Wise Women Surround You

Women love telling you about their births, especially if you are pregnant.  None of us will make the exact same decisions, just as we will labor differently, and mother our children differently.  

The wisdom of experience and hindsight are pretty incredible.  Do you know what the mamas around you have to say?  You might be surprised what a simple, casual question brings out. 

There are wise women all around you.   Here’s what a few I know had to say in response to this question:

What is the one thing you wish you'd known before having your baby? What is the one factor that most influenced the path you took?

·        * Before having baby #1 - I wish I'd known I was actually in charge of the decision making. What influenced the other birth (5) experiences - knowing that I was in charge of making decisions. 

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      * I wish I'd know that I didn't have to go to the hospital the same day that I started leaking fluid...I knew we didn't have to go immediately (no fever, fluid was clear, nothing in rule, baby moving), but I still majorly increased my risks going to the hospital too early.

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       * I wish I had known more about my "high risk" status and what exactly ruled me out of a VBAC. I researched...but military docs aren't exactly forthcoming about the info. If I had honestly known where the best info was, I might have done a home birth with my 2^nd.

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      * How little support you actually get from nurses and doctors...even the good ones just aren't there to hold your hand like you might need/want. 

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            * How long it takes to feel normal again.

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       *The difference between using my OB/GYN (first two pregnancies) vs. my midwife (last pregnancy).  Felt valued more with my mid-wife and less stressed (course having a 3rd baby - you already feel like you've been there done that after two babies so that might play into the lower stress experienced).  I felt more like a cow being herded in and out with my OB/GYN.  Only thing missing was a bell around my neck.  My midwife took time to really listen, devoted an hour to each appointment and made sure my labor was as even/balanced (for lack of a better word) than like an appointment.

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     * I, too, wish I’d been in charge of the decision-making for the 1st time around...2nd time around, the factor that most influenced my experience (for the better!) was the decision to have "people", ie: support people (you!) we knew would be there to help us through the process. It took so much of the stress out of the situation knowing I had experienced women available as a network of support before, during, after. Support team = awesomeness :)

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I    * wish 1st time around I'd known about the euphoria and sense of empowerment and achievement that hits you like a train the instant you push that baby out of your body! I honestly feel this got me through my labour and birth of my second child with much more ease knowing what was to come. It's truly amazing what a woman's body is capable of if we just listen to what we feel we need to do..... I was so glad that my first birth was midwife led in the UK, as that gave me the confidence to go for a completely natural birth here in the USA with my second child.

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     *Not going straight to the hospital when you start leaking and how awful induction is.  I had not planned for induction and didn't realize how much harder it is.

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          * That due dates are crap and inductions are very, very rarely a good idea. Oh and that the throw away underwear that come with the enormous pads at the hospital really are fabulous and you should steal a lot before you leave if you hospital birth! Home birthers-ask your midwives to find you some!! The number one factor that affected my experience was care provider. Didn't research cesarean rates on him etc and guess who had a cesarean?...

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            * My three boys' natural births took place in hospitals (Univ. Hosp. Bonn and Asuncion) and, all tardy by almost 2 wks, were just fine and like I wanted them to be…maybe I was lucky but I actually like hospitals and doctors (Daddy's girl :-). In the private Latin American hospital a funny thing was that in 1995 the nurses asked me whether all women in Germany have babies "peasant style" (ie natural, no appointment for cesarean and topped by breast feeding..) Phases and fashions, a lot of it, plus economics...

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       *That you need the giant pads after delivery! My poor husband had the pharmacist at Walgreens trying to help him get what I needed. He was totally clueless and stressed.

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      *My third was born at home in the quiet (except for me) and being mobile and changing positions really helped! I wish I had known all the things that go on "behind the scenes" when you give birth at a hospital with the first two.

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           *  There is a pain threshold and you can go over it and medicine will not control it. Induction is not any fun- and you should just wait and not be induced no matter how impatient you are!  My husband had to wait a long time while the doctors and nurses prepared me for the c section and he said that he got very nervous because it took a long time- and they started the surgery without him until I started screaming .

