Monday, October 21, 2013

Birth is Universal

We sat around my living room, the three of us.  We laughed about the ridiculous things we had seen and heard in hospital birth rooms.  We gushed about the awe and wonder of a woman giving birth in all of her glory.  We opened up to one another and shared our concerns and asked for input on how to be better - in both the hands on and business aspects of birth.  We ate scones and hummus and thousand-layer cake and chocolates.  We nursed babies and re-directed school-age children, and sent them upstairs to find their own entertainment.  The three of us, though not knowing one another well, we clung to one another's words, experiences, souls.

Three different women, three different continents, three different cultures.  Together we represented a very broad range of beliefs and ways of life.  But we convened for the purpose of discussing something universal.  Birth.

I have found that this profession - the profession of being with a woman through her birth - is one that is unlike any other.  While bankers, mechanics, graphic designers can all gather together and talk about their lives, their work, their difficulties and successes, nothing can compare to the sisterhood that is created in sharing this work. 

No matter where I go in this world, no matter what ethnicity or culture or continent I am with, I have found that birth is universal.  Every child from the beginning of time has come from a woman's body, and to witness this everyday miracle is such an honor.  Everywhere on earth, from the beginning of time, other women have gathered around the laboring mother to help her, love her, cherish her through the transition of motherhood.  It is an amazing privilege to be able to share this experience with women all over the world and throughout time.

After the get together at my house, we all went our separate ways.  Three different religions, three different lifestyles, three different households, and yet this love of birthing women connects our souls and leaves us with a feeling of unity that cannot be described.

Friday, May 31, 2013

Inversion - Going Upside-Down to Make Things Right!

For years in my childbirth education classes I would joke with my students about how the only position worse than laboring on your back would be laboring upside down.  We all laughed and thought it was hilarious to imagine a women doing handstands in labor.  Funny how perspectives can change.

I was originally introduced to inversions by my chiropractor, who specializes in pregnancy and pediatric chiropractic care.  I often invited her to come to my childbirth classes to talk about the importance of posture, optimal fetal positioning, and chiropractic support in pregnancy.  Since many of my doula clients also saw her, we have always had an open relationship about ways in which to help laboring mothers.

The first time I went to her office with a client in early labor she had my client put her knees on the adjustment table and her hands on the ground.  I thought it was a bit odd, but I have seen a lot of odd things in this job that end up working!  It didn't make sense to me at first, but the more I asked, the more I pondered, the more I practiced it, it began to make perfect sense.

The Baby Entering The Pelvis

Think about driving a car into a parking space in a crowded parking lot.  You turn the wheel of your car and try to ease in to the tight fitting space when you realize, uh-oh!  I don't have enough room to maneuver my way into this spot!  Do you then keep driving your car forward?  No way!  That would result in crushing cars parked in the adjoining spaces.  So, you back up, take a different angle and try again.


This can also occur in pregnancy and labor.  As mentioned in my previous posts, there tends to be an optimal position in which babies best fit through the mother's pelvis.  Sometimes, babies start to move down into the pelvis in a manner that makes an awkward fit.  This can result in a stuck baby who does not make much forward progression.  In these cases, getting baby to first back up and then come in at a different angle is what will help baby best to realign and enter in a more suitable manner.


How Do You Do It?

Inversions can seem a bit scary at first.  And it's okay if it is a bit awkward.  You have a large belly and it will be awkward! 

What you'll need:


- A support person
- Stairs, a low table, a couch, or chair

Step One. You should begin by starting on your hands and knees, facing away from the furniture that will be supporting you.


Step Two.  With your support person helping, crawl backward and lift one knee up onto the furniture.

Step Three.  Pull up your other knee onto the furniture.

Step Four.  With your support person supporting your shoulders, push off your knees, up onto your feet, lifting your bottom farther up into the air, and attempt to make your body into an angle of 90* or less.  Make sure the mom releases her belly, letting it fully relax.

Step Five.  Hold this position for a minute at a time.  (Notice how the support person uses her knees/legs to support the shoulders while holding/shimmying the hips).  Make sure mom is keeping her belly relaxed.


Step Six.  Alternate onto elbows if needed.

Step Seven.  If desired/necessary, have the partner shimmy your hips to help disengage baby.

Step Eight.  Take a break on your hands and knees/elbows and knees but do not stand upright.

Repeat steps 1-8 twice if in late pregnancy, in between each contraction if in labor.

Now this is important!!  Before the mother gets into an upright position, it is incredibly beneficial to sift the mother's belly to help baby rotate into a better position, or angle him/herself into a better position.


Why This Works

The Uterus - If your uterus has any type of twist or imbalance to it due to uneven ligaments holding it to the pelvis and back, the inversion will be incredibly helpful at releasing those ligaments.  We humans tend to spend all of our time in an upright position.  In this position, the heavy uterus hangs down in the same manner day after day.  When a pregnant woman inverts, her uterus then hangs in a completely different manner.  This allow the ligaments to be gently pulled on and balanced on both sides of mom's body.  This will help the uterus to become aligned, allowing more room for a baby to move around.

The Baby - This technique can be incredibly effective at getting a baby to find it's best position through the pelvis.  Once the baby has started to engage into the pelvis in late pregnancy, it is much more difficult for baby to maneuver his way into different positions.  If his hand is up by his head, his head is extended, he's come down oblique, or posterior (to name a few predicaments), getting him *out* of the pelvis will be a much more effective technique to realigning him than just trying to move him in an already tight space.  Like that car in the parking space, backing up out of the pelvis before correcting the position of the baby will be much easier than trying to reposition him while he's hedged in.

