K’s Birth – My Second HBA4C

KlaraYellowMy Dearest K, this is the story of your amazing birth, 9 days before your estimated due date.

You arrived on the day that Winter Storm Braden was blowing through and two days before a full moon. Daddy had his alarm set for 4:30am and he was packed and ready to head out of town for the week for work. Thankfully, you decided to announce your little arrival at 4:17am with the subtle, yet sure, “pop!” of my water breaking. I had been having a few minor contractions earlier in the night, but nothing that I thought would be heralding impending labor, so I am extremely grateful for the very obvious sign that Daddy should stay put.

Daddy and I got up and got the bed and birth supplies ready, he notified his boss, and then we sat and strategized how we were going to manage the day: would we send your brothers and sisters off to school? Would we just send them with Grandma? Not knowing how long things were going to take, we decided that treating it like any other day would be our best bet. So after a brief rest, we got up and started getting the big kids off to school. They didn’t know that you were working on making your appearance and they couldn’t tell that as I helped Daddy get bowls and glasses for breakfast, I would lean against the counter top and gently sway through the contractions that had begun to come about every 7 minutes.

After we got the big kids onto their buses, we called Grandma to let her know that you were coming so she could come and take your brother, C. It was about 8:15 when she arrived. The contractions were coming about every 5 minutes now, but they were still very mild. While I preferred not to talk through them, I could if I needed to, and then as soon as one was over, I was back to just going about the day. Because of this, I assumed we had quite a ways to go yet, so it was decided that Grandma would just pick the big kids up from school. Daddy finished packing some clothes for everybody and we sent C and Grandma on their way.

It was now about 8:30 and I decided I better get in the shower and get cleaned up. The warm water was really nice and we had a little chat, you and I. I still couldn’t believe that you were really coming! As a mama who’s never had a baby come early, I still figured I had at least a week of being pregnant with you yet. It took me a little while to do my hair and brush my teeth because I would stop during each contraction and just close my eyes and focus on getting to see your sweet face. Eventually,  because I was taking so long, Daddy came in to check on me and I told him that everything was just fine. I could still talk normally between contractions and just gently swayed back and forth during them. I clearly was in denial about how far along I was.

I finished getting ready and went to lay down on the bed to rest a bit. The second contraction on the bed made me get up on my hands and knees and as I heard a small grunt pass my lips and my body give just the slightest push, I thought “Oh crap! This is for real now!” All it took was that one contraction for me to realize that I had quite suddenly entered active labor and I needed my midwife to come. Now! Daddy called her at 9:12 and because we had called her earlier in the morning to let her know my water had broken, she was ready to come and immediately headed out the door. Our midwife is very wise, K, and she had a feeling that you would come in a hurry and that I would wait until the last minute to call her. Add the blizzard conditions outside into the mixture, and I am once again so grateful for her wisdom and preparation.

The whole time throughout labor, I kept comparing benchmarks I had had during C’s birth. When I got that first urge to push, I figured I was about 6-7cm dilated since that seems to be when I get that sensation. I made my way to the bathroom and as another contraction hit, it brought me to my knees and once again, I felt my body pushing just the slightest bit. At this point, Daddy brought me some towels to kneel over and said a prayer for both of us, and as contraction after contraction hit in rapid succession, I quite literally just held on for the ride. I would lean over the toilet seat in between contractions because it was so nice and cool on my face and then I would grip the seat cover as hard as I could during a contraction while I squatted over the towel. And noisy! Oh K, your mama was filling the bathroom with quite the guttural sounds that I’m not sure I could replicate outside of being in labor.

At this point, Daddy began to fill up the birth pool. I’m not sure he realized how quickly things were progressing either. It was only halfway full when I decided I absolutely needed to be in the water despite it not being quite ready yet. Because the contractions were coming so close together, I couldn’t stand up in between them so I crawled the short 3 foot distance between the bathroom and the birth pool. Just as I reached the edge of the pool, another contraction hit and I leaned over the edge, just grateful for my arms to be in the warm water.

It was then that I felt that the water pouring out of the hose into the pool was ice cold!! My instincts made me grab the hose out of the pool and shout at Daddy, “It’s cold water!!” I think he was not happy with me for just whipping a running hose onto the floor of our bedroom, but I didn’t have time to be rational at this point. So your daddy went to work filling pots of water to be heated on the stove so we could fill the pool the rest of the way.

