An Instinctual Birth

Gabriel Blayne - 8lbs 15oz
Born at Home – October 3, 2011

“Deep within each woman,
lies the knowledge to give birth
without outside interventions.”

My 2nd birth – the birth I’ve been dreaming of for so long.  Bell’s birth was incredible and life changing.  This birth was as close to biological as I could have ever wished for my family.  It was the birth that I talk about so much.  It was perfect.

After a week of on and off again mild regular contractions, the night before my birth I started feeling strong cramps in my cervix.  They were irregular, then slowed, and stopped before bedtime.  I had turned off the ringers at the house for the weekend, and each night took a long warm shower, and fell asleep listening to Tibetan Bells and relaxing to the scent of Lavender aromatherapy oil.  I had been waiting…. anticipating a past “EDD” birth – but not imagining I would go 2 weeks past.  I was ready to welcome labor with open arms.

I woke up each hour to pee – just like always.  But, around 2:00, I was feeling strong cramps, and felt like these were different than the contractions I’d been feeling throughout the past week.  I called James (who was on his 3rd midnight shift of the weekend) to let him know my contractions were regular and that I was going to call Donna (Donna Spellman, CPM) to see what she thought before he came home.  Donna said to call her back in an hour and we’d see how the contractions were, so I also let James know I’d call him back in an hour.  I sent a heads up message to Allie (our birth photographer with Allie B Photography), and gave Crysta (our doula with Gentle Beginnings) a call.  I was feeling like these contractions were pretty close, and was starting to feel like I wanted someone with me.  Bell was sleeping, and if things got intense, no one was here to attend to her if she would wake.  I told Crysta I’d call her back in 1/2 hour – but I was afraid to have anyone come if things were just going to stop.

Things weren’t stopping.  But I did take a moment to snap a picture of myself.

I’m a nut about documenting events.

I called James, Crysta, & Allie in 1/2 hour.  I wasn’t waiting an hour to get someone here.  I was ready for companionship.  I just wanted someone nearby.  I was really needing to concentrate during contractions, and had to quickly finish my message to Allie because that one was getting too intense to talk.  Yes, these were progressing fast…. but – wow, don’t I have at least 6 more hours of this… then transition… and still pushing?  These are one on top of the other, I’m moaning, and I’m getting a little nervous.  I’m not doing so well am I?  But wait, this is the exact same way I felt when I was in transition with Bell.  Am I in transition???

All the sensations and movements were running through my head.  I got the birth ball out to lean on… nope, that didn’t help – I needed to walk.  All the birth scenarios were running through my head.  Thinking of someong pushing on my back was running through my head.  Every direction of the baby, every little foot movement.  I could sense all of them – I could feel the whole birth.  I knew my body was working, and the baby was doing OK because I could feel him move. 

I called Donna.  I think it had been 45 minutes.  It was time.  She had over an hour drive, and this wasn’t stopping.  I still felt bad.  It was the middle of the night – and everyone was going to come out, and this was just going to stop.  I don’t care.  I need presence.

James gets home.  Relief!  Wow, I’m getting loud.  I really don’t need to be this loud – but it just feels good, so I went with it.  But, I’m still talking and doing just fine between contractions… gosh, am I going to have to deal with this all night?  Can I handle it?  I really don’t want to…  I’m kind of done – these are intense.  James is a little panicked.  I asked him to move Bell back to her bed, and get the bed ready.  He wasn’t putting the sheets on right – and that annoyed me a little.  I just wanted it prepped – and fast.  He started getting glasses of water, straws, and putting all our birthy-needs in place.  “I need you to HELP me!”  Yup – that same scenario with Bell’s birth was coming up.  James is a prepper… but doesn’t do so well with support.  When is Crysta going to get here?  Why did I tell her to wait?  I hope Allie gets my message.

I have to pee.  It hurts to sit on the toilet.  Same feeling I’ve had for 2 weeks.  I have to pee – and I can’t.  I constantly feel like I have to poop… I’m totally pooping when this baby comes out.  I just accept it.

