Pregnancy and Birth Outcomes...

...are influenced by a variety of factors, but cannot be controlled by planning.

Let me rephrase that.  Parents have an idea (fantasy?) of what it will be like.  Moms and dads get organized, read all the 'right' books, take classes, write their birth plan, hire a doula.  And the reality is nothing like they expect:

Just getting through a contraction blocks out everything mom has learned and read.

 
The parents expect to be at home with their doula in early labour and end up in the hospital for 18 hours instead. 

 
Mom says she will never get an epidural and after 30 hours of labour, gets it and wonders why she didn't get it sooner.

Most of us have a fundamental belief (whether we acknowledge it or not), that if we prepare in a certain way and do all the right things, we will have the 'good' birth.  If the birth we have does not match the fantasy, we make an assumption that we have done something wrong and judge ourselves as failing.

Part of what Birthing from Within is about is acknowledging this belief and shifting the idea of a 'good' birth. External factors (what happens) are not as important for parents feeling good about their birth as internal ones (what parents do in the moment).  Some people have unexpected cesarean births that they feel great about, because they know they did everything they could.  Others have a rapidly progressing vaginal birth with no interventions that they perceive as being completely traumatic.

Birthing from Within is not about laying down a plan to follow to the letter.  It is about preparing by putting out into the universe what we would like for ourselves, without being attached to what actually happens.  We are prepared to accept what is happening in the moment and do the next best thing, when necessary.

This is a huge departure from most of what is out there about birth preparation.  It can be scary to let go of the busy work that we do to get the 'right' plan.  And it is good to be a little bit scared, especially when we are stepping into the unknown.

Please check out www.birthingfromwithin.com and www.elliedoula.com for more about this unique birth preparation.

The Purpose of Childbirth Preparation...

...is to prepare mothers to give birth in awareness, not to achieve a specific birth outcome.

This Birthing from Within guiding principle was a real shift for me.  Before I became a Birthing from Within Mentor and Doula in June 2011, I was promising my clients a natural birth in the hospital. I had an intervention free hospital birth and at that time most of my doula clients where having the same type of birth. I was selling pregnant couples a 'good' hospital experience.  And of course couples were buying it.

My realization through my Birthing from Within training and experiences over the last year have helped me realize that truly birthing 'from within', has nothing to do with the type of birth you have and everything to do with where your head is at. Preparation is incredibly valuable, and it does not guarantee a certain outcome.

Research shows parents who receive support:

• Feel more secure and cared for
• Are more successful in adapting to new family dynamics
• Have greater success with breastfeeding
• Have greater self-confidence

These things are true for most parents who use doulas, regardless of the birth outcomes.  This is what I am now offering pregnant couples.  It is not a 'magic bullet', and sometimes it is hard for first time parents to understand how valuable building confidence and feeling good about the birth really is.

The DONA Website also mentions less interventions and cesareans.  While these statistics are valid over a large number of births, parents sometimes interpret this as: "If I hire you as my doula, I will not have an epidural or a cesarean." Promising this (even unintentionally) is doing a disservice to the parents and the doula. Doulas burn out because we take on responsibility for birth outcomes and then when it does not go the way we expect (and parents expect), we take it personally and it is emotionally draining.

Birthing from Within preparation and support includes preparing for every possible outcome and helps parents learn to be present in the moment and recognize their birth as a major rite of passage, whatever kind of birth they have.

Please take a look at my new website for more about what I can offer you.

Parents' Individual Needs and Differences Determine Class Content

Birthing from Within Classes are designed as gourmet meals, where parents can 'order up' different dishes  depending on their needs and appetites.

In a six week series, each class is a meal, which includes:

• APPETIZER: some type of introduction to whet the appetite
• BREAD BASKET: this is the pain-coping.  1/3 of each class is spent on learning practical skills that parents can use during labour.
• MAIN COURSE: the 'meat and potatoes' or practical information.
• SIDE DISH: enhances the main course.  It can include birth art, role plays or other activities to initiate parents - moving from the known into the unknown of birth and parenthood.
• DESSERT: closing the class by celebrating the pregnancy and upcoming birth.

A weekend class is designed the same way, with three complete meals on the Saturday and three more on the Sunday.

I have at least 50-60 hours of potential content and 15 hours of class time.  So while I follow this menu, and I have a general idea of what types of things might come up, the same class from one series to another can be very different depending on what kinds of questions parents ask.

I always begin the first class by asking:  "What would need to happen during this class to make it worthwhile for you?" and I use that in my preparation and delivery of class content.

The one thing I don't spend too much time on is providing a lot of obstetrical information.  I find that people who are interested in medical information usually have a lot of it by the time they take the class.  I am always happy to recommend books to parents and there are some suggestions on my website and this blog. Birthing from Within is really about learning what birth might be like from the parents point of view and to prepare them for their own birth experience.

