The truth about recovery

Oh dear, recovery.  Why do we always feel so uninformed regarding pregnancy/labor/birth recovery?? I thought I was informed having had classes on women's health, but I was so surprised at what recovery entailed with my first birth.  Of course, circumstances caused recovery to be worse than expected, but I just felt so clueless during those first few weeks.  Without further ado, let's dive in to the nitty gritty:

You get a massage a few times during your hospital stay

And it's not the peaceful massage on your back that you totally deserve.  It's called a fundal massage and it does not feel great because it is basically a uterus massage on your already-tender abdomen to make sure big clots are making their exit and not preventing healing as your uterus shrinks.

Speaking of shrinking uteruses...

There's also this unspoken fact that contractions continue postpartum. They're not as strong, but they tend to be worse if this baby is a second or third child.  Breastfeeding also causes a release of oxytocin, a naturally occurring hormone (Pitocin mimics this hormone) that causes contractions. I distinctly remember being shocked right after delivering my daughter and feeling those contractions with breastfeeding.

And now about breastfeeding

Ok, ladies, this is how it is- some ladies have tender nipples and other ladies don't. That's it.  Breastfeeding hurt like the dickens for me every time and made me want to say @#!?!*^#$ for the first 2-3 weeks.  It was longer with my son.  The nurses and lactation consultants for my first-time breastfeeding woes with my son kept telling me that "if it hurts, then you're doing it wrong. WRONG WRONG WRONG." So I sucked it up and tried to not cry for the first few weeks (believe me, there were tears shed), and finally, after a few weeks, it gradually improved until it didn't hurt anymore. **I should add that what was painful about it was the initial "latch" ** With my daughter, a wonderful nurse came to talk to me the morning after right after a lactation consultant told me that breastfeeding shouldn't hurt and said, "Honey, I don't care what they say.  I can't imagine breastfeeding NOT hurting- there's a baby constantly sucking on your nipples and you're not used to that. It will be a little painful, just count to 10 and it should be better by then." So there. I counted to 10 every time and she was right, the pain began to subside each time and made the experience much more tolerable. Though, I did get a horrible tension headache from tensing up so much for fear of pain...

You don't bounce back instantly. 

I figured I'd be tired and beat after a long labor.  I thought, hmmm I'll bet I'll feel better within the next week or two. Nope.  As I've learned, recovery can take weeks, maybe even months, and you won't feel like you have your old body back for quite awhile. This varies for every mom.  For me, I've had two experiences so far.  With my son, I didn't feel like I was truly getting better until about 6 weeks postpartum.  This is because of the blood loss, birth canal trauma, two bouts of mastitis, and breastfeeding troubles. I saw notable improvement after 3-4 weeks, but right after 6 weeks, I can remember thinking I got this. I never did feel quite like myself until a year after my daughter was born.  Recovery with my daughter was much better.  I felt better after about a week and fairly well-healed by one month postpartum.

Down below probably doesn't feel great

If you just pushed a baby out, you'll probably have some swelling.  Both hospitals I delivered at provided nice long ice packs and pack of Tucks to line them with and that provided great relief.  Tucks contains witch hazel, which comes from a plant (called... you guessed it, witch hazel...) and is great for pain relief for skin irritations. It's a fairly natural cleanser too.  The swelling can last a day to several days depending on how long you pushed for and any other tissue trauma such as forceps use. You will probably given a little squirt bottle that can be filled with warm soapy water so that you can clean your lady parts after going to the bathroom.  You'll want to take that home.

Blood

Postpartum bleeding (lochia) varies for all women, usually much shorter for c-section moms.  Don't be surprised at the large clots that can pass (unless they're softball-sized or larger.. your provider will want to know). Your uterus is purging all the extra linings and trying to clot and shrink back to the right size. I think mine lasted about one week of heavier bleeding and another week of light/spotting. If you don't recall from my last post, just know that you will receive a couple pairs of extremely stretchy (meaning, they'll fit both a petite lady and plus size lady) panties and sanitary pads that are basically diapers that don't close around your legs.

Bladder Control

I remember having to run to the bathroom when recovering from son's delivery because I was pretty sure I was going to pee in my super stretchy undies I just got. Ha.  Your pelvic floor muscles are just worn out from pushing a baby out, so just keep practicing your Kegels to strengthen them again.  For some ladies, this lasts awhile, others may not even experience it.

You may fear going #2

No one likes to fear a bowel movement, but your nethers may be swollen and you may have had stitches placed for tearing, so the first bowel movement can be scary.  Most postpartum protocols for providers include a stool softener regimen 2-3 times a day.  Don't be afraid.

Hair loss

Perhaps you read about this, perhaps not, but hair loss is common.  I feel like I'm always shedding when my hair is longer than 2 inches, but I did notice an increase in the amount of hair I was pulling out during showers the first few months.  I never did get any bald spots and you likely won't either. Go get a haircut and your nails done a few weeks postpartum and you'll feel like a new woman ;)

Emotions May Run High

Your body is going to go through drastic changes in a extremely short period of time, so chances are, you may being feeling a lot.... feeling ecstatic, feeling blue, feeling angry, feeling nothing short of asylum-crazy at times. There's a lot of anxiety being a parent of a newborn too- are they sleeping? wait, are they breathing?! Oh good. But did they eat enough??! Both times I have felt a surge of these extreme emotions on and off- it lasted the first two months for me. Thankfully, it would usually just be a short amount of time, like a few hours, here and there each week.

** Please also realize that postpartum depression is real and not just the "baby blues" though. While it's normal to feel some depression, it is not normal to feel like you have no control over yourself or thoughts to the point where you fear you may actually cause harm to yourself or another.  This can vary from feeling like your problems will dissolve if you just run away to feeling even suicidal.  Seek professional medical attention if you feel this way.