I decided getting in the shower will let me stand and pee.  I try the water on my back.  It was incredibly distracting.  I’m just not a water birther.  I’m a walker.  I couldn’t imagine sitting in a tub – I need to move.  I turn the water off.  Pacing – my same ritual I used with Bell.  It brings baby down, and it helps me deal with the sensations.  Oh WOW, those sensations!  I paced in our little standard 5′ tub.  “James, get the camera.”  I leaned on the bathroom wall with each contraction.  Really?  More hours of this?  Oh my gosh – someone just tell me I’m in transition and I’m doing OK.  “You can do it.”  “I can do it.”  “You’re OK… You’re OK.”  Nope – those don’t work.  Moaning… totally works.  And I was MOANING.  Bell is going to wake up, surely.  MOAN….MOAN…..OOOOOHHHHH…..I remember my deep noises this time, though.  Yup – bring that baby down, Danielle. 

“You’re doing good.”  What was that?  I thought…. James was telling me I was doing a good job….  He was taking pictures, and then just sitting by the tub watching.  He was so nervous… but this was great.  NEVER underestimate the power of encouragement and presence!  I AM doing good.  I’m loud – but I’m doing this!  And, I don’t have to get in my car and drive anywhere.  This is going to happen at my home!!!

I really need to pee.  Baby is pushing down and squishing stuff out with each contraction – but I just want to pee.  James, get me the peppermint oil on a tissue… nope, that didn’t work.  Worth a try.  Oh well, I’ll just stay in the tub.

Oooh… I am still doing this…  but how much longer?  I want to squat.  Wow, that kind of works.  I want to squat, and…. am I grunting?  A few squats with James supporting me (I almost knocked him in the tub with me) and my water broke.  Am I pushing???  No way…. no way am I already pushing.  I’m grunting.  Maybe there is a lip, I think.  These grunting pushes are good.  No one has even checked me – how awesome is that?!!  Oh, yea, I’m pooping.  Hey, at least I’m not going to feel like I have to poop anymore…Baby must be really moving down now…maybe if I poop it will make room for the baby.  (Seriously, you’ll think of all kinds of stuff when you’re in labor).  Where’s my labor land?  I so am not in labor land.  I am completely here – completely feeling everything, completely conscious and aware… but I’m doing it.  There’s no way I’m already in 2nd stage.  But, contractions were easier to rest through.  Still close – but I was getting a break.  Wow, this is awesome – totally intense, and I’m really ready to just be done.  James thinks about cleaning up the poop.  That’s love… that’s comfort.  Birth with someone who is OK cleaning up your poop!  But, I kept moving around, so he couldn’t get to it.  Wow, that stinks.  A few more pushes, and there went my water.  Oh NO!!  Meconium.  Wow, this bathroom really stinks now - and everyone is going to smell it.  Oh well… “James, call Donna… there’s meconium.”  Donna was about 15 minutes away.  I’m still squatting and grunting.  I’m going to have this baby!  Yes, I’m in 2nd stage.

James prays.  I think I pray at some point, too.

I want to stop standing.  Squatting just feels so much better. James lays down a towel and a chux pad.  Ahhhh – this is better.  I can lean… All 4s – what a powerful position.  Rest and birth at the same time.  Oh, I’m really pushing now.  No one is telling me to do anything – no one is touching me – I AM doing this all by myself!!!  James is just sitting behind me and waiting.  He’s nervous.  I’m DOING this!  I don’t care that no one else is there – I have a presence with me and I am DOING this!  I reach down… no head yet.  Oh, how long is this going to take?  A few more loud pushes – yeah, yelling just feels great.  I think of that carved stone face of the woman birthing – I totally look like her.  I’m POWERFUL!

Azstec Goddess Tlazolteotl Giving Birth - although I'm not keen on the idea of the "Goddess of Filth" this was, nevertheless, how I was picturing myself.

More pushes.  I reach down again.  I want to know how far the head is… I feel something squishy – but it is small.  It is that same distinct feeling I felt when Bell was crowning, just smaller.  OK, baby IS moving down… I AM doing this!  “Crysta is here,” James says.  I look out – she’s just quietly leaning by the wall in the bedroom.  Wonder what she’s thinking…. I’m LOUD!  Wonder if she thinks I’m nuts and not doing well… oh well… yelling just feels good!  More pushes, a little high pitched, but that’s OK.  Remember to just breathe, and you’ll be fine.  More pushes, and I’m feeling the head.  Oh, there’s that ring of fire.  I can do it – I think… I don’t want to – I think some more…  Just push – you CAN do it… you just HAVE to do it.  I only pushed for a few seconds with each contraction.  Not getting out of breath this time.  That was perfect – exactly what I could handle – no one telling me to do any more than what my body was ready to handle.  I could feel the baby moving down, then back up – wow, that’s crazy - doing the baby dance.  OK, I know we’ve still got more to go… baby is still moving up.  Oh, then there’s full on crowning.  My perineum is stretching, but I don’t think it is tearing.  Baby stops dancing.  Oh, we’re almost there I thought, and no one is interfering!!! 

