{new #OutsideTheMomBox post} "Did I have a traumatic #childbirth?"

I read a terrific blog post recently that one mom wrote about her childbirth experience. Her labor was long but not concerning. Neither she or the baby were in any kind of danger. From all outside appearances, things looks fine. The exact opposite of how healthcare professionals define "traumatic childbirth". But to this mom, her childbirth experience was traumatic. This is an important distinction.

If we followed the legal definition of domestic violence in terms of providing services to those in need, very few women would ever get help. The legal definition of domestic violence is just that limiting. Similarly if we allow medical professionals to define (or not) our childbirth experience, many of us would not only not have the opportunity to process it but perhaps more of us would feel reluctant to name our childbirth as traumatic. Both are problematic when it comes to our mental health. 

{Funny how both are "women's issues", isn't it?}

We make birth plans, hire doulas, take a childbirth ed class...all things we do to claim our childbirth experience. Claiming your childbirth experience doesn't end when that precious baby arrives in the world! If you feel that your childbirth experience was traumatic for any reason, that is enough of a qualification. 

You have a healthy baby, right? So what exactly do you have to "complain" about? Talking about your childbirth experience (or any aspect of mothering for that matter) is not complaining; it's you taking responsibility for your healing, your self-esteem and your identity as a woman and a mother. As new moms, it's important to practice separating out needs as individuals from our role as a mother so both pieces of yourself are allowed to matter. We've never done this before. As an individual, you have needs, dreams and wants. They are important. But as a mom, you're often told that your needs don't count. But that doesn't mean that those wants and needs go away. They are still important; we just need to own them better and feel supported doing so. Talking about your childbirth is one way to do this.

No, my childbirth experience wasn't traumatic. I feel very lucky because I have known so many women who did feel that theirs was traumatic but didn't feel that they could talk about it or name it for what it truly was. (And certainly no one asks!) This void is why I've started offering trauma counseling. Trauma counseling is a time for women to talk about a trauma related to their pregnancy or childbirth experience. So if you need to claim that childbirth experience as traumatic, today or five years now, you absolutely should...and feel supported doing so.

As always, thank you for reading! I am grateful that you're here.

{new #OutsideTheMomBox post} What is a contraction?

Practically synonymous in our culture with "pain", a contraction can be a scary concept for the first time pregnant mom. Understandably so, when we remember that -unlike getting your appendix removed, for example - each woman's labor is different. It looks different and feels different so a pregnant woman can't rely on another woman's experiences as a guide to what her own will look like. That's scary! But, let's keep in mind an unalterable fact: your body is designed to give birth. Amazing, right? So while you can't control what your labor will look like or how similar it will be to your sister's, education and support go a long way to diminishing fear and building confidence. So let's start there-

Contractions are often a sign that labor has begun. [But they aren't always! Click here for a terrific article by Lamaze childbirth educator Robin Weiss on five things that can cause contractions.] So, what exactly is happening during a contraction? 

A contraction is the word for the uterus pulling back on the cervix to open the birth canal (the passageway that will deliver your baby from the uterus through the cervix, vagina and vulva). The uterus is the largest and strongest muscle in a woman's body. A contraction is the tightening and release of the uterus. Prostaglandin is the hormone that helps facilitate this process by starting the softening of the cervix in the final weeks of pregnancy. The hormone oxytocin is what is makes your uterus contract.

Over the course of your labor, your cervix will expand (talked about as "dilation") and soften (talked about as "effacement"). In early labor then, as you might guess, a contraction might not feel like very much. You might suddenly not feel like yourself, or maybe feel crampy* or like you're coming down with a bug. There will be pressure but not usually pain per se in early labor. 

My husband's notes on my contractions. 

In early labor, I remember feeling like I had bad menstrual cramps but I had felt that way before so I just ignored the feeling, imagining that it would go away. The feelings weren't painful, just uncomfortable and it wasn't anything that I couldn't talk through. These feelings were irregular. They were contractions although I did not realize that at the time!

As your body releases more and more oxytocin the contractions get stronger and stronger. When this is happening, you are moving from early labor (when your cervix is dilated anywhere from 0 to 6 cm) to active labor (from 6 cm onto 8 cm). 

