Great Blog about Labor Progression

Found this terrific blog of a much more tenured Doula that I today. Here is a great article I have copied and pasted from her site. You can go there directly through the links at the top left of my home page. See Sarah Vine's blog.

How Dilated Am I? Assessing Dilation in Labor WITHOUT an Internal Exam.
7 March 2010 by sarahvine

It’s the magic question weighing on most laboring mothers’ minds: (as well as the minds of her partner or birth attendants!) How much longer? Is there any way to tell how far along I am in the birthing process? I’ve seen mothers beg for an internal exam and then be gutted about the answer (What? ONLY 4cm STILL!?) and suddenly *poof* she looses her resolve. It’s akin to having a test and finding out you’ve failed it, in front of your loved ones as well as complete strangers. Everyone knows this feeling is not conducive to labor – suddenly doubt and fear slide in and the laboring mother feels tense. Her oxytocin levels (our body’s natural pain-killer and labor inducer) take a nose dive and immediately she feels much more pain and she starts to run away from the contractions.

Happily, there are a number of external cues that can help you and birth partners get clued in to how much labor is advancing. Some are more subtle than others, but if you are ignoring the clock and keeping focused on staying in tune with your body, you will see them. Listen, embrace, wait. Enjoy the way it responds! It is amazing what it can do, this body that God gave you.

1. Sound. The way you talk changes from stage to stage in labor. With the first contractions, you can speak during them if you try, or if something surprises you, or if someone says something you strongly disagree with. You may be getting into breathing and moving and ignoring people – but if you really want to you can raise your head and speak in a normal voice. When the contraction disappears you can chat and laugh at people’s jokes and move about getting preparations done. During established labor, There is very little you can do to speak during a contraction. You feel like resting in between, you are not bothered what people are doing around you. As you near transition and birth, you seem to go to ‘another’ level of awareness – it’s almost like a spiritual hideaway. You may share this with someone else, staring into their eyes with each surge, or you may close them and go into yourself. In between surges you stay in this place. It is imperative for birth assistants and partners to stay quiet and support the sanctity of this space: there are no more jokes, and should be as little small talk as possible. Suddenly, the sounds start to change involuntarily: you may have been vocalizing before (moaning, talking and expressing your discomfort, singing, etc) or you may have been silent. Listen – there are deep gutteral sounds along with everything you have heard before, just slipping in there. You are about to start pushing.

2. Smell. There is a smell to birth, that hits towards the end of dilation, during intense labor, just before birth. It is a cross between mown hay and semen and dampness. It has a fresh, yet enclosed quality, and is pervasive. The Navelgazing Midwife has also observed this scent and writes about it here.

3. Irrationality. I love this clue – it often is a sign of transition. It always makes me smile, and I always warn women about this phenomenon so that when we hit it during labor I can remind them that what they’ve just said is irrational, and that I told her this would happen, and here it is! Relax, it means we’re nearing the end. Sometimes a mother will say she wants to go home, she is done now she’ll come back and do this later, she wants to put on her trousers and coat and go out the door. A mother who wants a natural birth and has been coping brilliantly will suddenly say she was crazy and needs pain killers right now, or that she didn’t want another baby anyways, who said they wanted a baby? Some will just curl up and say they’re going to sleep now. If she does this, that’s okay. The contractions may die down, get farther apart, and maybe she (and the baby) will get a few minutes of sleep. This slowed down transition sometimes freaks out doctors or hospital midwives and pitocin is offered – try to see if you can put them off for half an hour. Send every one out, lie on your left side propped up by pillows and have a little nap before pushing; it is such a wonderful gift.

4. Feel. Here come some of the more fun tools that you might not have heard of before! Think about the shape of the uterus. Before labor, the muscle of the uterus is thick evenly around all sides, above, below, behind. As the cervix starts thinning and dilating, all that muscle has to go somewhere – it bunches up at that top. The top of the uterus thickens dramatically the more the cervix opens. During a contraction, at the beginning of labor, check how many fingers you can fit between the fundus (top of your bump) and the bra line – you will be able to fit 5 fingers. As the top of the fundus rises higher during labor, you will fit fewer and fewer fingers. When you can fit 3 fingers, I usually tell mothers they can think about going into hospital as they will find they are around 5cm dilated. At 1 finger, you are fully dilated. (Awesome, huh!)

5. Look. There is something called the ‘bottom line’, which is shadow that extends from the anus up towards the back along the crease of the buttocks. It begins as 1cm and lengthens to 10cm, and it’s length correlates with cervical dilation. Why not look down there before inviting a stranger to put their fingers up inside you? It makes sense to me.

