Real Labor: 4 Things Doulas Know

If you were to get a group of doulas in a room and ask them some of the "realist" things about what happens in the labor room, you might be surprised! We want to share some light on what birth professionals know over years of attending pregnant people in labor and delivery.

Real Labor #1 - It's great to move in labor, but you may not want to.

Many people have a fear that they are going to be "tied to the bed" by the various medical instruments that come with having a baby in a hospital. There are heart rate monitors, contraction monitors, blood pressure cuffs, and IV line, and maybe more depending on the client. But for a lot of laboring folk, moving does not look like the long walks down the hallway and the active dance routines you see in online viral videos. For most people, when a laboring woman is going to the hospital, they are ready to focus, and rest when possible. Both of those things can be done in the hospital bed.

AND the hospital bed itself moves into various positions that can help with positions such as hands and knees, supported squatting, and more.

Key Points: Movement in labor is possible. Even small adjustments and shifts are helpful. You may not be interested in leaving the bed.

Real Labor #2 Not everybody poops, and if you do, we aren't going to tell you.

Another common fear for laboring parents is pooping while being in the 2nd stage of labor: the pushing stage. Pooping is common because as the baby moves through the birth canal, his or her head is physically pushing against the colon, helping to move any fecal matter that is still in the bowel out of your body.

For some people, they have emptied their lower bowel before entering this stage, and there is nothing for the baby's head to move against. For others, some poop may be present.

Surprise! Either way, you get good news! If a laboring person is pooping while pushing, it is a visible sign that they are pushing well and that they are making progress! And if there is no poop, well, then there is no poop!

Key Points: The fear of pooping is common. If you have some small bowel movements while pushing, your nurse is extremely discreet and will help clear it away usually before it is noticed. And, we aren't going to confirm anything if you aren't sure yourself.

Real Labor #3 When they say you can't eat in labor, it's okay because you won't want to.

Having a food restriction is a standard hospital practice. Having access to a clear food tray, or liquids only sound horrible to most people! But when we are talking with our clients, we want to give some reassurance about this fear of not being able to eat - once you get to the hospital, most likely you aren't going to be hungry.

Getting your body ready for labor may mean that in early labor while still at home, you are having nibbles and bites of food that sound good, and keep you energized. As your contractions start getting stronger and closer together, your body goes through a natural shift that begins to open your core and focus your attention and energy into giving birth to your baby. Bites of food can feel like whole meals, tasty snacks can quickly turn unsatisfying and dry.

Staying hydrated starts to become the focus, as does conserving energy in between contractions, and of course, actively managing pain and tension during contractions.

Your body too, will focus it's resources into your uterus, making eating sound unappealing altogether. Nobody wants to eat a cheeseburger while in labor.

Key Points: Hunger during labor can be satisfied with very little and is often not as overwhelming as it sounds beforehand. Once active labor has started, the idea of eating may not be attractive as your contractions get stronger. The first meal you eat after you deliver will taste incredible because of both your renewed awareness of your hunger and because you will have exerted so much energy giving birth

Real Labor #4 - Having a plan for your birth is great, but being connected to the birth that is happening is better.

So much talk about birth plans and how to have a good birth, when really what has been shown to make a difference on birth satisfaction is being supported without judgement, and being able to participate in making decisions during birth.

And not even getting what that person wants, just being included in the conversation.

And this isn’t to dissuade anyone from thinking about options and making a birth plan. Quite the opposite. It’s to allow each family some space to recognize birth is unknown, even in this day and age. Birth is unpredictable. And how a person feels during this unknown and unpredictable time is what should be taken into account even more.

Key Points: You are amazing and how you feel is a priority. Consent and information matters. Having a plan is helpful to learn options. Options can change quickly in labor and delivery.

Oh Baby, Get Me Back To Work

Sometimes you are with your newborn for 12 weeks, and it is hard but blissful. Sometimes after those 12 weeks, you are so sad to return to work and have anxiety about being apart from your baby. For some new parents, maternity leave feels like a flash in the pan, and it is almost unbelievable that it is already time to go back to work. 



And sometimes, for some parents, it’s not like that at all. 



Returning to work may sound like the best idea anyone has had in a really really long time.

12 weeks glued to another human who needs everything to be provided for them means one thing in theory, and feels totally different in reality.

Being with an infant is exhausting.

It is a time warp, and time seems to function differently. Having autonomy to care for yourself is almost universally put in second place to the needs of your child.

And it can be a scary thing to realize you would rather go back to work than be with your child. 

But if that is you, it doesn’t mean you hate your baby.

