1. What type of care provider do you want to support you?
2.Personal support people
Who will be with you during your birth?
Will you consider using a birth doula? A birth doula is someone you should trust and feel comfortable with. Ensure they are the right fit for you and all other support persons at your birth. Look for a doula who is trained and supports your birth choices.
4. Educational Support
How will you prepare for your birth? Have you considered taking childbirth education classes? Research and take a class that is geared to the type of birth you want. For example, do not take a class that talks mainly about hospital birth if you are planning a home birth and vice versa.
If you are planning on breastfeeding a preparation class can lead to greater success. It also connects you to a great resource person if needed later.
5. Birth Photography
Some people would like their birth captured by a professional photographer. How do you want them to be involved? It is important to have clear expectations of them. Make sure your personalities mesh well together, although they are there to document your birth, a negative energy could impact you in ways you don't expect.
I started my second pregnancy thinking I would have a scheduled repeat c-section. It was not because I wanted to. I have a tainted record in the world of medical obstetrics. Scarlet letters on my operative report that read "should be advised not to attempt vaginal birth."
My story is best explained with a little background about my first birth experience.
My first child was born by an unplanned cesarean section in 2010. This was due to complications resulting from her un-diagnosed double footling breech presentation. By the time I was prepped for surgery, I had delivered her up to her shoulders but due to the lack of training of the hospital staff, her head became trapped and I was rushed to the OR. She was so stuck in my birth canal the doctor extended my incision vertically (resulting in what's called an inverted-T incision). I recall the surgeon telling me after the surgery "you can have as many babies as you want but they will always have to be delivered by c-section". He also wrote in my report that my incision was "large". He explained to me it was larger than normal because he had such difficulty getting my daughter out. I was so relieved my baby was ok that I didn't let what he said sink in until years later when I began to plan another pregnancy. I just nodded and accepted what he said without question. The first two years of my daughter's life were dark and difficult for me. I suffered from thyroid disease and postpartum depression and anxiety.
After healing myself through counselling, my husband and decided to expand our family. I found out I was pregnant with my second baby in August 2014. It had been almost 5 years since my traumatic c-section. Within the first week I started searching for midwives and I hired a doula, Julie. I'd heard of the many benefits of having a doula and knew if I had to have another c-section I wanted a postpartum doula to help me in those first few weeks. I didn't think a vbac was out of the question at this point but I knew it would be a long road and a fight to find a supportive care provider. It was important for me to have a doula during the postpartum period but especially if I was attempting a vbac.
I began chiropractic adjustments with a Webster certified chiropractor at 7 weeks pregnant and continued seeing her throughout my pregnancy (highly recommend!). I called around a few places and got accepted into a midwife group that was close to home (I didn't mention my special scar over the phone). I figured surely I'd have better luck with midwives than an OB. My very first appointment, I presented them with my surgical report and my desire to vbac. The midwife left the room to talk to her superiors and when she came back she told me that a vbac was too risky, because of an increased risk of rupture, and while they couldn't force me to have a c-section they wouldn't recommend a vbac and sternly advised me against attempting one. She referred the ACOG guidelines and said that I was not a candidate for vbac. I haphazardly agreed to the surgery because I didn't want to lose midwife care. I had yet to discover that all midwives in Ontario are regulated by the government. There are no "home birth only" midwives in Canada. They are as I now like to call them "MEDwives" (medical midwives). I was so happy to be in the care of midwives I didn't realize I was not being supported in MY choice to vbac. I already knew it was possible and had spent hours researching the risks but felt powerless to fight against the force that is technocratic birth in this country. Every time I sat down to write a c-section birth plan, something didn't feel right. Tears would well up just thinking about walking into an OR, being injected with drugs and strapped to the table. No immediate skin to skin. The weeks of recovery and pain afterwards. The risks from complications and impact on my baby and any future pregnancies. How was I supposed to take care of a newborn and a 5 year old and recover from medically unnecessary surgery? How