My Soap Box

Expectant parents discussing with midwife

Various viewpoints on consent

Some people think of informed consent as a two step process. The care provider tells you the information and you consent. That’s the quick and easy way of doing it and it’s the way some care providers prefer it.

But TRUE informed consent isn’t quick and easy. It involves a conversation, not just a recitation of the form. It involves taking time to ensure all questions are answered and other options are explored. Including the option to refuse what’s being suggested. You cannot freely consent if consent is your only option!

Additionally, some people think of consent on different scales from other people. There are two ends of the scale of consent:

Pregnant person talking with a doctor

“Package Consent”

People who think of consent as a package deal tend to think that when someone has consented to a cesarean, that consent automatically includes consent for: IV fluids, blood pressure monitoring, urinary catheter, antacid medication, antibiotics, and pitocin to guard against excessive bleeding.

In this way of thinking, ideally all those other things that are part and parcel of a cesarean birth are discussed. Unfortunately that does not always happen as staff can assume that “everyone knows you get a catheter with a cesarean” when that isn’t really true.

“Piecemeal consent”

The piecemeal approach is one that I find more patients expect. I often see something like “I plan to stay involved in decision making, please discuss everything with me before using any interventions.” included in people’s birth plans.

Those who follow this viewpoint feel that even when someone has consented to the cesarean, they also need to consent to the IV fluids, blood pressure monitoring, urinary catheter, antacid medication, antibiotics, and pitocin to guard against excessive bleeding.

Where do you draw the line on what is included or not included? And does your care provider see it the same way? A mismatch in your approaches to informed consent can lead to conflict and frustration in labor.

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High school students being shown a scary birth video

Did high school make birth and parenting hard for you?

I’ve noticed the ghost of high school health class reverbating into adulthood in a couple different ways. And not in good ways!

Scary birth videos

I honestly LOATHE the idea of high schools using birth videos as birth control. Maybe it is because I get those same women 10 years later and have to work them through all their fears that come from being shown childbirth as a horrific thing when they are in high school. You’d be AMAZED at how often those high school experiences come up as fears in my classes and with my clients.

So when my oldest daughter’s high school biology teacher found out what I did for a living and asked me what was the most “graphic and terrifying” birth video she could buy to show to her class, she got an earful from me on the topic. Turns out she herself took HypnoBirthing and delivered unmedicated. And had never thought about long term effects at all.

I do want high school students to see birth. I want them to know how powerful birth can be. But I don’t want it portrayed as horrific or used as a fear based birth control tactic.

Teen boy holding fake newborn

Newborn Simulators

Whether it is an egg, a bag of flour, or an expensive robobaby, many high schools make students do an assignment where they “simulate” parenthood for a day or two, or even a week. In theory, this experience teaches students how hard it is to care for a newborn and discourages them from becoming pregnant as a teen. The reality, though, is that it artificially makes things HARDER than real parenting!

Most of the time, the assignment only allows for one person to care for the baby, while the reality is that partners, family, and friends can all help care for a real baby. When using the fancy robotic babies, students have a time limit and are expected to get the baby to stop crying within just a few minutes. The reality is that in real life, babies may cry for much longer, even when parents do everything right! The assignments are also being graded, and it’s possible to pass – or fail – because of things beyond your control. With unrealistic ideas that you have to do everything yourself without help, pressure from time limits, and being graded on your performance as your “simulation of real parenting” is it any wonder that new parents struggle to ask for help and feel pressure?

Plus, the research on these simulations actually might do the opposite of what they intend! Check out the references below or listen to this podcast on the simulations.

If any high school health or child development teachers are reading this, I strongly encourage you to rethink how you teach about birth and parenting. Focus your teaching on a healthy understanding of the birth process, the options available to them, and on parenting as a relationship rather than a graded performance. Preventing teen pregnancy should not be the primary goal while teaching these topics. Save that for *real* sex ed and include contraception in that part of the curriculum!

(And if you’re in the Salt Lake City area, I’d be happy to come be a guest speaker. I enjoy teens!)

References

https://www.bmj.com/content/354/bmj.i4666.full
https://www.statnews.com/2016/08/25/infant-simulators-teen-pregnancy/

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Relocating to a new city during pregnancy

I moved during one of my pregnancies. Or, more accurately, I *prepared* for a move during one of my pregnancies. The actual move took place on the day my daughter was born, after the main event was over and I went to the hospital from the old apartment and came home to the new one after I was released. It was not planned that way, just worked out that way. But it was HARD, and not recommended. And that was just a local move!

But sometimes, moving is unavoidable, or an opportunity too good to be passed up. I think it can work at most stages of pregnancy (though again, I really don’t recommend the same day as the birth!) and when you’re moving across the country or to another country or continent, there are a lot of things you can do to make the process smoother.

Throughout the process:

Don’t be afraid to accept help Gestation is hard work. Moving is hard work. If friends, family or neighbors offer to help or say “Is there anything I can do?” SAY YES.
Be gentle with your emotions Leaving your old home/city/friends and family could be hard, with varied emotions. Pregnancy has a way of magnifying everything and making them more evident. Those emotions are still completely valid, and it is okay to feel them. Give yourself space and grace to be emotional.
Communicate! Talk things over with your partner. Cut each other a lot of slack and be kind. Keep talking and working to understand.
Listen to your body and don’t overdo it The last thing you need in the middle of a move AND a pregnancy is a back injury! Take breaks, enlist help, and remember that it’s okay to have limits.

