Womb it may Concern

It's your womb. You should be concerned.

Labor support: a partner’s touch

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Give your laboring partner a hand!

Dads-to-be want to give their partners the best support possible during their birthing time. Here are a few simple ways to comfort, encourage and empower your partner while taking care of yourself, too.

be near

Your partner wants to know that you’re involved. She wants to see that you’re invested. You already know not to fixate on the machines, but do you know that there is a big difference between sitting next to her and standing 3 feet away?

Physical contact with a loved one may be one of the most comforting experiences a woman can have during labor. If she enjoys being touched, slow dance with her or sit in front of her and let her lean into your chest. If she’s not a big cuddler, hold her hand or rub her feet. If she doesn’t want to be touched, stay within arm’s reach. She may change her mind from one contraction to the next and will appreciate your unwavering presence.

Where ever you are and whatever you are doing, do it with the intention of being connected to your partner. Turn the TV off. Put your cellphone in the labor bag. Use your iPod to find an ambient station on Pandora and just wallow in the presence of your life-giving partner. Even if she’s updating her Facebook, resist the urge to do the same.

Temper your attentive focus with common sense. Don’t regard her like a science project. Scrutinizing her and asking “did that really hurt as bad as you made it look?” is not offering her emotional support. Stroking her back and telling her “you are doing so well, you were made for this” is affirming her hard work and giving her strength for the next challenge.

never fear

If the medical team moves into your partner’s space, don’t move out. So often during hospital births, a laboring woman and her partner may struggle to claim the institution’s space as their own. Birth centers tend to have a less clinical feel but are still someone else’s territory. Even the most comfortable couples can feel intimidated by the medical attendant who asks to do clinical tasks.

When this happens, ask the staff member, “do you have enough room there?” as he or she gets close to the area they need to be in to carry out their task. You’re not requesting permission to stay where you are; you are making it clear that you are stuck like glue. What you are doing is setting the foundation for a mutually respectful birth environment.

For example, hold onto your partner’s hand while a nurse checks her temperature.If the caregiver needs to squeeze in, shift just enough to give that person room to do so. It’s a small gesture that goes a long way. The caregiver will see that you are confident in your role yet considerate of the entire birth team. Your partner will see that you will always put her first and not leave her feeling alone during potentially uncomfortable moments.

Even if there is a concern for Mom or baby, assume that it is okay to stay close. Reassure your partner regardless of any anxiety you may be feeling. Pack up that big ball of stress and put it away so you can discuss it with when the worry has passed. Make eye contact with your partner and help her take deep, steadying breaths.

When in doubt, don’t freak out! The staff will not hesitate to ask you to step back if Mom or baby is at risk. In the very rare case of a true emergency, you will told to move out of the medical staff’s way immediately.

tank up

Take care of you so you can take care of her. Every time you remind your partner to drink, remind yourself to sip on something too. Water is one of the basics that should always be available, but be sure to pack some drinks with some punch too. Juices, coconut milk and gatorade can boost your energy level with some much needed sugar and calories. Be sure to offer your partner some, too!

Some things are just for you, however. Coffee is almost always available (especially if you’re willing to compromises on the quality) but keep in mind that coffee breath becomes 10 times more unpleasant to your partner when she’s in labor. If you’re putting Folger’s in your cup, there better be some Altoids in your pocket.

Make sure some one-handed snacks like apples and granola bars are easily accessible. It’s not very considerate of you to be chowing down on a greasy double cheeseburger while your partner is working hard through each contraction. Just like with coffee, consider the smells certain foods might carry. Be mindful of garlic, onions, pickles, barbecue sauce and the like.

dress down

Labor is an athletic event for birthing women and their partners. You will probably sweat and stretch alongside your partner, so dress appropriately. Take a cue from the clothes your partner is choosing to wear. Most women will want something that is loose fitting, soft, stretchy and comfy. If she’s in her pajamas, you can be too! Going to the birth place is not a new parent interview; no one is assessing your fathering skills based on how well your pants are pressed. Wear something that evokes positive thoughts (like a t-shirt your partner got you on a special occasion) but not something you wouldn’t mind parting with (birth is usually messy).

You may have already packed your swim trunks if your partner has expressed an interest in hydrotherapy. Just a casual change of clothes wouldn’t be a bad idea either. If Mom wants you near her but not in the water while she is in the tub or shower, you may end up soaked anyway. Everything from you wrist to shoulder may get wet while leaning in to apply counter-pressure to her back or squeezing her hips. Changing out of a wet shirt will be more comfortable for you and your partner. Plus, your new baby will want to snuggle on your nice warm (not chilly and wet) chest.

