Comfort Measures for Labor {A Birth Circle Topic}

Believe it or not, you can actually make a positive impact on your labor prenatally by practicing healthy eating habits and proper posture. There are also a few other things you can do prenatally that promote faster, easier labor!

Yoga during pregnancy

Image Credit: Health Me Up

In particular, this pose can help relieve lower back pain in late third trimester,

View Prenatal Yoga Cat & Cow Stretch for a Pregnancy Workout on Howcast

Regular chiropractic care is beneficial for pregnancy and labor! I recommend at least once in the first and second trimester, and twice during the third trimester; additionally, if you can find a provider skilled in the Webster Technique, chiropractic care can help encourage a breech baby into a vertex presentation.

Acupuncture can also facilitate rotating a breech baby, although you may consider breech a variation of normal!  Regular balancing treatments throughout your pregnancy can enhance your health and positively influence the development of your baby. Acupuncture can also help with nausea, fatigue, anxiety, back pain and more!

Along the lines of all this information regarding fetal positioning, you might like to check out The Miles Circuit.  Many people falsely believe that fetal positioning can prevent, or rather delay labor from starting and this is simply not true, however, having optimal fetal positioning can certainly facilitate a more comfortable labor!

Don't forget, in labor, your body is working and it's working hard!! To help it out, be sure to rest as much as possible in early labor! The best early labor advice I can give you -  is go to sleep. Or if it's the middle of the day or you can't sleep, simply go about your day as normal. Pretend it's not even happening! Nourish your body with healthy foods and drinks and relax.

There was a study done that eating 6 dates a day for the last 4 weeks of your pregnancy can shorten the duration of your labor. Of course dates are also great to ease the symptoms of constipation.
And while we're on the topic of nutrition, throughout the Birth Boot Camp course we'll go over tips to boost your nutrition.

And now... for what you've been waiting for.. Comfort measures for labor.

1) A doula!

Doulas and partners work together to help you have an #amazingbirth
Posted by Guiding Angels Birth Services on Sunday, March 22, 2015

How can a doula can benefit your labor? <-- Click the link for a great read by Evidence Based Birth 

Or visit my Pinterest!

Follow Jennifer Valencia's board Pregnancy & Child Birth on Pinterest.             Follow Jennifer Valencia's board Birth Stories on Pinterest.

Follow Jennifer Valencia's board Doula Goodness on Pinterest.

2) Positioning. Walking and other upright positions help increase the downward compression on your cervix to aid in dilation. Many women find hands and knees to be very comfortable during labor. Birth balls can be wonderful tools to utilize. Lean in to your partner; Bradley classes teach "slow dancing" for labor. Squatting, which is also beneficial prenatally, can relieve back pressure during surges. Lie semi-prone.  Generally, lying on your back or being in a reclined sitting position are the most uncomfortable positions for labor.

3) Water. 'Nuff said!

4) Acupressure or Acupuncture during labor.

5) Birth at home! By not transferring, you maintain the highest level of endorphins and other "happy hormones" that have been triggered by an uninterrupted flow of oxytocin. By staying at home you can maintain your privacy, continue laboring in a dark, peaceful and comfortable environment. Staying at home eliminates the first of all birth interventions.

6) Realize that contractions serve a purpose and pain is not suffering. Penny Simkin's article Comfort in Labor, How You Can Help Yourself to a Normal Satisfying Childbirth is excerpted below,

Most women today are expected, even pressured, to have an epidural in labor, because they and the influential people in their lives equate labor pain with suffering. While an epidural eliminates almost all sensation, including pain, it does not address fear, worry, loneliness, helplessness, or other emotions that lead to distress, dissatisfaction, or even suffering. To prevent suffering, women need more than relief of pain; they need to recognize that labor pain is a side effect of a normal process, not a sign of damage or injury. They need a sense of mastery and well-being as they respond to their pain, but they also need humane, caring, confident people giving continuous support throughout labor. 

7) Breathe. Rythmic breathing is taught in Lamaze and other childbirth preparation courses.

8) Rythm - find yourself in a pattern. That may be rocking, swaying, groaning, or whatever best suits you.

9) Low, deep sounds. Work with your body and "moan out" your surges.

