Laurita Dianita

Reflections and art on the topics of public health, social justice, and love

Archive for the ‘birth’ tag

A different telling of Rio’s birth

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I know I already wrote Rio’s birth story and shared it here. I wrote it as clearly and honestly as I could, with all of the relevant factual details, the small collection of photos that my globally-published photojournalist friend Ash was able to get me right away, and an attempt to be even-handed in its telling even though I felt heartbroken.

This is a different telling of it. 

I am telling it differently now because I now have all of Ash’s photos from which to choose, and I also now have license to share that the reason for my heartbreak was Oscar and the end of our marriage. We are going through a dissolution of marriage currently (in as collaborative and child-development-focused a way as possible). Though our relationship had been troubled for a long time, the night before the birth was particularly difficult. This was why I birthed through an ocean of grief.

In this version, then, I am visually telling the story (thanks to the gift of Ash’s photo-documentation) with a focus on what really matters to me from the birth. I am telling it with a focus on the narrative that strengthens me, the memory of it that reminds of me of my own fierce will. Most of all, I am telling it with a focus on what provided me the resilience I needed to cross that ocean of grief to meet my baby: the women in my life, the women in that room. They are the fountain from which I drew my resilience. When I had no tranquility and peace inside myself, I absorbed theirs. When I felt defeated, I concentrated on their love and belief. The faces and hands and voices of my mom and Jen are the way I want to remember this birth. Suki hugging me, Deb pressing the hot pack to my back, the quiet presence of Ash and of my sister, the sunlight from the window, the calm female voice singing “Ra Ma Da Sa” from Jen’s phone, the colors of my robe, the blue and purple of Jen’s hair, the tickly feeling of my mom’s gentle fingers, the love I spoke to Rio as I pushed him out, the way I reached down to feel him crown and to pull him to my chest, the sweet way Ida greeted her baby brother with a kiss. These are the things I want to remember. These are the elements that I am choosing to carry with me from this birth, to sustain me in this hard road ahead.

What I have learned in the last six months is that resilience is an active process. It requires choices in every moment to draw on the strengths around us, and it requires that there is something good around us and inside us that we can draw on. These women were my pillars and my lifeboats, and I wanted to tell the birth story again, with a dedication to them.

The collection of photos does begin and end with Oscar, though, because this pregnancy did begin with him, and because the birth ended with him. That is, we will be co-parenting together for the rest of our lives. The kids are ours. The moment of birth is brief; the process of parenting is life-long, and he will always be there, dedicated to our children alongside me, even as we craft separate lives.

But the birth, the birth I want to remember, is not about him at all. This is the story I want to tell.

[Please note that some photos are NSFW…unless you work in the birthing field, that is.]

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All photos by Ash Adams

Written by admin

December 3rd, 2016 at 10:17 pm

Rio Esteban’s Birth: Crossing an Ocean

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(All photos by Ash Adams)

 

I’ve been struggling with how to tell my birth story because it contains some personal emotional details that I don’t feel like broadcasting. But I find myself feeling blocked up from not having written it, not having cast it into narrative form, externalized it and made sense of it in writing. So this is my best attempt to tell the emotional truth of it and share it with all of you.

Before labor

Ida had come 3 days early, and my friends and my husband, Oscar, thought I was going to deliver even earlier this time, a prediction which I didn’t totally agree with, but his positon so low on my cervix made seem plausible. I was not expecting Rio to come so late. His due date was Friday, July 22nd, and my labor didn’t begin until the morning of Tuesday, July 26th. Although I had told myself that I would go back to work on Monday the 25th if I were still pregnant, I sensed that I just needed to take some time to myself and he would come, so I spent Monday getting a massage and a pedicure and meeting with my doula to work on pressure points in my foot and talk through things that were weighing on my heart. That seems to have worked.

Early labor

Early on Tuesday morning, after a poor night of sleep, I went to snuggle with my two and a half-year-old, Ida Luna, in her room, and fell asleep on her crib mattress on the floor. I then awoke around 7:00 with my first contraction. They came every 15 minutes after that, so I figured this was early labor, and I was hoping it would continue and advance. Oscar and I got Ida ready and after he left to take her to school, I slept for another hour and a half, waking every 15 minutes with pain in my pelvis and back. I recognized the contractions, but this felt markedly different than last time, mainly in that they were not accelerating and I was not diving into that deep, private, mental space of Laborland as I had in early labor with Ida.

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Later that morning at home, Oscar pushed on my sacrum as I sat in extended child’s pose, and this felt good, as all of the pain was concentrating in my back. My back, afflicted with spondololysis for the majority of my life, had hurt terribly throughout pregnancy, and I was expecting it to hurt during labor. Around 10-something I threw on a sports bra, a dress, and sneakers while Oscar grabbed the birth bag, and we headed out to go on a walk, to which I invited a few sister-friends. Before the walk, my mom (Geneva Woods Birth Center/Geneva Woods Midwifery owner and Certified Nurse Midwife, Barbara Norton) asked if I’d like to get checked, so I came in. I was 3 cm. dilated, 80% effaced, and my cervix was mostly soft but a little bit firm. She suggested that we not walk so far away at Kincaid Park, as we had been planning, but stay closer by the birth center, so we headed to the trails near Alaska Pacific University, texting friends to update them. In retrospect, all this texting and coordinating was not helping my labor at all, but I really wanted some sister-friend presence. Oscar and I walked for close to a mile, with me leaning on his shoulders and moving my hips and him swatting mosquitoes away from my legs during contractions, and then circled back to the car for a snack and water. I found it odd that I could eat during early labor, since last time I was vomiting at this point. When my friend Suki and my friend and birth photographer Ash arrived, we walked a few more loops with them, me laboring through contractions with the support of Suki or Oscar’s shoulders, Ash snapping photos, and some talking and laughing as we made our way over dirt trails through the beautiful birch forest. My contractions were about 3 – 4 minutes apart at this point, and closer on uphills, so, thinking I had progressed, we headed to the birth center. Oscar had turned the seat heaters on high, which felt amazing on my low back. I had a particularly uncomfortable contraction as we arrived at the birth center, which I got through in the parking lot, leaning against the car.

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My mom had mentioned earlier that if my pain is concentrated in my back, it may be that baby is in a funny position, and I needed to lay on my side with my knee close to my chest in order to get him to turn. By the time I arrived at the birth center again, however, the pain radiated from my pelvis out and into my back and hips, so we were less concerned about position. We settled into the birthing room I had chosen – the bright “Hummingbid Room” lit by sunlight from the large windows and my doula Jen Allison arrived. I got my dose of antibiotics (I had tested positive for GBS) and had a few contractions on the bed in extended child’s pose, with Oscar pressing on my back. Then I tried putting on my calming birth mix on my phone, and getting in the shower, but nothing was quite clicking, and my contractions slowed down significantly. I got out and Jen rubbed my feet and pushed on my labor pressure points, and asked me about the morning and the previous night, I believe trying to tease out from me what might be getting in the way of progressing.

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My mom came in with Deb Schneider, who is a certified direct-entry midwife (CDM), as well as a nurse and paramedic, who works in their office as a nurse and birth assistant. Geneva Woods is a CNM-only practice (that is, all births are attended and managed by CNMs), but Deb is able to offer her insight from her own CDM practice, which she maintains outside of her hours at Geneva Woods. For that reason, my mom wanted her help with my birth because she did not want to be the only midwife for her daughter’s labor/grandson’s birth, and the other CNM, Dana, was seeing patients all day. Deb checked me and I was still only 3 cm. dilated, 80% effaced, and a little bit firm. No progress at all. All that walking, all those contractions, some of them increasingly hard, and nothing. This felt defeating. I knew that there was emotional stuff getting in the way. It had been a hard few weeks before the birth, and a hard night, and there was a lot of heavy stuff floating around in my head and heart.

 

Active labor

This was about 2:30 pm. My mom and Deb suggested I could go home, or I could try sleeping here since I had not slept well the night before, and see if that helps. They also said if I like, in a little while they could try breaking my water to speed things up. I didn’t want to be stuck forever, so I considered the idea, but I was hopeful I could get into active labor without it — and it turned out that way.  A change of environment and focus was all I needed. Jen, Ash, my mom, and Deb, all left the room as I lay down with one of Jen’s rice-filled hot pads on my eyes, the rain sound from the white noise app on my phone, pillows between my knees, and Oscar next to me. I may have slept a few minutes before the first contraction hit. They then started to speed up and intensify some as I lay with my eyes covered and just the (artificial) sound of rain. In fact, they intensified so much that I vomited, just as I had at the beginning of active labor with Ida.