Also plan your foot wear with care. Be prepared to be on your feet. A lot. For a long time. Pretty frequently, your partner will need you to be standing, kneeling or squatting in order to offer her emotional or physical support. If you normally work in or like to wear heavy duty or inflexible shoes (think steel-toed boots, birkenstocks, etc) stash a pair of comfy sneakers in a strategic place ahead of time. Think about putting your birth shoes in the car you plan on taking to the birth place or in the labor bag. Think twice about flip flops or Vans. They may look like a good idea, but after a few hours of active birth support, your feet will not agree with you.

find your voice

Laborland is a wonderous place, infused with the same creative intuitive magic as deeply satisfying sex. Labor and birth work best when Mom and her partner feel free to do and say what feels right. So speak up! Even if you start out feeling as awkward as a high school freshman, you’ll get the hang of it pretty quick.

Look for her nonverbal cues first. When you say, “RELAX!” and grip her shoulder, what happens? If she tenses at your voice and touch, it may be time to soften your approach. Try again, saying “let your shoulders go completely limp and loose, just rela-a-a-a-a-x” while lightly squeezing her shoulder. Watch in amazement as her upper body sags forward and she lets out a long, deep breath.

If she is resistant, be gentle but insistent. Being able to relax the body when it is being gripped by one of the most intense sensations on the planet—a contraction—is a learned-on-the-job skill. Top notch encouragement will help her be patient with herself as she learns to work with her body. Keep trying different strategies until you find one that works.

There are some very obvious things that probably should not be said to a woman in labor. Unless your partner enjoys fart jokes, any joking references to her bodily functions or fluids are pretty much off limits (commenting on her vagina, vaginal discharge, vomiting, peeing or passing stool just to name a few). Birth is involves a lot of physical changes. Trust me, she is already super aware of that.

Don’t misunderstand—laughter is a powerful analgesic. Just use your powers for good instead of evil. Regale her with a funny story from when you were dating or talk about a movie you both loved to laugh about. Enjoy any poop or puke observations privately.

If you’ve got no idea what to say to her in the moment, try some of these out:

 

She says…

“It hurts.”

 You could say…

“Does it help if I rub/push here?”

“Let’s try something different with the next contraction.”

“All you have to do is breathe. Blow the pain away.”

“Relax your entire body. Let your belly and our baby do all the work.”

“The more we focus on something else, the less you’re going to think about it hurting.”

She says…

“This is hard.”

 You could say…

“Yes, it is. But you are doing so well!”

“Do you want to try that position we talked about before?”

“Remember how much better it felt when you were ____” (standing) (leaning) (swaying) (in the tub) (on the birth ball)

“I can turn off the lights and tell your (mom) (sister) (best friend) that we need some quiet time.”

She says…

“I can’t do this.”

You could say…

“You ARE doing it! You’ve BEEN doing it! You WILL do it!”

“Every contraction is helping you and our baby make lots of change and progress.”

“Maybe it’s time to try something new! What’s one thing we could change that would make it doable?”

“Let’s get back into your _____” (rhythm) (focal point) (favorite position)

She says…

“My back hurts.”

You could say…

“Let’s try a different position.”

“Do you want something warm on your back? I can heat up this rice sock.”

“Does it feel good when we do counter-pressure? Or the hip squeeze?”

“Why don’t we get in the tub/shower for a while.”

She says…

“I can’t believe I’m only ___ (3 cms) (0 station).”

You could say…

“Let the medical attendants worry about that. You’re doing so well. Let’s get back into that rhythm you liked.”

“Your body and our baby know just what to do.”

“Dilation ain’t nothing but a number!”

“Focus on what we’re doing now. We’re going to take these contraction one at a time.”

“Each contraction is bringing our baby closer to us.”

She says…

“This is taking forever.”

 You could say…

“We could cover up the clocks.”

“Let’s ___” (go for a walk) (change positions) (have a snack) (get some rest)

She says…

“I’m so tired.”

 You could say…

“You can lean on me. I’ve got you. You just work through the next contraction.”

“Let’s find a position that works for you to rest in between contractions.”

“I can turn the lights off and close the curtains.”

“We can put a cool cloth on your eyes while you rest in between contractions.”

Mother the mother like no other

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Mother the mother, or tend and befriend?

There has always been one caveat of doula-ing that I have resisted: mothering the mother (MTM).

Oh yes, the big one.

The big one that almost completely defines the spirit of a doula.

The biggest one (arguably) in both the formal and informal worlds of doula trainings and apprenticeships.

THAT one.

I heard the phrase while researching the original Klaus and Kennel childbirth-educator-turned-labor-support paper. Upon reading it, I think I literally cocked my head to one side and said “…huh?” My initial reaction was—why would any woman want that?

First off, the words literally bothered me. It might have something to do with the fact that I was forbidden to call my mom “mother”. She hated the word almost as much as she hated the phrase “that was a hoot” and the smacking of chewing gum. She’s not a tyrant. She is one of the most wonderful people on the planet. She just has a few pet peeves that we learned to respect at an early age.

So there’s strike one. The word “mother” has always had a negative connotation for me. Repeating it twice in the same sentence makes me grimace.

