Time Running out?

How will your birth turn out?

Of course there is no way of knowing for sure. One of the exciting, and scary, things about having a baby is that so much of it is a surprise! Your choice of caregiver though will affect the choices available to you and may affect the sort of birth experience that you have.

There are two types of care - we will call one routine, and one personalized.

Routine: Routine care is the most common form of care in most Western countries. It is called "Active Management" by the medical profession. Routine care involves having routine procedures and protocols that are applied to all pregnant women. For example, an obstetrician may give all pregnant women iron tablets, regardless of whether they have iron-deficiency anemia or not. The reason for this is that the caregiver is taking a "just in case" approach. This can seem very reassuring. However, it also means that the unique and individual needs of you and your baby are not being taken into account. It also means that you will be exposed to a number of interventions that are not medically necessary but are routine.

Personalized: Personalized care is more commonly provided by midwives although many obstetricians do take this approach as well. It is called "Expectant Management" by the medical community. In this approach nothing is routine, with protocols and hospital policies being less significant. Rather than treating all pregnant women the same, each woman is looked at individually. If she is showing signs of iron deficiency anemia for example, the caregiver might prescribe iron tablets. The interesting thing is that the research shows that mothers and babies are just as healthy with this approach as they are with routine care. The benefit is that you and your baby are being treated as unique individuals with unique needs, you will be exposed to less interventions, and have more choices available to you.

How can you tell if your caregiver is routine or personalized?

It can be really difficult to know which type of caregiver you have at the moment, especially if this is your first baby. If you have a routine caregiver there are a few clear signs though which include:

• Your prenatal appointments are generally short, often no more than 5 minutes

• Your caregiver always checks the baby using ultrasound rather than his/her hands on your belly and a tape measure

• You may have been having vaginal examinations throughout pregnancy and will probably be having them every appointment from 38 weeks

• Your caregiver may be reluctant to talk about a birth plan or tells you not to worry about anything and let them take care of it all

It can be helpful to have a few simple questions to ask your caregiver to get a clear idea on where they stand and then to be able to identify whether or not you have similar beliefs. The B'LIEFS tool can be helpful for this:

B - Bed (how do you feel about me being in positions off the bed for labor?)

L - how Long? (what sort of time limits do you have for first stage or pushing?)

I - Induction (under what circumstances would you induce labor?)

E - Episiotomy (how often do you find it is necessary to do an episiotomy?)

F - Food (how do you feel about me eating and drinking during labor?)

S - Supporters (what are your thoughts on me having a doula or additional supporter)

Even if you decide that you are comfortable with having routine care, asking these questions helps you to identify what is important to you and whether you and your caregiver are on the same page. Your doula or childbirth educator can help you to practice these and similar questions and how to explore your options if you decide you would like a different approach from the one you currently have.

This article is reprinted with permission from Childbirth International

Another type of birth story.

This is another type of birth story. It is graphic, due to nudity and childbirth photography/

Beautiful.

http://www.onetruem edia.com/ otm_site/ view_shared? p=3c5b874ed95f8e a9bf9466&skin_id=1009&utm_source=otm&utm_medium=text_ url

enjoy.

Birth and Choices

This all stems from a discussion group I am a part of, where we were debating the purpose, role and goals we should have as Doula's. I stand by my right to attend any woman who feels that my help will cause her less stress, more peace, less fear and more joy. Natural, or medicated, or c-section. I am not a judge, I am a comfort.

A piece of my mind... Why is only one way right? How can I say you shouldn't do what's right for you? But - You need to know what you want to choose. You need to care before you walk into the hospital.

What is it with women and pain? Why are we martyrs? I think women are martyrs when they stop trusting in the power of their own bodies wisdom and trusting the power of drugs. Yes that's right. I said it.

I support women through labor. I've seen them walk into hospitals and literally give themselves over to the medicine. They are doing fine- great!- and as soon as they see the hospital staff- bam! "I want an epidural- now!" Is it appropriate, is it necessary? Or is fear the great motivator?

Of course, the staff administers it to them. It is their responsibility to do so. If the patient asks for pain relief, you don't withhold it. Pain is whatever the patient says it is. Everyone has their threshold. And, they will be sued(rightly!) if they refuse to give it for any reason other than it is medically unsound.

But, I think women are sacrificing themselves. To medicine. When a woman is in labor and does so without medical intervention, natural endorphins are released and cause the woman greater satisfaction with the birth. Simple as that.

