Postpartum Haze: Impressions from Day One

The feeling of his head in my hand as I waited for the last contraction to help push him out.  Angel-soft hair.  Little wiggles – he is moving! – as he works to get his shoulder free and join the world.  A strong wave of pressure, a breathless second, a loud cry, my baby is born into my own hands.

Joy!  The air comes back into my lungs, back into the room.  Labor is over, life is beginning.

Catching my breath.  Lucy is coming up the stairs, walking towards us.  Kevin at my side, kissing my head, welcoming his son.  Slippery little man in my arms, crying his little head off!

Out of the pool, onto the couch on shaky legs, surrounded by loving arms, beautiful women, ecstatic family.  Is this umbilical cord a little short?

I feel triumphant, breathless, strong, a warrior, a goddess!  To say “I did it!” seems trite and silly, but I did it!  I made this!  I birthed my baby, in my own house, on my own terms, letting my body do what it needed to do.  Birth is involuntary; you just have to allow it to happen.  And I did.

Oh the perfection.  Sweet-smelling, gooey little baby snuggling against my chest.  The warm, safe presence of my husband beside me.

Hungry baby, latching on with no trouble, eat eat eat!

And then Lucy is with us.  What happened to my sweet baby girl?  Who took my little girl and turned her into this GIANT?  She’s HUGE!  And what big TEETH she has! Lucy, “Want MAMA MILK!  MINE!”  Meltdown in the works.  Oh dear, here we go.  I am not sure I want to nurse this enormous wolf-child who has somehow replaced my daughter.  But the wolf-child insists and I am blissed out on birth and baby, so have at it, kid.

Tandem nursing for the first time.  I am already stark butt naked in front of a roomful of people, why not sling a few boobs around for good measure?

The room clears out.  We are alone, me, Malcolm, Kevin.  Admiring our handiwork.  My God he is perfect.  Are those pointed ears?  Does he really have pointed ear??  My God he is perfect.  Sweet smelling.  Soft.  Squishy.  Still covered in mayonnaise and goop, but wonderful to seem smell, kiss, cuddle.  Bliss.  Absolute bliss.

Mairi (midwife) makes eggs.  Lots and lots of eggs with cheddar cheese in them.  I devour a heaping bowl.  The more.  Then toast and pineapple coconut water then chocolate.

I take a delightfully hot shower.  OH GOD I AM SO HAPPY NOT TO BE PREGNANT ANYMORE!  Oh God, what a smooshy misshapen belly is left over from being pregnant.  It looks like someone took a purple marker to a lump of sloppy bread dough.  Racing stripes.  Don’t look.  There will be time for assessing the damage later.  I am scrubbed and clean and cozy in my red bathrobe and snuggled back on the couch to watch Kevin watching his son.  More bliss.

There is a minor amount of poking and prodding and checking and measuring done on me and my girlie parts.  It feels like there must have been an atomic bomb that went off down there.  I am glad that I don’t have to look at it. No tear, just a split, just swelling, little bleeding.  Kat (student midwife) says “Seriously, Jenny, I was wondering if you lost any blood at all!  But it’s in the placenta.”  Oh.  Okay.  Good…?

Newborn exam. Malcolm does not like it.  He’s a big boy!  8 pounds, 14 oz!  Lucy watches.  Kat explains to Lucy what she is doing.  Lucy cares very little.  “Want to see Baby Muffin,” she says, not fully understanding that Baby Malcolm IS Baby Muffin.  I am now almost certain she thought that my belly button was the baby I was growing in my belly.

Bed, blissful, beautiful, cozy, clean.  My bed.  Ah.  I cuddle up with Malcolm on my chest, skin to skin, and Kevin at my side.  We can hardly sleep for being so exhausted.  We can hardly sleep from being so in love.

But sleep overtakes us and afternoon slips into evening.  He sleeps on me all evening, all night long.  I can’t think of a sweeter day.

Malcolm’s Birth

I had woken up for 2 or three days feeling very energetic (despite sleeping very poorly)…and I tried very hard not to do anything useful with this energy, hoping it was a sign I would be having the baby soon.  But I was still 2 weeks from my due date, so I assumed that it was a fluke and I would soon go back to feeling exhausted and crabby.  On Thursday night, I went to be early without eating dinner, which was very weird for me, since I had been eating like a starving horse for weeks.  But I just wasn’t hungry.  I lay in bed reading, playing scrabble on my phone, re-reading the last 2 chapters in my Hypnobabies workbook.  I was laying there for hours, not being able to sleep.  I wasn’t having any contractions, other than the strong Braxton-Hicks I had been having for several weeks.  Around 11:30, I started to feel a change in the contractions.  They were coming regularly and starting to feel a little more “real”.  Nothing urgent and nothing painful, just…real.  So I started timing them and was a little surprised to see them coming 5-7 minutes apart.  I tried to get to sleep, but it just wasn’t happening.  I got up to use the bathroom and noticed some spotting.  It wasn’t enough to be called a bloody show, but definitely spotting.  Funny what thrills you when you are nine months pregnant!  I was thrilled to see that little bit of blood!  Maybe this was it!

I got up to walk around and have a few glasses of water to see if that would stop the contractions, but they kept coming.  They were not terribly strong, but definitely regularly.  Around 3:00 am, I sat on the couch in the living room trying to decide if this merited a call to my midwife when I had a really strong, long contraction, as if in answer to my uncertainty.  So I called Mairi to let her know I had been up for a while with fairly regular contractions.  She suggested taking a shower and trying to get back to sleep.  So I took my late-night shower and oh did it feel good, but it didn’t do anything to make the contractions slow their pace.  I tried really hard not to wake up Kevin, figuring this would put me to sleep, but also wanting him to get a good night’s sleep if this actually was it so that at least one of us would be well rested.  I climbed into bed and he said “Are we having a baby?”  So much for not waking him.  I said I didn’t really know, but that we should try to get some sleep.  We both lay in bed for a while, and finally Kevin got up and I rolled over to try to sleep again.  All this time the contractions were staying regularly at around 5-6 minutes and lasting about a minute or so.  At 4:00 am I gave up trying to sleep.  I went downstairs and found Kevin watching TV and he asked if this was it.  I was sort of thinking I was going to have another start-stop-on-and-on-for-days labor like I had with Lucy, but it was feeling pretty progressive at this point, so I said “I think maybe yes…”  At this point, I could still talk through contractions, but I had to stand up and lean over the couch or stairs or something to work through them, so I knew they were getting stronger.  I had stopped timing them, so I didn’t know if they were getting closer together or not. 

