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I recently welcomed my fourth child into the world

I am absolutely ecstatic to announce that I had my fourth kid, and 2nd daughter in January 2015. She was welcomed into the world by her older brothers and sister with so much love.

Of course as a doula and prenatal teacher, I was very interested in putting all the skills I teach in my classes to good use in my own labour.

First of all, right from the beginning of my pregnancy, I wanted to choose the best health care provider that would be a good fit with my birth preferences. This is one of the most important things I tell my clients that will affect the kind of birth you have. Don’t just choose any random maternity care provider. Find the ones who best fit with the kind of person you are, and the kind of birth you want.

Secondly, birth can be unpredictable, so when things don’t follow the textbook version of labour, you have to make informed decisions regarding what to do. There are ALWAYS options. When my water broke and my labour didn’t start for over 24 hours, it was stressful because, of course, as a mom, you naturally worry. But I kept reviewing my options and the potential risks of all the options available and kept discussing things with my midwives. Just to be clear, I felt totally fine with having any medical intervention that was clearly necessary and helpful, but I also know when interventions are not entirely necessary. There are always risks to both sides – having a medical intervention or declining it. In my situation I had the options of going to the hospital to start an induction, using non-medical ways of starting labour (herbs/ acupuncture etc which can be highly effective), or simply waiting it out. That’s another reason moms love having a doula with them in pregnancy and labour – if unexpected situations arrive, the doula can often talk moms through the decision making process, empowering them with a range of information on options so that moms can make an informed choice and feel good about it.

I knew the risks and possible outcomes of all scenarios and decided to take various herbs to get labour started. I also know that emotions and ’emotional blockages’ can have a huge impact on labour. So with the help of my doula friend, I worked through any deep seated emotions I was having that could have been blocking my labour from starting. That was EXTREMELY helpful because after I realized a huge emotional block I was holding, and then let it go, my labour started soon after.

Thirdly, of course, is all the pain coping strategies I teach. Once labour started, the first half was the easy part. The key for that is to keep focussing on staying completely relaxed. Holding on to any tension or resistance will cause pain. I was able to feel no pain at all for the first half of the labour by breathing out all the pressure waves and making a low toning sound. You can try it now, just let yourself sigh with a deep sound. You naturally let all your tension go and you feel more grounded. Remember fear in labour = adrenaline = pain = more fear = more pain. You have to keep the adrenaline out of the equation in labour and keep deep breathing away any tension or pressure you feel building up. Pay attention to your body.

homebirth labouring mom As contractions intensified, I moved around, feeling for whatever positions felt more comfortable. Sitting, squating, standing, lunging, leaning forward on furniture, sitting backwards on the couch, swaying my hips etc. I was chatting with my doula, friend, mom, and midwives in between contractions. Eventually, I felt like leaving the living room and going up to my bedroom. In labour, women naturally experience a going within. They feel like they are going deeper and deeper inside themselves as labour progresses. A woman starts using more of her primitive, instinctual brain and less of the cerebral cortex. It is the instinctual part of the brain which controls the natural process of labour. Labour flows more smoothly when a woman is undisturbed so she can smoothly go deep within herself. Any distractions that pull a woman out of this state of mind will slow down the labour and also create unnecessary pain sensations. Bright lights, too much talking, asking questions, talking about time (which is a cerebral concept), telling a woman what to do so she can’t listen to her own body’s instincts, disturbances like frequent blood pressure checks, vaginal exams etc. will all take a woman away from her “labour land” state of mind. And to the labouring woman, this feels quite irritating.

I told my midwives that I wanted a very hands off approach to my birth. I didn’t want any unnecessary disturbances such as internal dilation checks or them telling me what to do. But having them there in the background helped me feel safe in the rare situation where medical help might be needed. It is important for birthing moms to feel safe and supported. That will lead to a smooth labour process. Anything that makes them feel worry, fear or anxiety will cause a slowing down of the labour process, or even complications.

homebirth labouring momOnce I got to my bedroom, the lights were off with just a dim light on in the bathroom. My older daughter had woken up by this point and she lit some candles to add to the mood of the room. My mom made sure the music playlist I had put together for the birth was still playing. I had complied a series of songs that I found both inspiring and relaxing. I love music and I find it helps me set the tone for focusing on feeling good. In labour, you want to take your attention off the pain sensations and replace them with anything that makes you feel good. My doula was massaging my sacrum while holding a hot pack on my lower back. My husband rubbed my back and shoulders. That all felt really good. By this point, I was not feeling zero pain, like in the earlier part of the labour, but all these things helped take the edge off the intensity of contractions so they were completely manageable.