A few more pushes and the head was out.  I DID it!  I DID it… and all I have left to do are the shoulders (oh, not fun) and the body!!!  “Can someone get Bell?”  Crysta says “she’s here.”  OH, cool!  I was SO glad she was able to be there – that meant the world to me!  I was worried she wouldn’t be able to see because of the small space – but James said she was watching.  I hear Donna, “There’s the head… but I’m sure you already know that!”  That was funny… I didn’t have the energy to laugh, but it was funny.  I feel her hold the baby – that was a little intense.  I knew I had to get the shoulders.  “Next contraction, I want you to reach down and hold your baby.”  OH – it is almost over… it is almost over!!!  I CAN do the shoulders – and my scar is giving me no issues (shoulders are what made me tear with Bell - that and directed pushing).  This is great!!!  I try to reach down, but I need to support myself, so I stop.  Donna holds the baby with the next few pushes, and AHHHH, relief – there’s that squishy body!

Crysta is taking pictures – AWESOME!  This birth was fast, and Allie wasn’t quite here yet.  The video camera’s battery was dead, but at least I’m going to have some pictures.  I move around, try to get into a better position, and then Donna hands me our little….  Its a boy!  A boy. I knew it!  I feel elated with this one – I didn’t have that instant feeling with Bell.  But, this was perfect – this was exactly the birth I wished for.

“Let’s cut the cord,” Donna says.  I check to see if it has stopped pulsing “Can we wait?”  “Do you still feel a pulse?”  I wasn’t sure – I was shaking – so she waited a minute or two longer.  She took the baby, and I moved to the bed.  We still had the placenta to go – but it was OVER.  2.5 hours from waking up to birth…. WOW!

We didn’t have a name picked out yet.  Interestingly, I was the one in a hurry to name him.  He was 8lbs 15oz – over a whole pound bigger than Bell.  But, was only 19.5″ long.

photo by allie b photography

photo by allie b photography

The cord was wrapped around his shoulder, which caused a little bit of cord compression, and likely the cause of the meconium staining.  He was fairly blue and limp at birth – alarming to me, but Donna checked him and he was doing well.  Funny – he has favored the ROA/ROP positions, flipping to LOA occassionally, but always back to the right.  I did some optimal fetal positioning, but felt like he was on the right for a reason.  I believe he was there because the cord was on his shoulder – and that the birth went fast so that he would do well throughout, and not have to deal with the compression for longer than he could handle.  God was watching over us.  He was well.  Not much bleeding from me, and he pinked up quickly.  He has a strong urge and suck to nurse – just like his sister did.  Now, just transitioning to a family of 4, and encapsulating my placenta next!

photo by allie b photography

What a magical experience.  Allie was able to make it for the placenta birth, and she got some beautiful pictures of our family – thank you so much for taking the time away from your family to document this special time in our lives you can watch the slideshow here – I’ve only watched it about 100 times http://gabriel.alliebphotography.com/).  Crysta was there with love and support… and she ended up cleaning up my poop.  Thank you Crysta, for being there – for being a wonderful presence – for being patient – for cleaning up my poop.   I was SO glad to have people there for 3rd stage and immediately after – just perfect! 

photo by allie b photography

Thank you Donna – thank you for no dopplers, for no vaginal exams this entire pregnancy.  Thank you for such wonderful care and advice – you are an absolutely amazing midwife!  Thank you to James for sitting patiently – for those small words of encouragement – I love you and am so glad to have been able to experience this birth in this way – even though you were nervous. 

photo by allie b photography

Thank you Bell – for starting my life over, and putting me on the path to experiencing this amazing birth. 

photo by allie b photography

Thank you God, for watching over our family and our birth team.  I didn’t need an unassisted birth… I needed THIS birth!

photo by allie b photography

Butterfly Birth

 

Biological birth is not simply “vaginal,” nor “unmedicated,” nor “natural.”  It is what nature intended.  It is if a mother were able to instinctively labor without being hindered in any way – from interventions, from watching eyes, or limits.  Esali Birth doesn’t teach about biological birth to make mothers feel guilty about their choices – but to educate how we control the situation and the effects that our choices have.  This allows us to make fully informed decisions, understand our birth experience, and be proud of how our births commence – no matter how far from biological they may become.  True biological birth is rare – mostly because of the fear placed upon birth, and human’s instinct to do everything they know of to survive and allow others to survive.   However, we have to understand the implications of these urges in order to understand how our birth experience affects our livelihood.