So for the next hour and 45 minutes, we set up all the things that we should have had ready before I went into labor.  We dragged the birth pool and supplies up from the storage closet.  We dug out the electric air pump, the pool liner, the thermometer, towels, shower curtains.  We tried to figure out how to turn on the electric air pump without waking up Lucy 2 hours early.  We ended up plugging the pump in out on the deck and attempting to keep the pump outside and the pool inside, hopefully making it quieter, but in actuality, we were just allowing dozens of mosquitoes to pour into the house (this we didn’t discover until later in the day when we all ended up covered in red bumps).  Of course, all efforts to remain quiet were thwarted by the fact that every 4 minutes or so, I had to drop what I was doing without ceremony and get on all fours to work through another contraction.  After literally tossing the air pump across the room as another contraction started, I decided that it was time to call Mairi again.  So at 4:45, I called Mairi and told her I never got back to sleep and the contractions were now strong enough not to talk through.  She called Kat (the student midwife who would also be attending the birth) and they were on their way.  I was starting to think I wasn’t going to have time to even fill the birth pool at this point.  But I was desperate for the warm water, so I went ahead anyway, as Kevin laid out the shower curtain and towels on the couch, lit some candles and got snacks out for the descending hordes.  I started filling the pool, and called my dad to let them know that if they wanted to be at the birth, they should get on their way as soon as possible.  Apparently my mom was not convinced and repeatedly told my dad this was false labor and they should wait for another phone call before heading out in the middle of the night.  I am so glad they didn’t!  Then I noticed that I hadn’t put the liner in the birth pool.  This wasn’t really an issue…but it sure would make clean-up a lot messier without a liner.  There was already 6 inches of water in the pool, so instead of taking the time to drain it, I just put the liner in over the water and started filling again.  And of course, I accidentally moved the faucet while I worked through a contraction and only noticed when the pool was almost full that it was only 80 degrees.  Never try to do anything requiring any measure of precision when you are in labor. 

Kat and Thaddeus (her 4 month old son) arrived around 5:15 and Mairi arrived a few minutes later.  I sat and chatted with Mairi and Kat between contractions.  I hadn’t gotten to practice my Hypnobabies as much as I intended, so while I was not experiencing a perfectly comfortable birth, it certainly wasn’t mind-numbingly painful.  I sat on the couch and breathed through a contraction, and I remember feeling like the earth was opening up and pulling me down.  I literally felt as though I was sinking down further into the earth with every contraction.  Mairi said that was Gaia reaching up and embracing me.  What a lovely image to get me through each increasingly challenging contraction.  We finally got the pool hot enough and I jumped in and stayed there for the next three hours.  I dozed between waves of increasing pressure, trying to remember my relaxation cues.  I read a quote recently that said “birth is involuntary; you just have to allow it to happen”.  It was so much easier – and much more effective - to just let all my tension go and relax into the pressure than to tense up and fight it. 

Lucy woke up sometime before 6:00 am and came down to see what all the commotion was.  She was so

incredibly sweet the whole time.  She brought me water and kissed me and patted my head and said “Feel better, Mama” and asked me what was happening.  We had watched a lot of birth videos in preparation for her being at the birth, so I told I was just working hard to get our baby out, like the moms in the videos we watched.  She seemed to understand and was perfectly at ease and really happy to be helping Mama to have the baby.  Eventually, though, she wanted to get in the pool and when she wasn’t allowed to do that, she got bored and restless so Kevin took her to get dressed and play downstairs.  I kept looking at the clock, knowing my parents were on the way and wondering when they would get there.  I wanted Kevin with me, and I didn’t know what we were going to do with Lucy if this lasted all day, which I was fully expecting.  I remember noticing that the sun was rising, seeing that it was 7:30 am, and thinking “30 minutes and my parents will be here to help…”

I heard ELMO’S WORLD starting on the DVD player, and then I heard my parents coming in the front door.  30 minutes had passed in what seemed like an instant.  I had been having pushy contractions on and off for a while.  There were super intense, 90 second or more, this-baby-is-coming-now contractions interspersed with gentler (relatively, anyway), calmer pressure waves.  I was grateful for this unexpected pattern, since it gave me a chance to rest and gather my strength, even though there was never a full break between contractions.  My dad and mom were talking loudly as a particularly long, strong wave hit me, and I remember having my one, less-than-zen moment of labor when I shouted at the top of my lungs “PLEASE STOP TALKING!”  Actually, I might have shouted “PLEASE SHUT UP!”…you’d have to ask my parents.  And I am sure I had more than one less-than-zen moment, I just don’t recall themJ  At one point, after breathing my way through another pushy contraction, I opened my eyes to see that Kat had put Thaddeus in the bumbo right next to the birth pool.  He was smiling and cooing like he was cheering me on.  It was such a delightful, unexpected surprise to see his sweet little face smiling at me – it reminded me what all this was for! 

A few minutes after my parents came, my water broke (according to my labor summary report, this was at 8:09 am).  Clear water, lots of vernix, all is well!  I don’t know how many times I pushed, or how many contractions I had after my water broke.  I don’t remember having a conscious urge to push.  Each pushing contraction did all the work for me.  I tried just to let my body go limp and allow my uterus to do the work for me.  I honestly don’t know how anyone could do anything BUT allow the process to unfold – it was so completely out of my control.  I couldn’t control what sounds were coming out of my mouth, I couldn’t control how my body was moving, and I certainly couldn’t control what was happening in my womb.  The impression I have from the last few contractions was of me, hanging over the side of the pool, body getting jerked downwards and arms flailing about as if I were being mauled by a shark or rolled by a crocodile or something.  Kevin assures me this isn’t what happened, but that is the picture I have in my mind.  These contractions felt like there was a very strong someone pulling downward on a rope tied around my solar plexus on the inside.  On Kat and Mairi’s suggestion, I checked myself and found the baby’s head was less than an inch away from crowning!  Soon, soon, soon!

I had torn pretty badly with Lucy, and really didn’t want to do that again, so as I felt the baby crowning, I covered his head with my hand and applied a lot of pressure where I felt the most stinging and pulling.  Then suddenly, his head was out!  Kat urged me to push again, without a contraction, to get the rest of him out; I guess there is only so long you want a baby’s head underwater before there is a possibility of him trying to take his first breath underwater – which isn’t a great idea.  I gave some pretty hard pushes, but he was not moving anywhere.  I still had my hand on his head, and I could feel him wriggling and turning, helping himself to be born.  This was absolutely the most amazing thing I have ever experienced.  My sweet baby and I had been working together this whole time so I could finally hold him in my arms.  Mairi thought his shoulder was a little sticky (not quite stuck, per say, but not in a hurry to come out), so Kat gently helped the shoulder out while I waited for the next contraction.  Ouch.  One more wave, one more push, and Malcolm

swam out into my hands.  I pulled him to my chest and sat back, giddy and laughing and crying all at the same time.

At Malcolm’s huge first cry, I saw someone ushering Lucy up to meet her new baby brother (I have no idea who it was, who was actually there when he was born, or what might have been happening outside the little circle of me, the baby and

Kat).  She stopped at Thaddeus and patted him on the head  – she might have thought he was the new baby - and came over to me and the baby.  She put her little hand on his tiny head.  It was so wonderfully, deliciously sweet to have my husband and my baby girl a breath away as we all met our baby boy together.  MALCOLM OLIVER CORBETT was born on 9/23/2011 at 8:27 am, 8 pounds, 14 oz, 21” long.

Later, Kevin told me that Lucy had been downstairs saying “Mama’s making lots of noise.  Like a heffalump!” 

We moved to the couch where Malcolm took to nursing like a pro – I didn’t even need to help him latch on!  When Lucy saw Malcolm nursing, she immediately wanted to nurse as well (had to stake her claim on Mama, I suppose!).  We had our first tandem nursing session ten minutes after Malcolm was born. I credit Lucy with helping to birth the placenta a few minutes later, and for the amazingly small amount of blood I lost. 

A Birth Story

I don't normally write birth stories for the births I attend. I don't consider them to be my stories to tell, and mine is an outside perspective. No matter how close I am to the process, I am still outside the mother's skin. But this birth was pretty special. This mom (we'll called her A for Amazing) and her previous experiences with birth was the one catalyst I can readily identify as the reason why I became a doula. I had inklings that this was a direction I wanted to take, but this mama and her second birth really clarified it. She had had one c-section and one hard-fought VBAC. After her second birth, she said to me "I heard your voice in my head saying 'you can do this, your body was made for this' and I knew I could keep going". When A said that, it flipped a switch in my brain and opened my heart to following this calling. I knew I wanted to be in the birthing room. So when she had a surprise third pregnancy, she called me and I immediately jumped at the opportunity to be her doula.

