It's Yours

I drank too much coffee today and now I am unable to sleep and thinking about...empowered birth. One thing that I believe is not talked about enough in the birth community is the parent's responsibility in their birth experience. And I get why it's not talked about... it could easily be taken the wrong way by mommies who had a bad experience. That is the furthest thing from my mind and intentions with this post. I never, ever want moms to feel guilty and blame themselves for a bad birth experience. 

That being said, responsibility is a HUGE part of an empowered birth. I think as women, especially in America, we are raised to blindly trust doctors and not question them. Unfortunately, this trust is not always warranted. Not to say that there aren't fabulous, amazing doctors out there. There are. And not to say that this lack of trustworthiness is always the doctor's fault, it's not. Some of it is a product of the bureaucratic system in which our medical system operates. There are so many lawsuits, with protocols to follow along after them to prevent more lawsuits. There are insurance companies that force doctors to play by their rules, or else. In general, it is a system which needs a lot of fixing.

Which is why women have to be more vigilant than ever when it comes to their pregnancies, births, and babies. Mamas, your body belongs to YOU. Your baby belongs to YOU. Your birth belongs to YOU. Not your doctor, not the nurses on call when you go into labor, not your doula or your friend or your sister. YOU. You (along with your partner) are the ONLY one(s) qualified to make decisions for yourself and your baby. You are the only one who should be making the choices in childbirth that you will remember forever. Yes, your doctor may be more educated in matters of the uterus and what to do in true medical emergencies. But that does not mean that you have to be uneducated. In fact, I have heard of moms who knew more about birth matters than their doctor! (One friend had to educate her doctor about delayed cord clamping... he had never heard of it before!)

Research. Research. Research some more. Don't take your friend's word for it that birth is awful and you are crazy to go without an epidural. Don't take your doctor's word for it that you HAVE to be induced at 41 weeks for the simple reason that you are 41 weeks. Or that because you had a cesarean before, you have to have one again. Don't take the mainstream's opinion blindly that your baby has to have every vaccine on the vaccine schedule at the exact time recommended. Research! Figure out what is right for YOU! No one else is going to take responsibility for you and your baby... only you get that great honor!

(source)

**Choosing a team (care provider, hospital, doula) to collaborate with to create the experience you want is up to you.
**Making a plan to outline your wishes to the best of your ability is up to you.
**Educating yourself on options and what is best for you and your baby is up to you.
**Standing up for those choices and refusing to be part of the "protocol system" is...you guessed it, up to you!

The doctor won't do it. The nurses won't do it. (Generally). They have their duties and responsibilities and advocating for your ideal birth isn't typically one of them. (All of the nurses I have worked with as a doula have been wonderful to my clients! I am not demonizing medical staff here... just trying to illustrate the point that they need to do their jobs, which include charting, monitoring, and reporting to the doctor. Their job doesn't necessarily include cheering you on... or trying to help remind you that you did not want an epidural... or encouraging you to get in the shower... or trying acupressure).

Mamas, be EMPOWERED. You have choices! Don't wait for "permission" to birth how you choose.. don't even think of it as someone "letting" you take a shower or walk around or decline an IV/epidural/amniotomy or whatever it may be. It is your right! I'll say it again.. You have the right to give birth how you want! Your birth belongs to you and no one else. Take that great responsibility into your hands and OWN it.

Preparing for your VBAC

With a cesarean birth rate of over 30% in the United States, VBAC has become a huge issue for 2nd, 3rd, and 4th time mamas. A cesarean may be done for a number of reasons - fetal distress, "failure to progress", STD's in the mother, "CPD" (cephalopelvic disproportion), and even convenience on the part of the doctor or patient.  This post is not to argue the validity of those reasons, but to help the moms who want to have a vaginal birth the next time around. It is entirely possible, safe, and is good for both mama and baby. I know there are a million and one posts about the various aspects of a VBAC, including benefits, risks, statistics, etc. Instead of rehashing those, I thought I would address how you, as the mama, can prepare yourself for a successful and rewarding birth.