10) Massage and other touches. I enjoy massaging my clients with a 1% dilution of lavender essential oil in grapeseed or fractionated coconut oil.

11) Hot and cold compresses.

12) Counterpressure and double hip squeeze; especially useful for back labor.

13) Many people find positive mantras and music to be helpful during labor. Guided mediation, as taught by hypnobirthing, is amazing!!

14) Surrender

15) TENS Unit or transcutaneous electrical nerve stimulation, can act as a "gatekeeper" to block pain messages to the brain and cause the body to release natural endorphins.

Understand that there may be times when intervention is very appropriate, such as in a very long labor, or perhaps your body needs some relaxation. At these times, women may consider an epidural or IV narcotics. Hopefully someday a combination of gas and air may be available in the United States.
Below you'll see a video on how an epidural is administered and I encourage you to take the time and read The Big Bad Epidural that has links to risks of the epidural but also talks about when an epidural can be a blessing to the mother! And more information at Childbirth Connection.

As mentioned, IV narcotics are another option. Some women describe these as taking the edge off, others dislike them due to the neurological effects.

Keep up to date with YC Birth Circle to join us the next time we cover this and other great topics or find a childbirth preparation course near you to practice some of the comfort measures we covered!

Past Birth Circle Topics:

• Share The Love
• Fertility Awareness
• Meet The Photog
• What's A Birth Circle
• Frequently Un-Asked Questions
• Childbirth In Pop Culture
• Nutrition in Pregnancy
• Essential Oils
• Homeoprophylaxis   
• Birth Stories

'Like' YC Birth Circle on Facebook

Sign up for monthly email reminders of our meet ups

Labor + Doula =

Happy World Doula Week / March 22-28, 2014

Share The Love {A Birth Circle Topic}

Sibling Bonding

A lot of parents are nervous for the arrival of a new baby. They wonder how their toddlers will adjust and how they will adjust. One option is to hire a postpartum doula; she comes in to "mother the mother". A postpartum doula brings the support you need to cherish your children, nurture yourself, and perhaps allow you 40 days of rest. She helps with small tasks around the home, assists with older siblings, family bonding, and more, all while helping your incorporate the parenting style you desire into your growing family.

Sibling bonding is an essential part of introducing a new baby into your home. So how can we best facilitate a stronger bond between our toddlers and newborn? 

Take off that hat!

Introducing a new baby into the family begins with pregnancy and is carried on after the birth with language - "Our Baby". Using terminology that includes your toddler, even giving him some stake, creates a bond of caring and protectiveness and can subdue the jealousy factor immensely. 

Including your toddler while nursing is also a great way to form bonding, including using sticker charts - let them give you a star each time your nurse! Or change the baby's socks. I loved to place a pair of socks at the other end of the room and play Red Light, Green Light with my tyke while I nursed; and when he got to the socks, he brought them over, played This Little Piggy on his brother, and put the socks on him. 

For other great activities, check out -

The Nursling and The Tyke

Don't forget to address factors such as how long/if your toddler is weaned. If your toddler has not been away from the breast for long, she may desire to reestablish that connection with you once the baby is born. The La Leche League can offer great support for tandem nursing and is also a great place to allow your toddler to see babies nursing. This is helpful for all toddlers, whether they need to see it and gain understanding of what to expect or whether the experience may allow them to understand that your breasts are not only for them but that 'all' babies nurse.

Other Birth Circle Topics:

• Fertility Awareness
• Meet The Photog
• What's A Birth Circle
• Frequently Un-Asked Questions
• Childbirth In Pop Culture
• Nutrition in Pregnancy
• Essential Oils
• Homeoprophylaxis   
• Birth Stories

VBAC

So you've had a cesarean - does that mean your other births must be a cesarean?  No! In fact, a VBAC (vaginal birth after cesarean) may be a safer option for you and your baby. What about 'once a cesarean, always a cesarean'? -Evidence shows otherwise; surround yourself with support and encouragement, educate yourself, hire a doula, choose your birth place and care provider carefully and avoid induction to improve your chances for a successful VBAC.

What are the benefits of a vbac?

An official statement by ACOG says

a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans

See the full article.

