Lamaze vs. Bradley or Hypnobirthing

I just thought I’d take a moment to pretend that I’m an expert on Lamaze and take a few hits at it. But seriously, though I don’t know very much about the Lamaze method of unmedicated childbirth, I still have negative feelings about it. First of all, I have known a few women who attempted to go unmedicated using the Lamaze method, but none were drug free. The success rate for unmedicated birth with the Lamaze method is extremely low. Secondly, it’s easy for a Lamaze mother to hyperventilate during labor, especially when she uses higher paced breathing. This is dangerous to both mother and baby as well as painful. The more oxygen a mom gets, the less pain she feels. The inverse of this is true. And since Mom is the means for Baby to get oxygen, when she has a shortage, Baby suffers.

Despite this, when most people think of unmedicated childbirth, they think of Lamaze with the rhythmic huffing and puffing. Bill Cosby made the rhythmic breathing legendary in his amazing skit on the birth of his first baby. Most movies where a woman is attempting to go natural feature Lamaze breathing. This is probably owing to the fact that Lamaze is an older method than the other methods. Still, I’d love to see a movie where the actress is having a Bradley or Hypno birth. Seeing a woman in the calm, resting state that comes with these methods might open some doors for curious man and women everywhere, and it might make unmedicated childbirth more popular and attainable to more women.

So what’s the difference? Well, here’s Babycenter’s description of the Lamaze method. Here’s the Lamaze website. I don’t know how much the breathing has or has not changed, but one thing seems to remain the same – Lamaze education is less gung-ho about the need to go un-medicated. (This might have something to do with the method not being very effective for avoiding medication).

Bradley and Hypno birthing (which are mainly the same, though Hypnobirth training is more technique focused and Bradley training is more about overall childbirth and pregnancy education) is focused on deep, deep relaxation to minimize pain. So where Lamaze is geared toward distraction from the pain, the others are geared toward minimizing or eliminating the pain by minimizing tension. Also, Bradley and Hypnobirthing take the no-medication thing pretty seriously, which I appreciate. If I’m determined to gain the medical benefits for my baby and myself of unmedicated and low-intervention childbirth, I want a method that is serious about helping me not want medication. It may sound more extreme, but a program that makes light of medication in labor has little right to claim that it’s a true advocate for unmedicated labor.

So let’s keep our fingers crossed that someday a big Hollywood film will feature a woman having a good Hypnobirth. Somehow I think that might make an impression on America. In the meantime, if you’re considering natural childbirth, think Mongan or Bradley, not Lamaze (no offense, Dr. L).

A Response to Hypnobirthing by Marie Mongan

I just finished reading Hypnobirthing by Marie Mongan last night, and I thought it was a great, very helpful book. It is a very positive, encouraging approach to childbirth with some wonderful specifics on achieving relaxation during labor. It was a good refresher to get me started on preparation for my next birth. There were, however, a couple of things that I was either concerned about or found myself questioning a bit. I'll share those in a second.

The best part about the book is it's positive message - that childbirth can be a comfortable and enjoyable experience without pain medication. (Hurray!) It also emphasized the need to avoid unnecessary medical intervention (which is so prevalent in this country). Mongan points out the importance of choosing your care provider very carefully. She expresses the importance of communicating respectfully with your doctors/midwives/nurses on your birth wishes in order to create a positive atmosphere in prenatal visits and in the birthing location. She even puts forth alternative language for birthing couples to use in order to keep the mindset of childbirth family, rather than medically, oriented. I found these all impressive and very encouraging.

There were a few concerns for me, though. First of all, Mongan is SO positive about her descriptions of the right birth that I fear it can raise unreasonable expectations about childbirth. For example, when she refers to the birthing stage known in the medical community as "transition," she avoids pointing out that the uterine surges or contractions reach a new level of intensity and that it requires the deepest focus and relaxation of all. She works so hard to avoid any reference to pain that I could imagine it might be an alarming stage for a hypnobirthing mom to reach if she starts to feel like she has some pain. For some women, the transition stage isn't a big deal. But for many more, it really is the point when the contractions totally peak, and it can start to feel painful - not unbearable and not even extremely painful - but they're strong enough that you have to focus intensely through each one and you might even vocalize a bit. She does acknowledge that it is a point when moms might start to doubt themselves, and she turns it around very positively by saying that this is an exciting sign - a sign that the birthing stage is near. This is great, but moms deserve to know that if you start to feel like the contractions are painful, it's okay. It is short-lived, and this is when your partner/coach should offer reassurance and praise to the birthing mom. Indeed, the end is near, and it's so awesome.

