I've given birth twice. There are moments of both of my births that feel somewhat unsettled and disempowered, moments that feel triumphant and strong, and moments that are simply amazing. While I feel mostly at peace with my birth stories, something in me wants to share what I did differently from one birth to the next, or what I could do differently, if I could do it again (note: two children is just the perfect amount for Adam & I!) Maybe it’s the birth activist in me. Or, the natural-minded mama. Or maybe it’s simply that hindsight is 20/20. I just wish that every woman could feel successful and glorious and proud no matter how she gives birth. I’m hoping that by sharing some of the things I’ve learned, I might help another woman reach that place of peace with her birth.
So, with no further ado… the things I’d do (or in the case of my 2nd birth, did) differently:
#1 – Study up on & practice birth positioning.
I think one of the most important factors in an easier labor is having optimal fetal positioning. That is, having a baby who is heads-down, facing mom’s back, with his back lying along one side of the front of mom’s tummy – in other words, Left Occiput Anterior. Why is fetal positioning so important? A baby who is occiput anterior will have his chin tucked to his chest, and be able to present the smallest part of his head to the cervix. What this means is that a baby in the right position will likely be born more quickly and more easily – less pain for mom, and less stress for baby. A baby not in the correct position (malpositioned) won’t put as much pressure on the cervix, so labor may not start naturally. Malpositioning may cause labor to be more painful, and baby may have a difficult time exiting, because their head isn’t presenting in a fully flexed position.
Case in point: My first baby was Occiput Posterior after being frank breech for the vast majority of my pregnancy. She turned in the week before she was born. My labor was long, extremely painful, and ended in a c-section for failure of decent – due to malposition (posterior brow presentation). I understand now this is a very rare position. Online I found an interesting case study in which the baby was previously breech, turned via ECV (external cephalic version – which was attempted with my daughter, unsuccessfully), the mom went into spontaneous labor, the baby descended in a forehead presentation, and was delivered using a vacuum & repositioning. I found this study interesting because it was done in Australia in 1998, and even then the author mentioned that the decision to rotate baby & deliver via suction (as opposed to c-section) was a tricky one, not easily reached. In my case, I’d gotten to 10cm (or nearly so – my midwife indicated that I had an anterior lip) pushed for hours in many different positions, and my midwife had attempted to reposition my daughter, but she was “stuck”. A c-section was decided on after much deliberation – part of which included my doctor not being comfortable with suctioning due to my daughter’s forehead presentation, and the other part being that my water had broken 31 hours previously, and I had developed a fever.
I want to clarify that I do believe, after much research, in spite of the best efforts given by myself, my midwife, the nurses, my husband, and my doctor, the c-section was warranted. Unfortunately, I still feel a lingering sense of disappointment and “what-if-itis”: what if I’d been able to hang on just a bit longer and try a few more positions again (we’d tried hands & knees, standing, birthing stool, lying back with stirrups, half-sitting with a birthing bar, kneeling & leaning forward on my elbows on the drop-end bed… you know, everything), what if I’d waited a little bit longer before getting an epidural (I got one somewhere around 20hrs after my water had broken – my detail memory is spotty throughout my birth story with my first – because it was so long, because I was in so much pain, because my midwife didn’t do many internal checks, and because I don’t have my medical records in front of me), what if I’d stayed home a bit longer (I headed in when my contractions were about 5 minutes apart for an hour – the hospital was 45 minutes away), what if we’d hired a doula who could have helped me understand that staying home a bit longer was okay, or who could have helped me hold out a bit more before getting an epidural, what if baby had been correctly positioned in the first place… the latter the cause for my listing optimal fetal positioning as my #1 do-over.
There are many ways to affect fetal positioning before labor starts – walking regularly, practicing prenatal yoga (which I did the 2nd time around), chiropractic visits, doing inversions, sitting on an exercise ball, sitting forward instead of lying back in the couch with feet up, doing regular pelvic tilts.
Some awesome resources, which I found during my second pregnancy, after learning about the importance of baby’s position in-utero:
Take your baby’s position seriously. It really can mean the difference between an easier or a more difficult labor and birth.
(on my birthing ball during my labor with my daughter – still smiling)
#2 – Hire a doula.
With my second pregnancy, nearly the first thing I did after realizing I was pregnant was hire a doula. The first time around, I didn’t really understand what a doula did, why they were so important – so CRITICAL – to birth – particularly when you have no previous birth experience yourself, and you’ve chosen a hospital birth. I remember wondering why a doula was necessary if you had a supportive partner. Wouldn’t your partner feel left out? What exactly would a doula DO if you already had a husband there?