Before the move:

Start exploring the birth options in your new area as soon as you can This will help you find a care provider who is a good fit for you. You don’t have to have made a final decision before you leave, but it can be helpful to have a few names on hand so you’re not starting from scratch once you’re in the new area.
Find out the details on your insurance plan in the new area – This will simplify your search. Sometimes knowing the company isn’t enough.
Hire out as much of the moving as you can afford to! While this isn’t an option for everyone, this is definitely a time when it is worth the cost. If you’re moving for a new job, see if you can negotiate for the company to cover all or part of the cost.
Start building your community before you arrive – Talk to people you know in your current city to see if they have any connections in the new city. It’s a small world and could easily be the case. Join social media groups for parents in your area, and search the archives of the groups for information. When you feel ready to join the conversation, do it. You can also check to see if there are meetups in your new area for new moms, and also for any other interests or hobbies that can help you connect to people. If you like photography, join a group for photographers. Join neighborhood groups, see if anyone has a friend of a friend in the area.
Plan for a transfer of your records Talk to your current midwife or doctor and ask them how to best handle the transfer of your medical records. It may be easier to start the ball rolling when you are there in person.
Shop around, but wait to buy baby gear until after the move This will give you less to move, and yet you can have a plan for what do buy because you’ve already done the research.

After the move:

Explore your new city before baby comes Find out where the grocery store, bank, birth center or hospital, and clinics are. Try out new restaurants that have takeout options that could come in handy after the baby comes.
Use your nesting instincts to settle in Do as much as you can each day, and take advantage of those bursts of energy that are so common.
Order or go buy the baby stuff you chose I’m generally a fan of online shopping, but doing this in person will help you get familiar with the shops in your area.

If you’re reading this and are planning a cross country move to the Salt Lake City area, contact me and I’d be happy to spend a half hour or so on the phone to help you navigate your way in this area!

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Pregnant woman staring in frustration at her cell phone

Dr. Facebook Will (NOT) See You Now

DoctorFacebook

Monday, 4:30 am. A new mom posts to Facebook that she is struggling with her baby being fussy at nighttime feedings. Within 2 hours, she has received four different diagnoses from fellow Facebookers: Dairy allergy, thrush, lip and tongue tie, and reflux. She’s been prescribed probiotics, gentian violet, nystatin, 4 different herbs, and a plastic device to help her baby pass gas.

Tuesday, 8:43 pm A 32 week pregnant mom posts to Facebook that she’s having lots of mucousy disharge tinged with blood. She’s had some “super sized Braxton Hicks” all afternoon. She just wants to know if this is normal, and doesn’t want to bother her doctor. She is assured several times that it is normal and the mucous plug will regenerate.

Wednesday: 1 pm New mom posts a blurry photo of her baby’s mouth with the lips held back while baby cries. “Does this look like a tie to you?” Dozens of responses within an hour, all agreeing that yes, that is a severe tie and mom needs to get it revised immediately. Recommendations for ENTs and pediatric dentists are given out, mom starts giving formula while waiting to get it revised.

Just an average couple of days on Facebook. I’ve noticed a trend lately – people posting to Facebook with their medical concerns instead of taking them to a provider. And it’s not good. The amount of conflicting and outright bad advice that is given over Facebook is a little frightening. Expectant and new parents find themselves more confused than ever at best, and damaged by bad advice at worst.

That mom from Monday ended up feeling very confused and not knowing what to do for her baby. Tuesday’s mom believed all the reassurance and stayed home and went to bed. During the night she unexpectedly delivered a preemie at home and her baby was unstable in the NICU when she checked in the next day. The mom from Wednesday called and set up an appointment for a tongue tie revision, only to find out when she got there that the doctor did not see any ties at all.

None of these moms was actually helped by their interactions on Facebook. A better option for each of them would have been an in person visit with someone qualified to help them.

I do understand that not everyone has the money for a visit with an IBCLC or a midwife – but in the case of Wednesday’s mom, she could have paid an IBCLC half what the surgeon charged and had a full evaluation to find and get advice for remedying the *real* issues. Instead she paid twice as much and had no idea what was going on.

Tuesday’s mom may have been able to avoid an expensive (and scary) NICU stay for her son if she had called her midwife and gone in to try and stop labor.

As a childbirth educator, I avoid diagnosing and prescribing because they are not within the scope of my job. This applies to my client work AND to my social media interactions. I’m likely to say “That is a great question for your midwife.” or “I think you would benefit from talking to a good IBCLC for a thorough evaluation.” and give out a number for a good one in their area.

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Woman in early labor, with partner timing contractions

The Fallacy of False Labor

The Truth About False LaborIt is a very common theme:

  • Women in my classes want to know “how do I know if it is false labor?”
  • Posts on Social Media “Is this real labor? I’ll be embarrassed to go in if it is false labor!”
  • Expectant neighbors or family members calling at all hours “should I go to the hospital, or is this just false labor?”
  • Clients who say “I’m sorry to call you, I know it might be false labor but I just can’t tell!”

So here’s the truth about false labor: IT DOES NOT EXIST. (OK, maybe it does kinda exist, but it’s a bad name for it and I wish the name didn’t exist!)

Some people define “False Labor” as “Pains resembling true labor but occurring before a labor pattern resulting in the birth of a baby.”