 

This certainly felt like progress, but it was also so hard, because I found I could not land on the right coping mechanism, could not decide on visualization or non-focused awareness or concentrating on the parts of my body that did not hurt, or thinking of sweet sleeping Ida that morning, or repeating “open” or thinking of a flower blooming. None of it quite clicked, and I was frustrated. Sadness seemed to be getting in the way of the peaceful, accepting space I wanted to create for me and my son, and sadness made the contractions really hurt. (Obviously, labor hurts, but it hurt more because of the sadness.) In fact, this pain and this sense that I was meandering around trying to cope with it (which was so different than last labor, when my coping strategies had fallen perfectly into place) and the lack of progress at my last check had me think, “Geez, I see why people get epidurals…maybe I should just…no, I know that epidurals increase the risk of c-sections and I do not want to recover from major abdominal surgery, and baby needs my flora. Plus, I know I wouldn’t feel as good and powerful about my birth if I did it that way and what if baby didn’t latch well, and ug, then I’d have to hang out afterwards in the hospital. Plus, I birthed without meds before and I can do it again, just as all of our ancestors have done.” Clearly I won the little argument in my head, but it was there, this little internal struggle.

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After a little while, Jen came in and asked Oscar to go to the store to get Natural Calm to help soothe my back muscles, and candles to light for the grief and pain and sadness that was getting in the way (this was, in part, an idea proposed by a fellow Mount Holyoke College alum and mama, Maya, who suggested I could invite in whatever is hard but set good boundaries with those feelings and relegate them to an appropriate place in the room). After Oscar left, Jen laid with me a while, and provided gentle reassurance and presence the way she always does. She also, upon my request, put “Ra Ma Da Sa” on repeat on her phone, and I let the song’s loving kindness pour over me. Then my mom laid down to talk with me briefly and I asked her to stay, and keep scratching my back as she had begun to do.

 

When I was a child, I was energetic and always wired, so it was hard to get me to fall asleep. My mom would gently trace her fingertips along my back until I fell asleep. This is what she did now, and it brought me such a beautiful calm – because, physiologically, that’s what gentle touches do, but also because it was my mom, and she was so loving and kind and tranquil and calm herself. At this point, my contractions really picked up and intensified. Jen (and sometimes Deb) made sure I had cool rags on my forehead and over my eyes and hot packs pressed against my back. I switched positions from my right to my left side, and got up to pee once, but otherwise just lay on my side with no visual input the entire time. I just let labor happen. I squeezed Jen’s hand during contractions and moaned, her soft voice reminding me to moan low, my mom’s calm voice assuring me through the hardest pains.

 

I have synesthesia, a cognitive condition in which all graphemes (letters and numbers and words) and many sounds and touches have a color – an absolute color assigned to them, not something I consciously decide. I don’t recall what color my pain was, but I do recall the color of the peace that my mom and Jen and the song brought to me – the red and yellow of the song’s words, the light pink and light blue of my mom’s back scratches, the brown and purple of squeezing Jen’s hand, all this bathed with the gentle window light from the overcast day. At every contraction, I concentrated on the peace and love and calm and colors I was being gifted by these women in my life, and that peace helped override the pain. That peace helped Rio know he was welcome in the world outside, helped me know that I could bring him here.

 

Pushing

From the time I had laid down to “sleep,” it had been just over an hour and a half before my contractions got incredibly intense and were more difficult to breathe through. Listening to and reading my labor, my mom asked, “Laura, do you feel like pushing?” I answered, “Uhm, I don’t know” for two more contractions because I wanted to be sure, and on the third, I said, “Yes, I do.” So she said, “Okay, we don’t need to check you; I can tell you’re ready.” And indeed I was. My sister, Claire Norton-Cruz, had been called in as the birth assistant to take over the job of listening to baby heart tones and other vitals, and to prepare things for the midwives. I still had a cold washcloth over my eyes, so I didn’t see her, but I was grateful she was there. Oscar also had come back from his errand and was able to video some of the pushing and birth, which is such a gift.

 

With both births, pushing felt strange and difficult in the beginning because I wasn’t sure if I was making any progress. But this time, after a few contractions, I gave a push and my water broke suddenly and with great force, splashing all over Deb. We all laughed, even me. It felt like a giant water balloon popping! A few more pushes — this time pulling my own leg up during contractions — and it was clear the head was coming down — I could feel it. From that point on, all I could think was, “I love you, baby Rio. I love you so much, baby Rio.” This was what I concentrated on as he crowned, as he pushed through the “ring of fire,” and as he sat there while my mom told me to wait before pushing him out so my perineum could stretch (this was very hard to do but I was very grateful for the instruction, as it kept me from tearing). I thought of how I loved him and how excited I was to meet him as I then pushed out his head and pushed out his shoulders (which were difficult to get out!) and then pushed out his big chest and his long long body. I was expecting his body to just slide right out after his head, so I recall being confused and yelling, “Get him out!” (my one rude behavior of birth, as far as I can recall). In total, pushing took about 15 minutes. He was born at 4:34 pm.

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Baby is born!

My mom said, “Take your baby, Laura,” and she put his slippery body on my chest as he cried loudly. In fact, he started crying before he was fully born. Hearing his cry, knowing his lungs worked and he could breathe, feeling his hefty little body on my chest, seeing his beautiful face, and knowing I was done – done giving birth to him, done giving birth forever — I felt such a rush of both relief and love. My sister and mom and Deb all toweled him off and got a warm blanket to cover him as he laid on my chest. Oscar came over to look at him and cried and cried. I just kissed Rio’s messy little head and asked Oscar over and over, “Isn’t he beautiful?”

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Meanwhile, the hemorrhage prevention plan we had put in place got implemented – Pitocin in the leg before the placenta is delivered, and once I pushed that out (which was easy, thank goodness), IV Pitocin and plenty of bi-manual compression. I am small and very sensitive to blood loss, so after bleeding last birth and feeling very faint afterwards, I wanted to prevent it this time. Plus, there is new evidence supporting this Pitocin-before-placenta approach. It was nice to feel like myself this time, and not weak or faint.

 

Rio latched on quickly and with great positioning, and began to feed vigorously. This came as a great relief, as Ida had dithered at the breast for a long time when I had really hoped for her help getting my uterus to clamp down, and she was not the most vigorous nurser as a newborn, which contributed to low(ish) supply issues. It looked from this first feed like things with Rio would be different, as indeed they have turned out to be – he has remained a voracious eater, and has grown so much since birth.

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Rio and I cuddled and nursed on the bed for a while as I inspected the burst capillaries all over my face and chest (oh well, I still haven’t perfected my pushing technique) and Oscar went to go pick up Ida from my dad’s house. When he carried her into the room, her face lit up so brightly to finally see “baby Zio” on the outside. She cautiously crawled across the bed to see him and touch him, and gently kissed his head. I had prepared her thoroughly to understand pregnancy and birth and babies, but still wasn’t sure how much she would understand that this baby is the same one who was inside, who she kissed and talked to through my belly each day. But she clearly did, and was quite in love.

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Ida was also fiercely protective, such that she cried intensly and was very difficult to comfort when my mom gave Rio his Vitamin K shot. After that, she mistrusted my mom and whimpered on my shoulder as my mom measured Rio’s head and chest and length, and weighed him. Ash had proposed we all wager bets on Rio’s weight, and her bet turned out to be right: 8 lbs., 3 oz. He was 21 in. long, his head measured 13.25 in., and his chest measured 14 in. People joked, “Where do you hide these big babies?” because even at 40 weeks I was measuring something like 35 or 36 cm., and looked small. (I think I hide them on my organs, because I sure felt squished at the end.)  Oscar then dressed baby and Ash went and picked up pho for us, which we ate in the kitchen area before heading home to manage that awkward first night of sleep with a newborn and a toddler.

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Reflection

This story ends well, with a natural birth, healthy mama, and healthy baby.  However, it is a much harder story to tell than that of my first birth. Even though the active labor was so quick (about an hour and forty minutes) and pushing was surprisingly quick (15 minutes), and even though I am proud of having given birth powerfully and naturally, and even though I am so intensely grateful for the support I received, I do still remember this birth as hard.

 

Whereas my memories of Ida’s birth are hazy and suffused with peace and joy, the story of this birth is more one of struggle, of overcoming adversity, of pushing through sadness and grief towards peace and power. I did experience peace and tranquility, and I did give birth with determination and power and a great welling of love for my son and belief in my body. I did it, and as I look back on it with more distance, it will serve as a story of my own resilience that will help me get through hard times; I know that. It will remind me of how I can push through any kind of despair that comes upon me because of the love I have for my family. I will remember being a warrior, and I will keep going. It’s just that those stories that strengthen us in the long run aren’t quite so heart-warming to remember and tell in the period afterwards. In fact, even if they have happy endings, as this one does, we tell these stories with some grief too. We wish we could tell simpler stories.

