Imagining a better birth « Back to Group Discussions

[kitteh]

Hi ladies! So I'm just now reaching the half-way point, and I've gotten really interested in watching birth videos and reading birth stories, which of course has me thinking of my own upcoming big event.

I'm mostly happy with my first labor and delivery experience. I had my prenatal care with nurse-midwives at UCLA and enjoyed it. I would have loved it if I were able to have my daughter in a birth center, but insurance wouldn't cover it so my second choice was to achieve a natural birth in a hospital setting. I wanted to hire a doula but we couldn't afford one, so I just did a lot of reading about natural labor and attended a class offered by the midwives, but I didn't choose any single method or use hypnobabies/birthing. Labor started around 1AM when my water broke, and ended 28 hours later. We arrived at the hospital when I was 4cm dilated and I did a lot of walking and also labored in the shower with hot water spraying on my back. The hospital did not have tubs available, but I wish they had. after a pretty productive first stage of labor, I stalled out a 7-8cm for about 8 hours, so they administered pitocin to get me through transition. It. Was. Horrible. The contractions came fast and furious, one on top of the other, and the little time I had between them was spent vomiting. After a few hours of that I was damn near ready to beg for a c-section. In fact, i'm pretty sure I told them just to knock me over the head with a lead pipe and get the baby out. Luckily my mom, husband, and midwife were amazing support and really helped me get through it, and I ended up birthing my daughter vaginally without pain medication (2.5 hours of pushing, no tearing) Overall, it was a positive experience and I have decided to go with the nurse-midwives again because of it.

I truly believe that my body stalled out right before transition entirely due to unrecognized fear of transition. I swore up and down that I wasn't afraid of going through natural labor (I didn't know anyone at the time who had given birth without an epidural) but I had read enough about transition to know that it can be intense, and I was afraid that my birthing team wasn't well-equipped or experienced enough to help me through that. It turns out that despite lack of experience on the part of my mom and husband, they were amazing and provided exactly the support and assistance that I needed (my husband provided counter-pressure through most of my contractions and massaged my back for hours and hours, and also held the broken shower head so that it would spray water on my back where I needed it. He was right there laboring along with me for the entire ride! And my mom was amazing at helping me to relax and visualize myself floating on clouds, riding out the contractions. She also helped me on all of my bathroom visits and even wiped me a few times when I couldn't manage it!)

Still, I distinctly recall when the contractions started to slow down in intensity, and instead of feeling like I should do something to encourage them, I kind of sank into the relief which ultimately was a bad idea. I also think that despite my attempts to relax through the contractions, I actually did more clenching to fight the pain, but I was kind of in denial about that because I refused to admit that I was harboring fear of the process. I'd like to figure out a way to get beyond that this time.

I also think I was too dependent on outside information, rather than going inside and listening to/trusting my body. I remember wanting frequent cervical checks to tell me how many cm I was dilated (thankfully my midwife knew better than to give into my requests given the fact that I labored 24+ hours with ruptured membranes. But my need to know how many cm I was dilated was a control-freak, anxiety thing for me and I think that it also contributed to my long labor and failed transition.

I have noticed that I am the type of person who likes to have an end-point in sight. I'm not very good at just being present in the moment, I'm always looking ahead. When I do workout videos, I prefer the ones that have a countdown clock in the corner for each 30 minute segment. When I can check in on that and see how much time I've got left, I'm better able to give my all to the workout. Also, I've learned a lot about myself from running, particularly from the longer distances. I love running because I know just how long I have to go before I reach the finish line, and I know roughly how long each mile takes me to run, so I have a time frame. When the going gets rough and I just want to quit I can tell myself I only have 1 more mile to go--8-10 minutes and it will be over. Or I can see the finish line or next mile marker coming up and I focus on that. For this reason, I abhor treadmill running because there is nothing to focus on but the digital timing display. Labor kind of feels like treadmill running, but without the timing display.

Anyhow, if anyone has managed to make it this far and actually understands what I'm trying to say through all of the above rambling, any advice (or commiseration!) would be appreciated.

[womenswisdom]

I understand what you're saying about your mindset affecting labor and I think that it would be good to do some mindfulness practice this time around to prepare yourself to be in the "now" headspace.

One thing that jumped out at me was that you had a stall at 7-8cm and pushed for 2.5 hours. Those are red flags for a posterior presentation, so you may also want to look at what you can do to prevent that from occurring again if you think that may have contributed. Just something I thought I'd throw out there.

[kitteh]

I do recall them saying she was posterior, and I had a lot of pain in my lower back and hips. What can be done do discourage posterior presentation?

[womenswisdom]

Posterior labors are very difficult! It sounds like you did a great job. The good news is that many times the issue will not repeat in a subsequent birth since the first baby has "paved the way". However, having had a cesarean for persistent posterior (pushed 4 hours with no descent), I always feel it's a good idea to do what we can to encourage a good position.

