You Are Doing It

It was a long time ago, and my client was probably a good 15 years older than me, having her first baby. She had taken childbirth classes, was using a doula (me!), and was so educated about birth, I was afraid she knew more than I did! However, when she started having contractions, the coping strategies she had learned in childbirth class collapsed after many hours of prodromal labor (that means early labor that takes its sweet time progressing into a more active pattern). Indeed, I think she “relaxed” herself into exhaustion! Spending twelve hours breathing and thinking about breathing, and she had barely started her labor. I went over, nervous and excited (which is absolutely how I still feel almost 15 years later when I’m headed to a birth), and watched her for a bit. She was tired. Tired is a word that may not quite encompass the despair a pregnant woman feels when her labor is long- it’s a profound tired- an exhaustion of heart, mind and body. She wondered if she “could do it.” I said then what I still say, “You are doing it.” But there was a real fear that she wouldn’t be able to do it without pain medication, or Pitocin, or another intervention that she didn’t want. I bolstered her back and knees with pillows, closed the curtains, and lay down beside her in bed. And then I pretended to sleep- with my whole heart I let my body go loose and started breathing deep and steady, like I do when I want to trick my kids into falling asleep. Breathe in- 1, 2, 3, 4. Breathe out- 5, 6, 7, 8, 9, 10. Repeat. Repeat. Before too long, her breathing deepened, her body truly relaxed, and her contractions came and went like gentle waves on the sea, never quite crashing hard enough to wake her.

Fear in Labor Will Slow You Down

Eventually she woke up, and while still tired, the fear that she wouldn’t be able to make it through had faded a bit. Labor got harder and we went to the hospital. She had contractions standing and squatting, in the shower and on the bed, sitting up and laying down. She moaned and sipped juice, sweated and moved her hips. Some were hard and long, some were short and easy- with any number of variations therein. She got tired again, and was very close to having her baby, but her contractions had spaced out and she seemed stuck. Her midwife suggested that she have a bag of IV fluids to reenergize her. My client didn’t want an IV. She thought it would lead to any number of interventions that terrified her. As a new doula, it took me a while to see that my client’s fear of medical intervention was holding her up! It doesn’t matter what you are afraid of, fear in labor will slow you down. (Forward, release, down, out…. The words we use in labor are all synonyms for letting go.) I followed my gut and told her, “Trust your midwife, that’s why you hired her!” While I didn’t expect a literal interpretation, my client looked her midwife in the eye and said, “I trust you.” (I cried a little- actually, I welled up just writing about it all these years later. There was so much emotion is those three words.) As the IV went in and the fluid just began its drip, she got the urge to push and had a baby-in-arms within 45 minutes.

 Lessons Gleaned From Birth

There are so many lessons in this one birth story. Sleep in early labor. Don’t over think things. Pick a provider that you trust, implicitly, to respect your wishes and to protect you and your baby. Get support, since you never know if you will spend 24 hours in labor limbo, or if you will have back labor, or if your partner might need to eat or pee or sleep (actually, that’s one thing you do know). Release your fears. You can’t control it. And, often a little help from medicine is truly “a little help” and not a big, bad scary trip to the OR. How can a childbirth class capture the meaning of these lessons when words are so limiting? By telling stories: simple, linear narratives that reiterate the fundamental trick of birth- let go, or be dragged.

The Pillars of Lamaze’s Philosophy

I certified with Lamaze International (http://www.lamazeinternational.org) as a childbirth educator in 2008. I had already been attending births as a certified doula since 2003. During my training, I realized quickly that while some of the women in my group had attended births, many had never been to a birth at all! The pillars of Lamaze’s philosophy are:

1. Let labor begin on its own.
2. Walk, move around, and change positions during labor.
3. Bring a loved one, friend or doula for continuous support.
4. Avoid interventions that are not medically necessary.
5. Avoid giving birth on your back and follow your body’s urges to push.
6. Keep mother and baby together, its best for mother, baby and breastfeeding.

Simple, right?

 The Best Strategy for a Healthy Birth

In theory, these fundamental underpinnings of physiologic birth make sense, and are easy to describe and elaborate on. In reality, the ways in which women know they are in labor, move through the stages, negotiate medical care, draw on support, expend heroic effort to push out their baby, experience the first hour after birth, and move on to breastfeeding a newborn are myriad, hard to describe, and unique to each of us. In order to get a feel for how labor will be, women need to hear stories about births. They need to feel a real sense of the rhythm and magic of childbirth, and examples of the universalities that underscore a subjective experience. It is also crucial to imagine the role of the care provider, and to think about the ways in which medical decisions are considered, negotiated, and made in real- life scenarios. The infinite variety of real life labor and childbirth is anything but simple, but it is very true that for most women simply leaving the process alone is the best strategy for a healthy birth.

 The Particulars Don’t Define Birth

Since my client had her baby (who must be headed for high school by now), I’ve been to many births. There is joy and triumph, but there have also been births that have demanded every last reserve of strength and love and bravery that a woman and her partner possess. Each time, the same mix of nerves and excitement, and of the known and unknown. Childbirth is an act of courage, and is mysterious in its simplicity. One of the best ways expectant parents can prepare for one of life’s fundamentally transformative experiences is by trying to understand that in many ways, the particulars are less important than the overall journey. That is, whether or not you have an IV, a short labor, need stitches, have a waterbirth, need an epidural, drink castor oil, need Pitocin, scream your head off or quietly rock your baby out, those things are part of your story, but they don’t define your birth.

Theories Come to Life Through Real Birth Stories

When I teach childbirth classes filled with mostly first time parents, I feel their excitement and nervousness, and I love making them laugh about small but significant concerns about birth. Poop and sex jokes rule the day as if we are all still in middle school. But after a laugh over the need to bring a fishnet for the birth tub, I tell them the story of a mom who sat back on her husband’s lap as he held her up, and as their daughter slid into the warm water of the tub, they both cried. Or when I describe bloody show, then tell the story of a woman sitting on the toilet in the magical laboring cave (because everyone loves the bathroom in labor), looking down at the mucus and blood and exclaiming, “Look at all the cool stuff coming out of me!” Talking about how different stimuli can help you cope in labor is illustrated with the story of a mom who needed to breathe in a lavender sachet for each contraction exclaiming, “I need my sniffer” as soon as she felt the next one coming on. Showing counter pressure is way more convincing when a pregnant woman sighs with pleasure as I show her partner the right spot- my hands just know where to go. Describing the appropriate use of an epidural or Pitocin is more effective with a story from real life. Those theoretical pillars of a healthy birth come to life through examples, through the stories of real women and their partners, and emphasizing again and again- your body knows what to do, be open, be patient, trust, don’t be afraid, and “you are doing it”. “However much we know about birth in general, we know nothing about a particular birth, we must let it unfold with its own uniqueness.” Elizabeth Noble Birth Stories in Childbirth Class