It doesn’t mean you aren’t a good parent.

It doesn’t even say you regret having this new person in your life.



But it can mean that you need work to be a good parent. 



Or in other words, it's okay if you need to regain a part of your identity to be healthy and have the ability to be present with your child.

Every single family is going to have conversations about how they want this crazy ride to go, and when they need to get off for a little while. Really common questions can be: How will you take breaks? How will you stay connected to your partner? How will you learn about what being a parents means? And when to go back to work, if at all?

Work for many people isn’t just a source of a paycheck. Work can be social stimulation, personal growth, or a creative outlet. Wanting to have a little bit of your “normal” back after so much change makes a lot of sense when we consider how much is thrown at new parents and especially those parents who give birth.

So if you are psyched to trade out the burp cloth for your laptop, know that in doing so you are not a bad parent. For many, going to work means you can take a big breath when you get home, and jump into caring for you child without resentment, because you might just find, you missed her while you were away all day.

Who Does What: Increasing Equality After Baby Arrives

New Baby, New Frustrations

With a new baby, there are great intentions about sharing responsibilities, but a reality that is just starting to get more attention is that two-parent heterosexual households are still not equal.

With having a husband being shown to add 7 hours of housework to a to-do list, a big worry of women is how they are supposed to take care of a baby and do everything else?

The answer is that women aren’t. So the way to make that happen is starting hard conversations. Conversations that have probably been long in the making. And talks like these are scary because they can go wrong so quickly.

Wanting to change the dynamic of a household means something, but change can’t happen unless everyone is on board. Sure, somethings can change without having conversations, but that is usually a short term battle of passive-aggressive choices to leave tasks undone, and postponing the inevitable - talking it out.

Some Language

Experts agree that discussing how you are feeling is more productive than blaming a person for not doing a task or attacking their character.

"Tell them you feel anxious, trapped, burdened, worried, alone, ignored, invisible, unappreciated, sad, or distant when you do it all and how you really don't want to feel that way," she said. "If you get your communication right, your partner will respond with empathy and compassion." - Alicia H Clark

Stop doing things. Not passive aggressively - but stop doing things compulsively. There is usually an "over-functioning" partner that compulsively attends to the task. It can be just as hard for this partner to learn some things don't need to be done, as it can be for the other partner to start doing more.

"This new baby is amazing but also really difficult. We both want to be connected to the new life that's joined our family but also be connected and stay sexual beings with one another. Let's be in this soup together; you and me against the world." - Laura Silverstein

Invisible Task List

One of the many direct conversations that have to happen is defining what the tasks are. And that is one of the problems. It is easy to agree that the obvious tasks with a new baby will be feeding, changing diapers, burping and holding, but if that were the problem alone, this would be an "easy fix."

However, life doesn't stop.

• Who takes out the garbage?

• Who makes sure there is toilet paper?

• Who RSVPs to parties and events? Who cooks?

• Who washes and folds laundry?

It's the entire life together that gets rearranged, and maybe you need to make a checklist. Perhaps it needs to be ridiculously long so all the jobs can be seen, at once, on paper. It may be the first time your partner can begin to understand what your day to day life looks like and vice versa.

Once the list exists, each person can have clear expectations of what each person is responsible. Also, for situations about preference, such as water glasses should live next to the sink and not in the middle of the counter - well, there may be some give and take. The important part is that you have started talking about it all.

Sleep Like A Baby: Why We Insist On 8-hours Of Care

 Every family is different, but when we receive a call for nighttime support, one policy we insist upon for everyone is our shift minimum — 8 hours with a Maine Doulas professional in your home, helping your entire family sleep. 

If we are asked to come into your home for one night or 50, we know we are going to be a part of some of your most vulnerable moments.  For those who have already experienced nights awake with your baby, you know there is a combination of surreal awareness of how quiet and calm the rest of the world seems, and a deep aching to find a way to help your baby back to rest.  Minutes seem never-ending.  

We know that sleep is one of the most important things a family needs to function well. However, it may be difficult to understand how far reaching the effects can have.

Sleep promotes healing 

Your body can produce more white blood cells while you are asleep than when you are awake.  Being in an unconscious state also allows your brain to take stock of your bodies needs and respond by releasing hormones that can repair tissue and blood vessels.   When you are not getting enough sleep, your immune system is not able to properly heal from current damage, or protect you from potential infection. 

Sleep offers your whole body a break

 When you are sleeping, the demands on your heart decrease and your blood pressure will naturally lower.  Hormones released while asleep also trigger slower breathing and deep muscle relaxation that cannot happen while awake, allowing for your entire body rest.