Many times posterior presentations are related to structural issues in the mother's body. There are several different things that can contribute. First, tight uterine ligaments can impede rotation. This can be caused by poor alignment (see http://www.alignedandwell.com/katysays/natural-pregnancy-natural-birth/ to start with) or pelvic issues with hips/spine that can be addressed with chiropractic (especially Webster technique). Second, a very tight pelvic floor can make it difficult for a baby to rotate. Focusing on squats rather than Kegels can be helpful, especially is you are a runner - http://mamasweat.blogspot.com/2010/05/pelvic-floor-party-kegels-are-not.html and http://mamasweat.blogspot.com/2010/05/pelvic-floor-encore.html.

You might also check www.spinningbabies.com for information on optimal fetal positioning.

Finally, it's important to know that you might have a FAR easier and faster labor this time if your baby rotates easily. If your labor starts seeming like it's going fast and furious, it probably is. We used to tell mamas that the second births we didn't make it to (as hb mws) were the ones where the mama had a long, hard first labor and she waits until it gets as bad as the first time. That never happens and all of a sudden she realizes the baby is right there and we don't have time to make it!

[kitteh]

Wow, thanks so much for the information! I didn't realize until I read your post (and started to cry a bit) that I was holding on to a lot of guilt for causing my labor to be long and difficult because of my fear and anxiety. I definitely want to do as much as I can to address those issues before this birth, but it is such a relief to think that maybe my less-than-ideal experience wasn't all my fault! I'm going to go explore those links you provided. Thanks!

[kitteh]

OK, I'm definitely going to work on squatting more, and making sure that my form is correct according to those guidelines. I do a lot of squatting most days, but I have never paid much attention to my form.

I'm also wondering about Hypnobabies or Hypnobirthing. Anyone here have experience with either of these? I'm not interested in attending a class, but would like to read a book and do some guided meditations I think. I kinds feel like I'm not sure where to begin, though. My local library doesn't carry any of the hypno books :/

[veggieviola]

Originally Posted by kitteh 

OK, I'm definitely going to work on squatting more, and making sure that my form is correct according to those guidelines. I do a lot of squatting most days, but I have never paid much attention to my form.

I'm also wondering about Hypnobabies or Hypnobirthing. Anyone here have experience with either of these? I'm not interested in attending a class, but would like to read a book and do some guided meditations I think. I kinds feel like I'm not sure where to begin, though. My local library doesn't carry any of the hypno books :/

I'm interested as well, and would love input from anyone with experience.

[bearandotter]

Im a hypnobabies flunkie. Bought the cds listened to them as required, fell asleep 2min into each and every session. Never learned a thing. Didn't use any of it in my labour. 2nd time around did the same - and same outcome - nada.... But many people swear by it. My MW only agreed to take on an aspiring hypnobirther if I promised not to feel guilty if labour didn't go as planned - I can see her point there is so much build up about no pain and easing your way through and remaining relaxed - I can see a mom feeling guilt if this did not happen. 

I had a smilar first baby story. Good strong labor, got to the hospital, and had my last spontaneous contraction waiting in the lobby for hubby to park the car. Complete stall at 5cm, no contractions x 6 hrs of effort (walking, stair climbing, accupressure, etc...). I am a nurse practitioner, I am not a patient. I feel like my brain completely turn off my labour the minute I walked into the hospital. Pitocin augmentation and then a quick but insane labor ending with a gorgeous baby girl. I carried a lot of fear that my second birth would be the same...

BUT..... 2nd time around woke up at 4am with mild but regular contractions every 10ish min. Could talk through them. Didn't seem to get worse, but were maybe every 6 min apart by 6 am. Called my midwife since she was to come to our home for antibiotics for my GBS and to check on me. She checked at 7am - 9cm!!! (still no painful contractions, they were 'uncomfy', I was doing my hair at 645 when she came over). Change of plans, unexpected homebirth less than 1/2 hr later... Now I fear not realizing I am in active labour again - cannot win ;)

Incidentally both my babies were posterior, only turning in the last few min before birth. I second the spinningbabies website recommendation. I find their daily inversions feel soooo good on my tummy, even at 20 weeks. 

So no real advice except from my experience - there is NO certainty that your second birth will be like your first. Try to be at peace with what the future holds

[womenswisdom]

Having worked with lots of Hynobirthing mamas (though not used it myself), I will say that my opinion is that any kind of mindfulness or meditation practice regularly during pregnancy will work well. The key is to be able to relax mind and body as thoroughly as possible during labor and practicing that beforehand is the only way to easily slip into that state. The first time to do it is not during labor! You'll get there eventually, but it will be a rough ride So just taking 10-15 minutes a day and doing something like progressive relaxation (consciously relaxing your body from head to toe, over and over) and paying attention to your breathing would be really beneficial.