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          *I wish I'd know that I could've said no to a 3 week early induction, or at least asked her to wait until after I'd had a large meal so I would have the energy for L&D.

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 I    *In the end, I was satisfied with how things happened but would probably not choose induction if the exact scenario played out. My AFI was a 2 and my husband and I were frightened, which is why I opted to induce, but she was strong and my body responded so well with minimal drugs that I feel very confident that I would have gone into labor on my own at any moment of I had just waited. That is probably my biggest lesson from this and hopefully a sentiment you can share.

What do you wish you would have know?  Please add yours in the comments below.

Hospital Plan v. Your Plan

Why You Need Independent Childbirth Classes

Hospital childbirth classes are usually free.  They cover hospital policy, mention comfort measures like breathing and massage, discuss the standard procedures when you arrive at the hospital, and let you know when you can get pain medication.  You see a labor and delivery room on a general tour.  Basically, they tell you what to expect when you arrive at the hospital.  They merely scratch the surface of labor and birth.

Is that really enough?  Nope, that isn’t enough for any anyone.   Even if you are certain you want an epidural.  In fact, your pain control preferences hardly factor into what a good birth class is about. That is just one of the many decision you make about the care of you and your baby.  Sure, we discuss various pharmaceutical pain management options , and there are important things for you to know.  The real “meat” is knowing the benefits, risks, and alternatives of ANY option and owning the decisions you make. 

The hospital in collaboration with the doctor you have chosen has a plan. They do this several times a day, day in and day out, so in many ways they are on autopilot.  If X happens, then do Y.  If you don’t educate yourself, you are not able to be an active participant.  You are put into the “assembly line” even if you’ve been dreaming of a natural birth for months.  There are a few different “combo meals” for this one—like a normal vaginal birth (maybe with tearing or an episiotomy), an assisted (forceps or ventouse) birth, or a cesarean.  Maybe you get off to a good start breastfeeding.  Maybe your baby doesn’t latch well.  Maybe the “good” lactation nurse is there.  Maybe not. 

You’re completely at their mercy and mostly in the dark. 

Even if you aren’t “into” birth, how your child enters the world is important.  A lot of moms are left feeling like something is missing after one of these “would-you-like-fries-with-that” births.  You know deep inside that it’s more important, that you are an individual, but the system caring for you gives you a number and moves you on down the line. They are just doing their job. 

At better beginnings, we know that the doctors and nurses as individuals are genuinely good people who have your best interest in mind, but frankly, the stats reveal a different big picture view.  The United States rates of cesarean surgery, maternal morbidity, maternal mortality, and postpartum depression are all too high for everyone’s standards.  Our breastfeeding rates are dangerously low.  Our maternity care system in the US is not working as well as it should.  Amongst other nations, we rank in the upper 20s—not the top 5 or even top 10.  It is up to you to take charge of your health and demand the very best care, backed by the latest evidence.

You can have an empowering, healthy birth in this same system, with the same caregivers present, with the same people supporting you.  You just have to do some work ahead of time. 

Here’s the heart of the matter: your care provider, your birth, the things that happen at the hospital are all choices—YOUR CHOICEs.  You have the opportunity to make informed decisions and actively participate in ALL of the choices made about your care unless a true emergency arises.  Even then, you can still have a say, but you have to know how and when to speak up.

If you are a healthy person expecting a healthy baby, you don’t HAVE to do any prenatal testing.  You don’t HAVE to be induced.  You don’t HAVE to push at 10 cm.  You don’t HAVE to have an episiotomy.  You don’t HAVE to have a cesarean.   Your baby doesn’t HAVE to go to the nursery.  You don’t HAVE to do anything.  Honestly.  You decide what is best based on your knowledge and consultation with your trusted care providers.  You’re paying for it, after all.  

You also have to know how to cope with labor, regardless of your pain management preferences.  What if your epidural wears off or doesn’t work?  What if you’re having lots of contractions and they won’t admit you?  What if you get to the hospital too late in labor for any medication?  What if you need or have to have a cesarean? 