Sleep helps with mood and outlook

When asleep, your body has fewer demands placed on it, so your body and mind participate in restorative tasks.  After waking from a restful sleep, your body, mind, and stress levels have been adjusted, allowing a refreshed outlook on situations that may cause overwhelm.  Postpartum mood and anxiety disorders are a common part of recovery from birth, and one of the ways to take an active role in your recovery is to be committed to getting at least 7 hours of restful sleep each day.  

When we receive inquiries for overnight help, we want families to know we are committed to their long term success. 

So long term success means being committed to rest.  It may not be possible for everyone to have a doula help with night parenting and emotional support through tough feeding sessions for months at a time.  However, we are committed for whatever length of time we are with you, and for that reason, we insist on overnight support lasting at least 8 hours.  

We want to understand your concerns, help with multiple feedings, and then settle you and your small child back to rest to allow your entire household the opportunity to get a long stretch of restful sleep.  

Our policy isn't about us. It's all about you.  Let us know if you are interested in help for your household to wake rested and well cared for.  

Power Positions: Standing in Labor and Birth

If you are a person looking for options to explore for your upcoming birth, let's take a minute to talk about the power of standing up.  Yes, even for pushing!

Standing and being upright during the first and second stages of labor, while it can limit your provider's view and access to your baby during birth, has long been a traditional position for women and laboring persons to take for as long as babies have been born.  

When contractions start to come more regularly, and you creep toward that focused mindset being upright is a huge benefit.  Laboring while standing offers practical and physiological advantages over laying down.  The pressure of your baby, uterus, and organs is not resting on your back muscles and spine, so there is more blood flow and comfort.  And your hips and pelvis can ambulate in any direction, allowing for your baby to more easily enter and turn in the pelvis.  

Beyond comfort, studies conducted also show laboring persons without an epidural also had "a lower risk of abnormal fetal heart rate patterns, ...,  and less use of vacuum/forceps and episiotomy."  

One of the things that Maine Doulas hope our clients explore has nothing to do with a specific decision, position, or delivery method.  What other doulas and we know, and what we hope to model and support, is the process of families exploring what it means to make decisions that are best for them can help them to have a more satisfying birth experience.  

And one of the choices a family can explore is the choice to put your body into positions that traditional western medicine tends to suppress.  

"...Most people who give birth vaginally in U.S. hospitals report that they push and give birth lying on their backs (68%) or in a semi-sitting/lying position with the head of the bed raised up (23%). A small minority push and give birth in other positions such as side-lying (3%), squatting or sitting (4%), or hands-and-knees position (1%)."  (source)

A few reasons so many don't explore options for different positions: 

• they think they have to ask to move

• they think if it were an option, someone would tell them

• they don't know anything but how birth is presented in media

• to some, the idea that standing would make delivery "easier" doesn't seem logical and the big one...

• western medicine didn't allow women to birth in any position but on their back for decades.  
  

And what we mentioned above about standing while pushing - that is an option some explore for their birth.

There is evidence to show gravity is in favor, perineal tearing may be reduced, and pain is reported to be less acute. While standing is rarely used in a hospital setting, other upright positions, like squatting and hands and knees, can offer the same benefits. 

So when thinking about how you want to have your baby, we hope you expand your vision of delivery to include any movement you are curious to explore.  When in the moment, you may be struck to follow your body's urge to move away from the standard inclined lying portion, and to that, we say, yes!  You can do it.  

Real Stories: Plans Change

There was so much focus on creating a birth plan.

"How do we feel about delayed cord clamping?"

"Good?"

"Vitamin K Shots?"

"Good?"

"Do I want to wear my own clothes during labor?"

"Isn't it going to be messy?"

"I don't know!"

After going over all the options and templates, again and again, I felt like I had a pretty solid vision for how I was going to give birth to my baby. I would labor at home for a good while, go to the hospital when it got intense, then push out a baby and come home. Hard but doable, right?

I wanted to try to have an unmedicated birth. I wanted it to be natural. I wanted to connect with the other women who had given birth before me through the act of giving birth, and I was excited. I wanted to be a mother, and I wanted to feel the power that so many write about in books like Ina May's and blogs like Birth Without Fear.

It seemed like everyone stressed I should really try at wait to go to the hospital until I thought I couldn't be at home any longer. The choice of when to leave my home was treated as a pivotal point of many unmedicated "success" stories. They stressed that laboring at home would be way more comfortable and less stressful, and I could move around as much as I wanted, instead of being tied to a hospital bed.

