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                                       Natural Birth

In the last weeks of pregnancy, maternal antibodies are passed to the baby—antibodies that will help fight infections in the first days and weeks of life. The baby gains weight and strength, stores iron, and develops more coordinated sucking and swallowing abilities. His lungs mature, and he stores brown fat that will help him maintain body temperature in the first days and weeks following birth. The maturing baby and the aging placenta trigger a prostaglandin increase that softens the cervix in readiness for effacement and dilatation. A rise in estrogen and a decrease in progesterone increase the uterine sensitivity to oxytocin. The baby moves down into the pelvis. Contractions in the last weeks may start the effacement and dilation of the cervix. A burst of energy helps pregnant women make final preparations, and insomnia prepares them for the start of round-the-clock parenting.”

“The induction process is a fairly invasive procedure which usually involves some or all of the following (you can read more about the process of induction here). There are a number of minor side effects associated with these medications/procedures (eg. nausea, discomfort etc.) There are also some major risks:

  • Prostaglandins (prostin E2 or cervidil) to ripen the cervix: hyperstimulation resulting in fetal distress and c-section.
  • Rupturing the membranes: fetal distress and c-section 
  • IV syntocinon / pitocin: Mother – rupture of uterus; post partum hemorrhage; water intoxication leading to convulsions, coma and/or death. Baby – hypoxic brain damage; neonatal jaundice; neonatal retinal hemorrhage; death. There is also research suggesting that there may be a link between the use of syntocinon/pitocin for induction and ADHD (Kurth & Haussmann 2011)

Pain Relief In Labor

This is one area where I will definitely never judge a woman for deciding to get pain relief of some kind. In labor, I cry like a baby and sometimes even curse like a sailor… I understand the pain.

That being said, there are inherent risks with any medical pain relief options, and corresponding reasons to avoid them if possible.

Epidurals are the most common form of pain relief during labor. Over 3/4 of all women report getting an epidural during labor, and like I said, I can understand why! This article explains how an epidural works:

“In an epidural, a local anesthetic – still derived from cocaine – is injected into the epidural space (the space around the tough coverings that protect the spinal cord). Epidurals block nerve signals from both the sensory and motor nerves, which provides effective pain relief but immobilizes the lower part of the recipient’s body.”

No intervention exists in a vacuum, and even epidurals carry their share of risks. This article has the most in depth discussion of risks I’ve seen:

I have only seen this mentioned by some sources, but from my own experience, my spinal with my c-section led to horrible itching all over my body for several days after, and I didn’t dare take Benadryl since it can affect milk supply. Personally, I’d rather have pain for a day than horrible itching for three if given the choice!

Epidurals pose their fair share of risks to baby too, including:

  • Similar levels of epidural drugs are found in baby’s blood stream, but baby takes longer to eliminate the drugs because immune system is still developing
  • Epidurals can affect fetal blood and oxygen supply, leading to the need for more intervention
  • Some studies show a decrease in APGAR scores in babies whose mothers received epidurals.
  • Higher risk of fever in babies whose mothers received an epidural
  • Some evidence shows that mothers may have more difficulty bonding immediately when they receive an epidural
  • Evidence shows an increase in difficulty breastfeeding when a mother receives an epidural

Opiate based medications are another common pain relief option in labor (though these are becoming less popular). While these allow movement, unlike an epidural, they affect the baby as well as the mother, and personally, I wouldn’t even consider using opiate medication during labor. This article from American Pregnancy explains the common risks of opiate drugs in labor.


Natural Pain Relief Options

Deciding against medical pain relief options doesn’t mean suffering though labor without any relief. There are a variety of natural pain relief options that work with a woman’s body and can also help labor progress.

These options will not provide the relief that an epidural will, but they also don’t carry the risks.

From personal experience and from working with laboring women, I’ve found that preparation and knowledge are absolutely key to having a smooth natural birth. I’m yet to meet anyone who goes in to labor with the “I’ll try and see if I can do it without drugs” mental attitude who actually goes drug free.

Labor is hard work and it is painful at times, but knowing and expecting the different stages so the fear of the unknown isn’t there can make a tremendous difference. As a personal example, with my first, I didn’t expect the vomiting/severe shaking in transition and this scared me and intensified the pain. Just fear of labor itself is often enough to intensify the pain and make contractions more difficult.


