Saturday, 10 November 2012

Guest post: A doula's path through pregnancy/birth (Part 2: Preparation - physical, mental, and more)

My friend and fellow AmeriCorps doula Chris wrote her first post in this guest series, "A doula's path through pregnancy and birth", way back in April: Part 1: Prenatal care and education. As she notes at the beginning of this next post, time flies (for me, too!) so this next installment is a little delayed. But I think it's very well worth the wait - there's so much great advice and experience in here (check out the birth plan, for example.) Big thanks to Chris for working so hard on it!

Birth story is coming very soon!

(And if you haven't already, don't forget to check out Chris's intro post, one of my favorite doula stories from our year in AmeriCorps.)

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So I had big plans of writing about how we were preparing for birth as we were actually preparing. Then life got away from me, and all of a sudden here I am writing about preparing for birth while my 6-month old baby girl is asleep.  The upside is that I’ve had a chance to reflect on how our preparations affected our experience of birth, and I can comment on the parts that (in hindsight) seem particularly important.  Here’s what we did, and soon you can read about how it worked out.  

Luckily my pregnancy proceeded without complication, and Kevin and I started preparing for birth pretty early.  Rebecca has a post about why you shouldn't "try" to have an unmedicated birth--you have to prepare to have one (like you prepare for running a marathon; you don't just get up and try it).  I think the comparison between endurance running and giving birth is apt.  Both require preparation in many different ways--physically, mentally, and emotionally.  Here's how we got ready.

Physical Preparation:
I started going to a prenatal yoga class quite early in the pregnancy, at maybe 12 weeks.  I felt a little silly at first, sitting in the room with all these women sporting huge bellies and due dates only weeks away, but my fantastic teacher Cundy says there is no such thing as too early or too late to start prenatal yoga--the important thing is just to get there.  I went to yoga once or twice a week almost every week for the rest of the pregnancy.  It was excellent physical preparation for labor--lots of pelvic strengthening work, lots of squatting, and lots of practice with deep relaxing breathing.  I think it was also an excellent mental break every week, and a chance to absorb positive messages about giving birth.

I did my best to stay active with cardiovascular exercise while pregnant.  I ran pretty regularly prior to getting pregnant, though that ended with the first trimester (I ran/walked the Athens half marathon at 13 weeks pregnant, and after that set my running shoes aside).  I walked all day every day for work as a high school teacher, and also made long walks part of my weekly routine.  As my belly grew my walks got shorter.  :)  Interestingly, when I was newly pregnant walking was about the only way I got any relief from the near-constant nausea.  I think it had to do with the breathing.

Looking back after the delivery, I can say that I am glad I stayed relatively active and I'm particularly glad I stuck with the yoga so regularly.  Though I remember feeling exhausted while in labor, it was more of the I've-been-up-all-night-can't-I-have-just-a-few-minutes-to-sleep tired, not the type of fatigue one feels from reaching the limits of what your muscles can do.  I felt strong even as I felt exhausted.

Mental Preparation
Pretty soon after realizing we were pregnant, I sat Kevin down and we watched The Business of Being Born.  (FYI: you can stream this movie via Netflix).  If you're on the fence about what kind of birth you want to have or if you're looking for encouragement to have a natural, normal birth, this movie is a must-watch.  You see a little more of Ricki Lake than you ever thought you would, but I know every time I watch that movie I come out of it thinking Ricki is pretty much a rock star.  It's also a great one to watch if you are trying to get a loved one on board with your ideas about birth, midwifery care, or how to avoid getting sucked into the medical monster.  Put it on your list!  We also watched the movie Babies (the one that follows infants in different parts of the world through their first year).  That baby in Mongolia is VERY cute.