The fact is your body will be different postpartum.  There is no simpler truth about recovery.  You will feel strong emotions at times through the first year, especially if you breastfeed- breastfeeding affects every mom differently, which includes crazy hormonal shifts that affect your body mentally and physically. It's ok. It's normal. You may feel like crying one day because your husband didn't say the right thing or because dinner wasn't made on time.  Or perhaps you'll be suddenly so flippin' upset that someone said something that felt offensive even though it wasn't. Just remember, ok, crazy hormones are trying to control me right now. But you got this.  You'll get through it, I promise! Try to accept the new normal and appreciate your capabilities.  There may come a day when you feel like your pre-baby self, but for now, focus on all the great things, like a new baby :)

I really enjoyed writing my blog series and can't believe I'm done!   Thanks for reading, I have been surprised by how many times this blog has been viewed in just the past month when I first started! I am planning on continuing the blog in a few weeks sharing birth stories from now on and any other motherhood related items that cross my brain. Good luck with your labors and recovery!

Preparing for labor and what to bring to the hospital

Preparing for labor can be a daunting task when you have no clue what to expect. I am hoping this blog has given you a few ideas to research because I personally believe preparation comes from the time you put into reading about the things you want in your labor.  You want a medication-free birth? Read about all your options.  You want an epidural? Read about common side effects and other moms' experiences. The Internet is full of advice and you are likely surrounded by women who have all had different experiences.  In the end, your labor will be unique to you, but at least you felt a little prepared :)

How about what to bring? My advice- ask other moms.  They will all have different opinions and tell you things that are complete opposite of what another one will tell you, but it gives you an idea of what may work for you or what may not.

What is on my list to bring to the hospital? It's definitely simplified from my first baby. I had a whole rolly suitcase filled with crap that I didn't need then haha. 

Personal Nightgowns. three pairs, one for labor and two for recovery.

I have always brought my own gowns for recovery and just started bringing my own for labor with my daughter. I always want something super stretchy, so my gowns are all jersey knit material and very soft. I had a full sleeveless gown with my daughter's labor, but this time, I am planning on a skirt, loose racerback tank, and a stretchy nursing bra meant for sleep. I like bringing my own gowns because I want to nurse more easily without messing with stiff hospital gowns.  I am doing a two piece labor outfit because last time I did not enjoy being butt naked immediately after delivery to be able to nurse and have skin to skin contact. Don't worry, I was covered in blankets so I wasn't truly butt naked. 

Comfort Items

This varies for everyone, but I am bringing my hypnosis mP3s to play in the background. You may want soothing music or perhaps if you're planning on having an epidural from the beginning, you'll want time-passing things like a good book, a sudoku puzzle book, or a season of your favorite TV show on Netflix.  

Socks/Slippers

I prefer my own fuzzy socks over the scratchy ones with rubber grips. For walking around the room, I like having my own slippers. Don't be fooled, hospital floors are always disgusting. On the subject of slippers, I was pumped full of fluids with my son for some minor hemorrhaging postpartum so my feet were so swollen, they wouldn't fit my slippers.

Robe

I didn't bring my giant microfleece robe each time, but this time, I will be bringing a light jersey knit one. It's nice to have some kind of covering. Are you beginning to see a trend that I prefer stretchy, soft, fuzzy things?

Nursing Bra/Undies

Don't get sized until at least two weeks postpartum because if you're like me, your boobs may go crazy once your body is in nursing mode.  Just bring a comfortable nursing bra meant for sleeping in that has plenty of stretch so that it isn't a nuisance to navigate around.  

Post delivery, you get a pair of fantastic one-size-fits all undies.  I liked them because they were so loose, but just bring a few pairs if that does not sound like a great undie option.

Personal Pillow

I admit, I am a pillow snob.  I prefer to bring my own pillow for recovery only because I can get a stiff neck easily without the right pillow.  Something to consider, but perhaps you can do without.

Toiletries

The usuals: deodorant,  shampoo/conditioner, lotion.  Whatever you use on a daily basis.  I'm pretty sure hospital shampoo is just dish soap.  With my daughter, I brought my own lady pads too.  Hospital pads are like giant diaper boats, which isn't too bad for the first or second day of postpartum bleeding.

Important Documents

It's just a good idea to always have your ID and health insurance on hand when you are planning on going to the hospital.  I recommend pre-registering for admission with your hospital several weeks in advance just so they don't ask you a bunch of annoying questions like emergency contact's numbers (I don't know, I have to look it up! Who memorizes numbers these days...) or your home and mailing address.  

Birth Plan

Have a birth plan.  It doesn't have to be complicated and it could just be a paragraph long, but I encourage you to have some sort of written plan that indicates things you definitely want or do not want both during labor and with baby afterwards.  Here is mine:

medical speak: gravida refers to what number pregnancy and para refers to how many births greater than 20 weeks gestation

If you would like a copy of it in a Word document, contact me via Facebook, in the comments section or by e-mail here: rockthatbirth[at]gmail[dot]com.

Camera

Seems like a no-brainer, but you'd be surprised at how often this is forgotten.  Thankfully, it seems as if we live in age where at least 5 people you are close to, if not yourself, have a smartphone and always have a camera on them! Make sure your batteries are all charged too. With my son, we brought the camera, but our battery died right after he was born. Ha! We did bring the charger with though.

Money!

You may want to have a couple dollars worth of quarters in case your support person wants to get a snack at a vending machine.  My hospitals have always had snacks for the significant other, but you may not be as lucky.  If your hospital is more updated, they may even take a credit card swipe instead!

Chargers

Device chargers.  Communication has totally changed in the last few years and things like FaceTime and texting photos is a regular occurrence.  They also use up a lot of battery juice.  So, don't forget the chargers.

Clothes for Baby!

Don't go overboard with this one. There is no need to pack a whole wardrobe- the hospital usually provides open end onesie-sleepers that make it much easier to change diapers.  I also bring hand mitts for baby because my children have a tendency to cause self-inflicted wounds with their razor sharp nails. I'd skip bringing diapers and wipes too- let the hospital provide those while you can! No need to pay for extra diapers.

• I'm skipping bring a boppy nursing pillow this time.  I found I preferred being surrounded by a million pillows instead of one to help with nursing position. 

Snacks

It's nice to have a good snack on hand.  I always liked having a small selection of goodies for myself.  And a good drink.

That's all I have on my list.  What did you bring?

Upcoming Post: Recovery!

Who will be present during labor and delivery?

Who will be there?

Well, that really depends on you, mom.  Who do you want to be there? This is not the time to do something for someone because they want it- this is ALL about your comfort level.  Basically consider this- who wouldn't you mind seeing yourself butt naked and completely exposing your lady parts too? That changes the mood a little now.