 

Bonding

Labor is an intricate dance of hormones; the most important of these- the "hormone of love" -oxytocin. This is not to say that you can't bond with your baby if they are born via cesarean but this very important hormone that enhances the bonding experience is lost in an [elective] cesarean section.  A cesarean section is major abdominal surgery and can be painful to recover from.  This associated pain can inhibit the bonding you experience during breastfeeding and can make breastfeeding more difficult. When a baby is born via c-section milk may take a few extra days to come in- don't let this discourage you.

 

The Big Squeeze

When a baby is born vaginally, fluid is expelled from the lungs when the baby is 'squeezed' through the birth canal. When a baby is born via cesarean section this factor is lost and can result in faster, shallower breathing; this is usually resolved within 24-48 hours. Another benefit lost to cesarean section would be delayed cord clamping.

 

What about a uterine rupture?

According to a recent UK study, the risk of uterine rupture is .2%; the study goes on to say

For women with a previous cesarean section, risk of uterine rupture increases with number of previous cesarean deliveries, a short interval since the last cesarean section, and labour induction and/or augmentation.

The fear of uterine rupture is the most common concern I hear in regards to a VBAC; according to the NIH consensus, 99.5% will remain intact. [This blog shares the evidence for decreased risks after multiple VBAC's.] There are risks associated with both an RCS (repeat cesarean section) and a TOLAC (trial of labor after cesarean)- the problem lies in that most women who are considering a VBAC are told of the risks associated with a trial of labor but not the risks associated with a cesarean section.

 

Risks of Cesarean

Risks for Mother	Risks for Baby
·         Infection ·         Longer hospital stay ·         Hematoma ·         Return to hospital ·         Extended recovery time ·         Injury to organs ·         Ongoing pain (6-12months post delivery) ·         Chronic pelvic pain ·         Hemorrhage ·         Mortality ·         Negative emotional reactions	·         Respiratory problems ·         Pulmonary hypertension ·         Difficulty breastfeeding ·         Premature birth (in a planned cesarean) ·         Fetal Injury ·         Lower APGAR scores
Risks for future pregnancies
Risks are greater after 2 or more cesareans. It is recommended to have a minimum of 18 months before a TOLAC.       ·         Placenta previa       ·         Placenta accreta       ·         Placental abruption ·         Uterine rupture

The fact of the matter

VBAC Support

Cesareans don't just require physical healing, they impact us emotionally and socially as well.  Both mothers and babies benefit from a successful VBAC with fewer complications, easier breastfeeding and a more positive outlook of the birth experience. There are many factors that go into achieving your VBAC, the most important of which is support.  Finding a care provider who will support you and a birth place where you are comfortable are critical components. You will probably find doula support to be indispensable -- a doula will support you prenatally as well as offer emotional [and physical]comfort during labor, which may be a central component to your VBAC. For online resources and to find support in your area, visit my helpful links tab.

Above all, be empowered in your birth by making an informed choice on this Journey of Life. I hope this blog post can help support that decision and would love for you to share your VBAC story here!

Do You Doula?

Emily says,

 With my first two pregnancies, I didn’t hire a doula. Heck, I don’t even think I knew what a doula was. I felt that giving birth was a completely private event, and I only wanted to share that experience with my husband and necessary medical staff.

~Read her story to find out what changed her mind and how a doula impacted her subsequent birth experiences.

Crystal says,

my sister-in-law announced that she would be using a doula for her second child’s delivery.  ”A what?” I asked…”a doula.” was the reply.

With three children to my credit, I have always been happily pro drug, pro hospital, pro doctor.

Read her very well written account of a doula attended birth to see what changed her perspective of a doula and made her say..

at the risk of sounding like a crazy, hippie-dippy, sparkly rainbow lover and magical loving fruit loop of a nut job, I will put it out there.  I will say it.  This magical gift of a woman, this doula was wonderful. 

In what was, for me, the comfort zone of beeping machines, copious hand sanitizer and droves of personnel equipped with advanced degrees and special badges, I watched the most basic of all things natural unfold.  A woman, comforted, coached and calmed a laboring mother while she brought her baby into the world.  It was a revelation for this mother.  How a delivery could go so smoothly...