6. Gooey Stuff. Also known as bloody show; there is usually one at around 2-3 cm dilation, and it can happen during the beginning of labor or a few days before hand. Sometimes it’s hard to know what is or isn’t a show, since during the days before labor the amount of vaginal mucus increases in preparation and this can be confusing. A show is up to a couple of tablespoons in quantity, so quite a lot. It can be clear, but is usually streaked with pink, brown, or bright blood. If there is more than a couple of tablespoons of blood then you do need to go straight into hospital to make sure the placenta is not detaching, but if there is just a bit and then it stops, then it is just show. There is a SECOND show at around 8cm dilation. This second show means that birth is near.

7. Opening of the Back. This is just at the spot where your birth partner has been doing lower back massage, at the area above the tailbone. It is a little smaller than palm sized, rather triangular-shaped area that bulges out during pushing. At this point you’ve waited too long to go into hospital, and you need to refer to my last post, 4 rules of what to do when delivering a baby!

8. Check yourself. Okay, so technically this one is an internal check, but it done by YOU. You don’t have to announce the results or write them down: it is not an exam. To me it’s obvious that as the owner of your body, you have more of a right than anyone else to feel comfortable with it and understand how it works. It is best to get to know what your own cervix feels like from early on in your pregnancy, if not before, and then to keep a regular check on what feels normal. If you do this through out your pregnancy you will keep your flexibility into the 9th month. This is also an excellent time to remind you to not neglect perineal massage since you’re already down there! Check out the website My Beautiful Cervix to see photos and descriptions of what a cervix should feel like. At 1 cm you can fit the tip of one finger inside. Use a ruler to practice discerning how many centimeters dilation feels like, measuring with your pointer and middle finger. NOTE: Always, always, always wash your hands thoroughly beforehand, up to the elbows, for 4 minutes at least. Do not assess your own dilation after your waters have gone.

For more labor tips and information about external assessment of dilation, I recommend finding a copy of Anada Lowe’s book, The Doula Guide to Birth, Secrets Every Pregnant Woman Should Know. This is one book packed with practical and useful information!

The Risks of Being At-Risk

So I am almost 36... will be in about a month so that makes me at-risk...ha!ha!ha! I'd say living in Asia puts me more at risk, but who's comparing notes? Anyway, my doctor, a very likable man, non-chalantly told me during my first visit that he would schedule me next time for screening. I declined, but he didn't note it so on my second visit he told me while doing my sonogram that he would schedule me to see his colleague for screening and that at that time I could find out the sex of the baby if I wanted. I brushed it off and told him I wasn't interested in having the testing done. He was fine with that and there was no further discussion.

Back home a week later... I am reading a book and come across data regarding amniocentesis. I was already aware of the findings, but reading it again after my own experience with my doctor I began to think about it deeply. I wonder if he was going to tell me the risks, or if he was just going to send me off to someone else and expect them to tell me the risks - minutes before they were going to perform the procedure. Do women really know that there is a .5- 1% chance of miscarriage after amniocentesis is performed? Do they know that there are other risks, like low birth weight and respiratory distress syndrome associated with the test? Well, I for one have heard the way doctors downplay the risks of tests... "oh, yes, there is a slight risk, but nothing to worry about..." Well that is a pretty big risk if you ask me, especially since the risk of having a child with down syndrome is less that 1%... I'm not grieving the doctors. I have heard all kinds of whacked out stories about parents suing doctors for not diagnosing their child with this or that before hand so they could have terminated the pregnancy. I guess that is where the risks of the test becomes the biggest issue for me and many other moms out there. I mean, really, if you aren't planning on terminating the pregnancy no matter the outcome, then why on earth would you take the risk? But there is no true counsel. At this point I am really glad that I have the knowledge to make informed decisions because being at risk seems to pose a lot of risks.

New Baby Brewing!

I enter into the 2nd trimester tomorrow and that makes me excited! This has been the roughest pregnancy yet as far as morning (all day) sickness and headaches. Every pregnancy truly is different. Every birth is too... Gracie, my first was a doozy! She was posterior and 9lbs plus which gave me quite a time. Not knowing what I know now I didn't know what to do and ended up with an epidural and Gracie coming into this world with the help of forceps. Lola was easy. No pain... I mean really! The pregnancy was crazy, I experienced gestational diabetes, pneumonia, and a UTI. Not fun, but can't complain about the labor end. Now #3 is on the way and I am wondering what to expect. Best bet is not to expect anything and hope to be pleasantly surprised! I am armed and dangerous this go around, so I am really looking forward to how all this knowledge in my noggin will affect my experience! If I were in the States I may go for a homebirth, being in Asia I will settle for a friendly hospital in HK where I have been told I can labor as I please. We'll see about that : )

Looking forward to posting interesting things I experience over here. And I need to get back to posting helpful hints. As I prepare for my own birth experience, I'll be sure to share!