I thought I would want to eat because labor takes a long time. I thought I would want to sleep in my own bed, and pee in my own toilet. I felt really at ease. I was nervous. Who wouldn't be nervous for the birth of a first baby? But I was also feeling really ready.

The one option I didn't spend much time thinking about, ended up being how my daughter decided to start her birth process.

(And no, not surgery. I always knew surgery was possible.)

The way my daughter came into the world was very, very slowly. It was so slow. So slow, that there wasn't any sign, other than me feeling contractions, breathing heavily, and being super uncomfortable, that anything was even happening.

And lo and behold, it has a name.

My birth story started with prodromal labor.

Prodromal labor is when it looks and feels like labor, but the cervix doesn’t change. My feelings were real, but to the medical world, I was not in labor.

I started feeling contractions in the middle of the night, and I could breathe through them, but I couldn't sleep. Every 9-7 minutes, until morning came, and then they backed off for a bit. I started my day. I ate. I showered. I showed the contraction log to my partner, who had happily slept through them all. And we got excited for them to start back up any minute!

And then they didn't start again until night again. And still, I had contractions, but I couldn't lay down this time, every 7-9 minutes, for less than a minute. And again, when morning came, they went away.

Were they Braxton hicks?

Did I do too much?

Was I dehydrated? Probably yes to all of those, but hindsight is 20-20.

They just kept popping up and then taking a break. Starting and stopping. I went to my 40-week appointment hoping my Doctor would tell me how close I was and that it would almost be time to go to the hospital. But when my cervix was checked, she said I was still at 1 centimeter.

So they sent me home and told me to rest.

I tried. I was really tired.

But the contractions started again, and they didn't stop. They got closer together, ranging between 4-6 minutes. So I moved when I needed to move. I took bites of food when it was put in front of my face. I peed, I walked, I sat, I bounced, I laid on my side, I took a shower, I contracted over and over.

I have a hard time being objective about the level of pain I was in because I was so tired. I would fall asleep between contractions and then be jolted awake. I stuck with what the books said about labor progress and stayed home because I was still contracting every 4-6 minutes.

This lasted for two days. When the third morning came, I was desperate and told my husband we were going to the hospital.

I was done.
I was over labor.
I was over birth.
I was not prepared to be in labor for 4 days. Even if this wasn't "real labor," I was done.

We went to the hospital, we went into triage, and after all that, I got what I thought was horrible news: I was 3 centimeters dilated. 3. I was so sad. So defeated. So angry. And it just didn't seem fair. I was trying to do everything right, and my body wasn't following the plan.

They asked if I wanted to go back home and continue to labor there, and I said, "hell no. I'm done."

My Doctor was at the hospital that morning and came in to talk about my options.

• I could be admitted, have an IV line set to rehydrate me, and that might help labor progress.

• I could have Pitocin to help make my contractions get stronger and closer together, to encourage more cervical change.

• I could get an epidural and sleep, which may help my cervix dilate.

• I could have some IV pain relief that might allow me to sleep for a few hours.

• I could have my bag of waters broken and have the baby's head press against the cervix to help encourage it to open.

• Or I could have an elective cesarean.

I cried.

I looked at my husband and just cried.

There were too many options. I was too tired to pick. I wanted someone else to take over making the choices, and I just wanted to be taken care of for a little bit.

I just sobbed. No one told me I could be in labor for 4 days and be driven to what felt like madness.

Sleep sounded so good. So, so, good.

I said, "I want to sleep. How can I sleep?"

So I chose to get an epidural.

As soon as that medication went into my back, my eyes dropped. My husband said they had to wake me a couple times to take vitals and blood pressure, but I don't remember any of it.

I slept. And it was glorious.

I woke up 4 hours later.

I changed positions.

I drank more water.

I went back to sleep.

They would come in and check things and I would answer some questions, and then roll over and go right back to sleep.

Around 2pm, my Doctor came in and asked if I wanted to be checked to see how things were going.

I laid back and waited, and she looked up at me, smiled, and said, "Are you ready to meet your baby? You are complete. Let's get the room set up, and we'll get going. Has anyone talked to you about pushing?"

WHAT?

The room jumped to activity, and I just stared at my husband. It went from 0 to 100.

Nurses were calling people.

A cart was set up.

My Doctor was getting a gown on.

The bed morphed into a half bed with footrests.

A light came out of the ceiling.

My room was a Transformer.

And then someone told me to push like I was pooping. So I did. And I did again. And again. And then all of a sudden she was there! I was holding her, and she was perfect!