The next facet of my resistance to MTM was the perspective with which I was personally approaching motherhood. Being a 20-year-old-first-time-mama disrupted my transition from being my mother’s daughter to being my own daughter’s mother. My view on mothering had been sucked into a vortex; I was fixated on my most recent experiences with my mom rather than the earliest. Unfortunately, I was stuck in the tumultuous high school and college years when my mom was more of a manager on duty than anything else. There was a lot of directing and facilitating, but not a lot of hands-on or heart to heart. I had so little time to adjust to the idea of being a mom myself that I completely forgot to consider the experience of being on the receiving end of mothering as a child.

There’s strike two. In my frenzied attempt at merging my identities as “the mothered” and “the motherer”, I had bypassed the early years of baby and toddlerhood and preserved the most recent memories instead. Treating my clients like unruly teenagers was not an appealing thought.

Finally, at the age of 22, I could not fathom “mothering” women who were, more often than not, older than myself. Of the handful of clients I started with, the majority of them were older than I was. It was uncomfortable for me to even imagine mothering these mothers. I envisioned myself puffing up like a brood hen and drawing these women beneath my feathers. It was absurd. It didn’t fit who I was. What did fit was more of a casual, instant-friend-who-knows-and-trusts-birth position that set me up as a friend/confidant/educator/therapist. As I stepped into this role I had built for myself, I felt comfortable and confident. I felt like I was the doula I wanted to be. Mother the mother? No. Tend and befriend the mother? Yes.

That’s strike three (if you’re still keeping score). Being young and deeply convinced that mothering was a brood-hen-ing/hyper active management syndrome did not make MTM a good fit. At the time, MTM meant putting on a persona that I felt was poorly fashioned for my disposition.

There I was, a doula who didn’t believe in MTM, a doula who had struck out with one of the basic tenants of doula-ing. Then an epiphany came that changed the whole game.

One sunny day I took my daughters (4 years old and 2 years old) to a family farm. As we wandered from one end of the small establishment to the other, my littlest one tripped and went sprawling into the gravel. She cried over her scratched hands and knees. I scooped her up, murmured incoherent words to her, set her on her feet and marveled as she instantly went back to running down the lane as if nothing had happened.

Later, as we were lavishing worshipful love upon a farm dog named Cricket, my oldest daughter took a crack on the nose from the top of the dog’s head. I gathered my child in my arms, showing her how to rub where it hurts to help the pain go away. Then I distracted her by imploring her to hop on one foot and taking her on a butterfly hunt.

And then, just as we were leaving, my kids took on the most confrontational duck I have ever seen. They must’ve gotten a little too close to the flock, for I heard my girls scream just as I saw the big male duck lower his head, hiss, and charge at them. As ridiculous as I found the sight (it’s a DUCK not a raging BULL), my children were terrified. I stood up from the crouch I had been in, towering over the duck, and with a stomped foot and forceful “shoo!” sent the animal hurrying back towards the pond.

On the drive home, it finally struck me: I had doula’d my children while mothering them. With the scraped knees, I had offered nothing but a warm embrace, unconditional affection and acceptance of how she coped with her pain. With the busted nose, I showed her how to use her body’s very real (and still startlingly magical) abilities to soothe it’s own hurts and the power of distraction. As the duck charged, I showed my children how to face their fears—whether they be big or small—with the help of a confident ally.

I mothered my children. I have been doing it since they were in utero. I’ve been telling myself, however, that I was “nurturing” instead of “mothering”. Both these the labels fit, but until now, I failed to realize how powerful and important the key components of mothering are when it comes to labor support. Mothering means:

  • Emotional and physical affection & unconditional acceptance
  • Awe of women’s bodies & their innate capabilities and power
  • Support, advocacy & faith in how birth unfolds

I have made my peace with “mothering the mother”. Regardless of what I have chosen to call it over the years, I know it’s there. I see it working every time a woman I am with during labor literally looks at me for comfort, burrows her head into the crook of my arm as we embrace, or asks me to tell her “it’s okay”. I have mothered these mothers in my own way, but now I understand the words as they were intended.

To “mother” is to completely surrender yourself to the needs of another, to subjugate your ambitions to the desires of those you care for. To “mother” is to come when you’re needed, to stay until the job is done, and to be connected forever after by the tender threads of compassion. We “mother” our clients as we ourselves were (or should have been) mothered. We honor our clients by mothering them.

Seduction of the Deployment Induction

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Is a deployment induction an act of altruism or an obligation?

The #1 reason a military wife may ask for an induction & the 5 things she may not have considered

Deployments are no respecters of persons, be they pregnant women or their husbands. As an added irony, the majority of the DOD families are in their childbearing prime, adding a new baby to their brood every couple of years.

Even the most well-timed conceptions, planned around workups or battalion schedules so that both parents can take part in the birth of their baby, can be usurped by Uncle Sam. After all, the only predictable aspect of the military is that work and deployment schedules are completely unpredictable. So is the timing of spontaneous labor and birth. This truth often makes for an anxious, stressful end of pregnancy for many military Moms.