So let’s look at what is happening with false labor:

1. Mom’s uterus is actually contracting. That’s not false. It’s something that is truly happening.
2. Mom’s cervix might be dilating. Many women begin labor with some dilation already happening, and this is when it happens. It’s real, true change.
3. Mom’s cervix might not be *dilating* but it probably is making some of the other changes that are still progress in labor: effacement (this is huge for first time moms!), change in the cervical position, ripening the cervix, helping baby to rotate and engage in the pelvis. These are real, true progress.
4. Mom may be missing out on sleep, unable to focus on other tasks, and is feeling some real discomfort.

Personally I think that it is patronizing and dismissive to call these very real experiences of women “false” – it can be hugely discouraging!

There are several other terms that could be used to describe what mom is feeling, all are better than “false labor”:

My preferred term is “warmup labor” – her body is warming up, getting ready, and literally flexing the uterine muscle in preparation for birth.

Some call it “prelabor” – meaning it is happening before the labor that ends with the birth of a baby.

Some call it “prodromal labor” – this is not my preferred term because it sounds as though something is wrong that needs to be fixed or treated. Sometimes even doulas jump to “If you’re having prodromal labor, it must be a positioning thing! Let’s (insert their favorite “prescription” for “fixing” it here.)

Having periods of contractions off and on before the birth of your baby is a very normal and common thing. It doesn’t need to be fixed, it doesn’t need to be hurried. It usually isn’t even important in the moment to know for certain whether this is a temporary warming up or a warming up right before the big event. It’s OK to not know for sure. And it is fine to call your midwife, doula or doctor if you are not sure. They will likely tell you to watch and wait and see what happens. Either way your baby will eventually come!

But don’t ever let anyone convince you that it is “false” or all in your head!


Want to learn more about the birth process and how it works? Take my comprehensive online and personal childbirth class!

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27 Smartest Things Partners Say in the Labor Room

I’ll admit it. This is a VERY reactionary post. I saw this list: 27 Dumbest Things Dads Have Said in the Delivery Room and it bugged me. Because in the many births I’ve attended, the amazing, supportive, helpful and loving partners have far, far outweighed the fumbles. And I’m really tired of the “dad as useless buffoon” stereotype. So in a knee-jerk response, I’m going to list the amazing and helpful things I’ve seen partners do and say at births:

1. “Let me do that for you.” Mom might be trying to press on her own back, or get her hair out of her face. Partners do a good job of picking up on helping those things.

2. “I’ve seen you run a marathon, I know you can do this.” A shared history, seeing mom conquer obstacles, and bringing that experience to help her find her inner strength goes a long way.

3. “I’m proud of you.” No matter how the birth goes – I’ve heard partners say this after all kinds of births. Often followed by specifics – the way she navigated an unexpected turn in the plan, the way she pushed through a longer labor than she anticipated, etc.

4. “I’m scared too, but we are in this together and I’ll be with you every step of the way.” Loved how this dad was able to connect with mom and feel okay about the fear and vulnerability she had just expressed.

5. “I don’t know why people say women are weak. Birthing babies takes so much strength and power!” I had to agree. That mom was powerful! (As are all the other moms I’ve worked with.)

6. “I’m right here.” And often, not leaving mom’s side. Sometimes I have to convince partners it is OK to take a moment to use the restroom or get something to eat, they are so focused on mom.

7. “Seeing you do this makes me love you more than I ever thought I could”

8. “Remember how you thought you couldn’t make it to the top of the mountain when we were hiking? And you pulled it off anyway? Whatever you did then, do it again!” Again with the shared history. The partner/doula team is a good one. The partner has experience with *this mom* and I have experience with birth.

9. “It’s OK to make sounds. I can take it.” Helping moms feel comfortable with whatever they need to do in order to birth is a very useful thing.

10. “I’m turning off my phone because I cannot deal with all of them and also help you.” Laboring moms who get partner’s total focus benefit from it. And thankfully partners who don’t give full attention is pretty rare.

11. “You did it! You really did it! and you were AWESOME!” I can’t adequately express the giddiness this particular dad had, nor can I convey the way he was doing a little happy dance for her. This particular dad was very skeptical of mom’s initial plans to birth unmedicated. But when he got on board, BOY did he get on board!

12. “You know what you’re doing. Keep it up.”

13. “I’m so excited to see you become a mother. You’re going to be a great one!”

14. “What do you mean you can’t do it? You ARE doing it!” Sometimes this encourages moms to keep going. But sometimes instead partner will say something like:

15. “Would you rather try something else? How about (Fill in the blank)? You said before you wanted to try that in labor.” This shows thought and remembering what was important to mom.

16. “Remember her birth plan asked for (fill in the blank)” Taking charge of reminding staff of mom’s plan if mom is too deeply into a labor zone to have that discussion can be a huge help. And partners are in a much better position than doulas to do it.

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17. “Yes, I am tired, but I’m happy to keep going with you.” Moms know you’re lying if it is 4 am, you haven’t slept all night, and you say “I’m not tired!” – honesty goes a long way.

18. “I’m here if you need me, but if you don’t want to be touched, that’s fine too.” It’s hard for partners to feel like the massage and hand holding they’d envisioned themselves doing to help mom in labor isn’t wanted. This dad understood that it wasn’t a rejection and just sitting nearby would meet her needs just as well.

19. “Remember when we were on our honeymoon? We landed in Madrid and….” I had one dad spend five straight hours talking his wife through a detailed trip down memory lane. Mom listened quietly with her eyes closed, occasionally adding a detail or two he forgot. He did a wonderful job telling the story with detail, color and storytelling. Best use of visualization ever, and it wasn’t even planned.

