Monday, October 27, 2014

Why would anyone want to have a natural childbirth?

Can I just say that I love teaching Birth Boot Camp classes? I get to meet lots of cool people who actually want to listen to me talk about natural childbirth. I get to hear their stories too, and boy do they have good stories to share.

I'm not sure that I have had a Birth Boot Camp student or doula client who hasn't told me that they have been questioned as to why they are having a natural childbirth. "Why would you do that? That's crazy!" This is especially true for first time moms. There is no shortage of comments about how crazy it is to want to have a natural childbirth, especially for someone who has never experienced birth before. I know it was true for me. I heard plenty about how I would beg for the epidural as soon as I experienced my first contraction. I heard that I was crazy once or twice. I heard scoffs, experienced eye-rolls, and even some laughter. "Yeah, okay. You're cute, Kristi."

I did it!
Unfortunately, I think this comes with the territory of doing something you've never done before or if you are doing something out of character. I think planning a natural childbirth was a little bit out of character for me. I'd never been one to take on difficult physical challenges before. I wasn't athletic. I wasn't strong. I was a soft, sweet, flute player- a soft, sweet, flute player planning to take on the biggest challenge of her life.

Don't get me wrong. I had some support. There were a few people in my life who believed I was capable. I wasn't sure, myself, but they were. I'm thankful for their support.

My reasons for wanting a natural childbirth the first time were motivated by fear. I was scared of having an epidural. The thought of having a needle in my back terrified me enough to start me on the path to natural childbirth. The more I learned about it, the more I wanted one just because, well, just cuz. I wanted a natural childbirth just because I wanted one.

We cover many of the evidence-based reasons for having a natural childbirth in the very first class in a Birth Boot Camp series, but those reasons really were not my motivation at all. Science is nice. I like having that support, but if I am honest, that really isn't why I wanted to or why I still want to even after experiencing it twice now. Especially after experiencing it twice now.

I also figured I would feel pretty proud of myself if I was able to accomplish the thing that is supposed to be one of the most difficult challenges a woman can experience. But I still didn't want to have a natural childbirth just so that I could feel proud of myself. Feeling proud doesn't really capture the deep, almost primal, longing to give birth without any pain medications or unnecessary interventions. There was something deep in my heart and soul that just wanted to do this. Something beyond thought, words, reason, or explanation. Something beyond studies, science, and evidence. I just wanted it, and I was going to do everything in my power to accomplish it.

In my experience, great things don't happen without first experiencing my fair share of challenges. I understood that birth is unpredictable, and there is that mystical element of birth that is just plain ole out of anyone's control. We humans try to control this force of nature that refuses to be bridled, but there is only so much we can do. I did just about everything I knew to do in order to stack the odds in my favor of having a natural childbirth. I chose supportive care providers, took an independent childbirth class, and prepared as much as I could. I surrounded myself with supportive people. Then there was the challenge of birth itself. The day finally came, and I finally had the natural childbirth I longed for. It was one of the most amazing experiences of my life! I couldn't believe that I did it! We did it. I am so thankful to my little girl for giving me that experience of meeting her in that way. I will cherish that memory forever. I feel like it gave me the boost I needed to be the best mother I could be. Until that moment, I never really thought of myself as someone who was strong and capable of hard things, but at that moment, I was a warrior woman! I was a soft, sweet, flute player who could give BIRTH. I think that it was the first moment in my life that I truly felt like I was awesome.

Nearly there. Just keep going. 
After that day, I was hooked on birth. I was hooked on my baby, and I was hooked on birth. I never considered myself a baby person, but I loved my little girl with a fierceness that I never thought was possible for me. I never wanted to be far from her. I remember missing being pregnant because we just weren't close enough. That feeling has passed now that she is older, and I am enjoying being a witness to her growing independence. However, I will never forget what she gave me the day I became a mother.

Everyone's reasons for wanting a natural childbirth are different. Some people want one because they want to accomplish something great. Others have done a lot of research and feel like natural childbirth is the best option for them. Whatever the reason, they don't have to explain it to me. They don't have to justify why they want one. I feel like many women feel like they have to explain themselves for making this choice. Why can't we just want it just cuz? Why is that reason not good enough? No one asks me why I choose to shower everyday. No one asks me why I want to lose weight. No one asks me why I want to run. No one has called me crazy (yet) for running my first 10K yesterday, but people still call me crazy for having had two natural childbirths. People still look at me like I have two heads when I say, "I would totally birth all the babies if I could. It's the raising of them that keeps me from it."