[jr'smom]

I love Hypnobabies and have used it 3 times.  I used the Bradley method before that.

You can find the home study usually on ebay at a discount over full price.

You CAN listen to the CDs while you're awake and active too to hear what they say and also listen to them when you are relaxing (if you tend to fall asleep every time.)

The other things you can do to have a better birth is read Ina May's Guide and a Thinking Woman's Guide to a Better Birth.  Trust your body!

See http://www.spinningbabies.com/ for good positioning.  Hire a doula who is very supportive and can help guide you (with labor positions, confidence, avoiding interventions, whatever) when you are struggling.

[pokeyAC]

The biggest thing I took away from Ina May's Guide to Childbirth is her sphincter theory.  She talks about how animals need to feel safe in order to give birth.  If we are interrupted and suddenly feel unsafe, the cervix can actually close back up a little or stop dilating.  That could be what is happening when labor stalls, especially if you go from your safe warm home to the strange environment of a hospital.  It makes sense that this change could slow things down a little.  It seems that the key is maintaining or recreating that safe environment so that you feel secure to keep dilating and let your body do what it needs to do. 

I plan on reading Birthing from Within.  I'm not really into the art project aspect, but I think it could give me some good ideas on how to prepare for labor.  Hypnobabies can be a little pricey, but I have seen it on ebay for a little less than the new price. 

[veggieviola]

Originally Posted by pokeyAC 

The biggest thing I took away from Ina May's Guide to Childbirth is her sphincter theory.  She talks about how animals need to feel safe in order to give birth.  If we are interrupted and suddenly feel unsafe, the cervix can actually close back up a little or stop dilating.  That could be what is happening when labor stalls, especially if you go from your safe warm home to the strange environment of a hospital.  It makes sense that this change could slow things down a little.  It seems that the key is maintaining or recreating that safe environment so that you feel secure to keep dilating and let your body do what it needs to do. 

I plan on reading Birthing from Within.  I'm not really into the art project aspect, but I think it could give me some good ideas on how to prepare for labor.  Hypnobabies can be a little pricey, but I have seen it on ebay for a little less than the new price. 

On a totally unrelated (yet somehow related) topic, there is a pedagogue of note in my instrument who was known for talking about how important sphincter release is in ease of playing and expression.  Nothing can flow out - music or babies - when we get scared and clench up!

[kitteh]

I did do a lot of reading the first time around, lots of Ina May stuff, and I think it really helped. However, I didn't have a doula and wasn't sure how my birthing team would respond to me in labor. I was afraid of transition but unable or unwilling to acknowledge that fear, which I do believe played a significant role in slowing/stalling me out for those 8 hours that I was dilated 7-8 cm. Although I thought I trusted my body to do its thing, looking back I see some evidence that my trust wasn't as solid as it should have been. The fact that I really wanted to be checked frequently and told how many cm I was (luckily they didn't check me more than a few times, but I kept right on asking them to!) tells me that my faith was faltering and that I was relying too much on outside information or reassurance. I think I am going to try to focus on "going inside" this time around.

I don't think that the environment of the hospital room in particular was to blame, and I say this only because we arrived when i was 3-4 cm dilated and I didn't really have trouble getting to 7cm. However, I do believe that we went to the hospital sooner than I should have. This time we live right across the street from the hospital where I will be giving birth, and I intend to wait as long as I can to walk over.

I'm not sure if I will be hiring a doula. It would be nice to have someone experienced who could give me suggestions for positions and pain-relief, but I really think that my midwife did a pretty good job of that last time. And I think that if I express my desire for that sort of assistance and suggestions this time around it could help. Also I was really blown away by how well my mother and husband did in supporting and comforting me, so I have a lot more faith this time around that my birthing team knows how to give me what I need.\

I am definitely going to go back and re-read some of the books I read the first time around. I've already re-skimmed Thinking Woman's Guide. I've got Birthing from Within on hold at the library. And maybe I'll pick up Ina's Guide to Childbirth again.

Thanks for the suggestions, ladies.

[FarmerMomma]

Birth stories forum has quite a thread on one woman's experience w hypnobabies " very confused , hurt..." I think I understand bearandotters midwife after reading this thread.

I have some sphincter knowledge due to constipation issues. Cold toilet seat bad. I have gotten some logs out that would have torn me up in the bath with warm water running on my hiney.

I had a fast birth with my first, fully dialated at the hospital and pushed for 20 minutes. But I did tear. Hopefully home water birth will help with that. Also calling midwife and doula ASAP. They are kind of far away anyways. So they need the heads up. Looking for other ways to prepare for birth.