Methods of Natural Pain Relief

  • Walking around*
  • Sitting/rocking on a birthing (exercise) ball*
  • Taking a hot shower (aimed at your low back)*
  • Sitting up and rocking
  • Massaging your back (well, have someone else do it)*
  • Counter-pressure on the back (especially for back labor). Try tennis balls.*
  • Massage oils for all-over massage*
  • Chiropractic adjustment (some will make house calls)
  • Prayer/meditation*
  • Focusing on the baby and “opening”
  • Changing positions*
  • Soothing music*
  • Foot massage (pressure points; can take your mind off the pain)*
  • Getting in a pool of water
  • Staying hydrated*
  • Eating small snacks, if you want to”

As a doula, the things I most often use to help women get through labor as easily as possible are:

  • Temperature changes- I bring both a microwaveable heating pad and a personal fan to help mom cope with the temp changes
  • Food and drink- this is sometimes discouraged in hospitals, but I encourage mom to keep her energy up by staying nourished and hydrated (here is my recipe for a natural sports drink)
  • An old soccer sock with three tennis balls tied in to it is great for counter pressure for back labor
  • Natural massage oils and massage help mom relax
  • Calming music
  • Birthing ball for bouncing if it feels good to mom
  • Guided relaxation- I often try to keep the room as quiet and dark as possible as this seems to be the most natural for  woman in labor. During contractions, I will provide whatever relief mom needs, but will also touch a specific area (often the jaw) that seems to be especially tensing during the contractions and remind mom to relax here. Relaxation makes a HUGE difference during labor, so just helping a woman gently relax her jaw, arm, etc. will take her focus away from the contraction and help her return to a relaxed state
  • Stress balls and focal points
  • Getting mom to change position or helping her get in to water (if possible)

Birth Plan

Labor is not a time to be unprepared! Having a plan and a birth team can make a big difference. Personally, I recommend having a good birth team, including a doula, and a simple but detailed birth plan to help hospital staff support mom. Statistically, doulas can make a tremendous difference in labor outcomes including:

  • 50% reduction in the cesarean rate
  • 25% shorter labor
  • 60% reduction in epidural requests
  • 40% reduction in oxytocin use
  • 30% reduction in analgesia use
  • 40% reduction in forceps delivery
  • Drink red raspberry leaf
  • If you talk to virtually any midwife or doula, you’re practically guaranteed to hear about the miracles of red raspberry leaf, an herbal tea that’s been used for thousands of years to support respiratory and digestive health and—here’s where things get really interesting—to ease and shorten labor.
  • If that sounds too good to be true, there are some studies to back up these claims, including one published in the Australian College of Midwives Incorporated Journal, which suggested that women who drank the tea were less likely to need forceps, vacuum assistance, or require a C-section.

Your birthing partner - be that your husband, your mom, your best friend, your sister... whomever - can be a huge help during your birthing time. They can also be no help at all 

You probably want someone who is really going to help you - and again, that takes some planning and preparation!

It's ideal if your partner can go through birthing classes with you. For an in-person class, you'll probably want them to go to each class session with you. If you're doing an online class it may be designed for both of you to go through each lesson, or some lessons may be geared towards you and others towards you and your birth partner. MamaBaby Birthing is a full online class with sessions that are beneficial for both of you as well as some you can go through on your own if you'd like to - I've had students who go through everything together, and some where the mama goes through and chooses what she'd like both of them to go through.

Regardless of what class you choose, be sure your partner goes through the important parts of it with you:

  • How labor progresses
  • How hormones impact labor and make it safer for mama and baby
  • What interventions might be suggested (and how to decide to accept, decline, or wait)
  • How to help you work with labor
  • How helping you can help the baby do his/her work
  • What happens immediately after the baby is born
  • How to protect mama and baby's time early postpartum

These are the top points to cover - obviously your birthing classes can go into a lot more depth and cover other important topics (like prenatal nutrition).

Eat dates

If I told you there was a particular food that’s associated with a lower risk of induction, premature rupture of membranes, and the need for Pitocin to boost contractions, you’d eat it—right?

Well, a small study published in the Journal of Obstetrics & Gynecology (and now this second study) suggests that dates during pregnancy are that miracle food. More specifically, eating six dates a day from 36 weeks onward appears to result in shorter, easier labors. (Apparently, dates have an oxytocin-like effect on the body; they’re also rich in fatty acids, the building blocks of prostaglandins.)

How lucky are we that this labor-inducing superfood isn’t, like, mayonnaise? Or turnips? Or goat brains?

