Monday, August 28, 2006

Quote of the month

"Having a highly trained obstetrical surgeon attend a normal birth is analogous to having a pediatric surgeon babysit a healthy 2-year-old." -M. Wagner

"The knowledge of how to give birth without outside interventions lies deep within each woman. Successful childbirth depends on an acceptance of the process." -Unknown

Thursday, August 24, 2006

Benjamin's Birth

Hi Lisa,

Wasn't sure how to blog straight to the site so I'll leave this for you to post. Apologies for the length, but really this is the short version. The full version would really have to start the day our daughter Abby was born as I've realized that that experience and all subsequent emotional, psychological and physical experiences have prepared me for this birth.

Can't thank you and Kari enough for the class. It really was the difference between a birth based in fear or trust. Luckily the latter prevailed.

With love and gratitude,
Jenn, Darren, Abby and Benjamin

journal entry, birth day, July 29, 2006

You are here little Benjamin! We are so in love with you! You are gold. Pure gold. 9 lbs. 1 oz. and a sturdy eater, beautiful color, such a golden pink.

The day leading to Benjamin's birth was the first cool day in weeks. We were already a week overdue and our regular doctor left for holidays. We met her replacement, Dr. Doig and I felt completely at ease with her. She reassured me we wouldn't have to induce at the 10 day mark and instantly I felt all pressures and expectations fall away. It was the first day in weeks that I felt calm and comfortable and trusting in my body and baby. I had felt so frustrated for days, even weeks leading up to this birth, but suddenly I didn't feel frustrated anymore. It was the first time I just let go of thinking about labour and how it would all turn out. 333At around 6:30 pm we were all in the backyard watching my 3 year old, Abby, go around and around on her tricycle saying "look at me, mommy, look at me!" I was feeling an incredible amount of joy and began to laugh like I hadn't laughed in so long. At that moment my water broke--not enormously, but enough to take my breath away. I kept it to myself and carried on with serving dinner. Every time I stood up from the table I would feel another gush so I decided to call Robyn, our doula, to let her know. When I was dialing her number I realized this was it and began to cry. I had been wanting to cry for days and it felt so good to have an emotional release. All my waters were finally flowing!

At around 7 pm I started to experience the most gentle contractions. I was so excited to feel them. I had been induced my first pregnancy and never knew what it was like to go into labour naturally. I greeted each rush with pleasure and excitement. I truly have never felt so calm and grounded in my life. I felt each contraction was a step toward meeting our son. But I wanted to walk. Slowly and rhythmically, so Darren, my mom, Abby and I headed to the neighbourhood park around 9 pm. My contractions were becoming more regular and frequent, lasting about one minute, five minutes apart. I would stand up and walk off alone through each contraction. I just walked through each contraction meditatively, listening to my footsteps in the grass, smelling the sweet bundle of clover Abby had picked for me, watching the sky. It was beautiful how much I was able not just to walk through the sensations, but to relax, breathe and find my own rhythm. I was actually feeling joy during each contraction. Darren would time and watch me from the park bench. I felt myself getting pulled deeper into myself, into the moment. I felt stronger and more centered through every contraction. At the same time, the world seemed to be narrowing. I was less aware of my surroundings and more connected to my own breath. It was very primal. Extraneous things seemed to fall away. I suddenly wanted to go inside.

At around 10 pm I suggested we walk home. By the time we got home I could no longer talk through contractions. I shuffled laps around my kitchen and living room through each contraction until it was no longer possible to walk. When I felt I was losing confidence, I got Darren to massage me between contractions. During contractions he squeezed my hips until I couldn't feel any pain. Truly his hip squeezing took away the contractions! It was so wonderful to discover this and we laboured like that for quite a while. I felt immense power between each contraction and really was convinced I could have a natural birth. Darren massaged me in between contractions so each contraction was met from the calmest possible place of strength within myself. Then suddenly the hip squeezes weren't helping as much and I began to feel restless. I didn't know what I needed and was frustrated not knowing what position to labour in. I started to panic a bit. We went into our dark bedroom and lay on the bed together, but laying down made me feel scared and I began to lose my ground. Suddenly the contractions were intensifying. I began to vocalize through them which really seemed to help not only with the sensation, but in staying grounded and connecting with myself and the baby. I was considering running a bath when Robyn calmly suggested we go to the hospital. Turns out I was in active labour then and about to go into transition. I was Robyn's second birth and she thought if we didn't get to the hospital soon she'd be delivering our baby in the tub!