People often tell me that I’m brave to have a homebirth. Nothing could be further from the truth. The truth is, in terms of pain management, homebirth is often easier to manage because I feel more comfortable at home and there are so much fewer disturbances to my instinctual state of being. In terms of safety, solid evidence shows that homebirth is as safe, if not safer, than hospital birth, as long as it’s a healthy pregnancy, there are trained care providers in attendance, and a hospital is less than an hour’s drive away if there is a need to transfer. Here in the lower mainland, BC, Canada, we are so lucky to have a fantastic midwifery system that functions relatively smoothly at home or hospital. If you feel more comfortable having a homebirth, definitely go for it, or at least look into it. If you feel safer and more comfortable in a hospital, then hospital is the place for you. Birthing moms should be in the place that is more conducive to them feeling safe and supported. You have to know yourself, and know what you prefer. It doesn’t matter what anybody else does. It only matters what kind of experience you want and how you’re going to get it.

waterbirth home birthEventually, my contractions got pretty strong and I wondered if getting in the bathtub with warm water would help. I wasn’t particularly planning a waterbirth, but I always keep my options open. The warm water does take the edge of, but of course, labour is still a pretty intense and powerful process. At one point I joked with my midwife, “So you brought an epidural with you, didn’t you?”

“Yeah, it’s just in my back pocket,” she smiled.

“Oh good. I wouldn’t want to be crazy enough to have a natural birth.” 🙂

(Just in case you didn’t know, you can’t have an epidural or any other drugs at a homebirth because of the risk those things entail.)

I remember, through one contraction I just swore the whole way. Then for the next one I struggled to remember what the purpose of all the pain was. Oh yeah, to open the cervix and let the baby out. So I started chanting “Open, open…” through the whole contraction, while visualizing my cervix opening fully, quickly and easily. Soon after that I started to feel worried. I had the presence of mind to remind myself that this was a normal emotion during transition (the last bit of the dilation phase before the pushing phase). I was worried that this would go on forever and the baby would never come out. It’s common to have this rush of irrational feelings in transition, and a doula often reassures a labouring mom that this is a natural part of the process and it’s good sign that means things are progressing. It is important for the mom to go back to her state of feeling safe and relaxed instead of letting the worry and the adrenaline intensify. Again, smooth, fast and instinctual pushing phase vs. prolonged and worried pushing.

homebirth, waterbirthI soon began to feel “pushy”, meaning I felt like pushing a little at the peak of each contraction. I let the midwives know so they could get ready and everyone else too. My younger two kids were woken up so they could be present for the birth. I tried different positions in the tub – on my back, side, hands and knees, until I found the most comfortable position for myself, which just happened to be squatting facing the width of the tub instead of lengthwise so my feet could push against the side while my back rested on the other side.

Pushing contractions feel different than dilation contractions because you’re not just trying to relax through each one. You’re actually actively pushing with each one. And in a drug free birth, you can feel the powerful force of your body pushing instinctively. It’s not something you can stop. It’s like one mom said, it feels like you’re body is just vomiting the baby out. It’s so strong and so involuntary. In a drug free birth, no one has to tell the mom how to push. Her body just does it. Pushing feels way more fun than the dilation phase before it. I felt very powerful.

Once the baby’s head was low enough in my pelvis, I could feel it. It was definitely a strange sensation and I exclaimed to all the 10 people who, by now had piled into my bathroom, “It feels like a bowling ball.” I put my finger in and felt the top of the baby’s head less than an inch away. A couple more pushes later and I could feel her head crowning. This feels like a burning sensation as the perineum stretches around the baby’s head. I expected this part to take a while, as it can take several pushes to slowly push the head out. But my body just kept going and in one push she went from completely inside to completely out. I had planned to catch her myself if possible, but she came so fast. No one was quite ready for that. Luckily my husband was speedy quick in catching her and lifting her out of the water and onto my tummy. She was happy and content sitting on my tummy, looking around.

homebirth, waterbirthWe hadn’t found out the gender, so it was very exciting to look down and see it was a girl. My daughter finally got the sister she had been hoping for for so long. Here’s the picture that captures the sheer intensity of emotions of that moment right after birth – relief that it’s over, exuberance over the new person you are meeting, and for me the shock of how fast she came out and surprise that I got the girl I wanted.