Topics covered in a typical Birthing from Within Class:

• How to cope with pain in labour (what it might look like, practical non-medical and medical ways of coping)
• Nutrition and physical health for pregnancy and postpartum, including breastfeeding.
• Labour itself:  early signs, a 'map' of labour, things that help labour progress, what might a 'normal' labour look like.
• Unexpected events: Induction and Cesarean Birth are covered
• Special class for dads:  dad's role as the main support person; special concerns of dads
• Life with Baby: includes expectations, practical information, where to get help
• Ways to celebrate birth and new parenthood
• And lots more....

Please get in touch with me to register for the classes I am offering in Lethbridge and check out www.birthingfromwithin.com to find Birthing from Within Mentors in other parts of the world.

Like my Birthing From Within Lethbridge Facebook page for interesting information and connection to community resources.

Practices That Promote Safe, Healthy Birth

I recently re-read The Official Lamaze Guide and I was impressed with how much it resonates with me and my own philosophy of birth.  Similarly to Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers, the authors of the Lamaze Guide are able to use a few simple principles to help women move towards the best possible outcomes for themselves and their babies.

They explain that up to 95% of women should have 'no-risk' pregnancies and be able to give birth safely, without the need for interventions.  If this is the case, why are so many women being labelled 'high-risk' and even those who are 'low-risk' ending up with all kinds of unnecessary interventions and births that are not what they had hoped for?  Simply, it is because we (parents, medical practitioners, support people and the general public) need to remember that birth is a natural part of life and that even the most subtle interference can have an a major impact.

The authors cite a lot of research, especially work that can be found on the Cochrane Library database, which proves that many routine interventions do not improve maternal and infant health and in many cases are potentially harmful.  They distill this research in a way that is easy to understand and, more impressively, in a way that supports their common sense birth practices. Most pregnant women will read this book and feel more confident in themselves and their ability to give birth in a safe and healthy way.

SIX PRACTICES THAT PROMOTE SAFE, HEALTHY BIRTH

Let Labour Begin on its Own:
Medically speaking a term baby is between 37-42 weeks gestation.  Many doctors encourage their patients to induce labour between 40-42 weeks or even earlier.  Usually there is no medical indication for this..  Many women at this point are understandably tired of being pregnant and misunderstand their doctor's encouragement as a medical necessity.  If your doctor suggests induction before 42 weeks, ask what the medical indications for induction are.

Sometimes women will be told that there is a risk of their baby being too big (macrosomia). It is important to know that this is not a true medical indication for induction (or for c-section) and that means used for establishing the size of a baby have a margin of error of more than 25% or more.  This means that your supposedly 10 pound baby could end up only being 7.5 pounds.

It is important to know that there are  risks to being induced and it can also negatively affect the birth experience, as most induction methods affect the body's natural ability to cope with pain.

See Lamaze International for more on letting labour begin on its own.

Walk, Move Around and Change Positions Throughout Labour
This one seems kind of obvious, but sometimes labouring women don't want to move.  They either find a position that is comfortable or they are uncomfortable and concerned that changing positions will make it worse.  The authors say the one of the purposes of pain in labour is to encourage us to move, find a new comfortable position and move the baby down.  The best thing to do is trust your body and ask for help from your support people if you want to try something different.

Obviously, the more interventions you have the move difficult movement can be.  In Lethbridge, you generally will not be allowed to move much if you have an epidural, but you should still be able to switch from side to side. If you are induced or labour is augmented with Pitocin, you will be required to wear the monitor most of time.  You can still get creative changing positions in and around the bed.


Bring a Loved One, Friend or Doula for Continuous Support
It is essential that your support people understand and agree with the type of birth experience you want.  Especially if you do not have a doula, the need to be well prepared and ideally have previous experience with birth.  Childbirth education classes can be really helpful and I hope to be offering them starting in the summer or fall of 2011.  Please contact me if you are interested.

You know best who can support you best during your birth.  In the Lethbridge Hospital there is a rule of 2 support people, which means you may have to choose between a family member and a doula.  If you choose a family member or friend along with your partner, try to envision how you would like them to help you during the birth.  Birth is very intimate and emotional and sometimes unresolved issues can come up and negatively affect labour.  Make sure personal issues are resolved before labour begins.


Avoid Interventions that Are Not Medically Necessary
Some interventions (such as IVs, epidurals, breaking your water, continuous monitoring) are done routinely, but have been shown by research to negatively affect labour (by slowing it down, increasing the need for even more interventions, increasing challenges with breastfeeding).  Make that there are good medical reasons for whatever interventions you agree to and try to come up with a compromise that will not affect your birth as much.  For example if you are Group B strep positive and need antibiotics, request a Hep(arin) lock to receive your antibiotics.  This way you can still move around freely without an IV pole and receive medication only when you need it.