Step 1: Find a Supportive Health Care Provider
This is a biggie. Not all OBGYN's or midwives will take on a VBAC client. It is important to shop around for one who not only will take you as a client, but who will really strive to honor your wishes for your birth (this goes for any birther, not just VBAC'ers). Ideally, this doctor or midwife will have seen and assisted with many VBAC's, because the more comfortable they are with it, the more likely they will be to let your body do it's work without any interventions.

Ask lots of questions when you interview them. How many VBAC's have they attended? How many were successful? Do they believe in inducing, and how long will they "let" you stay pregnant? Are they open to letting you be in different positions to push? How do they support you so that you may have the best outcome?

If they don't meet your standards or you don't feel completely comfortable with them - keep looking! Don't be afraid to find a doctor out of your area. It will be worth an hour's drive when you are having your baby!

Step 2: Stay Healthy
Women who remain healthy, active and fit during pregnancy tend to have easier births. Remember, labor is like a marathon. Your body should be ready to handle the work it will have to do. While you're pregnant, take walks, eat healthy, get chiropractic care, exercise moderately (after discussing with your care provider). Pregnancy yoga classes are a great way to stay flexible and fit, as well as the added bonus of helping you breathe and stay calm. I would recommend this book, "Real Food for Mother and Baby", for a healthy pregnancy diet.

Step 3: Release Fears and/or Past Birth Trauma
Many (but not all) women who have had a past cesarean birth have strong feelings about it. They may feel angry, disappointed, like they failed, or even traumatized. These feelings are completely normal, but they need to be worked through. Find a doula, friend, counselor, someone who you can trust and work through these fears/feelings with. You don't want to be carrying them with you to your next birth, because they will impede the natural work of your body. A scared mind makes a scared body, and a scared body can't give birth the way it needs to. 

Having a doula at your birth can make a huge difference. Doulas can use their knowledge, experience, and relaxation techniques to help you stay calm and at peace. They are a constant source of information, encouragement, and support.

Here is a great article about healing after a past traumatic birth. It mentions hypnosis - I can attest that this works! I have had a few birth clients who have used the Hypnobabies program with great success. This CD from Hypnobabies is just for VBAC mamas.

Step 4: Find Success Stories & Surround Yourself with Positive People
This goes for all pregnant mamas. Be surrounded by positive, not negative!! Don't hang out with the friend who always feels the need to tell you how awful and painful her birth was (or at least ask her to stop talking about it!). Don't watch sensationalized shows like A Baby Story. Politely ask people not to say anything negative about labor, or your pain tolerance, or their own traumatic stories.

Instead, find online forums for other VBAC moms. Connect with moms who have had successful VBACS. Watch youtube videos of VBAC births, or just beautiful births in general. Do pregnancy and birth affirmations. Don't let your own mind talk negatively to you either!!! Tell yourself positive, uplifting, encouraging things.

Step 5: Know Your Resources
Read, read, read. Read some more.
Watch this video, and others like it.

Check out these websites:
www.vbacfacts.com
http://ican-online.org/
http://www.childbirth.org/section/VBACindex.html
http://www.vbac.com/

Read these books:
The VBAC Companion
Vaginal Birth After Cesarean
Natural Childbirth After Cesarean
The Thinking Woman's Guide to a Better Birth
Ina May's Guide to Childbirth
...and others like them

Check out this article..
VBA3C Study: Vaginal Birth After 3 Cesareans is Safer than Repeat Cesarean

Step 6: Strive for a Natural Birth
The less you mess with it, the better off you'll be. What does this mean? Strive to let labor begin on it's own. Avoid pitocin or other labor inducing drugs. (Pitocin and Misoprostil cause greater risks of uterine rupture in VBACS... and P.S., avoid Misoprostil during ANY birth). While epidurals do not add risk to VBAC itself, they do make it more likely that you will end up with another cesarean for other reasons. Advocate for the ability to move around as needed and wanted during labor, and push in a position that you are comfortable with. Again, this is an area where doulas can be a fabulous help and resource.