When that next contraction was over, I climbed my way over the edge of the pool and sunk as low as I could in the half-deep water. But as the next contraction came over me, and I got up on my knees to lean over the edge of the pool, I felt overwhelmed and out of control and I cried into a towel. It was then that it dawned on me in some far-away place in my brain that these contractions I had been feeling were transition. It was another benchmark that I had been watching for: the time during labor where I feel that I am absolutely out of control and contractions come one on top of the other; when it seems that I just can’t possibly do this for one second longer.

And then just as quickly as I made that realization, the next contraction came with a new purpose: I could feel that you had dropped into the birth canal and it was time to push for real. It was another familiar benchmark along the way. Pushing contractions come with such a relief for me since they space out a bit and don’t carry with them the incredible loss of control that their previous counterparts do. I remember acknowledging the “rest and be thankful” phase in between the last “transition” contraction and the first “pushing” one. I remember in that moment understanding intellectually really how far we had progressed, but still being in denial that it could be happening this fast.

I believe I had pushed in earnest maybe 3 or 4 times when I told Daddy that I could feel your head. I couldn’t believe it! There you were just ready to come out! And then I started bugging him about when our midwife was going to arrive. It felt like it couldn’t possibly be taking her this long, given the miles you and I had covered. Because we had traveled so quickly, so far, time took on a very skewed perspective. But he got up and looked out the window, and there she was, just pulling in.

Our dear midwife arrived at 10:03 after battling the wintry roads. I remember proudly telling her that I could feel your head and she said “Well, OK then! Let’s have a baby!” and she sat down on the floor in front of me. I think there was about 2 pushes where I would push and then feel your head move back up and then swivel from side to side like you were shaking your head “no”. Instinctually, I just felt that you and I needed to work out our positioning a bit. I had been leaning over the edge of the pool and it seemed to me that your head was hitting the front of my pubic bone. I asked our midwife about that and she said that sometimes women find it easier to lean back just a bit and let baby come out forward. I was also trying to not push too hard and quickly and just “breathe” you out, but we decided to go ahead and “just push a baby out”. So during the next contraction, I leaned back ever so slightly and pushed your little head out all at once. With just one more push, I felt your front shoulder come out and then just like that, you swam up to meet me and I grabbed you into my hands and up to my chest! You were here!!! You arrived at 10:13am – just 10 minutes after our midwife arrived and almost exactly one hour from the moment I decided I was in labor for real!

We didn’t look right away to see if you were a boy or a girl – we were so busy loving you just for the wonderful, new little person you are. But when we took a peak and discovered you were a girl – the third girl to even out the score against three boys – tears filled our eyes.

Just like your brother before you, you didn’t cry right away when you were born and our midwife asked me to give you a few breaths to get you going and let you know you were born. You still didn’t let out a lusty cry, but you assured us that all was well as you pinked up and we watched the gentle rise and fall of your chest.

You have continued to be so quiet and peaceful… a total contrast not only to the weather you arrived in, but to the rate at which you arrived. You open your beautiful eyes and look around the room and at all of us around you and just quietly take it all in. We are so, so, so in love with you, sweetheart. I can’t wait to someday share this story – your story – with you and let you know how you reminded me of the beauty of losing complete control and just surrendering and trusting and believing.

All my love,

Where I’ve Been!

Whew! What a whirlwind these last few months have been for me. I started this blog back when I wanted to get more involved in birth work and shortly thereafter, I found myself more involved with birth work, forcing this blog to take a major back seat! Funny how that works.

I’m still not sure where this is all going to take me, but I wanted to share with you just what I’ve been up to recently.

I am very excited to be involved with the organization, Improving Birth. The mission of this organization is: to bring evidence-based care and humanity to childbirth. You may be surprised to know that much of what is standard procedure in American hospitals is NOT based on evidence of what is best for moms and babies. In the words of Dawn Thompson, the founder of Improving Birth, our goal is clear: “It’s about women being capable of making safer, more informed decisions about their care and that of their babies when they are given full and accurate information about their care options, including the potential harms, benefits, and alternatives–then, within that decision, to be treated with dignity, respect, and compassion.”

My particular role within the organization was previously to be the local coordinator for the annual Improving Birth rallies that take place all across the country. I am still continuing in that role. However, in the last month or so, I have been fortunate enough to join the “advocacy branch” of this organization. We are specifically working to educate women about what exactly their rights in childbirth are. It saddens me to see how many women don’t understand that they can say ‘no’ to medical procedures that they do not desire – mostly because I WAS one of those women. So many women are surrendering to their doctors’ wishes – despite that they are very much against them! – simply because they don’t understand that they have a right to say no. And I’m not talking about doctors indicating a c-section because of placental abruption or persistent transverse lie. I’m not talking about induction because mom is having complications of pre-eclampsia. I am talking about women who have no medical indication of needing these interventions, knowing that they have no medical indication for these things, and yet not understanding that they can tell their doctors ‘no thank you.’