Me and Baby P

A little background: After each birth, A had suffered some sort of awful postpartum experience. Her blood pressure skyrocketed after each birth, requiring medications incompatible with nursing and after her second she got a case of Cdif which landed her in the hospital again and ended her nursing relationship after a month. Her blood pressure issues the second time around got her passed from doctor to doctor and in and out of the emergency room as each subsequent doctor washed his hands of her (her OB actually said this to her literally). She also suffered a spinal headache for over two months postpartum from the epidurals she had had for each birth. As her doula I focused on helping her line up a team of caregivers that included a cardiologist and a lactation consultant. We hashed out a birth plan that included refusing all IV fluids and medications in the hopes that the artificial raising and lowering of blood pressure that happens with the administration of IV fluids, pitocin and epidurals might stave off a sharp rise in blood pressure postpartum. If it didn't stop that issue (and I wasn't by any means sure it would - it was just a factor she could control that might make a difference) then at the very least no epidural would mean no spinal headache. She was open to an epidural if her blood pressure started to rise during labor as this might prevent a c-section.
A's third birth really started two weeks before the baby was born. She was wakened each night with prodromal labor. Real, intensifying contractions that kept her up most of every night. Twice she thought her water had broken, and twice was sent home from the hospital with her waters intact. By the time she was 38 weeks, she was over 4 cm dilated and 60% effaced. At 39 weeks, she was 5 cm and 75%. Contractions every evening and night, painful baby wiggling all night long, no sleep and two other boys (3.5 years and 17 months) keeping her busy all day long. She carries her babies deep and low, so he was firmly engaged and making very step agony. Misery.
My thought was that the baby was poorly positioned and trying to move around into a better position for and easy birth. So we tried The Miles Circuit, lunges, stairs, birth ball, steep inversions, belly sifting, pretty much everything in my fairly small bag 'o tricks to get the baby to shift and get labor started for real. Nada.