On the contrary, dates are delicious and extremely versatile, so you can enjoy them a number of ways. Heather has a bunch of wonderful recipes like:

3. Stay active during your pregnancy

Not long ago, mamas-to-be were thought to be so frail and fragile that they were discouraged from doing much of anything physical. A pamphlet distributed by the Canadian government in the 1940s, for example, warned that even watching sports might prove too strenuous for pregnant women—forget playing them. (Also dangerous, according to The Canadian Mother and Child? Listening to the radio too loudly, because “real harm may be done to the nervous system.”)

Even more recent guidelines treated mamas-to-be with kid gloves: In the 1980s and early ’90s, we were told not to let our heart rate exceed 140 beats per minute, because it was thought that strenuous exercise would divert blood and oxygen away from the baby.

Turns out, that’s not true, either—the American College of Obstetricians and Gynecologists removed the recommendation from their guidelines back in 1994.

These days, despite all those old-school worries and warnings, we know that regular exercise is actually one of the best things you can do for your body and your baby. Starting or maintaining a workout routine can:

  • Increase the likelihood that you’ll stay within a healthy weight range—and get back to your old self more quickly after giving birth

And the best news is that you don’t have to join CrossFit or sign up for high-intensity spin classes to reap the benefits: just 30 minutes a day of moderate exercise is enough for most women.

So get out there and keep moving, mama!

4. Take good care of your pelvis

In conjunction with staying active, you’ll also want to take good care of your pelvis. Sounds weird, I know, but you want a balanced and relaxed pelvis in preparation for birth.

You see, the trappings of modern life might contribute to the way baby situates himself in utero. After all, we:

  • sit (usually slumped or slouched) at our desks all day,
  • spend hours driving around in our cars, and
  • recline in comfy love seats and sofas at night

These postures can compress the pelvis, narrowing the passage through which baby will eventually travel on his journey to meet you. They also encourage improper alignment, which can make a natural birth not just difficult and more painful, but perhaps even impossible.

Regular chiropractic care from a Webster-certified practitioner can do wonders. Other moms swear by acupuncture, prenatal yoga or other pelvic exercises. Here are 7 easy pregnancy exercises that can help keep your pelvis limber and prepare those muscles for childbirth.

5. Get a doula

Throughout history, mamas have been delivering babies with the guidance and encouragement of other women, experienced birthers trained to offer physical and emotional (if not medical) support. Today, we call these wise women birth doulas.

Mountains of research, including studies published in the Journal of Perinatal Education, the British Journal of Obstetrics and Gynaecology, and by the Cochrane Review, have shown that women who receive this kind of continuous care and companionship during labor are:

  • more likely to go into spontaneous labor,
  • less likely to need an epidural (60 percent less likely, if you can believe that!),
  • less likely to need vacuum extraction or forceps assistance,
  • less likely to birth via Cesarean, and less likely to have negative feelings about childbirth.

Furthermore, babies born under the care of a doula are more likely to go full-term and to have higher APGAR scores. Some studies have shown that laboring in a clinical setting—like a hospital’s standard maternity ward—can undermine a mama’s confidence in her ability to give birth naturally. Doulas, however, can give Mama that confidence back.

Even the American College of Obstetricians and Gynecologists acknowledges that doula care is not only effective, but “one of the most effective tools to improve labor and delivery outcomes.”

Seriously, if I had to boil this list down to just one tip, it would be: Do whatever it takes to get a doula.

during labor. This is where having a doula at your side is so helpful as she’ll tell you when it’s time!

If it was up to me during my first birth, I would have gone to the birth center at 2 centimeters dilated. But my doula helped me wait it out, and I arrived at 7cm.

Of course, you never want to push it so late that you’re putting yourself or baby in danger. In general, midwives will advise you to follow the 4-1-1 Rule.



THE 4-1-1 RULE

When you’re in labor, don’t leave for the birth center or hospital until:

  • Contractions are 4 minutes apart
  • They’ve been that way for at least 1 hour
  • And they’re at least 1 minute in length

The problem with arriving to hospitals too early is that you are now “on the clock” and if your labor isn’t progressing, the staff will start pushing (or even mandating) labor interventions. Plus, at home, you feel the safest, which bodes well for birth! (No need to spike stress hormones that shut down labor because of the bright lights and loud noises in hospitals.)

7. Birth in water

Water births are on the rise, and for good reason—a Cochrane review of existing studies confirms that immersion is not only an effective pain-relief technique, but that it actually reduces the need for an epidural.

(Although, I don’t find this surprising—I mean, who among us hasn’t soaked in a tub to soothe tired and achy muscles?)