 

The story of this birth will serve as a reminder that resilience is a quality not just generated by an individual, but is something that is made possible with the support of others. Sure, I was resilient, and, as my doula said, I “crossed an ocean” by myself in the process. But my resilience was the determination to find what was good around me and concentrate on that – and I was surrounded by good. I was surrounded by love and peace and strong, caring women and all I had to do was to visualize that, to focus on it and let it fall over me — and then, with great effort and great joy and loving encouragement, to push my baby out.

 

And although I don’t believe in gender essentialism, and I know that not all people with uteruses who labor and birth or who assist labors and births identify as women, I did feel in this birth the particular comfort of women. I was reminded of why labor and delivery has been, for most of human existence (and even primate existence) supported primarily by other women/females. Whether by design or by socialization, there was a particular ambiance created by these women – all but one of whom had pushed their own babies out in the same way, all of whom had overcome adversities particular to being female in a patriarchal world, an ambiance that I needed to feel at peace.

 

I also knew that I was safe and that baby was safe. I felt absolutely no fear because I had confronted my fears while pregnant with the help of the midwives at Geneva Woods and my friends and Jen and my Blessingway Ceremony, and had let go of them. I felt no fear because I knew from her record of outcomes that my midwife mama, Barbara Norton, was safe and the staff she had helping her were safe and competent (that Deb was a paramedic for decades and that my doula was a nurse were both extra bonus sources of reassurance). It is easier to practice resilience and to find peace amid turmoil when you can be confident in the physical safety of you and your children.

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There is sadness in telling this story, as well as a sense of pride and power, and most of all a sense of gratitude. I am so grateful for the support I had from my birth team and the care I received from Geneva Woods Birth Center. I wish for everyone the kind of preparation for birth that Jen Allison provided for both me and Oscar, and the kind of loving, empowering, and evidence-based care I got from the staff.

 

Rio Esteban – this long, heavy child of ours; our sweet, sleepy, strong son, is waking up from his resting spot on my belly now, so I best change his diaper and engage with him. I am so grateful that this beautiful little soul has joined our family, and so grateful for the experience of labor and birth, however hard it was, that brought him out into the world.

 

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Written by admin

August 17th, 2016 at 9:41 am

Posted in health

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Two additions

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1.) Today is my due date, and I am still pregnant! This is a first for me. In a way, it’s satisfying to get to that nice even number of 40 weeks, and to be able to make the last page in the pregnancy section of Rio’s baby book. So, as an update to this post on the “pre-baby book”, here are the two most recent pages:

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2.) Also, Geneva Woods Birth Center, where I am fortunate to receive care and at which I will soon give birth, has a blog on their webpage, and they let me guest blog for them! It’s an abbreviated version of my blog entry “Birth is Painful for a Reason. I am grateful for it.” You can see and read my guest blog entry here, and look at their other great entries written by CNMs Dana Deane and Barbara Norton:

http://www.genevawoodsbirthcenter.com/news.html

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Written by admin

July 22nd, 2016 at 9:05 pm

Posted in health

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Birth is Painful for a Reason. I am grateful for it.

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Moaning through contractions in the shower during Ida Luna's birth. All photos by Ash Adams.

Moaning through contractions in the shower during Ida Luna’s birth. Photo by Ash Adams (http://ashadamsphotography.photoshelter.com).

 

This is the conclusion I came to after giving birth for the first time in January of 2014, and have been thinking often about as I prepare for the birth of my second child this July:

 

Birth is painful for a reason, and for that same reason is a process that takes some time. When we embrace this, we can go into a deep and peaceful place inside ourselves, a place that shows us what we are capable of, and that shapes us as people and as parents.

 

This reason has nothing to do with divine punishment, nor with masochism (as is often the accusation against those who choose or advocate for natural childbirth). Of course, there is a wide range of how much time birth takes and how much pain the woman/birthing person experiences, but in all cases, birth is a process, an inherently challenging and revelatory and opening process.

 

I am not someone for whom mindfulness and a peaceful, non-worrying presence comes naturally. Nor has patience always been my strongest, most natural attribute. I am someone who moves through the world to make the world better. I am fiery. I am critical. I am eager and energetic to make change. And, like many other flawed human beings, I do not do this work with the perfect balance of compassionate curiosity and self-reflection and humility. My traits usually serve me well in my work to prevent violence, child trauma, and injustice and to improve systems and create cultural change. However, they also carry with them sometimes painful self-reflection and self-critique, excessive worry, and anxiety. Those things are not particularly helpful in labor – both because they can cause unnecessary suffering, and because they can interfere with the oxytocin and prolactin needed to open the cervix, pelvis, and vagina.

 

Two and a half years ago as I prepared for my first birth, aware that I have some traits and mental patterns that could get in the way during labor, I invested wholeheartedly into childbirth classes, books, and pain coping meditation practices, and I was gifted a blessingway ceremony. I did this because I knew I wanted a natural birth to avoid the effects of pain relief drugs on babies and on maternal oxytocin production for early bonding, and because of the increased risk of a c-section (that is, a major abdominal surgery) resulting from epidurals. I also knew I wanted a natural birth because I didn’t see how I could improve on what my ancestors have done since time immemorial, and because my mom, Barbara Norton, is a Certified Nurse Midwife (CNM) from whom I have heard my whole life about the beauty and transformative power of birth. Plus, as a bonus, non-medicated and particularly out-of-hospital births are a lot less expensive. What I did not know then is how grateful I would be for the kind of challenge that the pain and length of birth presented to me, the way it forced me into the deepest place inside of myself and the way that it brought me and my husband, Oscar, together and formed us as parents.

 

I should note, as a caveat, that I did not have what many would consider a particularly long or difficult birth: about 3 hours of early labor and 5.5 hours of active labor, including 70 minutes of pushing. However, ~8.5 hours of labor and 70 minutes of pushing out my giant-headed baby (her head really is big; it was then and still is in the 80-somethingth percentile) was painful and challenging, to say the least. And I am grateful for this.

 

In order to cope with the pain—which I felt in my uterus, hips, and low back, and which was exacerbated by a pre-existing back condition I have called spondololysis—and in order to encourage my cervix to open, I had to go inside myself, deep inside myself. I had to turn off my reactionary self, silence the parts of my brain that worry and experience fear, turn off my evaluator self and critical self and activist self, and just ride along with full faith and trust that my body and baby would do what they needed to do, and my midwives at Geneva Woods Birth Center would do what they needed to do (which I why I chose them—they are trustworthy). As it turned out, each of us did do precisely what we needed to do.

Holding Oscar and breathing in the early stages of pushing. Photo by Ash Adams.

In early labor, I used a Kundalini breath technique I had learned in prenatal yoga. Then I vomited some, but returned to my breath. As I moved into active labor, I used non-focused awareness, a technique I had learned from the book Birthing From Within and Jen Allison’s class, and later, I used visualization. I also breathed at a natural pace and exhaled with low moaning sounds. Meanwhile, Oscar soothed my body with the shower nozzle and hot water. As I danced my way into transition (the hardest part of labor, when the cervix moves towards complete dilation), I listened to the joyful Brazilian and Malian and Puerto Rican music on the playlist I had made, moaned, and held Oscar’s elbows and arms as he smiled at me calmly. As I pushed, I concentrated on baby’s head moving and my vagina opening, and I relaxed deeply between contractions and pushes as though I were lounging in a hot spring. As baby’s head burned my perineum, I focused on the elation of touching her head while it moved out (per my midwife mama’s advice) and knowing she would soon be in my arms. And then she was! I had gone into a deep, peaceful place inside myself so that I could minimize and get through the pain and so I could do my part in bringing forth her joyous entrance to life in the outside world, and my body responded by opening up and moving my daughter down.

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After all that work, I had her in my arms. It was the most glorious feeling imaginable. Photo by Ash Adams.

In the months following, as my baby Ida Luna cried her newborn cries and Oscar and I had to navigate the unknown terrain of new parenthood, it became clear how this experience of having to go inside myself to cope and to find peace for labor had prepared me for parenthood. Having done it already while enduring the most intense pain I had ever felt, I knew I could return to peace and self-soothing while experiencing anxiety about my baby’s cries. This is not to say that I always did find peace in those trying moments, no no, but I did have my own example to follow. I soon learned that singing to baby Ida was the most effective way I could calm both her and myself.  As she got older and more emotionally and intellectually complex, Oscar taught her to ask for hugs when she would begin to have a tantrum, and this turned out to be the most effective way for Ida and us to calm down. We have multiple options now that we can offer her when she gets upset, but they all require us, as her parents, to calm ourselves.