And speaking of running. I'm getting hooked on the high that you get after accomplishing something you didn't think you could. I completed my first 10K yesterday, and I am still flying high on that accomplishment. I'm super proud of myself for setting that goal, for training for it, and then doing it. But I have to admit, the running high just pales in comparison to a birth high. My birth high lasted months!

Has anyone ever asked you why you want a natural childbirth? What did you tell them?

Tuesday, October 21, 2014

Evidence-Based Care in Birth

On Saturday, October 4th, I attended the annual B.I.R.T.H. Fair. B.I.R.T.H. stands for Bringing Information and Resources to Houston. It lives up to its name because there were tons of vendors, excellent workshops, and even a fashion show. I signed up to volunteer, but there were so many volunteers I wasn't really needed. I decided to just stay and take it all in as a consumer. I'm glad I did!

I didn't take pictures at BIRTH Fair, so enjoy some of my
random baby pictures!
My favorite workshop of the day was entitled "Evidence-Based Care Teaching," which was taught by Dr. Christina Davidson, Dr. Julie McKee, and Sherri Urban, RN. Dr. Davidson is the Chief of OB at Ben Taub Hospital. Dr. McKee is an associate professor in the Department of Family Medicine at UTMB in Galveston. Sherri Urban is a Lactation Consultant at Memorial Hermann The Woodlands Hospital. These women received the Physician and Community Friends Awards this year. 

I wish I could have recorded this workshop because there was so much information that I could not write it all down. I wanted to capture every word. This class made me realize how important it is to take advantage of opportunities to hear leaders in the birth community speak as often as I can. I learned so much!

At the beginning of class, I heard a little bit about how Ben Taub has changed under the direction of Dr. Davidson. I learned that Ben Taub has no nursery, and that all healthy babies stay with their mothers. There is only a NICU for the babies who need that, but for the most part, babies go directly on mom. Also, Dr. Davidson teaches students at Ben Taub certain skills that she called a "dying art" such as VBAC, vaginal twins, and using forceps. She said when she first arrived, there were a lot of practices going on that she referred to as "Ben Taubisms." She would ask the other medical personnel why they were doing certain things, and they didn't have an answer other than "Because that's how we've always done it." They had no idea why they were doing them, even if the practices were good ones. It was just the way it was. 

This story led to a discussion about the differences between evidence-based practices and cultural practices.

What is evidence-based care? 

Evidence-based care is healthcare that includes the following three components: First, one must take into account what the latest reliable scientific research says about a practice. Second, one must consider the experience and knowledge of the care provider. Finally, one must include the knowledge and desires of the patient when practicing evidence-based care. True evidence-based care must include all 3 components in order to be considered evidence-based care. 

Dr. Davidson mentioned that there isn't always evidence to support every practice. This is where care-provider knowledge and expertise and the desires of the patient come into play. She said, "There won't be a random controlled trial on jumping out of an airplane without a parachute, but everyone knows not to do it." Good point.

Baby #1 minutes old-unmedicated hospital birth
After doing some research, a healthcare consumer might find that not all practices are evidence-based. Some of what happens is based on the culture of a certain healthcare facility. Sometimes it takes time for the culture to catch up to the evidence. For example, this explains why ACOG might say that a Trial of Labor for a woman who has had two previous Cesareans is a reasonable option, but there are still VBAC bans in many hospitals. According to Dr. Davidson, "Your practice has to change as the evidence changes." This was a concern of mine as a doula at one point, because I felt bad for sharing information with past clients that has become outdated at this point. My job is to provide information to my clients, so I try to provide the latest evidence-based information. Because I plan to be a doula for many years, I imagine what I tell people will change as the evidence changes. This isn't a bad thing! 

Dr. Davidson went on to say that if someone has been practicing a certain way for a very long time, it might be harder for that person to change. They may not feel comfortable with the new information, which may involve practicing new skills that they don't really have practice with. She mentioned that she has skills in certain areas that she used often when she first started practicing medicine, but because the evidence for it has changed, she doesn't use it anymore. It doesn't matter that she's good at it. The evidence says she no longer needs it. 