 

When a caterpillar is ready for their transformative stage, they spin a tight chrysalis that protects them during the process.  When the butterfly is ready to emerge, it moves about in the chrysalis and makes a tiny hole.  Upon observation, it would appear that the butterfly struggles through the hole – and to someone who is unable to simply watch nature’s intention, they may feel a strong urge to interfere with the process and “help” the butterfly with their struggle.  The problem is, this does not help the butterfly, but actually affects their quality of life.  During the emergence, the pressure from the hole squeezes the butterfly’s body and pushes fluid to the wings.  Without this process, the butterfly weakens and will not fly – but will be forced to crawl around, and will be unable to feed and continue their life cycle as nature intended.  This is the importance of biological birth.  Biological birth is intended so that humans can be transformed into the butterfly that has the strength to parent, to breastfeed, to walk, crawl, breathe, and everything else throughout our lives.  Our birth experience is one of the biggest events that will affect the rest of our life.

 

During pregnancy, the mother who takes responsibility for her nutrition and well being will create the optimal situation for a biological birth.  If she eats well, exercises, and is emotionally healthy, she will create an environment for her little one to thrive, and reduce risks associated with birth which enable her to make numerous choices for her experience.  If a mother does not take care of herself, then her body will have more difficulty accommodating the biological process, and interventions would become necessary.  However, the important thing to remember is that our bodies were made to birth.  Out of every human function, the female system was designed for reproduction and is not flawed from the beginning.  We do, nevertheless, affect the way our bodies work – so it is important to think of how our lifestyles will affect our reproductive years.

 

Just as with the butterfly, the perinatal period is simple, yet at the same time intricately full of survival mechanisms.  If mothers are supported in a positive manner and not educated to fear birth, they have the ability to birth their baby without taking a class or understanding much about the process.  A change to any of these mechanisms is a change to the biological process, and what is intended for our species.  Everything from the scent of amniotic fluid, to the positions used in labor – there is a reason for each unique system.  Spontaneous labor allows the newborn optimal time for development.  Reducing limits during birth allow the mother to move freely and work the baby through the pelvis, as well as keep up energy levels with food and drink.   Contractions help to move fluid through the newborn’s body and create the optimal setting for efficient oxygenation at birth.  An unmedicated birth allows the newborn the strength to crawl to the breast, and self-latch for the first breastfeeding.  Various biological measures are in place to reduce bacterial infection in the mother and newborn.  And, even after birth, the organ [placenta] that supported the baby’s life for so long, continues to contribute to the health and well being of the mother and baby.  These are just a few of the many methods our bodies use for survival during this spiritual period.

 

What happens when you veer from the biological process?  Sometimes, there are severe complications – sometimes, there are treatable complications.  Every time, there are implications that we may not be aware of until years down the road, or we may never notice the connection.  Does that mean they shouldn’t matter?   The most immediate complications usually involve breastfeeding difficulties which in turn may end up affecting breastfeeding success entirely.  Other common complications include assisted/cesarean deliveries, vaginal and perineal tears, postpartum hemorrhage, newborn jaundice, and newborn breathing.  These are all complications that often result in further complications – and the truth is, we just don’t know when or what complications will occur.  So, you be the judge.  Get educated about the biological process, how you affect the biological process, and then make informed decisions for your situation.

 

If you would like to learn about the survival mechanisms during the perinatal stages, and the amazing way our bodies work, join Esali Birth for a Butterfly Birth workshop.  Not in the Mid-Ohio Valley?  Contact us about a Butterfly Birth Webinar.  These, free, workshops are wonderful opportunities to learn about the significant impact we have on our birth experience, and for developing a positive attitude towards biological birth.  Hope to see you there!

