VBAC - TOLAC

Recently, while attending a wonderful VBAC birth (vaginal birth after cesarean) at a local hospital, I was reminded of the power of words.  And more specifically acronyms.  I have always called a family trying for a vaginal birth after cesarean as a VBAC birth. But on this day - all the medical personnel used the term "TOLAC" or Trial of Labor After Cesarean. They told me until the birth ended, it was not technically a VBAC but a TOLAC. (I think sometimes it is a medical mentality that all births are a TOL which again may be true technically but we used to just call it labor for the work at hand, not for the pass/fail conclusion).

It always seems that a negative spin is put on birth - especially for a family facing tough or unexpected paths.  Why do we call the need for surgery as a FTP (failure to progress)?  I know it may be technically accurate - but it seems to say to the family "you have failed" in what is a normal process.  Perhaps surgery became necessary due to a baby realizing it wasn't safe to proceed in a vaginal process. Perhaps mom's health would be compromised if it proceeded vaginally.  Could it be that the family actually were extremely successful in their decisions and a successful outcome of a healthy baby/healthy mom was achieved? But moms many times end up feeling they are a failure - does that start from the words used?

I'm just thinking out loud here - but I prefer to always believe a birth will work and I feel with good information, decisions, patience, etc, births do work.  It is just that we forget, babies have the ultimate say. So THEIR stamp of success on the birth could be a surgical ending but a wonderful beginning for a family of a new baby.  So for the next VBAC/TOLAC birth, I think I will just call it what it is -  "a birth".

Water births

I was contacted tonight by a wonderful client that I had the privilege to attend two births for almost a decade ago.  And in between those two births, I attended her mom's fourth birth as her doula.   So fun to be part of a family's growth.  She is now due with #3 - yeah!  But she brought up the thought of waterbirth in a comment she made to my blog. So I thought this might be a great time to discuss the value of a waterbirth.  Her 2nd birth and her mom's fourth birth were both done in the same birthing room - and were waterbirths.

Sutter Davis, the Birth Center and homebirth are the 3 places you can achieve a waterbirth currently in our area.  If there are more places available - please let me know!  But I see such a great value to waterbirth.  First of all, the tub is relaxing to the laboring mom - she can get lost in the flow and feel of warm water and with low lights and quiet voices, it can be so calming to the birth.When a contraction rises, a mom can have movement in the water while feeling supported by the water, almost acting like another support person.  Also dads have entered the tub  and provided physical support and enjoyed sharing in the birth of their child up close and personal.

So some of the basic elements for dealing with labor are presented by a water birth - heat from the temperature of the water, physical support from the bouyancy of the water, movement, lower lights, and a more intimate sense for a mom to give into the labor process.

And when a baby finally emerges and is put up to mom's chest to be snuggled, there is such joy and peace in the room.  The babies seem calmer and when allowed to float on their back in the water with mom or dad supporting their head, they literally unfurl.  So amazing.  See the comment on my last entry that Julie made - she says it better than I can.

So are waterbirths worth working for?  I say a resounding YES.

The Value of Water

Water is such an important component of labor support. This will not be a statistical/medical discussion, just my observations.  Hydration is extremely important  during labor, so coaches need to be vigilant about encouraging the laboring mom to consume lots of liquids.  Unfortunately, labor also brings on nausea so there are definitely times only ice chips or IV fluids are invaluable.

Water is an important component to getting an epidural.  By flooding the system with fluids, it can benefit blood pressure level.  And it is really amazing how much hydration is needed during labor - the body is working so hard!