Luckily I agreed to go to the hospital at that point as I wasn't comfortable at home anymore. At midnight we made our way to the RUH. Robyn set up the back of her van so Darren could still give me hip squeezes. Though they weren't helping as much anymore, it helped to feel the pressure and his physical support. The van windows were open and the heavy scent of rain flooded the air. My face was cooled in the wind and I sent my moans out the window. By the time we went through admissions, I was dropping on the floor and moaning "mooooore" through each contraction while Darren squeezed. At one point I thought how much my requests for "more" sounded like "mourn"! I was conscious about the tone of my moaning and kept bringing it lower. My voice really took over through each contraction. It was as if my voice was coming from within and outside of me all at once. It really helped to block everyone/everything out except for Robyn and Darren. Despite all the commotion of doctors and nurses who were worried I'd push the baby out right there in the hallway, I really felt as if it was just Darren and Robyn and I. The three of us had such a rhythm together and their attention was so tuned into me, that it was as if we were the only ones present. They were there for me whenever and wherever I needed them. As we made our ways through hallways and elevators and assessments all I had to do was say "NOW" and they would be there squeezing my hips, encouraging me and giving me love. During transition I really just concentrated on staying inside myself and getting through each contraction as Robyn and Lisa and Kari had all said. I felt alone in my pain, but never unsupported. I kept thinking about how close we were getting to meeting Ben. It was close to torture to go through assessment and to have an exam. I thought I'd die if I had to take a contraction on my back, but the doctor on duty wouldn't have it any other way. Luckily I was at 8 cm and feeling the urge to push so they sent me up to labour and delivery right away. As they wheeled me through the hallways I ordered them to stop at every contraction so I could rest on my hands and knees. At one point I yelled "I'm pushing!!" as I squatted in the hallway. My entire body wanted this baby to come out but Robyn helped me to breathe in a way that helped me not to push. My vocalizations began to take on words and phrases such as "come on baby" and "I'm puuuuushing! or "it's coooommmminggggg!" The words and my voice and the tone were key to my power. All at once I felt the most powerful and the most pain I have felt in all my life. But luckily the frequency of the contractions didn't leave any room to be overcome by fear. All other intentions beyond absolute necessities got squeezed out of consciousness. The room lost its detail. The hallways and rooms became spaces of horizontal and vertical objects. Every object was a potential support to lean on through a contraction. Objects lost their regular purpose and everything was centered around me and the baby and how we could get through this. I was able to zone in instantly on what might help us and simultaneously dismiss anything that didn't serve us any purpose.

When we got to the birthing room I scoped out the bed, ripped off my gown (which was so annoying) made a tower of pillows, and leaned over it as I bore down on my hands and knees. Darren and Robyn stood on either side of the bed and pressed my hips. The contractions were at their most intense and frequent and the pressure to push was in full force. I focused all my energy on my voice calling out and sent my energy down through my vagina. With each contraction I visualized opening up around the baby and the baby's head slipping out effortlessly as it had happened in all my birthing dreams. The pressure was tremendous and the contractions were radiating down my thighs. I didn't push with my breath but rather with my voice. I called out from as deep a place as I could. I kept waiting to feel the release that I hadn't felt the last time because I had had an epidural. Most surprising was the pleasure I was feeling. The pressure didn't hurt. In fact if it wasn't for the contractions in my thighs and hips I think with all my screaming it could have been orgasmic! I was getting so tired but I drew energy each time from a reserve that surprised me. It was really just me and the baby at this point. Dr. Doig had arrived just as Ben was crowning and I could feel her applying a tremendous amount of counterpressure which encouraged me that we were nearly there. The whole time I was pushing I was inside and outside of myself. So powerful inside and so proud about how I was doing this from the outside. The baby's head came through and there was that release! I was there, I was nearly there! The shoulders took one more push and at 12:53 am, just 50 minutes after arriving at the hospital, Benjamin was born. I was so exhausted and relieved I could hardly turn around and meet him. They put him in my arms immediately. He was absolutely perfect. And there we all sat, Darren, Benjamin, Robyn and I adoring him. We had done it (we had!) as naturally as we had planned.