could I willingly do that to myself? Don't get me wrong, I realize that c-sections save lives and if it was medically necessary for me to have one, I would! But I knew VBAC after a special scar was possible thanks to the Special Scars ~ Special Women community. I just had to fight through my fear of the unknowns. I found the best way to do that is empowering myself with knowledge. My husband had heard what the midwives were saying and he was unsure of me attempting a vbac at first and it was important to me that he felt comfortable with this decision. I needed him to have confidence in me and the more we talked about it, he came to agree that I should at least try to have a vaginal birth. He became my biggest supporter. We learned to educate ourselves, do our own research and question everything. He came with me to my prenatal appointments when he could and didn't hesitate to call them out when they didn't have answers to our questions. The small study available (Landon Study, 2004) did nothing to gain support of my midwives who tried their best to convince us a vbac was not a good option for me. One midwife told me that me and my baby could die, right in front of my 5 year old daughter, without any regard as to how that might affect her. This was extremely unprofessional. What that midwife fails to understand is there is no such thing as a risk-free birth. Women without a scarred uterus can rupture. There are no guarantees. I remember emailing Julie and admitting to her that I felt selfish for wanting a vbac. I was so glad when she assured me that I wasn't being selfish and she happily listened while I vented all my frustrations. She got in touch with her contacts and recommended some midwives closer to Toronto that might support me. I did find young midwife who wanted to help me. She pleaded my case to her superiors but was ultimately unsuccessful in gaining their support. These midwifery practices have huge insurance premiums and they don't want to take any risks no matter how small. I returned to my original midwives for a prenatal appointment. They tried to appease me by referring me to a local OB for a consult. When I met with him the first thing he said was "you cannot have a vaginal birth". He then told me some scary stories (scare tactics) and I walked out of his office feeling angry but not defeated. I would not let him or any provider make me cry no matter what horrible things they said. On the bright side at least he wasn't a bait and switch! There was something he said that disturbed me. He said that if I showed up to the hospital in labour they could do a c-section with or without my consent. I was horrified at the thought of this. It was at this time I started researching unassisted childbirth. I felt backed into a corner and it seemed like a better option that being forcefully cut open for no valid medical reason. I love everything UC stands for but it's not for everyone. Ultimately, I couldn't take the responsibility for my own birth, which makes me sad but it was the best decision at the time.
At 28 weeks pregnant, I fired my midwives. I couldn't put up with the bullying anymore. It was too stressful. I wanted to enjoy being pregnant. I contacted my local ICAN chapter. I was referred to another midwife group that had supported a mama who wanted a home birth after 2 c-sections. I thought they might give me a chance. When I met with them, they still refused me as a patient and said if I chose to schedule a c-section they would be happy to have me as a patient. Uh, no thanks! Before I left, the midwife made sure to tell me 3 different horror stories (scare tactics again!) about uterine rupture. I was glad they didn't accept me into care, I didn't want MEDwives again anyway.
Thankfully another member of ICAN, and coincidentally a mama with a special scar herself, referred me to an OB who had supported her desire to vbac. I tried to remain optimistic but thought it wasn't likely he would support me because my incision extends into the upper segment of my uterus, which is a slightly higher risk. After doing a background check I discovered this OB was leading a task force to lower the c-section rate at his hospital and had a great reputation, I walked into the appointment cautiously optimistic. I told myself if this OB wouldn't support me with a vbac, then I would just book the c-section and be done with it. I didn't have any fight left at this point and just wanted to stop worrying about it. I was so nervous walking into the appointment. I was afraid of more rejection, I considered not even telling this OB about my T-incision but my husband convinced me that wouldn't be a good idea and I eventually agreed. After the initial paperwork and routine check up we started talking about a vbac. He saw it had been 5 years since my c-section and it was for a breech baby so he thought I was a GREAT candidate for a vbac. "but...I have a T incision" I admitted to him. He shrugged and said "in that situation they would've had to T it up". Like it was no big deal. I will never forget that moment. I was shocked/relieved/nervous/excited all rolled up into one. I was so elated leaving that appointment!