But what I love about water in labor is the use of a tub or shower.  Imagine the sense of warmth and privacy a shower can provide. I really like to keep lights low in the bathroom and with dad supporting through either physically holding the shower head, pressure on the back, verbal coaching, moms can let go in a shower.  As the steam builds a mom can feel warm and fuzzy and relaxed and contractions feel less intense. Gravity, if she is standing, can help move babies down while moms are more relaxed. If there is back labor, having the warm water on her back can provide relief through the water temperature or just the feel of the water on her lower back.  And if a mom's water bag is ruptured or she is bleeding a little, hopping in the shower can give her a sense of cleanness.  When a mom has worked through the night of labor, getting a shower at the beginning of morning just gives her a sense of renewed commitment.

If a family is home, using a shower to relax a mom for sleep or to help her regroup from feeling overwhelmed is a wonderful support tool. Many moms have had several showers during labor because they loved the result.

I have always felt that a shower is a great exchange for a narcotic - same effect of relief but no side effects. There have been so many times a mom has used the shower only to see amazing results in dialation or progress.

But many times it is still a struggle to get a laboring mom is be open to the idea of a shower in labor. She is not sure her ability to cope with labor will continue if she is getting up, undressed, etc.  I can only say in 99% of the cases, moms have said it was wonderful, and we have a harder time getting them out of the shower, than we did getting them into the shower.  So next time a doula suggests a shower, don't be afraid to try it.  You'll be so glad you did.

Stay tuned for a blog on waterbirths - another great use of water.

First birth - Experience

When first time parents are facing their birth,some have found the support of a doula to be a nice addition to their team. This first time birthing couple had plans to go unmedicated, feeling it would be a safer birth for mom and baby.  When labor began, dad did a great job of coaching mom through positions and breathing at home.  Doula was able to give suggestions by phone and with labor going fairly quickly, the team regrouped at the hospital.  Mom arrived already dialated to 7cm which was exciting.  In the hospital room, dad and doula helped mom try different positions including using the birth ball and within 3 hours mom was ready to push.  Different positions were tried for pushing and their baby girl arrived safely in less than 2 hours of pushing.  This unmedicated vaginal birth was an exciting ending to their pregnancy journey.

There was a downside to this birth - having personality issues with the first nurse who was there the first 3 hours.  You never know in labor whom your medical staff will be  - having a continuous labor support person in the room can make a difference to having a calm labor room for mom and dad to enjoy the birth.

The mom made this comment after the birth :  I concentrated on getting through each contraction rather then the entire process and what was going on around me, or what was going to happen next.  I stayed in the moment of each contraction.

This birth will be a great memory to myself and the parents!

FEAR OF LABOR - Part 2

Do we need to  rid ourselves totally of all fear of labor?  Realistically this is probably not going to happen.  But we can reduce the fear.  Knowledge helps us reduce fear - if I know that babies actually do emerge from moms' bodies all the time, it really does work, I have seen it over and over in videos and talked to other moms, then that knowledge should work in my favor when I suddenly face fear in pushing. When my mind is suddenly saying, "How am I going to get this baby out?"  If I tell myself with each pushing contraction, "I can do this" or "This is working", I will be working with the natural forces inside of me to produce the baby and pushing the fear aside.

If I know in advance that there will be sensations that are normal to labor - nausea - shakiness - hot/cold flashes - then could I use that information to remind myself that these "normal labor" sensations are telling me that labor is progressing, that my body is doing exactly what it is supposed to be doing to complete this task? 

So knowledge is one way to reduce the fear.  What doesn't help is hearing numerous negative birth stories from everyone we meet.  A mom's memory of her birth is her own - good or bad.  But we need to remind ourselves that each of us will uniquely experience this journey and that others' experiences are their own - not ours - this knowledge can help us to move forward to build our own birth story, hopefully with less fear and more determination of the job ahead.

Comments?

I am hoping that my postings will be helpful to others so I would love to have some feedback. If you have any comments, questions, concerns, would love to hear from you!

"650"

No, not six dollars and 50 cents.  I had the pleasure of attending my 650th birth on Tuesday.  And I do mean my pleasure.  It was hard to get that first l:30am phone call when I had not slept well the night before, but once I was up and moving, the day moved quickly.