It was such an empowering experience to birth Benjamin naturally. We couldn't have planned it better. If Dr. Doig hadn't arrived when she did I might have had a doctor who insisted I lay on my back. The nurses as it was seemed to be slightly freaked out that I opted not to have the cytocinon injection nor to have Benjamin bathed or weighed before we had held and breastfeed him and the cord had pulsed out. Unfortunately their reaction to our requests turned into a bit of a negative experience when they were convinced I was hemoraghing (though I was not) and instilled fear in me for hours after the birth that I translated in my overly-vulnerable state, that I might be dying. Luckily Robyn stayed and reassured me for 5 hours after, rubbing my thighs and serving up Rescue Remedy as needed. Her reassurance and support from the day we met until immediately after the birth was so important. I would never attempt to have a child without at least one doula. She really helped me overcome a lot of anxiety I was harbouring from the last birth and prepare me for a new experience--an experience that turned out to be the most empowering of my life.

I am so so blessed for this baby, this birth and all the wonderful and beautiful people who loved me and honoured pregnancy and the birth experience enough to make this all happen the way it did.

Thank you all!
I'm including a picture of our first moments with Benjamin.

"People spend more time shopping for a car or home than they put into their births." -- Kim Wildner from Mother's Intention

Friday, August 04, 2006

How Fear Affects Labor and Birth

The emotional state of fear on the part of the birthing woman can have a negative impact on the progress of her labor and her overall experience of birth…. Slowing down or arrest of labor [is a] physiological phenomenon observable in animals, whose bodies instinctively cease to labor when a threat is perceived. …The same [response is] noted in women upon arrival at the hospital…. Emotional changes are shown to affect the physiological state of the birthing woman…. This is a difficult concept to accept and integrate into current US culture, where the separation of mind and body has been universally accepted under the tenets of Cartesian Dualism…. Modern US biomedicine is deeply entrenched in this concept and rarely focuses its care on the mental side of medical situations.

…Scientific studies, however, indicate that certain hormonal changes take place in the presence of fear, stress and anxiety…. Adrenaline has been referred to as the antithesis of oxytocin, the naturally produced hormone that stimulates uterine contractions.(Gaskin 2003) Another category of hormones (catecholamines, which include epinephrine, norepinephrine and dopamine) is indicated by other studies as one of the causative factors in fetal distress as well as problematic labor. Catecholamines…circulate when the pregnant mother is anxious or afraid [and pass through the placenta to the baby, affecting] the baby's environment. [Under these conditions, the risks of fetal distress during labor are increased, and medical intervention ensues.]
The level of fear experienced by women today may be in part due to the removal of birth from the natural feminine realm…. The medicalization of birth in part causes fear, which causes the rising hormone levels, which in turn causes complications that lead to medical intervention. The resulting circular logic normalizes birth as a medical event.

— Colleen Bak, excerpted and paraphrased from "The Role of Fear in the US Birthing Process," Midwifery Today Issue 67

Kitzinger, S. 2000. Rediscovering Birth. New York: Pocket Books.
Klaus, M., J. Kennel and P. Klaus. 1993. Mothering the Mother: How a Doula Can Help You Have a shorter, Easier, and Healthier Birth. Cambridge, MA: Perseus Books.

