Tag Archive | labour and delivery

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

 

 

 


 

Community Birth Program in Surrey Memorial opens its doors

Community Birth Program in Surrey

A fantastic new program has opened in the Jim Pattison outpatient clinic at Surrey Memorial Hospital for expecting mothers in Surrey, Delta, White Rock and Langley. The Community Birth Program is modelled after the South Community Birth Program in Vancouver, BC.

Both the Vancouver and Surrey programs are based on the groundbreaking and innovative Collaborative Care model where Physicians, Midwives, Nurses and Doulas work together as a team. Doulas are provided to clients at no charge because of funding from Fraser Health Authority. That means that even low-income women, immigrant women or women who have never even heard of Doulas can have one to support them through pregnancy, labour and post-partum. The women are thrilled to bits to have someone give them personalized attention, in their own homes, and help them navigate the new territory of parenthood, especially if it’s also in a new country. (If you’re not sure what a doula does, read my page What is a Doula?)

Fraser Health decided to provide funding for this program because of the immense success the Vancouver program is having. Significantly lower c-section rates, shorter hospital stays and higher breastfeeding rates. These is all great news for mothers and babies, but also for the budget of the Medical Services Plan so it makes sense to fund doulas and midwifery/physician collaborative care if it’s going to save on the other end with reducing unnecessary medical  procedures.

Normally, reducing the medical budget compromises patient safety, but for maternity care in particular, there’s lots of room for reducing unnecessary medical procedures while not compromising necessary ones. For example, the World Health Organization suggests that the optimal C-section rate is probably around 15%. Less than that and women who really need it, may not be getting it, which is often the case in impoverished countries. But more than 15% and probably too many women are having cesareans that may not always be necessary.

To find out what the cesarean rate is in the hospitals near you in BC, go to British Columbia Cesarean Rates. For example, Surrey Memorial Hospital has a cesarean rate of  28.65%. So there’s room for reduction. While a small number of mother’s would rather have a cesarean, the vast majority would rather avoid one. So reducing rates would benefit moms as well as reduce costs. Pioneering programs, such as the Community Birth Program and many others that are effective at reducing intervention rates without compromising safety are important for helping maternity care providers as a whole understand how to effectively reduce rates. 

I’m really glad the Surrey Community Birth program has finally opened after years of preparation. It’s going to be a really positive direction for expecting moms in Surrey and the Fraser Valley. While maternity services in BC are already so good,  and has continued to improve over the past years, there is always room for improvement. 

What I would like to see is good quality prenatal education that is available to ALL first-time moms – that effectively teaches pregnancy nutrition, making informed choices and real labour coping strategies. (I say “effective” and “real” because obviously, I have my opinions about how ineffective and unrealistic some prenatal classes are in regards to those topics)

Choosing an appropriate caregiver for pregnancy is one of the most important decisions women make that effects the path their birth will take. I always teach in my prenatal classes how to figure out if your caregiver matches the kind of birth you want. But by the time they come to my classes, their already in their third trimester. It would be great if women got more information about caregiver choices early on (like before they even get pregnant, or at least in early pregnancy). When women go to their doctors for the first pregnancy test, what I would really like is for those doctors to provide a handout about the three kinds of maternity care providers in BC – Family Physicians and Midwives for low-risk pregnancies and Obstetricians for high-risk pregnancies. 

I would also like every pregnant woman to be informed by her initial doctor about what a doula is and how a doula can help her in labour and delivery. It is up to the woman to choose if she wants one or not, but I believe every woman should at least get the information that such support exists and is proven to be helpful. There have been numerous scientific studies which prove the effectiveness of doula support at reducing unnecessary medical procedures while increasing maternal satisfaction and breastfeeding rates. If a doula were a drug, it would be unethical for doctors to not recommend them. But doulas are not a drug, and are not at the moment funded by the Medical Services Plan, so expecting families hire a doula privately. Maybe someday there will be MSP funded doulas available to all women. But for now, there are three options:

1. Find a volunteer doula. The BC Doulas Association has a list of newer doulas willing to volunteer their services. Give them a call. In Surrey, you may also be able to find a volunteer doula through the Healthiest Babies Possible Program.

2. Interview a few doulas in your area and ask if they are flexible with their rates or if they have payment plans. I am very flexible with my rates because I know not everyone can afford them but I am passionate about providing support to women who want it, and lots of doulas feel the same way.

3. Register with the South Community Birth Program if you live in Vancouver or the Community Birth Program if you live in Delta, Surrey or Langley to get access to midwifery care, physician care and doula support.