 

Our ability to prevent Ida from escalating and our ability to self-regulate (calm ourselves down) and help Ida Luna self-regulate comes both from knowledge of child development and parenting, and from our confidence and practice in self-regulation and attuned, compassionate responses. Speaking for myself, it is not always easy and I do not always do it. I have never yelled at or threatened or hurt Ida, but I have reacted to her behaviors and cries with anxiety, confusion, and impatience, and I have snapped at Oscar in moments of anxiety over her. Unlike the one-day-only, high-stakes process of labor, when I was fully prepared and committed to self-soothing and focus and had the support to do so, parenting is a constant process—sometimes a slog—, and I am not always well enough prepared (or well-rested, well-fed, or well-supported enough) to check in and self-regulate. I am even less skilled at doing this when it comes to marriage, which I find is much more challenging than parenting. However, again, I do have my own example to follow, and I know that I can do it, and this does help me more often than not.

 

As I write this, I realize this discussion of self-regulation all sounds so scientific. I work in the field of child trauma and resilience, protective factors, early childhood well-being, etc. and so I think in terms like caregiver self-regulation and infant brain development, and see how my natural labor prepared me well for this most important of roles. But zooming out, I also think it’s bigger than this, more philosophical, more spiritual. I believe that the time that labor and delivery takes is an important process, a ceremony even, to move us from the long process of pregnancy into the much longer process of parenting. It is a liminal space between life stages, a ceremony of transition from one to the other. I also believe that coping with the intensity of natural labor teaches us (and teaches our partners or others who are there to support us) that pain and hardship need not lead to suffering; that freedom from suffering and a sense of wholeness is available to us even in the most difficult of moments.

 

Applying this specifically to parenting and all forms of caregiving for children, this ability to get through the really hard parts without suffering can help us to get through without blaming and shaming and hurting children, without turning to alcohol or drugs, and without disengaging and ignoring problem behaviors. If we can move through hardship without suffering and having to find an outlet onto which to throw our suffering, we can more easily raise children with dignity, peace, unconditional love, clarity, and consistent teaching and guidance. Given that early life experiences shape people indelibly on behavioral, neurobiological, and epigenetic levels, this is important. It is of the utmost importance.

 

_ _ _ _ _

 

In sharing my belief that the pain and process of natural labor can help us learn to cope with and move through hardship without suffering (a belief born from my own experience of birth and parenting and from the experiences of many others), I do not mean to imply in any way that natural birth is the only or best way to come to this kind of peace. Many people who never give birth are able, through many other means, to cultivate the peace within themselves to be fantastic teachers, health care providers, aunties and uncles, foster parents, mentors, etc. And clearly, many people who give birth via cesarean section or using medication are also able to cultivate these qualities by other means.

 

I also do not mean to imply that natural labor alone can be expected to alleviate all suffering, or to transform neurological programming for anxiety, depression, or reactivity that have resulted from childhood trauma or other risk factors. Even though birth can be deeply healing and transformative, typically other forms of support are needed as well to cultivate peace and healing. I certainly do not mean to imply either that the solution to intergenerational trauma and harmful practices of parenting and caregiving lies in individuals alone – these problems are exacerbated by and therefore must be addressed at the levels of policy, institutional structure and practice, culture, community systems, family systems, etc. Parents should be able to lead lives of dignity that are free from violence, make adequate wages, have maternity and paternity leave, and access social supports that support them in their parenting.

 

There are so many areas where change needs to happen in order to create healthy, happy childhoods for all human beings, and in my professional work I try to address every level of the social ecology  — from individuals to organizations to policy. But I do believe that our personal experience of birth is one of those areas where we can make a difference for parents and children. The reason I am writing about this belief is because we do not, as a culture or as a medical system, value this gift of birth; we do not value the pain and time of birth and what it can do for us as people and as parents. And because our culture and medical systems do not value it, we end up denying women/pregnant people and their families the opportunity to experience these gifts.

 

Without going into too much detail about it because it has been written about so eloquently in other places, the current US medical system (and those of many other countries as well) tends to push interventions and neglect to provide the compassionate, present, and evidence-based care and birthing environments that increase the likelihood of a natural, vaginal delivery. As a result, the national c-section rate is 32% and the percentage of births that include epidurals nationally was found to be 61%, according to a 2008 study, but can be up to 75% in some hospitals. The problem is not that c-sections or use of medication is inherently wrong or ill-advised in all circumstances; indeed, they can save lives and be the most compassionate approach. The problem is that they are over-used – with negative consequences for both maternal and infant health and even our maternal and infant mortality rates (which are among the worst in the developed world)– and that patients are coerced into them before and during labor. The problem is that patients are too seldom fully informed and empowered to make these choices for themselves and too seldom supported by providers to do so.

 

Very linked to the factors in the medical system is how our culture has come to approach and talk about childbirth and its pain and, on a broader level, other forms of pain and discomfort, both physical and mental/emotional. At least speaking of US American culture, which is what I am most familiar with, there is a cultural belief that we should be able to live free of pain and discomfort, that we are in fact entitled to do so. Heck, I like comfort and pleasure too, and I cultivate them in my life, so I understand why this is. The problem is when this reliance or over-attachment to comfort leads us to ignore or negate uncomfortable or painful problems (from global climate change and institutional racism to our own health conditions or dysfunction in our families) rather than solving them. The problem also comes when our reliance on comfort leads us to de-value natural – and often challenging – processes such as breastfeeding and birth.

 

If we do not understand what gifts natural birth can bring us, and specifically, what gifts are inherent in its pain – including the physiological process in which labor pain helps release oxytocin and endorphins that help progress labor and help us cope—, then we may think, as many who are preparing for birth do, “Why torture myself?” Partners and other supporters of a pregnant person may give them a hard time for considering a natural birth and accuse them of being masochistic or dramatic or “woo woo.” Healthcare providers, especially OBs, may talk women/pregnant people into unnecessary interventions, saying things like, “Why torture yourself trying to push out that big baby when it’s not going to work anyway?” The idea that birth pain is torture, the idea that it serves no purpose, the idea that it not only can but should be alleviated by external means, the idea that women/pregnant people are so weak that we cannot manage the pain with our minds and breathing and comfort measures and support people – these societal messages block us from experiencing the gifts of natural birth. These messages are harmful, both because they lead to worse health outcomes and because they reinforce the idea that pain and discomfort are equivalent to suffering.

 

Since parenting is full of pain and discomfort (and inconvenience, annoyance, sacrifice, fatigue, etc.), sending parents the message that pain and discomfort inherently lead to suffering and therefore are bad and should be avoided is not a healthy one. When people believe that their kids are making them suffer, they are more likely to treat their kids badly or to ignore problem behaviors while they get out of control. They are more likely to make “jokes” about how their kids drive them to drink (I see this all the time on facebook). They are more likely to place the responsibility for their own happiness onto their children, thereby giving their children an impossible job. And they are more likely, in some cases, to abuse their children. Again, I am not saying that if you get an epidural you are more likely to abuse your children. I am saying that the larger societal belief – of which our reliance on medical pain relief in birth is a symptom– that difficulty = suffering and that children make us suffer, that this is a belief we should do more to dismantle.

 

How about, instead, we as a culture embrace the idea that – to quote a punk song – “the only way through your problems is straight through them?” How about we see birth as ceremony and preparation for the life-long, challenging commitment of parenthood? How about we view and treat women/pregnant people as incredibly strong and capable, and create more opportunities to send them into the difficult work of parenting with this self-perception and a powerful birth experience to back it up?

 

Having experienced this kind of birth experience with my daughter, having experienced pain without suffering, I believe this equipped me for parenting her. It equipped me for hard nights of viruses, hard days of balancing work and meals and bedtimes, and guiding her to learn hard life lessons like how to share.

March 2015, nursing a very sick Ida during the layover of a very long day of air travel. Photo by Oscar Avellaneda-Cruz.

March 2015, nursing a very sick Ida during the layover of a very long day of air travel. Photo by Oscar Avellaneda-Cruz.

I look forward to returning to that deep place inside myself as I give birth to my son this summer. I look forward to the challenge of birth that is forcing me again to practice cultivating peace, and that will make me turn inward in labor and address my pain without suffering. I look forward to applying this lesson as we navigate the new world of parenting two children at once and cultivating healthy sibling relationships. Parenting, which is a mix of the glorious and beautiful with the mundane and the difficult, will certainly require this of me, of us.

 

I am so grateful to have had a mama-midwife and another midwife, a birth assistant, a partner, childbirth class instructors, and a social support network who believed this about me for my first birth. I am so grateful to have a birth team and others who believe it about me now as I prepare for this birth. I am so grateful to have friends share with me their strong birth stories and the faith and confidence and healing that was born in them as their children were born. I am so grateful that our bodies work the way they do, and that this process is perfectly built to prepare us for parenting. I am grateful that birth takes a while, and grateful that it is hard.

 

(A shortened version of this will appear on the Geneva Woods Birth Center blog in a week or two.)

 

Written by admin

June 6th, 2016 at 4:14 pm

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Birth

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Our daughter, Ida Luna Avellaneda-Cruz, about 3 hours old. All birth photos by Ash Adams

Baby has joined us on the outside.

