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Friday, 13 June 2014

My guide to a positive birth experience

Here are some tips for preparing for a positive (natural) birth experience. However, they still apply in situations where medical intervention becomes necessary.


It can basically be broken down to two main aspects:

  1. Preparing oneself for the birth; physical preparation (nutrition, exercise, body work), spiritual (prayer and meditation) and psychological (mental pain management techniques), as well as becoming informed of the birthing process and about common medical interventions (including making a birth plan).
  2. Choosing appropriate caregivers and supportive birth partners, who will help maintain physical and psychological health during pregnancy and create a calm, supportive birthing environment
A third aspect, I suppose, is implementing this advice when you actually go into labour. 

There is a lot of good information about these topics, so I won't put everything down.  Below are just a few things that may not be commonly known.

1. Preparation

Health and well-being

Exercises and treatments for positioning in pregnancy and birth
  • Fetal positioning exercises are helpful in positioning the baby for an easier birth. For example, to avoid a breech presentation. You can start early in the pregnancy. Part of it is just how you use your body every day, such as avoiding standing or sitting for too long, walking and stretching regularly etc.  Another part of it is specific exercises that release muscular tension in muscles supporting the uterus that may be unevenly tense leading to the baby not having enough room to move into an optimal position for birth.
    See http://spinningbabies.com/ and http://spinningbabies.com/product/spinning-babies-parent-class/
  • This is also a great video explanation: https://www.youtube.com/watch?v=qsV70xXivH8
  • Exercises for core strength are important to improve the baby's position to avoid a difficult labour, avoid diastisis recti and gynecological problems like prolapsed uterus in the future. Wearing a support belt can also help.
    See http://midwifeatyourdoorstep.com/articles/optimalfetalpositioning.html
  • Another perspective on the pelvic floor and why squats might be better - http://breakingmuscle.com/womens-fitness/stop-doing-kegels-real-pelvic-floor-advice-for-women-and-men
  • There are numerous exercises and positions that can be helpful in labour that not only aid in the baby's positioning and descent, but also in the release of painkilling hormones.  For example, learning forward, swaying the hips and using a birthing ball, plus the spinning babies labour exercises, especially "The Fantastic Four". http://spinningbabies.com/learn-more/techniques/the-fantastic-four/
  • Chiropractic care (especially the Webster technique), osteopathic care or other forms of bodywork can be options - if your pelvis is misaligned or the muscles that support the uterus are unevenly tense, birth can be more difficult because it's harder for the baby to get into an optimal position. Spinning babies explains very well why this is the case.

Emotional readiness for birth

  • Previous trauma, perhaps because of sexual abuse or traumatic sexual experiences can affect birth by making the mother less able to release and relax in labour, other emotional issues and stress can be barriers to a good birth experience, so it's worth working through these.


Psychological preparation for birth

  • Many women like the idea of going drug free, but when the time comes, they are unprepared for how to handle the sensations.  In addition to things like rocking the hips, using a birthing ball, being upright and especially leaning forward, mental and breathing exercises can really help. 
  • Hypnobirthing/natal hypnotherapy, "Calmbirth", as well as mindful meditation are all mental preparation tools that help manage stress in pregnancy as well as providing wonderful mental coping strategies.  During my first pregnancy, I ordered myself a Hypnobabies self-study course. Here is another good video about hypnobirthing. Some women achieve pain-free labour using these techniques. I personally didn't have that experience, but I still found the preparation helpful in getting through my 36 hour labour. There were some aspects to that philosophy which I now find lacking.  For my second birth, I prefered to use mindful meditation.  The book "Mindful Birthing" by Nancy Bardacke was quite helpful.  You can listen to it here.
  • I also really like the Bradley method, especially the deep breathing. Oxygen helps reduce lactic acid build-up, which is part of what causes pain - https://www.youtube.com/watch?v=I5HJ83xXQvM
  • Lamaze breathing is another option
  • Read POSITIVE birth stories that help create a positive mental picture of what birth can be! For example, http://birthwithoutfearblog.com/


Spiritual Preparation

  • Connected to psychological and emotional of course, but spiritually preparing oneself through prayer and meditation is very important in helping to prepare ourselves for whatever happens, and also in overcoming fear.  Some people talk about birth as being a spiritual experience.  I think it is! Part of that can be learning to accept whatever happens and surrender to the power of the experience.  This is a bit different to the hypnobirthing perspective which states that birth shouldn't be painful.  Perhaps it can involve pain, but if we surrender and relax and use it as an occasion for spiritual growth, it is bearable and a very positive experience.


Become informed about birth physiology

It's really helpful to understand the beauty of how our bodies were designed to function and how to support the body in reaching its biological potential, thus reaping the benefits of a physiological labour, birth and post-partum.

Become informed about birth and newborn interventions

2. Choice of Caregivers and Birth Setting

Caregivers

 If at all possible, my personal preference for a caregiver for pregnancy, birth and the postpartum period is midwifery care.  Midwives are trained to support normal birth and do a lot to make that possible, including providing information about nutrition and health, providing support in labour and parenting and breastfeeding support afterwards. Research shows that midwifery care, especially when it is continued from the duration of pregnancy results in a much reduced level of intervention compared to obstetric care, even when looking at women of the same risk factor levels. Why is this the case? Well, obstetricians are experts in managing all the complications that can arise. In their training, they rarely see a normal, uncomplicated and unmedicated delivery.  They see all the risky cases where medication, monitoring and/or surgery is needed.  When they see a healthy women having a normal labour, they can tend to see signs of complications, when in fact there is nothing wrong.  They are just so used to intervening that they are uncomfortable sitting back at letting nature sit in the driver's seat.