Because we are led to believe that laboring women need monitoring, constant checking, IV’s, medications, interventions and whole carts of instruments to bring a human being into the world.  When maybe the most effective, and dare I say most important vehicle to assist in delivery is a calm companion.  Someone who knows, with unshakable conviction that women were designed to have babies.  That birth is not an instantaneous process.  Someone comfortable with the fact that labor and delivery take as long as they take, and someone that is adept at soothing a mother through the pain and anxiety of childbirth.

Dads say,

When my wife told me that she wanted a doula, I was hurt. I truly though with our first baby I'd be able to be the end all be all for my wife

after the birth they say,

Now I don’t know how anyone could manage to give birth without one. Our doula really helped bring me together with my wife as she gave birth. My wife remembers my constant support and never failing love or knowledge. She remembers the doula as a nice person who did some stuff in the background. We won’t give birth without a doula.

Find out why!

What do the experts say?

 

The Cochrane Collaboration finds,

Given the clear benefits and no known risks associated with support, every effort should be made to ensure that all laboring women receive continuous support. This support should include continuous presence, the provision of hands on comfort and encouragement.

Pam England declares,

Asking your husband to be your sole guide through labor is like asking him to lead the way on a climb of Mt. Everest.  He may be smart and trustworthy, you may love him, but in the HImalayas you'd both be a lot better off with a Sherpa!

John H Kennell, MD writes,

If a doula were a drug, it would be unethical not to use it.

In this Net Wellness article he says, a doula is  

a risk-free option for pain relief during childbirth.

Penny Simkin, PT says,  

support and assistance of a doula during birth enhances postpartum recovery. 

In her book, The Birth Partner, she explains,

While the doula probably knows more than the partner about birth, hospitals and maternity care, the partner knows more about the woman’s personality, likes, dislikes and needs. Moreover, he loves the woman more than anyone else there. The combination of partner and doula, along with a caring staff gives the woman the best chance of an optimal outcome.

Suze Orman says,

 a doula is a need not a want  

~on Can I Afford It? Bethany
 
 DONA Position Paper: The Birth Doula's Contribution to Modern Maternity Care

More about "what's a doula" 

How do I doula?

 

I support your birth, your way.  Visit my website and my Doula Match Profile to learn more about my qualifications and the services I offer for you on this Journey of Life.

Informed Consent

According to the American Medical Association, informed consent

is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.

In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with your patient:

• The patient's diagnosis, if known;
• The nature and purpose of a proposed treatment or procedure;
• The risks and benefits of a proposed treatment or procedure;
• Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);
• The risks and benefits of the alternative treatment or procedure; and
• The risks and benefits of not receiving or undergoing a treatment or procedure.

In turn, your patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention.

A key factor in the case of labor and birth would be timing.  Be sure to ask if the situation is urgent or if the procedure can wait.  Consider what is being used to indicate timing.  For example, does an electronic fetal monitor indicate baby's heart rate is dipping?  Note your position.  Are you lying on your back?  This position cuts off oxygen to the baby which results in a stressed fetal response,  Try lying on your left side and see if this fixes the problem. 

Continuous monitoring became a standard obstetrical procedure before studies could show if the benefits outweighed the risks, and without clear-cut guidelines on how doctors should interpret the findings. (Brody, 2009)

Evidence shows intermittent auscultation is the best way to monitor baby during labor.  Were you told this or of the risks of cEFM, including increased vacuum extraction, increased incidence of cesarean section without a reduced risk in perinatal mortality?  I have seen all too often women whose doctors told them they'd have the freedom to move during labor only to find once in the situation they were restricted far more than they would have liked and had been led to believe by the monitors.  In the examples above and below, restriction to the bed could be the cause of the 'problem.'

Perhaps your labor seems to not be progressing.  Before you sign the consent for a cesarean , consider dilation is not the sole purpose for contractions.  Labor is a delicate dance, according to an article in Midwifery Today,

What a contraction is doing is always ahead of what a cervix is telling.

There is purpose for pauses in labor, yet some medical professionals tend to jump the gun and assume labor has stalled, opt for a c-section and jot down "failure to progress" on your medical record. Easy, safe, fast fix.  Though it's not always safe.  Let me remind you, to be informed you must be aware of the risks and benefits of accepting the intervention as well as declining it.  Informed consent should not be fear based, yet the laboring woman is told you're not progressing, something is wrong.  This creates fear & anxiety, which are not conducive to labor and birth, and also puts the pressure on the laboring mother to "hurry up and dilate" -a bodily process she cannot directly control. 

