7.40 MB | 18:27 Min
Dr. Keith Eddleman is the Director of Obstetrics and a senior member of the Division of Maternal-Fetal Medicine at The Mt. Sinai Medical Center. He also co-authored the books Pregnancy for Dummies and The Pregnancy Bible with Dr. Joanne Stone.
Susan Scott Gill is a Certified Professional Midwife at Blessed Beginnings Midwifery in California. She is also certified in Neonatal Resuscitation, Adult, Child and Infant CPR and Standard First Aid and IV Therapy. She has taken advanced training in water birth.
Kim Wildner is the author of Mother’s Intention: How Belief Shapes Birth. She is an expert in the childbirth technique known as hypnobirth. She is a Certified Labor Assistant and Childbirth Educator and a Certified Hypnotist. Find out more at her website here.
Welcome to your Pea in the Podcast. I’m Bonnie Petrie with everything you need to know about your body, your baby and the big changes ahead in your life as you begin your journey as someone’s mom.
This week, we’ll sort out your labor options. You may know what you *don’t* want.
“I just felt like I don’t want to have a C-section, I don’t want have an epidural. I was so scared of those things.”
But what *do* you want? Is it a home birth in the water?
“Water has shown to be a significant pain reliever for people who are in labor.”
Or is it a hospital birth with maybe a doula?
“I look back at that as some of the best money I ever spent.”
And what classes should you take to prepare? Well we’ll walk you through the maze of labor options this time on your Pea in the Podcast.
So your baby’s coming whether you’re ready or not. But you’d rather be ready, right? So you run a search on your favorite search engine ‘labor options’ and you get millions of hits. So you talk to your friends and they all have different advice for you. All those voices, what’s right for you?
Well you might start by imagining your ideal labor. Do you see yourself in a hospital or maybe a birthing center? Are you at home? Are you hoping to do this naturally without pain medication? Or do you expect that anesthesiologist is going to be your best friend? Is your labor partner going to be enough for you or do you want a little bit of extra support?
Most moms use an obstetrician to manage their care, and Dr. Keith Eddleman, author of Pregnancy for Dummies ,says finding the right doc for you isn’t like throwing a dart at a dartboard.
“You have to spend time with the person and ask them questions and have dialogues, have conversations with them.”
Dr. Eddleman says you need to build a relationship with your OB if you’re to trust them when difficult decisions need to be made. Now how do you build that relationship?
“Well, you ask them anything that is concerning to you. All throughout the pregnancy you meet with your obstetrician regularly for prenatal visits and you ask them questions. If you get answers that are understandable, that seem compassionate, that seem like they’re addressing your concerns, that they’re responsive, then you know you build a trust over a period of time. If on the other hand you get answers that are non-responsive or flippant or sarcastic then it’s time to look for somebody else.”
When you have those conversations with your OB, I advise you to write down questions you might have for them between appointments, because often when you get there and you see that white coat, every question you’ve had goes immediately out of your head. So you’ll need to refer to that piece of paper to be able to get those questions answered.
Other moms are drawn to the extra attention that can be provided by a midwife.
“Midwives are trained in dealing with normal birth, normal pregnancy and normal birth. So we’re trained to handle normal prenatal care and to pick up problems.”
Susan Scott Gill is a professional midwife at Blessed Beginnings Midwifery in California. She says someone in her position can spend a lot more time with you than a doctor might be able to.
“The average OB appointment lasts 10 minutes. Now that’s the amount of time the woman spends with her OB. She may spend 2 hours in the office, but the average CPM licensed midwife appointment last 60 minutes.”
Gill says during that hour that she spends with you, she listens to the baby’s heartbeat and she takes your blood pressure.
“Those are just standard measurements to see that everything is status quo. But the rest of my 50 minutes is making sure that mom’s well-being is healthy too.”
Because she says mom’s state of mind matters to the baby.
“If mom’s an emotional mess because her mom is dying of cancer, that can affect her pregnancy. And so I’m there to support her through emotional problems, good or bad.”
Some midwives – certified nurse midwives – will deliver babies in the hospital. Other ones, like Gill, attend home births. That’s an option being considered by a growing number of moms, like Carolyn Jenkins.
“I’m a teacher. I live in a house in a normal neighborhood. I’m just a normal person.”
Not the reckless risk taker some might expect a woman who’s had two home births to be.
“People think you’re all crazy hippy or you know you’re some sort of rebel. It’s like I am such a normal person. I’m just not either crazy or a rebel, radical hippy. You know what I mean?”
Carolyn says she just wanted to have her babies, her way, with minimal intervention, and her way was at home with her husband and some midwives and one giant tub.
“It’s a soft sided tub with a thick plastic liner on the inside and then you get your own personal sterile liner that is only yours and it goes over and covers the whole tub inside and out. The tub is about 4 and a half feet across and deep enough; it’s about 2 feet deep. So when I’m sitting on the floor in the tub, the water comes up to about my chest.”
No epidurals available at a home birth, and she says the mobility that she had in that tub was great for pain management and the water was very soothing to her.