Mongan doesn't like the word "coach." It makes it sound like birth is an athletic event to her. I get that. But "coaches" aren't necessary yelling at their wives. They are encouraging, comforting, soothing - and I don't think there is anything wrong with the word. (Besides, I'm a Bradley mom, and you're kind of picking on my lingo, Lady.) :)

There was an overall sense in the book that childbirth shouldn't seem exhausting. I wholeheartedly agree with this in that it shouldn't involve intense huffing and puffing (which can lead to hyperventilation anyway), and pushing should not be some Herculean task that breaks blood vessels. But labor does require some stamina, especially if any stage of it is prolonged or if it begins at the end of a long day and goes into the night (which often happens). This is okay, and it provides good reasoning for consistent exercise during pregnancy. Mongan touched on exercise, but more lightly than the Bradley method does (to which I'm so obviously biased).

I was intrigued by her thoughts on stage 2 of labor, typically referred to as the pushing stage. She strongly criticizes the idea of pushing a baby out and points out that it can not only make the baby's experience more violent, but that it can increase damage to the pelvic floor as it can cause the perineal muscles to constrict. She encourages instead "gentle birthing" and "breathing" the baby down. This is a terrific concept, don't get me wrong. I love the idea of gentle birthing, and I've noticed that in my own experience with my second baby and in many birthing experiences, the final "pushes" in crowning are best if they're not really pushes. A nurse or midwife might say with that last contraction, "Okay, don't push on this one. Just breath deeply." This can be great, because a baby on the threshold of birth who is "breathed out" can have a more gentle birth, the body will be more relaxed, and it can/will minimize or eliminate tearing.

Here are my concerns with the "breathing them out is best" principle: First of all, if your baby is in an awkward position or is particularly large, breathing down your baby might not be possible or could take much longer than everyone expects it to. It might require you putting some pushing behind it. In Bradley training, we're not taught to push with all of our might. We're taught to push as much as we comfortably can, but we're a very active part of it. We're also taught the signs of appropriate pushing - that is, the best sign is that the perineum (the muscle between the vagina and the anus) is bulging. This is not constriction of the perineum - it encourages the perineum to unfold.

Also, Mongan's description of "breathing your baby down" makes it sound like crowning shouldn't involve any pain. Again, we're back to my unreasonable expectations issue. What if it does hurt at that point? I've noticed in my births (with my reasonably large babies - 9'4" and 8'1" with knots and tangles) that once the dilation stage is over, pushing is really comfortable (and cool), but crowning stings a bit - it even hurts at some point. Does this mean I've done it all wrong? I don't think so. First of all, you can't really practice this stage much during pregnancy except when you're having a bowel movement, and even then you need to take it easy. So I'd honestly be curious to poll hypnobirthing moms about crowning and how it felt to them. Did it hurt? Sting? Burn? Did they push? How was their pushing?

Of course, these concerns and speculations might be answered if I took a hypnobirthing class. Perhaps in the class the teachers give a more realistic view of the experience. Also, the "breathing down" might make more sense to me if I saw a woman do it. But I think it would be advisable for any woman to prepare for the possibility that if her baby is not progressing much with the "breathing down" method, more active pushing might be needed and shouldn't be feared.

Another thing that concerned me was Mongan's use of the words "needing an episiotomy" (in case baby isn't being born quickly or easily enough). Mongan clearly wrote this in the age when the medical community still saw tears as something to seriously avoid. I'm not saying tears are swell, but as I've already pointed out, tearing is not a big deal. It's so much better to let mom tear than to cut her unless there is an urgent need to get the baby out now. If a mom is afraid to really push her baby out and she has this fear of tearing, then a practitioner might feel the need to perform an episiotomy - and you know how I feel about episiotomies (and the tears they sometimes bring along with them). So, basically, I'm just allergic to the word "episiotomy" and it makes me sad when I hear those words...