 A contraction in active labor is something that you can't miss. No longer will you feel like taking a bath or finishing the baby's room; things are now serious, you'll realize. You might feel irritable, apprehensive or suddenly concerned. Contractions in active labor get longer and stronger and are closer together. They are like waves, steady and unwavering no matter what you do or what position you are in. This is around the point where you might call your doctor, doula or midwife. [Note: definitely call one of these folks before you head to the hospital. Heading to the hospital can stall labor because essentially you are heading from the safety and comfort of your own home to the relative unfamiliarity of the hospital. That can feel unsafe and your body need to feel safe for you to have your baby. I'll talk about this more in a future post.

Ideally when you are at the hospital, you're in active labor. Contractions continue and soon your cervix is dilated to 8 cm. When that happens, you are "in transition". Your labor is literally readying to transition from contractions that open the cervix to contractions that will push your baby out. This is a brief phase.

Helping with the pain of those contractions at this point are hormones called endorphins. Endorphins are a naturally occurring opiate, a feel-good drug basically. Endorphins recognize that your body is going through a tremendous amount and they work in two important ways related to labor:

1. ...acting as painkillers, helping to decrease your perception of the pain;
2. ...helping you turn inward, concentrate better and find a rhythm that works.

Remember that a contraction is a tightening and a release. Things don't stay "tight"! This means that the pain is intermittent, not continuous. And when you break down a contraction, into pieces (isn't it always easier to tackle something bit by bit?) it actually looks like a wave: there is the build-up where you can feel it coming, the cresting when the pain is at its peak and the downslide where the pain is ebbing away. You will be in "build-up" and the "downslide" more longer and more often than you will be in the cresting phase. That's good news! If it helps to look at the wave mathematically, you will likely be in the crest for 20-30 seconds every 5 minutes (assuming your contractions are about 5 minutes apart and last about 1 minute). In my childbirth class we talk about how to maximize those rest periods because labor is a long haul.

From here, we head into pushing but there's not much new to share about contractions during that point so I'm going to save that conversation for a future post. Something to keep in mind: all of the above will happen but how quickly and efficiently things progress depends a great deal on letting labor begin on its own, being able to move/walk/change position and having minimal or no interventions. An epidural, for example, can complicate how your labor progresses, among other things.

Questions, thoughts? Leave me a comment below!

Pregnant and need a childbirth ed class? Click here for details on my Fall class for couples and click here for my Fall virtual session for survivors.

Thanks, as always for reading.

{new #OutsideTheMomBox post} Expanding bellies, empowering steps

I read this article via NPR recently about inductions declining. Which is of course, a good thing so yay, but I was struck by the language in the title, the content of the article and the comments. 

Here's what I mean-

• "fewer women are having labor labor induced earlier," - title

• "There has been a major effort in the past several years to reduce the rate of early elective deliveries." - first sentence of story

• "the overall drop in induction rates may be fueled by doctors cutting down on their use of elective early induction as awareness of its potential hazards has spread." - middle of story

• "It's important that women who have a real medical reason for delivering early aren't scared off from doing that, he says. But for everyone else, he advises giving the baby an "extra edge" of those last few weeks." - end of story

Fascinating how in the title the blame for early inductions seems to be dropped squarely on mom, "fewer women being induced earlier", but the credit for this shrinkage in inductions goes to doctors and hospitals. The massive effort on behalf of childbirth educators, the March of Dimes, birth doulas, even women themselves, to lower the number of inductions goes completely unmentioned. 

To me, this seems like such a typical example of the double standard that we place on women, a double standard that can be especially challenging for pregnant women. Pregnant women are just trying to do the right thing for themselves and their baby/babies but pregnancy can be a vulnerable time. Everything you know to be true of yourself and your life is changing or will change. At what other point in our lives is this the case? So it feels crappy even to me, a non-pregnant woman, to read an article like this. The message seems to be: don't get induced but if you do, it's likely your fault.

The reality is so much different. Everyday I hear stories from new moms about their birth story and all too often a part of that story is not feeling heard or respected. Whether that's the mom who says that she was induced because she was "too small" to deliver vaginally or the mom feeling traumatized because of what one nurse said or by the med students in the room. The list goes on. I will never forget the new mom who told me, "I wish that I had been told that I could be a bitch in the delivery room." And by this she meant, someone who would be relentless when it came to questioning what was happening and saying exactly what she wanted. This mom didn't feel as if she had that power. Many of us in the exact same place, scared and uncertain, don't either.

