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So What Exactly Happens At A Home Birth?

by Amelia on June 3, 2008
category: Labor and Delivery,Pregnancy

homebirth.jpg What is it like? I just experienced going to a home birth as a birth assistant a few weeks ago and it was awesome. It felt so normal and natural for the mom to labor and birth in her own home with her other children nearby. As a supporter and advocate of mother centered birth I have always been excited about home birth and the idea that women should birth their babies where they feel most comfortable. For some women, it is their home. They feel more comfortable and safe in their own familiar environments. They don’t have to worry about poking and prodding from strangers and can simply move from room to room as they feel during labor. Once the birth is over mom can shower in her own shower and then go to her own bed with her baby. So easy! After seeing it firsthand I can understand in a new way why mothers choose home birth.

Where does the mom birth her baby? Wherever she chooses. Midwives have a list of supplies for the mom to acquire before the birth and one of them is usually a clear vinyl shower curtain that can be laid on top of the bed or floor to protect the surface. If a mom thinks she will want to birth in her bed she will put on a set of sheets, the vinyl shower curtain, and then another set of clean sheets on top of the shower curtain. The shower curtain protects the mattress and once the birth is over all the midwives need to do is take off the sheets and shower curtain used to birth on and throw them in the washer and then mom has some clean sheets to lay down on. A lot of moms will birth their babies next to the bed in a squatting position or in the living room. Some midwives have birth stools for the mom to sit on while she pushes the baby out. Midwives will talk with the mom either when she arrives for the birth or ahead of time about where the mom thinks she will birth the baby. If the mom has a good idea where she will want to birth the baby then the midwives will set up their equipment nearby so it will be convenient to get to during labor and birth.


My Top 5 Labor Tips

by Amelia on May 15, 2008
category: Labor and Delivery

baby-graham-008.jpg Okay, so maybe it isn’t the ultimate top 5. It is really hard to choose 5 because there are so many things to be prepared for when it comes to labor and birth! These are good ones though–so if you are pregnant for the first time, third time or know someone who is pregnant looking for some labor advice this may help.

My philosophy is that you should educate yourself about labor and birth in the same way you would when you buy a car or choose a college. Take an independent childbirth class other than what is offered at the hospital: The Bradley Method, HypnoBirthing, BabyBodyBirth, Birthing From Within, ICEA are all good choices. Try not to wait until the last minute to take a class since some classes are as much as 12 weeks long.

Here are the tips:

1. Have a person committed to being your labor support. Most often it is the husband but some women find comfort in having their mothers, a friend, or hiring a doula to be their labor companion. Also–and this one is really important; tell your labor support to pay attention to YOU–not the electric fetal monitor. You don’t need them to tell you when you are having a contraction or how intense it was– you know because you can feel it. What you need most is for someone to help you relax through the contractions. It is really hard for some people to NOT watch the machines in the room–kind of like when a tv is on in a room–it is hard not to watch it– but when a mom is in labor she needs the attention more than the machine.

2. Don’t go to the hospital too soon. This is probably one of the biggest mistakes that parents make. When it is your first time to have a baby it is exciting and you don’t know what to expect so it is easy to head to the hospital too early. The big problem at arriving too soon is that you begin being held to the hospital’s time table and unfortunately many birth attendants will begin to offer to help “speed things along” by offering pitocin when it really isn’t needed. Meddling with a labor that is doing fine often leads to many other interventions and problems. Heading to the hospital when contractions are a minute long and 5 minutes apart for at least one hour is a good rule of thumb. If you can still walk, talk, and laugh during contractions it is too early to go to the hospital. Because labor patterns vary it is probably better to look at the physical signposts of a mom to help determine when to head out to the hospital. When mom can’t talk during a contraction and starts to need to relax and be quiet between contractions that is usually a good sign to go on to the birth place.

3. If you are shooting for an unmedicated birth practice relaxation techniques for several weeks before the birth. Relaxation techniques can even be helpful for moms who want an epidural. Most doctors allow epidurals when women get to 3 or 4 cm and having some relaxation techniques in your “tool box” of laboring knowledge can help a mom cope with the pain of the contractions. Some things I teach in my class are massage, progressive relaxation, and visual relaxation. Some moms enjoy being read poems, literature, scripture, or listening to some relaxing music while laboring to cope with contractions.

4. When working with contractions make low pitched groaning sounds (like a cow moo) rather than high pitched squeals. Some moms find a lot of relief vocalizing through contractions and the low pitched groans are relaxing. You can practice now if you want. Try making a high pitched squeal and you will find that your shoulders or other parts of your body tense up. Tensing up during a contraction actually causes more pain. The low moans help you release your muscles which makes the contraction less painful.

5. Relax your jaw. Ina May Gaskin, a well-known midwife in Tennesee says that women with a relaxed jaw and mouth have a relaxed bottom and that it helps the cervix open faster. It is easy to grit your teeth when in pain but focusing on keeping that jaw relaxed can speed labor along. Taking a bath, staying upright during labor, getting massaged from your labor supporters can all help the jaw stay relaxed.

I find myself mentioning most of these when asked for advice on labor. I hope you or a friend might find them helpful too.