As a word of advice to hypnobirthing moms, really work on your breathing down. But if baby isn't coming out with that, don't be afraid to push. Get those knees back, and try to pee on someone! :)

Another thing that frustrated me a little when reading the book was, again, her extreme optimism - only this time about the medical community. She repeated here and there that there were "many" practitioners who would support birthing requests, etc. I don't know how obstetrics is in New Hampshire, but here it's another story. If you want a practitioner who is supportive of natural birth and routinely avoids unnecessary intervention, it is like looking for a needle in a haystack. They are hard to come by. For one thing, there are laws which make it difficult for them. For example, Utah law basically states that doctors and midwives have to induce you by a certain time past the due date. They are required to do so. These laws must be based on some of the challenges that can come with overdue babies (especially in epidural births), and they are pretty apprehensive of big babies. (Believe me, I know.) Another thing is that birthing in a tub (which she mentions lightly but advocates) is illegal in Utah (I believe). It happens in certain home-births but never in hospitals out here. You may labor in a tub, but not birth in one. (You are welcome to contradict me on this, by the way. This is based on my understanding of the laws and has no legal references to back it up).

It's a big challenge out here to find a doctor or midwife who routinely holds back unnecessary intervention. It's also difficult to know how a doctor will handle your labor. They don't fess up easily on their routines. I didn't know until I was in the hospital with my oldest that continuous fetal monitoring and IV's were non-negotiable with my doctors, but no one would say this upfront. You have to know exactly what to ask about when seeking a practitioner, know what signs to look for, and you have to tread very lightly while asking your questions. Also, their answers to a less experienced mom might be deceiving. For example:

Me: So do you encourage your patients to have epidurals, or can they choose not have one?

Evil Dr. J (aka - Cervix Assaulter): No, if you don't want one, you don't have to have one. My wife didn't want one, because she didn't think the contractions were that big a deal. Her dad was a drill sergeant, you see. She actually broke her arm once, and no one realized it because she didn't mention it to anyone for a whole day.

On the surface it sounds like he's saying that epidurals aren't forced on you and they totally respect your wishes. But he's also saying that you'd have to have a ridiculously high pain tolerance to endure unmedicated childbirth. Well, I don't have a high pain tolerance. If I stub my toe unexpectedly I curse, and I try to not curse. So if you express a desire to go natural and your practitioner tells a story like this, switch doctors NOW.

Here's another dialogue, because that last one was so fun:

Me: So do you routinely perform episiotomies? (I worded this badly. The word "routinely" is a red-flag to doctors...)

Evil Dr. J: Hey, if your bottom's big enough, then I won't cut you.

This was a favorite exchange of mine. Since I'm rather gifted with languages, I'll translate: "I don't believe in the perineum's ability to stretch, and I don't like tears. It takes too long to sew them up. If your baby isn't coming out as easily and as fast as I like, then I'll cut you." I know, can you believe that much was said in just those few words???!!!! Some languages are just weird!

What you want to know is not whether or not they like epidurals. It's whether they are happy to hold back intervention in your low-risk labor. Unnecessary intervention could make your labor less manageable, and hence you might end up choosing an epidural. When you're looking for a provider, you want to know some of the following: When do they use IV's? Are they comfortable with intermittent fetal monitoring when mom and baby are doing well? Are they comfortable allowing a mom to tear (or not tear) instead of performing an episiotomy as long as the baby is well? Do they mind sharing their cesarean rates with you? Do they use vacuum or forceps frequently in births? Do they get uncomfortable with moms having large babies if the mom is no petite lady (not necessarily a problem, by the way)? Would they allow eating or drinking in labor? Are they comfortable with a "birth contract" or a "labor wish list?" Would they mind if you hired a doula? Will they always consult with you to discuss interventions and allow you veto power unless it's an emergency? Do they attend a lot of unmedicated births?

I can't tell you exactly how to ask these questions. It's important to be respectful, but you don't have to be sheepish either. It's your birth. If you start asking these questions and the doctor or midwife is enthusiastic or plainly states something like, "Labor, when issues don't arise, should be a natural as possible," you've found yourself a winner. You can reassure them that you are prepared for the possibility that some things might go wrong, and you're glad you're in good hands. (Of course, that doesn't mean to skip the "wish list.") If, however, you start asking these questions and the practitioner gets uncomfortable or makes a joke about having to catch a baby on the ground or something (happened to a family member), then you have a red flag. Switch practitioners NOW. And if you're 32 weeks along when it hits you that it's time to change, don't beat yourself up. Take control of your birth.