She is the most beautiful, amazing little blessing I could’ve ever imagined. Oscar and I love her so much and are having fun figuring out this parenting thing—despite a lot less sleep than normal.

Here’s the story of how little Ida Luna came to be born. I’ll spare you much of the graphic detail, but if you are squeamish about how our species reproduces, you might want to stop reading here.

Her due date was Monday, January’s 27th. My last scheduled day of work was Friday the 24th. However, I had a feeling she might come early, and that Tuesday morning, the 21st, I had requested a cervical check, which showed that I was 1 cm dilated and 70% effaced, but with a firm cervix, meaning that I could go into labor in the next few days or maybe in over a week. I went to prenatal yoga on Thursday night, the 23rd, where I received a beautiful sendoff from our instructor and all of the other women there. I was ready for whatever was going to happen.

The beginning

That night before bed, my mom texted me to tell me that she had two women in labor. So when I woke up at one in the morning with what I thought was broken water, I figured I could call her cell phone because she would be awake. Luckily by then, one of the women had already given birth at the hospital and another midwife was with the second one at the birth center, so my mom headed over to my house with test strips. It appeared that it was amniotic fluid, but the findings weren’t super definite because apparently mucus plugs can change test strips too and the color wasn’t super dark. She advised me that we both needed sleep if I was going to be in labor soon, so I managed to sleep a few hours and we agreed to meet at the office in the morning. The second, more accurate (slide under a microscope) test at around 9 a.m. did not show clear signs of fluid, but by then I was having contractions every 10 minutes. So I spent the morning at home getting through the contractions in the shower with Oscar spraying me and then in bed, trying to sleep.

Early labor

During this period of early labor, the technique I used to cope with the pain and to breathe was a Kundalini breath meditation I had learned during prenatal yoga. It is a structured series of four breaths and I was able to get through about two cycles of it per contraction. It really helped me be at peace mentally and physically during this stage. It continued like that, with the contractions coming about five minutes apart, and then four, until I started puking. By that time, which was around 12:30 p.m., my mom had arrived to check me and I was 4 cm dilated and 95% effaced. With this happy news, we headed to the birth center.

Active labor

After checking vitals and fetal heart tones, texting our friend Ash to come, and having a few contractions in bed and one more good puke, Oscar and I headed to the shower. There I labored sitting on the birthing ball, on hands and knees with my arms on the birthing ball, and laying down with pillows for the next two hours. Oscar had on his knee pads so that he was able to help me in whichever position, spraying my hips, back, and pelvis with the shower nozzle. I was very specific about which parts of my body needed to be sprayed because my hips and back and pelvis hurt a lot with each contraction. Ash took photos and he and Ash took turns giving me water or juice or ginger ale, and ice water rags for my head. My mom and the other midwife, Trina, came in to check baby’s heart tones with the fetal Doppler and suggest position changes.

Oscar used the shower nozzle to relieve pain and keep me warm as I sat on the birth ball or tried various positions.

During this stage of labor, I practiced two basic coping techniques. The Kundalini breath had stopped being useful as the contractions had intensified, so my breath had become vocalized with low sounds accompanying each exhalation. I kept my eyes closed most of the time through contractions in order to visualize. Now, I am not very good at deep, in-depth visualizations like many techniques teach. However, I had discovered during pregnancy that if I had to cope with some sort of pain (usually related to my carpal tunnel syndrome), that a very simple visual of heading up a grassy hill bathed in golden light with an apple tree on top seemed to help. I turned to this hill while laboring in the shower. I discovered I needed to include baby in this visualization because what we were doing was a partnership—me birthing baby and baby cooperating nicely and being born. (And baby was definitely doing her part—heart tones stayed normal and, being who she is, she kept wiggling and kicking). I also wanted to stay focused on the purpose of all this, which was meeting our child, who we loved so dearly. For these reasons, I imagined myself carrying baby up the hill during each contraction. Not yet knowing baby’s name, I thought of baby as baby Riolda, as my cousin Lilia had jokingly called her—a combination of our boy name Rio and our girl named Ida.

Each contraction stood by itself. Each one was a journey uphill and, as far as I was concerned during the contraction, it was the only journey up the hill before I could head downhill. I had to take each one at a time. I did think a few times, “Wow, this could last a lot longer. How will I get through it?” But my answer to myself generally was that this is how the species has reproduced for as long as we have existed, so it will work out fine and I better just concentrate on the contraction at hand and trust that everything will progress as needed.

Oscar was smart and brought kneepads. My sister said they are now inspired to buy some to keep at the birth center for labor partners and they can nickname them “dad pads.”

As the pain intensified, this imagined hill became the tundra-covered last uphill of the Lost Lake race. And as it intensified further, I realized I needed to use a different coping technique, so I turned to what Pam England, the author of Birthing From Within, calls non-focused awareness. It is just non-judgmental attention to the sounds around you, to the things that are touching you, to your breath, and to whatever you see with your eyes in one spot.  So I listened to the meditation music on the iPhone, the sounds of murmuring voices, the sound of the water hitting me and draining, and I opened my eyes to stare at the silver and black of the light contraption that Ash had set up in the bathroom. I also then melded the two techniques, telling baby Riolda that for this hill, we are going to play the listening game and we would go uphill playing the listening game together. After Trina or my mom–I can’t remember who–had explained to me that changing positions helps the baby move down and get into the right position, I told baby, “Now we are playing the moving game” or “now we are playing the you-turn-into-my-pelvis game as we go up the hill.”

Eventually, Trina told me that I should get out of the shower and move around to help baby move down into my birth canal and to cool off. I trusted the whole time that my cervix had been opening, but I hadn’t thought about needing to bring baby down with gravity and movement. I realized that this was a perfect opportunity to shift the tone and my coping strategies and to enjoy the labor and delivery dance mix that I had made back in the fall (after realizing that dancing through pain helps during kriyas in prenatal yoga, so it would be of use in labor). When the music started – music that I had carefully chosen because not only can I move to it gently, but because it is filled with beauty and optimism and joy – I felt enlivened. I moved my feet and hips dancing in between contractions.  I also ate mango popsicles and even chatted a little in between contractions. During contractions, I held Oscar’s forearms while he held mine and we swayed together, me with my head down, usually moving from my toes on one foot to my toes on the other, stretching my hips out, moaning and breathing deeply. For my mental coping during contractions, I listened to the lyrics (whether I understood them or not—there were quite a few songs in Portuguese, Japanese, and various Malian and Nigerian languages). I listened to the music. I let it infuse me with its joy. While moving through contractions, I also listened to Trina telling me that with each movement I was bringing baby into position, and to Oscar telling me he liked my smile (I had asked him beforehand to kindly remind me to smile) and liked how I was swaying, and all of this felt really affirming. Man I am blessed with who I had there.

Oscar helping me dance through contractions.

Interestingly, in this period of labor and all the others except for early labor, I could not stand for Oscar to touch me in any of the ways I had thought I would want, such as acupressure points on my sacrum or hip squeezes to help my back. My back and hips hurt, but I could only stand to be touched on my hands and arms and sometimes neck. The contractions that hurts the most were the ones where I felt panicked about something being wrong, such as when I asked Oscar to squeeze my hips but then realized my mistake, or when I thought that squatting would help my back as it did throughout pregnancy, but it just hurt more.  Those brief feelings of needing to control something quickly so that it would get better put me back in a state that was not surrender, that was not peaceful acceptance, and so the pain was sharper. Luckily, I can count these moments on one hand.

Transition

After dancing for a while and then pain getting much more intense with each contraction, the midwives asked me if I felt like pushing. I said I didn’t quite, but it did feel very different than before. They told me to reach up and feel my baby’s head. It wasn’t all that far up there and I could feel a sizeable piece of it, which told them that my cervix must be pretty wide-open. My mom checked me and I was complete. I said I was starting to feel like pushing, and I wanted to push wherever it would hurt less, which meant in the tub. As they prepared the water, I had a few contractions on the bed on hands and knees with Oscar’s face only inches away, telling me nice supportive things.

Pushing

In the tub, to help my back, I tried to remain on hands and knees for as long as possible, but had to shift to my side eventually so that the midwives could watch baby and be able to reach down if there was cord around the neck or anything like that. Pushing at first felt strange and unproductive. But after not too long, I learned to smile and breathe and relax as deeply and pleasurably as possible between contractions, and then start each contraction with deep inhales and strong pushes. A few times, I opened my eyes and smiled at the people gathered around—my mom and Trina, the birth assistant, Victoria, who I was so happy to see had arrived (and who checked baby’s heart tones frequently), Ash with her camera, Oscar in the tub holding my leg and looking at me with such confidence and belief.