At 5 days past her due date, she threw in the towel (and who wouldn't?!?). Her OB asked if she wanted to go have her water broken immediately instead of wait until 41 weeks. Shew as relieved to say yes, and just get the show on the road already.
And now the real stories starts.
I met them at the hospital at around 1:00 PM. At 1:30 PM the OB on-call came in and said hello. They chatted a little and Dr...we'll call her Dr. I for "I'm Dreadfully Inconvenienced By My Job" or "I'm So Impatient" or "I Prefer Fear Tactics To Real Information" or...I could go on...and I'm sure I will later! Anyway, Dr. I seemed really nice and chipper and on A's side. She said one thing that gave me a little pause when referring to A coming in when she thought her water broke. "We want you to come in if you think your water broke! We don't want you sitting around getting infected!" Hmm... She also says "I ordered the epidural already, so if you want it, you can just ask and they don't have to track me down." Another pause...but I gave her the benefit of the doubt.
Anyway, Dr. I checked her (6cm, 80% effaced) and broke A's water at 1:35 PM. Contractions had been going on and off all day, but pretty mildly. They picked up quickly in intensity, but just to the "Early Labor" sort of intensity and regularity, instead of the prodromal on and off stuff. I thought that was fine. For all intents and purposes, it was early labor. She was 6cm, but her body still needed to warm up to labor. We did belly lifts, squats, lunges, birth ball, and all the other physical stuff we had been trying throughout the week to get things moving. After about 2 and a half hours of us being pretty much left to our own devices, contractions really picked up into active labor territory. The nurses were amazing and supportive, the doctor was absent.
Within the next 90 minutes, things got really intense. A stopped chatting between contractions, using the time to recover and get ready for the next one. She started moaning and deeply breathing during them. All signs pointed to her being deep in active labor.
Dr. I Am Too Impatient To Wait For Your Body To Work came back after roughly 4 hours. She said, before she did anything, "Something is keeping the baby in. It should be out by now! I'm going to check you and see if maybe you need a little help." She spoke in a chipper, high-pitched voice, alas kindergarten teacher. She checked A.
Dr. I: You're at 6.5 cm and your body is really not making much progress. The baby really should be out by now. We are going to put you on a little Pitocin. You need to be progressing, and if that doesn't happen unfortunately we are talking about a c-section.
A: (Her face got pale, her eyes got wide. Panic face. I hate this doctor instantly and notice she is the perfect height for me to elbow her directly in the nose.) Um...can we wait an hour?
Dr. I: (cheery as hell) Nope! We won't use too much, since you're a VBAC we are not going to be super aggressive, but the baby needs to come out. You really should be progressing at a centimeter or even a centimeter and a half per hour, and that's really the lowest 95% percentile of how most women progress at this point.
She looked at me nodding, as if to get me on her side, my eyes went wide and I looked at A. I couldn't shake my head, I couldn't say "Wow, you're full of shit!" All I can say is "Do you and J want to take a minute to talk about this?"
Dr. I kept talking about how she's going to give her Pitocin and A's husband J cut in.
J: You don't have to, A. You don't have to do anything you don't want to. (I mentally punch the air "YES!")
Dr. I: (backpedaling and talking in an "I think this is a terrible idea and later I'll say I told you so" voice) Well, ultimately, yes, this is your show, you're in charge here so I'll let you have an hour, but this baby should really be out by now.
I thought "So the real answer is 'yes, of course you can have an hour." Grumble.
She stalked out. A got up, and kept laboring, but really worked hard to get the most intense contractions as possible. A is for Awesome. She kept going, practically begging for more, more intense, more close together. She did NOT want Pitocin. I reminded A & J that they can't do anything without A's consent. I reminded them to ask the doctor is she and the baby are okay, and if the answer is "yes" then nothing more needed to be done.
Dr. I Just Want To Go Home came back 15 minutes later.
Dr. I: So I'll give you an hour, but if you don't make any progress, we can let you go any more without help.
J: Is A okay?
Dr. I: Yes, for now. (Emphasis NOT added)
J: Is the baby okay?
Dr. I Am Not Above Playing The Dead Baby Card: Yes, for now. The issue is the scar can only contract so many times, and we don't want the uterus to rupture. This is her third birth...(kindergarten/speaking to the mentally deficient voice again).
J: The first was a c-section. This is only her second vaginal birth (points to dad for saying "vaginal" without stammering!). And she was in labor for 14 hours with the second, why are you concerned after 4?
Dr. I: (getting deeply annoyed) Okay, fine! Her second birth, but still. You're not understanding that she came in at an advanced stage of dilation and it shouldn't take this long!
I stood across the room helping A through really hard contractions. I was seriously in love with this dad for is tenacity and willingness to stand up to Dr. I Should Have Chosen a Different Specialty If I Didn't Want to Deal With The Unpredictibility of Labor.
J: Okay, but if A is okay and the baby is okay, a c-section is not an option. And she doesn't want the Pitocin right now.
Dr. I stalked off ostentatiously.
I was so proud of them.
We worked hard for the next hour. Well, A worked hard. Really hard. And J supported her like a champ and I guided them and spelled J when he was tired of hip squeezes. Dr. I came back in an hour and checked A. "You're 7 cm, so you're progressing, just very very very slowly." No mention of Pitocin that time. She left again, we kept working hard. Another hour, another check. She was 8 cm.
Dr. I Just Want To Cut Her Open: You're 8 cm and it's all anterior. And the cervix is starting to swell.
J: What does that mean?
Dr. I: The baby is pressing on the cervix from all these contractions. I've seen a baby be born with a swollen cervix before, but...
I thought "All these contractions?!? She's only been having real contractions for 4 hours!" Holy crap!
Dr. I Don't Like This Doula turned to me and practically spit "Get her in a position to get rid of that lip," and stormed out. She spent a good deal of her time with us storming out.
Sorry we ruined your evening with our excruciatingly long, abnormal, clearly dangerous birth.
I suggested A get on hands and knees on the bed. Within 20 minutes, she started having pushing contractions. She angel nurse checked her and says the lip is almost completely gone, but wait just a few contractions before really bearing down. I whispered to A as I sit by her head, holding her hand "You are doing amazing. Just keep following your body. You are doing this perfectly." She blew through a few contractions, and then couldn't help but bear down. Dr. I came back and checked A 10 minutes later. Complete! Push push push!
Dr. I: So after the baby is out, you're going to have to have some medicine for bleeding. I can give it to you in an IV, in a shot or a tablet in your rectum. Which do you think you want?
A (she's PUSHING HER BABY OUT!): Umm...Ugh. Ooooohhhhh. Do I have to decide now? I don't care right now.
Dr. I: Nope!
I thought "Then why the hell did you ask?"
She left again, but this time just to behind the curtain were she stood looking annoying and texting. Another 10 minutes went by and the pushing was getting real. A was still on hands and knees. J asked Dr. I about the medications she talked about earlier, concerned about A's history of high blood pressure. I didn't catch the whole conversation, but here is some of what I overheard.
J: I'm just concerned because of her high blood pressure.
Dr. I Don't Like To Be Questioned: We give it to patients with severe preeclampsia.
J: How will it affect her blood pressure?
Dr. I: SIR. It is safe. (Not said in the kindergarten teacher voice. This was said in the "You're drunk and you'll have to leave the bar now" voice)
J: I just had never heard of it before.
Dr. I Know More Than You So Just Do What I Say: (in a sing-songy syrupy-sweet voice) That's why you have OBs!
Again with the stalking.
Me: You have every right to ask her questions. And you can keep asking until she gives you answers you are satisfied with.
J: Well she's not. She's not giving me answers at all.
I quietly explained to J what the Pitocin and cytotec are and what they are used for postpartum. I told him sometimes it is given routinely and sometimes they wait until there is excessive bleeding before administering it. The angel nurse added that they often use it routinely after VBACs because the scar tissue sometimes doesn't contract evenly and excessive bleeding is more common after VBAC.
J: That's all I wanted. Just a little information.
Why does a simple request for more information have to be so threatening? No one was questioning her judgement, just asking for the "informed" part of informed consent.
A was getting close. I asked the angel nurse if Dr. I will catch the baby in this position and she laughed. "I like how you say 'catch' the baby. That's pretty much all she's doing. I will ask. I want to applaud you all for standing your ground with the doctor. She could sense you really didn't want to have Pitocin."
I thought "sense it"? They outright SAID it!
I said "I am very impressed with them, too. Thank you for being so supportive."
Dr. I Only Deliver Babies My Way suited up and said "I am not trained to deliver babies like this, so I need you on your back."
I whispered to A "Stay here as long as you want."
10 minutes, heavy pushing, big progress on all fours.
Dr. I: I really need you on your back. Now, A.
Me: Do you want to get through this next contraction before moving?
A: No. Then I'll never move.
I hoped she would decide not to roll over. She did, so I helped. But it is the only point the doctor scored all day, so I'll let it go.
10 more minutes and a gorgeous baby boy is born. 7 lbs, 11 oz, healthy and squalling. 6.5 hours from AROM to baby. How was that "too long"?
Dr. I'm Outta Here cuts the cord immediately, even though A wanted it delayed. So two points for the doc. She checks A for tears, orders preventative Pitocin for postpartum bleeding. Then she leaves.
I wish it wasn't like this.
But...baby nurses. A looks amazing. She feels good. Such a triumph. I am so deeply honored to have been able to share the moment.
A took baby P home less than 24 hours later. He got a tongue tie released at a week old and is now nursing like he was born to it...which who are we kidding? He was! A had a small rise in blood pressure, but after her nursing issues were dealt with and she got some sleep, it went down to normal and has thus far stayed there.
I love my work. I love seeing families triumph and claim - or reclaim - their power. I love seeing babies born. I love witnessing the birth of a mother and of a family.
But I hate that there has to be a fight for informed consent and birth rights. I hate being so powerless in the face of hospital policy and the "cover your ass" practice of medicine. You shouldn't have to fight to get something as simple as information. It shouldn't take three births and an epic battle to feel heard and respected by your care provider. Women don't cease to have rights as human beings when we begin to birth our babies. Everyone has the right to know and understand the care they are being offered and no one should be bullied or scared into a course of action that conveniences the care provider but doesn't serve the best interest of mother and baby. A healthy baby isn't enough. Before anyone starts throwing things at me for that statement, let me clarify - of course, it is the priority. "If the baby and the mother are okay" is the foundation on which everything else is set. No one chooses a good birth experience over a healthy baby, not even us crunchy, home birth moms. But the birthing mother has to be treated with respect. Not only that she deserves to be spoken to as an adult with both rights and feelings about her body, her birth and her baby. If interventions become necessary, fine! No one is arguing against medically necessary interventions that save lives. The arguments come from misinformation, scare tactics, procedures of convenience or expediency masked as necessary, used to open up beds faster or get doctors home for dinner, bullying, or just plain treating a birthing mother as a number to be processed, delivered, sewn up and sent home, not to be checked on by a caring professional for 6 weeks.
A healthy baby cannot be well served by a broken mother.
We can do better. We have to do better.

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The Purpose and Value of Labor Support

I had to write an essay on this topic for my DONA certification packet.  I haven't written a real essay since 1998.  I am also physically incapable of keeping the word count to 1000.  I welcome constructive feedback on the structure, clarity and content of this essay.  I think there are a few awkward paragraphs... 

Please pass it on and share your thoughts!

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Throughout all of human history, women have helped women through the process of giving birth.  When birth migrated from a home-based, women-centered activity into the medical world of doctors and hospitals, this critical element was lost.  As women put their births in to the hands of the doctors, pregnancy and birth turned from a sacred rite of passage, guided and supported by midwives and female friends and relatives, into a condition to be assessed, managed and treated.  Somewhere along the way, the only acceptable goal in this setting became a healthy mother and baby, regardless of what the woman had to go through to get it.  While many hospitals and obstetricians today a least give lip service to the idea of a mother-friendly birth, the fact is that most women who wish to define for themselves what constitutes a satisfying birth experience must fight through miles of red tape and protocol to be “allowed” to labor as they choose and give birth in the way that feels right to them.  Introducing a doula into this scenario brings back a little bit of the human element that was lost in the transition from home to hospital.