20. “You are my hero.” This dad said this to a mom who had just birthed by unplanned cesarean. It meant the world to her.

21. “I’ll go tell my mom to go away if you don’t want her here.”

22. “Anything you need, I’ll do.”

23. “Lean on me. I’ve got you.”

JuneKellerBirthWebSize-19

24. “I’m so excited to see our baby.”

25. “Go ahead and cry if it helps. My shoulder is right here.”

26. (Silence) I’ve had two moms who wanted NO talking. And two partners who spent hours pantomiming everything that needed to be communicated. Every question they had, every time they needed to step out for a moment, etc. Initially it’s not easy, but in both of those births, the partner and I noticed we became pretty highly in tune with the mom, just because we had to spend so much time watching body language and behavior to know how to help.

27. “I love you” – Nearly all the partners I’ve supported alongside have said this to laboring moms. It helps every time. Hard to go wrong with a heartfelt “I love you”

As simple as that, I came up with 27 helpful supportive things partners say. What helpful things did people say to you in labor? Share it in the comments!

And here’s to all the great partners out there!

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Cartoon woman holding sign that says No Thanks, with cartoon doctor in the background

If you don’t want it, just say no!

Vaginal exams in pregnancyWarning: Rant ahead! I wrote this years ago – the original version was a little more, um…passionate. I’ve just now toned it down to where I feel comfortable posting it. Still pretty opinionated. This rant doesn’t apply in the least to moms who want exams and get them. This rant is about moms who feel bullied into an exam they don’t want.

So three times in three places in the last 24 hours I have had people ask “Can I say no to a vaginal exam?” or “I really hate vaginal exams and wish I could say no.”

Can I just say that it really disturbs me that we live in a culture where women do not even KNOW that they can control what happens to their bodies? That they even think they do not have the power to prevent someone from sticking fingers into their vagina?

When will girls be taught that they are in charge of their own bodies? So that they grow up into women who know they are in charge of their bodies? My girls definitely know that, but so many others are being taught otherwise. It makes me sad.

NO ONE, not a doctor, not a midwife, not your partner, NO ONE BUT YOU gets any say about what does – or does not – happen to your body. Anyone who thinks they can override mom’s control over her body is crossing a scary line.


Why they suggest it:

To satisfy curiosity

What it tells you:
It tells you where things are right now.

What it can tell you about the future:
Absolutely NOTHING. I’ve worked with moms who walked around 5+ cm dilated for weeks. I’ve worked with moms who were emotionally devastated because the cervix was closed, firm and posterior at a prenatal, only to have a spontaneous labor and happy baby in their arms less than 24 hours later. There is absolutely no evidence that exams in late pregnancy have any benefit or predictive value.

What you can do if you don’t want one:

Take someone else with you to your appointment, and have them come in the exam room with you. It’s easier to say no when someone has your back.

Keep your pants on. It’s harder to say no when you’ve already disrobed from the exam.

If you’d like to learn more about creating positive and collaborative communication with your care provider, you can enroll in my complete online and personal childbirth classes where I teach some helpful communication skills!

If you don’t want it, just say no! Read More »

New mom depressed

When birth does not go as you’d hoped…

Speech bubbles with insensitive Comments

Can you think of anything worse to say to a mom who is opening up about feelings of disappointment or pain after a difficult birth? I can’t. The unsaid subtext mom hears goes something like this:

“Just be glad you have a healthy baby. Any other emotions you have don’t count. There is only one acceptable emotion to experience after having a baby and that’s pure happiness and joy. Anything else means you are doing it wrong.”

“A healthy baby is the ONLY thing that matters. You, as a mother, don’t matter. Any fear, pain, or helplessness you felt during your birth does not matter. You are unimportant, your experience is irrelevant, and you should get used to it.”

“I don’t know why you are upset, from what I can see, your birth was perfect and you are being unreasonable if you are unhappy about that!”

If I could help new moms understand just ONE thing about processing their birth experiences, it would be this:
You can feel pain or disappointment from your birth and be happy about your baby at the same time!

It is possible to be happy and disappointed at the same time. It is OK to experience BOTH joy and pain at the same time. Negative emotions do not invalidate the happiness and positivity of birth. Having a mix of emotions about your birth is very common and normal.

Your feelings about your birth do not have to be ALL happiness. You can be happy that your birth was amazing AND disappointed a little as well. You can be sad that your planned natural birth turned into a cesarean AND happy to be snuggling your healthy newborn. You can be happy about how your birth went AND sad that breastfeeding is a struggle. You can be thrilled that you were able to birth unmedicated AND struggle with how intense your precipitous labor was and how overwhelmed you felt.

Jen Shipston, from Queensland, Australia, wrote this about her most recent birth experience:

“When I was pregnant, I was informed, excited, confident and knew exactly what I wanted. I did everything I could to ensure a safe and happy birth. One of the things that was so very important to me was having the birth documented, something I’d also wanted with my second but that did not happen. I booked my photographer/videographer almost as quickly as I booked my midwife! The time came for my baby to arrive. I let my photographer know things had started, and kept her updated in the hours that followed. I called her when things were still quite slow and manageable, but not stopping, because she lived just over an hour away. 2 contractions later my waters broke, and my girl arrived beautifully, into my arms, in water – just as I’d wished for, 50 minutes later. 20 minutes before the photographer arrived. My birth was amazing but I was so disappointed to have missed having it documented. It seemed silly – I had an amazing birth, so something as insignificant as photos shouldn’t matter, right? But those photos/video were not insignificant to me, and I mourned…I can be disappointed about what didn’t go to plan while still being thrilled about my birth experience and completely besotted by my baby. Because that’s just how birth is.”