 

Approaching Biological Birth

At Esali Birth, we promote the perspective of biological birth.  Though there are many differences in birth location that affect how your birth may go, there is no difference in birth location that affects how your birth should go – and because of this, we educate our students on biological birth so that they understand why choosing the right birth team and birth location is vital to their experience.  If we teach normal physiological birth with an instinctive birthing approach, then every woman understands how their body is amazingly designed.  Therefore, stressing the importance of responsibility and making choices during the perinatal period to support biological birth is one of the most important strategies of an Esali Birth class – not only does this give mothers the information they need for a wonderful birth, this also gives them understanding of how their birth may have differed from a biological norm (necessary or not).  One of the approaches to biological birth that I find very important is to remove “pushing practice” from a class setting and instead teach biological birth during 2^nd stage.

I repeatedly find outdated practices being taught in modern childbirth education settings – whether from a formal class, a typical conversation, or direction from even home birth midwives.  With all our approaches to natural and instinctive labor, why is it that when it comes to stage 2 – the birthing [pushing] stage – are we so medicalized?  Just because providers may practice this outdated method of birth does not mean we shouldn’t make mothers knowledgeable about the way their body was designed to biologically birth their baby – through all stages.

The birthing stage can bring a wonderful break for a mom, especially after an intense transition and active phase of labor.  Why deny her of this opportunity to rest and relax as her contractions spread out and change direction from dilating and effacing to expulsion?  This only tires her and increases incidence for unnecessary interventions and complications.   Although many mothers may welcome a more active birthing phase, birth attendants also seem to get this burst of energy during this time as well – thinking everyone needs to “do something.”  This is further from the truth.  Birth attendants need to be on their toes… making sure they’re not interfering with one of the most delicate parts of the birth process.

Prior to this point in labor, emotions and birth environment have a definite impact on birth experience, and it is somewhat easy for a mom to digress in her labor in order to find a safe location for birthing her precious child – it is all about survival.  Now, however, she is almost to the point of no return.  Stopping labor at this point would be difficult after the woman’s body has transitioned into the birthing stage – so keeping this space sacred and just as calm and instinctual is vital to the mother-baby’s health and experience.  It takes an extremely patient provider and very knowledgeable attendant to “do nothing” during 2^nd and even 3^rd stage labor.  If we can wait 24 hours for this point to arrive, what is it that makes everyone want hands in, hands on, and mouths directing?  Well, simply, the reason is history. 

Directed 2^nd stage came around when medically managed births were introduced.  A variety of reasons included getting this stage over as fast as possible because providers believed this stage was dangerous for the baby, to the need for directed pushing because most mothers were medicated, and even knocked unconscious with drugs like twilight sleep.  Just as with every other unnecessary intervention we see today, some stuck with modern techniques because so many providers are being incorrectly taught about physiological birth (or they fear birth) and there is a large misunderstanding about the importance of biological birth in this industry – even among home birth midwives.  I stress this because so many parents get the idea that hiring a “midwife” indicates they will have a biological birth – but just as with any provider, credential does not mean quality.  Unfortunately, women need to know a lot about the perinatal period in order to even have a biological birth.

One of the easiest – yet seemingly most difficult – things to do to facilitate a biological birth is to stop paying attention to numbers.  Who cares how long this woman has been in labor if everyone is doing well?  Who cares how much she is dilated?  Who cares how much she is effaced?  These things tell so little about the birth, why they are even monitored is beyond me.  Even attendants who promote this idea [of avoiding numbers] still use these methods to determine if mom is actually in labor, if she is actually progressing, and if she is actually ready to birth her baby.  Why?  Convenience?  For whom? 

A mom calls her provider and says “I believe I’m in labor.”  The first thing they want to do is check dilation and effacement.  Why have we stopped believing the mother?  This is the first step to saying “well, you really don’t know what you’re talking about – and even though dilation and effacement aren’t going to tell us when the baby will arrive, we’re still going to stick our fingers up there and see how far along you are anyway.”  That is mistrust.  It is mistrust for the birth process and mistrust for the mother.  We know the other signs to watch, why aren’t we watching them?

