labor

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!

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.

Don’t plan your wedding!!!

Don't Plan BirthI’ve really gotten tired of it. Pregnant women who are planning for a specific kind of birth are told things like:

“You know what is so cute? You – when you’re pregnant and think you actually control how things go in the delivery room.” -ScaryMommy

“I encourage my clients to create “birth preferences” rather than a “birth plan.” In this case, semantics are important. By writing your preferences instead of a plan, you maintain the understanding that circumstances beyond your control may change and you’ll need to adapt your preferences accordingly.” -Fit Pregnancy

“Since you can’t plan how your labor and birth will unfold, I prefer to talk about your birth wishes or birth preferences than your birth plan.” -Motherscircle.net

“If my births and every single birth story I’ve ever heard is any indication, birth follows anything but a plan.” AnHonestMom.wordpress.com

“The word “plan” in reference to normal, unmedicated birth is pretty silly, actually.” – Facebook post

Why is it that when it comes to birth, women are shamed and told they should not expect to have any control? Birth is life. Life is unpredictable, in any given day you may have “circumstances beyond your control may change and you’ll need to adapt” – but no one says that we should not take time to plan out our day to make things run smoothly and we don’t miss anything we need to do! When I am teaching about birth plans in my classes, I ask for a show of hands who in the class had some plan for their day when they woke up this morning. Nearly everyone raises their hand. I ask how many had their day go exactly as planned – and most (if not all) of the hands go down. And yet somehow, in pretty much every class, someone talks about how the plan helped them adapt and/or prioritize when things went wrong.

Think about another significant event in the growth of a family: A Wedding.

Would it ever be OK to tell a prospective bride something like:

“The word ‘plan’ in reference to a wedding is pretty silly actually. After all, things go wrong at weddings all the time!”

“If my wedding horror story, or the ones I’ve read online are any indication, weddings follow anything but a plan!”

“Since you can’t control the weather or the behavior of your guests, I think it’s better to think of it as ‘wedding wishes’ or ‘wedding preferences’ rather than a plan for your wedding.”

“As a wedding planner, I encourage brides to create ‘wedding preferences’ rather than a ‘wedding plan.’ In this case, semantics are important. By writing your preferences instead of a plan, you maintain the understanding that circumstances beyond your control may change how your wedding day will go and you’ll need to adapt your preferences accordingly”

“You know what is so cute? You – when you’re engaged and think you actually control how things go on your wedding day.”

PinterestWeddingI sincerely doubt anyone would dare tell a bride any of that. And yet, things go wrong at weddings all the time!

Instead brides are advised things like this:

Unexpected Wedding Disasters and How to Handle Them

Wedding Planner Disaster Stories – and How to Avoid Them

Top Wedding Disasters and How to Plan for Them

Not a single story I read on weddings mentioned avoiding planning as a way to make the day run smoothly. Huh.

They all mentioned planning well, carefully evaluating the people who you hire, having backup plans, and thoroughly evaluating your options.

Sounds like a Birth Plan of Action to me….

Go ahead and plan for your birth. Yes, PLAN. Not “Wishes” or “Preferences” but actually plan for and put your plan into action. No, it’s not a script or a guarantee, but it does significantly increase the chances of having the birth you want.

Wednesday Wrap Up January 20

WednesdayWrapUpAThis is so true, and something I have tried to convey to the women I work with. If you don’t like the care, and it’s not a good fit for what you want, move on. Take your health care dollars elsewhere!

Maybe I loved this so much because I can relate, but I really appreciated how this letter to the bloggers and writers who want to feature birth photography addressed the issues we face as birth photographers. I’ve been there, and it’s not fun.

There is some irony in the fact that this article is published….on the internet. But it’s a good one anyway: 4 Things You Can’t Learn About Birth On The Internet

I have explained this to so many parents, it’s a ridiculous conundrum. Why Most Private Practice IBCLCs Don’t Take Insurance (Hint: Probably better phrased as “How Most Insurance Companies Get Out of Paying for Mandated Breastfeeding Services”)

Great overview of why cesarean rates are high, and how they can be lowered. I found it really interesting to see what step had the biggest impact in this pilot program in Southern California.

Newborn looking at mom after birth

My favorite moment at births

There are many things I love about births. I love seeing women be strong and powerful. I love seeing the relationships between partners and the way partners step up and provide just what is needed, or say just the right thing at just the right moment. I love the humorous moments – and a time or two the parents and I have had an inside joke by the end of the birth.

But there’s one thing that I see almost every time, and it gets to me every single time. Not unusual for me to have the tears start welling up at that moment. It’s that moment when a parent makes eye contact with their baby for the very first time.