With all my reading, all my planning, and all the encouragement I had from my family to have this baby on my own, I don't know why my labor was so drawn out. I'm sure there are those people who would say I didn't need the epidural. I'm sure some may say I just needed a different position, or different mindset, or different whatever.

But I know I had villanized getting an epidural. I had thought that people who got epidurals just didn't try hard enough. And now I'm ashamed of those beliefs. I needed the relief that came from having that medicine, and I needed the sleep.

My plans changed, and I changed, and I am proud of the work I did at home. I'm proud of asking for help. And I'm no less connected to those wise women before me.

Real Pregnancy: 5 Lesser Known Truths

There are so many birth and parenting books out there that it seems silly to imagine that anything about pregnancy is "lesser known" at this point, but alas, it's true.  Trends change, research is updated, and now it's you who are looking!  Here are some things about pregnancy that you may not have known, and could be helpful!

1. Swelling happens for all sorts of reasons - some harmful, and some not.  

Swelling, or edema, can be one sign that you are pre-eclamptic, which is a severe condition that needs attention from your medical provider.  There are other symptoms as well, like high blood pressure, and protein in your urine, but those are hard to know on your own.  Swelling is then an indication that something might be up.  

But swelling is normal in pregnancy and can happen from diet, exertion, and from the fact that your body is literally filled with more blood and fluid when pregnant.  

Some ways to find relief is to:
 

• use cold compresses on the swollen area

• use compression garments, for feet and wrists

• elevate the swollen area and rest

• drink more water
  
  

2.  Provider Appointments

If you were like me, when you found out you were pregnant, you didn't know what to do next.  So I called my mom.  And then I called my doctor to schedule an appointment.  At this appointment, you will be asked about the dates of your last menstrual cycle, and you may have a transvaginal ultrasound to confirm the age of the baby.  From there with a normal pregnancy, you will have appointments every month up until your 28th week, twice a month until 36 weeks, and then they will happen weekly until you deliver.

In addition to these appointments, there will be other appointments for routine ultrasound near 20 weeks, and a glucose test between 24-28 weeks.  

There are a lot of appointments!  Usually, the time you have with your provider is 15-20 minutes, and it can feel like a whirlwind.  However, prenatal appointments are your opportunity to learn about your provider's standard practices, discuss your birth preferences, and have any questions addressed.  Writing down your concerns before your meeting can help ensure you are getting all the information you need to feel prepared going into labor. 

3. Dressing Your Pregnant Body

Pregnancy trends have fluctuated dramatically from loose-fitting gowns to closely cut stretch everything.  There is no wrong way to dress.  Some items may seem more practical, but practical may not be your style.  Do you! Regardless of when you have your baby, you will be moving through 9 months of weather, and each comes with its pros and cons: 

Spring: 
Pro: Mild temperatures and light layers
Con: Wild fluctuation possible as spring storms roll through and you may be caught unawares

Summer: 
Pro: No need for bulky jackets and extra garments
Con: Sweat, Swelling, and Possible Sunburns (Your pregnant skin is more sensitive!) 

Fall: 
Pro: Back to light layers and the most fashion-forward of the pregnancy seasons (as is the case for all fashion)
Con: The beginning of carrying more stuff to be equipped for cold spells

Winter: 
Pro: Many pregnant people appreciate the colder weather because they feel hot most of their pregnancy
Con: Finding an outer layer that fits over your bump, watching out for ice on the ground

4. A new relationship with your bladder

There are so many jokes about pregnant people needing to pee all the time, that it is probably one part of pregnancy you knew was coming.  But the reality of it is something hard to plan for until you have experienced it.  

The reason you are running to the restroom more often is two fold - you need to drink more liquid during pregnancy, and your bladder is being compressed by your growing baby (and uterus.)  There simply is not as much room for your bladder to fill up.  

And when you can take the opportunity to void your bladder's contents, there is a new struggle as you may not be able to empty it completely.  The same reason your bladder can't fill as full is also pressing down on your urethra.  So when you are there, take a deep breath, and try to relax to loosen the muscles in your pelvic floor fully. 

5. The Stuff

When you become pregnant, you unknowingly have become the target market of a whole new industry.  The adds in your Facebook feed will change.  The adds on your browser will do the same.  

Many gadgets and products can be handy, and you get to choose if you want them or not.  Having an awareness that you are in a very short, and very impressional part of the retail market may help you find tools that will help you solve a problem (sleeping unwell, swelling, or supporting your back), instead of collecting the newest craze.  Go to town if you want to, or don't.  It's totally up to you!