Dr. McKee mentioned that once the evidence changes and the culture finally catches up, then things become the "new normal." She began to talk about how a lot of changes are money-driven. "Money is attached to outcomes," she said. She relayed a story about how she got chastened by an L&D nurse for taking the baby from the mother too soon after the birth, which she doesn't ordinarily do. She said she was tickled that the nurse did that because it had become the norm not to take the babies from the mothers. However, it only happened because of a grant they received to work toward becoming a Baby-Friendly Hospital.

Baby #2- home birth
The moderator then asked the panel what they wished that the community knew about the obstacles they faced. Dr. McKee said there are a lot of politics care providers have to face. There is good evidence, but sometimes there is a culture to overcome. I liked what Sherri said about overcoming obstacles. You either have to go around them or go over them. A bridge is a good way to do what. Building bridges is very important. We have to try to build bridges in our community. 

Dr. Davidson said that she wished there was an easier way for consumers to find the right doctor. She would also like to see fewer women needing a VBAC in the first place and more emphasis on "how to prevent the first Cesarean."

Sherri says we need to have more consumer driven healthcare. "You have to care about this." 

One last thought was from Dr. McKee. If there is an opportunity, and you feel comfortable, allow the students and residents to learn from the awesome doctors in the area. If we have the opportunity, we should help future generations of women by helping train the new generations of doctors on how to perform these skills that are considered a "dying art." We need to have a birth Renaissance! 

In order to have a re-birth of evidence-based care practices in this area, it will take all of us as the consumers to do it. There won't be change unless we demand it. 

Tuesday, October 7, 2014

How do I have a fast birth?

When I get the chance to share my birth stories with Birth Boot Camp students or anyone else who feels like humoring me, I often get the question, "How do I have a fast birth?" Usually I respond with, "If I knew the answer to that question, I would be living in a huge mansion." Then I pretend to throw my fast-birthing fairy dust their way, and we all have a good laugh.

I honestly have no idea how I've managed to have two quick and relatively easy (for labor) births so far. I feel like a large portion of my good fortune, is well, exactly that. I've had really good luck so far, and for that, I am immensely thankful. I'm really a wuss when it comes to pain, so I am glad that my labors didn't last too long.

In any case, I will share some of the things I did to prepare for my births, just in case someone finds any of these ideas helpful.

For birth #1:

I chose amazingly supportive care providers for the type of birth I was seeking. I wanted a natural birth in a hospital setting, so I chose the midwives with The Women's Specialists of Houston. At the time, they worked at St. Luke's. Now they attend births out of Texas Children's Pavilion for Women.

Following the advice of my midwives, I did my best to eat a good diet that consisted of food that was as close to its original form as possible. I also cooked most of my own meals, and I cut out all of the sweets. Even my beloved brownies. Especially my beloved brownies. I can brag that I did not have a single brownie when I was pregnant with my first baby. Of course, I was not perfect with my diet. There was still more to learn. I gained 35 pounds with this pregnancy.

Baby #1
I walked everyday for at least 30 minutes.

I took a thorough independent childbirth education class.

I learned the art of denial. Even though I was feeling pretty crampy for awhile, in my mind, I wasn't going to have a baby. Even though my midwife stripped my membranes, I wasn't going to have a baby. Even though my water had broken, I still wasn't going to have a baby. I just knew they were going to send me home because I wasn't having any contractions. Even though we were peacefully driving to the hospital to get checked out, I still wasn't going to have a baby. When the security guard asked me if I was going to Labor & Deliver to have a baby, I said, "I doubt it." When they hooked me up to the monitors and told me I was having contractions that were 2-3 minutes apart, I still wasn't having a baby. I told the nurse that I wasn't feeling anything, and she looked at me like I had two heads. 

Until, suddenly,

I FELT THEM. OH MY GOODNESS I FELT THEM!!!! I felt them so much that I started to shake and dry heave. I began to doubt whether or not I could do this anymore and "they" were all right that as soon as I felt my first contraction, I would be begging for the epidural. Only I didn't say anything other than, "I don't know if I can do this" to my poor husband. I wasn't even in a Labor and Delivery room yet. I was still in triage, and they were preparing my room. Robbie told me to "remember my sounds" and I started to moan. Or, rather, moo like a cow like I planned.