This is not a philosophical view, it's plain old evidence.

So there, I am a radical practitioner in saying that though many women think their birth experiences are good with epidurals(and they are!), they are fantastic without them.

I stand by women, and when I hear Doula's espousing only one way is the right way- well, I think it's wrong. I love my profession, my work- but there has to be a time where the sisterhood of our jobs has a boundary. This is it. I will not be accused of carelessness because I feel every woman has a right to choices and my standing by them through their labor.

Where is my line? I won't attend to women in elective abortions. I attend women who have elective c-sections, vbac's, epidurals, leboyer, home births. A woman giving birth, is still in need of support.

But if pushed, non-medicated births, gently and naturally- those are the best. I love those. But all are beautiful. A new family is a beautiful thing.

Oy, I really have gone off the story telling path. Okay, next time- a story.

Okay, Okay- but I really had to share this one!

Birth is not only about making babies. Birth is about making mothers ~ strong, competent, capable mothers who trust themselves and know their inner strength.- Barbara Katz Rothman

Might I add, that fathers are made too! ... But how true is this?!

Devina & Emma

Finally- sorry, time got away from me!

Devina was a 17 year old unwed mom. She had come from a family where dysfunction was an understatement for the state of being. Devina became pregnant when she was dating a 23 year old. Her parents abandoned her and she was sent by the department of child and family services to a home for unwed, pregnant teens. This is where I met her. Devina had a sincere desire to change the negative patterns in her family. She had plans to attend college, and earn a degree in sociology. She intended to make changes in her world. This girl was focused and determined to live her life better than before.

I had begun working with her as a nurse in this maternity hospital setting. I really connected with her. Devina was determined to give birth in a natural and non-traumatic way. But- remember, she was seventeen years old. I was able to speak with her about her goals and what she needed from her support person- me. She had never had a nurturing mother and was determined to be one, someday. I believe strongly that one leads by example. So the nurturing I was doing was making a psychological imprint on her.

On a Sunday night at 1 am, she began feeling her first contractions. She informed the overnight counselor that she was feeling contractions, but wanted to be alone and went to her room, but kept the door open. I arrived for my shift at 6:30 am, to find Devina in early labor at 3cm dilation. I remained with her and walked with her until 8:30 am, when her water broke to go the the hospital wing- the birthing center. I helped her check in and her back pain was increasing. We began to sway. She was now at 5cm dilation. Devina was asked if she wanted any pain relief but she looked determined when she refused. She touched my heart and told me that this was nothing compared to some of the pain she experienced growing up. I told her that I was proud of her, but that if she felt like she was "loosing it" she should not panic. I know that she was scared. 1:00pm- At 6.5 cm dilation, she began to withdraw. She was receptive to encouragement, she allowed me to rub her back, to massage her neck and to coach her breathing and position. But she stopped verbal communication. The active labor period took two hours. It was now she began to whimper and to cry. Transition to 10 cm was 20 minutes. Devina was determined to get through it, but in reality- she was still a child herself. But as we know even seasoned birthing mothers respond this way at the end of the first stage.

At 3:00, she felt the urge to push. Sheer panic hit her- the reality of pushing was scary to her. When she pushed ( involuntarily) she felt the pressure and began to fear the pain. I looked at her and said "Devina, you can do this. You are a strong young woman. You are capable. This, is the moment you waited for. Push, Devina- I believe in you. Push!" She took it one push at a time. She was squatting and had a bar to lean against. She delivered a beautiful baby girl she called Emma. She held her for a while and then gave her to me for a hold. She delivered the placenta half an hour later and when she had spent another hour with the baby- she did the most amazing thing I have ever seen a mother do. It has not occurred since. Devina spoke all her secrets to her daughter. She told her that she is loved, and that is exactly why she has made this decision. She handed the baby to the pediatric nurse and said goodbye. She put Emma up for adoption. The Adoptive Parents were notified and were waiting to receive their new baby.

Devina cried, so did I - she looked at me and said: " I'm not a bad mother, I just can't give Emma what she needs and I need to be a better me- before I parent. " I told her that Emma was the luckiest little girl in the whole world. And that Devina was going to be an amazing woman. Her post partum recovery period was fine, at that time she was given a shot to stop the milk production and she turned 18 the following month. She got a job, and took the High school Equivalence exam. Then I lost touch with her. She was off to live another life, in another state.

It was quite a powerful experience to have been privileged to be a part of. Emma should be about 15 years old now.

* names have been changed to protect privacy.