Labour in a clinical environment may undermine women's feelings of competence, perceptions of labour, confidence in adapting to parenthood and initiation of successful breastfeeding. (Hofmeyr, Nikodem et al. 1991) 

This referenced study exhibits some of the risks of laboring at a hospital.  A hospital 'requires' at least one cervical exam and the risks explored here include unnecessary surgery, postpartum depression and more.  Were you informed of this?  Were you informed of the risks and benefits of cervical examines?  Did you know you have the option to say no.  Remember, it's your body, your birth experience.  Keep calm and birth on!

A person must be "in a reasonable state of mind" in order to give informed consent.  A woman in a non-medicated labor is in a primal state- this is not of reasonable mind.  When in this state, being coerced with fear does not equal informed choice.  It is essential to educate yourself on labor and birth, create a birth plan, get to know your care provider and hire a doula- this person can advocate for you and help you remember your options and assist you in making informed choices when emergencies arise.  Labor and birth are unique to each woman and each birth yet too frequently women are treated on the same basic template.  When something arises that an intervention is suggested, a woman in labor is not necessarily of a "reasonable state of mind" and her partner may become intimidated, stressed and concerned for her well being and that of the baby.  A doula comes equipped with a clear mind in the time of need and knowledge of the physiology of labor and birth, of various medical interventions and of hospital protocols.  Using a doula facilitates informed consent.  She is not there to make choices for you but to inform you of your choices.

Evidence shows that using a doula decreases the request for epidurals.  When a woman asks her doctor about pain relief it isn't very often they recommend a doula, most frequently they'll mention narcotics and epidurals.  Ask about the risks and benefits! And don't accept the answer that there aren't any risks- it's simply not true. 

Empower yourself on this Journey of Life with education to understand all of your options for labor and birth.  Be informed when you consent!

Who Will Attend Your Birth

Did you realize this the birth of your baby?? The people there should be those chosen by you!  You hire your doctor/midwife, you hire your doula, you invite whoever else you please and restrict anyone you like.  I've already mentioned the benefits of a doula here and be sure to read up on what the American Pregnancy Association has to say about having a doula. 

If you're wondering whether or not to have your mother or mother-in-law present, have a chat with her.  Let her know what kind of support you will find beneficial at your birth and decide from there.  Do you have a sister who offers too much unsolicited advice?  A best friend who loves updating her facebook every contraction?  You may want to kindly ask them to wait in another room and invite them to visit your new little bundle whenever you're ready.

An OB or a Midwife- which is right for you? 

 

An obstetrician/gynocologist is a phsycian who provides medical and surgical care for women, with specialize training of the female reproductive system and pregnancy.

This OB/GYN link specifies their training requirements and more.  An OB is a great choice if you are high-risk because they are trained to find complications and manage them. OB's attend hospital births which typically cost $16,000-$21,000 for an uncomplicated vaginal birth.

When deciding on an obstetrician get an idea for their view of childbirth with these questions:

1. What is your philosophy about childbirth? What do you feel your role is?

2. What is your cesarean rate?  (The WHO recommends no higher than 15%)

3. How do you feel about parent written birth plans?

4. How do you feel about unassisted childbirth? (This isn't to say your planning on one, it's just to get a feel for how much this particular care provider trusts birth.)

5. What is your episiotomy rate?

6. What do you do to reduce the chance of tearing or the need for an episiotomy?

7. How do you feel about doulas?

8. (If they are female) Do you have children? Tell me about your birth experiences.

9. What happens if my water breaks before labor begins? What kind of time-frame am I restricted to?

10.  Do you practice active management of labor? Do you routinely intervene or allow labor to progress normally?

11. What hospital(s) do you practice in?

12. What happens if I go past 40 weeks? 41 weeks? 42 weeks?

13. What is your induction rate? Under what conditions to you advice an induction?

14.  What natural induction techniques do you recommend?

15. What percentage of your "patients" are high-risk / low-risk?

16. What conditions do you consider high-risk?

17. How do you handle fetal monitoring?

18. Will I have freedom of movement during labor?

19. Can I try alternate birth positions?

20. Do you have any plans or interferences around the time my baby is due?

21. What prenatal procedures do you typically do?

 

A midwife is a person trained to assist women in childbirth. 