The coolest, most amazing thing about the birth experience was when my mom told me to put my hand on baby’s head as I pushed. I did this through a few contractions and got to feel the progress that I was making. After that, pushing became fun and exciting and something that I looked forward to in my rest period between contractions. Feeling all of the hair on her head made her very real too, very much Oscar’s child, which we all sort of laughed about as we saw her thick black hair. I didn’t feel like talking at the time, but I was thinking, “I need to tell them how awesome this is.” I eventually got to feel her crown, and fortunately she stayed there long enough that she could stretch out my perineum so I didn’t have to purposely not push to avoid tears. It worked out beautifully, and my perineum stayed intact.

For the early part of pushing, we lit the tub with candle-like lights, but turned the lights on for the later part. It was more or less the same to me; I was in my internal space.

Birthing

Of course it hurt when she came through what people call the “ring of fire.” I said, “Ow!” very loudly. But it wasn’t so bad because I knew that she was about to be in my arms. My mom told me, “Probably with this next contraction she will be born,” and I can’t imagine a better inspiration to keep pushing hard. (I pushed very hard, by the way, and my mom says very efficiently. This came at the expense of my throat, which still hurts a little, and I burst capillaries in my face and chest–and yes, I know that pelvic muscles do not require my face muscles, but oh well, I can perfect my technique for next time.  But I got her out efficiently and, the midwives observed, with probably a great deal of abdominal muscle help.) Her head was fully born with one push and the rest of her body with the next, and then she was coming up towards me. Oscar helped bring her up to me along with my mom. This was 6:09 p.m., and this might have been the first time since the morning that I knew what time it was.

My two midwives: my mom, Barbara Norton, CNM, and Trina Strang, CNM embrace after the birth

Meeting our daughter

It was so amazing to meet her on the outside at last. At that time we did still did not know whether she was a boy or a girl. We made sure she could cry and her skin tone was good, and once we know she was well we took a look and saw that she was a girl, and called her by her name, Ida Luna. I remember feeling both incredible excitement and love that we had our daughter right there on my chest, and also immense relief that labor was over. They drained the tub, my mom helped Oscar to cut the cord, and they got their cord blood samples to send off. My mom handed Ida off to Oscar so I could focus on birthing the placenta. It came out easily and was kind of beautiful and gory at the same time. I looked at Oscar holding Ida with tears in his eyes and in that moment, just like at our wedding when I had looked up at Oscar’s wet eyes, I felt it too, the gravity and completeness of what had just happened and what we had now in our lives.  Oscar can always ground me in the significance of the experience.

Mi amor always manages to ground me in the emotional significance of an event, as he did when I saw him looking at Ida with tears in his eyes.

Afterwards

My sister, Claire, meeting her niece while I chow on a coconut popsicle and Ida chows down on her first meal of colostrum.

As I was preparing to get out of the tub, I started losing blood, so they gave me first one shot of Pitocin and then another—as the bleeding continued— in my leg, and they did bimanual compression to make my uterus clamp down. I went to the bed where we hung out as a new family for the next few hours, eating popsicles and animal crackers, drinking juice, being fed pho broth through a straw by Ash after my sister arrived with dinner, trying with very skilled and patient help from Victoria to get Ida to suck on my nipples (it took her a while but eventually she did, which helped my uterus clamp down better). They kept doing bi-manual compression on my uterus and finding it firm, but since I kept passing blood clots in between, they put me on IV Pitocin and fluid. I had gotten pretty dizzy and vaso-vagal and had to lay down for a good while.

While we all cuddled on the bed and tried to get Ida to feed, my dad (who is a pediatric radiologist) and the Geneva Woods staff did Ida’s newborn exam, weighed her, etc. My mom was delighted and surprised to find that Ida weighed the exact same as I did as a baby–7 lbs., 10.5 oz. My sister came and visited, as did Jen Allison with a post-partum gift and a hand-dyed rainbow onesie. It was so great to be in this warm, peaceful place with people I loved and trusted for the four hours after the birth, and then to go home that night with my dad camped out on the couch to help take baby’s and my vitals every few hours.

My dad meeting his granddaughter for the first time.

Lessons learned

Labor was not easy. It was painful. But it was beautiful and powerful and peaceful and so worth doing it naturally. What made it that way? Here’s what I believe helped:

  • Loving and competent and confident support from Oscar (thanks to who he is and also thanks to wonderful preparation we received through childbirth classes and prenatal visits)
  • Conversations over the last few months with Oscar about how we might best communicate during labor
  • A friend there to offer quiet help and take awesome photos
  • Being able to trust completely in the competence of the midwives. A few times I thought, “Hm, they’re talking to each other—should I be nervous?” or when baby was moving too much in utero to get consistent heart tones, I considered worrying for about a millisecond and then thought, “Nah, being afraid is not my job. Worrying and thinking is not my job. My job is to breathe and release positive birthing hormones so baby can be born.” I knew that me being nervous or even asking a bunch of questions about my progress would serve no one. So I just did my mama job and let them do their midwife job (and later, let Victoria do her birth assistant job). And they all did a damn good job because they are intuitive and evidence-based and safe and compassionate. I want care providers like them for every birthing woman.
  • No one trying to make me afraid
  • The right music
  • Being in a birth center where I could make as much noise as I needed to without being self-conscious and without any nurses giving me the stink eye
  • Being in a birth center where they use dopplers for fetal heart tones instead of making me lay in bed on a fetal monitor belt, and where I didn’t have to listen to machines and where, as Oscar said, I didn’t have to look like I was sick or be treated like a potential surgery patient
  • Being in shape. I used my core muscles to get baby out! It also helped for maneuverability that I had only gained 22 pounds during pregnancy and didn’t feel burdened by my body’s size in any way.
  • An arsenal of available coping techniques that made sense for who I am
  • No rigid ideas about the “right” way to birth (e.g. silent and stoic, must do “hee haw” breathing, hypnobirthing breathe-your-baby-down-you-don’t-need-to-push, etc.)
  • The understanding going into it that pain serves a purpose for the hormones of birth and that pain is okay, and one need not suffer due to pain (the latter being a particularly useful insight I learned from Vipassana meditation)

For these things, I have to thank the Geneva Woods “Childbirth Basics” class taught by Janie, “Birthing From Within” class taught by Jen Allison, the book Birthing From Within, awesome prenatal care, the birth stories of my friends who have had natural and empowering births, the stories that other dad friends have shared with Oscar, prenatal yoga at Open Space studio, the confidence that my community and all of my people have instilled in me, and of course, my midwife mama for helping me filter out all of the fear and misconceptions about birth and birth intervention that are rife in our society and in U.S. medical practice.

My mama midwife, holding her granddaughter for the first time.

Most of all, I’m grateful to my partner in life and parenthood, to my body and mind, and to our wonderful, healthy little baby.

My favorite photo. This is our family now.

Written by admin

January 28th, 2014 at 5:42 pm

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Week 34

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Oscar took these photos with the tripod in between us getting the house ready for our baby shower/Oscar’s 30th birthday party. We are so grateful for our friends and family who helped put the party on (esp. Ash Adams who made almost all the food and decorations and ran the Photo Booth all night) and who support us in so many ways.

Being an informed birthing person* and finding the right care provider, Part 2:

[* As a 2016 update to this guide, I will use the words person and woman interchangeably, with the recognition that women and people with female reproductive organs who have other gender identities (trans, gender fluid, androgynous, etc.) can become pregnant and give birth.]

I cannot claim to be an expert on this subject, but because of the continuous learning about birth that I have grown up with and the maternal child health (MCH) knowledge I have acquired through my work in public health over the past few years, I am eager to share a few tips and tools for finding the right prenatal and birth care provider.

For brevity, let’s skip the part about finding insurance and assume that you have some way to pay for care, whether through work or the Affordable Care Act’s individual plans or Medicaid or the tribal health system, or because you live in a country other than the USA that believes health care is a right. So, payment aside, the first question would be:

A.) What kind of prenatal care and birth experience do you want?

One good tool for helping you examine what type of experience you want and what kind of care provider—Obstetrician/Gynecologist (OBGYN) vs. a Certified Nurse Midwife (CNM) or direct entry midwife (CDM or CPM) –can be found at this website:

http://www.babyzone.com/pregnancy/prenatal-care/ob-gyn-midwife-choosing_71051

Also, Our Bodies, Ourselves: Pregnancy and Birth book has clear and thorough information for understanding the differences in approach.

These websites have an incredible wealth of information about types of providers and birth settings and ways of understanding your options as a mama/parent and patient:

http://www.childbirthconnection.org

http://evidencebasedbirth.com

B.) What kind of prenatal care and birth experience do I want for myself and for others?