Newborn looking at mom after birth

Often that sweet moment comes soon after birth, when mom is snuggling that baby skin to skin and baby lifts their head up to look at mom eye-to-eye. Often there will be sweet words for the baby “Oh how I love you already!” or “Hi, I’m your mommy and I love you fiercely!” are two from recent memory.

Generally a little while later comes the moment when the other parent gets a chance to hold baby close and stare into their eyes. This sweet little girl even reached up to touch her mama’s cheek!

Newborn touching mama's cheek

I’ve loved and appreciated these moments throughout my entire doula career, but it’s only in the last few years when I’ve been doing birth photography that I’ve been able to capture them and share them with the families I serve. I hope you enjoy this collection.

Venn diagram of the three kinds of birth doulas

There’s more than 1 kind of birth doula?

Venn diagram of the three kinds of birth doulasIt’s been at least a decade since I first heard of the concept of birth doulas with different ways of looking at the job, and it has been an interesting concept to consider as I’ve come to know other doulas and mentor new doulas just starting it. I feel it can be a useful concept for parents considering which doula can best help them meet their goals as well.

At some point in the first 2-3 years of being a birth doula, I took a little quiz that categorized doulas into three types:

Birth focused – These doulas were focused on helping moms have the kind of birth that they felt was the best. They are the ones who are advocating for all low risk women to birth at home, for midwifery to be the standard of care unless higher level care is needed, and who have in mind an ideal birth they’d like to help their clients achieve. They tend to be huge fans of birth plans and often align themselves with specific methods of childbirth. Some doulas who have this philosophy will work only with out of hospital birth, and many go on to become home birth midwives.

Baby focused – These are the doulas who view everything about birth through the lens of the impact on the baby. They tend to be attracted to the work of APPPAH, to encourage mothers to talk to their babies and to be huge proponents of skin to skin bonding and breastfeeding. Many doulas who philosophically fall in this area tend to be very much against circumcision, routine newborn procedures, and formula. They can be passionate and valuable advocates and supporters of moms who have similar philosophies.

Woman focused – These are doulas who are most concerned with mothers feeling supported in their decisions and having the power and right to make decisions for themselves. They have an easier time supporting moms who make decisions that they may not have made for themselves. They tend to work in homes, hospitals and birth centers somewhat equally, and can support women planning everything from a planned cesarean birth to an induction with epidural to a home waterbirth or lotus birth.

Now these three types of philosophies are not at all mutually exclusive, nor are they unchanging and constant. As doulas learn, grow, and see more births, their thinking often changes. I would say that when I started out, I was definitely more birth focused, but over time I have become more woman focused, though I still do have quite a bit of overlap between the two with some baby focus thrown in there for balance. I feel pretty passionately that there is not any ONE way of giving birth that is “correct” for everyone, and I firmly believe parents have the right – and should be trusted – to choose what is best for their family.

Want to take the quiz for yourself? You can find it here: What Kind of Advocate Are You?

I don’t think that any one focus of a doula is necessarily any better than any other, but I do think it is important for parents to consider if the doula they are interviewing has a focus that is a good match for them. Most doulas will (like me) have quite a bit of overlap, but often there is one area that is more passionate for them, and it sure comes out when doulas talk about what drives their work and motivates them to do this job. You’ll hear it in their tone of voice, in the fire in their eyes, and in the power of their words.

One thing to watch out for is the doula that ProDoula founder Randy Patterson calls the “Birth Avenger” style of doula work. I’ve seen many times that new doulas come to this job because they had a horrible birth experience and they want to “save others from what happened to them” – this can create a really difficult situation when the doula has not processed and resolved her difficult birth experience. I’ve heard from a doula that she had to leave in the middle of a client’s birth because “she was going down the same road I did and I could not stick around for the train wreck” that she believed was coming. It was her last birth as a doula, she dropped all her remaining clients and left the field. I’m sure the client felt abandoned at a vulnerable time as well.

I’ve counseled doulas who were retraumatized by attending births at the hospital where they delivered – even if all went well.

Let me be clear here: Having experienced birth trauma does not mean a woman can never be a doula. It does mean she should do whatever it takes to process and heal from her birth trauma before attending other women’s birth. It may mean she sets boundaries such as not working with a specific place of birth or provider, too.

Being aware of what drives a doula philosophically is an important thing when practicing as a doula or when choosing which doula to hire. Not all doulas are alike, and find a good match in style, philosophy and personality is crucial for a good working relationship with your doula.

Wednesday Wrap Up Sept 24

WednesdayWrapUpCSymphysis Pubis dysfunction is a painful (and surprisingly common) complication of pregnancy and can progress to a full on separation. One woman’s experience and some tips for working through that kind of pelvic instability are here. I would recommend a women’s health physical therapist as well as a chiropractor.