There are different types of certification and training for midwives, the most common of which I'll cover. 

There are direct-entry midwives, who do not require prior education as a nurse.  These are CPM's, or a certified professional midwife who has met the standards for certification set by the  North American Registry of Midwives or licensed midwives, LM, who practice in a specific state.  These midwives work in out of hospital settings. A typical home birth varies in cost by location.  After midwife fees, supplies and labs you can probably expect to pay $4000-$5000.

Some questions to ask a potential midwife:

1. What is your philosophy about childbirth?

2. What is your training and experience?

3. Do you routinely perform vaginal exams or only by request?

4. What other methods do you use to assess dilation?

5. What happens if I go past 42 weeks?

6. What do you do if the baby is breech?

7. Regardless of whether you will attend a vaginal breech birth, how do you feel about them?

8. What do you consider high risk?

9. When in labor do you come to my home?

10. How often do you check baby's heart rate and what do you use?

11. What is your episiotomy rate?

12. What do you do to help prevent a tear? 

13. What kind of equipment and medication do you have at a birth?

14. How does a transfer work? What is your transfer rate?

15. What are your fees? What is included/not included?

16. Do you offer placental encapsulation?

17. What happens if my water breaks before labor begins?

18. What is your experience with shoulder dystocia? Cord prolapse? Postpartum hemorrhage?

19. Do you work with doulas? Birth photographers?

20. Do you recommend or work with a doctor in case of emergency?

21. Who will attend my birth if you are sick or unavailable?

22. Do you offer or recommend a particular childbirth education class?

23. Can I have a water birth? Do you supply the tub?

24. Can I eat while in labor?

25. What do you normally do during labor?

26. Can my partner catch the baby?

27. Under what circumstances would you artificially rupture the membranes?

28. What newborn procedures do you typically do?

A CNM, or certified nurse midwife, is an advanced practice nurse who attends your birth in a hospital or home.  They work with a doctor who backs them up should complications arise.  I like to think of CNM's as the in-between- you don't want a doctor but you still want to birth at the hospital. Or possibly you'll choose a CNM because they are covered by your insurance provider.  No matter who you choose, remember you have hired them! You can change care providers at anytime if you determine they are not the right fit for you!

Getting ready for your baby's Journey of Life can involve making a lot of decisions; it's important to have people beside you who will support you in positive ways and empower you in your childbirth experience.  

What questions do you ask potential care providers and doulas?  Share your experiences here!

Doula Without Guilt

This blog is in response to a book published in 2011 Epidural Without Guilt.
Below the author addresses "epidural myths" and attempts to dispute them.  Quite often he avoids the real truth and topic at hand, so I've taken each issue and readdressed it.

"* Epidurals will slow down my labor

This is a commonly believed myth, but in fact is not true. Since 2005, there have been four scientific studies published on this issue. Three of the studies found that instead of slowing down labor, pregnancy epidurals and spinal epidurals actually speed labor up – especially when pregnancy epidurals are given before the cervix is 4 cm dilated. The fourth (and largest) of the studies showed no difference in how long labor lasted, whether or not a pregnancy epidural was used. So pregnancy epidurals do not slow labor down – they may even speed it up."

If a woman has been in labor for a long time (whatever she deems as long) an epidural can indeed relax her enough and provide her with much needed rest to continue and even speed up her labor.  Until you get it, you don’t know how you’ll respond to it, therefore a better option may be to hire a doula and take childbirth education classes that teach you natural coping methods.  There are plenty of natural techniques and tools for relaxation; water and breathing to name a couple.  Ina May’s sphincter law explains why relaxation is so essential. 

The problem with receiving an epidural before 4 cm dilated lies in the increased risk for baby going to NICU.    Quite commonly when a woman has had an epidural she will develop a fever; medical personnel have no way to determine whether or not this is due to an infection and therefore baby will be sent to NICU “just in case.”  The longer a woman has an epidural the higher her temperature may be.