Even more troubling are the women I hear about who are legally threatened with medical procedures such as inductions and c-sections. In the last 2 months, I have talked with women who have been faced with a court-ordered c-section, received the threat of having CPS called on them for declining a c-section, and been required to take a psychological exam for declining intervention during labor. This is INSANE! Yes, these are the rarity – most women “give up” before the doctors go so far as to threaten them with legal action – but this is not OK. In America, we have the right to bodily autonomy and the right to make decisions about our own health care. In what other field would we be required to give up those rights? If a cancer patient was suggested chemo treatment and the patient declined, would they court-order the chemo? Of course not! That’s just insane!

The thing is, women have more rights than they think they do. It’s just a matter of educating them and connecting them with resources to support their decisions…. which is where the Improving Birth advocacy comes in. I am so passionate about this work and it is so fulfilling to be able to help these women – especially fellow VBAC women! – know, understand and receive the care they and their babies deserve.

You can find out more about the Improving Birth movement on their webpage at www.ImprovingBirth.org or on their Facebook page.

Nuchal Cord Basics

I was talking with an acquaintance the other day who mentioned that she was so thankful for her c-section because “the doctor saved her baby’s life because he had the cord wrapped around his neck twice”. This comment made me curious about the evidence behind nuchal cords and their management.

First, a nuchal cord is defined as: “a condition in which the umbilical cord is wrapped around the neck of the fetus in utero or of the baby as it is being born”. Research suggests that around 1 in 3 babies will have a nuchal cord and it is more common in male babies, and with longer gestation.

While I don’t want to completely negate the fact that nuchal cords CAN cause problems, I think it is important to point out that they more often do not. In fact, the cord is designed to be able to handle being wrapped around the neck – and even in some cases, in true knots – without causing problems. This is partly because the cord is coated in something called Wharton’s Jelly. This gristle-like substance actually cushions the cord and helps prevent it from compressing the arteries and vein that run through the cord. Secondly, the average cord is long enough to be wrapped around the neck and still have additional length leftover so as not to cause problems.

Currently, ACOG recommends checking for nuchal cords after the head is born and if the cord is loose enough, unwrapping the cord from around the neck. If the cord is wound too tightly around the neck, ACOG recommends that the cord is clamped and cut. However, these practices are based on inconclusive evidence, and in some cases, can even cause damage because a baby’s “built-in life support” is cut prematurely. “There have been successful malpractice actions against obstetricians in the U.S. who cut nuchal cords prior to shoulder dystocia.” (Midwife Thinking, July 29, 2010) In other words, baby got stuck at the shoulders after the head was born and suffered some degree of oxygen deprivation since the cord had been clamped and cut before baby was using his/her lungs to breath.

Another thing to keep in mind is that babies are often “diagnosed” with a nuchal cord in hindsight. Meaning, a baby may show signs of distress or labor may be labeled as “failure to progress” when a c-section is performed. It is then that the doctors point to the nuchal cord and indicate that as the reason for distress, when in reality the cord may have had nothing to do with either.

This post is not to deny the stories of women whose babies have had complications due to a nuchal cord. It is only meant to encourage parents to rest assured that a nuchal cord does not necessarily present problems and to urge them to become aware of what the best evidence-based practices are in dealing with a nuchal cord so truly informed choices can be made.

Please read here for further information about nuchal cords and their implications.

Know Different, Do Different

I was reminded of this blog post I made on my personal blog over a year ago – before I decided to go for my HBAC – and felt compelled to share it here. I know it is not evidence-based in the strictest sense, but I feel it does give insight in to where I come from and why I am so passionate about birth. Information is power!

May 1, 2011: Why What I Know Now Will Change Forever the Way I Feel About Birth

I apologize ahead of time for how long this post has become, but once I started I couldn’t stop.

Three months. Just three months until we welcome another new little one into this world. While I should be excited and happy and filled with joy at the prospect of this new arrival, instead I am filled with fear and quite frankly, dread.

I cannot WAIT to meet this new little person. I cannot wait for our other children to meet their new sibling and to watch our family open our hearts to another one of God’s blessings. What I am dreading is HOW this baby is going to enter the world.