There’s no need to feel guilt over your feelings. Feelings are what they are.

Birth photographer and videographer Brooke Walsh, also a mom who experienced very mixed emotions about her birth that made it hard to talk about, shares what she’s learned:

“For most women, birth is a mix of glee and sorrow. It’s easy to feel that these divergent emotions don’t belong together, but they are perfectly valid. Somewhere in sifting through them we become better mothers, cognizant of the joy and hard work in our lives with our children as they grow, just as we found in birth. Being joyful about the beautiful moments in your birth does not tarnish the validity of the traumatic moments, nor does accepting and working through birth trauma remove the bliss from your baby’s birth. Sometimes birth is a mystery of divergent elements.”

You may find, though, that there are many in your life who are not willing to hear about how you feel. Hopefully you have someone in your life who will be willing to debrief and discuss with you. You can see if your midwife, doula, or childbirth educator can talk with you. Online, you may find the group Solace for Mothers to be helpful. This group was founded with the sole purpose of providing mothers with a place to work through emotions after a difficult birth.

Locally, I really like the women at The Healing Group for all kinds of support and help during the childbearing year.

I love this article, called “Making Peace With Your Birth Experience” by Kathleen Kendall-Tackett as a resource for helping moms process their birth experience.

If you are a friend, family member, doula, or lactation consultant wondering what you CAN do to help, here are some suggestions:

  1. Listen. JUST listen. Don’t tell mom what you think she could have done better, don’t try to find reasons for what happened, don’t try to make her feel better, don’t try to “focus on the positive” JUST LISTEN with full attention and some occasional reflective listening. Some moms might feel more comfortable talking if you work together on a talk like washing dishes or folding laundry rather than a face-to-face talk.
  2. If she needs to cry, let her cry. Don’t try to console her or make her stop, just hold her and comfort her while she cries.
  3. Don’t tell your birth stories. This is not about you. Your positive birth stories make it seem like you are trying to show you did it better, your difficult stories can turn into a “well I had it worse than you did!”
  4. Let her know you’re willing to listen again another time if she needs to talk. She may not be ready yet. She may need to talk more than once. Sometimes it takes moms a few times to process things. Sometimes they don’t get to the full depth of their experience the first time.
  5. Don’t tell her she can do better next time. While this is true, it does not help her process through THIS birth experience. A better birth next time will not erase this experience. When she’s ready to have another baby, then ask her if she’s open to suggestions.
  6. Don’t tell her to “focus on the positive” – instead allow her to process any negativity so she can move on. And SHE gets to decide when she’s processed enough, when she’s ready to move on.

Becoming a mom (or a mom again!) can be a difficult enough adjustment, let’s all gather around new moms and give them the freedom to feel and process their experiences without judgement, and with plenty of loving support.

When birth does not go as you’d hoped… Read More »

Pregnant woman sitting in ocean waves

Surfing the Labor Waves

Surfing Lessons For Labor“You can’t stop the waves, but you can learn to surf”

This quote (attributed most commonly to Jon Kabat-Zinn but occasionally to others as well) has been commonly used to apply to labor. It is a good one, and one that definitely applies.

Last week my husband and I went to California to celebrate our anniversary. We spent a good hour watching the surfers in the wave.

The beach where we were sitting is in an area considered “advanced” and is dangerous for beginning surfers, so the surfers we watched were the more skilled and experienced surfers. As I watched, I noticed several things about their surfing, and this quote above came to mind. Here are seven of the things I observed (and yes, some of these metaphors are a bit mixed, but let’s just roll with it):

1. None of the surfers rode every wave. They didn’t even ride MOST of the waves. Often, they relaxed and let the waves roll on by without trying to take them on. In labor, particularly the first part of labor, much of labor is about letting the waves come and do their thing without inhibiting them or interrupting them. You don’t *have* to be active. You don’t have to get to standing and riding each and every time. You can relax and bob in the water and let the waves roll on by. Not all waves are alike. Some are small swells that crash too close to shore. Some are large, but collapse too early. Some have a perfect shape. The tides move in and out, but the waves are not always changing in a linear way. You can have 5 small ones in a row, followed by a large one, followed by 3 medium ones and then a much larger one. It’s all good, but you will deal with them differently.

2. While they are waiting for the next wave, they don’t usually spend energy swimming. They rest. Those times between contractions when you can rest are invaluable! And when the surfers rest, they rely on their surfboard to carry them. Laboring takes good support, too. Your partner, your doula, your family, or your midwife can all be the support you need. Most surfers don’t ever want to be apart from their board. They tether it to an ankle to keep it close. Keep your labor support close and connected, too.

3. The waves closer to shore feel safer, but the waves out in the deeper water are often easier to ride and give a better, longer ride. Don’t be afraid to “go deep” in your labor. Deeper into relaxation, so deep you pull your focus inward. Deeper into your own power and strength. I’ve seen many women pull power and strength from deep within that they didn’t even know they had.

4. When they did try to catch a wave for a ride, they often didn’t ever get up. Sometimes they spectacularly wiped out, sometimes they just missed it. And they never let it get to them. They let it go, regrouped, and waited for another try. Sometimes in labor you’ll feel like you can’t manage well. Don’t let it get to you. Let it go, regroup, and try another technique.