An epidural comes with an I.V., a blood pressure cuff, continuous fetal monitoring (which since began has not shown a decrease in infant mortality but an increase in cesarean rates) and the inability to move.  This limit to mobility is what results in a slower labor and increased risk for a cesarean.  A better option would be to keep your mobility.  Use your doula to help you find a rhythm.  Trust your body to birth and you’ll naturally find the positions best suited to work with your labor.  Doula’s are experienced in labor and can help with suggestions for comfort and assist in helping baby into the best position resulting in a more efficient labor.

"* Epidurals will increase the chance that I will need a cesarean

This is an old myth will not go away, even though many studies from different parts of the world have found that pregnancy epidurals do NOT increase the chance of needing a cesarean. So why all the confusion despite solid scientific evidence? It’s because pregnancy epidurals are associated with cesareans, but they don’t cause cesareans. What do I mean by this? Well, women who have difficult, painful labors are more likely to need a cesarean. And these are the SAME women who are more likely to ask for a labor epidural – so there is an association between labor epidurals and cesareans. But the labor epidural does NOT make a cesarean more likely."

On the side of medical interventions, what an epidural does negatively interfere with is pushing; resulting in the increased use of vacuum or forceps extraction and an increased risk for tearing. 

Cesarean rates are increased for women receiving an epidural accompanied with induction or augmentation.  When Pitocin is administered contractions are more erratic and forceful, due to this most of those women receive an epidural.  Pitocin will gradually be increased throughout labor based on physician direction and other medical protocol.  Once the epidural is administered, the woman no longer feels the pain of the contractions and therefore will not direct stopping the drip.  The epidural has cut off this(pain) necessary means of communication.  Meanwhile, though contractions weren’t feeling stronger for mom, they were becoming increasingly stressful on baby.  The only way baby communicates stress is a drop in the heart rate.  Once this happens, even if Pitocin is turned off its affects can still be felt for an hour, which is far too long for a decreased heart rate in baby, resulting in a c-section.  Pitocin and Epidural do a dance together, as they each have opposite effect.  One relaxes and one stresses and therefore as you give one you necessitate the other.  The real problem of the two being pitocin.

Doulas are beneficial no matter what type of birth you plan on having.  Studies show that using a doula decreases the incidence of cesarean!

"* Epidurals will cause backache

It turns out that backache is very common during pregnancy and after pregnancy. In fact many women experience backaches after they deliver that can last for many months. Scientific studies of backache after delivery have found that the chance of having a long-lasting backache is the same whether or not the mom got a labor epidural."

Backache is the least of your worries if you are faced with PDPH, better known as Postdural puncture headache.  When signing the informed consent form, most women are not told that it is a blind procedure and that every woman is different!  Due to this and the precise location the medication needs to be administered into, it is not uncommon that the needle goes a bit too far causing a leak in spinal fluid.  What happens then is your brain is compressed heavily against your skull and no longer cushioned by the fluid resulting in an extreme headache when in any position besides lying flat.  The best fix for this problem being the epidural blood patch.

Due to not being able to feel when pushing, it is not uncommon that women overstrain themselves, therefore resulting in more of a backache than they may have had.  Pushing with an epidural can take longer because the woman may not be pushing as effectively as she could be.  Women pushing with epidurals are generally pushing as directed.  There are numerous benefits to pushing on instinct that are hindered by epidurals.  You’ll never know, so why not take the more natural approach and use a doula to help with coping during labor.  If you don’t have an epidural you can (ideally) push in any position you’d like.  More optimum pushing positions result in more effective pushing and less strain.  Listen to your body and trust birth!

"*Epidurals are dangerous for my baby

This is a particularly wicked myth, because it makes women feel guilty for wanting to their pain relieved. Although there are certain problems with labor epidurals that could be bad for babies, for example, a significant lowering of the woman’s blood pressure – most effects of labor epidurals are actually helpful for the baby. An example of this is the labor epidural lowering the woman’s stress level and thus getting more blood flow and oxygen to the baby during labor and delivery."