The March Of Dimes is one of the loudest voices urging mothers and care providers to do away with inductions that are not medically indicated. But when an expectant mother is just a few days or weeks shy of her due date with a deployment on the horizon, an elective induction is incredibly tempting. Some may even argue that to choose NOT to induce would be selfish; if the pregnancy is in the “safe zone” of 36 weeks or more, Mom owes it to Dad to give birth while he’s still around. It can quickly become less of an option and more of an obligation.

Who would say no to a woman who wanted to have her husband with her during labor? What could possibly be more important than a parent holding their child for the first time? Why would a woman choose to stay pregnant knowing that her husband would not hold his child for the first time until the baby was nearly crawling?

There is no one-size-fits-all answer. Choosing an induction because of an impending deployment is a personal decision. But the risks of starting labor artificially before a woman’s body and baby has decided they are both ready are not always factored into such an emotional decision. There are many reasons to consider when weighing the pros and cons of elective inductions. Here are just 5 factors to consider.

1 - Marathon of Labor

What seems like a straight-forward process (and can be under specific circumstances) is different for every woman. A Mom beginning her labor with an unfavorable cervix may be agreeing to a much more invasive and lengthy process than she had first anticipated. Inductions, especially for first-time Moms, can mean many hours or possibly a few days before the baby is born.

If Mom’s cervix is long, thick and closed a cervical ripening prostaglandin gel may be her care provider’s first suggestion. If the cervical ripener was enough to help Mom’s body begin labor, she can progress to the birth of her baby on her own. If not, as is more likely when Mom’s body is not naturally ready for labor, Mom’s provider may suggest more interventions to speed the process. These procedures are typically tied together in a cluster known as the “cascade of interventions”.

2 – Caught in the Cascade of Interventions

With each intervention comes new risks; higher incidences of fetal distress and increased odds of maternal and fetal fever are just a few of the side effects associated with interventions. The short explanation of the cascade looks like this:

  • Prostaglandin gel doesn’t start labor
  • Pitocin is administered through IV
  • Constant electronic fetal monitors are needed
  • Immobility and strong contractions increases Mom’s pain
  • Mom asks for narcotics or an epidural for the increased pain
  • Narcotics slow labor, so more Pitocin is needed or Mom’s water is broken
  • Baby’s descent into pelvis is slowed or stopped by Mom’s immobility
  • Mom cannot feel urge to push or has a long pushing stage
  • Forceps or vacuum are used to increase progress during Mom’s pushes
  • Mom is offered or given an episiotomy to speed the baby’s birth
  • Mom is exhausted, baby is in distress or baby is in a difficult position for vaginal birth and a cesarean birth is recommended

The cascade is a very simplistic way of explaining a complex process. How one intervention during labor can necessitate or predispose a Mom to needing another is going to be different for every woman. The pattern, however, is widely accepted as how events intertwine during birth.

Not every induction involves an epidural or an episiotomy, but the risks are still very real. For Mom’s having their first babies, the odds of having a cesarean birth are doubled when labor is induced.

3 – Cesarean: Short term

When a baby must be born surgically, Mom is exposed to greater risk of infection both at the time of surgery and during her postpartum recovery. She will probably lose a greater volume of blood than she would during a vaginal birth. Mom is at greater risk for accidental injury to her bladder, bowels and other internal organs that may be grazed by a surgeon’s knife during the procedure.

Babies who are born surgically have a harder time transitioning to life outside the womb. They tend to have lower scores on immediate newborn assessments that measure reflexes like breathing, muscle tone and blood oxygenation. Babies born surgically also have greater difficulty breastfeeding and depressed breast seeking instincts.

Mom and baby will have a longer hospital stay while Mom recovers from surgery. Mom will not be able to lift anything heavier than her baby for 6 weeks and may need a full 4 to 6 weeks to return to her everyday activities. The difficulty of physically and emotionally recovering from a surgical birth may be increased if her husband deploys immediately after the baby’s birth.

4 – Cesarean: Long term

After the uterus is cut for a surgical birth, it will knit itself back together into a strong, thick scar. The scar tissue can cause fertility issues for Mom as she becomes more vulnerable to miscarriages and may experience a delay in future conception. The scar tissue can later become the site of a future baby’s placenta, creating a condition that can be life threatening for Mom. If the placenta imbeds itself deeply into the scar tissue inside the uterus, it can be difficult to remove and cause major blood loss. In some cases the placenta may be impossible to remove, making a hysterectomy necessary.

Scar tissue can form at many different sites inside the pelvic cavity after a surgical birth, causing pain for Mom and complications for future births. A cesarean birth also impacts Mom’s ability to have a vaginal birth with her future babies (called a VBAC). She may have difficulty finding a care provider who will support her as she VBACs. In some areas, she may have no choice but to agree to a repeat cesarean if she wants to give birth in a hospital.