My mama taught me that there’s no such thing as too much reading, and my doula experience exposed me to some titles that everyone planning for a non-medicated birth should know about.  So upon getting a positive pregnancy test, I busted out my copy of the trusty Pregnancy, Childbirth, and the Newborn by Penny Simkin and ordered The Pregnancy Book and The Baby Book (both by Dr. Sears), which I read in chunks here and there. I ordered my wonderful husband a copy of Simkin’s The Birth Partner.  He worked his way through it over the course of the pregnancy, starting with his biggest concern--how to deliver the baby in an emergency.  :)  I also enjoyed Ina May’s Guide to Childbirth, which was wonderful--I’m an especially big fan of her chapter on Sphincter Law.  It gave me lots to think about.  As the pregnancy progressed, the question “How on earth do you take care of a baby?!” occupied more and more of my brain, and I read the ubiquitous Happiest Baby on the Block by Harvey Garp, which backs up a lot of what the Sears book teaches.  One book that I thought would at least be funny but turned out to not work for me at all was The Girlfriend’s Guide to Pregnancy, which was recommended to me by pretty much everybody I know who has had a baby in the last 10 years.  I read some of it and wound up feeling fat and neurotic--two adjectives that I don’t think generally apply to me, pregnant or not.  I quit reading it about halfway through, and wouldn’t recommend it.  Later in the pregnancy I read a book on the Bradley method for childbirth.  Most of it didn't really suit me--I found it to be way too structured--but I did like the parts about visualization and relaxation during contractions.

After we hit 20 weeks, we started the most important mental preparation we did--our prenatal Centering program.  Centering is basically group prenatal care for the second half of the pregnancy.  Every other week, Kevin and I met with a midwife and a group of 3 other couples due at roughly the same time we were.  The meetings (which happened in the evening, to accommodate work schedules) started with individual check-ins with the midwife to listen to the fetal heart tones and discuss any private concerns.  We also checked our own blood pressure and weight and peed in the obligatory cup.  After that we sat down as a group to discuss anything that was going on with our pregnancies.  It was a great time to get ideas for dealing with discomfort, to see what other people were reading, and to get some reassurance about what was happening with our bodies and our lives.  We also did potluck dinners, which was really fun.  Finally, we would discuss a topic relevant to pregnancy and birth, and in that respect it was a lot like a childbirth class.  We covered the progress of labor and birth, options for pain management, breastfeeding basics, and how to take care of a newborn.  Our centering group really connected, and we've stayed in touch even now that all the babies are on the outside.

Because I had a very solid background in childbirth education through my doula work, and since we were already covering lots of relevant topics in Centering, we decided that a full-scale multi-week childbirth class was not for us.  But when the opportunity arose to take an independent one-day childbirth course taught by a very well-respected member of the Athens pregnancy/early-parenting community, we decided to go for it.   It turned out to be a good review for me and a great way for Kevin to run through everything we learned in Centering again.  We practiced with birth balls and rebozos, worked on breathing and relaxation, and focused on the principles that set you up for a normal birth.  We are very lucky to live in a community with excellent resources for prenatal support and education.  Between Centering, midwifery care, prenatal yoga, and our childbirth class, we both felt confident as I approached the end of the pregnancy.

In the last few weeks of the pregnancy, we created our birth plan.  At first I started with a list of things that I did NOT want, but after a little bit of writing I realized that type of birth plan was probably not the most useful approach.  I think I needed to work through some of the baggage I had from the difficult, medicalized births I had seen as a doula.  But through writing down what I was worried about, I came to the understanding that by making smart choices about my prenatal care, a lot of my concerns would not be an issue.  I didn’t need to write “no episiotomy” on my birth plan because not one of the midwives in our practice would ever dream of doing a routine episiotomy.  We'd had a chance to discuss a lot of potential hospital pitfalls during Centering, and I came away feeling confident that these midwives were for real.  Their very low c-section and induction numbers backed me up.  So I rewrote the birth plan and talked it through with our doula.  This is what we came up with:

Labor:
We have been preparing for a normal, unmedicated birth.  Any suggestion or assistance that supports that goal is welcome.  Christine is aware of all medical pain management options and will ask for them if wanted.  We are working with a doula and her support is important to us.

