are some positions that limit the level of penetration that may be more comfortable such as spooning.
Why am I a big fan of sex for pregnant couples? Well, there are multiple reasons:
- First, it increases the intimacy of the couple. This intimacy is so essential for the labor and birth. A couple who feel more connected work better together during the labor.
- Second, it allows for orgasms which not only are fun, but give you a boost of oxytocin which will help in getting ready for labor.
- Third, the semen is full of prostaglandins which help to ripen the cervix and get it ready for labor to begin.
- Fourth, celibacy during the postnatal period is not fun for your partner, so being celibate ahead of time is extra frustrating.
So, please realize that unless you have an issue like preterm labor or placenta previa, and are in good health otherwise…. have sex! Talk it over, find time to have time for each other in this special way, realize this intimacy helps build your relationship and prepare for this new baby.
But don’t just listen to me- here are some more links with suggestions for positions and answers to more questions you may have.
Baby Center Pregnancy Modern Ghana Doctissimo And even a few movies to watch Empower Her to watch kama sutra yoga for pregnancy, Parents and The Bump!
Rebecca Gay and Teresa Howard were able to attend a six hour workshop by Nicholas Olow, an acupuncturist from San Diego who specializes in working with pregnant, laboring and new moms. A dozen doulas and several midwives in the metro area were able to attend this wonderful offering as well.
What if I told you acupuncture could do help you prenatally with:
- morning sickness
- low back pain/ sciatica
- carpal tunnel syndrome
- pelvic pain
- anxiety and depression
- babies who are small for gestational age
- breech babies
- malpositioned babies
And we were taught how to use acupressure to help with nausea and vomiting. We learned how to help with low back pain and even hemorrhoids. We were encouraged to share how to do these techniques work with the pregnant mom’s partner so they can help her daily if needed.
We learned how to help re-establish contractions during labor. We were taught how to help a baby move down into the pelvis during labor. We learned how to help a cervix dilate faster- which helps a woman not be diagnosed failure to progress! And of course we learned how to help with generalized pain in labor, especially with lower back pain/sciatica. And those are the physical things. We learned how to help a mom be less stressed and have less anxiety. And to top it all off, we learned how to help with malpositioned babies- specifically occipital posterior and asynclitic babies.
Now you may think gee, isn’t that enough- but no! Nick taught us how to help a mom during the postpartum period. He showed us techniques to help a mom with uterine contractions that are caused when initially breastfeeding as the baby is helping to get the uterus to shrink down, after birth pains. And you know that perineal discomfort? We have techniques to help with that- and it does not mean touching you in a personal spot! And even postpartum depression and baby blues can be assisted with acupressure. And to top it all off we learned how to help a mom during breastfeeding- with difficulty with let down, low milk supply and engorgement. And if you have hemorrhoid issues and low back pain can be assisted with the techniques we learned.
Can you say, whew? We have lots of handouts so we can practice and Rebecca and I plan to share the wealth of information with our doula sisters in our group. And we hope they will attend the next workshop when we get Nick to return. We feel it is essential and important to continue our education toward becoming even better doulas. We want to thank Debbie Schneider, a wonderful homebirth midwife, for bringing Nick to town to teach us this wealth of information!
Sometimes folks share their birth stories with me. Sometimes births occur within our group where there is a lesson to be learned. I hope to share some things with couples preparing for their births that will help them understand how to really prepare.
You can choose the perfect location for your birth… choose a fabulous midwife…. choose a wonderfully supportive doula…. take informative classes…. but things will not go well none the less. It is important to consider a few things:
- Location is one piece of the gentle birth pie. If you choose the wonderful hospital that offers supportive staff and even water birth but you choose a care provider who does not offer that- guess what? You will not be having the births you read about from your friends about that location- you chose the wrong provider – one who does not support water birth!