Energy is flowing, mom is getting grunty, and she’s beautifully moving with her contractions.  “Hmm… we better check you.”  Lightbulb?!  If you think she is to the point of transition and moving into the birthing stage, what is making you not trust your knowledge that you need to check effacement and dilation which we know doesn’t tell us much about labor progression or birth time?  These grunty pushes are most likely dilating the cervix the rest of the way, or removing an “anterior lip” which so many attendants fear because “pushing may cause cervical swelling.”  A mom who is directed in pushing can most certainly swell her cervix if it has not opened as wide as what her baby needs.  But a mother who is instinctively and biologically birthing her baby will use these grunty pushes to do exactly what nature intended – gently moving her baby through her body the way her body and baby were designed.  And, not to mention, we know baby’s heads are not all 10cm – so why even use 10 cm as a guide?  There is that number issue again…  What if we tell a mom, “yup you’re 10 cm – you’re OK to push” and start directing her birthing stage, when her baby actually needed 11 or 12 cm?

So, the first approach to biological is a provider who not only understands, but actually practices biological birth methods.

The next approach is through instruction.  For years and years, mothers and birth partners have been lead through labor rehearsals and “taught” how to push – and even in recent years, at the same time told “don’t use directed pushing.”  If we know how important instinctual birth is, why are we still not teaching this?

Directed pushing in ANY form may cause (to name a few):

• Decreased energy levels
• Increased length of pushing stage
• Increased vaginal swelling
• Increased risk of perineal/vaginal tears
• Increased maternal & fetal blood pressure
• Decreased fetal oxygenation
• Fetal distress
• Increased need of assisted delivery and/or cesarean birth
• Increased risk of CPD misdiagnosis

Don’t get the idea that just because someone isn’t counting to 10 that you’re not being directed to push.  How many times have you done something in your life simply because someone won’t stop asking you to do it?  “Are you ready to push yet?  Do you feel the urge?  Are you sure?  Maybe try a little push and see how that feels.”  Even gentle approaches to encouraging a mother to push can change the way she births her baby.  No matter how knowledgeable mothers are, they are at an extremely vulnerable stage.  Try taking morphine and see how easy it is for you to make decisions or not listen to the people you hired to protect you during this sacred time.  Now you kind of know what it is like to be in the birthing stage.  Beta endorphins and oxytocin have been flowing through the mother’s body – continuously increasing; she is literally on a natural high (similar to the affects of morphine).  This is not a point where she should be making decisions, answering questions…etc.  She needs to continue to work with her body to biologically birth her baby…instinctually.

 

Take any time to rest and relax until you feel the expulsive urges that you cannot resist rather than beginning to push when it is not necessary.  Pushing before you have the urge is unproductive.  And, no, contrary to what many would have you believe – not all mothers get an uncontrollable urge to push.  Some mothers simply birth their babies gently, and some mothers may go through the birthing stage and only experience the fetal ejection reflex (FER) that occurs when birth is imminent – causing this overwhelming power in the mother where all her doubts and fears have disappeared and she is ready to get this baby out.  This is another survival mechanism of birth.  The baby is ready to come out, and mama needs to get the baby out so that her and her baby are not vulnerable to “predators.”  Instincts… we have them for a reason.

 

Learning how to push can be a difficult task.  It’s not something that you can really practice, and if you’re a first time mom, it may be difficult to understand because of so much misinformation in the birthing industry.  Although pushing is similar to the concept of a bowel movement, and it may very well feel as if you are about to lose control of your bowels when the overwhelming urge to push occurs, it is NOT the same.  As the baby moves through the birth canal, its presenting part moves along the rectum, which may give you that feeling that you need to have a bowel movement.  And, yes, occassionally, the baby’s head will push anything left out and you and your providers will go about your birthing business.  Don’t let this stress you out - it is a normal part of labor – but often much of this is expelled during the early labor stages. 

 

During pushing, you are using a different set of muscles than with a bowel movement: the ones being strengthened and exercised with the Kegel exercises.  These are also the same set of muscles that contract during an orgasm.  With low stress births and a calm environment, it is very much possible to have that orgasmic feeling during birth, as you’re stimulating the same nerves and energies as you would during sexual intercourse.  For first time mothers, pelvic bones have not been moved and stretched, which takes a little time, and you probably have a little fear due to the unknown.  Additionally, hearing so many stories of women pushing for hours, and being directed to push can get mothers into the mindset that they need to do something during this entire 2^nd stage.  Use the more spaced out contractions during this stage to get the rest you need – you deserve it.  The best thing you can do is relax your bottom, remember to breathe, and surrender to the overwhelming urges, should you experience these.  If not, that’s OK – just rest a little more, your uterus needs no assistance to move that baby out of your body – otherwise we wouldn’t have the stories of women in comas having easy births.  Once you accept birth and let your body do what it needs to do, rather than your brain (or birth attendants) trying to direct it, the baby will come more easily.