Although this is definitely a milestone in my doula career, each birth still has such special meaning to me.  I am in awe of the laboring mom and dad working their way through the process, weighing decisions, grabbing at the "anchors" I provide in a position, a touch, a word.

The strength women show in labor is always encouraging and remarkable and a pleasure to witness. The power a dad shows in his hold, his touch, his presence is a joy to watch.  Two people coming together for a common goal - a healthy birth.

And if anyone has any comments on my blog, I would love to hear them.  This is a journey I hope to share with many families.  I would love your feedback.

So when this 650th baby emerged into the arms of her mom and and dad that morning, I was just as amazed as I was the first time I attended a birth. And so grateful for the privilege of being asked to serve as a guide, a witness, a participant in the process.  Thank you to all the wonderful families who have allowed me to share their journey.  I'm ready for the next birth!

I'M SO TIRED!

Hmmm, After 2 births in 24 hours, these words could definitely apply to my own level of energy.  But I was actually thinking about the condition in labor where a mom feels she would do just about anything for a little sleep. 

It is very common for me to hear a mom observe that she is just so tired. She has usually missed a night's sleep from contractions, anxiety over labor beginning, excitement, etc.  She would like to just lay down for a little while, but once she is reclined, the contractions can be so much harder to deal with and her resolve to go forward unmedicated can be challenged.

I have always looked at that "sleepy" attitude as a good sign of active labor.  When a mom looks very shut down and sleepy, I know her endorphins are kicking in and helping her deal with her labor.  But how do you handle this situation and continue to support a mom "moving forward"?  Keeping the reclining period to no more than 30 minutes can help - allowing a mom to rest her legs and body  while actively supporting her through contractions can give her a break.  She may not come out of it feeling that she is  "rested" but she has allowed her body to relax between contractions. And reminding her of the reason she is laying down, to take advantage of the time in between the contractions to just sink into the bed and rest her mind and body.

Using a shower for 30-60 minutes can help a mom to relax and feel "restful" before laying down for that 30 minute period.  I have seen moms actually snore between 2-3 minute contractions catching seconds of rest during the last of labor.  Low lights, soft music, gentle touch, and lots of pillows  can all aid her in feeling that she is resting.

Feeling tired is definitely a part of labor.  Being exhausted and fighting contractions is not where you want to end up. So continue to look for little windows of opportunity to recline or rest while keeping your mind on the ultimate goal of accomplishing the birth of the baby in a healthful, happy way.  And having a doula support the mom and dad in this journey can feel  invaluable.

PATIENCE

When we prepare for parenthood, we can be overwhelmed by the many responsibilities and requirements coming our way.  But that preparation is enhanced by facing pregnancy and labor.  In dealing with the many changes and demands of pregnancy, we are starting to learn how to make decisions with the baby as first priority.  For first time parents, there is a wonderful training ground that pregnancy provides.  And one of the important lessons is patience.

There can be many goals and dreams we develope in the first 8 months of the pregnancy as to how we want the labor to go.  And then those last weeks or days seem to just drag by.  Each minute becomes an hour watching for labor signs.  Life seems to stop until that big event unfolds and we find that patience is now running out.  All those great plans of letting labor happen when the baby is ready can be changed in an instant with a simple suggestion - induction. (Now, of course, I'm talking about induction for non-medical issues.)

I have seen expectant moms receive multiple calls from their physicians offering that "they are on call that day and there is a bed available at the hospital for them" and the temptation to just get labor over seems great  but they have been firm in their determination to have patience.  And the very next day labor begins and quickly a baby is in their arms.  Would their trust in their own bodies have been as richly rewarded if they had succumbed to induction?

There is the issue of patience in labor. When those first contractions start, the big question is "Now when do we head to the hospital?"  It is very difficult for a family to determine the right time to go even though moms are equipped with such a great instinct as to the best time.  Those who had said they wanted to stay home as long as possible, find that quickly they are puzzled with how that will happen.  (In those instances, having a birth doula can really help!)