I threw myself into preparing for a natural vaginal birth. I let Julie know right away and we started planning for a vbac! About a week before my due date, pre-labour started. I had mild contractions during the day about 10 minutes apart but they would stop at night and they weren't painful. I continued about my normal routine and hit the gym every other day or so just walking the track or bouncing on an exercise ball. I did yoga, swimming and weight training all throughout my pregnancy. I wanted to be as healthy as possible and do everything in my power to ensure a good outcome. The day I gave birth I was at the gym, which makes most people laugh or think I'm crazy but when I tell them about my labour/delivery, its easy to see the benefits of a healthy and active lifestyle. I had sent my husband to work that morning and my mother-in-law picked me up for our usual class at 8:30 am. I decided just to bounce on an exercise ball during the class and I also walked the track. After about an hour on the track, my contractions picked up and were about 5-7 mins apart. I texted my husband and told him to come home. Once I got home from the gym my contractions slowed down to about 10-15 mins apart so I took a nap and told my husband there was no rush but he came home anyway. About 3pm my husband left to pick my daughter up from the bus stop and I was folding a load of laundry when I felt a pop and a gush. My water broke! I sat on the toilet and more fluid came out, nice and clear. My husband returned with our daughter and I told him what happened. I wanted to think I had lots of time before active labour would kick in but the contractions picked up almost immediately. I had a shower while my husband loaded up the car and called my mother-in-law to come pick up our daughter. Julie arrived and she asked me what I wanted to do. My plan had been to stay at home as long as possible but I felt like I needed to get to the hospital. I felt like once I was there I could relax and focus on birthing my baby. I told Julie "I just want to go to the hospital and have the baby." So we left. On the way there my contractions were only about 2-3 minutes apart but I was still talking through them and returning to normal in between. It was about a 35 minute drive. Finally we got to the childbirth centre. I went into triage and the nurse checked my cervix. "You are 2-3 cms dilated and 80% effaced. Unfortunately we don't have any rooms or doctors available so I want you to walk around the hallway for an hour and then come back and reassess. If anything changes before then come back." So we set off down the hallway. At this point my contractions were very intense and coming fast. I was getting tired and just wanted to sit down. So we sat in the hallway and I laboured while people walked by. It was weird because I'm a private person but luckily it wasn't too busy. I stayed calm and composed (Julie later told me she couldn't believe I went through transition so composed) I tried my best to relax through the contractions and not fight them. It was pain with a purpose. It had been about 45 minutes when I felt the contractions change. I was no longer comfortable sitting and when I stood up I grabbed onto my husband I said "the baby's coming out! I feel pressure." Julie ran to triage to tell the nurse we were coming back now. I had another contraction on the way in and I knew the baby was coming because I felt like pushing and started making those grunting sounds everyone talks about. "Don't push!" someone told me but I couldn't help it my body was taking over. They got me onto the stretcher and checked my cervix. "The head's right there!" The nurse said. She ran out of the room and called the OB. My husband heard her say I was fully dilated and before I knew it they were running with me on the stretcher from triage into a birthing suite. This is when I realized, the hard part was over. All I had to do was push my baby out. I was so happy. "I'm going to do it!" I remember saying. Once we got into the birthing suite, I crawled onto the bed while all the nurses gave each other high fives. "We didn't have a baby in the hallway!" one nurse laughed. They couldn't believe how fast I went from 2-10 cms. The OB on-call came in and her cell phone rang. She picked it up and said "I'm going to have to call you back in 15 minutes." My husband looked at me and said "were going to have a baby in less than 15 minutes!" The OB then told me on my next contraction to hold my breath and push and while it was weird at first (as I was used to breathing through the contractions and not holding my breath) by the second contraction I pushed again and my baby was born. "It's a boy!" My husband told me. "It's really a boy?" I was shocked...I thought for sure he was going to be a girl! "Yes! Look!" someone lifted his leg and yep he was a boy. I was elated!! "That was awesome!" I said, and everyone was laughing. "Did she just say that was awesome?" I heard a nurse say. "I've never heard anyone say that!" Then another nurse asked if she could take Bryce to weigh him while I delivered the placenta and got my one stitch from a small tear I had. They brought him back for skin to skin and he latched on to my breast right away. My husband was amazed that a baby only a few minutes old had such a good sucking reflex.