Knowing how to relax yourself, slow and deepen your breath, and having people with you who know how to support you calmly benefits you and your baby in any of those situations.  Knowing how to stay cool and express yourself well are good skills for life.  Period.

In our classes, you’ll learn how to make YOUR plan, not a one-size-fits-all method or hospital default.  You’ll learn how to keep yourself healthy so that you can have all of the options available when it’s time to give birth.  You will learn what options are realistic at every step and come to understand that it is important to be flexible and stay open to change.  You and your support will learn to advocate for you and your new baby.  This is part clarifying what is most important to you and part communicating with your caregivers (doctor and nurses).   Again, life skills—what’s your goal, and how do you reach it?

You’ll write a birth plan—not to tell the doctor and hospital staff how to do their job, but aiming to avoid the slippery slope of interventions that go along with the hospital default.  It will politely and succinctly express your preferences and expectations.  It will guide the conversations you have with your doctor prenatally.

Building Blocks for Birth is a real class to prepare real people for real birth.  You are too important for a fast food birth.  We want you to be confident, realistic, and prepared to get what you want in the setting you’ve chosen.  Did I mention that it’s all your choice?  You can leave your care provider at any point, or even leave the hospital in labor and go to a different hospital where you’ll be treated with more respect.  After all, nobody likes poor customer service.  You’d speak up if you ordered a burger and got a burrito instead.

RESOURCES: Evidenced Based Maternity Care

Consumer Reports
When it's time to bring a new baby into the world, there's a lot to be said for letting nature take the lead. The normal, hormone-driven changes in the body that naturally occur during delivery can optimize infant health and encourage the easy establishment and continuation of breastfeeding and mother-baby attachment. Read more...

Study: Two-Thirds of OB-GYN Clinical Guidelines Have No Basis in Science
Majority of ACOG Recommendations for Patient Care Found to Be Based on Opinion and Inconsistent Evidence, Read More....

Birth Advocates are always saying that obstetricians shouldn't be doing such-and-such routine procedure anymore, because it is not the best for mother and baby.  Complete with references, here are 10 Common Obstetric Procedures Not Supported By Science, Read More...

Childbirth Connection
Despite good intentions of many dedicated health professionals and very large expenditure of resources, the U.S. maternity care system has many shortcomings. Many women and babies receive poor quality maternity care, including many procedures, drugs and tests that are not needed — "overuse" — and failure to get many beneficial forms of care — "underuse". Read more...

World Health Organization, Care in Normal Birth
The report addresses issues of care in normal birth irrespective of the setting or level of
care. Its recommendations on those interventions which are or should be used to support the processes of normal birth are neither country nor region specific. Enormous variations exist worldwide as to the place and level of care, the sophistication of services available and the status of the caregiver for normal birth. This report aims simply to examine the evidence for or against some of the commonest practices and to establish recommendations, based on the soundest available evidence, for their place in normal birth care. Read more....

Mother Friendly Childbirth - Highlights of the Evidence
Citizens for Midwifery and BirthNetwork National have developed this summary of the research findings regarding the Ten Steps of Mother‐Friendly Care. Read more...

The Journal for Perinatal Education
In this column, the author presents summaries of four current research studies that further support the benefits of normal birth. The topics of the studies address the benefits of the hands-and-knees position in labor, postmenopausal urinary incontinence, the impact on perinatal outcomes of coached versus uncoached pushing during the second stage of labor, and the impact of the duration of breastfeeding on the likelihood of developing type-2 diabetes later in life. Read more...

Our Bodies, Ourselves
The existence of two separate approaches to the care of pregnant women began in ancient history; ultimately it led to the development of the two professions of midwifery and medical obstetrics. Each of these disciplines is based on a different understanding of the nature and significance of pregnancy and childbirth. Read more....

Practice guidelines by specialist societies are surprisingly deficient Read more...

A note about our "Resources" pages: We offer these resources as one step of your informed decision-making process.  Each mother and each circumstance are unique.  There is no one "right" way.  One article or study does not an informed decision make.  Read more.  Research more.  Talk openly with your carefully chosen care provider and those who will support you.  Then, make the decision that is right for you.