It was a lovely family experience to have all my kids there, my mom, sister-in-law and friend. My husband caught the baby, my daughter took the photos, my older son cut the cord and my younger son helped the midwife weigh the baby. My kids will all grow up knowing that birth is just a normal, natural and safe part of life. Not something to fear. By the way, I wanted to wait till after the placenta was out to cut the cord, or at least until the blood in the placenta had finished pumping to the baby, instead of cutting the cord immediately. This is so that she can get her full blood volume and have a gentle transition to life on the outside.

Once I got out of the tub and walked back to my bed, I birthed the placenta and breastfed my baby before letting everyone else have her for some cuddles. My mom made me a nutritious, yummy smoothie with a tiny piece of placenta blended in. Having a bit of placenta reduces the risk of postpartum hemorrhage.

It was a lovely morning. I stayed in bed all day snuggling my new sweetheart. And the other kids were just over the moon excited with their tiny sister. Plus they got to take a day off school. 🙂

newborn baby holding mom's finger

 

 

 


 

Join me on my own pregnancy journey

Hello everyone,

baby bcbaby bcSo I have some exciting news! On Mother’s Day 2014, I found out I’m expecting my fourth child. mom and baby vancouverbaby bcbaby bcbaby bc

I’d love for you to join me on my pregnancy journey. I know you’re going to learn lots along the way.

For those who don’t know me, I’m a Birth Doula and Prenatal Teacher in the Surrey, Langley area of British Columbia, Canada (near Vancouver). I had my first two kids in hospital and the third one was the most fun birth yet – it was a homebirth. So for this one, I am of course, planning another homebirth. I’ve moved neighbourhoods since my last one, so I have to find another midwife. (You can read more about my first birth, and see the slideshow of my home birth at Birth Stories

I thought today I’d provide you with some information about midwives in BC.

 

1. Midwives are covered by MSP in British Columbia

That’s right! I’m always shocked and horrified that people don’t know their options when it comes to midwives. They think they have to pay out-of-pocket. They think that they have to have a doctor.

Here are the facts in BC : there are three kinds of maternity care providers and they are all covered by MSP, which means it is free for you – Family Physicians who do maternity care, Midwives, and OBs.

2. If you have a midwife, you don’t need to have a doctor for your pregnancy

In some countries, midwives are like nurses. But in BC, midwives practice independently so if you have a midwife, you do not have to also see a doctor for your pregnancy.

If you have a high risk pregnancy, OBs are a great option for you. In fact, family physicians and midwives will refer or consult with OBs if any high risk situation occurs.  But, research shows, if you have a low-risk pregnancy, midwives are a great option for you. Midwives specialize in low-risk birth, so they have the kind of skills needed to help you have a natural birth, and yet are trained to deal with situations where more medical help is needed. OBs, specialize in high risk birth and are not skilled in helping moms have a natural birth. They resort to medical intervention much sooner than midwives would. As such, comparing all low-risk pregnancies, OBs have much higher cesarean, induction and instrumental delivery rate.

3. Midwives have much longer visits

Midwives are paid more than Family Physicians for each pregnancy mom they have, but less than OBs. This is because midwives spend 45 mins with each client at prenatal appointments as opposed to the 5 – 10 mins doctors spend. This is to build a relationship and cover more comprehensive information with women which includes, nutrition, wellness, informed decision making, choices in birth and so on.

4. Midwives are responsible for you and your baby up to 6 weeks postpartum

Midwives provide continuity of care through the whole pregnancy, birth and up to 6 weeks postpartum.

5. To find a complete list of midwives in your area of BC

Go to BC College of Midwives

Or Midwives Association of BC

6. Register ASAP

I’d suggest calling several or all the midwifery offices in your area and registering as soon as you can. Midwives fill up fast. It’s ideal if you can register as soon as you find out you’re pregnant. If you would like to close the best midwife for you, register with a few so you can have a chance to interview them and decide which ones you like best.