 

When you tighten up (which can be caused from anxiety, pushing too hard, or trying to “use” your kegel muscles rather than relax them, which often occurs with directed pushing) your cervix and bottom tightens, which makes it harder for the baby to be born.  One way to “practice” for pushing is while you’re sitting on the toilet.  Sit up straight and tall, drop your shoulders, and relax your jaw so that your face goes limp.  Take one deep, cleansing breath, and let your stomach go loose as you exhale every last drop of air until you make the grunting, cow-like, noises that occur when you have pushed all the air out of your lungs.  Think about opening your bottom and releasing that tension as you relax your body and let yourself urinate or have a bowel movement, using no extra pushing force.  Keep doing this relaxation and breathing exercise until you’re finished.  This type of relaxation is what you need to achieve for pushing to be most affective.  You really don’t need to “push” your baby out, as your body will do this for you.  And birthing [pushing] practice really isn’t to teach you how to push during birth, it is to teach you how to relax your muscles.  The more in tune with your body you are before birth, the easier it will be to get into this state during birth.

 

Though the toilet setting may be the most convenient ways of “practicing” how to birth [push], one of the most effective ways to understand pushing is through intercourse.  Having intercourse (on your side might be the best position initially to get the understanding of it) you want to concentrate on staying “open.”  Getting an understanding of how open you need to be, and how relaxed you need to be is the goal, and the act of intercourse allows you to concentrate on the muscles needed for birth, while there is actually something in the vagina. 

 

Just as in the previous exercise, you want to open your mouth and drop your jaw into the most relaxed position possible (this directly affects your ability to relax your vagina), and close your eyes. The amount of force needed to say a very deep “uuuuuhhhhhhhhhh” (doing this WHILE you are exhaling at the same time, a very “airy” uuuhhh, kind of moaning) is all the “force” you need to “push.”

Now, while you’re “uuuuhhhhing” and exhaling, you want your partner to have slow deep thrusts.  I realize how intimate this sounds, but birth is a very intimate experience, and the energy used to create the baby, is the same energy needed to bring the baby into the world.  Focus on relaxing all of your muscles, particularly the vaginal and kegel muscles.  Remember that the Kegel exercise is great for strengthening the muscle, but learning how to relax the kegel and vaginal muscles are far more important.  You want to be extremely open, calm, and relaxed.  Don’t concentrate on having an orgasm – this is not the goal, just let it happen if it occurs with no resistance and no force. You want to focus on relaxing all your muscles in your vaginal area, and relaxing your entire body. 

In summary, you want to have sex, relax your jaw, close your eyes, say “uuuuuhhhhh” while exhaling, relax all your muscles during thrusts, and everything else will come instinctively.

During the actual birthing [pushing] stage, you may want to use upright positions that help the baby move past the pubic arch and widen the birth canal.  When pushing in reclined or back-lying positions the baby has less room to move through the birth canal, and has to go down under the pubic arch, and then up to be born.  A side lying position in birth doesn’t utilize gravity, but it also doesn’t work against it, so it can be beneficial.  When in a squatting position, the birth canal is opened approximately 10% (some sources suggest 25%) wider allowing more room and less effort.  Pushing in an all fours position can give mom a bit of a rest as this requires less energy.  There are many different positions that can be beneficial for different situations.  It is important to use positions that are comfortable and instinctual for the mom, as these positions are usually comfortable for the baby.  Rarely would a mom instinctively move into a reclined position to labor or birth. 

 

And, just to repeat what has been continuously said in this article, don’t use directed pushing techniques where someone counts as you push (unless you’re medicated and cannot feel to push – and then it may be necessary).  You want to push to the point of comfort and remember to take breaths for your baby.  If you can push 3-4 times with one contraction, this is fine, but if someone else is urging you to push when you cannot, these extra pushes are only going to wear you out and be ineffective. 

 

How does your care provider and birth team approach 2^nd stage?