For me, I only wanted my husband there. Him, my trusted OB, and the random medical staff in the hospital.  No offense to my family or close friends, but I really did not feel like I'd be able to concentrate very well if I was trying to push a baby out and worry if the family member or friend were seeing too much of me in a way they never had before.

Let's go through all of the roles who may be involved:

Physician

I had an OB/GYN doctor for my first delivery.  They are a medical doctor who has gone through medical school and a residency program specializing in women's health, including obstetrics and surgery for cesareans.  For my second delivery and current pregnancy, I am seeing a family practice doctor.  I chose a family practice doctor because they would be able to see me for prenatal care, women's health issues, and other illnesses, like the flu.  They would also be able to do pediatric care as well, so my new baby will see the same provider as me.  I like having a family practice doctor for this very reason.  They are also more likely to be present at your delivery instead of being in an office where there is a group of doctors where any one of them may be on-call the day you go into labor.  This varies between offices, of course, but I choose my providers carefully for this reason.  The only issue with a family practice doctor is that they are likely not trained in surgery (though some are), so if you need an unplanned c-section, you'll go with someone you may have never met.

Midwife

There are two kinds of midwives, certified nurse midwife (CNM) and certified midwife (CM).  A CNM is a registered nurse who has completed a graduate-level degree in nurse midwifery.  They are basically nurse practitioners who have specific obstetric education and can diagnose, prescribe medications, and treat you as any other primary care provider.  A CM is a medical professional who did not previously have a nursing education.  They are still required to have a bachelors degree prior to beginning their program and are trained extensively, but because they are relatively new, CMs are not legally allowed to practice in many states.  They are gaining more rights as practitioners though, so soon, they may be just as available as a CNM. A CNM can deliver both at the hospital, birth center, and at home and a CM will mostly only be allowed for home births and some birth centers.

You would think I would have opted for a CNM to support my fellow nurses, but circumstances have just always brought me to seeing a physician.  There are many, many CNMs/CMs who are just as competent at delivering a baby though :)

Doula

I had no idea what a doula (DUAL-luh) was until my second pregnancy.  I had told my chiropractor that I was planning to have an medication-free labor and delivery and she said, "well, you're going to have a doula, right?" A doooo-what? I researched them for awhile before coming across a lovely lady who I ended up having present at my delivery.  So, a doula in my definition is like a hired friend/support person- they can be your partner or they can enhance the support your partner gives you.  They are certified and trained to assist families in having safe and focused labors- I don't think I personally would want one if I was planning on having an epidural, but for a unmedicated labor and birth, they can help you stay focused and provide the support you may need.  My doula took on a few roles- she helped apply counter-pressure to my low back when I needed my husband by my side provide the cues I needed to stay in hypnosis, she took pictures for us, she helped me cheer me on when I needed more support, and she was just so wonderful to have as an extra support person who had "been there, done that" many times already.  She was a birth doula but there doulas trained as postpartum doulas and can be of great assistance for things such as breastfeeding education, infant care, and support for mom in the weeks following delivery- a person who will regularly check in on you to make sure your needs are being met.  Doulas can cost anywhere from $200-$800 (or possibly more!), so having a little disposable income is helpful.  

http://www.dona.org/mothers/ for more information on doulas.

Birth/Midwife Assistant
There is a newer role called a birth assistant or midwife assistant- they are not as common, but more training programs are popping up here and there.  Their role is to assist with the delivery- one step up from a doula, so they have a little more medical training in regards to actual baby delivery. 

Registered Nurse (RN)
For the sake of not having to go into what kinds of licensed nurses there are, I am just going to cover the nurse role as an RN.  Depending on your facility, you will likely have a Labor and Delivery (L&D) nurse and a Mother/Baby nurse.  I have only had good experiences with the nurses that cared for me (except for that one nurse who I swear had no clue what she was doing when trying to show me how to nurse my son...) and am always grateful for the help.  What does the nurse do in either of these roles? So much more than you can see.  First of all, they monitor your health and the baby's- you will be connected to monitors to measure vital signs like blood pressure and heart rate as well as a tocometer, which is often shortened to "toco" (think taco, but with a TOE sound) and monitors contractions and fetal heart tones/tracings (FHT).  Depending on hospital protocol, you may be allowed to be disconnected from all of these things to be able to move around more freely.  With my daughter's birth, my hospital had wireless toco monitors so that they could have continual monitoring without interfering with me too much.  I'll admit, I shook off the pulse oximeter (measures your O2 levels- it's the clip that goes over your finger and lights it up like ET [phone hooome]) and any other cord my nurse attached to me when she came in to chart my vital signs. Nothing more distracting than being tangled in a cord! Your nurse will also be the one who places an IV, does cervical checks to check labor progression when the provider is not present, and basically watches your every move even if you don't see them.  They are the middleman when communicating with you and your provider- both parties heavily rely on the nurse to be effective communicators.  Nurses complete most of the patient charting- this charting goes on your medical record so that insurance (and heaven forbid, lawsuits) can see it and it also holds the nurse accountable for all interventions and patient care. No pressure.

Patient Care Assistant (PCA) or Certified Nurse Aide (CNA)
A PCA and CNA are the same, it just depends on what the hospital calls them- I will just call them CNA in this post. Nurses rely on CNAs to assist in patient care- without them, nothing can be fully done.  A CNA will be responsible for different things depending on the patient- they can monitor vital signs, assist you to and from bed, answer your call light, and communicate with your nurse if the nurse is with another patient.

Lactation Consultant
The booby nurse.  Not always a nurse, but usually.  They specialize in breastfeeding assistance and can be a godsend if you are having breastfeeding troubles.  They will evaluate your baby's ability to nurse and will give you helpful advice and hook you up with different things like a nipple shield and breast pump supplies.

Social Worker
Sometimes a social worker will come in just to make sure your needs will be met when you go home.  They can help with any legal paperwork too like completing social security paperwork and obtaining a birth certificate.  If I recall correctly, bring a checkbook because both these things cost $$.

Phlebotomist
This is the dracula of the hospital.  Just kidding(ish).  They are trained medical professionals who draw your blood for lab testing.  You will likely encounter one at least twice, if not more, during your stay.

Janitor
I probably don't need to include this, but anyway, a janitor will come into your room at some point to clean.