If you are expecting and would like to register with the Community Birth Program go to Fraser Health – Community Birth Program for more information. If you would like to BECOME  a doula with them, also contact them.

 

 

Love In The Delivery Room – Memoirs of a Doula part 2

You wouldn’t expect labour and delivery rooms in hospitals to be places of great romance, but I’ve seen it with my own eyes. Much has been written about the love between mothers and their newborns. Sometimes it’s a quiet, gentle love, and sometimes it’s an overwhelming, life changing love. But the kind I’m talking about right now is the love between the mom and the dad in labour.

The media has solidified an image of the interaction between moms and dads in the delivery room revolving around the mom swearing profanities at the dad, and the dad being mostly clueless and bumbling. I honestly don’t know how representative that is of most labours because I don’t see most labours. I only see the ones I’m doulaing for. And what I see is the deeply moving culmination of the romance and bond of the two people who have worked so hard and put so much of themselves into bringing forth a new life.

I see men who love and care for their wives and newborn children with so much strength and intensity. I am profoundly touched every time I see a dad wrapping his arms around his wife’s shoulders, putting his forehead against hers, supporting her through contractions, loving her with every fibre of his being. Every time a dad goes hours, tirelessly massaging his wife’s back to take the edge of each contraction, or holds her under the shoulders to support her weight if she’s more comfortable in an upright position but is too tired to support her own weight.

I see the look in their eyes as they look at their wives with awe of her strength and beauty through the whole amazing process of birth. The worry and concern they have if their wife is having a hard time. I see women holding on to their partners for solace, or resting their heads against their partners chest to help them relax. I see dad watch mom’s every move, anticipating when she might need a sip of water or a cold cloth to wipe her brow. The sweet whisperings of encouragement and love. I see the tears of joy or beams of radiance when dads hold their newborns for the first time. It’s such a well deserved high for both the mom and dad who’ve worked so hard together.

I see men who will be forever changed by the experience of being so helpful and supportive of their wives through labour. It deeply strengthens their relationship and connection to their partners and their children.

I don’t know what dads are like at births I’ve not been at. I imagine some men are naturally great at supporting their partners in labour, and some are not because they are feeling unsure, overwhelmed or disconnected. I know some parents-to-be, when considering if they want to have a doula with them at their birth, are concerned that the doula will take over the dads role. I can understand that concern, but actually, it’s quite the opposite.

I don’t ever take over the dad’s role. That is the primary relationship that the doula can never replace. The dad is so helpful in the delivery room just by being there and loving his partner. I always recognize and support their relationship. I’m just there for a short period of their lives, but they are the ones who are going to be raising their child together for years, so I try to enhance their connection during this intense experience of labour and birth.

For the men who are unsure about what to do in the delivery room, they quickly gain more confidence by watching what I’m doing and figuring out how they can support their wives. Quite often dad and I tag team to provide massage, counter pressure or hip squeezes to mom for hours on end. If dad has any concerns, I am immediately there to answer all his questions as best I can. The dads never feel overwhelmed that too much responsibility is on their shoulders.

Occasionally I meet a dad at the prenatal visit who really does not want to be in the delivery room. If the mom doesn’t want him there, then it’s fine. But if she does, then I want to make sure I address his fears and make it clear that he can participate as much as he’s comfortable with since I will be there too. If he’s still not convinced, I talk to him about something extremely difficult he’s experienced or witnessed in his life. Then I get him to imagine the difference between having people to support him through it versus doing it totally alone. That’s always enough to flip the switch and motivate the dad to commit to being there no matter what.

Sometimes a dad will have a strong emotional reaction and it helps to have someone there to share it with instead of keeping it to themselves. One dad was really worried for his wife when she became sick with an infection in labour. He felt relieved after talking to me about his fears. Another dad took me aside after the birth to talk to me. The intensity of the experience brought up memories of their previous child who was stillborn. He recounted his last experience and said that him and his wife had no one to support them through that. They felt so alone. In contrast, this time, they felt so supported. He thanked me for, “caring for his wife better than her mother could have.” I was so moved by this man’s love for his wife, the strength of their bond through their shared experiences and the deep healing of the past hurt.

I am confident that these couples will go on with their lives with more love and connection than before their birth experience. I know the dads will continue to express their profound love beyond the delivery room in practical ways – caring for their newborn, waking up in the middle of the night to rock a crying baby or change a diaper, working extra hours to provide for their families.

 

Romance in the delivery room is such a special thing and I am so grateful to be able to witness it. What are your thoughts and experiences? Leave your comments below.