Praise the Lord for His goodness! We are so thankful for this new life growing in my belly!

The Importance of Baby's Position

I have spent a great deal of time researching and studying malpositioning and methods to get baby back in the right position to come down smoothly. Positioning refers to how the baby is lying in the uterus and how the head is presenting at the cervix and/or vaginal canal. There are so many abbreviations and different positions noted that it can get really confusing, so for the sake of simplicity I'll just compare the optimum position - Left Occiput Anterior (LOA) and a less favorable position - Right Occiput Posterior (ROP). Basically, you want baby to be facing your spine with his head down. Laying on the left side is more favorable than the right. When a baby is posterior he is looking away from mommy's spine. This causes all kinds of problems from severe back pain to the head extending and creating stalled labor or a baby "stuck". Many times when a woman in told her pelvis is too small this is why - instead of the baby flexing his head (tucking his chin into his chest) and creating a smaller diameter presenting through the birth canal, the baby's head extends and the presenting part is larger. Often, babies who are malpositioned will not put even pressure on the cervix during labor which causes longer labors and "stalled" labors because the cervix doesn't open as it would when there is even pressure from the head during labor.

So what is there to do? Fortunately - a lot! I have recently found a website (look under info for moms) that listed many of the popular ideas out there. There are also several good books out there if you want to read more(several mentioned in the article), but really knowing the simple exercises that seem to encourage rotation are probably all you need to know, that and also the knowledge that your posture matters. Apparently having good posture is extremely important. All these things are outlined in the article I sited so I won't rewrite it all here, but note the importance of this information. Most OBs will not employ these methods, and they may or may not even tell you if your baby is malpositioned unless you ask. So, get informed so you can experience all the blessings of childbirth.

To VBAC or Not

A friend asked her doctor the other day under what circumstances he would do a VBAC - the answer she got was "NONE". That is becoming a reoccurring nightmare of an answer. This friend may or may not be sold out on wanting to have a VBAC, but it is definitely something she has been looking into, especially since her last Cesarian section left her in a lot of pain. Why is major abdominal surgery the only option for my friend? Well, it isn't if she wants to change doctors, change hospitals, and wrangle with her insurance company - but she most likely will not do all of those things.

The doctors not only use scare tactics to discourage women from having VBACs, they have convinced themselves that VBACs shouldn't be done using the very same scare tactics. Fear always debilitates us. It is very difficult to make rational decisions when fear has gripped your heart. So, if you are contemplating a VBAC clear your mind and do some research. Sure, ask your doctor all about it, but also look at all the information he will most likely not offer. Look at the stats... are there more complications from VBACs or Cesarians? Are there special circumstances in your case? Circumstances that would make a VBAC more dangerous than a repeat section? Do you know the risks to the baby from Cesarians? Do your homework and make an educated decision based on what is best for you and your baby. In the end, it should be your choice how your miracle enters the world.

Check out the link on my homepage for VBACs.

Breastfeeding in the thick of it....

My sweet Lola has been trying to "ween" herself for about 7 months now. So says a host of well meaning people. If that is indeed what she has been trying to do then too bad - she has one stubborn momma. The interesting thing is that the kid will not drink any brand of formula, fresh milk or the like. Yogurt is about as close as we come... but she loves her momma's milk. She doesn't however like to sit for very long when she is wide awake and nurse. So what on earth do I do? Well, I let Lola be Lola. Now maybe my mom is right - if she gets hungry enough she will drink another form of milk, but why on earth would I plan to withhold what God in His infinite wisdom created for her to drink and hope that she would accept a substitute? Yes, she still wakes me up twice each night to nurse and usually ends up in my bed. I used to think this was a destestable practice. I've read all the well meaning books that have been written about training children and I even followed them with my oldest - and she complied nicely, but kids weren't made with a cookie cutter and despite my efforts to conform to the Western norm, my Lola will not conform. I'm writing this post today to encourage all the moms out there who are struggling with sleep deprivation, all those who are wondering where they went wrong with breastfeeding since their child doesn't comply with their efforts to set feeding parameters, moms who cringe at the thought of being criticized for co-sleeping, and especially for all the moms who think their sweet little babe is trying to "ween" himself and think it may be time to do so. I have wrestled with all these things and finally I have come to the conclusion that moms just do what they need to do. They do what is best for their babies. Breast milk is best for your baby so keep on keeping on! When you decide it is the right time to transition your darling to some other form of liquid nutrition then make that decision because you know it is the right time, not because you have been bullied by a cultural standard that your child may not be able to fit. Questions and comments valued!