And so, I rocked my un-medicated VBAssC with Inverted T (vaginal birth after special scar). Just like that. Active labour was less than an hour and my 7lb 6oz son was out in 2 pushes. I'm proud of myself that I didn't give up and that I pushed through all of the opposition I faced. I questioned myself many times but I conquered my fear with knowledge and committed myself to doing everything I could to ensure a good outcome. I kept up my fitness regimen and incorporated spinning babies techniques into my daily routine to help ensure optimal fetal positioning (this is so so so important!!!). I believe the regular chiropractic adjustments helped immensely to correct misalignment's in my pelvis, and allowed my baby enough space to rotate into an optimal position. I also owe my success to my supportive birth team. Julie was a great friend, resource and support. My husband, who advocated for me and had my back and my OB who treated me like a normal patient without a scar. We all worked together and I was able to achieve something I once thought was impossible. I'm so thankful to have had a healing birth experience and I will continue to support, educate and inspire women who are fighting for their right to give birth how they want.
"Whenever and wherever you give birth your experience will impact your emotions, your mind, your body for the rest of your life." - Ina May Gaskin
A special thank you to Renee for writing and sharing her birth story!
February is the month of love. The perfect time to talk about oxytocin, also referred to as the “love hormone”. Oxytocin gets its name for the role it plays in intercourse, fertility, contractions during labour and birth, and the release of milk in breastfeeding. During labour this “love hormone” stimulates powerful contractions, which causes your cervix to thin and dilate in order to give birth to your baby. There are many ways to increase oxytocin in labour naturally. A heated topic of debate is the use of a drug called Pitocin, which was created to mimic oxytocin. Although Pitocin was created to work like oxytocin, it functions differently in our body.
You may have heard care providers use the term oxytocin and Pitocin interchangeably, or refer to them as the same thing. They may seem the same but they work differently. Oxytocin is a hormone created naturally in your body, whereas Pitocin is the synthetic drug created to mimic oxytocin. How do they work differently? Oxytocin never shows up to the party alone. It invites friends, more specifically calming and pain relieving hormones known as endorphins. These endorphins increase during your labour to allow you to cope and flow with the surges. Pitocin is a bit of a loner when it shows up to the party. It doesn’t bring anyone with it. Instead of contractions coming on slowly and allowing your body to adjust to the surges on a more gradual level, contractions with Pitocin may come on quicker, stronger, and feel more painful. Without our friends (endorphins) to tag along, our bodies struggle to stay calm and navigate through the surges of labour. It’s a shame Pitocin doesn’t have more friends like oxytocin.
So in what circumstances might we need Pitocin? Your care provider may suggest Pitocin for a number of reasons.
- Labour has not begun on its own
- You have been stuck at 5cm for hours and hours
- An epidural may have caused contractions to slow down or stall
- Augmentation is required because the membranes have broken but contractions do not start
Pitocin isn’t always unnecessary, but it does change how you will labour. If you can avoid Pitocin and get that oxytocin flowing naturally it can really benefit your labour and birth.
How can we get oxytocin flowing in a momma in labour? Lots of ways! It’s as simple as touching or hugging someone. Hugging someone you love will release oxytocin. I encourage couples to slow dance and hold each other during contractions. This closeness with the one you love is really beneficial, as are hand holding and kissing, even finding a quiet spot to fit in a smooch or two. Music, soothing music during labour can help you feel calm and relaxed and keep the “love” flowing. Laughter, if you can find a way to laugh throughout your labour this is key, not just for the oxytocin factor but to help relax those tense muscles. Deep breathing stimulates our relaxation response which allows for our “feel good” hormone (oxytocin) levels to increase. Massage and other forms of touch will allow for positive feelings and decreased pain. Even during nipple stimulation, oxytocin is released in the body. Nipple stimulation is gently rubbing or rolling the nipples, or suckling the nipple. This technique is often used to try to induce labour naturally. Don’t worry, it’s generally not your doula doing the stimulation. Oxytocin is also a very important hormone to breastfeeding. It allows the milk ejection reflex to occur, otherwise known as the “let down”. When you are breastfeeding, the oxytocin stimulates uterine contractions that help contract and return your uterus to its pre-pregnancy size. This love hormone is released when we breastfeed our babies. It helps us to bond and fall in love with them.