I now know differently. Firstly, a doula is familiar with birth – with the stages, the process, the pain and how to cope. She’s familiar with hospital staff and policy (and which “rules” can be bent or broken). She’s there to help navigate the turbulent and unfamiliar waters of anxious soon-to-be parents, impatient doctors, pushy nurses, and crowding friends & family members. She can help a mom dedicated to a natural birth plan remember, in the midst of the worst pain of her life, why she wanted to go natural in the first place. She helps a dad know how best to help. She’s able to help the laboring mom clarify and state her needs and desires to staff. She can help a new mom latch her baby on – and this is critical, especially in hospitals who don’t have full-time lactation consultants on staff. Perhaps best of all, and what I missed the most by not having a doula the first time around, is the certainty with which an experienced doula can tell mom in the midst of a very long labor: “yes, this is normal”, and “yes, you CAN do it”. Though my second birth ended with a necessary emergent cesarean (olighydramnios + breech + previous C) at 36 weeks, I was still grateful for my doula. She helped me make clear my needs post-surgery, and helped me with nursing. She set the stage for making me feel empowered in my birth, even while the best laid plans for a natural VBAC were quickly and unexpectedly unraveled. Hire a doula – you won’t regret the money spent.
(me and my doula - before my son's birth)
#3 – Put EVERYTHING in your birth plan.
Not just the good stuff, but the not-so-good stuff too. From early labor right through to the days after baby is born. While creating my first birth plan, I barely scratched the surface of things I didn’t think would ever happen (i.e. an IV, constant fetal monitoring, pitocin, nubane, epidurals, and a c-section). Naively, I really didn’t imagine anything would go any way other than as planned. While that type of thinking may have set my mind for success, by doing so, I unfortunately missed out on educating and preparing myself for the “what ifs”. I didn’t fully research the process of c-sections because I assumed I’d never need one. I didn’t look into alternatives to pitocin, nor the side effects of it, because I assumed labor would move along just fine. Yes, I’d read about the “cascade of interventions” and how consenting to meds could lead down a path more likely to culminate in a c-section. Yet, in my head, I wasn’t going to have a cesarean section, and I wasn’t going to need any interventions, so I needn’t put any further thought into it. Why plan for a disaster when it’s not even on your horizon, right? Except… when I hadn’t slept for 24 hours, and hadn’t made any progress… in spite of my “birth planned” walking, standing, bouncing on a ball, showering, breathing, visualization, all without continual monitoring… and when the pain in my back from my daughter’s posterior position became unbearable… only then, I realized I really had no game plan. I hadn’t thought of the what ifs. Because they weren’t going to happen. Yet… there they were.
To put it simply: being informed of the side effects of pain meds when you’re nearly out of your mind with pain and anxiety and tiredness isn’t really being informed. It’s certainly not the optimal time in which to be making decisions. And being completely immobilized on the operating table doesn’t lend itself well to making your desires and needs known for post-surgery care for yourself and your new baby.
So make your plans – all of them – ideal birth AND less than ideal – beforehand. Put them in writing, and share them with your support people.
(getting sewn up, with my son on my chest)
#4 – Be ready with lactation support.
I was lucky the first time around. The hospital where I gave birth was working on “baby-friendly” designation at the time, so, there was a lactation consultant on staff at all times. Rooming in was strongly encouraged – they didn’t even have a nursery set up for non-urgent care infants. There were no free formula samples, no bottles or pacifiers given, and all the neonatal nurses were educated and supportive about breastfeeding. But personally, I had only read a few things online and in books about breastfeeding. I knew my mother and mother-in-law had breastfed, and I planned to do so myself. But that was the extent of my preparation for breastfeeding. Again, like with the c-section, I never imagined that things could or would go other than “as planned” – so I didn’t have any alternate plans. Had I not had the amazing support of the staff lactation consultant, I’m not sure I’d have been able to make it through delayed milk coming in, an extremely jaundiced baby (due to ABO incompatibility) in the hospital for a week, and the complexities and frustrations of using an SNS and pump. At the time, I didn’t know anyone in La Leche League – in fact, I’m not sure I’d even heard of LLL. I didn’t have any friends in real life who had breastfed. So, really, in the case of successful breastfeeding, I was just plain lucky. The second time around, I was prepared with a doula, my LLL contact, a lactation consultant, and friends in my phone. Not to mention the experience of successfully breastfeeding my first. Don’t leave your breastfeeding relationship to luck. Be prepared.
(my milking machine & SNS - my constant companions in the hospital after my daughter's birth)
What I’ve learned through two pregnancies and births is that you can’t control everything. There’s always an element of the unknown; the unknowable. Yet the more information you have, the stronger you will be. The more able you’ll be to make real informed choices; to feel empowered; to have a plan and make your plan known. There’s a sense of calm that comes from preparation, and with that you’ll be better able to craft your birth in a way that is more altogether more comfortable, safe, and satisfying in the end. Here’s to better birthing!