5 –  Baby is not ready for birth

If full-term means giving birth to a baby who is ready to be born, full-term becomes a very broad term. Significant brain growth and lung maturation happen in the last weeks of pregnancy. A baby who is born after labor starts spontaneously is more likely to be able to breathe and breastfeed well on his or her own.

Due dates are an approximation that can be off by two (or more weeks) in either direction. A woman who chooses an elective induction at 38 weeks of pregnancy may be giving birth to a baby who only has 36 weeks worth of development. Although 36 weeks is considered “safe” for a baby, newborns with a 36-week gestational age may need a lot of help transitioning to breathing, eating and keeping warm on their own. A baby who is not adjusting well will be admitted to a Level II or NICU nursery, prolonging the hospital stay and adding obstacles to breastfeeding and family bonding.

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Just like many of the events we experience in military life, the time frames in which labor begins and birth ultimately happens are unforeseeable. What makes an elective induction the best choice for a woman and her family is extremely personal. Perhaps that it is a discussion that is best kept private. But here in the public sphere information is freely shared. Protecting your body and your baby begins before birth, and the decisions we make have life-long effects on the entire family. A healthy birth is worth the debate.

The average woman’s road to a satisfying birth

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You can't get where you're going until you know where you're going and how you're going to get there.

I am a weenie. A wimp. Me and pain? We’re not friends. I don’t want to feel the burn when I work out. I don’t like to push through it. I can hardly even talk myself through it. It’s not mind over matter, it’s a matter of me minding the discomfort. I take Midol for cramps and whine and mope when I PMS. I’m not, in short, an adrenaline or exertion-induced euphoria junkie.

Why then, if I know for a fact that I tremendously dislike pain, would I deliberately reject narcotics during childbirth? The answer is not easy. Many months of reading and watching and epiphanies led me to a dedication to unmedicated birth. What it boiled down to was this: it was the healthiest way to bring my baby earthside. As the idea rolled around in my head, it began picking up little nuances along the way.

An unmedicated birth is easier; no drugs, no epidural and no Pitocin means no constant monitoring and no IV.

An unmedicated birth is more woman-centered; no machine will tell my birth attendants how often my contractions are coming. If they want to know, they’ll just have to stand back and watch me work through 10 minutes worth of labor.

An unmedicated birth is less complicated; if there’s nothing moving my labor along but me and my baby, there’s no risk of adverse reactions to drugs or interventions.

The idea grew more wonderful as each day took me closer to labor and birth. I will do this, I told myself, because I want to and because I can. The idea also became achingly romantic and perfect. I would labor beautifully, mooing like a cow with my contractions and bearing down like a goddess.

When labor began in earnest, I began to question these lovely ideas. It became clear that I had not been remembering my first labor and birth experience accurately. As my body chugged past the point where I chose an epidural last time, I began to seriously doubt my sanity. How did I talk myself into this?

It was simple. Mother Nature was my doula.

She is wickedly clever when it comes to the propagation of our species, it turns out. As she lead me through pregnancy, my to desire to escape the aches and inconveniences of the last few weeks of gestation quickly outweighed any lingering anxiety about birth. She built in phases and stages of labor that increased as my courage increased, an ebb and flow that reached it’s peak as my baby was born. And then, sly lady that she is, Mother Nature slowly smudged any sharp edges poking out of my birth memories. She muted the pain. She reframed it with convenient amnesia. She made it fuzzy and bifocal. Although the discomfort is always in the foreground, it became blurry as I focused on the bigger picture.

Within a few hours, days or weeks after giving birth, we women almost always look at the fruit of our labors and think: I’d do it all again tomorrow! We might even think that we’d enjoy it. Strange as it may sound, there are plenty of women who do. I am thoroughly grateful to be amongst those mamas who find a peace with the rhythm of labor.

Athletes and artists who truly excel in their profession find themselves in a flow state during intense physical, emotional or mental exertion. Often, it’s a mix of all three that intermingle to produce this otherworldly sense of wellbeing. When the process of creating an object or guiding a process is truly intuitive, it comes with a unique sense of fulfillment that is unrivaled.

That is what my unmedicated birth became—a masterpiece of my own making. It is mine. It will always be mine. Completely and totally my work, my blood, my sweat, my tears, my breath, my body. Just me.

There are days when I overhear childbearing women say, “I’m not good at pain,” or “I’ve never been in a car accident or anything like that so I don’t know how to manage a lot of pain”. The good news is, you don’t have to know. It’s not on any of the questionnaires you may fill out at the hospital or at your birth center or with your homebirth midwife. There is no looming box imploring you to check YES or NO.

And the truth for me is, there is no good or bad when it comes to birth. A woman can’t do it wrong or fail to bring her baby into the world. Whether vaginally or surgically, to a breathing child or a sleeping angel, pre-term, at term, or late—all women who have borne children have an equal share in this worldwide club of motherhood!

I have said it for nearly two years now and I suspect I will be saying it for a long time: what matters in birth is what we remember. As we make decisions for ourselves, we must keep this caveat in mind. We cannot redo the births that have already given us our children, but we can shape the births we want to happen for our future babies and influence our friends and family and the women in our communities.

