Being Motivated "Towards"

I just read a really interesting post about motivation by Felice at The Gift of Giving Life. Since I haven't blogged in a while, I would like to respond to her ideas in my own post.

I think it is interesting that motivation towards something is more effective at generating action than motivation away from something. I used to clean my house to get away from messiness, I now clean it to move towards control, order, and a more peaceful atmosphere. Towards motivation does seem to be more effective in this particular instance.

Felice's post focuses on motivation for choices while preparing for childbirth. Fear of pain (an away from motivation) is a common motivation for women in this situation,. Early on in my first pregnancy, when I was planning on getting an epidural, I was motivated by fear of pain. When I discovered the risks of epidurals, I was still motivated by fear--fear of complications resulting from overuse of medical interventions. This is still an away from motivation, even though it was movtivating me in a completely different direction--to have an unmedicated birth. I started to discover other motivations in that pregnancy, but did not have a lot of time to explore them.

In my second pregnancy, I was not so afraid of intervention. I'd had a medically managed birth that turned out fine. I had some fears, but they were more fears of "failing" (in quotes, because I now realize that the word failure has no place in birth) than of complications. I was determined that (of course as long as there were no complications) I was going to do it without drugs. I was motivated to prove that I could do it. I was motivated away from failing. I was also motivated towards an enjoyable birth, a safe birth, an empowered birth--and I worked to keep my choices in line with what these words meant to me at the time, which I'm sure was very different from what they would have meant early in my first pregnancy. They probably mean something slightly different even now.

When we move away from being motivated away from pain and away from "failure" and learn to be motivated towards the most positive safe birth experience we can have, it is then that we discover that gettting a "perfect" birth experience doesn't matter so much and are able to embrace whatever birth gives us and learn and grow from it.

Doula mini-documentary

This video, created by the doula credential organization DONA International, explains what a doula is and how having a doula can benefit you. Every birthing family can benefit from a doula, no matter what kind of birth they are planning. It includes interviews with researchers who did some of the original studies on continuous labor support. Although I am certifying with Childbirth International, I think DONA did a great job with this 15 minute documentary and it describes the role of the doula very well.

The Myth of "Early Labor"

Expecting Mother By Petercantfail at en.wikipedia [Public domain], from Wikimedia Commons

As a science, medicine seeks to define things in specific terms. As a natural process, childbirth doesn't always fit into perfect little boxes. Childbirth education often uses the explanations from medicine in attempts to help women understand the birth process. However, based on my own observations, the "textbook labor" does not apply to the experiences of a very large proportion of birthing women, and I wonder if we are, by using it, doing women a disservice by creating false expectations.

The general model that is taught is that there are three stages of birth: dilation, pushing, and birth of the placenta. Within the dilation stage, three phases are taught: the early/latent phase, active phase, and "transition."

• Early phase is usually defined the time when the cervix is going from 0-3 cm dilation, and is characterized by pressure waves that are spaced far apart and my be irregular.
• Active phase is defined as cervical dilation from about 4-7 cm, and is when the waves get regular and increase in intensity and frequency and cause measurable cervical change.
• "Transition" is when the cervix goes from 8-10 cm, and is usually explained by its physical and emotional intensity and the presence of symptoms such as shaking, nausea, and vomiting.

There are a few problems with this construction.

• If this is the "normal" birthing women whose births do not fit this pattern may consider what they experience as "abnormal."
  
• It relies very heavily on measuring the cervix as a basis for knowing how far along a woman is.
• Some women's cervices will be reach dilations where thy should be in "active phase" but stay there for days or weeks before the baby is born, and there is nothing pathological going on
  
• I specifically disagree with the way "early/latent phase" is characterized.

The impression that this model gives is that from "not in labor" to "in labor" is a one way street; once "labor" begins, you are "in labor" until your baby is born. I feel that this construct, together with unrealistic media portrayals of childbirth (where it always seems like a woman is going along minding her own business, suddenly her water breaks, chaos and rushing ensues, as well as some screaming, and then someone is handing her a "newborn" the size of a 3 month old), encourages women to head to the hospital as soon as they have contracting sensations that they can tell are more intense than the Braxton Hick's they have been having.

I have been participating in an online support forum for women who are planning natural births for about 3 years now. On our group, we have a fun tradition called Lodges, which are a sort of journal for pregnant women that lasts from 36 weeks to about 1 month postpartum. I have followed many lodges in the past three years, so I have read updates from women as they are nearing the births of their babies. From my own informal observations, it appears to me that a majority of women experience periods of regular and intense pressure waves (not Braxton Hicks, but the same kind you have during birthing) on and off for days, weeks, and in some cases months, before giving birth. They will go long periods with no pressure waves, then have them start again for a few hours, then they'll go away. So, does early labor stop? Can early labor last for two weeks? Or is our idea of "early labor" a myth?