Delivery:
Immediate skin to skin contact is a priority, as is early breastfeeding. We would like all newborn exams performed while we hold the baby. Kevin would like to cut the cord once it has stopped pulsing.

Newborn Care Preferences:

  • Christine intends to breastfeed--please no bottles or pacifiers.
  • We plan to use Dr. M as our pediatrician.  We will begin the baby’s Hepatitis B vaccinations through Dr. M’s office.  
  • We would like the vitamin K injection and eye ointment to be delayed until we have had some time to spend with our new baby.  
  • We would like the baby to stay in the room with us for as much of the time as possible. If it is necessary for the baby to stay in the nursery, Kevin would like to stay with her.
  • We would like to help give the baby her first bath.  

In case of cesarean:
We ask that as many of our preferences regarding delivery and newborn care as possible be respected (family-centered cesarean).  Kevin would like to be in the operating room, and we request to be included in all decisions related to the care of our baby.  

In case of baby in the NICU:
Just as with a cesarean, we request that as many of our above preferences as possible be respected, and we ask for any support available to promote breastfeeding.  We would also like to spend as much time as possible giving skin-to-skin contact.

Thank you!
Kevin & Christine

I think it's also worth noting what we did NOT do prior to the birth.  We did not spend one minute watching nonsense "reality" childbirth shows on TV. While this choice could most directly be attributed to not having cable, I wouldn't have wanted to watch that stuff anyways.  They present a sensationalized version of childbirth that makes having a baby look like a scary emergency every time.  If you want to have a normal, unmedicated birth, the last thing you need is a bunch of stories emphasizing worst-case scenarios and medical-model labor.  It's totally normal to be thinking about birth and the baby all the time, but if you want to immerse yourself in learning about birth, spend some time reading or go whole-hog and get MORE Business of Being Born, good old Ricki's new project that is an even more in-depth treatment of natural birth than the original BofBB.

People Preparation
One aspect of birth that I think can be easy to overlook is figuring out exactly who you want to be with you when it’s actually baby time.  Your caregiver and your partner are obviously very important, but it’s worth considering who else you want with you when you’re in labor.  It’s also worth it to start talking to the people who are important to you ahead of time and find out what their expectations are for the day of the birth.

Kevin and I were planning to have a doula and we eventually found one, but we waited probably a little too long to actually go about our search.  I think I got the impression that in a town like Athens, doulas were practically coming out of the woodwork.  That turned out not to be the case, and about 2 months before I was due, when we finally started getting serious about the doula search, we discovered that 1) it was hard to find a doula that wasn’t booked, and 2) doulas cost more than we anticipated.  In the end we found an apprentice doula who was available and within our budget.  We almost didn’t hire her (based on the idea that my prior doula experiences had left me better prepared than the average first time mom), but in the end, I came down firmly in favor of having a doula.  Here was my reasoning:  maybe we’d be fine by ourselves if everything went perfectly smoothly, but what if something came up?  If I had a 60 hour labor, I wanted a doula.  If I had to be induced, I wanted a doula.  If we had to decide about a c-section, I wanted a doula. And you can’t just call a random doula when you’re 6cm dilated and ask her if she can hop over to the hospital.

The other people we took into consideration when planning for the birth were our parents.  All four parents live within 2 hours of us, and this being the first grandchild on either side, we knew they would want to be involved.  However, I didn’t want a bunch of people camping out in Athens, waiting for me to go into labor.  I also wasn’t sure I wanted lots of people there for every nitty-gritty moment of the labor.  I was OK with the idea of both the moms being in the room at least part of the time because I knew they wouldn’t try to pressure me to do anything I didn’t want to.  My mother had 2 unmedicated births, and Kevin’s mom had 6 babies in 6 different ways.  I was lucky that they were on board with the idea of normal birth and that I never had to explain or defend our birth plan. But even though I have a very good relationship with both my mother and my mother-in-law and had no reservation about them being present at the birth, in my head, we would wait to call them until we were admitted to the hospital and knew that I was well into active labor.