Tuesday, August 01, 2006

Induction of Labour

Are you comingup on your "due date" and beginning to hear rumblings of induction from your health care providers and well meaning friends and family. Here is some information to help you make informed decisions around your birth...

Synthetic oxytocin administered intravenously in labour acts very differently from a labouring woman's intrinsic oxytocin. First, the uterine contractions produced by IV [oxytocin] are very different from natural contractions—possibly because it is administered continuously rather than in a pulsatile manner—and can cause detrimental effects to the baby in utero.

A woman's uterine contractions can occur too close together, leaving insufficient time for the baby to recover, and [synthetic oxytocin] also causes the resting tone of the uterus to increase. Such effects can produce abnormal fetal heart rate (FHR) patterns, fetal distress (leading to cesarean section) and even uterine rupture. As well, oxytocin augmentation stimulates uterine contractions out of proportion to cervical dilatation, compared to a natural labor: this increases the possibility of a "failed induction," where a woman's cervix fails to dilate and a cesarean becomes necessary.

...oxytocin, whether synthetic or not, cannot cross from the body back to the brain through the blood-brain barrier. This means that when it is administered in any way except directly into the brain, it cannot act as the hormone of love. It does, however, generate negative feedback—that is, receptors in the labouring woman's body detect high levels of oxytocin and so signal her brain to reduce production. We know that women who labor with an oxytocin infusion are at increased risk of postpartum haemorrhage, because their own oxytocin production has been shut down.

What we do not know, however, are the psychological or psychoneuroendocrine effects of giving birth without the peak brain levels of oxytocin that nature prescribes for all mammalian species.
In one study, women who had synthetic oxytocin augmentation did not experience an increase in beta-endorphin levels in labour, indicating the complexities that may result from interference with any of the hormonal systems in labour.

Other research has suggested that exogenous oxytocin may pass through the placenta unchanged, which implies that the baby's oxytocin system may also be disrupted by administration of synthetic oxytocin in labor.

Michel Odent notes, "Many experts believe that through participating in the initiation of his own birth, the fetus may be training himself to secrete his own love hormone..." Odent speaks passionately about our society's deficits in our capacity to love self and others, and he traces these problems back to the time around birth, especially to interference with the oxytocin system.

— Sarah Buckley, excerpted from "Undisturbed Birth: Nature's Blueprint for Ease and Ecstasy," Midwifery Today Issue 63

Induction is a minefield, a setup for complications. An induced labor forces the baby out before the body is ready; before the complex hormone interaction has primed the cervix; and often before the baby has reached his full intrauterine maturity. We have drugs now that can produce contractions and soften the cervix; but this is only a small part of the complicated process of labor. We can make a woman have contractions, but we don't always succeed in forcing her body to release the baby and give birth. If we start a labor with chemicals, we may very well have to finish the labor with the surgeon's scalpel.

In some studies, induction raises the risk of cesarean by 800 percent. [Electronic fetal monitoring (EFM)] must be used in all chemical induction methods because of the risk of hypertonic contractions and fetal distress. [EFM] alone increases the risk of cesarean and of vacuum extraction or forceps [use]. Amniotomy increases the risk again. Cesarean for fetal distress is even more common—whether the distress is real or a result of EFM artifact—since non-reassuring fetal heart tones are frequently observed. Meconium staining, meconium aspiration syndrome and even shoulder dystocia are directly associated [with] inductions. The rise in induction closely mirrors the rise in cesarean delivery, as does the rising incidence of post-cesarean rupture. A woman with prior cesarean is unlikely to suffer a uterine rupture (odds are usually given under [one] percent). But if she is induced, her risk may rise to 2 percent to 4 percent.

— Gail Hart, excerpted from "Induction & Circular Logic," Midwifery Today Issue 63

Women need all of the information before making these imporatant decisions. Trust Birth.

July babies!

I am looking forward to posting the stories of three women from our Birth Rhythm Prenatal class who gave birth last week. Keep checking in and remember:

Birth is safe, Interference is risky.