Some people would call the off-and on periods of pressure waves "false labor," but I really dislike that language because it implies that the woman doesn't know what she's feeling. In many cases, the only way to tell the difference is in retrospect: sometimes they go away and sometimes they continue to the birth of a baby, they usually don't really feel much different from each other, contrary to what some will tell you. "False labor" also implies that it is not doing anything, and I am of the opinion all pressure waves do something, even if it is not causing measurable dilation. It could be effacing the cervix or encouraging the baby to rotate into a better position. In some cases, dilation is occurring, just not quickly enough for it to be measurable. For women who have "false labor," it may just be that their body does the "early labor" work incrementally, with long periods of rest.

The problem is that I suspect that the majority of women don't know how common start-stop labor (as I like to call it) really is. I recently read a blog post by a nurse (shared on facebook by The Deranged Housewife) who blamed the "need" for hospitals to use pitocin on women going to the hosptial and getting epidurals too early. Comments on the facebook link suggested that the problem is not the patients themselves, but that someone is failing to adequately inform them what the end of pregnancy is really like. The nurse's post really made me wonder how many women are getting pitocin for "stalled labor" when actually they were having an episode of pressure waves that would have gone away? How many of these babies would actually have come days or weeks later without the pitocin?

(On a similar note, I also love this post by midwife Stephanie of Vita Mutari questioning the logic that it is "safe" to "labor at home as long as possible" in order to avoid crowding the labor and delivery floor and avoid interventions, yet "unsafe" to plan a homebirth with a midwife.)

The concept of "early labor" is misleading because it is so easy to mistake start-stop labor for "early labor," and if women assume "this is it"and run to the hospital at the first sign of a pressure wave, they are guaranteed to either be sent home disappointed or have a whole lot of interventions, and neither of those is a desirable thing. I know I fell into the "early labor" trap myself with my first birth--I remember thinking "I've been in early labor for two days and I'm only 1 centimeter?"

For real, human women, not mythical "textbook" ones, the onset of the birthing time is a fluid process that they may move in and out of at their own unique pace. The last few weeks of pregnancy are the orchestra tuning up before the concerto, the engines revving before the race.

Order in Our Lives, Even with a Baby

I know some people say that it is okay for your house to be messy when you have a baby. To some extent, this is true, it is important to not be so focused on having a clean house that you never play with your children, but having a really messy house can really make parenting difficult. When the house always messy, you can never relax and enjoy your kids because you are always thinking about all the cleaning you need to do. Humans need structure in their lives. Order allows us to have peace.

I recently realized that I my kids and I really needed a little more order and structure in our lives. I realized that I felt overwhelmed by my house never being clean, and I was using the computer as an escape from my responsibilities. When I did clean, I would exhaust myself trying to clean everything at once, and then I would feel "burned out" from cleaning and wouldn't maintain it, and the house would soon deteriorate into chaos again. I really wanted to develop the concept of rhythm for my kids, as taught in Waldorf education (which I have been studying after Sheridan blogged about the changes she is making in her home now that her kids are going to a Waldorf-inspired charter school), but I realized it wasn't possible with the level of chaos in our environment.

I found a wonderful system for establishing habits of cleanliness. It's Flylady's Beginner Babysteps. I am on Day 8 today, which means I have been doing it for a week, and the improvement is slow, but it is lasting change, not a temporary fix. I feel like I am finally getting some control in my life. One of the routines is you get dressed first thing in the morning, from head to toe. This encouraged me to finally go out and get my hair cut. I hadn't had my hair cut since I was pregnant with my son, who is almost 9 months old. And my kitchen is clean, which means I can actually cook dinner for my family.

I have been limiting my computer time, and as a result haven't been working on blog posts as much. I have a second post in the works about the book I read, Sisters on Journey, which I will hopefully finish eventually. If you don't hear from me, I am probably either enjoying my kids or working on creating a more peaceful environment for them.

A Birthy Thanksgiving

I found out that Preparing for Birth is doing a blog carnival for Thanksgiving on being grateful for our birth experiences, so I'm joining in. I have so much to be thankful for with my births, both good and bad.

In my First Pregnancy and Birth:

• I'm grateful that I found information about natural childbirth. The paradigm shift I experienced changed me forever, and having had both a pro-epidural and low intervention attitude, I understand better where people are coming from.
  
• I'm grateful that I asked questions of the OB I had been seeing and realized his policies were not good obstetric medicine so that I didn't end up giving birth with him as my provider.
• I'm grateful that I found a wonderful midwife group who took me at 34 weeks and were very supportive and made me feel comfortable.
  
• I'm grateful that I learned how harmful going to the hospital too early can be.
• I'm grateful that I experienced pitocin induction, so I can sympathize with other women who have had it.
  