All of my babies have been born via c-section. It is a bitter pill that for some reason, I cannot swallow even as the years pass. Maybe it’s because knowing what I know now, I look back and realize that I got robbed and coerced and completely misguided into thinking my c-sections were medical necessity. The only reason they became medical necessity is because of what the mainstream medical community did to my body.

With my first pregnancy,  I was 2 days overdue when my water broke spontaneously on a Friday night at 10:30pm. We had just finished watching the news and I stood up from the couch to fold up the blanket I had been using and whoosh!! I remember shaking with excitement as I prodded Ryan and said “My water just broke!” My contractions started within 15 minutes of that and as we called the hospital to let them know, they said to come right in.

Mistake #1: Not staying home longer to let my body get through the first, slower part of labor.

As labor slowly got under way, the nurses were telling me that my body “just wasn’t getting into a predictable labor pattern” and they told me I needed some pitocin to get things moving.

Mistake #2: Letting them pump me full of a chemical to force my body along instead of just letting my body and baby work things out.

Of course, once the pitocin was started, that meant I needed continuous fetal monitoring. Which in turn meant my movement was from then on restricted by wires and IV lines. Which means I spent a lot of time on my back in the hospital bed.

Mistake #3: Spending too much time on my back.

And the pitocin was not a one time thing. They continued to increase the dose and increase the dose so much that I remember lying on the bed in so much pain, the nurse coming in and doing something over at the IV pump. I remember looking at her with tears in my eyes saying “No! Don’t increase my pitocin again!” But she just smiled and said that she needed to “keep things moving”.

Mistake #4: Not ripping that blasted IV out of my arm right then and there.

After enduring the pitocin-induced back labor for some hours, I finally caved and requested an epidural. I was exhausted, sore, panicky about not having any control over the process and I thought “I can’t do this anymore!” and got the epidural.

After that, things went downhill even further. For the rest of my labor, I laid on my back in pain (because apparently I am one of the lucky 2% of people that epidurals don’t work for) unable to go anywhere or do anything constructive for my body. They continued to poke my body 4 times in an attempt to get an epidural to “take” but none of them worked.

After 21 hours of my water breaking, they told me that the baby needed to come out because she was exhibiting “some signs of stress” and they feared that I was developing an infection in my uterus that could affect the baby. They told me a c-section was the safest way to get baby out. Even though I was 9cm with “just a little lip” and my body was already wanting to push, they told me “No, don’t push. You’re not ready yet.” I was so close and didn’t realize at the time that the next 20 minutes would change my life forever.

Mistake #5: Not knowing then that 24 hours is the “magic number” of the amount of time that most doctors like to let a woman go after her water breaks. Upon approaching that magic number, it seems that all babies are immediately in danger of an infection and must be extracted post haste. (insert sarcasm here)

Mistake #6: Not telling the doctors and nurses to keep their fingers out of my vagina since each vaginal exam has the opportunity to introduce bacteria! I don’t know how many times I was checked for dilation, but again, knowing what I know now, I would decline all vaginal exams.

Our little girl was born via c-section on Saturday night. While she came out with extremely low apgar scores (a score of 1 at 5 minutes and a score of 5 at 5 minutes) and looking more gray than pink, I believe this is due largely to the amount of pitocin that was causing my uterus to clamp down so hard that she was probably getting decreased oxygen. They cited fetal distress as the reason for this c-section, and I wholeheartedly agree: fetal distress caused by all the interventions that led up to it.

With our second pregnancy, I vowed that I was going to have a better birth experience. My doctor agreed that a VBAC was safe with one caveat: I would need to be induced 1 week prior to my due date so baby would not “get too big”. (I won’t even get into how ridiculous that reasoning is.)

Mistake #7: Allowing the doctor to induce me. Statistics prove that induction raises the c-section rate significantly. But of course, at that point, I still trusted that the doctors knew what was best.

So, on Friday, May 13th, we went to the hospital at 6:30 in the morning all excited to bring another baby into the world. They broke my water around 8:00am and after that we walked and walked and walked up and down those halls trying to get contractions to start. Finally by 10:00, I started to feel that contractions were coming and once again, I vowed to have a different birth experience. I was NOT getting in that bed, I was NOT letting them give me Pitocin, I was going to DO THIS!