If you want happier staff, bring a treat in during your stay :) I brought a sealed container of cookies from Trader Joes both times- not sure if all nurses are like me and some of my old coworkers, but I rarely trusted homemade treats from patients haha!

Support Person
This can be anyone- your go-to helping hand.  Some women want their significant other, some may just want mom.  Maybe your person is your BFF.  Having someone personal present at the birth is comforting and I highly recommend it.  No matter what method you deliver by, having someone you trust present to share the experience with is great.  I cannot imagine not having my husband there with me! Limit your visitors to those who will only uplift you, not test your patience or break your concentration. As I mentioned in the beginning, consider what your support person will see you doing- moaning, deep breathing, yelling, etc. and possibly dressed in your birthday suit only.

As suggested by my friend, Michelle, she also had present at her birth of her second child:

Birth Photographer
This is a great idea if you want some truly beautiful keepsakes from your experience. A birth photographer can capture the joy of meeting your new baby in a picture. The nice thing is that you have someone who will be able to take a picture of you and your support person and any others involved, instead of having your support person take on the photographer role too.  Cost depends on the area and demand. I did not have a professional photographer at either of my births, but I did consider it! With my son, I didn't take nearly as many pictures as I wanted to and while I got a lot of pictures with my daughter, having some professional pictures would have been nice.

Interpreter
My friend's husband is deaf so she actually had an interpreter present during her son's birth! What a great idea.  Consider hiring/having an interpreter present for either you or your support person if you are birthing somewhere that does not speak your native/primary language.  There is a lot less confusion and potential miscommunications.  Most hospitals in the US are legally required to have an interpreter present for you, the patient, if English is not your primary language, FYI.  Of course, keep in mind that an interpreter may really just be a "language line," which is a phone connected to an interpreter somewhere else.

Hoping you feel enlightened and more prepared about the people you may encounter during your own labor and delivery! I will add in more if I can think of any more roles.

Alternative Birth Methods

There are many methods for childbirth that do not involve medications.  There are also many reasons why someone would choose not to have medication.  I used to be completely against medication-free births because my thought was why the heck would you want that if you have modern medicine? Well, silly me, there are many reasons.  Some reasons other moms have told me are:

• because medication makes them feel funny/out-of-control 
• they have an immense fear of needles
• having control over their body is more comforting than being numb
• to be able to labor and deliver in the position of their choice
• they believe all drugs are harmful (not true, but this isn't coming from me)
• they want to feel more connected to their baby (I also disagree with this one)
• just to feel like a warrior princess (ay ya ya ya ya!! xena!! please tell me I'm not the only one who grew up watching xena...)

For me, it was having more control over my body. Aside from the whole blood pressure fiasco with an epidural, I loved being numb and feeling relaxed while laboring. I could chill, watch a movie, chat- it was great. But tell you what, when I felt the grinding of the forceps deep within me, even my fatigued i've-been-pushing-for-three-plus-hours thoughts couldn't hide oh lawdy, this is gonna be a scary recovery. And it was. So when I was preggers with number two, I researched and researched a method that could get me through contractions and have some kind of peace during labor. And with preparation, I was able to achieve my goal!

Before going too into my own experiences, I want to highlight the most common alternative birthing methods:

Bradley Method

The whole course is focused on learning to "trust your body" because birth is a natural process.  It teaches key relaxation techniques and overall good health habits during and after pregnancy.  Pain management is focused on the body relaxing and embracing any pain as part of the natural process. The class is 12 weeks long and is taught by an instructor, so you would need to be able to attend an actual course.  I'm sure there's a modified version where you can learn from home, but the Bradley Method is a registered trademark and is based on this 12 week course, starting around 5 months pregnant.  The class heavily relies on having your husband or significant other as a coach, so those who are more independent may not like this option.  Link to official course here.

Lamaze

The Lamaze method has been around since the 1950's and from what I'm reading now at this present time, there has been a shift in method to a more general focus of "increasing women's confidence in their ability to give birth."  The method was known for its classic "hee-hee-hoooooo" breathing technique.  Now, they focus on the whole aspect birth- before and after. The method wants you to feel prepared for anything and to have as few interventions, like artificially rupturing membranes or epidurals for example, so that you can let your body do what's most natural. They are supportive of birthing positions other than being on your back.  Pain management is much like the Bradley Method in that it is a natural process of childbirth and learning relaxation techniques can help minimize the pain and help you cope.  The course is usually around 12 hours- the duration really depends on the instructor, so anywhere from 4-8 weeks.  They also have online course opportunities.  See more on the official site here.

Hypnosis

The main focus of using hypnosis for childbirth is having a peaceful, gentle, and painless childbirth.  I know, it sounds kooky as soon as I said painless, but for many women, it is painless.  In general, self-hypnosis techniques are taught in these kinds of classes/books and by utilizing these techniques, a peaceful and fearless childbirth can be achieved. The main emphasis is total relaxation and using hypnosis to change your perception of pain.  One of the main ways to achieve this is reducing the negativity around your regarding birth. Every woman who has given birth has some kind of significant experience and sometimes it is less than ideal, so naturally they want to share and warn other expecting moms of their issues.  Well, if you are particularly sensitive, this kind of information can instill a little fear regarding childbirth and make it challenging to have total relaxation. Using hypnosis can be as structured as you'd like or be more flexible and self-taught with the guidance of a book.  From what I've gathered, there are two main classes to utilizing hypnosis for childbirth:

• Hypnobabies (what I used)
• The Mongan Method

Hypnobabies is both an instructor-led course or home-study course. The class is set up to be completed at a minimum of 6 weeks or longer.  There are 6 sections and many women take 2 weeks per section, totaling 12 weeks. The home-study course is a set of CDs with hypnosis scripts on them , narrated by the Hypnobabies founder, Kerry Tuschhoff.  There is also a workbook that structures the class and has additional reading to study on your own.  Attending a live class just goes over the workbook and scripts on the CD and is more ideal for people who are less self-motivated for a home-study course. Link to official course here.