Don’t count yourself out of a tremendously fulfilling, blissed-out birth before you try. I’ve seen them happen in hospitals. I know they happen at home. I have faith that they can happen in operating rooms. They happen when labor is induced. They happen when a woman labors with an epidural. But they also happen when Mama feels every last bit of her birth pain.

Give yourself a little credit. You’re stronger than you think. If it’s okay for Little League coaches to say to tee-ball players, why can’t we say it to our expectant mothers and their partners? I’m saying it to you now. Have the birth you want, where you want, with whom you want. After all, it belongs to no one but you. Take care of what is yours.

The last let-down

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My much-loved and well-worn nursing tank top.

As I step out of the shower, I hear the slap-slap of my child’s bare feet on the bathroom tile. My nursling toddler comes running as soon as she hears the water stop. It’s a familiar ritual. If she catches me before I get dressed again, I will sit down in my towel and nurse her. It’s a quiet, if not soggy and slippery, moment in our otherwise boisterous day.

With a sweet smile, she unlatches after a few minutes and flashes me an even bigger grin before vaulting off in search of her older sister. I smile too as I reach for the same piece of clothing I have been wearing for the better part of two years (and by better parts, I really do mean the best parts): my nursing tank top.

Two months shy of my boobie baby’s second birthday, I am still shrugging into the same two nursing tops that I stuffed into my “hospital bag” the day she was born.

This is the material that hugged my postpartum shape as her nursing shrunk my deflated belly.

This is the material that was soaked over and over with my ferocious let-down, the kind that makes Niagara Falls look puny. And, as we later learned, the kind of let-down that made nursing my first baby so painful and ultimately, unsuccessful.

This is the material that covered my stretch marks as I nursed my baby in parks, play places, Walmart lines, doctor’s offices, Mothers Of Preschoolers meetings and sacrament meetings.

This is the material that I hand expressed in as I watched, waited with, and supported my laboring clients bringing their own babies into the world.

This is more than just clothing; it’s a tangible string of memories linked together like the thread in the neckline.

The thin, soft chemises are a testament to the sentimental breastfeeding relationship I share with my little one. Just like I will wait for my daughter to decide when she is done nursing, I will wear my tank tops till they decide they are done being worn. I will wear them until they are iridescent rags!

Everyday, I wonder…Will I get to wear them till they reach the point of indecency?  What will I do with them when I no longer need snaps and flaps? Long after my milk is gone, where will my nursing tops go?

From the beginning, the tops have been steeped in meaning. The tank tops were a wishful, last-minute purchase I made during the ready-to-be-done-being-uncomfortable phase of my last pregnancy. They were a $20 impulsive purchase at Target (but for me at Target, what ISN’T an impulse buy?). After a disappointing go at nursing with my oldest daughter, I bought new breastfeeding gear as an investment in the future.

More than material, the soft construction shelf-bra shirts were a promise.

I would fight harder this time.

I would succeed this time.

My nursling and I would make it, one day at a time.

And so we did. One week turned into one month, then six months, then a year had passed. Before I knew it, me and my tank tops were nursing a walking, talking toddler with a mouthful of teeth and a smile full of mischief.

Another year passed. We nursed through a 1,000 mile move, work-related weeks away from their father, family vacations, sunburned afternoons at the lake and snowy mornings waiting for the heater to turn on. My tank tops handled it all with comfort and ease.

Now as I look at the frayed hemlines, the tiny holes where the material caught on my belt buckles, the snaps whose familiar click could wake my nursling from a deep sleep—I truly appreciate that these tank tops have been so much more than clothing.

They have been my personal badge of triumph. The straps have peeked out from under my v-neck shirts saying, “I feed a baby!” to any woman who recognizes the snaps. They have admonished me to take care of myself, telling me that it’s okay to dress down, slow down, take it easy. They have reminded me that I still have sex appeal, as my husband expresses his appreciation for my one-handed-over-the-head removal of the tops (which I do with far more finesse than I could ever muster with a Victoria’s Secret bra).

They tell me that I do indeed have super powers, that beneath the lovingly worn grey shirt are two examples of nature’s greatest design: lactating breasts. My boobs fed an entire human being, from birth to toddlerhood, while lowering both our risks for disease and illness later in life. Nearly nothing brings me more satisfaction than that.

As the intervals between nursings become longer day by day, and my little golden-haired girl grows in confidence and beauty, my heart skips a beat each time I feel my breasts grow full. Will she ever empty them again?

I can’t imagine that she will send me a two-weeks notice, telling me that my job as her nursing mama is about to come to an end. No, her weaning will be more along the lines of a California-style, open door employment policy: either party may immediately terminate the agreement without cause and without reproof. Our breakup (as a dear friend puts it) will be just another day in her life, but it will be a teary time for me. Maybe I’ll recycle my tank tops into rice socks, little lavender-dotted pillows I can heat in the microwave and snuggle when my breasts become painfully full of outgrown milk.