But there are some benefits associated with hopping in a birth tub other than pain relief: The buoyancy helps keep you in an upright position (so that you’re working with gravity, rather than against it), as well as eases the feeling of pressure.

A warm bath is also relaxing; the less tense you are, the less likely you are to secrete fear-based hormones that might stall your labor.

Not planning a water birth in your living room? No worries! You can still reap the benefits of hydrotherapy. I spent a long time in the shower during my first birth, letting the water beat down on my back, which helped considerably. You might also try sitting down on a shower stool and directing the shower head where you need the most relief.

1. Get a solid prenatal education

Seek out classes that include how labor and birth work and natural labor pain management techniques, such as breathing, self-hypnosis, relaxation and other coping mechanisms. Your hospital probably offers an evening or weekend course, but that might not be enough information, especially if they have a high epidural or C-section rate. Instead, research independent educators. Try a few different classes or styles until you find one that feels like a good fit.

2. Pick a health care provider who's into natural birth

Some are, some aren't and your chances for achieving your goal are increased if the people taking care of you are on the same page. You might also want to hire a doula and, if you're delivering in a hospital, ask for a labor nurse who's into natural births, too.

3. Don't gain too much weight

Labor tends to go more smoothly for women who aren't overweight. They have fewer complications and require fewer medical interventions.

How much weight should I gain? Use our tool to calculate your BMI.

4. Go for a low-intervention pregnancy

Women who "go low" during pregnancy set a precedent for going low-intervention during labor, too. If you don't have any particular health problems, opt for fewer rather than more tests, treatments and interventions during your pregnancy. Obviously, some tests are important for every mother, but many are entirely optional.

Whenever tests or procedures are recommended, ask why you need it, if it will change or improve your health or if you'd be just fine without it. If your doctor or midwife provides compelling reasons why you need certain interventions, then get them. They're there for good reason, but not every patient needs everything.

5. Spend early labor at home

You can move around, get in the tub, eat and drink and go for walks. When your contractions are consistently less than five minutes apart and getting stronger for at least a couple hours no matter what you do, then you can check in with your provider. If you go to the hospital and you're not very far dilated, go home.

6. Use water

A shower, bathtub, birthing pool and hot compresses are Mother Nature's tools for easing pain and helping you relax. Spend as much time as possible in water.

7. Use your prenatal education

Breathe, meditate, relax, move, change positions, get a massage, listen to music, whatever it takes.

DON'T listen to others' horror stories. A positive mindset means everything. Now is not the time to listen to stories about your cousin's emergency C-section and your neighbor's slow-to-arrive 12-pounder with the gigantic head. Preserve your can-do attitude by surrounding yourself with natural birth success stories. Cut negative feedback off politely but immediately.

DO find a supportive birthing environment. That could be a small hospital with low epidural and C-section rates, a birthing center, or your home. "At home, a natural birth is easier to achieve because there are no drugs available," Lorillo says. "It is all natural all the time." But home births are appropriate only for healthy, complication-free pregnancies, and for safety reasons, they should be attended by a licensed midwife or another qualified practitioner. You also want to be near a hospital in case of an emergency.

DO learn various coping techniques. The more mental and physical pain-management skills you have in your proverbial toolbox, the better. You never know what will -- or won't -- help. My first time around, using a TENS unit (which blocks pain receptors in the skin), along with walking between and squatting through contractions, saved me. The second time, I didn't touch the TENS, and walking didn't do it for me, but meditating silently on a birthing ball and using techniques learned during Hypnobirthing classes did.

DO consider a birth doula. She's your own personal cheerleader who supports you before, during, and after labor. "My doula knew that I wanted to labor at home for as long as possible," says Tina Jones of Iowa City, who gave birth to her son, Jack, naturally in 2010. "As soon as she came over, she took away the pen and paper I was using to keep track of contractions, which let me focus on how my body and baby were interacting and how I felt. During contractions, she would rub my shoulders or squeeze my hips when I told her that my back was hurting. She was very calm. I don't think I could've managed at home so long without her." Jones went to the hospital 10? hours into her 13-hour labor.

DON'T forget your birth partner's needs. You've done most of the heavy lifting since your baby was conceived, but labor and delivery is an emotionally and physically draining process for both of you. A partner who is comfortable, hydrated, well-rested, and fed is a much better help to you than one who isn't. "Looking back, Reid could have used some pre-labor Tylenol and some tennis balls or some sort of massager," says Darcie Peifer of St. Paul, who gave birth to her son, Huxley, without drugs last November. "He got pretty worn out too. Still, my supportive husband was my best prop."