The Mongan Method, by Marie Mongan, is similar to Hypnobabies except that it focuses more on an instructor led class.  Otherwise, much of the techniques are similar in teaching self-hypnosis.  There are not CDs or set hypnosis scripts, so it relies more on the student to master these techniques on their own. Marie Mongan has written a book that can be used as a basis for a home-study course, but it is not as structured as her course.  The actual course is 5 classes long, about 2-3 hours each, so the duration of the overall course is set by the certified instructor.   Link to official course here.

Other- there are many ways to learn self-hypnosis.  Google is filled with endless possibilities. Self-hypnosis is nothing new as people with allergies or anxiety have been using the techniques for at least the last 15-20 years with dental and minor surgical procedures. I would be weary of buying a course other than the two listed unless you have read testimonies of other moms' experiences who you know and trust.

Water Birth

A water birth is not necessarily a method, more of a position in birth, really.  You can use any method and have a water birth.  The whole point of a water birth is that it is supposedly an easier transition for baby to go from womb to warm bathtub water instead of cold air- makes sense to me! Moms also may prefer having a water birth because they feel lighter and less pressure on their whole body if they can float a little, lessening childbirth pains.  Water births can be anywhere- many hospitals that are supportive of alternative birth methods are beginning to include birthing tubs as an option to labor in and even give birth in! Some women who choose to have a homebirth will get a blow-up pool and set it up in their living room. Water births are illegal in some states, so check before planning your dream birth. http://www.waterbirth.org/ has a lot of helpful information regarding water births.

DIY

I say do-it-yourself because there are women who choose not to follow any of these methods and do so successfully.  If you think you have enough willpower and self-motivation to go without a course of any kind, then just make sure you research interventions before D-Day so that you can give your truly educated informed consent before receiving any interventions.  A few books that either I have read or have heard good things about are:

• Ina May's Guide to Childbirth- Ina May Gaskin is a nurse midwife who's like the ultimate natural birth guru. She is totally hippy and has a lot of good insights.
• The Birth Partner- by Penny Simkin. It is a guide for your supportive partner/doula during childbirth
• Hypnobirthing- by Marie Mongan.  I mentioned her earlier- her book is a great intro to hypnosis for childbirth and also shares key techniques for relaxation.
• Natural Hospital Birth- by Cynthia Gabriel. This is an empowering book but I would just keep in mind that although it suggest to always stand your ground, it is a good idea to ask educated questions regarding an intervention that is suggested (ex. so why do I need to have an IV? or what happens if I don't have my membranes ruptured right now?)

Now that you are aware of some options for alternative birthing methods, here are your three main options for places to birth at (and while I want to say these are your only options, you can always find a YouTube clip for something like a "natural birth in the woods" or "childbirth in nature with community group." It's true.) -

Home Birth

Some women dread the idea of being in a hospital full of sterile items and medical professionals or perhaps home is the place they are most comfortable at for everything, childbirth included.  Whatever the reason, this is a popular choice among many moms choosing alternative birth methods.  Generally, you have a midwife who will come to your home and you labor where you are most comfortable at. Some women deliver on their bed, others in the living room.  As mentioned earlier, a water birth can be set up in your home too. I'm sure this will rub some people the wrong way, but I am not an advocate of home births.  Emergencies are uncommon, but if they occur, I certainly would not want to be at home.  Also, I am lazy and I would not want to clean up... birthing goo.

Birth Center

A birth center is now a more common option.  Many are set up near a hospital and are like a bed and breakfast set up practically, but with necessary medical equipment.  You have the comforts of a homey-feel yet you don't need to worry about anything in your actual home.  I have heard of many positive experiences regarding stand-alone birth centers. Some hospitals are beginning to have birth centers within them- kind of like a hospital within a hospital.  I love this concept.  I had my daughter at a birth center within a main hospital and the staff were supportive of my decisions and I got to labor/deliver and recover in the same room, which was wonderful.

Hospital

There seems to be a shift in hospitals now with their L&D units- I see a lot more mom support now with alternative medicine and less intervention pushes.  There is also a lot of breastfeeding advocacy and the concept of skin-to-skin contact (learn more about Kangaroo Care here). A hospital is a safe place to be at to deliver.  What it all really comes down to is if your provider you choose is supportive of your childbirth wishes and plans because if they aren't, the hospital staff are less likely to be.  I always look for a provider who is on the same page as me because after my first experience, I realized that besides preparation, I depend a lot on my provider too to support me.

I hope this information can help you make an informed decision about what route you may want to take regarding your birth experience!

As I mentioned earlier, I did use Hypnobabies.  If you want to read about my birth experience, you can check it out on my family blog. 

Pain Relief During Labor

Pain relief.  I know that was the first thing on my mind when I truly felt and knew what a contraction was the first time I was in labor.  I'll just begin by saying that you will NEVER understand what a contraction is like until you feel it for yourself.  No blog, book, person's word will teach you better than your own body. Oh boy.  The first time I felt a true contraction, I was stoked. This is it! Contractions are just like my period cramps! Not bad! How naive... I had just graduated from nursing school and passed my boards and learned a lot of science in regards to labor, but not a lot in the actual experience.  I really wasn't sure what labor was going to be like, so I did not prepare much in regards to pain relief.  I basically decided that I would see what it felt like first and then get an epidural if I really needed some relief.  Tell you what, I was begging for an epidural as soon as the triage nurses decided that I was actually in labor and those two or three hours I didn't have any relief were agony.

Knowing what I know now, I wish I researched all my options very carefully.  Pain relief is definitely possible in multiple ways, most commonly through medication. Let's go over our options, ladies:

Epidural

I am putting this one first because it is the most common one we all hear of.  Talking about epidurals will probably be the longest response out of all the pain relief options.  Epidurals are a regional anesthetic, which basically numbs you from waist to knees, if not toes too.  You will begin with a 1-2 liter fluid bolus as an epidural will generally lower your blood pressure.  A anesthesiologist or nurse anesthetist will place the epidural.  It is placed in the lumbar region of your spine- about where the curve of your back is.  They will have you either sitting on your bedside, hunching over a bit, or laying sideways in a "fetal" position:

The provider will first numb the skin/tissue in front of your spine with a local anesthetic (Lidocaine) and then proceed to first insert a hollow needle (Tuohy needle) between your vertebrae into the epidural space, the space between your spine and spinal cord that's filled with cerebrospinal fluid (CSF).  Next, they insert a thin tube (catheter) into the Tuohy needle and thread it up a couple of centimeters, remove the Tuohy needle, hook it up to a pump, and begin a continuous infusion of anesthetic (usually some kind of -caine ending medication [lidocaine, bupivacaine, etc.] and a mix of something else like a narcotic).  The catheter is taped down your back and you should be feeling fairly numb by now.