So we walked and walked until the contractions started to get a little more intense and I asked to go into the tub. I laid in that tub and was actually able to get a good handle on the contractions for a while. Suddenly though, I just felt this incredible urge that I needed to get out. I was getting panicky and I know now that I was entering transition. I got out of the tub and my body was wanting to push so the nurse checked me and said that I was 7cm. I panicked. Labor was moving so fast this time (for me!) and I was afraid I wouldn’t be able to do it without drugs. I told them I wanted an epidural. (Knowing full well that it wasn’t going to work again, but in my transition-state of mind, I wasn’t thinking straight.)

Of course the epidural didn’t work. All it did was make them continuously monitor me again and keep me on my back in that hospital bed. After a while, our baby’s heartbeat started dropping (I still don’t know exactly what they meant by that… how deep and when exactly the decels were occurring) and after some careful monitoring by the doctors, they decided an emergency c-section was necessary, fearing a uterine rupture.

Mistake #8: Getting that epidural. When baby’s heartbeat started to dip after that, the doctor automatically assumed uterine rupture. Never mind that babies’ heartbeats normally dip during a contraction and that an epidural can cause even more decelerations. Because I was a VBAC, uterine rupture HAD to be the default scenario.

Our second little girl was born Saturday afternoon, only 7lbs 9oz (remember how concerned they were with her getting “too big?”) and healthy as can be. My uterus was fine. Although, I wasn’t aware of any of this until some time later as I was completely put to sleep for her delivery and had to spend time “waking up” in the recovery room.

When we got pregnant with baby #3, my doctor recommended a scheduled c-section due to the “risk” of uterine rupture after having 2 previous c-sections. He sang the praises of having a scheduled c-section such as being able to pick the baby’s birthday, coming in and having a baby a few hours later, and an “easier” recovery from my last birth which he said was ‘a horrible disaster’. Babies #3 and #4 were both born via scheduled c-section, each c-section putting me more and more at risk.

Which brings me to today. I have 3 months to gear up for yet another c-section. I’m not sure I will be able to willingly sign that consent form that day that states that I understand the risks involved of what I am about to do. I feel like I am signing my life away. Because we don’t know if we are done having children, I am significantly putting myself and any future babies at risk by having yet another c-section.

How can I gamble with a 3.5% chance of needing an emergency hysterectomy in future pregnancies when my chance for uterine rupture during a VBAC ranges from only .07% – 2%? While neither choice is completely without risk, doesn’t the 98% chance of having everything go well sound better than the 96.5% chance? My birth experiences are not anything I can change at this point. My only hope is that other woman out there are better educated than I was and that they have the faith in their bodies that I lacked.

One Year Ago Tonight

Exactly one year ago tonight, literally to the minute as I type this, I woke my husband up from his nap on the couch and asked him if he could start helping me get through the contractions. It would be an hour and a half later when my water would break. It would be another 5 hours and my vision of myself would forever be altered.

Growing up, I listened to the women in my family talk about birth. They all seemed to have one thing in common: labors that were long and hard. The women in our family had forceps births and c-sections. Labor that would go on for days and days. They talked of excruciating pain, failure to progress and babies that just wouldn’t come out on their own. I think before I was even pregnant for the first time, I had already “learned” that my body was just not made to birth.

So when my first birth was long and hard, with a body that didn’t seem to progress fast enough for the nurse’s timetable, I was not surprised when it ended up in a c-section. This is just what happens to the women in my family, right?

Despite that, I wanted another go at it. I figured, now that I knew what labor was like, I could do it “better”. It would be different the next time. So, baby #2 was an attempted VBAC…. that ended up in an emergency c-section. I was devastated and it glaringly reinforced the ugly truth that I was, indeed, broken.

When baby #3 and #4 came along, for some reason, I still longed for another try. I pleaded with my doctors, even looked into other care providers searching for someone who would believe in me. Believe in my body. But instead, everyone told me I couldn’t do it. They used words like “Too risky”. “Not a good candidate”. “High failure rate”. Even the doctors believed I was broken.

And this changes a woman. To constantly be told that your body doesn’t work changes you. At least it changed me. I mourned the loss of a “normal” birth like one would mourn the loss of a beloved friend. I ran over the scenarios in my head over and over trying to reconcile what had happened and figure out why I just couldn’t do what other women did so easily.

And I remember once, I dreamed about it. I dreamed about giving birth. In my dream, I actually had a baby slide out from my body on its own and it was so vivid that I could feel it. Literally feel how it would be to give birth. I was amazed at how vivid the dream was, especially since I obviously had no idea what it was like.