5. When they did catch a wave and get a good ride, they rode it for as long as they could. When in labor, when you find a good rhythm and a technique that is working for you, ride it out as long as it is working. I sometimes hear women advised to change every 20-30 minutes. I don’t think an arbitrary time limit serves moms well. If you are riding a wave and surfing well, keep it up until you need to change.

6. The rides never last forever. And when it is over, they head back out to start finding a wave all over again. If you find when you’re laboring that the swaying and moaning you’ve been doing are not working as well as they used to, find another wave to ride. It probably won’t be the very next one, though, so keep trying until you catch a good one.

7. Learning to surf can be a long process. Or a short one. It’s OK if you don’t master it early in the process. As a teenager, I tried and tried and tried to learn to surf. I mastered many parts of it. I could swim out past the breakers with my board. I could identify good waves to ride. I could straddle my board and wait, or lay on my board to rest. I could bring my knees up under me and orient myself to the waves. What I never, ever managed to do was hop up and get my feet under me to stand. Oh, I could do it on the shore, I did it probably a million times. But in the water? Wipeout every single time. But I kept trying. I went out two or three dozen times a summer, for hours at a time. I worked with lots of different people trying to learn. (Every single one of my boyfriends thought HE could be the one to inspire me to make a breakthrough!) But I never did master it and surf the way surfers are “supposed to” do it.
Labor WavesInstead I learned to enjoy and appreciate the parts I could do. Some of my best memories from high school are from those days. I loved being able to push through the breakers and feel strong for moving forward despite their power. I loved lying on my board resting and feeling the warm sun on my back. I loved laughing with friends as we all sat straddling our boards resting out past the waves. I really loved it when a seal would come and play in the waves nearby and I could sit on my board and watch. If I’d given up on surfing after my first try, I would have missed out on many of those good times.
And my many wipeouts taught me how to roll in the surf and not get hurt.

I firmly believe that nearly all labors and births can have those moments of joy. Those happy memories. And there are things to be learned if things don’t go as planned, too. Don’t let complications or changes in the plan take those moments from you. Look for them. Do what you can to make them happen.

Surfing the Labor Waves Read More »

Pregnant person with suitcase

Packing for labor

I know there are LOTS of lists out there for what to pack for labor, but I wanted to post my own. If you’re planning a hospital birth or a birth center birth, this list is for you! (One nice thing about home birth is you don’t need to pack…) You won’t need EVERYTHING on this list, but this will give you some good ideas to get you started!

Header saying "Labor Items" with blurred background image of packing a suitcase.
iPhone showing music playing in a hospital bed next to a person having a baby.

Music This can be a whole post of its own – and someday I will write it. Basically, make two playlists or Spotify lists: one for relaxing music and one for energizing music. You don’t need special music, chances are you already have plenty of music you like.


Lip Balm Bring several of these, because those little suckers tend to get lost during labor. Moms in labor tend to get dry lips and hospitals either won’t have anything you can use, or they’ll give you a small tube of Vaseline and charge you $20 for it.


Tennis Balls Or, if you prefer, racquetballs. As a professional, I prefer racquetballs for their ability to be sterilized between clients, but tennis balls work just as well for personal use. These can be used for a rolling massage on the lower back or pressed firmly into mom’s lower back for counter pressure if she is experiencing back labor.


Unscented oil/lotion Laboring women are really extra sensitive to smell, so I recommend unscented. You can always bring a scented *and* an unscented if you want to give the scented a try. Just have mom take a sniff before you slather it everywhere in case it is too much.


Massage Tools I wouldn’t recommend you go out and buy any, but if you have massage tools around the house that you like, go ahead and throw them in your bag. If they are the vibrating kind, make sure you have batteries – and spares – for them.


Warm socks It’s normal for women to feel cold feet in labor. Sometimes it is the figurative kind (I’ve heard lots of moms say “I don’t think I’m ready to be a mom!” in labor.), but here I am talking about the literal cold feet. Warm socks – several pair – are good to have on hand. The kind that have tread on the bottom to make it less slippery are good if you have them. Or bring slippers.


Food Moms are burning LOTS of calories in labor, and if you’re hungry, EAT. Researchers are proving that food and drink in labor are just fine. Here’s a great article on what kinds of foods are good in labor.


Dim light Sometimes it is hard to get nice dim light in a hospital, especially in the bathrooms. If you’d like to labor in the tub and have dim light, bring some battery operated candles or a smallish flashlight.


Birth Ball Many hospitals have these, but it can be nice to have your own for use in early labor at home, or in case the hospital’s ball is not available. Get a standard exercise ball, sized right for you. I recommend it should be the burst resistant kind, and one that can hold 500 pounds of force at minimum. (I *know* you don’t weigh that much. We’re talking about FORCE, not weight!)

Couple carrying pillows into the hospital for their birth.


Pillow You may or may not want to bring your own. Most hospitals have plenty. But if you’re super attached to your pillow (like I am!) you will want it in labor. If you tend to bring it (or wish you could bring it) when you travel, you’ll want to pack yours. But DON’T have it in a white pillow case! It would really be sad to have it get lost in the hospital linens. Anything but white or close to white!


Fan Some moms really like a small battery operated fan.


Cheat Sheets I always tell my classes “Labor is an open book exam!” It’s OK – and GOOD – to look at your reference materials. Bring any books you read, any handouts from a childbirth class, and have mom make a list of things she wants to try. I also really like the iBirth App and the book “Deliver!” for this.