A lot of times they will give you a patient-controlled button to press when you feel like the medication is wearing off and needs a boost.  This is called a patient-controlled analgesia (PCA) pump. Some women find the epidural placement uncomfortable and others may not even notice it since they are too focused on their contraction pain (me).

Pros- complete pain relief, obviously.  There's a reason this is one of the most common pain relief options for labor! Also, the medication does not cross the placenta/blood barrier, so it wouldn't directly affect the baby.  All those reports of epidurals causing groggy babies are lies.  Haterz gonna hate!  Epidurals can sometimes be what your body needs to just relax enough to dilate/efface completely and push the baby out too.

Cons- there's a nasty adverse reaction of dropping your blood pressure too low.  It doesn't happen to everyone, but it can happen and can vary.  For me, it was quite unpleasant as my blood pressure suddenly dropped from its usual 115/80 to 70/50 or less immediately.  This caused me to feel faint and dream like and both my son and I were not getting enough oxygen.  Fortunately again for modern medicine, there are medications the anesthesiologist will be equipped with to reverse these kinds of reactions and the nurses are trained to respond quickly.

So indirectly, yes, an epidural could affect the baby, but most women seem to have a positive experience.  There's also always the possibility that the epidural won't work, won't last, or only affect one side.  From being completely numb, you may or may not have as much ability to push the baby out so you rely a lot more on the nurses and provider telling you when to push.

Visual aid of an epidural placement:

Spinal Block

So similar to an epidural placement, a spinal block will be administered much the same except it is a one-time injection of anesthetic into the CSF instead of a steady flow.  Spinal blocks last only 1-2 hours because of this.  As I mentioned in a previous post, this is more commonly given when having a c-section, but sometimes you may have this as an option. With both a spinal block and epidural, you will definitely get IV fluids, a urine catheter probably, and your blood pressure will be monitored.

Pros- much the same as an epidural. Complete pain relief! Shorter duration (which could be a con I guess if you still need the pain relief) and does not directly affect baby.

Cons- From what I've read, the severe headaches associated with a spinal block (spinal headache) are much less common now, but I guess that's always a risk.  They occur from a little of your CSF leaking from the puncture site and the headache lasts for 24 hours at most typically.  Low blood pressure is also a side effect too.

Narcotics

Narcotics, or also called opioids, can be given intravenously (IV, through a vein) or intramuscularly (IM, into a muscle like your shoulder, leg, or buttocks) and will not numb you completely.  They basically "take the edge off" of the pain.  Some common medications a labor nurse told me they use are fentanyl, stadol, or nubain.

Pros- it lasts a couple of hours and may just decrease enough pain for you to still move around during labor, if that's what you want to be able to do.

Cons- I am not a huge advocate for narcotics just because these do cross the placenta/blood barrier and could directly affect baby.  It's safe enough- narcotics are rated by the FDA as category C, which basically means that there is insufficient data to say it definitely or does not affect your unborn baby and that if needed, your provider can choose to give it to you.  Some babies will be born a little groggy and if too sleepy, they will be given an IV narcotic reversal medication called naloxone, or also called Narcan. Narcotics can also make you a little too sleepy, so take that into consideration.

Other medication

I'm categorizing everything else as other mainly because I highly doubt that you will use anything else besides what's listed.  These are less common, but still options depending on where you deliver:

Nitrous Oxide- I've only seen people outside of the US using this during labor.  It is an inhaled analgesic and makes you relax, a lot like a narcotic, but shouldn't affect baby directly.

Local Anesthetic Injection- I am unaware of this being an option before the baby is born, but I suppose it could be.  A shot of anesthetic, like Lidocaine, will be directly injected into your vaginal walls or perineum, causing numbness.  Usually, it is given when suturing tears or an episiotomy. There is not effect on baby.

Alternative Pain Relief

I will go into unmedicated births in an upcoming post, but I just wanted to list a few different methods people use for pain relief without medication:

• hypnosis (this is number one and very biased as this is what I used)
• breathing techniques
• redirection (focus! you'll be holding a little baby soon!)
• pressure points- certain acupuncture points can assist with pain relief
• movement
• yelling at loved ones and strangers- hey, it could help.

Most of the alternative pain relief options are focused on trying to totally relax your body and reduce the anxiety associated with labor and feelings of pain.  After all, pain is subjective meaning it varies from one person to another- what is excruciating pain to one mom may just be tolerable for another, but whatever it is, it is still very real for that person so that's why we need to treat it with what works for you.

*Thanks to MayoClinic.com for all the helpful pictures and information and Drugs.com for medication references.

Cesarean (C-section) Birth

Some women will have to opt for a cesarean section (c-section) as an alternative for childbirth.  There are numerous reasons, the most common being that a vaginal birth is less safe or impossible for the mother to do.  Fortunately, we have modern medicine now and a c-section is fairly routine, typically a 30 minute surgery with about 1-2 hours of recovery post surgery.

I will be honest, I do not have any experience with a cesarean section- I was really close to having one with my son, but then other means were used to get him out.  However, I would still like to go over basic information regarding c-sections so that you can get a general idea of what to expect.

C-sections can go two ways: scheduled and unplanned. Your doctor will weigh the risks and advantages of both a c-section and vaginal delivery and determine what is safest for you. Side note: I know that there's always some documentary or news article about the alarming increasing rates of c-sections, but let me just say- don't judge.  We may not know why someone chose to have an elective c-section but it's none of our business to begin with.  Most doctors will make an informed decision about your health- after all, it's their job to provide care.