My room was finally ready, and they wheeled me to my room. Oh my goodness the breeze felt so good. As I was getting out of the wheelchair, I had a contraction. I just stood there in the middle of the room not knowing what to do. I think I reached out to thin air, and suddenly the midwife was there, hugging me tightly and swaying with me. Her embrace felt so good. She was so strong. She asked me if I wanted the tub. In my mind, I screamed, "YES!" I think all I managed was a nod, so she started running the water. The sound of it was wonderful. I made it to the bathroom and somehow I became naked. During the next contraction, I leaned over the sink to rock my hips back and forth. I remember the midwife telling me I was doing good, and I thought, "Huh? What am I doing? I'm just doing this. Doing this right here is all that exists right now." I didn't say anything out loud.

I made it into the tub, and it was wonderful. The midwife turned the lights off, and then Robbie was there. He vocalized with me, and it was wonderful. I didn't feel self-conscious or alone while he was with me. Having him there meant the world to me. The midwife stood by the wall and would remind me every now and then to relax my shoulders. Mostly it was me and my husband sounding together, with the whir of the jets in the tub and warm water relaxing me.

I visualized. I imagined standing on a beach next to the ocean. It was foggy. I was standing at the opening of a cave that was facing the ocean, and I held my baby in my arms. The wind was fierce, and the ocean waves would flow into the cave and flow back out. I imagined my uterus was the cave, and every time the wave would flow into the cave, and go back out, it was pulling my baby out a little bit more each time.

I made noise. I mooed like a cow. I mooed louder and louder and my sounds became more gritty and intense. Suddenly I was being pulled out of the tub, and I didn't know why. When I was standing upright, preparing to step over the edge, I said to whomever felt like listening, "I need to poop." The midwife said, "That's the baby, Sweetie." Somehow at that moment, I had absolutely no idea that needing to poop meant the baby was coming. That information had never been a part of my brain, ever. According to my brain at that very moment, that was the first time I had ever made that connection. Poop equals baby? Wha???

When I made it to the bed, the midwife checked me and proclaimed I was 9.5 cm with a little bit of lip. She said I could start giving little grunt pushes, and I believe I said, "Oh shit!" Which was the first thing I had said since I started feeling my contractions. I just couldn't wrap my mind around the fact that it was already time to push. I hadn't done any of the positions I learned in childbirth class. What happened to early labor? What about slow dancing? I didn't even do perineal massage!!! I never got around to it. 

After a few little practice pushes, my cervix melted away and I pushed my baby out. Once she was born, she was placed directly on my chest. I marveled at how big her mouth was. Of course, she was screaming right in my face. It was wonderful! From the first contraction that I felt to the birth of my  8 lb 3 oz baby was 4.5 hours.

Here is where I think I was really lucky.

I was lucky that my contractions started so quickly after my water broke that I didn't need to be induced. I think back on that quite a bit that things could have been very different for me if my body hadn't gone into labor on its own after my water breaking.

I was lucky that I had a tub to labor in. I think having water and the ability to move freely helped my labor to speed along like it did.

I was lucky that my baby just happened to be in the optimal starting position without me having to try to do anything to move my baby. In fact, I didn't even know about Optimal Fetal Positioning or Spinning Babies.

I was very lucky to have such wonderful support. I couldn't have done it without my husband being there every step of the way, starting with his unwavering belief in my ability to give birth naturally. 

For birth #2:

I chose an amazingly supportive care provider for the type of birth I was seeking. I wanted to have a natural birth at home, so I sought the services of a home birth midwife.

I hired a doula. This doula is also a really good friend of mine, so it seems really weird to me to say that I hired her, but I asked her to be at my birth. I just wanted her to be there.

I practiced the home study Hypnobabies program. It was so wonderfully relaxing. I was not yet a Birth Boot Camp Instructor at the time, so naturally, at this point I prefer Birth Boot Camp. However, I still love the Hypnobabies program although it was not the one I felt drawn to teach. 

I worked even harder to have a better diet than before. My midwife really helped me to incorporate more greens, more protein, and fewer carbs. She advised me to be careful of my carbs. I tried, but I couldn't resist peanut butter and jelly sandwiches. They were so good. Also, dark chocolate. So yummy. I gained 25 pounds.

I tried to exercise. I walked when I could, and I went up and down our stairs a lot. My midwife told me that 50 times a day wouldn't be too much.