A doula is a non-medical, trained birth professional whose primary responsibility is to the woman giving birth.  The doula knows the woman, her birth preferences and her partner.  They work as a team to help the mother give birth to her baby in the way that feels best to her.  A doula is not there to speak for her client, but rather remind the client when the course of events is veering away from her birth preferences and to support the client in getting the information she needs to make an informed decision.  At its most basic, the role of a doula is to provide emotional and physical support for the laboring mother so that she can have a “safe and satisfying childbirth as the woman defines it”. That last part is key - “As the woman defines it”.  A doula must not project onto her client her own desires, fears or “birth baggage”.  Birth is the mother’s journey.  The doula’s role is to follow the mother’s lead and gently remind her of the path she had wished to follow.

Over the last few decades, there have been many studies that show the benefits of providing women with continual labor support.  The largest systematic review of continuous labor support studies (published in 2011), found that introducing a doula into the birthing room dramatically lowered the instances of obstetric interventions, including cesarean sections, the use of Pitocin, and the use pain medications. Besides these medical benefits, mothers who have a doula present throughout their birth are also less like to view their birth experiences in a negative light, regardless of the outcome.  When a woman feels heard, honored and supported during her birth she can own the decisions that are made and deal with them from a place of empowerment instead of helplessness.  It almost doesn’t matter what the decisions turn out to be, as long as the woman can make them with her own voice and under her own power.  Women who have satisfying birth experiences are less likely to suffer from postpartum depression which can disrupt mother-baby bonding and deeply distress the entire family.  The benefits of having a doula go well beyond the birth itself. 

Doulas provide physical, emotional and informational support during the birthing process.  When a doula is present, the mother and her partner have someone there that they know is unequivocally on their side.  The birthing family knows they have an advocate who has no conflict of interest.  A doula is not tied into the often competing demands of the patient’s true best interests and hospital protocol.  A doula is a witness to their process, a shoulder to lean on and a gentle guiding hand to help the mother find her voice.  She helps the mother find ways to deal with her pressure waves by applying comfort measures, assures her that things are going well, tells her that she is doing a good job, helps the partner to participate at his comfort or her level, and finds natural ways to get labor moving past a plateau.  A doula reminds the family when things are veering away from their desired birth and gives them the confidence to speak up when they have questions or concerns about the care they are receiving.  Partners may feel less stressed to have a trained and knowledgeable birth professional present who is not the care provider.  Because a doula is not a family member or close friend, she is not tied in emotionally with what is happening during a birth.  She cares deeply and works tirelessly to help her client have the birth she desires, but she can see things objectively because she has no personal stake in the outcome.  She can provide needed assurance and guidance to a partner who may be distressed to see his or her loved one in pain.  She can also take the pressure off of a partner who is reluctant to participate actively in the birth by allowing the partner to engage with the birthing woman at his or her own comfort level.  A doula provides informational support prenatally and during the early postpartum period to help ensure the family is as prepared as they can be for the demands of labor, birth and caring for a newborn. 

A DONA certified doula has a responsibility to follow the Code of Ethics and Standards of Practice set by DONA International.  She also must not overstep the scope of a doula’s practice by providing medical advice or interfering with the relationship between the mother and her care provider.  Helping a mother find her voice does not mean speaking for her.  A doula also must be committed to providing her clients with the services she has promised.  This includes securing a back-up doula in the event that she cannot attend her client’s birth for unforeseen reasons, and providing a client or potential client with referrals to other doulas if she is unable to serve as the woman’s doula.

            When I had my first child 4 years ago, I had never even heard of a doula.  I did not have one at my first birth.  In retrospect I know a trained doula could have potentially shortened my 50+ hour labor and reassured my very nervous husband that everything was okay.  To some, having a doula may seem like a fad or another way to have a “trendy” birth.  In reality, the resurgence of the doula is a return to our roots as human beings.  In ancient times, women always protected each other in that sacred space between pregnancy and motherhood.  The transformation between “woman” and “mother” was a rite of passage to be honored and celebrated.  Women have always supported, guided, encouraged and upheld the birthing women in their communities.  As the modern world has caused families to scatter and allowed women to have babies later in life, the natural childbirth support system of made up mothers, sisters, aunts, friends has also scattered or been lost altogether.  The doula fills this ancient, sacred role.

It Happened Again

I guess when I imagined being a doula, I imagined other women's births through the lens fashioned by my own experience. The moment when mama meets baby. Working hard, breathing through contractions, pushing baby out. No drama, no worry, no tubes and cords and beeping and whooshing. Just warm water, soft voices and gentle hands. Trust in a woman's strength and wisdom. Trust in the natural process.

I'm not sure how my head got so far up my ass.

My births were beautiful, memorable, empowering. In fact, I can honestly say I love giving birth. I would do it again in less than a heartbeat. I am finding out first hand that most women don't have that experience.

The urge in the medical world to do MORE to "help" a woman birth her baby, to "help" a woman start her labor, to "help" things along a little is just utterly baffling to me. And it should be baffling to every single person in this country. Our c-section rate is abysmal-more than twice what is recommended by the WHO. Our maternal and infant mortality and morbidity rate is unacceptable for a first world country. I am at a hospital today that has 50% c-section rate for their induction patients. FIFTY PERCENT of women they try to "help" into labor end up with a major surgery instead of a vaginal birth. One would think that such a sad, sad statistic would beg some review of their standard procedures. Such as not "allowing" women to go past 41 weeks. Because...? A client of mine was actually told that there is no benefit to allowing a pregnancy to go past 40 weeks. She's a first time mom. Meaning she was likely to gestate to at least 41 weeks, if not more. The baby was doing great, the placenta was healthy, blood flow and fluid was good. All indicators that her pregnancy was continuing in a healthy, productive, safe manner. And yet...

This is the second time this month my first time mom ended up with a c-section. The first one as a prostaglandin induction. Sort of sneaky. They didn't tell her it was an induction. And these were midwives. Very, VERY disheartening. The second was a full-on, strong-armed, get-your-ass-to-L&D bully induction. She knew she wasn't ready. Her body knew it. And then, after 31 hours of going through the meat grinder ("going through the ringer" doesn't actually capture the spirit of it), the baby knew it and told everyone else what mama knew from the outset -this was a bad idea. And yet, the OB's act like they had nothing to do with it! One actually said "sometimes this happens when a baby truly won't fit, and it's not your fault, it's not anyone's fault." I know they say this to make the mom feel better, but it is just not true. It is the fault of the OB who said "You are not allowed to continue this perfectly healthy pregnancy because I think you've been pregnant too long."

So what is a doula to do in the face of this? I can't make the decisions for the family. I can't change the minds of the doctors. I usually can't even outright say "I think this is a terrible idea." Toeing the line between helping the client get all the information and being respectful of their choices - even when I don't agree with them - is really really hard. At what point do you shut up and let something happen? How do you stand by when everything you see is headed the wrong direction and there is absolutely nothing you can do to change the course of events? How do you do it?

So it happened again. And I believe even more strongly about the importance of my role in the process than I did a month ago. But how can you hold a sacred space for the most beautiful, challenging work she will ever do when those responsible for her care and physical well being won't just leave well enough alone?

This is not a rhetorical question. Someone answer it for me. Please.

 

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My First Birth as a Doula

I've had two babies the all natural, old school way. And when I say old school, I mean like in my home, with a midwife, doing my own thing however the hell I wanted to old school. But I had never watched another women give birth before. Until Friday.