• I'm grateful that I had an epidural, both because it was what I needed at the time and because it taught me to be able to tell other women that sometimes the epidural is the best choice for that particular birth.
• I'm grateful that my epidural worked as it should, not too numb and not ineffective, and my baby was born without needing any further intervention.
• I'm grateful that I tore so I can empathize with women recovering with perineal stitches.
• I'm grateful that my husband was exactly what I needed him to be through the whole experience.
• I'm grateful that my birth experience was not exactly what I wanted because it inspired me to prepare more for my second birth and was part of what inspired me to pursue a career as a birth professional.
  
• I'm grateful for my beautiful, healthy little girl, who is now almost three.

For My Second Pregnancy and Birth:

• I'm grateful that I ended up with an amazing OB, who restored my faith in the profession.
• I'm grateful that I experienced the benefits of using Hypnobabies during my pregnancy
• I'm grateful that I can compare pitocin induction to spontaneous labor.
  
• I'm grateful that I got to labor as long as I did in the comfort of my own home.
• I'm grateful that I learned that I had the power to make my birth much more comfortable with focus and relaxation.
• I'm grateful that I progressed smoothly and arrived at the hospital at 8 cm, which further removed the temptation of pain relief.
• I'm grateful that I didn't know I was GBS positive so I didn't go to the hospital earlier, and that my baby was still healthy.
• I'm grateful that I learned how hard it can be to maintain focus with hospital distractions.
• I'm grateful that I wasn't able to keep using my Hypnobabies during second stage so I can understand how intense natural childbirth can be.
• I'm grateful that I did not tear and got to experience how much smoother recovery goes with an intact perineum.
  
• I'm grateful that my nurse carefully read my birth plan.
• I'm grateful that my husband exceeded my expectations as a birth partner.
• I'm grateful that my mother-in-law did not circumcise my husband, so my husband and I easily agreed to leave our son intact.
• I'm grateful that my experience with this birth reinforced my interest in becoming a Hypnobabies Instructor.
  
• I'm grateful for my beautiful, healthy 8 month old boy, who thinks he is a toddler already.

My babies have truly brought me a cornucopia of blessings :)

painting by Jan van Kessel the Elder [Public domain], via Wikimedia Commons

Happy Thanksgiving, everyone!

Traditional Birth Secrets: The Rebozo

What is a Rebozo?

A rebozo (pronounciation) is a woven piece of fabric used by Mexican women as a shawl, a baby carrier (similar to the way I use a wrap, but the fabric is not as long), and a comfort and positioning tool for pregnancy and childbirth.

Photo by Luis Marquez
Courtesy of Special Collections, University of Houston Libraries

Rebozo Use during Childbirth

Techniques for the Rebozo in childbirth include:

• "sifting" the mother
  
• to aid in the double hip squeeze
• rocking or dangling the mother
• covering the mother's eyes and ears to block distractions
  
• for the mother to pull on, especially during pushing
  

The "sifting" technique is the most well-known uses of the rebozo in birth. It is a method jiggle a woman, similar to what Ina May Gaskin calls "shaking the apples." The motion promotes relaxation of the birthing muscles, which can aid in rotation and decent of the baby. Here is a demonstration of the "sifting" technique from a doula training:



Here is the above technique being used in at the hospital during a pitocin induction:



The technique used in the above two videos are explained more in-depth at the Spinning Babies website.

In my doula training, I learned how to do a technique called a "double hip squeeze" with my hands to open the pelvis. This video explains how to use the Rebozo to make the double hip squeeze easier:



More articles and pictures:

• The Rebozo: a transcript of a rebozo workshop given by Doña Irene Sotelo and Naolí Vinaver, published in Midwifery Today (more pictures can be seen by following the link below the photo shown)
• "Comfort Measures for Childbirth: Let's do it with a Rebozo"--a collection of images by Patti Ramos taken at a rebozo workshop with Guadalupe Trueba, including images of the rebozo used for rocking , putting it over the eyes to block out distractions, to pull on while pushing, and other uses
  
• The Many Uses of a Rebozo at Birthing Essentials--short explanations with pictures of many of the techniques
  

For more information on traditional baby carriers and rebozos, visit www.rebozoway.org.

Research-backed Benefits of Hypnosis for Childbirth

As explained in this article, a meta-analysis of selected studies on hypnosis for childbirth found that women who used hypnosis were:

• 51% less likely to use drugs for pain relief (38% of the hypnosis group used pain medications, compared to 74% in the control group)
• 70% less likely to have their labors augmented (11% in the hypnosis group were augmented, compared to 70% in the control group)
• 67% more likely to have a spontaneous vaginal delivery (meaning they were not induced and did not have cesareans)

The limits of this study

Despite it being a meta-analysis, the sample sizes are still quite small. As far as I can tell, the control group represents the standard population, which would include women who do not do any childbirth preparation and/or who planned to have epidurals. It would be interesting to see research comparing women using hypnosis with other methods of natural childbirth preparation, since that would provide a clearer picture of the unique benefits of hypnosis.

One reason why hypnosis is such an effective method of birth preparation: research shows women are more easily hypnotized during pregnancy.