This article explains quite well what the differences are between an obstetrician-gynecologist and a midwife.  This youtube talk is also very interesting.

Having said that, it does matter what kind of experience the midwife has had.  An independent midwife who has a lot of experience in homebirth is more likely to have skills and knowledge that will help avoid unnecessary interventions than one who has mainly worked in a high-risk hospital setting, for example. It's important to talk to your midwife about how she feels about things like prolonged pregnancy (going past your due date), meconium staining, waterbirth, delayed cord clamping, nuchal cord and so forth (midwifethinking.com explains how many of these things are not as scary as they are made out to be).

Where you have the birth also matters - this article explains the options quite well.

If you're planning a hospital birth, it's especially important to be informed about medical interventions in birth, and when they are needed as well as when they are not necessary.  A birth plan can be helpful in this regard.  A birth plan is not just a list of what procedures and medicines you want and don't want.  It recognises that sometimes there are deviations from the norm, and so a birth plan has a plan B and maybe a C and D.  It answers the question "How can I keep things as optimal for my baby's health and my birth experience if I this or that happens...".

In any setting, but especially in hospital, a doula can be helpful in advising you about medical interventions, advocating for your wishes and providing physical and emotional support.

Birth environment and setting

It should be noted that birth outcomes are not just about the health of the mother when she walks into the hospital.  And it's not just the interventions she endures, either (though this is very significant).  It is significantly linked to how the mother is feeling.  Her emotions (such as feeling in control and safe in her environment versus scared and powerless) can help or hinder the release of birthing hormones and it is these that ensure safety! Not many obstetricians acknowledge this.  They think they can manage things when they go wrong, but what about preventing things from going wrong in the first place?! Allowing the hormones to function properly, through meeting the physiological needs of a labouring women can do a lot to doing this. This includes the things I've mentioned, plus a darkly lit, warm, quiet and private space.  These things also make the 'pain' of childbirth less 'painful'.

The home environment provides all of these conditions - a sense of familiarity, control over the physical space and how others interact with you in your own home, privacy and freedom of movement, freedom to access natural comfort measures, and a much reduced likelihood of unnecessary intervention. Plus, when intervention is needed, most western countries have the facilities to make a quick hospital transfer smooth and successful. I feel that choosing home birth is about giving yourself the best chance of a successful physiological birth.  So, given a situation where there are no pressing medical concerns, I would never ever choose a hospital birth, if I had the choice. I know that not many women don't have that choice, so then it is about optimising the hospital experience so that it supports normal physiology.

This talk explains the advantages of homebirth and you can read more about homebirth here.

Rallying Support

 Finally, it's important who you invite into your birthing space and their attitudes towards natural labour.  Not just the care provider and possibly a doula, but also family members! Rhea Dempsey in her book "Birth with Confidence" emphasizes that a birth support person should be strong for the mother and not overly sympathetic.  She tells the story of an athlete preparing to do a solo swim across a sea. She carefully selected a small group of people who would be in the small boat that would pull along the shark cage she would be swimming in.  Their role was to watch out for hazards, cheer her on and possibly pull her out if she had an accident.  She would have to swim throughout the night and day for a long period and she knew that she needed to keep up her morale, because there would be times when the loneliness, the cold, the fatigue and painful muscles would get too much and she would beg to be pulled out.  She knew that if her own mother was on that support boat, she would not have the strength to watch her daughter begging to be taken out and refuse to do that.  The swimmer didn't need people on the boat like that.  She didn't need rescuing when all that was wrong was a lack of confidence, but rather she needed people who could be strong for her, to rally her on and show that she believed in her strength. In every labour, there are times when the sensations get very intense.  We don't need the siren call of the epidural.  We need someone to tell us "you're doing a great job, even though you don't feel like it, you are so strong and you are going to birth this baby so well!".

Conclusion

To conclude, both of these aspects of personal preparation and supportive care are important. In stories I hear about birth, it sadly happens too often that a woman is well-prepared for birth but her experience is made so much harder by caregivers who are uninformed about best-practice and are too keen on intervening.  Sometimes it's not possible to avoid this, but in some cases, women pay extra to go to a private hospital and end up receiving unnecessary interventions because their caregivers are just more comfortable with medicalized birth.  On the other hand, a woman could have awesome caregivers, but still have a less than ideal experience if she has preventable health conditions or makes decisions based on unnecessary fear or lack of preparation.  However, I tend to think that the choice of caregivers could perhaps be more important than preparation.  If a women is minimally prepared, but has a great midwife whom she trusts, her midwife can really help her navigate the common pitfalls she could encounter.  And, of course, in the end, birth is not in our control and we shouldn't feel guilty if things don't go to plan or if we were unaware of something we later realized was important.  We do the best we can under the circumstances and in every case, we learn and grow!
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