Once decided that you are going the c-section route (let's say this is a planned procedure and not emergent), your day will go something like this: fasting 8-12 hours before surgery, arriving at the hospital at your scheduled time, and then receiving anesthesia.  I believe a spinal block is preferred over an epidural and is more common (just a quick note- epidurals are like an IV in that a small tube is left in your spine and spinal blocks are one-time shots into the spinal fluid. We will discuss this in more detail in an upcoming post). You will also have a urinary catheter placed so that your bladder can have relief while you have little control as well as an IV to receive medications and fluids through. After all prepped, it's surgery time! The operating room (OR) looks like any OR and your doctor, an anesthesiologist, and a team of nurses and scrub techs will be there.  Everyone has a purpose, so don't worry, you're not on display for any reason.  Most providers put up a privacy curtain to block your view and your partner will typically be allowed to be present at your side.  They will provide him/her with a pair of surgical scrubs too.

Now from your perspective, you may just feel a little pressure (or nothing) and then hear a baby cry after a few minutes. You may become a little nauseous- this is normal. But so much more is going on! There is a lot of precision and care when performing a c-section.

At this point in medicine, c-sections will typically have a curved transverse (horizontal) incision, sometimes called a "bikini cut" made in the low abdomen instead of a vertical incision. Studies have shown that there is less abdominal pain and a faster recovery with the transverse cut and it is also less noticeable in the long run.  Vertical incisions are more common in emergent situations, but even so, many doctors are able to do a transverse incision emergently too.  Here's a visual aid:

thanks for being realistic, Baby Center, by including the stretch marks! Moms can appreciate this.

A scalpel is used and after the incision to the skin, the doctor will cut through the adipose (fat) tissue, then the fascia, which covers the abdominal muscles, and then the abdominal muscles midline (which runs vertically) can be pulled apart and held open. The peritoneum is what lines everyone's abdomens and "encases" your innards.  This thin layer is then cut as well, exposing the bladder and uterus.  The bladder is kind of in front of the uterus, so the team will pull it downward and out of the way, giving a clear picture of the uterus.  Once the uterine incision is made, the delivery is much like a vaginal delivery in that the head will come out gently as the rest of the baby is guided out.  The umbilical cord will be clamped and cut, parents get to say hi to baby, and then baby is whisked away to get cleaned up and assessed.  The doctor will gently pull the placenta out and begin to close you up.  Closing the incisions will be much like the initial procedure in reverse, but of course much slower.  First the uterus is sutured and then the peritoneum suturing is actually commonly skipped as studies have shown that this step is not necessary and can prevent complications of the uterus or bladder adhering to it.  The abdominal muscles can be left alone or have 2-3 sutures to help it "remember" where to heal, and then the fascia is carefully closed.  The fascia is like the glue in the abdoment, holding it all together.  The fat can also be skipped when suturing, and then the skin will be carefully stitched, stapled, or glued.  All internal sutures will dissolve on their own.  Did you note that there are seven layers to get through? 

Watch an animated c-section here and skip to 2:09 to visualize the procedure:

I'm not sure why, but this baby is not delivered head first- maybe just the positioning...

Following the end of the procedure, you will be wheeled to a post-op recovery room where a nurse can monitor your vital signs as anesthesia wears off. Once decided that you are stable, 1-2 hours later, you can be wheeled back to your postpartum recovery room to join your new addition and family! Expect to stay for at least 3 days in the hospital.  This obviously varies between patients- I have heard of some women staying for only 2 days too because they were recovering really well and their hospital protocol was more flexible.  If I were you and I just had abdominal surgery, I'd be happy to stay for three days in the hospital with my baby and not have to fret about everyday things like laundry and dishes. Just sayin'.

The recovery of a c-section is much like a vaginal birth recovery- we will go more in depth in an upcoming post- but some things you can expect are vaginal bleeding still and a particularly sore abdomen.  Remember, as routine as a c-section is, it is still abdominal surgery! Many women stay in bed for at least the first half of the day post c-section, if not the whole day.  Your urine catheter and IV will be removed within 24 hours and you will likely need to be supervised when first getting in and out of bed.  Passing gas is normal and a good thing as it shows your bowels are "waking up" from the anesthesia.  You may want a postpartum abdominal binder/support (Belly Bandit is the only one I can think of, but there are many brands)- this is somewhat of a hype in that you probably won't get that celebrity beach body from this alone, but it acts as a good splint/brace for everyday things like getting out of bed, sneezing, light lifting, etc.  I have also heard of women using these with vaginal childbirth too.  Pain medications you will receive will be much like vaginal childbirth- narcotics, tylenol, ibuprofen. 

Almost like a smile with those starry eyes.... courtesy to Google Image search for "real c-section scar."

Having a baby should be an empowering experience whatever the route they arrive.  You should feel accomplished about your pregnancy more than anything else and embrace the fact that you are a mama to a snuggly newborn! 

*information courtesy of Dr. Dileo and Lalaena Gonzalez from Babble.com and also Mayo Clinc.

Expectations of a normal vaginal birth

Today, I am sharing with you what you can expect during a normal vaginal birth. We will mostly go over different terms the nurses and docs will throw around as well as some other terms that only some "seasoned" mothers will be familiar with.

First things fist, what are common signs that your body is preparing for labor soon 

• the baby will drop which just means that the baby will move into "go-time" position by dropping deeper into your pelvis *hopefully* head first.  Some women notice, others not so much. I couldn't really feel a difference because by that time, I was feeling just a little smaller than a beluga whale. However, I had at least a dozen people (mostly my coworkers who were also nurses or providers) tell me that I had "dropped."
• more regular Braxton-Hicks contractions.  These "practice contractions" occur throughout the pregnancy though, so don't count on these too much. If they aren't regular and increasing in strength or frequency, then it's just your uterus doing some exercising.
• Mucous plug. I just remember being disgusted each time I discovered my mucous plug had come out. It's basically a "cork" in your uterus opening and the release of it generally means labor is soon.  Now, each body is different and soon might be tomorrow or perhaps a week.
• Dilation and effacement- your cervix may be ripening (or softening if ripening sounds too much like fruit) and prepping for baby to make its debut.  Dilation is the cervical opening widening and effacement is the cervix getting shorter/thinner. I will cover more on this in the next section below. Take a look at this video clip to visualize it better:

Signs that labor is about to begin or very near:

• Your water bag breaks.  The amniotic sac is the thin membrane that lines the uterus, is attached to the placenta, and holds the baby and all the amniotic fluid.  This can rupture on its own before any contractions are ever felt (less common) and it could be a trickle of fluid or gush depending where the baby's head/body is.  Providers sometimes rupture the sac by assistance or they will let it break on its own, depending on their practice methods.  Call your provider as soon as this happens as each one will have a specific protocol they follow.
• Contractions, the rhythmic movement of the uterine muscles that move the baby down, will be more frequent, about 3-5 minutes apart, and will increase in strength over the duration of time. This is key.  It can be confusing to any mom when contractions are felt and they feel strong but then go away.  The usual pattern is increased strength and frequency. For me, contractions felt like menstrual cramps that radiated upwards through my whole abdomen and, later in labor, to my low back as well.  Depending on the birthing method you choose, your contractions could feel different (pain vs pressure).