S's labor was atypical. She is a first time mom and so didn't really know what to expect from labor, but hers started weird and just never settled into something she could recognize from all her study and preparation as labor. She had contacted me around 8:45 am on Wednesday saying she thought her water was leaking since the night before and that she was having what she thought were contractions. But they weren't in her belly, they were deep below, her thighs were shaking and tingling and they were lasting for "no more than five minutes, about once an hour". Five minutes? Once an hour? I didn't really know what to think of it, but said that it sounded like she was feeling her pain as pressure on the cervix (that is where all the action is, after all). I told her to try to rest and that her midwife could tell her if it was amniotic fluid or not. They went into the birth center, were told the baby had dropped and that was why she was in such discomfort. She got no information on dilation or effacement, so assumed there was none. They sent her home.

Besides an email expressing some doubts as to whether she could handle a natural birth, given that the pain she was now experiencing was apparently not labor, that was the last I heard from her until 3:38 am on Friday morning.

You would think this little scare would have prompted me to get my doula bag together, get a pair of clothes set out and ready. Alas...

I heard the phone ring through the veil of a dream. I had turned the ringer down earlier that day (thank GOD I hadn't accidentally turned it off!) so it was barely loud enough to wake me. As soon as it registered what I was hearing, and seeing S's husband's name on the missed call screen, I was immediately awake, adrenaline pumping, blood whooshing in my ears. I called A back and he said they had thought it was a false alarm, but definitely not. I asked if they were on the way to the center, and he said they had just arrived. Holy cow! At the birth center! This is it!

I pretty much flew out of bed. As I brushed my teeth and put my contacts in, I mentally gathered all my stuff. Rebozo in the office, honey sticks on the shelf in the living room, toiletries on the kitchen table, tennis balls by the front door, birth ball in the basement. And crap. If I wanted this birth to count towards certification, I needed the midwife evaluation form with me, which was somewhere on my computer. I gave myself three minutes to try to find it before giving up and getting in the car. The damn computer is so damn slow, so I after two and a half minutes I shook my head and said "What are you DOING?!?!? Get out the door!" I left the house at 3:49 am and headed to the birth center.

My mantra in the car: don't get lost, don't get in an accident.

I pulled into Special Beginnings at about 4:25 am and went to the back door. They were the only family there that night, and I was met by the nurse who told me S was in the tub, and the midwife who told me that she was 9+ when she arrived an hour earlier and there was just a small anterior lip left.

The lights were low. S was laying on her side in the tub, eyes closed, holding A's hand. A was sitting on a stool by the tub. Each contraction came and went, and S breathed slow and deep, moaning through each one. When she tried to run from the contraction, the nurse gently reminded her to slow her breathing and focus on her breath. I felt slightly superfluous at first. Clearly this was a place where the mother is honored and supported, doula or not, and they had been laboring for an hour here together, getting their rhythm. I was coming in late to the party. But S wanted me there, so there I was. I had to find my rhythm, too. I put a cool rag on her head. I gave her a drink of water. I reminded her to breathe slowly and deeply. Keep her sounds low and deep. Rest between. Quietly, somewhat tentatively, reverently, I melted into her labor dance as best as I could, reminding myself this was not about me.

An hour floated by in labor land. The nurse checked her, the midwife encouraged her to push. She did. The baby's heart rate began dropping. Without making it too much of a deal, they quickly got her out of the tub and into the bed to better be able to monitor the baby and make sure he was safe if he needed extra help when he was born. After several more contractions, the heart rate was much better and the air of tension lifted from the midwife and nurse. S said she doesn't want to push so hard because it feel like she has to poop. Me, the midwife and the nurse all say pretty much the same thing using different words, all at once, "Perfect! That's exactly what you should be feeling! The baby's right there!"

S was exhausted. She'd barely slept since Tuesday night and it was now Friday morning. Each push is a battle for her. A and I have to hold her legs, put her hands on her knees, remind her to work her hardest. She needs the midwife to tell her when a contraction is building and tell her it is time. She is so tired. I massage her hand between each contraction. S asks us to shake her hips between contractions to relieve some of the pressure. I gently pressed my hand on her forehead and whisper "relax...rest...breathe...that one is done, you never have to do it again." And another one rolls around, builds, peaks, disappears. Relax, breathe, rest, let it go. A started to tell me about the last two days and nights. S said "Baby, please stop talking. I just want to get this done." A smiled at me and stopped talking. She pushed through another contraction and another and another. The baby starts to move down, decisively. He stays down, we see the hair, the head...and more head and more head. This baby's head is a perfect, long cylinder! S says "the pressure...there is just so much pressure". One more push, the midwife says, almost there. I can actually see the baby rotate as he comes out. He was trying to get out sideways, but turned at the last possible second to come out the right way. I am in awe. There is a picture of S in the throes of a contraction, the baby's beautiful little cone head 90% out, me, holding her leg, smiling like a complete dope. I am amazed by this woman, this baby, this birth.

The head comes out. The baby seems to be stuck. The midwives seems to be yanking, pulling, twisting to get this child out. S is pushing with all her might. The contraction is over, she says "I can't, I just need to rest. Can I wait for the next one?" She does, the baby is still not out. She pushes, the midwife pulls, the baby is born. He is purple and silent.

Oxygen, rubbing, oxygen. Closed eyes. Silent. The nurse is telling S to talk to her baby, let him hear her voice, as the midwife resuscitates the tiny boy. She's looking at her watch, getting his heart rate. It feels like an eternity, though it may have only been one or possibly two minutes. And angry cry, a pink baby. All is well!

S holds her son. A sits by his wife. Kisses her head. They admire their boy. He latches on and nurses like a champ. I take pictures.

Amazing.

I was only with them for a little over two hours before the baby was born, so the form I was searching for frantically at 3:30 am was completely unnecessary anyway. They were almost as unprepared as I was and have no food for breakfast. I offered to go to Safeway to buy some yogurt and bananas for a snack. I do...and them in the parking lot at the birth center, I somehow manage to lock my bag, keys, phone and the food in my car. Nice.

I called Kevin at 7:30 am. He found my spare key by some merciful act of God, packed up both kids and drove the 40 minutes out the Arnold to rescue me. While I waited for him I had a cup of coffee, chatted with a remarkably chipper new mama, helped a little with breastfeeding, talked a bit about the birth and held the tiny boy after his newborn exam (6 lbs, 11 oz - so much smaller than either of mine!). They were a little at odds on the name, with A telling family one name and S smiling as she rolled her eyes and saying they would discuss it in the car.

When Kevin got there at around 8:45, I passed the bananas and yogurt on to the nurse to give to S (since now I had a hungry toddler in tow) and headed out to the car. Malcolm was groggy from an almost-nap, so I nursed him in the car and then headed home. I haven't stopped thinking of them since. I can't wait to hear the whole story of what transpired between Wednesday morning and Thursday night.

I think I could do a lot of this.

 

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An Evening with Penny Simkin

Penny Simkin (as our hostess, Claudia Booker, said) is the "Ina May of doulas". She was in DC in late April and it was such an honor to meet her! As a new doula, I am looking for as many sources of information and inspiration as possible. Having read many of her books, I was excited to be able to hear Penny speak in person. The majority of her talk focused on the topic of helping survivors of childhood sexual abuse (CSA) to give birth feeling empowered and safe. It is a topic I have not yet begun to explore and have not encountered, but since so many women have been the victim of such abuse, it is certainly something I am bound to encounter in my work as a doula.

After the presentation on CSA, we moved on to some fun stuff!

Demonstrating the Lap Squat for the pushing stage and an exhausted mama. This allows e benefits of a squatting position, without the mom having to support her own weight.

This is a supported squat position

Penny demonstrating the Take Charge Routine for difficult moments in labor

Hip Sifting with the rebozo

Using the rebozo for the belly lift

Me and Penny!