If you’re further along and you have decided to switch from doctor care to midwifery care, do not despair. Although it can be hard to find a midwifery office with space, it is possible. I have had many doula clients decide mere weeks before they gave birth that they wanted to switch to midwifery care. They called a couple of midwives and found them to be full but after my encouragement, they called ALL the midwives in their area until they managed to find midwives with space. Go to one of the websites above and call ALL the midwives in your area. Don’t just give up after one or two.

 

For the Crunchy Granola Mammas :

 

Now having said that, if you are of the crunchy granola sort, like me, you wouldn’t just want to stop at choosing a midwife attended birth. You would want to carefully select a midwife who aligns with the kind of birth preferences you want. All registered midwives in BC practice within a range of guidelines. But there is a wide range of what some midwives are comfortable with. There has been some criticism that some midwives practice too much like doctors, jumping to medical intervention too soon before trying natural methods. They have been termed “medwives”.

There are also a few midwives who have chosen not to be registered with the college of midwives, and do not follow their guidelines. This is an interesting point, because before 1998, all the midwives were not registered with MSP. MSP only started including midwives in 1998. So a few of those midwives did not register because they felt registering would inhibit their ability to practice in the way they had previously been practicing. So the college of midwives now refers to them as “Lay Birth Attendants”  instead of midwives. Why would they not want to be registered? Well, before the college was established, the midwives were trained in and regularly attended breech or twin births. Remember, in Europe, these are seen as variations of normal birth and not high risk situations. If the birth attendant is trained in how to properly attend breech or twin births, the risks are minimal. But in North America, breech and twin births have been considered too risky and are reason for automatic cesarean.  Over time, the doctors and midwives skilled in such births have retired and the new ones left are not skilled in such births, which really does make it risky.

So if you would like to really increase your chances of having a gentle, natural birth or even a homebirth, but you don’t want to go with a birth attendant who is not covered by MSP, what do you do?

Like all advice about choosing your caregiver, you need to interview them and choose the one who matches your expectations. Don’t assume that just because they are midwives that they will all be totally crunchy granola. Here’s an example of what I mean by that : some women really want their pregnancies to be rushed along towards the end. They don’t mind having a stretch and sweep of the membranes in hopes starting labour earlier. But some women would be insulted at the mere question of whether they want a sweep. They want labour to start on its own. Some midwives routinely offer sweeps at 39 weeks and some don’t. So figure out what you want and find the care provider who matches.

Here are some questions you can ask :

1. Are you comfortable not doing any vaginal checks for dilation?

2. Are you comfortable attending a homebirth?

3. Have you attended water births before?

4. If the water breaks before contractions start, are you comfortable waiting without inducing as long as their are no internal checks and signs of infection?

5. Are you comfortable if a mom declines all or most prenatal screening tests?

6. Are  you comfortable waiting a long time before cutting the cord, if at all?

7. Are you comfortable with a natural third stage (placenta stage)?

 

Hope that helps you in choosing the best care provider for you and your pregnancy!

 

kaurina danu doula surrey langleyBTW, if you would like to know more about any of these questions and why they might be important, leave a comment below, send me and email at kaurina @ prenatal journey. ca or call me at 604 809 3288.

 

 

Once You Go Homebirth You Never Go Back

Once You Go Homebirth You Never Go Back is an apt phrase that has made it’s rounds in birthing circles. It’s so true. Almost everyone who has experienced Home Birth never chooses to have their next baby in a hospital. (There are always a few exceptions for everything.)

This poem on the wonderful blog – DrMomma.org describes it so perfectly. Women’s bodies were designed to give birth. But in a hospital system, with all their protocols and policies, the natural tendencies of birthing women are hampered, and so is the indescribable power that emerges from a birthing woman who is undisturbed.

Here is an excerpt :

And yet I was not designed to birth
between these hospital walls.
Monitors mess up my flow.
IVs cramp my free movement.
Food and drink restriction famish my muscles.
This gown cramps my urges.
My body is stepped upon.
My spirit is caged.

If you are interested in having a homebirth or finding out more, you can call 604 809 3288 or email Kaurina @ Prenatal Journey .ca