It’s not nearly as melodramatic as it sounds, but the last day she nurses will mean just as much to me as the very first. The last let-down is coming, whether I’m ready or not.

Gentle cesarean, difficult discussion

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With women pressing for better birth options and doctors eager to explore new techniques, surgical birth is getting a make over. Or rather, a make under—with the help of the Gentle Cesarean (GC). As Rhode Island Family Health Practitioner Suzanna Magee, M.D. puts it, a GC is “every bit as magical” as a vaginal birth.

GCs are easy enough to understand and carry out. A GC retains all the the “gives” of a vaginal birth (baby slowly emerging and mom holding her baby as soon as possible) and loses all the “takes” of a cesarean birth (doctors bantering with each other during surgery and discouraging skin-to-skin contact ’til well after surgery is complete).

With that kind of description, it’s hard to see from the ordinary person’s perspective why the idea has been slow to implement. From the extraordinary perspective of a birth supporter, to embrace GC almost seems like sleeping with the enemy.

GC is a contradiction in the birth-world because cesareans have come to symbolize maternal victimization, iatrogenic harm, and overall trauma and stress for mom and baby. There are even professional birth supporters who would shun GCs altogether, seeing the guidelines as just another way for providers to talk a woman into getting on the operating table.

As we struggle to lower both the primary and repeat cesarean rate, GC can look like a wolf in sheep’s clothing. How can we encourage lovely c-sections without discouraging lovely vaginal births? Won’t glamorizing surgical deliveries boost the c-section rate? Aren’t there doctors out there who will perfect GCs and then convince their patients to skip labor altogether?

The simple answer is, no. Cesareans by maternal request are reported as rare by all statistical studies. A little mood music and not having to hear about a doctor’s golf plans during surgery will not send hordes of pregnant women to the ORs of this country in a riotous c-section demanding frenzy. If that were all it took, there are many hospitals that would not ignore such a cash cow and would have changed their cesarean policies by now!

Birth support is as much about advocacy as it is about activism. We cannot advocate for the best birth possible for each client if our activism for natural birth gets in the way. A GC when cesarean is unavoidable does not mean GC when vaginal birth is still an option (although some will never believe it).

On the most extreme end of the birth beliefs spectrum, there is the unspoken-yet-tangible sentiment that cesareans are unpleasant for a reason: to teach the recipient that next time, she should try harder to have a vaginal birth. (And by try harder, we mean not ask for or accept drugs, refuse non-medical inductions, not let herself be strapped into monitoring equipment, refuse breaking her bag of waters, etc.)

It sounds harsh. It is harsh. If we are to truly serve women, we must examine our own prejudices and put them aside in the best interest of maternal health, both body and soul.

Cesareans are not a punishment or a reward. They are a mode of birth.

I think we can all agree that regardless of the people or equipment involved, we strive for the very best births we can achieve every time a baby is born.

When cesarean becomes the only option, we should make it the best option. Period. Mothers who end their pregnancies under the knife deserve the same compassion and care as those who do so in their living rooms or leaning over a hospital squat bar. Even when said with good intentions, a recovering mama never needs to hear that she may not have needed that c-section if she hadn’t agreed to a saline drip and thus brought the cascade of interventions down on her head.

The stage is set for GCs to spread, but it’s a three-pronged effort. Mothers, medical care providers and birth supporters (I’m looking at you, doulas) all have to be energized enough to move the idea forward.

Moms-to-be must educate themselves and ask for the option. High quality care is patient driven, but hospitals won’t know which road to go down until a patient asks for a different route.

Doctors and midwives must also educate themselves, engage in peer-to-peer discussions and examine the impact GCs could have on their patients. Dr. Magee and Dr. John Morton are two physicians working with their patients to change the way birth unfolds in one set of Rhode Island operating rooms. And under Dr. Magee’s supervision, Brown-educated physicians are learning the technique as well, taking GCs into the future with every new class of MDs.

Finally, birth supporters must be educated and able to accept GC when it becomes the right path at the right time. There is nothing worse than watching a heartbroken client trying to put herself back together after major surgery, knowing that you may have held the key to something better. One of our primary goals is to honor a mom’s birth preferences. If she wanted a healthy mom and baby, but she is nursing mental and physical postpartum wounds, we failed her. A defensive attitude toward GCs will only make them less attainable for every woman who could benefit from a GC—which is every woman who gives birth surgically.

Take a moment and examine your own heart when it comes to Gentle Cesarean.

Does it get your goat?

And if it does, what’s catching it?

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LINKS!

A minute-by-minute account of a GC as performed by Dr. Nick Fisk, the father of the Gentle Cesarean technique:

http://www.guardian.co.uk/society/2005/dec/03/health.medicineandhealth

More information on GCs, as presented by Dr. Magee and Dr. Morton on December 5, 2010 at Bellani Maternity in Warwick, RI:

Gentle Cesareans (GC) are being orchestrated at Memorial Hospital in Rhode Island, an institution that averages about 380 births a year. Statistically in the US, that means approximately 114 Memorial families will give birth in the OR. For the families choosing GCs, the experience is worlds apart from the standard surgical birth.