That is, until a year ago in the wee hours of the morning, when I realized that it was all a lie. My body was not defective! It worked! It actually worked! One year ago tonight, I had midwives at my side helping me climb through the tangle of my own personal Mt. Everest. And together, we triumphed! Not only did I receive the gift of a son that night, I gained the gift of trusting myself again. The gift of knowing that I will never again let someone tell me what I am or am not capable of.

One year ago tonight, I gained the gift of knowing my own strength.

Conscious Decision-Making

There is an old story that goes something like this:

A young woman is preparing her very first roast. As she is preparing the meat, she promptly cuts off the ends and puts the roast into the pan. Watching her, her new husband asks why she cut off the ends of the meat and she says, “That’s just the way my mother always did it.”

The next time the young woman sees her mother, she asks her why they always cut off the ends of the roast before putting it in the pan. Her mother replies, “Well, that’s just the way Nana always did it.”

Now more curious than ever, the young woman decides to pay a visit to her Nana. “Nana, why did you cut off the ends of the roast before putting it in the pan?” To which the old woman replied, “Well, otherwise the roasts didn’t fit in my pan.”

Cute story. But unfortunately, many of the practices in current obstetrics are based on this theory: it’s just the way things have always been done – despite new medical evidence to encourage otherwise.

Therefore, I encourage you to read current research on the following topics so you can make fully-informed and deliberate choices based on this information.

– Induction for post-dates or “big baby”
– Artificial rupture of membranes
– Continuous electronic fetal monitoring
– Eating and drinking during labor
– Pushing in a supine position
– Umbilical cord cutting
– Placing baby in a warmer after birth
– Eye ointment
– Vitamin K (injection or oral)

My hope is that One Birth will continue to bring you current information on topics such as these so you don’t risk lopping off the ends of your roast just because that’s how it’s always been done.

Tips For a Natural Hospital Birth

My fifth baby was born at home and was by far the most amazing experience of my life. Should there be a sixth baby, barring any unforeseen medical reasons, we would plan for another home birth. However, I know that home birth is not for everyone. I realize that for some, knowing that an OR is just down the hall in the event of an emergency is of great comfort, and perhaps in some cases even necessary, in order for labor to progress due to the mother’s comfort level. For all of those people, these are my recommendations to help you get your natural birth in a hospital.

1. Avoid third trimester ultrasounds. Unless there are definite concerns about the health of the baby, I would not encourage consenting to an ultrasound this late. Third trimester ultrasounds are notoriously inaccurate in determining baby’s size and sometimes care providers will start suggesting induction if the ultrasound indicates that baby is getting what the doctor considers “too big”. Which brings me to item number 2:

2. Understand the evidence regarding induction. Again, unless there are definite concerns about baby’s health, it is so important to just let baby come when baby is ready. Familiarize yourself with the risks and benefits of induction and learn what the evidence says for many common reasons women are induced. I know the last month can be really uncomfortable. I know the anticipation of meeting a new little person can feel almost too much to bear. I know it can happen that doctor is on vacation the week after your due date. But not only does waiting ensure that baby is strong and physically ready to be born, it also gives your body a chance to warm up to labor naturally… which means labor at the pace and intensity that is right for YOUR body.

3. Avoid routine constant electronic fetal monitoring. Some fluctuations in heart tones are completely normal for baby during the course of labor and sometimes over-analyzing these benign changes cause doctors to worry needlessly. Read here for an article about recent studies that show that constant electronic fetal monitoring does not necessarily provide better outcomes for mom and baby.

4. Avoid vaginal exams before and during labor. I know it can be reassuring to know that progress is being made, and indeed, there are times when a caregiver may want to check progress. But the number of centimeters dilated is a somewhat meaningless number. A woman can be at 3 cm for hours, days – weeks even – and 3 hours later, be in active labor at 7 cm. An attentive care-giver usually will be able to get a general idea about progress without checking dilation. (Read this great article here for more on that!) Not to mention that if they don’t check vaginal progress, there will be no such thing as “failure to progress”.

5. Hire a doula. I cannot stress this enough. If a woman desires a natural birth in an American hospital setting, I believe it is imperative to have a knowledgeable, assertive support person that can help guide you to a successful outcome and provide emotional and physical support for both mom and her partner. I believe it is specifically beneficial to have FEMALE support during birth. A doula will also help ensure that if you are about to deviate from your birth plan, you are doing it consciously and because the circumstances call for it.

Natural birth CAN happen in the hospital setting! It just may require some extra diligence and conscious decision-making on your part to make it so.