Pitocin vs. Oxytocin is a great debate that is talked about a lot in the birth community. This article is not really about the great debate but more about how to get the best experience from your birth. I believe using natural ways to get oxytocin flowing in your body is a great start! So my friends, LOVE ON!
Doulas support birth... Yes even ones with epidurals!
When people learn I am a Doula, I hear a variety of responses. Lately this one keeps popping up. “I want an epidural, hook me up to the drugs!” So often it is assumed that doulas and epidurals don't mix, that they can't go together. Plenty of my clients choose to have epidurals, some tell me on our very first visit that it is a must.
Doulas are there to support the birth you want. Home birth, hospital, birth centre, epidural, or no epidural. When I support my clients I use my skills, experience, and education to provide the best support I can based on their birth plan.
So what does a doula do when you have an epidural?
When you are in labour you will have to experience some contractions before being given an epidural. Having a doula will help you prepare for what to expect during early labour before an epidural is given. Doulas can walk you through the process of getting an epidural so you feel calm and ready when the time comes.
After an epidural, a doula will make sure you are feeling relaxed and comfortable. Most of my clients enjoy a leg or arm massage. This may be a time when your partner will want to nap, grab a snack, update family or friends, perhaps you don't want to be alone, your doula will stay. Once you have an epidural it is important to switch from lying on one side to the other. A doula will use different techniques to help you remain comfortable and encourage your labour to keep going. A peanut ball can be a great tool to use when you have an epidural, a doula can help facilitate positions with this.
Once you begin to reach transition and are ready to push, a doula will help guide you. An epidural may take away those feelings/urges to push so you may actually need extra coaching during this time. There is so much more to birth than epidural or no epidural. Whichever you decide, having a doula will not be something you regret. An epidural doesn't mean you don't need and deserve continuous support during your birth. Consider the whole picture, an epidural might just be part of the story.
Team D – Dads and Doulas
The perfect dream team includes both dads and doulas. It happens after every birth as he is holding his beautiful baby, a dad tells me “we couldn't have done this without you!” Why do some dads hesitate to hire a doula? It seems natural to hire someone who has expertise, experience, and spends most or all of their time supporting families through pregnancy, birth, and the postpartum period.
For some dads like Greg “The idea of a doula (whatever that is!) seemed a bit New Age for me; a notion catering to curly haired, alfalfa eating, year round sandal wearing, unicycle enthusiasts. Why would I, a masculine, hairy chested carpenter ever be interested in such a device.” Dads may envision themselves being left out of the experience in some way or feeling replaced by a doula. Stranger danger! Why would my partner want someone we just met present during such a private and personal time in our lives? Dads view themselves as the strongest support person their partner can have, why do we need someone else?
“It turns out our birth doula had all the answers and was invaluable during the arrival of our son. My partner and I had planned a home birth and felt well prepared until we experienced a very short labour that caught us off guard! I quickly found myself pacing frantically in the hallway outside the bathroom door seemingly forgetful I had ever been to prenatal class.” Greg has a great point. A doula is a real life cheat sheet for remembering specific labour positions, breathing techniques, and all of the other information you learned in prenatal classes that you may suddenly forgt. There are many doulas out there, yes even curly haired, alfalfa eating ones. Interview as many as you like until you find the one that fits with you.
This notion of dads being replaced couldn't be further from the truth. A doula wants dad to be number one! A doula should serve as a side kick, helping dads be the leading hero during labour. Teaching dads how to do massage specific to labour, offering position changes, and guiding breathing/relaxation techniques will make dads even more valuable to their partners. Doulas are all about team DAD! This is all taught prenatally, and it is quite common for dads to become nervous and have a lapse in memory when they see their partner in labour. A doula's job is not to take over and do, it's to remind, encourage, and help dads support their partner. There is more than one role in birth. Remember...
Dream Team = Dad and Doula!
There are many roles to be filled during labour. The number one job of any care provider is the health of mom and baby. Doulas speak the language of labour and birth so they can offer insight into situations which may seem unclear. Care providers are not there to provide physical and/or emotional support (although some do),that is the role of Team D! Team D is a well oiled machine that works together to support a positive birth experience.
“How does Team D work? Give me an example!”