DO prepare both physically and mentally. Jones went on 30-minute walks throughout her pregnancy. She also prepared with prenatal yoga and positive affirmations, such as "I trust my body; I follow its lead" and "My mind is relaxed; my body is relaxed," which she read each morning and night. "I really tried to look at birth as a natural process, telling myself that women have been giving birth for eons, that my body will know what it's doing, and not looking at labor as 'pain' but as 'progress' -- one step closer to my baby being born," she says. "The mental preparation ended up being the most important for me."

DON'T starve yourself. "I highly recommend eating a good meal before you leave home," Peifer says. "My husband made me scrambled eggs at 4:30 in the morning. I needed the energy and it was worth the chance that I'd poop during pushing." I couldn't agree more. I downed an egg sandwich at home during early labor, then snacked on toast, Jell-O, and, when I was at the hospital, the kind of electrolyte jellybeans used by marathoners. I may or may not have pooped during pushing. At that point -- somewhat surprisingly -- I didn't at all care.

DO expect to want to quit. You'd be in the minority if you didn't. "Every woman reaches a point in labor when she doesn't want to do it anymore," says Kelly Camden, LM, CPM, of Holistic Midwifery in Albuquerque, NM. "Fortunately, for most of us this happens when we are nearing the end of labor." Lean on those around you who are there to support you, and focus on how it will feel to hold your baby for the first time.

DON'T beat yourself up if you don't have the natural birth of your dreams. I, for one, am still quite proud of my almost-natural first birth. Did I mention that I labored drug-free for nearly 30 hours? I did the very best I could. And I know more than a few women who did the same, who had everything nicely in place for a natural birth, yet ended up with drugs and C-sections. And, more important, healthy babies. Which is truly the ultimate goal, right?

Believe in Your Body

It's designed to grow a baby for nine months and welcome her into the world. "The pelvis and vaginal tissues were built for delivery, the brain releases endorphins that help with pain, and the fetus has a soft spot on her head so it can mold to fit out of the birth canal," says Dr. Dickerson. What's more, "complications are the exception -- not the rule." So each time you look at your beach ball of a belly in the shower and start to panic over how that baby is going to squeeze out of there, repeat this mantra: Birth is a natural function. My body knows how to do it, just like it knows how to breathe. You were born to breed!

Learn to Let Go

From my second trimester on, each night before falling asleep, I tensed and released various muscle groups while chanting a mantra that went like this: I am relaxing my forehead, I am releasing my forehead, I am relaxing my forehead. I am relaxing my nose, I am releasing my nose, I am relaxing my nose. I focused on each part of my body from head to toe, imagining melting each one into my mattress like a scoop of ice cream on a hot sidewalk. This exercise, called Progressive Relaxation, teaches you to isolate muscle groups, so you're aware of them during labor and can make sure they are limp and lax, says Julietta Appleton, certified childbirth educator, hypnotherapist, and labor doula in Bedford Corners, New York. "During labor you want all of your voluntary muscles -- like your jaw, shoulders, and back -- to let go so your blood supply is focused on your hard-working uterus." Practice releasing your muscles 15 minutes per day, says Appleton. They'll be more mellow when it's go-time.

Don't Sit Still!

When you arrive at the hospital, keep moving to stay comfortable. (If you're strapped to a monitor, you're bound to bed; ask ahead of time if your hospital allows intermittent fetal monitoring, which gives you the freedom to get up, or if they have telemetry, remote monitoring that allows a woman to walk the halls while monitored.) "Walk and stretch, sit on a birthing ball, and hop in and out of the birthing tub if it's available," says Dana Gossett, M.D., an ob-gyn at Northwestern Memorial Hospital in Chicago. And use a combo of gravity and hip movement to help the baby come down, advises Dr. Rinehart, who delivered two of her own three children naturally: "When you take the cork out of a wine bottle, you don't take it straight out, you jiggle it back and forth to get it to ease through," says Dr. Rinehart. "Movement of the hips, belly dancing, hula dancing, squatting, rocking, pelvic tilts and such help manuever the baby down and through to find the easiest path out of the mother," she says. Get shakin'!

Visualize the Finish Line

The Transition phase, when the uterus is dilating from 7 to 10 centimeters and then it's time to push, is when most moms-to-be want to call it quits. Make sure your partner knows you'll need a good pep talk at this stage