  • I want patients in general, and in this case pregnant patients and families, to get attentive, informed, compassionate, competent, culturally-humble and culturally-competent care.
  • I believe that prenatal appointments should be long enough to not only listen to fetal heart tones, etc. but also to talk about nutrition, exercise, stress, preparation for birth and other issues—and that the provider should be well-informed enough to do this effectively.
  • I believe that the provider should be attentive to the psychosocial needs of their patient and invite patients to think about issues that might come up for them in the birthing or breast-feeding or pregnancy process, such as sexual trauma, body image, relationships, social support, etc. Providers should also ask about and support patients with logistics (e.g. Do they have a car seat? Leave time? Do they need referrals for social services or assistance programs?)
  • The provider should be competent, able to use evidence-based approaches, and do what helps pregnant and laboring patients and babies. That is, they should neither push patients into the cascade of interventions that is so common in the medical approach to birth, nor sit passively by letting them labor for far too long without active help or under dangerous conditions (e.g. breech babies or moms with preeclampsia at home). That cascade of interventions I mentioned often begins with inductions  (The decision to induce labor –> Pitocin –> tremendous pain –> epidural –> fetal distress and/or failure to progress –> c-section) .  In fact, first time moms who receive elective inductions  have a 45% chance of a c-section.
  • And of course, on the most basic level, the provider should believe in each woman’s ability to give birth and should see birthing a child as a natural process to safely help along rather than as a problem that has to be solved or, worse, extricated.

If this sounds good to you, as it does to me, then how do we go about determining whether a provider or a practice is like this? In the websites above, I could not find a handy little interview guide, so that’s what I will try to share here. It fully contains my biases and areas of interest, and might leave out some of yours. Totally add to it or subtract from it as you see fit.

C.) Laura’s interview guide for determining whether the provider/practice is, on the one hand, intervention happy, or on the other hand, reckless and out there:

[First, a tip on asking questions: Don’t ask in such a way that they know what answer you want. Word your questions in an open-ended way where the answer you want is not stated in the question, and pay attention to what your voice and face are communicating.]

I. General Qs:

1.) What is your C-section rate?
(The World Health Organization recommends 10% or lower. Unfortunately, the C-section rate in the United States as a whole is ~34%, so you have to be selective if you don’t want a high-risk for C-section. This varies significantly by practice and hospital. For example, in the case of the Alaska Native Medical Center (ANMC) in Anchorage, AK, all of the high-risk women from around the state have to go to that place rather than stay in their regional clinic, so you would expect the rate to be slightly higher than other hospitals because there is a higher-risk population — though you would still want it to be fairly low. Interestingly, the ~12 – 15% C-section rate at ANMC is far lower than the ~34% at Providence Hospital in Anchorage.)

2.) Which patients do you induce?
Sometimes it needs to happen, but it shouldn’t be happening very often. It should only be done under circumstances such as preeclampsia or hypertensive patients or those who are well overdue and low on fluid—not, for example, because the provider says your baby is big, or because of call schedules or vacation.

3.) What is your episiotomy rate?
Shouldn’t be higher than 5%. It is sometimes needed when baby’s heart tones are down for a while and progress is not being made well, but for the most part, they do not need to be cutting open women’s perineums.
4.) How long are the prenatal appointments?
Seriously, that 15 minute business is not enough. Especially for first time parents.
5.) When in labor will you be with me?
Funny story: Oscar and I recently took a tour of Providence Hospital, in case we have to get transferred there from the birth center or in case we have a preterm labor. The woman giving the tour said something about how the provider won’t be with you in labor until near the end, that you will primarily be with the nurses. I asked her, “But what about with midwives?” She replied, “Yeah, they tend to come near the end too, like the doctors.” I furled my brow confusedly and asked, “Do you mean the midwives who are based here in the hospital? Because I am with Geneva Woods…” She quickly replied, “Oh, yeah, they will be with you the whole time.” Lesson learned: not all midwifery practices follow the same model. And docs tend to stroll in  quite late. Don’t be afraid to ask questions.
6.) If for medical reasoning I have to be induced, what methods will you try?
Say your water has broken and you haven’t gone into labor yet, or you have been diagnosed with preeclampsia.  Then you do want some help getting labor going. But you don’t want someone starting with Pitocin and breaking your water, as is standard in many hospitals, because it causes absolutely torturous pain and increases risks.Providers should work on cervical ripening prior to even considering Pitocin. This includes:

  • Cervadil
  • Misoprostol
  • Balloon catheter insertion
  • Stripping of membranes

There are also some things a practice might suggest you try at home to get labor going if you want to move it along but an induction is not needed yet. These include black and blue cohosh, enemas, breast pumping, nipple stimulation, and sex—that is, as long as your water hasn’t broken)

Also, FYI: in Alaska, direct-entry midwives’ licensing regulations do not permit them to do inductions.

7.) What percentage of your patients’ babies have Apgar scores lower than 7 at five minutes?
You want good outcomes, so you want this percentage to be very low, somewhere less than 2%. (Note that this may be a little higher if this is a hospital-based practice or EMTALA doctor who takes walk-in patients who have not received prenatal care and/or who have been using substances during their pregnancies.)

8.) What will happen with baby right after she/he is born?
Given the overwhelming evidence in support of immediate skin-to-skin bonding, you want a provider (and a facility) who understand and support it, who will determine baby’s Apgar score while baby is on your chest (barring any major complications that require NICU or other kinds of attention), who will promote breastfeeding, who will wait to cut the cord until it’s done pulsing in the vast majority of cases, who won’t let the nurses whisk the baby off to be weighed and bathed right away, etc.

You may not even get answers to all of these things because the practice might not track or have that data available. That says something. Or you might get a provider who is defensive and upset that you are asking these questions. That also says something.

_ _ _ _ _ _ _ _ _ _

II. Qs specific to midwives who practice out of hospital (homebirth or birth center)


[First, some background: Both Certified Nurse Midwives (CNMs) and direct entry midwives, who are called either Certified Direct-entry Midwives (CDMs) or Certified Professional Midwives (CPMs), can practice out-of-hospital birth. However, they have different skills and different licensing regulations. This is because CNMs are advanced practice nurses who also function as women’s health care nurse practitioners, meaning they provide well-women’s care (e.g. yearlies, family planning, menopause, STI treatment).  CDMs and CPMs, on the other hand, entered midwifery directly without a nursing degree, generally can’t do well-women’s care, and only care for low-risk women. Also, licensing of midwives and of birth centers is different for each state.

Research has shown that midwives are, on a whole, safe and effective care providers for birth and that out of hospital birth is a good option for women who are not high risk. However, there are some midwives out there who do not follow their own regulations, whose risk-taking drives up licensing fees for other direct-entry midwives, who have bad outcomes for babies and moms, and who give the profession a bad reputation. I believe that all families deserve to avoid such midwives and their birth centers and that it is important to advocate for better training and higher standards.

The American Association of Birth Centers website is a wealth of information on this subject.]

1.) If a complication arises in my pregnancy, what will you do?
You want to provider who is safe and humble enough to transfer you if your pregnancy becomes higher risk than is allowed by her regulations. CNMs can work with pregnant patients with complications, but they may consult a doctor and/or work with the patient  in the hospital. They may also collaborate with a physician if it is a high-risk issue, or transfer to a doctor if it’s a very high-risk issue. Direct entry midwives are required to transfer a patient if she has certain complications (e.g. high blood pressure, gestational diabetes). You want the CDM to have a collaborative, friendly working relationship with CNMs to whom she can transfer patients, rather than just dumping you. If she has a contentious relationship with the other practices in town, that might not be a good sign. And if a CDM disregards her regulations by offering to deliver breech or pre-term or women over 42 weeks, women whose water has already been broken for 24 hours without labor starting, or VBACs out of hospital, then she is one of those risky midwives, and these midwives tend to have worse outcomes, including babies who go long enough without oxygen after birth that they can suffer brain damage, and even higher infant mortality rates.

2.)  [if a birth center:] Is your birth center licensed by the state and accredited by the Commission for the Accredidation of Birth Centers?
Google is our friend here, because all of this information is publicly available on the Internet. But it might be worth asking too, to see what they say. Accreditation is voluntary, but means that the birth center is held to a higher standard and that its staff receive support and training through the national organization.

3.) [if a birth center:] What is your transfer rate?
According to the two major birth center studies, the average transfer rate is around 15%. Too too low (or birth centers who say they never transfer patients) may mean they are not transferring people who need it and too high might mean that they may not be managing labor very well, resulting in obstructed labor, fetal distress, etc. which can often be avoided.

4.) If I have to transfer to the hospital, who will be my care provider? And will you be there with me?
It is a great relief to me and Oscar to know that if we do have to get transferred,  the CNMs in the practice have hospital privileges and will take care of us there. But if we were going to a practice with only direct entry midwives and this were not possible, I would hope that the provider or practice would have good working relationships with doctors or midwives who do have hospital privileges rather than dumping me on whichever doctor happens to be on call—because some of the docs are not so nice or competent — it’s luck of the draw… I would also hope the CDM would stay with me as a support person if I had to be in the hands of an unknown doctor.