Avoid Giving Birth on Your Back and Follow Your Body's Urges to Push
The Lethbridge Hospital has squat bars that attach to the bed and these can be very effective for some people.  You might have an idea for a position to try, don't be afraid to ask, or even move into that position (with help from your support people).

Sometimes women are asked to wait before they start pushing and this is difficult to impossible for most.  In a non-medicated birth the urge to push for most people is overwhelming.  Once you are pushing, medical staff sometimes make suggestions for pushing.  Sometimes they can be very effective, but pushing harder than your body wants to or before you are ready will result in exhaustion.  Some women have a brief rest period after they are fully dilated, before they feel an urge to push.  If you have this break, take advantage of it, it is a gift to help you get ready for pushing.


Keep Mother and Baby Together, it's Best for Mother, Baby and Breastfeeding
Here in the Lethbridge, hospital staff will usually place your baby on your abdomen immediately after birth, if you request this beforehand, if you do not request it, they will usually take the baby away to be weighed, measured and checked.  Weighing and measuring does not need to happen immediately and the baby can usually be checked in your arms.

If the baby is skin to skin in your arms you body will regulate his temperature and he will be more likely to latch on and breastfeed successfully. Babies born without medication have a very awake period immediately after birth and this is the best time to start breastfeeding.  See my post on breastfeeding, for more on this.

If you are pregnant I would recommend signing up for the Lamaze International blog Giving Birth with Confidence.

Mother's Advocate has videos and handouts about the Six Lamaze Healthy Birth Practices.


As always, please feel free to contact me if you have any questions or if you are interested in a doula.

Healthy Pregnancy, Healthy Baby(ies)

I just finished reading Having Twins And More: A Parent's Guide to Multiple Pregnancy, Birth, and Early Childhood by Elizabeth Noble.  It is part of my required reading for my DONA Postpartum Doula Certification (which I will have all the requirements completed for in the next couple of weeks).  I loved this book, and much of the information it provides is useful for  parents of 'singletons' (as they are called in the book), as well as parents of multiples.

My only complaint about this book is that it was published in 2003 and I hope that a new edition will be published soon.  It is very much based in research and I am certain that even more research has been done in the  past eight years to support some of her points of view.

The book is extensive and covers everything from health in pregnancy to bonding with your babies to coping with infants with disabilities and even the death of a baby (which is more common in multiple pregnancies).

For the purposes of this post, I will pull out just a few of the ideas that struck me as interesting and that are useful to me as a doula, supporting pregnant women and families with new babies.

Pregnancy
Noble shows that the single most important factor that results in a positive outcome for twins (and more) is the health of the mother.  Good nutrition, hydration and moderate exercise are the most important things pregnant women can do to ensure the delivery of full term, healthy babies.  Certainly, this is also true for single babies.  This is great news, because it is something that pregnant women have control over. We can decide to eat well, drink lots of water and go for a walk around the block once a day.

I have recently started taking yoga again, which I previously did when I was pregnant, and I am amazed at the effect it has on me physically and emotionally.  I would highly recommend prenatal yoga classes for all pregnant women.  If you can't afford classes or they are not available in your area, check the online Prenatal Yoga Centre for free videos on yoga to do during pregnancy.

Birth
One of the reasons that taking care of yourself during pregnancy is important is to avoid preterm birth, meaning birth of your baby(ies) before 36 weeks gestation.  According to Having Twins And More preterm birth is by far the major cause of complications and infant deaths.  In fact, 75% of all infant deaths in the U.S. are babies born before 36 weeks.  Some babies are born premature regardless, but good health and nutrition does reduce the chances of preterm birth and therefore can improve outcomes for babies.

Another thing that was interesting to learn from this book, is that prolonged bed rest during pregnancy, does not reduce the chances of premature birth and it greatly increases the potential for health issues in the mother. A NASA study shows that one week of bed rest results in the equivalent of one year's worth of ageing on the skeleton!

Often with twin or higher multiple pregnancies, doctors will recommend elective cesarean section.  Mothers agree to this because they believe it will result in better outcomes for their babies.  But the research shows that multiples (and singletons) delivered vaginally have lower mortality and morbidity overall, as do their mothers.  There are certain situations where a c-section is necessary, but most pregnant women (regardless of how many babies they are carrying) should be able to deliver vaginally.  Also, taking care of newborn babies is much more difficult when recovering from major abdominal surgery.

Parenting Multiples
Having Twins And More has great information about bonding with twins, their relationships with each other and with their parents and other siblings.  One interesting thing that Noble points out is that with more than one new baby the number of new relationships within the family increases. She provides suggestions on how the parents can help foster those relationships.  There is a lot of focus on the importance of recognizing the twins as separate individuals, rather than as a unit.

Overall, I would highly recommend this book for anyone expecting multiples or anyone who works with multiples and their families.