Using Ritual

Rituals are something we all use in our daily lives. Sometimes rituals stem from our religious beliefs, but they are largely cultural and traditional. Some rituals you may be familiar with include praying before meals or at bedtime, locking your doors at night or maybe even during the day, and brushing your teeth every morning. These rituals are common place for a lot of people and you may not have considered them rituals at all, but they are - they give us stability and faith that all things will be ok. We pray to communicate with God and give thanks or make requests and we believe He hears our prayers and answers. We lock our doors because we believe this practice will keep us safe from intruders while we are sleeping or relaxing in our homes. We brush our teeth every morning because we believe this practice will keep our teeth healthy and keep us away from the dentist. These rituals instill faith and help us get through daily life.

In times of extreme stress or pain people often become unreasonable and out of touch with reality. Their only reality is their stress or pain. Rituals are valuable during these tough times because they give people a handhold that keeps them from buckling under the stress or pain. Whatever belief system you come from, its rituals will comfort and calm you. In America most people say they believe in God even if they have no church affiliation or daily walk with the Lord. This is obvious whenever a plane is experiencing trouble and most people begin to pray. During 911 people rallied to pray. This was indeed a coping mechanism. For some, their faith was real and still is, but for others prayer was a tool they used to get through.

Let's talk about ritual during childbirth. Coming from a technocratic standpoint (use of technology, including medicine and procedures used in hospitals) we find that people who believe in this system are often very satisfied with their hospital births. They may use the breathing techniques learned in a hospital based childbirth class (2 thumbs up) for a while, but when the pain becomes intense they will often fall back on the technocratic rituals used in the institution which may include narcotics or an epidural. They also may be completely comfortable with other procedures like labor induction or the use of forceps. If you agree with the technocratic method, then you will look to it to comfort you. I have heard innumerable times "how wonderful the epidural was" or how awesome the doctor was when he used forceps or stitched up an episiotomy. Granted, an epidural is wonderful for the moment and God bless doctors who can successfully use forceps. But if this is not where you are coming from, then you will most likely not be comforted for long. The physical pain of childbirth is real, but so is the disappointment when you realize your pain is gone but you are immobile, out of control and at the mercy of your doctor and nurses. You buckled.

Using ritual during labor is a great way to cope with the stress and pain that accompanies contractions. You must find something that works for you - tailor made because no one can pop in at the time and say, "here, say these words and you'll be able to cope" and expect that to really work. You may get lucky, but it is far better to plan in advance and know which rituals you may want to incorporate during your labor.

Many women like to take a warm bath or shower. The warm water soothes them and helps them relax. How many of us like to do that when we have had a stressful day? I know I do. Some woman don't think about this option because they are so in tune with "how things are" in the hospital that they assume laying on their back and maybe getting a back rub is their only option. Other rituals include listening to music, singing, repeating phrases or prayers, breathing exercises and even slow dancing with your partner. I suggest that people talk with their hubbies and other birth partners in advance about what rituals they may want to use. If they have something in mind they should use it as often as possible, especially during stressful times in order to practice and make their minds familiar with the ritual. If you sing or worship in the car or shower now, then this is probably a good ritual for you - it allows you to remove yourself from your surroundings and enter a quiet place. Maybe that is not the kind of singing you do - then maybe you need to think of another ritual that will work for you.

Other rituals that may need to be cleared with your doctor, but should not be an issue, may include wearing a favorite comfy gown or t-shirt, eating and drinking certain goodies or watching a favorite movie or movies during labor. While these kinds of things may not eliminate pain, relaxation can greatly reduce it. Being comfortable lends to being relaxed.

Grantly Dick-Read came up with the pain-fear-tension cycle in the mid 1900s. Basically it is the concept that pain leads to fear which leads to tension which increases the pain and the cycle continues. You get the picture - your pain gets worse because you get tense. So you have to find a way to chill out!

By the way, not only does being relaxed reduce the amount of pain in childbirth, it actually facilitates the opening of the cervix. Yes, labor could be shorter if you can really relax and trust in your body to do what it was created to do.

*FYI - One method of natural childbirth that uses learned ritual is hypnobirthing. I am just now getting familiar with this method, but it makes sense. Look for a post dedicated to hypno- birthing in the near future!