Some good sources are:

Mind Over Labor by Carl Jones (This book is an amazing resource for relaxation techniques)

Ina May’s Guide to Childbirth by Ina May Gaskin

The Birth Book by Dr. Sears

This is a great resource for your labor support person. It has some great tips on how to help a laboring mom.

What did you find helpful during your labors?

Is it necessary to be induced for Group B strep?

by Amelia on February 26, 2008
category: Labor and Delivery,Pregnancy

mommyandnewborn.jpg Let me start off by saying that I am not a doctor, midwife, or other health care professional. I am a birth instructor. One of the things that I focus on in the classes I teach is to educate couples so that they can make informed decisions of the issues facing them.

I recently saw one of those baby shows that come on cable. I have a love hate relationship with these shows because I see so many things that make birth more difficult for mothers but sometimes I see something really remarkable which in essence makes them worth watching. In the show I recently watched the doctor was talking to her patient and told her that because the mom tested positive for Group B strep (GBS) they would need to induce her and the words out of the doctors mouth were something to the effect of “or something really tragic might happen”. I started talking to the TV and said, “Why is THAT a cause for induction?”!

The Academy of Obstetricians and Gynecologists (ACOG) officially recommends induction for a few reasons: Going past 42 weeks gestation, placental abruption, preeclampsia, an infection of the amniotic sac, and premature rupture of the membranes. Many women are induced for LOTS of different reasons than the ones stated above (I won’t get into that during this post) but this was the first time I had heard of a doctor wanting to induce because a woman was GBS positive!


Are Birth Centers Safe?

by Amelia on October 29, 2007
category: Labor and Delivery

We got this email from a reader:

I had my second child without medication. Not by choice but because I didn’t make it to the hospital in time. It was painful but I liked that the recovery was so much easier. I am considering going natural when we get pregnant with our third child. I like the concept of childbirthing centers. Is natural childbirth safe in a childbirthing facility? What if something unpredictable happens during the birth? How are the midwifes prepared for emergencies?

Amelia responds:

Since I have only had unmedicated births, I don’t have anything to compare it to, but my friends that have had a natural birth after a medicated one have also said that the recovery time is easier and faster. I would love to hear your birth story!

Free standing birth centers are a great place to have a baby and yes they are safe. I would venture to say that natural childbirth is safer at a birth center than in a hospital. They are a great alternative for people who want a more home-like facility but don’t feel comfortable having a home birth. Some moms prefer a birth center experience after having a disappointing experience at a hospital or want a natural birth and don’t want to hassle with routine hospital procedures. Birth Centers are usually run by Certified Nurse Midwives (CNMs) which means that they have a nursing degree and have also completed a degree and training in midwifery at an accredited school. Birth centers typically have lower c-section rates, episiotomies, inductions, infections, and the list goes on. For example, the birth center I had Graham in has a 7.5% C-section rate, compared to a 30% national rate. Midwives are often better trained to help women cope with the pain of labor and are available to help support the woman throughout the labor. Birth centers also let women eat and drink throughout labor. Hydration and food for nourishment are important factors for allowing a woman’s body to flourish during labor. No matter where a woman chooses to give birth, the most important thing is to feel confident and comfortable with your birth provider and the birth facility.

A word about midwives:
Most midwives have a different perspective when it comes to birth. Midwives are trained to look at birth as a normal, natural event. Obstetricians are trained surgeons and are trained to scoping out problems. As a result OBs tend to do a lot more testing and intervention during pregnancy and birth and have a much higher c-section rate. Many midwives also spend more time with their patients and take time to answer questions.

In my own experience with midwives, I have left appointments feeling like they have taken the time to get to know ME as a whole person. The midwife group for my last pregnancy was amazing. I felt like they were looking out for me during and after the pregnancy. The midwife who caught Graham called me this past Monday, seven weeks after the birth, to check up on me and the baby. They knew that I had struggled with postpartum depression after my second birth and have been very proactive about making sure I have the support network I need.

To answer your question about emergencies, birth centers are often close to a hospital so that if a transfer is needed it is easy to get there in an emergency. Birth centers also screen their patients throughout the pregnancy to make sure they are low risk. Most births will proceed with little problem and usually when a problem develops it shows up over a period of time. A woman that falls into a high risk category (i.e. pre-eclampsia, diabetes requiring insulin) will be asked to birth in the hospital. Women who need to be induced with Pitocin will be asked to birth in the hospital as well. In my last birth, I had shoulder dystocia, which is where the baby’s shoulders get stuck under the pubic bone. Graham’s head was out and we had to get the rest of him out quickly. Our midwife was calm and instructed me how to help her get the baby out. It was a serious situation. After Graham came out he was floppy and needed oxygen. The midwife and nurse knew exactly what to do and did it well.

Midwives are required to be trained in infant and adult resuscitation. They also have local anesthesia available for any tissue repairs after the birth. They have medications available for things like postpartum hemorrhage and will transfer to the hospital should a need arise during or after the birth.

I would encourage you to find a birth center in your area and ask to take a tour. I would also encourage you to take an independent childbirth class or do some additional reading to help you prepare for your next birth.

Some great books are:

Creating Your Birth Plan: A Definitive Guide to a Safe and Empowering Birth by Marsden Wagner

Thinking Woman’s Guide to a Better Birth by Henci Goer

Natural Birth the Bradley Way by Susan McCutcheon

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