Bottom line, VBAC mamas, go for it!! You CAN do this!!!!

Mother, Baby, or Birth?

In doula training we did a self assessment which helped us, as doulas, determine what about serving others in birth was most important to us. If we identified most closely with the mother, it meant our philosophy on birth was to help the mother have HER best birth. If we identified mostly with the baby, then it was most important to us that the baby be healthy and have the least amount of interferences for its own well being. Lastly, if we identified most closely with the birth itself, that meant that we valued our idea of the "perfect birth" above all else. For most doulas this is a "natural" birth, or a birth free of any and all intervention.

At first I thought I identified most closely with birth. After all, a "natural" birth was what was best for the mother and baby anyways, right? Over time and through experience, I have come to change my mind. Yes, there is an ideal in the doula birth community, and it is intervention-free birth. Most parents want intervention-free birth as well. Some do not.

Now, I would classify myself as identifying most closely with the mother, with the baby coming in at a close second. What am I there for, if not to serve the mother (and her partner)? Am I there to serve my own purposes? And have my own agenda for birth be carried out? "May it never be so!!". What I want in birth does not have any bearing on the situation, unless it is MY birth. I want what my clients want. I want what they have chosen to be BEST for them, their baby, and their unique situation. I read in an article somewhere (cant remember which one) that birth is like snow and each client is a snowflake. They are all different, unique. A mother may choose or need to have a cesearean birth because of sexual trauma, or because of an STD that she doesn't want to risk passing on to her baby. Or it may be, after DAYS of labor, that she finally decides with the help of her support team, to have a cesarean birth.

There are also limitations within the obstetrical world, from what I've seen. A lot of families are birthing in hospitals, 99% countrywide, in fact. When you birth in a hospital, you cannot always have your "best case scenario". We as women are limited in our birth choices sometimes. Is it the mother's failing, then, that her water broke and her contractions aren't progressing, and because of the medical model she is in, she has pitocin? (Sure, you could say she chose to birth in a hospital, and it's easy to say that when we are not in the situation of having no spare cash to pay for a midwife or a birth center that our insurance won't cover.)

I agree that so many interventions and procedures are done far TOO OFTEN and should not be standard by any means. I am painfully aware that our model of care for birthing women needs to change drastically in this country. I will be the first one to advocate for that change and for a mother's right to birth how she wants.

The reason that I bring all this up (and the long awaited point here) is that I see some birth professionals discounting mothers birth experiences because they were not strictly intervention free. I see them saying that it is not a natural birth if pitocin was used, or an epidural. That 'it is sad that we would call something natural' if those things occured.

My problem with that is, it discounts the mother's experience. If she had pitocin, a little or a lot, and delivered vaginally, and is SO PROUD of her natural birth, who are we to tell her that was not a natural birth? If a woman has a long and exhausting labor and needs to REST, and so decides that it is best for her to have an epidural, who are we to tell her she didn't have a natural birth if thats what she identifies it as? And who really cares?? Why are we so caught up in an ideal that we are making moms feel like they failed because they had an IV, or had their waters ruptured, or had medical pain relief? It is so unfair, in my humble opinion, to taint feelings of pride and accomplishment for an ideal that we hold personally. It is not about us. It is not about me. It is not about my opinion of a mother's birth, it is about how SHE felt about it. It is my goal to have a mother walking out of that hospital saying "I did it, I am proud and happy with my birth", HOWEVER that may come about.

Yes, there are things to be said about the dangers and downsides of various interventions. Yes, I would rather, for the sake of my client and her baby, not have them exposed to the risks of interventions. But they are grown women, and as long as they know the benefits and risks of every procedure they undergo, I am right there with a smile on my face supporting them wholeheartedly. I want my mamas to have a wonderful, empowered memory of their birth. That is my ideal at the end of the day.