[kitteh]

Originally Posted by womenswisdom 

One thing that jumped out at me was that you had a stall at 7-8cm and pushed for 2.5 hours. Those are red flags for a posterior presentation, so you may also want to look at what you can do to prevent that from occurring again if you think that may have contributed. Just something I thought I'd throw out there.

Man, I can't tell you how much this has helped me re-frame and process my birth experience with DD. I've been looking more into posterior presentation and came across this website

http://www.pregnancyandbaby.com/pregnancy/articles/938043/tips-for-altering-your-babys-position

Posterior babies can cause a multitude of labor problems for women having their first babies, including postdate pregnancy (going overdue), rupture of membranes with no labor, a labor that is more painful than normal, a prolonged latent phase, slow progress in active labor, arrest of progress, and a prolonged second stage. Cesareans for failure to progress are common.

Every single one of these problems was present during my labor.

...postdate pregnancy (going overdue)

I was a week overdue.

...rupture of membranes with no labor

My water broke at 1 am and labor didn't start immediately. I wasn't even sure that I was in labor, but figured that since my water had broken I MUST be. By 5am I was admitted to the hospital and dilated to 3cm. Not sure if that is a normal time frame for that amount of dilation or not.)

...a labor that is more painful than normal

Labor was painful, but with no frame of reference I can't necessarily say it was "more painful than normal." I sure hope it was, though! If next time is less painful that will be amazing

...a prolonged latent phase

I think  I had a prolonged latent phase (lots of "non-productive" contractions for days leading up to labor, which made sleep difficult. But I was used to having lots of Braxton Hicks throughout my pregnancy, so I didn't really think much of it at the time.) I don't recall losing my mucous plug, I think it happened slowly over the period of many days.

...slow progress in active labor

I DEFINITELY had a slow progression here. It took me 10 hours to get from 3 cm to 6-7 cm. That whole time I was having horrible back labor (though it did ease up a bit between contractions.) Spent a lot of time in the shower on my hands and knees while DH pointed the hot water at my lower back. Then we tried the hip-flare press thing while I stood and rocked during contractions. And then...

...arrest of progress

Yep. Got to 8 cm and stayed there. For 8 hours. Brutal. They introduced pitocin and 4 hours later I was begging for mercy. I literally told my mom to knock me over the head with a lead pipe and have them cut the baby out. If I hadn't been with an amazing midwife and really supportive DH and my mom, I'm certain that I would have had a c-section.

...and a prolonged second stage.

I did push for 2 1/2 hours, but part of that might be due to the fact that I started pushing before my body was really ready. I never felt the urge to push, and only felt mild pressure in my bottom. I was only a good 9 cm when my midwife agreed to let me try pushing, and I think she did because she knew how close I was to giving up and letting them cut DD out. In the end DD came out with a squished, twisted nose (it straightened out within a day) and bruising around her eyes.

Looking at all of that information in this new light, I'm actually incredibly grateful that I didn't end up with a C-section! I had no idea that all of my labor difficulty was directly related to malpositioning, and instead blamed it all on my fear of transition. I don't think my fear helped, but at least I now know that I wasn't the CAUSE for my crappy experience.

However, I DO think that lack of information leading up to labor was a problem. I didn't know anything about baby's position, other than the fact that she was head-down. I remember hearing about avoiding reclining positions, but I had no idea why that suggestion was made. I was working on my feet at the time as a waitress, but only spent 4-5 hours a day doing that, and then spent a good remainder of the day reclining. When I wasn't reclining I tended to be hunched over in front of the computer, which isn't exactly a great position for "making room for baby."

So now, in addition to the work that I'm doing to confront my fear of labor pain, I'm also already doing a lot to encourage good positioning. I have signed up for prenatal yoga classes and plan to go once or twice a week til I have this baby. I also plan to blow up my large exercise ball by the beginning of the 3rd Trimester so I can spend a lot of time sitting on that instead of the couch. I'm still running 4 times a week and plan to continue as long as possible, switching to brisk walking if the impact ever becomes a problem. And simply having DD around is keeping me more active and up on my feet than I was last time. I'm hopeful that this labor will be better than the last!

[kitteh]

I'm also feeling very fortunate that my labor and recovery weren't worse after reading this:

"Persistent posterior positions are associated with an increased incidence of premature rupture of the membranes, oxytocin induction and augmentation, epidural analgesia, chorioamnionitis, , episiotomies, severe perineal lacerations, vaginal lacerations, excessive blood loss, and postpartum infection (Pearl et al, Ponkey et al). Worse, there is a sevenfold increase in the incidence of anal sphincter injury, that is, third- or fourth-degree perineal lacerations (Fitzpatrick et al). Babies delivered from the posterior position were more likely to have Erb's Palsy and facial nerve palsy than those delivered from the anterior position"