At Memorial Hospital, a GC is an “opt in” program, which means a mom-to-be must ask for it. All of the staff has been specially trained to accommodate a GC safely and compassionately. A GC can be planned in advance (ex: for a breech, since Memorial does not attend vaginal breech births) or can be implemented during most emergent cesarean situations. Dr. Magee and Morton agreed that c-sections that are a true medical emergency are incredibly rare but are not compatible with GC protocol.

A GC at Memorial means:

-a quiet room, free from extraneous noises/conversations and filled with the mother’s choice of music

-more than one support person for mom and partner

-each member of the OR room team focuses on mom and partner’s birth experience

-delayed umbilical cord clamping

-skin to skin contact between mom and baby on the OR table; if mom is not able, birth partner is encouraged to do skin to skin with baby until mom can do it herself

-minimizing separation of mom and baby during and after birth; once a vigorous (and naked!) baby is in mom’s arms, both are covered with warm blankets and baby is not removed until mom agrees to baby being weighed and measured

A GC at other hospitals may also include:

-allowing mom to visualize the birth, through the use of mirrors

-propping mom up on the table to help her see her baby emerge

-slowly bringing baby through abdominal opening to simulate vaginal birth

Baby dispenser

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Turning a natural, inclusive experience into an unnatural, medical process.

A laboring mama, a labor doula, and a midwife are working together through a long pushing phase in a hospital.

Doula: You’re doing so good! Every time you push, you’re making progress, even if we can’t tell from the outside.

Mama: Can you see anything? [Meaning, could the Doula see the baby's head as Mama pushed]

Doula: Do you want me to look? Or we could get you a mirror. Or you could just feel with your hand. Your midwife said the head is right there.

Midwife [to doula]: You mean, you haven’t been looking this entire time?

Doula: No, it’s not my body giving birth. I’ve got no reason to be looking at her vagina if she’s not asking me to.

Midwife: Really? It’s [pointing to mom's vaginal] so fascinating. How could you not?

At first glance, the conversation seems innocuous enough. Labor attendants and support persons see enough women in a naked, glorious state of birth-giving that nudity is just par for the course. With so many babies emerging from so many vaginas (or not, in some states), it’s easy to disassociate a woman’s holistic health from her lower half. When a baby is being born, the vagina is all that matters.

Or is it?

For the woman who is naked from the waist down, exposing her most intimate anatomy to (in most hospitals) an audience of 3 or more strangers, she might be wishing that somebody in scrubs—anybody—would look her in the eye; ask her if she wants a sip of water; cool her brow with an icy washcloth; or just acknowledge that she is, in fact, attached to the vagina on view.

During labor and birth, the love and care given by support people is the stuff memories are made of. There’s something unforgettable, though, about the attitude of a care-giver in hospital uniform.

When a person who seems to be in a position of power reduces a woman’s body to a baby dispenser…well…it becomes easier for the woman to see herself that way, too.

How a woman feels and is made to feel on the day she brings her baby into the world is important. It’s more than just a day in her life; it is a seminal event that shapes her views on her body, her baby and her ability to be a mother.

A long-term study of a mother’s birth memories found that 15 to 20 years later, women clearly remembered their experiences during labor.

“Those with highest long-term satisfaction ratings thought that they accomplished something important, that they were in control, and that the birth experience contributed to their self-confidence and self-esteem.”

The interactions of their care-providers played a significant role in how women felt about giving birth. “They [women] had positive memories of their doctors’ and nurses’ words and actions. These positive associations were not reported among women with lower satisfaction ratings.”

Respect for women during the childbearing experience seems to be in short supply. Women are told by care-providers that they have a “lazy uterus”, a “low pain tolerance” or are “failing to progress” . Either outright or through intimation, women are told that they just can’t give birth without Pitocin or pain relieving drugs or surgery. Care-providers talk about a mother’s condition or plan of care as if she weren’t present. As Denis Walsh puts it, it is a matter of “doing to” women instead of “being with” women.

How do we change this environment? Get out of the hospital! For low-risk women, home is the safest place to have a baby. Out-of-hospital birth centers are second to home. Without the medical model constantly promoting interventive behavior, women have the opportunity to experience normal, healthy birth. Incidentally, out-of-hospital birthers also have higher satisfaction and self-esteem than those who give birth in a large institution.

If a hospital birth is most appropriate for personal or medical reasons, hire a labor or birth doula. Speak up when a laboring woman feels devalued. Ask for a different care-provider (doctor, nurse or midwife). File a complaint with the hospital. File a grievance with the care-provider’s college or certifying board.

Do something! If you wouldn’t repeat your birth experience with the same provider or recommend that care-giver to your best friend, take the steps to make other women aware.

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