Amazingly, that’s more or less how things worked out, and everybody seemed to feel good about it in the end. My relentlessly prompt parents did arrive on my due date, before any signs of imminent labor, and they literally camped out about 20 minutes away and waited on me to have a baby (which they assumed would happen fairly soon, given the genetic tendency towards promptness).  However, since I went into labor at night, we didn’t let them know what was going on until about 5:30 the next morning, when the delivery looked pretty close.  So my mom got to be there for part of the labor and for the birth but not for so much of it that I felt like I had an audience waiting on things to move along.  We called Kevin’s parents at the same time we called my parents.  But just to prove that you can never predict birth, when they arrived after their 2 hour drive I was still laboring.  Kevin’s mom chose to stay in the waiting area, but all four grandparents were close by when it was time to meet the baby.

We are lucky to have a very low stress family situation and to live in a community where it is possible to find doulas.  But for anybody preparing for birth, I think it’s really worth it to give some thought to who will be with you on the big day and to have those conversations early.  When it’s time to have a baby, you want to feel surrounded by support and encouragement.

Emotional Preparation
I wonder if perhaps the most important preparation we did for the birth wasn't the emotional work.  It's certainly important to be fit and educated when the time comes, but I think all of that work is for naught if you don't have confidence that you can have a normal birth.  For me, a lot of that confidence came from surrounding myself with people who shared that goal.  Our Centering group provided an important emotional connection to pregnancy and birth.  Kevin and I looked forward to the social aspect of Centering--we ate together, discussed progress and difficulties, and shared the process of beginning to imagine ourselves as parents.  I also found pregnant friends through yoga class, which was another powerful affirmation of the process of growing a baby and giving birth.  I think that if I only had one piece of advice for a newly pregnant woman, it would be to surround yourself with positive people who will help you stay confident in yourself and your body.  Find pregnant friends (and friends with young children) who share your goals and priorities.

Kevin and I are not usually huge fans of what we call "barfy baby stuff"--going to someplace like Babies ‘R’ Us to make a registry was so low on our list that it never got done. (Way better registry for people who hate shopping:  do one online through BabyList).  But the one thing we did that sounds like it's straight out of TheBump.com is take a babymoon.  If you can swing it, I totally recommend it.

My school's spring break fell when I was about 36 weeks pregnant--about our last chance to take a relaxing trip prior to baby go-time.  We drove down to a cottage in Florida belonging to some friends of Kevin's family and spent a very relaxing few days swimming, enjoying the beach, and just hanging out.  It was a really nice time spent just being together, getting ready emotionally for how our lives were changing.  I think pregnancy lasts 9 months not just to give the baby time to develop but also to give the parents time to prepare themselves.  A lot of that work is emotional.  Kevin and I had been together for a decade before getting pregnant, and I think we needed a minute to say goodbye to our exclusive little club and get ready to add a new member.

One of the sweetest memories I have of Kevin and I getting ready for the birth together happened at the end, when I was right at 40 weeks pregnant.  I was feeling stressed for all kinds of reasons, and I'm sure he was too.  But instead of escalating my little freak out, Kevin sat me down, rubbed my neck, and talked me through some relaxation.  He helped me breathe, and we practiced how I would relax when the actual labor began.  I'm not sure I managed to relax physically that same way during labor, but I know I went back to that emotional space when I felt overwhelmed by the experience of giving birth.  It was a really nice place to be.

In sum, I think the ideal preparation for birth (for anybody, not just me) puts you in a place where you feel confident in your knowledge, in your caregivers, in your support system, and in your body.  If you're getting ready for birth, take inventory of how you feel about each of those areas.  If you find that any one of them doesn't make you feel good about giving birth, make the changes you need to right now.  You will thank yourself later, and so will your baby.