Baby #2
When I rested, I always made sure to rest smart.

I processed my fears. I was really afraid of having a 24 hour labor, and I would tell my husband. I was afraid of the pain and worried I would not be able to handle it. He expressed the utmost confidence in me. I was afraid that if I had a home birth transport that ended in Cesarean, people would be secretly satisfied and think that I got what I deserved for being such an advocate of natural childbirth. I never expressed that fear to anyone, but I processed it in my own way. I wrote that down somewhere and got those fears out of my heart.

I used denial to my advantage. I never prepared my birth pool because I was certain I would have time during labor. I figured I would need something to do to keep my mind off the contractions. When I thought my water had broken, and I couldn't go back to sleep, I started cleaning the kitchen. Once I was done with the kitchen, I opted to practice a relaxation on the couch. My contractions started when I was trying to do the Hypnobabies Deepening CD. I just couldn't get comfortable. Thinking back on it, it felt like I needed to go to the bathroom. It felt like something was being pushed up the wrong way when I would try to sit.

I was so uncomfortable, and I was frustrated at how uncomfortable I was. I just couldn't understand why I was SO UNCOMFORTABLE WHEN LABOR JUST STARTED. How could I be this uncomfortable already. I started blowing up the birth pool, and I didn't care that it might wake the neighbors. I couldn't sit while I was waiting. I had to be on hands and knees. I started rocking back and forth and bonking my head into the side of the pool. Somehow that felt good to me. Robbie came out of the bathroom, and saw me there. I was nearly in tears. I was so uncomfortable! He asked me about calling the midwife, and I just repeated, "I don't know! I don't know! I don't know!" He tried to get me to vocalize, but I argued that it was too soon for that. I think he talked to the midwife and he asked if she should come. I answered like before. "I don't know! I don't know! I don't know!" Then he asked if he should call the doula, and I said, "Yes! Tell her I am irrational." She would know what that meant. I remember him saying, "You want the doula but not the midwife?" In my mind, I wanted them to arrive at the same time. The doula lived further away.

Finally, I stopped being in denial and retreated to the shower. I asked Robbie to continue preparing the birth pool. I vocalized just like old times. I allowed myself to be as loud as I needed to be. My doula arrived, and she smelled so good. I knew she was there by the smell of essential oils. I thought, "Mmmm. Doula." Once she got there, I was honest with my feelings. I growled, "I hate this!" She reminded me of my baby, and asked me if I felt pushy. I thought that was a silly question since I had just started laboring. But as soon as she started asking me the sensations I was feeling, I started to be more aware of the sensations. I started to notice the feeling of needing to poop, so I yelled, "Poo poo!" At that point my midwife was there. She asked if she could check me. I didn't want to let her because I knew I was just 3 cm. I consented, and I noticed her fingers didn't get very far. At that point they were trying to convince me to get out of the shower and labor on the toilet. I didn't want to, but I did it anyway. I knew I needed to.

My midwife said I could push if I wanted to. I swear, if she never told me that, I'd still be in labor. I pushed for a few minutes, stood up, and Robbie suddenly was there. I feel like I was trying to walk, when my baby fell out of me. They helped me sit back down, and I had my baby in my arms. I was in shock. It happened so fast.

From the first contraction that I felt to the birth of my 9 lb 4 oz baby was 2 hours.

Here is where I think I was really lucky.

With this birth, I feel like my body took off without me. I didn't do anything to help my uterus work as efficiently as it did. That part is luck. 

I had such amazing support. I had my husband, midwife, and doula who believed in me and created a safe place for me to let go and just birth. I didn't care about anything when they were there. I didn't need to care about anything. I could just be exactly who I was at that very moment, and that was a laboring woman. Things come out in labor sometimes: bad words, poop, gas, and most importantly, babies, but I felt secure that I could be anything and do or say whatever I needed to do or say without being judged for it.

I am also really lucky that I have been in the right places at the right times to meet some very special people who opened my eyes to the fact that there are OTHER ways to have a baby. Before being introduced to the wonderful world of natural childbirth, all I knew about were OBs, epidurals, and Cesareans. I didn't know women had options. I didn't know women could make their own choices. I didn't know that women were ALLOWED to give birth without epidurals. I didn't know natural childbirth was still around. I didn't know that midwives still existed.

I've learned a lot since then. I've been really lucky.