One problem is that most childbirth education classes, especially the larger ones that are hospital-based, offer very little in the way of practical tips or coaching on how to respond or deal with hard conversations. Such as when your ob asks about scheduling a csection when you're hoping for a VBAC. Or how to find out how long your ob's practice usually lets women "go" if they are an "older" mom. Or what your options are if progress has slowed. These can be hard conversations! While the topics are introduced, ways to address them with your provider usually are not. More traditional childbirth ed classes offer outstanding, current information but not a lot of support beyond the facts. Even the chairs generally suck! So women may end up feeling more informed but sometimes not any more empowered with real tools in which they can advocate for themselves, in the moment, than they did before the class.

So, lets not throw the pregnant mom under the proverbial blame bus with articles like this. All too often the medical professional in charge is the one wielding the magic wand of decision-making power. Instead let's move toward the use of inclusive, empowering language when it relates to pregnant women so they are part of the conversation...and not just in title alone.

Starting in September, I will offer a multi-week, weekday evening, "traditional" (for couples) Lamaze-based childbirth ed class for expecting parents. Among the usual topics (stages of labor; pain theory; non-pharma pain management; labor support, etc.), I will also include coaching around how best to advocate for yourself in the moment, how to challenge your ob, how to ask better questions, how to make your voice heard, etc. If you'd like to be emailed when registration opens or for more details, click here to head to my contact page. As always, thanks for reading. To leave a comment, click the bubble icon below.  

{new #OutsideTheMomBox post} Touring The Birth Place at #Duke Regional Hospital - Part II

In this post, we continue where we left off and will tackle what happens from delivery to discharge. Part I of this post was published here.

After you have delivered your baby, you will spend only about 2 hours in your labor & delivery room. Then onto the mom & baby rooms. Before that your nurse will help you get up at some point and use the bathroom. At Duke Regional, the labor and delivery rooms are separated from the mother and baby rooms by the nursery. It's a nice quick jaunt to get from one to the other. However you'll likely be in a wheelchair. If you delivered vaginally, you may find yourself to be ravenous (I was!) and you are encouraged to eat. Your IV will be removed. If you delivered via csection, it will be a slower progression to get to foods but the goal is to get you back on a regular diet. 

This is a L&D room from the 1960's. Thanks News Tribune Attic for this photo.

Once you are in your new room, you can expect to stay there for 2 nights if you delivered vaginally or 3-4 if you delivered via csection. It is your right to leave after 24 hours but this is discouraged for many reasons, not least of which is due to helping you figure out breastfeeding. An IBCLC at Duke Regional will come after the first 24 hours because after the first 24 hours is when a feeding challenge might show up and because newborns are super sleepy in the first 24 hours so may not be as interested in feeding. These rooms are private and simple, not fancy. They don't offer much in terms of comfort for your partner i.e. there are "reclining chairs" not a sofa for them to rest on. There were be pretty regular interruptions as staff come in to check on your and baby's vitals but they will try to be mindful of your rest. The nurses will teach you how to swaddle, diaper, bath baby and also help with breastfeeding. They will likely show you the movie "The Period Of Purple Crying" and perhaps offer a copy for you to take home or...share with your nanny or other caregiver. Circumcision, if you have decided to go that route, can happen anytime but like the hearing test, baby will be removed from the room for this. The newborn screen includes a bilirubin test as well as the hearing test. Finally, the carseat will need to be brought into the hospital on the last day of your stay. You cannot leave the hospital without a carseat so my guess is this extra schlepping is simply to prove you have one.

A couple of other miscellaneous bits of information:

• If you do't have a breast pump, you can buy one at the gift shop at Duke Regional with a 35% coupon that comes in your tour packet. I advise checking which brands they stock and the price. THEN comparison shop a bit at places like Buy Buy Baby or somewhere similar to make sure you are getting the best deal.
• There are options for photography in your room, at the hospital, if you are interested in that. It's free, easy and confidential. I've blogged about wishing I had more photos of myself and Elisabeth during the first few days so I think this is just a terrific service.
• There are no set visiting hours at The Birth Place but there is a very strict security system. Your baby gets a little bracelet that, if it falls off or is removed, will alert staff to come and check on baby as well as lock down doors (although perhaps not immediately). 

As always, one of the most important bits of advice I can offer is to make sure that you have good support before, during and after childbirth. That means a birth doula, childbirth educator, postpartum doula and IBCLC. But good support i.e. a birth doula, during labor, increases your satisfaction with your birth. Greater satisfaction with the birth process (feeling heard, listened to, appreciated, understood, comforted) helps decrease the chances of a postpartum mood disorder. 

What have I missed? If there is something you wish I had included here, please leave me a comment below and let me know. Thanks for reading.