 

 

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A Simple Birth Plan

I'll just admit it.  I am a doula and I had no birth plan for either of my births.  I was giving birth at home and I just assumed that "Home Birth" inherently covered all the things I wanted in a birth.  I toyed around with a document with birth preferences, but it was just for the people I imagined would be there ("I have no idea what I'll want or who I'll want around me.  If I ask you to go see a movie please, it isn't that I don't love you!"), and to please not tell me what time it was or how long I had been at it.  I assumed that if I needed to go to the hospital, it would only be because I needed this intervention or that one.  It may have been naive, but it all worked out fine.

But I am in the minority.  The vast majority of women birth in the hospital and if these women want a natural birth, a birth plan is not just a good idea, but essential to making sure they are on the same page as their caregivers.

So what does the doula who has never written a birth plan have to say about writing birth plans?  My recommendations to my clients for birth plans are based on the words of the L&D nurse who attended my doula training workshop.  She said (and I quote): "Oh, I usually read them.  I definitely read the first page, then depending on what's happening on the floor, I'll scan the second page.  If there's any more than that, I just don't generally have time for it."  She also said (and I paraphrase) that she hates the birth plans that have all the little checks of I don't want this or I don't want that, and there is one important point no one ever puts in that she would tell all her doula clients to add.  More on that later.

Keep in mind, this is from a nurse who was at a doula training workshop so she could be as supportive of natural birth as she could.

So let's deconstruct her statement.

"I usually read them."  

Note the word usually.  That means, of course, that sometimes she doesn't.  Is it because she doesn't care? She doesn't want to make sure you get the birth you want?  Of course not - remember, she was at the doula training to learn how to be more supportive of the natural birth process.  Moving on:

"I definitely read the first page, then depending on what's happening on the floor, I'll scan the second page. If there's any more than that, I just don't generally have time for it."

So this shouldn't come as a shock, but hospitals are often sadly understaffed.  And in the DC area, we have a lot of baby-factory hospitals churning out babies by the hundreds every month.  There is a lot going on at any given time and one nurse will often monitor 3 or 4 mamas at once.  She doesn't have time to read a 20 page birth plan.

So based on her statement, this is what I suggest.  And of course, all of this is predicated on the health of the baby and the mother.  I can't emphasize strongly enough that your caregiver must be on board with your plan.  If s/he is not, you may consider switching providers to one more supportive of your choices

Keep it Simple.
There are things that are worth fighting for.  Waiting for labor to begin naturally is a biggie.  It is one of the best ways for you to ensure that you get your natural birth.  But other little details may not be worth fighting about.  This L&D nurse said that a mom agreeing to have a heparin lock in place is viewed as a mom willing to compromise on the little things, and so some of the harder-line nurses are more willing to work with her on the big things.  (This is just an example - if not having a hep lock IS deeply important to you, by all means, mention it).  So keep it simple.  Narrow it down to the things that are really truly deeply important to you.  And see if you can get it all on one page.

Keep it Positive
This goes back to getting the nurses on your side.  In a perfect world, we would have "sides" when it comes to birth.  But sadly, mamas wanting a natural birth in a hospital setting often have to fight the hospital powers that be to get it.  So instead of handing a group of over-worked nurses a list of "I don't wants", try using positive phrases, such as "I know there are pain medications available.  I will ask for them if I need them" instead of "I don't want an epidural."  Or "I would like to use the position that feels most comfortable to me during the pushing stage" instead of "I don't want to push on my back."  I sort of equate this to talking to my kids.  If you use all negatives - Don't run, don't hit, don't throw your brother down the stairs - all they hear is the "don't" and the "no" and miss the actual message.  Make your plan an expansion of the statement "this is what I want from my birth experience" instead of relying so heavily on "This is what I don't want".

Get Attached
This is from NATURAL HOSPITAL BIRTH by Cynthia Gabriel (and GREAT book that I cannot recommend enough!).  Get attached to your plan.  Be willing to fight for it.  Yes, birth is unpredictable, and you have to be willing to shift gears if something goes awry, but be committed to it.  Be dedicated to getting your natural birth.  It is the same in life.  You are not going to get that which you don't set your heart on.  Obviously, if an emergency comes up, you will go with it.  No one - not even us dirty hippie home-birthers - is putting the birth experience ahead of a healthy baby.  But in the absence of an emergency, you need to be attached to the idea of natural birth.  Otherwise it is too easy to be swayed by the "this" and the "that" that the staff could do to make things "easier".  Get attached.  Be passionate.  Be informed.

The One Important Point
This L&D nurse told us at my training that if you are started on Pitocin to help with progress during labor, the nurses will routinely up the level of the drip at regular intervals - REGARDLESS OF HOW YOUR LABOR IS NOW PROGRESSING.  Pitocin makes contractions hard.  I mean HARD.  She said that if the patient requests it, they will not do that.  So consider adding a line that says something to the effect of "If I need Pitocin to augment my labor, please do not routinely increase the level after it has been administered unless absolutely necessary," or "If Pitocin is needed to augment my labor, I would prefer that the initial dose not be raised unless absolutely necessary and only with my knowledge and consent."

So that is my simple guide to a simple birth plan.  Here are some suggestions of what to include:
* A short message to your care provider/nurses a la "I'm really committed to and excited about a natural birth. Anything you can do to help me achieve this would be greatly appreciated!"
* Preferences about letting labor begin on its own
* Who you want in the room
* Whether and/or when you want to be offered pain medication
* Being able to move freely and eat/drink throughout labor
* Avoiding vaginal exams
* Pushing positions
* Preferences on coached pushing
* Whether and how long you want to delay postpartum and newborn procedures (cord clamping, vitamin K shot, eye ointment, weigh/measure, bath, etc) while you bond with the baby
* If you plan on breastfeeding

Heidi Thaden-Pierce (a doula in Texas) has a wonderful resource called Things to Consider.  It is a pretty comprehensive list of things to think about while formulating your birth plan.

Stuff I Learned from Being a Mama #1

I wrote this for my mama blog in 2010, about 9 months after my first child was born.  I think it bears repeating on the doula blog!

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My friend is having her first baby in September.  I had my first baby last September.  She recently asked me if I had any words of wisdom for her.  My immediate reaction was "WISDOM?  What wisdom?  I am making this up as I go!"  Of course, upon further reflection, I realize that IS a sort of wisdom.  It is a trial-by-fire-in-the-trenches-let's-see-if-THIS-works kind of fearless (sometimes) experimentation that has yielded some good results.  It has, admittedly, steered me wildly wrong a few times.  But the path of parenthood seems to me to be an old-dirt-road-looking sort of thing.  Lots of people have passed before me and the path is very well worn, but everyone takes a slightly different course and leaves a slightly different mark in their wake.  Also it's bumpy.

So here it is.  Everything that I have learned in the last 19 months since I conceived my daughter.  Okay, not EVERYTHING, but some little tidbits that I wish someone had told me beforehand.  I am also realizing how long-winded I can be, so this wil be first in a series.   Some of this might qualify as TMI.  You have been warned!

PRENATAL ADVICE FOR MAMAS-TO-BE

You just can't worry about everything.  Everyone has another thing that could be harmful, that will be dangerous, that should be avoided.  And the list is twenty miles long.  You simply can't worry about everything.  I am not saying ignore the list altogether (or the advice of your caregiver), but if you accidentally eat some non-pastuerized cheese or forget to nuke your deli meat till it steams, chances are everything will be fine.