“I just felt completely supported physically, emotionally and spiritually just having that. It’s a very grounding element.”
Now birth is a messy affair with all kinds of bodily functions to consider.
“My husband always teased me about no pooping in the tub. That was the rule.”
Despite her husband’s rule, they were ready just in case.
“One of the things that was on our birth kit list was a fish net, like for fish tanks, just in case someone poops in the tub. We didn’t have that, fortunately, which I’m glad about.”
Even in a low risk pregnancy things can go wrong during delivery and Carolyn says there was a little scare with her daughter.
“At one point during the pushing her heart rate started to go a little bit low.”
Our midwife, Susan Scott Gill, says when she attends a home birth she has a plan in place for just that kind of situation.
“If I truly have an abnormal heart rate, I have my own personal rule is 10 minutes. I have 10 minutes to fix the problem, if I can’t fix it by changing the mom’s position or hydrating the mom, then we go to the hospital.”
Carolyn says in her case no 10-minute rule was necessary.
“The midwives are very, very prepared for unexpected situations and were able to give me some oxygen to help the baby’s heart rate get back to normal, which it did right away, and I was able to push her out beautifully and safely in our home.”
Then there’s that intense time of bonding immediately after birth that home birthing moms are really seeking to preserve. Gill says the midwives are there to help them do that.
“So we try and do as little as possible to the baby. If baby is pink and breathing, mom’s usually elated at this point, we’re watching the water for signs of bleeding. We’re just gentle guardians of that really precious time that we only get once with our kids.”
So let’s get back to the mess. You know you’re thinking about it.
“The midwives clean up.”
In fact, Carolyn said she felt very well cared for by her midwives.
“I got up out of bed about 4 hours after my daughter was born and went out in the kitchen and there was the midwives, they had cleaned up and they had cleaned the kitchen and they had made themselves a bowl of pasole that my mother-in-law had cooked for us, so I got to go out there and got fed and my house was clean and my baby was sleeping. It was wonderful. It was wonderful.”
Not everyone is a fan of home birth. Our OB, Pregnancy for Dummies author Dr. Keith Eddleman, for example.
“I think it’s crazy. I think there are too many things that can go wrong.”
Eddleman believes the hospital offers the best of all worlds.
“I understand the sentiment surrounding home birth, but I think in most labor and deliveries now you can, you know we have rocking chairs, you have quilts, you have the comforts of home but you also have the benefit of, if something goes wrong, of having people there that can take care of you.”
So, okay, you want to have your baby in the hospital and you want a doctor there. Sheri was one of those moms, but there were a couple of things she knew for sure she didn’t want.
“I just felt like I don’t want to have a C-section. I don’t want to have an epidural. I was so scared of those things.”
Susan Scott Gills says for a mom like that
“When you do a little research it’s going to come right up there that if you hire a doula, you’re going to reduce your chance of pain medication by a large percentage. You’re going to reduce your chance of a C-section by a large percentage.”
What in the world is a doula?
The Greek definition of the word is trusted servant or woman servant, but now it generally refers to a woman who helps a couple through childbirth. Sheri and her husband decided to find one.
“Our doula, we met with her I think three times before the birth and she just went over different things like do you like scents? Do you like to be massaged? All different kinds of things because she was saying during pregnancy if you don’t like aromatherapy it’s going to be particularly annoying when you’re giving birth. Or if you want to listen to music or if you just have anything like don’t touch my feet or any kind of idiosyncrasies in the respect. Just kind of getting us ready.”
The morning of her daughter’s birth, Sheri called her doula, who offered her some immediate guidance; “It’s early, just eat some breakfast. Go for a walk. Really take it easy. Then later in the day as labor was progressing a little bit, my husband called her and checked in with her and she finally said, ‘Okay, I’m going to come to your house and just see how things are going.’”
A lot of couples are hesitant to go with a doula because they think the doula will displace dad during delivery. Sheri says though that wasn’t the case at all. She says her doula actually helped her husband be more involved.
“Right before she came we were kind of getting to the stage where I was getting really uncomfortable and he wasn’t sure what to do for me. So I think if she hadn’t come and just been really calm and said we’re going to do this, we’re going to do this. She was just so calm the whole time.”
So while Sheri’s husband was chipping ice and making some tea and offering her loving moral support, she labored in a tub. When it was time to go to the hospital, the doula managed the move, Sheri says, with skill and composer.
“Okay after this contraction we’re going to get out of the tub. After this contraction we’re going to get your clothes on. And it was great. She was very helpful at the hospital that she was familiar with all the local hospitals of how their different protocols went down so she had kind of given us an idea beforehand of what to expect at the hospital. When we went there she talked a lot to the nurse and to the doctor so that my husband and I could just go along our merry way. She was the only one that thought as the baby was being born to take pictures. So we had these wonderful photographs of our delightful faces as we see our daughter for the first time. Even thinking about it now, I’m like oh those pictures. Those were worth it in and of themselves. After the baby was born she said you’re hungry, I’m going to run across the street, I’m going to get you something. What do you want? So all of that stuff was really great.”
Of course after the baby came, the doula continued to advocate for the couple.