I feel this completely is avoiding the topic at hand- that epidurals are derived of cocaine.  No matter how you spell it, drugs cross the placental barrier and baby is receiving the drug as well.  The bonding between mom and baby is threatened from an epidural in that it reduces the suckling desire, causes baby to be drowsy and increases the risk of baby being sent to NICU resulting in a loss of that precious bonding time.  The safest bet for baby and bonding is a natural labor allowing the amazing hormones of pregnancy to do their thing.  Epidurals interfere with the natural flow of hormones that are so important for bonding.

Using a doula reduces the likelihood of requesting an epidural.  Doulas can help you relax and manage the sensations of labor without drugs.  A doula is there to help you have your ideal birth; if you plan on using pain medication and doula can most definitely support you in that as well. 

"*Epidurals will prevent me from breastfeeding my baby

I hear this myth repeated all the time, but the scientific evidence is scanty, at best. Modern pregnancy epidurals and spinal epidurals use such low doses of medication that it’s hard to imagine a negative effect on breast-feeding the newborn. In fact, pain after delivery can be bad for breast-feeding. Pain reduces the amount of milk a new mother produces. And a new mom in pain may be less likely to want to interact with her new baby. So I suggest something that isn’t usually considered: think about using a very low-dose labor epidural after a difficult vaginal delivery, and certainly after cesarean. It’s the best way we have to make the mom comfortable without being drowsy."

It has been proven that women who receive epidurals are more likely to have pain once it has worn off because they have not received the necessary hormones that flow in a natural labor and they have possibly strained more than necessary while pushing.  When a woman uses natural coping methods and allows the natural flow of hormones she experiences elation after the birth of her baby, experiencing the unsurpassed “birth high.”  She is able to get up and walk around, without pain and bond with her baby as nature intended.  A doula can help a new mother begin breastfeeding.  A baby who has not received epidural drugs will root for the nipple and latch on its own.   

After birth, a woman feels “after-pains” which is the uterus contracting to return to its original size and place.  This is a necessary part of birth that does become more intense after each child.  These after-pains can be felt for days after birth; it took nine months for your uterus to expand, it needs sometime to return to its original shape and size!  Oxytocin is the hormone that stimulates the uterus to contract and is released while breastfeeding.  Your milk, which won’t come in until a few days postpartum, will not be hindered by this as the paragraph in the book seems to be suggesting! 

Whether you have the epidural or not, your doula will be there to help you start breastfeeding; lean on her again to relax and breathe through the after-pains.  However you do it, do it without guilt; this amazing part of the Journey of Life.

What's a Doula?

I am so passionate about my work.  I love making a difference in the lives of families and helping them to a better birth experience.  My biggest challenge? Educating women that they have options! This is their birth experience!  Most people don't even realize that they can make choices to influence a better birth experience.  Too many people have never heard of a doula despite the great statistics there are on the benefits of using a doula.  Most women don't realize that their partner is not their doula, rather the doula and the partner work as a team.  Most men don't realize how much they'll appreciate the help from a doula so that they too can enjoy the birth experience. To both you and your partner, a doula is a comforting constant, especially when in a hospital setting where there's nurse shift changes and a greater chance of interventions. 

 So what's a doula?

Someone who knows, with unshakable conviction that women were designed to have babies. Someone comfortable with the fact that labor and delivery take as long as they take, and someone that is adept at soothing a mother through the pain and anxiety of childbirth. -Crystal

A birth doula is a trained and experienced professional who provides continuous support throughout labor.  It is a Greek word meaning "woman who serves."  A doula supports the emotional and non-clinical physical needs of the laboring mother and her partner. 

We'll save "what's a postpartum doula" for another blog. 

So why use a doula??

• Continuous support from another woman has been proven to have a positive impact on labor. Birth Matters!
• Having a doula as part of your birth team decreases the cesarean rate by 50%, the length of labor by 25%, the use of oxytocin by 40%, and the requests for an epidural by 60% -according to the American Pregnancy Association
• A doula can help ease the stress of labor for the birth partner and can help him share in the birth at his level of comfort.
• Women who use a doula report more satisfaction with their birth experience.
• A doula helps you have Your Birth, Your Way!

http://www.dona.org/
http://www.americanpregnancy.org/labornbirth/havingadoula.html

I'm passionate about women knowing their options and educating themselves about their pregnancy and birth!  This is an amazing part of the Journey of life, perhaps the most important; that first moment of bonding between mother and child begins a lifetime of love.