Mom is experiencing a lot of back labour and is requiring constant back massage and counter pressure, but she is also hot, thirsty, and struggling to focus on her breathing. How does one person meet all the labouring goddess’s needs? Team D. It's that simple! Why wouldn't we give moms the best of everything. Dads pick a spot they feel comfortable with, whether it's massage KING, ice chip PRINCE, hydration GLADIATOR, or relaxation EMPEROR. Doulas will fill in the gaps and amplify your awesomeness!
Doulas are experts in supporting birth, you are experts on your partners. Together Team D will provide the best possible birth experience.
I remember showering shortly after my son was born and looking down at a fistful of hair in my hands. Not the average sized hair loss I was accustomed to but enough to at least start a wig! “What the heck?” My collection of hair kept growing. I told my sister in law about my accumulating hair collection in the drain, to which she replied “Oh ya that happens”, as though it were the most normal thing on the planet. “Oh ya know you just lose your hair after you have a baby!” WAIT, WHAT?! That's not all, there are so many other things people don't tell you after you have a baby. Hunger -- that little human wants to eat all the time! Long gone are the days when you could sit down to a hot meal, or find a moment to stuff a snack in your face. Frozen pads, sitz baths, I imagined myself curled up with my sweet baby peacefully. HA. It would take me 5 minutes just to figure out how to sit down comfortably. Someone should come up with a front door sign for mommas that indicates their current mood to warn anyone who approaches. Come back later momma and baby sleeping, only knock if you have food, come in and do my laundry we are resting, knock on this door and I will hurt you! As you embark on this new adventure there will be many ups and downs but the best start is being prepared – or as prepared as you can be as nothing can really prepare you for parenthood until you are there.
You need a postpartum plan
It is a good idea to do this with your partner before the baby comes. You will want to discuss things like meals. Who will cook, will you eat out, or order in, will you prepare meals before hand, or have people make meals for you?
As you create your postpartum plan here are just a few areas to cover.
1. Baby Stations
Setting up your home to be baby functional is key. Have baby changing stations on each level of your house, use a basket and put diapers, extra baby clothes, wipes and whatever else you may need so you aren't going up and down all time time.
2. Breastfeeding/feeding Places
When you sit down to feed your baby, use this as an opportunity to nourish yourself. Have a bottle of water, and some one handed snacks in the areas you are most likely going to feed in. Make sure you have everything you need so you can enjoy this bonding time with your baby and not be rushed because you are starving or thirsty.
Make a plan for how many people you want around those first few weeks. It's important that you and your partner are on the same page. Ask for help when visitors come, they can bring food, pick up diapers or throw a load of laundry in. As much as people want to meet and hold your baby, they want to help but just don't always know how. Don't be shy! And for those visitors you are comfortable with and trust, sleep while someone else gushes over your little tiny human! And don't be afraid to put that sign up on the front door!
Who will be a part of this team? Do you have family members or friends? Consider hiring a postpartum doula. Shameless plug -- a postpartum doula isn't your guest. They are there to support you and your family, not to visit and make more work for you.
5. Redefining Roles
Now that there is a newborn to take care of, some of the household responsiblities may need to shift. Talk to your partner about what will likely change, consider hiring a cleaning person for those first few weeks if having a clean space is something you are worried about. Who will do the laundry, who will look after the pets, who will run errands, or transport siblings?
6. Sleep and Rest
How many hours of sleep do you usually need a night to feel rested? Try to fit these hours of rest/sleep into the day by napping when your baby is sleeping, or taking turns with your partner so you can each rest. Reach out to a support person you trust to be with your baby while you both nap.
I highly reccommend you take a prenatal breastfeeding class, it can help give you the knowledge and tools to be successful. Have the numbers to local breastfeeding clinics and/or lactation consultants near by if you end up needing them. Ask your doula for support.
As with most things in life, the key to a successful birth and child rearing adventure is planning. Plan, plan, and when you are done that, make another plan. A huge part of my work as a birth doula is to make a plan with families, for birth and postpartum. Everything doesn't always go as planned, especially in the case of birth and babies but having a plan will help you be more successful and confident in making your first decisions as parents.