“She was great at saying, you know I think they’d like to be alone for a few minutes if you could, everybody exit the room for them, that would be great. Which all of those things were things I wouldn’t have wanted to negotiate after just giving birth, trying to be polite and diplomatic and saying could you just get out?”
Bonus! Sheri accomplished her goal! She had a pain-med free, vaginal delivery of her beautiful, healthy daughter, Maya.
“I really attribute it all to the support she gave us, because I remember that moment where I was just so uncomfortable and I could tell my husband was so scared. I think we may have gone to the hospital too early and we live close to the hospital and when we got there they said okay you’re 10 centimeters and I felt like I had just won the lottery. Because I felt , well that’s it – no interventions because I’ve reached the magic point of being ready to push the baby out.”
But doulas don’t discriminate if you do want to use pain medication; they are there to help you too.
So where do you find one? Dona International is a professional organization for doulas, and you can start your search at their website. If cost is a concern, BellyWomen.net may be a great resource for you.
Most all of you will consider taking childbirth classes, whether you want to have pain medication or not. It’s really not about that. Most hospitals offer them and they’ll offer at least a passing understanding of breathing techniques and relaxation, things that you will use whether you use pain medication or not. But some of you will want to know more, and here’s the rundown of some of the techniques out there available to you.
Most of you have probably heard of Lamaze. That’s the technique where the mom is panting that you see on TV all the time. I’d do it for you but that’d be a little embarrassing. It focuses on concentration though and relaxation and rhythmic breathing, and teaches your partner how to support you and comfort you through contractions with things like massage. You’ll also learn about choosing a focal point, something to focus on during your contractions. You’ll also learn a lot about childbirth in general during a series of Lamaze classes, and you can find out more about that at Lamaze.org.
The Bradley Technique of childbirth is another very popular option for parents right now. It bills itself as “husband-coached” childbirth. Instructors spend a lot of time talking to you about nutrition and exercise as ways to improve your birth experience. Of course you’ll also learn about breathing and concentration and since most Bradley classes are 12 weeks long, you’ll get some in-depth information about pregnancy and birth. You’ll talk about nursing too, if that’s important to you. For more on Bradley, go to Bradleybirth.com.
Fewer people are familiar with the Alexander Technique, which focuses on the use of posture and movement for mom to manage pain.
These days, some moms are turning to hypnotism to deal with the pain of labor.
“Hypnobirthing is using deep relaxation to birth perhaps more comfortably, perhaps with less intervention.”
Kim Wildner is a hypnobirth instructor who uses the Mongan Method, and she’s also written a book called Mother’s Intention: How Belief Shapes Birth.
If hypnobirth conjures up images for you of someone swinging a medallion in front of a laboring mom…
“It doesn’t work like that at all. What hypnosis is is a deep focusing. It’s like if you are reading a good book and someone said your name and they had to actually say your name again or tap you on the shoulder to get your attention. Your brain wave state would have been in the same type of state that women are in when they’re hypnobirthing.”
Wildner says that most of the pain from labor contractions — which she calls “surges” — stems from fear.
“A mother is afraid, the fear, tension, pain cycle is engaged. So what happens is she feels that surge coming on and because she’s afraid it’s going to be painful, she gets tense and that tension tightens up the pelvic floor, which means that those uterine muscles are pushing down against a rigid musculature in the pelvis so that the baby really isn’t making progress and that creates pain.”
Wildner says the hypnotic prompts helps mom let go of that fear.
“With hypnobirthing, our aim is just to keep the mother relaxed and in control so that she can keep all of those muscles nice and loose and the baby can just move down.”
Wildner says your labor partner can be very involved in your hypnobirth.
“Sometimes they will read, they will record the relaxations in their own voice. They get a copy of the Rainbow Relaxation script. They learn prompts; they learn the different hallmarks of the transitioning phases of labor so they can best assist their partners through that.”
Hypnobirth is for anyone.
“I’ve had home birth couples; I’ve had hospital birth couples. There are physicians who are hypnobirth practitioners, there are certified nurse midwives within hospitals that are using the technique and teaching it. There are traditional midwives whose clients are having wonderful hypnobirths at home. So it’s really kind of a wide range of people.”
Wildner says you can usually learn hypnobirth techniques in about 5 classes.
“My absolute favorite hypnobirthing story is about my best friend who had broken her tailbone four days before she gave birth to a 10 pound, 4 ounce baby boy and her first words were, ‘It’s over? Already? Oh my gosh! It was so easy!’”
…and after all, no matter what approach you choose, isn’t that what we all want to say at the end of our labor when we’re looking down at our healthy babies, of course?
We hope you’ve enjoyed this Pea in the Podcast: Labor Options. Please visit our website, peainthepodcast.com, for more information about our experts, to find links and transcripts, and to register to receive tailored week-by-week shows for each week and stage of your pregnancy. It’s everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy. For Pea in the Podcast, I’m Bonnie Petrie, thanks for listening.
A Special Thank You To…
Carolyn in Oregon and Sheri in Maryland, who graciously shared their birth stories with us for this podcast.