And why is patience such a great lesson?  How patient do you have to be to establish breastfeeding?  How patient do you have to be when your baby's schedule of sleep differs from your routine?  How patient do you have to be when your baby is teething, learning to hold objects but dropping everything quickly, and even later, learning to tie their shoes?  Patience is vital to a parent and it begins in pregnancy.  When we view pregnancy and labor as a wonderful training ground, it can add so much to our own qualities as a parent. So take a breath, let go a little, and relish the peaceful quality of patience!

TO EPIDURAL OR NOT TO EPIDURAL - THAT IS THE QUESTION!

Today the majority of women  in this country facing labor feel comfortable with the choice of an epidural.  Many women don't have any friends or workmates who have tried to go without an epidural in labor - or they have talked to women who started with that goal but abandoned it during the labor.  After over 600 births, I do not feel that there is one way to have a baby - I feel  it is important for women to be comfortable with their choices and realize this is not a "pass or fail" process.  I'm really most concerned that moms feel they have made informed decisions. And one of those decisions could be to avoid pain medication.

I have worked with many moms who were upfront that they planned to use medication in birth.  They wanted a support person who was comfortable with their choices. I provided support for the birth with their choice in mind.

I have also worked with many moms whose goal was to go unmedicated.  Is this possible?  Yes! Is it valuable to pass on an epidural and get through the labor process unmedicated?  Yes!  But is it the only way to birth a baby?  Of course not.

We never know the challenges a mom will face in labor - and babies have to cooperate with the process also. Sometimes they are the smart ones, knowing it was safer to come through surgery than vaginally.  We just never know until we get into the process.

Why do some moms choose to avoid medication?  It's certainly not that they want to be martyrs.  Many times it is hoping to avoid the risk of medication or what they feel will be a domino effect - starting one process that leads to the next, etc.  Some feel their body knows how to birth a baby and they want to trust the process.  Some want the  challenge of working through labor and having nothing to dull their senses or the experience.

Whatever the motivation, I am happy to support the goal.  I have seen so many unmedicated births where the value of that choice was not realized until later.  And when I ask after the birth - are you happy you did it this way - almost every mom has said an emphatic YES.

Does that mean moms who choose medication are not happy with their choice.  Not at all.  Again - the biggest issue is informed consent.  Has the mom weighed the risks and benefits and made a choice with this given birth and circumstances that she is happy with.  Then it is probably the right choice for that birth.

Having a goal for birth is wonderful - it is a dream to reach for - having a great birth memory is a happy memory.  Should it be unmedicated or medicated?  Ultimately it is usually your choice. Having a support person or doula is also your choice - and I'm hoping it is a choice you will definitely consider!

Fear of Labor - Part 1

What I have found to be the biggest issue of moms-to-be is "fear".  For a first time mom, it is usually the fear of the unknown.  How long will labor take, how hard will it get, can I get through it okay?  For the 2nd, 3rd, etc mom, it is the fear of the "known".  How will I make it through labor again when last time I labored for 2 days, pushed 3 hours, etc.

Now in generalizing feelings, I am also well aware that there are definitely moms who have no fears and moms whose first births are short and sweet. 

But fear is still a big issue for many expectant moms.  As a doula, I'm always trying to explain enough about labor to eliminate some of the "unknown" for first timers, and some of the "known" for multips.  The reality of labor is that the less fear we have, the easier it is to handle labor.  But how do we get rid of the fear or do we even really need to get rid of all of it?

Tune in for part 2.

Greetings

I'm embarking on a new journey - one of sharing my thoughts on birth.  I have done this on an individual basis for the last  24 years.  But now I would like to give more families encouragement and hope and lessen the fear of labor. 

Are you ready to start this journey with me?  This is your personal invitation. 

Cyndi
A birth doula