Birth Plan If you created a written document, print out several copies and bring them. Neon paper is good and helps keep it from getting lost in the shuffle. Give to your nurse, post one on the wall, etc.


Flavors for ice If you’re restricted to ice chips, having something to flavor the ice chips and add a little calories can help. This can be juices, electrolyte drinks, etc. Just no caffeine!


Ziplock Bags I use these mostly for creating ice packs (fill with ice, seal, wrap in a towel) or hot packs (Get a towel soaking wet with the hottest water from the tub or shower and seal it up so it doesn’t drip. Wrap in a towel or gown.) Occasionally I’ve used it to seal up something smelly (like a tuna sandwich with pickles one dad brought!) so mom can’t smell it any more. I bring sandwich size and gallon size and I prefer the freezer kind. They’re tougher.


Band for long hair If you have long hair, you may want to put it up to get in the shower, bath, or just because you’re hot and sweaty. Even if you never wear it up, pack something so you have the option. Most women just use a pony tail holder, but you could bring a clip or a shower cap, too.


Hand mirror I can’t emphasize enough that it needs to be an UNBREAKABLE hand mirror! Some women really benefit from seeing the results of their pushing. This is why many hospitals provide mirrors. Unfortunately, some hospitals mount the mirror to the ceiling (so it only helps if mom is on her back) or they have a small mirror on a big pole. An unbreakable hand mirror can be used in ANY position and has a lot more flexibility. They are particularly useful when mom is squatting, kneeling, or standing to push.

Header saying "Toiletries" with blurred background image of packing a suitcase.



Toothbrush/toothpaste
Because that hairy feeling in your mouth is no fun. And because moms want their partner to have fresh breath!

Assorted toiletries packed in a travel bag


Hairbrush Because it can feel nice to brush your hair out and feel good. Some moms use hair brushing as a labor comfort technique, too.


Contact lens supplies & spare glasses While most hospitals won’t make mom remove contacts for birth, even with a cesarean, if they’re bothering her she’ll want to take them out. And backup glasses so she can still see baby clearly at birth if she takes them out.


Deodorant Remember what I said above about moms being extra sensitive to smell in labor? ’nuff said.


Spare clothes for both partners Labor can go long, it’s nice to have something fresh to change into when it has been 24 hours. Plus I’ve seen moms pull their fully clothed partner right into the shower with them, and then you REALLY want something else to wear! Some partners will bring a swimsuit in case mom wants him in the tub or shower with her.

Basically pack everything you would pack for a weekend getaway, for BOTH parents!

Header saying "Don't Forget" with blurred background image of packing a suitcase.

Camera Since I am also a birth photographer, clearly birth photos are something I value and I would hope most parents do, too. Don’t trust them to just your cell phone camera. Have a better camera on hand, along with spare batteries, a spare memory card, and a charger if it uses a special camera battery. Or just hire a birth photographer and leave it in the hands of a pro. (BONUS! When you have a pro, both parents can be in the photos!)

Close up photo of phone charger


Phone charger Or iPad charger, Kindle charger, or charger for whatever electronics you might be bringing to the birth room. You don’t want your phone to die just before you send out the “BABY IS HERE!” text!


A list of the people you want to remember to contact, so that no one gets forgotten. I would hope that families would cut new parents some slack, but I’ve seen a lot of pettiness over who gets called first, who gets a text and not a call, etc. etc.

Packing for labor Read More »

Partner taking picture of mom and new baby

To tweet, or not to tweet? Social media during labor

Social Media Graphic

Most people would not dream of streaming their birth live on the internet or inviting strangers to be there as a piece of performance art. But just how public and immediate should your birth story be? With social media, it’s easy to have an audience of friends and family waiting for the minute by minute details. If you are thinking about posting your birth on Twitter or Facebook, here are some things to consider:


Who will see it? These days, not everyone you are “friends” with on Facebook is really someone you know. You have even less control over Twitter followers. Do you really want relative strangers knowing that you are away from your home and will be for quite some time? Do you want them knowing the current status of your cervix?


What will others do with the information? You can control what information you put out there. You cannot control what they do with it. I have seen family members show up to the birth – uninvited – after seeing on Facebook that mom was in labor. It got awkward since the parents did not want them there. While you might want to have people thinking of you and sharing your joy in real time, it also means they are waiting for a follow up. Once you put it “out there” that you are in labor, expect a large response of people calling/texting/posting wanting updates. It might make it difficult to focus on your labor.


What will you do with the responses you get back? Similarly, the responses you get may not always be supportive and positive. Some people have nothing better to do than to criticize the choices of those around them. I had one instance where mom was planning a home birth but when complications arose transferred to the hospital. Her husband had posted on Facebook hoping for support from friends and family but instead got responses like “Good! Home delivery is for pizza, not babies.” and “I told you that you’d never be able to do it naturally.” Both comments hurt the parents feeling deeply at a time when they were feeling scared and vulnerable about the change in plans. Might be a good idea to have someone else filter out the unhelpful comments you may receive back and only pass on the helpful stuff.


I urge you to think carefully about what you put out there on the internet. Sometimes staying off the radar until the big “It’s a GIRL!” or “He’s HERE!” announcement might be the wisest thing to do.

To tweet, or not to tweet? Social media during labor Read More »

The Birth Plan of ACTION!!

You can find boatloads of information out there on birth plans. But most of them miss what I consider to be the most important part: Putting The Plan Into ACTION!