In Labor

The inversion is most effective if done prior to the onset of labor.  This allows the repositioning to be done without the counter-acting forces of contractions.  Since contractions forcefully push the baby into the pelvis, trying to disengage the baby from the pelvis during labor can be difficult.  The contractions act as an additional force to gravity, like a bulldozer pushing that car into the parking space.  But, it can be done!

In labor, assume the inversion position as often as you can in-between contractions.  It can be difficult to hold the position through a contraction, but see if mom can do that as well.  The contractions will feel very odd in this upside down position, and mom will need a lot of support.  If mom is laboring in a hospital, you may need to work around a lot of wires and lines.  Having an i.v. or hep lock in her hand will cause some difficulty in leaning forward on her hands.  Helping her on to her elbows will be a better position if this is the case.



Signs That An Inversion Would Be Helpful

In Pregnancy:

* You are in your third trimester of pregnancy
* You have round ligament pain
* You have pressure in your back or bottom
* You have pressure in your hips

In Labor:

 * You are having prodromal labor
* Your contractions are sporadic or spaced out
* You are feeling the contractions mostly in your back
* Contractions are strong but baby is not moving down
* Contractions are irregular - coming at varying lengths, piggy-backing, or double peaking
* You are feeling a lot of pressure in your back or in your hips
* You have an urge to push while only 4-6 cm dilated
* You seem to be "stuck" at a certain dilation


Please reserve the inversion for women with intact waters.  Once the waters are released, there is the added risk of a cord prolapse.  A mom can go to knees and elbows at this point, but a full inversion may add to the risk.
Please reserve the inversion for women with normal blood pressure.  Make sure mom feels okay with this position, can support herself with her arms and does not get a headache from being upside down.

Tuesday, March 12, 2013

Trauma, unexpected

Many times as doulas we are called to support a mother through a birth that doesn't go the way she expected.  Like the wedding we plan since childhood, our birth experiences are something we often dream of, plan out, idealize.  And sometimes it goes just so.  Perfectly.  But more often, there are things that go awry.  Sometimes in little ways, other times in large ways. 

These unexpected births can be difficult for the mothers and difficult for the doulas to know how to process, to support and help the mother through.  We've all had those births - the ones that encompass an unplanned epidural, a transfer from home to hospital, or an unexpected cesarean.  When mothers encounter resistance at the hospital, we know to pour on the love and support.  When mothers suffer through the agony of back labor, we know to keep our hands pressed firmly and endlessly in counter pressure.  When labors tend to go on and on with little progress, we persevere ourselves with endless encouragement and optimism, utilizing every possible tool we can find.  Those difficult hairpin turns in the labor can take a moment for our actions to support our ideas of taking everything in stride and readjusting our expectations.  But we keep on supporting, loving, tending.  And we know that these mothers will often need more time to process their births afterward, and that we need to be available and open for listening to the mother share her experience, her feelings, her grief.

But many of us have the idea that it is only those births that were intended to be natural births and ended up being medicalized that are the ones which mothers need longer support to process.  When we see a birth go quickly and naturally, we tend to rejoice and applaud the wonders of such an efficient birth process.  We often think, that was easy!  She got her natural birth, she must feel great!  This is not always the case, and we really need to be careful to not assume that any birth outcome is exactly what the mother intended.

My most recent client's labor started out slow and steady, easing into contractions, gradually building up in length and intensity.  And then, all of a sudden things changed so quickly, we barely had time to blink before we were rushing off to the hospital.  This mama's body switched gears so fast that her baby was born in the car in the hospital parking lot.  At first I was so pleased for this mama, who was fearful of encountering resistance to her natural birth plan in the hospital.  She didn't have to fight for a single one of her wishes!  Her baby came without any interference!  But I knew.  I could see it on her face.  That look of shock and trauma.  I knew how that felt. 

There is no place in another woman's birth experience for our own feelings.  There is no where in her own perception that we need to place our own feelings, or the way we think she should feel.  Mothers get that all the time from outsiders.  "You should be happy that you have a healthy baby!"  "You are fine."  "Just focus on the relief of this being over with!"  Why do so many press upon the mother how they need to be feeling?  We do this often in the obviously traumatic births.  But we also do this with those births that are unexpectedly traumatic.  "Wow!  That was fast!  You must be so happy!"  "How exciting that your baby was born in the car!"  Why must we assume that a mother feels a certain way just because we would feel a certain way, or because we expect her to feel a certain way?

Those births that seem great from an outside perspective are those that we, as doulas, need to be very aware of.  Never assume that a mother feels great, or doesn't feel great about her experience!  Check in with her.  Look her over, holistically.  How is her emotional state?  How is her mental state?  What is she presenting physically?  Touch her and look at her.  Quietly assure her that you are there for her and that she can feel safe to tell you her story.  Many times women are afraid to tell the truth of how they feel.  When everyone around them expects them to feel one way, why would they feel safe in countering everyone?  If even her doula expects her to be happy, then how does that impact the mother who is, in fact, not happy with her experience?

So doulas, listen up!  Make sure you are not overtaken by your own feelings.  Because, while they matter to you, they don't matter in the experience of the mother.  Only her feelings matter there.  Save your own feelings for your debriefings and reflections, but tuck them aside and open your heart to see and hear the story that the mother tells.  You may find yourself quite surprised that it is a very different story from the one in which you feel you just took part.