- A fabulous midwife is a huge piece of the pie. But if you are not honest and open with her about your concerns and she for some reason does not hear you if you do- is she listening or are you not really opening sharing? You must convey clearly what you desire to have her be able to help you achieve your desires. Communication is key. If you do not feel you can communicate before you are in labor- don’t think that that will change in the midst of the labor!
- A supportive doula is a great idea. But does your doula know the facility you are birthing at well? Is she an experienced doula who takes this role seriously? Do you feel a connection with her that builds trust and allows you to be vulnerable? Is she available for you to talk to when you need to do so? If she offers her expertise, will you listen to her?
- If you can not afford a good class- look at your budget again- ask for classes as a gift- find a way. Carve away some expenses that are extraneous- make it happen. And if you do take classes- please practice and work on making the lessons become part of your daily activity so you will be able to use them in labor with ease. And if you can not find the money- then go to the library and check out some good books- we offer a list here in our store. And if you can take 30 minutes a day to read this blog, that will help you a lot in your preparation.
Preparation is the key.
These are some of the things I hear that make me cringe:
- “I knew my doctor was not supportive, but felt it was too late to change.” It is not too late!
- “I am hiring a doula but don’t have the money to take classes too.” That is like taking a cooking instructor to a cooking contest and expecting her to teach you while you compete!
- “I took a ton of classes but just don’t have time to review the material or do the exercises.” You just wasted your time and money.
- “I can always change this at my next birth.” Really, you will have more time and money when you have a toddler at home? And recovering from a difficult birth and healing enough emotionally and physically in order to birth again, is not so easy for some.
- “My doctor does not listen to me or have time for my questions. But he is quite busy.” No he is quite disinterested in what is important to you.
Please prioritize the things that can really make or break your birth experience.
I wrote an article regarding pebbles representing skills for doulas. I think this analogy works well for couples preparing for birth as well. Let me see if I can explain.
There is a basket of pain coping skills and mindset ideas for you to consider for your birth preparation. And as you engage these skills, gain knowledge of new concepts and ideas and practice them, you move the pebbles from the basket and put them into your jar. For example, my daughters, Julie and Jami, they grew up around birth being talked about on a regular basis- you know- “your body is meant to do this.” you are capable and strong women.” “natural birth is what our bodies were meant to do…” You get the drift. And they had an example- me! So they already had quite a few pebbles toward their birth preparation before they had even begun.
Then Julie took prenatal yoga classes. This added several pebbles to her jar. She really knew her body well having been an athlete but this engaged her body and her mind in preparation for her births. Jami reads a ton of books and so she devoured books that helped reinforce the belief in her body and her birth process. Clink- this added more pebbles to her jar. They both took childbirth classes that offered numerous pain coping techniques- not just one approach but many. This filled their jar even more. They had great prenatal care, exercise, etc.
So when I hear about a birth that did not unfold the way the woman desired I ask a few questions. And besides the location and the provider she chose, one of the biggest ones is what childbirth preparation she did. Often times I hear that she did not take classes. She meant to…. but time got away. She wanted to…. but finances were tight. She desired it… but her partner was not supportive. Or she took a class online- or watched videos only- or listened to tapes… hmmm. I have never been a fan of classes that did not offer a lot of interaction and time to process and then follow up with questions. Nor have I been a fan of only having one tool in your toolbox for labor as some techniques rely heavily on one tool.
Now will you use every tool you learn if you take a comprehensive approach to your childbirth preparation? No. You may only use a few- but the practice and preparation has done a lot of the work before your labor even began. There is a study that shows the number one thing that helped women have a natural birth was confidence. Confidence is built by flexing your muscles along the way and learning things you did not know that helps you begin to believe in your body and your birth process. So the pebbles you will need to take out and use may vary depending on your labor- but having them handy is valuable.
So consider preparation a way to fill up your jar with pebbles that may be useful as a laboring and birthing couple- but also as a person in general. Many of the tools you learn in our classes help prepare you for parenting and for your life in general. Preparation is not wasted and should not lack the priority that it should have.