I consider there to be 4 steps in writing a birth plan:

  1. Researching your options
  2. Deciding what is important to you and what you want
  3. Writing the document
  4. Carrying out the plan

We will briefly go over the first three before discussing that fourth, often forgotten step.

STEP 1: Researching your options

There are the major choices like

  • Where to birth (home, birth center, hospital, WHICH birth center or hospital)
  • Who to hire as your care provider (Midwife, Family Physician, Obstetrician)
  • Hiring a doula
  • Whether to use pain medications or not

and more minor decisions like

  • Which music to listen to during labor
  • What to wear in labor
  • To tweet or not to tweet

Consider all your options and figure out the pros and cons of each.

STEP 2: Deciding what is important to you and what you want

Once all the facts are in, spend some time deciding what is most important to you and what you want. For some, birthing with a midwife might be more important than whether or not they hire a doula. For someone else, the doula might be more important than the place of birth. There is no one RIGHT answer to all of these options, only the right answer for YOU.

If there is something you do not have a strong opinion about, it does not need to be in your birth plan. Save the most important topics for your plan.

STEP 3: Writing the document

Does the thought of doing this make you cringe? That’s OK! You can totally skip this step if you want to! While having a written birth plan can be an excellent communication tool for the nursing staff, the document is not what birth planning is all about. Everyone has different planning styles. Some people like to just think about what they need to do that day when they shower in the morning. Some like to make a list on the back of an envelope (that’s me!) and some like to have color coded calendars. All are perfectly valid ways of planning.

If you want to just think about and discuss what you want, that’s plenty. And you can skip to step 4!

If you’re interested in a formal written birth plan, keep reading!

Some tips for a written birth plan:

  • Make it yours! Don’t do a checkoff plan from the internet. You are not ordering off a menu, and you want the written plan to accurately represent the time and consideration you’ve put into it.
  • Keep it to one page maximum! Bullet points are nice. This is where prioritizing is very important!
  • Keep it positive in your wording. Your aim is to enlist the staff’s help in achieving your goal, not to put off the staff with “NO this, NO that!” I like to suggest wording like “I plan to birth unmedicated and you can help me by encouraging me to stay active and suggesting techniques you think may help.” or “Since I am planning a HypnoBirth, I would appreciate it if you would chart “Patient declined” instead of asking me about my pain levels during labor.”
  • Address any non-birth related issues that you think might be helpful. I have had clients use the written birth plan to remind the nursing staff about Latex or iodine allergies, request a special diet, and inform the nurse how to best communicate with a client who was deaf and needed to lip read in order to understand the nurse.

Step 4: Carrying out the plan

THIS is where most birth plans fall apart, in my experience. Just like browsing Pinterest for 600 hours won’t get you the wedding of your dreams, writing the document without doing anything to make it happen won’t increase your chance of getting the birth that you want.

Some important things you can do to carry out your plan:

Laboring mom’s best friend providing great active support.
  • Choose a birth place that does births similar to what you want on a regular basis. I have had many friends and neighbors choose to go to the hospital close by, just because it is close. They plan for and want a natural birth, but they have chosen to birth in a place with very high induction, epidural and cesarean rates. And (not surprisingly) they have a very high chance of being induced, getting an epidural, or having a cesarean.
  • Choose a care provider who practices in the way that you hope to birth. A perfect example of this is episiotomy rates. I have yet to meet a pregnant woman who wants an episiotomy, so they often discuss it with their doctor or midwife. Invariably, they get the response “I only do them when necessary” so they feel good about that – but they don’t realize that everyone’s idea of “necessary” is very, very different. I’ve known providers who do 1-2 a year, and I once heard a doctor say that his idea of necessary was “every first time mom needs one, and every mom who had one before needs another one.” Dig deeper. Ask how often they do one, ask if they think you will need one, ask how they can help you not need one. But look closely at the care providers you are considering, and don’t be afraid to change in order to get care that is compatible with your values!
  • Take a GOOD childbirth class, actually go, and PRACTICE what you learn! I’ve had moms tell me they only went to 2 of the 5 classes, never practiced a thing, and then be disappointed that hypnosis “didn’t work” at all. Practice will help you to master the techniques before you need them.
  • Build a birth support team that will build you up and help you reach your goal. Choose carefully who will attend your birth. I hope you’ll choose to hire a professional doula (maybe even me? :)) and bring others who are supportive of your goal. If your mother thinks the natural birth you’ve planned is a stupid idea, you probably don’t want her fretting in the corner about how hard it is to watch you in pain (been there, seen that!). If your sister thinks epidurals are an anti-woman plot by the paternalistic misogynistic health care system, and you plan to use an epidural, maybe she should wait out in the waiting room. (Also been there, seen that!) You deserve to be surrounded by supportive, helpful people, not Debbie Downers!

So you’ve gone through all four steps, and your Birth Day is finally here! Will it all go exactly as planned? Not too likely. Keep in mind that life rarely goes exactly as planned, and birth is no different. If things do happen and you have to adapt your plan, that’s OK. It does not mean you need to give up EVERY aspect of your plan, it just means you have to improvise a little. Writing a birth plan is not writing a script, but rather a process to help you get the birth you wanted. Staying in the game as an active decision maker is an important part of having a birth experience you can remember as a good experience, and that is possible in just about any type of birth experience.

If you want to learn more about birth planning, and get my downloadable birth planning templates, you can sign up for my Birth Connected Childbirth classes, with online learning and personal support, or just sign up for the Birth Planning module.

The Birth Plan of ACTION!! Read More »