Mongan isn't wrong to be optimistic and positive about the medical community, but when she uses the word "many" in referring to supportive doctors/midwives/hospitals, it feels overly optimistic. Hypnobirthing moms would do well to take extra care in choosing their providers and should not feel abashed about asking a lot questions. Most of us don't have a ton of babies, and you have a right to have say in how your care is handled. It's your baby and your body.

How about nutrition and medical interventions and their risks and benefits? What if things go wrong? Well, that's my final concern with the hypnobirthing book. Well, it's not really a concern with the book itself. The book is great for preparing you for an uncomplicated delivery with a good low-risk pregnancy, but I felt that it touched only very lightly on the more comprehensive parts of childbirth education - the medical and nutritional side of childbirth. It's good to keep the language positive and gentle, but when you're birthing in a hospital, they use terms like "transition," "contractions," "water rupturing," instead of gentler hypnobirthing terms. Hearing the more common medical terms shouldn't frustrate couples. Knowing what they mean should be comforting.

Again, I haven't taken a class, and it's very possible that the class fills in some of these gaps. The book is definitely not meant to stand alone, though, as Mongan repeatedly refers the reader to their Hypnobirthing teacher and specific handouts. Couples considering a class might want to ask if these extra topics are covered and, if not, what books or websites might be a good supplement to the class.

For someone only reading the book, I'd definitely encourage hypnobirthing couples to supplement their education with other materials, like a friend's Bradley class workbook (and a few hours doing research on the internet) or Childbirth the Bradley Way by Susan McCutcheon. It's a little dated, and there are tons of nudy shots (so sorry for that!! I suggest post-it notes to cover the photos), but the book not only gives some great detail on childbirth, but it helps you educate yourself comprehensively on nutrition, medical interventions, and what is best when some things can go wrong. This might sound a little negative (which Mongan is anxious to avoid), but if a complication arises and you understand what it is and what care is best, then you can still feel good about the good parts of your labor. And you can feel great about being a couple that understands what is going on and what care is best for the situation.

Much of this might sound negative about the book, but I really do think it's a great book, especially as part of preparation for the deep relaxation necessary for comfortable childbirth. In Marie Mongan fashion, I want to end on a positive note and point out two of my favorite parts in the book.

First of all, I love Ms. Mongan's descriptions of her own birth experiences and the genesis of hypnobirthing based on them. In her first two experiences, she labored comfortably, completely unassisted and unmedicated, despite the derision of the nurses, and was crowning before she was forcibly put-under and her baby was birthed with her unconscious. By her third labor, she stood up for herself and made firm requests about birthing her baby consciously and about having her husband in the room. This was so unorthodox and extremely brave. She is such an amazing woman to have been able, at such a time, to stand her ground and have relatively positive birth experiences. And all of it started with her reading Childbirth Without Fear by Grantly Dick-Read. Her own experiences and her courage are very inspiring. She also takes some time to outline the history of viewpoints on childbirth, and you can see how the emotional atmosphere in our society has really fostered pain in childbirth. Women are scared to pieces and dread labor, and then they have traumatic experiences that pave the way for other women. And these are great, amazing women who are being terrified into fearing a very important event in their lives. Mongan is an amazing pioneer in natural childbirth, as was Dr. Dick-Read and Dr. Bradley (and even Dr. Lamaze, I'm sure).

The other part I loved - my favorite part - was a chapter that I really needed on releasing fear. I am so grateful to the friend who suggested this section to me. I realized that I had been getting very caught up in the negative aspects of my previous labors and was stressing myself out everyday replaying the experiences in my head. It was very distracting. Mongan warns that fear from any source - abuse, previous birth experiences, others' birth experiences, the opinions of others, etc - can become self-fulfilling prophecy in a bad way. Every woman, every pregnancy, and every labor is different. There is no need to assume that because something went wrong once, it will happen with every labor. There is no need to fear complications in a healthy labor. Things can happen, but they usually don't - and moms don't need to stress themselves, their partners, or their babies out with anxiety. What a blessing to be reminded of this and to be advised that I have to let go of the disappointments of the past and have faith that it'll be okay!

Hypnobirthing is a great book and an excellent resource for any mom preparing to birth naturally. I wouldn't use it as my only resource for preparation and education, but it would be a valuable staple in the natural birthing mom's library. Borrow, buy, or steal it (no, don't do that, I'm just joking). Just get it and read it often!!

My Second Bradley Birth, well sort of...