Eat.  Eat.  Eat.  But eat WELL.  Don't be obsessive about the weight you gain.  Your body needs to gain weight to support the pregnancy.  As long as you are not packing on Haagen Daz or donut pounds, you are doing okay!  Lean protein, veggies, fruits, grains, eat the good stuff.  And then don't worry about it!

Don't look at the scale when they weigh you.  It is just better that way.

That being said, there is only one time in your life that eating a pint of Ben and Jerry's in one sitting is cute (and pregnancy is IT), so if your health permits it, don't be a food nazi either. 

Make lots of food beforehand and freeze it in single-serve portions.  Or buy a bunch of microwave dinners (though the "real" food will be nicer - it will be like your mom is there cooking for you:-).  Fill the freezer.  Don't skimp.  You will bless your forward thinking when Baby is 2 weeks old and there is not a scrap of fresh food in the fridge.  And you will bless your forward thinking when Baby is 6 weeks old and there is not a scrap of fresh food in the fridge.  Seriously.  Freeze everything.

Consider your birth options.  Do some research.  Consider using a midwife for a home or birth center birth.  

Studies show that home birth - for healthy, low-risk mother and babies - is as safe or safer than giving birth in a hospital.  The American College of Obstetrics and Gynecology (ACOG) and the insurance industry want people to believe that home birth is at best risky and at worst recklessly engangering the life of mother and baby.  But this is simply not the case.  The midwifery model of care (as opposed to the medical model of maternity care) is based on allowing a woman's body to work naturally.   The link above explains it much better than I would, but midwives allow the process of birth to unfold naturally.  They are well-trained professionals who know, understand, and HAVE WITNESSED the process of birth from beginning to end without intervention and therefore are an excellent judge of when something doesn't look right or when something is perfectly normal.  My labor took 50 hours from onset of contractions to the birth of my daughter.  FIFTY hours.  Contractions were 5-8 minutes apart for more than 30 hours.  I was dilated past the "you shoud go to the hospital" stage for about 24 hours.  If I had been at a hospital, I firmly believe I would have had a c-section.  Lucy's head was tilted up slightly and was therefore not pressing and opening the cervix as effectively as if her chin had been tucked.  But mymidwives knew that everything was fine.  The baby's heartbeat was fine.  I was tired, but not exhausted.  I was eating, I was drinking and labor was progressing, however slowly.  So we let it keep going.  And everything was fine.  She was perfect (Apgar score of 9 at 1 minute).  She was beautiful.  She was born in our family room, among our family, gently, beautifully, naturally.  I also firmly believe that our breastfeeding relationship would have been toast if we had been in a hosptial.  We had so much trouble at the outset that if either of us had been drugged, it would have been a lost cause.  I could go on about this for a long time, so maybe I'll save the rest of it for another post.  That you have a choice.  Know your options, and make an informed decision.  Some books to read:

The Thinking Woman's Guide to a Better Birth by Henci Goer.  Very informative look at hospital vs. birth center vs home birth.

Obstetric Myths vs. Researc Realities by Henci Goer.  Just what it says.

Ina May's Guide to Childbirth by Ina May Gaskin.  Beautiful natural birth stores along with...well...a guide to childbirth written by one of the country's best midwies.  Also includes a CRAZY picture of a baby coming out FACE FIRST!  Not for the faint of heart.

Journey Into Motherhood - Inspirationl Stories of Natural Birth Beautiful, inspiring stories of women giving birth on their own terms.

Baby Catcher: Chronicles of a Modern Midwife by Peggy Vincent.  This book clinched my desire to have a home birth.  Wonderful, moving, inspirational, heartbreaking, uplifting.

Spiritual Midwifery by Ina May Gaskin.  More from Ina May Gaskin - wonderful.

Consider breastfeeding.  Do the research.  Best for mamas, best for babies.  Get prepared.  It is natural, but almost never instinctual or easy to begin with. Attend La Leche League meetings - they have them all over the country and the leaders are well informed and very very helpful.

The Nursing Mother's Companion by Kathleen Huggins is a great breastfeeding reference.  I still reference this book from time to time, and it was a lifesaver in the early months.

Ask questions of your caregiver.  Get REAL answers, not the "that's just how we do it" crap I got from my OBs before I switched.  If you don't like the answers, or if you liked what you initially heard and they start to change to something less palatable the closer you get to birth, switch caregivers.  IT IS NEVER TOO LATE TO SWITCH.  My friend switched at 37 weeks when her OB insisted on a scheduled c-section for her breech twins.  37 weeks.  She found an OB willing to let her try a natural vaginal delivery, and that is just what she got.  You are a consumer, not cattle.  You have rights.  Birth is a HUGE business.  HUGE.  A lot of hospitals are baby factories and you will just be another bed they want to empty out as fast as possible.  Doctors want to cover their asses (often with good reason in our overly-litigious society), but it usually comes at the expense of mamas and babies.  KNOW YOUR OPTIONS and YOUR RIGHTS.  Make a decision, make a birth plan.  Be willing to be flexible, but ask questions, ask why, be an active participant.

No matter where you choose to give birth, consider taking a birthing class.  Even if you intend to show up at the hospital and immediately get an epidural, chances are you will be laboring at home for a number of hours before you are permitted to check in.  If you have no relaxation or breathing techniques at your disposal, these are likely to be very long, uncomfortable hours.  I took a Hypnobabies class and my labor - while inordinately long - was generally very comfortable.  I had no pain (only what I would call discomfort), I didn't feel the baby crown (no "Ring of Fire"), and even though I tore, I didn't feel it at all.  People swear by the Bradley Method, and there are many MANY other classes out there.  Just don't think taking the class the hospital offers will be good preparation.  From what I have heard, it is a "here's the epidural needle, who wants to sign up?" and admission procedures.  I am sure this is not the case for every hospital, but everything I have heard from moms who have taken these classes leads me to believe they are not worth the time.

Take some time with your spouse/partner before the baby comes to talk about who you are and how you see yourself as a parent.  It helps to be on the same page.

Spend some time with your spouse, just the two of you.

Unpackage, wash and put away everything you have for the baby.  Nothing is worse than having a poop blowout and a crying baby and all the clean sleepers are on hangers, stapled together with those stupid unbreakable plastic tie thingies.

I liked taking baby bump pictures every week.  Now I have a visual record of my changing body - and it is really cool!  I also had a fun pregnancy journal called The Belly Book.  It is a really cute and sweet keepsake of my pregnancy that I'll give to Lucy one day.

Get a fork lift to help you out of bed in the morning during your third trimester.  Heh.  If only.

Braxton-Hicks contractions can last for a long time.  I walked around with a rock-hard belly for an hour at a time on occasion.  Call your caregiver if they are coming on regularly or they hurt, but your uterus is warming up and conditioning itself for the marathon of birth.  Don't let it freak you out.

Chamomile Tea will calm BH contractions if they are bothersome.  My midwife said that the Amish have been known to keep an antsy baby inside for weeks just using chamomile tea.  I would make an extra-big, extra-strong cup of tea, mix in some honey, pour it over a liter of ice and sip it all day long.  Once again, always call your caregiver if you are concerned, but if she says you are okay and the BHs are irritating, chamomile is a lovely aid.  And it helps you sleep.

Ask for help and accept help when you need it.  Seriously.

More later on what I learned from labor and birth and the postpartum experience.  If any of you other first-time moms have anything you want to add, leave a comment!  I'd love to hear the things you've learned!