Let's take a moment to discuss dilation and effacement again.  You will hear these terms throughout your pregnancy and on Facebook statuses of laboring moms.  Right? "______ is at 6 cm now and 80%!!! Baby will be here soon!!" Dilation/effacement can occur weeks before labor actually begins though! For example, I had been having irregular contractions around 35 or 36 weeks and my doctor thought she'd just check and I was already 3 cm.  By two days before I went into labor at 38 weeks, I was 5 cm dilated- just walking around and working, halfway done with labor (ha! If only labor could be something we multitasked). To deliver, you must be dilated completely and go from 0 cm to 10 cm and be 100% (or close) effaced (paper thin).

One more term you will hear during labor is +/- station. This refers to where the baby's head is at in your pelvis.  Generally, you will here a range from -3 to +3. -3 is at the very top of your pelvis and +3 is when the baby is "crowning." Crowning is the visibility of the top of the baby's head beginning to peak out.  Here is another visual aid for fetal stations: 

We are so close to the actual birth now! Just to refresh you from previous pregnancy readings, labor comes in three stages (four if you're in nursing school).  The first is when productive contractions begin and you are awaiting complete dilation and effacement.  The second stage is actively pushing the baby out resulting with the delivery, and the third is the delivery of the placenta.  You will likely hear all about the ring of fire if you are researching med-free births- it is the reported burning sensation a woman feels as she is crowning and the skin is stretched to capacity.  Note that I say "reported" because I personally did not feel it during my med-free birth experience.  Some providers consider recovery as the fourth stage, but you probably won't hear this that often.  

So when the baby is coming out, your provider will try to as gently as possible guide the head out first.  Babies have flexible skulls that mold to the shape of your birth canal as they exit, hence some babies have coneheads when born.  Also, our coccyx bone (tailbone) is flexible, albeit somewhat limited, but can generally accommodate a baby.  After the head is out, your provider will untangle the umbilical cord that is sometimes wrapped around the baby, and guide one shoulder out at a time.  After the shoulders, the baby will come out more quickly.  Keep in mind, you are pushing during this time, often with your provider saying "push now, hang on, ok push again, wait," etc.  You may have a little more control with an epidural but without any medication, you may feel little control as your body goes into autopilot mode.  Time to visualize the birth with the following clip (don't you love the classical music accompanying the videos?):

The placenta will deliver on its own between 15-30 minutes postpartum (after birth). Sometimes the provider will tug on it gently to help it come out.  So that's what a normal delivery looks like! Complications, often minor, can arise at any point and interventions will be necessary.  Some common interventions during the second stage (pushing):

• forceps: if baby is posterior, gravity is working against you, or perhaps just  "stuck," your provider may suggest forceps use.  They look like giant metal salad tongs.
• vacuum: it is what it says and looks like- a baby head vacuum.  The suction may be just enough to help pull the head out, the widest part of the baby. 
  *just my personal input- I would try to avoid forceps at all costs if I could do my first delivery all over.  It is very invasive and will cause more tearing deeper inside, which makes recovery worse.  Nonetheless, if it can't be avoided due to safety, then take the forceps.
• episiotomy: this is an assisted cut to your perineum, the skin that is between the vagina and anus.  This will stretch thinly during the second stage and sometimes tear on its own (see this site more on the degrees of tearing) but if the provider feels that the natural tearing may be worse than an assisted cut, they will perform an episiotomy.
• amniotomy (or artificial rupture of membranes): this is when the provider ruptures your membranes/water bag.  The tool used looks a lot like a large crochet hook.

Common pain medications and other meds used during or to induce labor:

• epidural/spinal block
• IV or IM (muscle injection) narcotics- a common one is Nubain but I have also heard of morphine being used
• pitocin- also nicknamed "pit." Many women either have labor induced with this or if their labor is not progressing fast enough, they will be started on it.  It increases the strength and frequency of contractions. Sometimes a shot after delivery will be given just as protocol for postpartum bleeding or if there is a little excessive bleeding, an IV infusion will be started postpartum.
• prostaglandins- medication inserted into the vagina to induce labor. Cervidil is the most common one I know of.  Prostaglandins are naturally occurring hormones that when stimulated help soften the cervix and kickstart dilation/effacement.  A common protocol with this one is being admitted just before bedtime to induce labor overnight.  If labor doesn't start, than other induction methods will be used.
• other induction methods I know of: is the use of a Foley catheter.  A Foley catheter is typically used to drain the bladder.  It has a balloon near the tip and instead of inserting it into the urethra, it is inserted into the vagina and the balloon is inflated in the opening of the cervix, applying pressure to it to hopefully start the natural release of prostaglandins. Membrane sweep- or also called "stripping the membranes.  This is done in the office, often when the provider suspects labor is nearing and only if you are term and dilated to 1 cm or more.  The provider will use their finger and sweep along the inside of the cervix to manually pull the membranes away from the cervix.  This can also stimulate the release of prostaglandins

Before I end this post, I want to share a little about the, *ahem*, less glamorous aspects of a vaginal childbirth:

• you're often naked or really exposed.  Your va-jay-jay is everyone's business and really, you probably won't care after a couple of hours and a little fatigue.
• there can be poop involved.  It happens. But don't worry, your nurse will be really professional and probably not even make a comment cleaning you up because it happens to many women. And it'll be so fast, you may not even know it ever happened. Seriously, you're pushing like you're about to have the largest bowel movement of your life.
• you may say crazy things or get angry at loved ones
• you may get nauseous and need to expel some contents out of your stomach
• Feel free to comment below about other less glamorous things

Hoping this is another helpful post, let me know if you have any questions and I will do my best to answer you or find the correct answer!