Fear of labor can be just a normal thing in pregnancy, but it also can escalate to a phobic level, and this article talks about why and how we can help.

ACOG, the American Institute of Ultrasound in Medicine, and the
Society for Maternal-Fetal Medicine have issued new guidelines on estimating a due date in pregnancy. I’ve seen some crazy, crazy things happen when providers move around due dates as late as during labor. I love that they still call it “estimating” and that they discourage making small changes in the second & third trimester.

An interesting way to preserve and remember your breastfeeding experience. Would you do it?

14 ways to use the birth ball. Practice all of these and adjust/adapt to your own body and birth!

Here’s a great video on how to find and paint your baby’s position on your belly.

Wednesday Wrap Up August 13

WednesdayWrapUpNNo one, NO ONE, has the right to decide for a woman if her birth was traumatic or not. My Traumatic Birth, According to Me

One of the frustrations about living in Utah. People are so afraid of seeing women’s bodies they do things like call the police over a breastfeeding booth at the Farmer’s Market.
Thankfully the chief of police is well versed in Utah’s laws and handled it well.

And to get my blood pressure down again, I could use of these apps to learn relaxation and meditation in pregnancy.

A new Pinterest board you might want to check out “What Childbirth Educators Want You to Know About Birth”

I’ve already shared a bunch of funny pregnancy announcement videos, but I found a new one that is a fun one:

Wednesday Wrap Up July 30

WednesdayWrapUpNFor two out of my three pregnancies, I chose not to find out if my baby was a boy or a girl. I *loved* the anticipation of not knowing and the moment of surprise at the birth. (For the third, I let my husband get his way and find out. Naturally, he refused to believe it was another girl until she was born, despite making the guy go back and look again FIVE TIMES….) If you’re not sure you want to know, here are 8 reasons to not find out.

Fifteen things no one tells you about motherhood while you’re pregnant. There are a lot of lists like this out there, and I find that most of them are things people DO tell pregnant moms, but they are interesting anyway. I love the last one here.

Loved this explanation of how dads can bond with their baby.

5 Things NOT to say to a woman with postpartum depression – and what to say instead. There needs to be more articles like this. I have heard every single one of these said to or about moms struggling with depression.

Since I also do professional birth photography, I loved this short video on capturing this one of life’s poignant moments, from New Zealand birth photographer Keri-Anne Dilworth

Birth – First Light Birth Photography – Auckland, New Zealand from Keri-Anne Dilworth on Vimeo.

Wednesday Wrap Up July 16

Wednesday Web LinksLast week, Rebecca Dekker of Evidence Based Birth released a much anticipated review of the literature on waterbirth. She includes a critique of ACOG’s statement from earlier this year on the subject.

The Lamaze International blog Science and Sensibility has an exclusive Q&A with Rebecca Dekkeron the topic that I found interesting.

Improving Birth published a response discussing how moms demand and deserve better use of scientific evidence.

The American Association of Birth Centers released its own opinion on the subject, saying that it needed to “ease inappropriate fear about the safety of water birth and provide childbearing families access to accurate water birth information.”

If you’d like to read the original ACOG Opinion that started all of this, you can find it here.

Naturally, today’s video is from a waterbirth! Laura Paulescu of Crowned Photography in Seattle put together this great video. I love the baby’s hand coming up to mom’s cheek and how closely she hugs him!

The birth of Cody Taylor | Waterbirth at Mountain Midwifery Birth Center in Denver, CO from crownedbirthphotography on Vimeo.

Wednesday Wrap Up July 9

WednesdayWrapUpKNice rundown of what you need to know about Breastfeeding and the Workplace.

I wish these stories did not need to be told. But they do. Sadly, some people cannot accept that birth trauma happens at all, and of those who acknowledge it, many feel it is a mother-only thing. But Birth Trauma is Not Just for Mothers, as this father’s story shows.

A follow up to a post from last weeks story about a mom who had a positive breastfeeding experience in Starbucks. When the story went viral, it was not exactly what the mom had anticipated. Here are her thoughts on The Disturbing Trend I Noticed When My Breastfeeding Story Went Viral.

If you can’t laugh at yourself, you’re not having enough fun. The Onion takes on home birth.

A look at how fear plays a role in the low numbers of VBAC births. Do Malpractice Threats – Real or Imagined – Lead to More C-Sections?

It *is* important to get the terms right! Notes on postpartum mood disorders

An illustrated example of why it isn’t so simple as “just cover up” when nursing in public.

Today’s video is a small teaser snippet from an upcoming movie called Trial of Labor – all about VBAC. In this clip, you’ll learn more about the obstacles moms face when planning a VBAC.