5.) What do you do if I hemorrhage?
I am not an expert on hemorrhaging, but basically, listen for a confident, competent, medical evidence-based answer. There are medicines such as Pitocin and Methergine they should have handy and they should provide bi-manual compression.  Plus, there should be an emergency transfer option if needed.

 

6.) Are all of your midwives and birth assistants certified in the Neonatal Resuscitation Program? How often do they have to renew their certification?

You want the people there to know how to assess the need for and administer neonatal resuscitation correctly. The Commission for the Accreditation of Birth Centers requires updating of certification every two years for accredited birth centers, so that is one standard you could look for. You also want to make sure that they have Positive Pressure Ventilation equipment with them at the birth and have it at the ready, just in case. I don’t say this to make you afraid; if I know that my birth attendants have all that taken care of, it can free me from fear so I can just relax and let my birthing hormones do their thing.

7.) [Insert your own questions and concerns about medical issues, such as shoulder distocia or cords around the neck or whatever to make sure that they practice according to the up-to-date evidence and experiential wisdom.]

And it may go without saying, but make sure that the midwife’s license exists and is up-to-date. Apparently, there are a few women in Alaska who call themselves “lay midwives” who have no training or licensure at all but who catch babies — with some very bad outcomes. These so called “lay midwives” are breaking the law, deceiving families, and putting women and babies at risk. In Alaska, the only “lay midwives” allowed to practice are Alaska Native ones who were trained in the traditional way, such as tribal doctor, midwife, and Yup’ik elder Rita Blumenstein.

Bonus question idea:

If you can, ask nurses or providers at the nearby hospitals, especially Labor and Delivery (L&D) and Neonatal Intensive Care Unit (NICU) nurses, as well as paramedics and ambulance drivers, about the kinds of transfers they get from different birth centers and home birth midwives. They see the safe transfers and the transfers that clearly resulted from poor care — breech babies that got stuck, babies that didn’t get resuscitated in a timely manner, and so on.

_ _ _ _ _ _ _ _ _ _ _ _ _

Again, this comes from me, a social worker in the public health world, with help from my mama, a CNM and birth center owner and Board member of the American Association of Birth Centers who is very familiar with the research on risk and outcomes and best practices. So here are our biases and interests, but also the research, the evidence—including evidence that the American College of OBGYNs puts out. And it comes from what I hear from women and families about their experiences with prenatal, birth, and postpartum care. So I hope that this bit of insight is helpful for you or your friends, and that you can use it to create your own interview guide to bring to first appointments when looking for a provider.

On a totally different note, here is the art project invitation & CD cover that Oscar and I created for the baby shower/30th birthday party:

And here is the close-up of this week’s rainbow-colored ink painting/drawing:

[Note: This guide was written in Dec 2013, and some updates were made to this guide 3/19/16, including adding the bonus Q, adding the Q about neonatal resuscitation, and adding some gender-neutral language.]

Printable interview guide:

interviewguideprenatal

Written by admin

December 18th, 2013 at 8:14 am

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Week 30

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A few notes on the photo and art: 1) I painted baby a little big on accident. 2.) I love Oscar and admire how he rigged up this photo shoot. I wished he could’ve been in it, but his transmitter was broken. 3.) My face is swollen from flying for two days in a row right before this photo was taken. 4.) I am now entering the 30s weeks which, due to my synesthesia, are pink. It is perfect then to be photographed with so much pink and red around me as I enter this stage.

Leaning In

In childbirth class recently we watched a film that midwife and natural birth author Peggy Simkin created. It showed one contraction at each stage of labor from many different women. Using home video footage, it moved from the slow rocking and hummings of early labor to the rhythmic grunts, moans, words, breaths, and motions of active labor, all the way through to pushing, a few short screams and exclamations, and many a squiggly little baby coming out and being placed at mama’s breast. As we watched it, I didn’t know that Oscar was observing me and the others in the class; I was completely absorbed in the film.

What Oscar told me later meant a lot to me. He observed that some of the mamas-to-be in class leaned away from the film with a look of fear or that they tucked their heads down, as though to hide from it. But a few other women and I did not. Oscar said that I, in fact, leaned forward in my seat. He told me, “You looked like when you are watching Glee, only much more intense.” This, he shared, made him confident that I would do fine in labor.

I don’t think I am inherently any more suited for labor than anyone else is, nor do I have any ideas of myself as some kind of birthing superstar who will have quick labors and meditate so deeply that I don’t feel the pain. Nope, no such illusions here. In fact, I have a good chance of having a whole lot of back pain because, well, I have spondololysis and it hurts even when I’m not pregnant or don’t have a baby’s head moving down onto it. Plus, I am not a very disciplined meditator or positive visualizer and I don’t anticipate that changing profoundly in the next 10 or so weeks. And yet, I agree with Oscar that I will be fine. I am truly excited to give birth, and to do so naturally.

I am confident and excited because I have been blessed with amazing opportunities to prepare myself to lean in to labor with openness, curiosity, and strength, and roll with whatever it brings me. Here are a few of these blessings:

1.) Hearing my friends’ positive, healthy, strong natural birth stories. Some had quick and relatively easy labors and some had much longer or more challenging labors. What all of these women shared in common were the optimism, joy, and strength with which they met every challenge that came their way. I figure: if they can, why not me?

2.) The book “Birthing From Within” and the class we took from Jen Allison by the same name. The approach starts with the recognition that because birth is a natural process for which we all have some internal wisdom, a specific, rigid technique cannot be prescribed and followed. Rather, mamas and their birth partners are encouraged to explore and tame their fears/barriers before birth, to create and advocate for the kind of stress-free environment the mama wants in labor (and develop strategies for how to respond and cope if the environment is not what she wants), and to practice the coping techniques that make sense for them. (E.g. a quiet woman should not be expected to be super vocal in labor and a vocal woman should not be expected to labor in silence; there are great pain coping techniques that either can use.) I love this because it feels realistic and liberating, because it helps Oscar to play a really caring and supportive role, and because it affirms the fact that I have the wisdom of how to give birth already within me.

3.) Prenatal yoga. I cannot sing the praises of prenatal yoga enough. I’ve been taking it at Open Space in Anchorage with Svia as the instructor. The healing environment created by women sharing with one another at the beginning of each class, the mantras and Yogic principles, the breathing and strengthening and stretching, all of it feels like quenching a thirst. But oh, the kriyas! They are the best part. Here’s my uneducated explanation of them:  Kriyas come from Kundalini yoga and involve doing the same movement or holding the same position, often with the arms, for a long time. They are hard.  Your forearms or shoulders can get to screaming at you something fierce. And in there is the lesson for labor: your mind wants to get in your way and tell you you can’t do it, you can’t hold your arms out at your sides for four straight minutes. This means you get the chance to figure out how to let your body take over for your mind and simply do it. You have a chance to figure out what kind of coping techniques help you turn off your mind’s tendency to suffer unnecessarily and, in the words of poet Anne Sexton, you let “your belief [undo] your disbelief.” Through kriyas I have found how useful smiling, dancing, breath awareness, and non-judgmental awareness/observation with all my senses are. I am so grateful for this practice.

4.) Exposure to birth and midwifery practice. Growing up with a midwife mama who has such a mind for public health and policy, I of course came to understand and care passionately about the politics of birth, the socio-cultural and economic issues involved in birth and the midwifery versus the medical model, the importance of evidence-based practice, the risks involved with interventions and the astronomical rates of inductions and c-sections, etc. as well as the risks with reckless “free births” and midwives who don’t practice within their scope. But also, thanks to my mama, Barbara Norton, I have heard about every kind of birth and reaction to birth. I have also had the opportunity to witness and help out with three, both in the hospital and the birth center. I have seen these women experience pain, cope with it just fine, and get through it to birth beautiful little babies who they and their support people then meet with such joy and pride. I have learned from her that the trick to labor is to shut off the over-analyzing and worrying and controlling mind (and I sure have one of those) so that the body can be in charge, so that you can surrender to the process. (Plus, she says, core muscles and overall health and fitness help a lot too.)

These are some of the things that ground and prepare me, that make me excited about birth, that steel me against the cynics who like to scare women about labor or mock them for feeling optimistic (e.g. the “You have NO idea what you’re getting into” people.) I know that labor will surprise me. I know that I can’t anticipate and plan it all out and I don’t need or want to. I just need to be with providers who I know will make good decisions and treat me with respect, and I need to prepare myself and have Oscar prepare himself so that I can let go of control and do this thing my body was built for. And I believe we’ll be just fine.

While it felt amazing to finally be mixing thick paint again after so many years, it did come at a cost to my painful little hand, which meant I didn’t keep painting with the goal of hyper realism. This temporary disability is going to have to force me to get much better with my left hand and be even more creative in how I make art for these last 10 weeks or so.

Written by admin

November 19th, 2013 at 3:27 pm

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