I say "well sort of" because, in my mind, a Bradley birth is more than just unmedicated birth. It is relaxed, more comfortable birth. It's a really wonderful experience, and I fully admit that I wish I could share the Bradley gospel with all women, because it is such a blessing to not have to fear labor and be in terrible pain. I said "sort of" because baby #3's labor wasn't as comfortable and relaxed as baby #2's labor was. His birth, however, was at least as surprising.

By the way, I'm reading the Hypnobirthing book right now, and it's pretty amazing too. I've noticed so far that the main difference between Bradley and Hypnobirthing is that Bradley tends to be a little more comprehensive and inclusive of diet, exercise, education on medical interventions and their risks and benefits, etc. It's a little more medical minded, and hypnobirthing tries to be a little more natural minded. So far hypnobirthing seems to be mainly about the birthing event, but that's not to bag on the book. It's extremely positive and has already helped me start to feel better and have more faith in my next labor, and I'm only halfway through it!

The biggest reason I am about to share this experience, even though it's not a very relaxing one, is that if an induction becomes necessary for your baby's safety, it is still possible to have a good, healthy labor without an epidural. I say this because when I was pregnant with Mr. Handsome and had not yet experienced childbirth without medication, I was uncertain if I'd be able to ever endure a Pitocin induced labor. From my third labor I now know that, while there is a difference in the pace of contractions and the environment in the labor room (more anxiety than is ideal), the contractions don't actually get any stronger than your strongest natural contractions. A woman can still relax through those powerful contractions and give birth to her baby without feeling the need for an epidural. Isn't that good news?

Here's my story:

After a normal, low-risk, healthy pregnancy, I went to my 39 week check-up with my two rowdy kids in tow. There was a male midwife in training joining the regular midwife, but that didn't bother me. He just happened to have been there when I had my strep-B swab a few weeks before (how nice), so I didn't care that he was there to hear a heartbeat. To our surprise, the heartbeat was low - around 90ish (when it should be around 120). I had noticed some slowing in the baby's movements, but he had still consistently moved pretty frequently throughout the day. It had also become difficult to take the time to count movements since I was chasing after my other kids, and summer vacation had just begun. Anyway, the midwife suggested that I have a non-stress test (aka NST) in their office for an hour or two. It was disappointing, but I will admit that I had been very anxious for several weeks now. Mr. Handsome's birth was often running through my mind, and I was practically convinced that something would not be quite right again. I still wonder if this was self-fulfilling prophecy.

During the NST, the heartrate was not steadily low, but there were variables in the heartrate. It would look great for a few minutes, and then there would be a small drop, and then it would be great again for a few more minutes, and then drop again, and so on. It went back and forth like this. After a rather stressful, uncomfortable hour of watching the varying heartrate (as well as watching my children ransack the room I was in and calling my husband for help), the midwife on call asked me to go to the hospital for an extended NST.

My husband met up with me, we got our kids to his parents, and he and I grabbed dinner before getting to the hospital for my NST. I found a good comfortable position, and this time our baby looked great. No variables for two whole hours. The midwife on call came in, said that everything looked good and he was obviously a healthy guy, but advised that we should check again in a day or two and pray that our baby would come sooner. She speculated that there might be something going on with his cord.

Two days later, we packed our bag in case we had to be induced, got our kids to my husband's parents, bought a birthday cake and OJ for after the delivery, and went to the hospital with mixed feelings. I wanted the baby here and safe and was anxious to birth him, but I wanted him to be healthy and fine and not need an induction. Again I didn't want to have an unmanagable labor, and I feared that if I was induced with Pitocin then the contractions would become more than I could relax through, and I might give in. As a reminder, I didn't want to risk another fever or slowing down a labor or having difficulties pushing the baby out - especially if he was struggling.

I picked the best position I could find and settled in with my husband for the NST. There were variables the whole time. After about 45 minutes or an hour, the little guy did a pretty interesting stretch, and his heart-rate dropped down to 90 again. David and I looked at each other - was that him or me that the monitor picked up? I still don't know, but it was enough to get me checked in for the night. I was not happy. I was as concerned as everyone, but I wanted my body to just get to work. I had a feeling that once my body got going that it would progress fast. And I was afraid of the Pitocin.

I had the blessing of two midwives that evening - midwives J and M. I was grateful, because though M was more experienced and confident, J was a little nicer and more helpful to me. She also had longer fingers. (This is a good thing for cervical checks). I got changed, got my monitor and IV (IV always come with Pitocin induction - that's how they give it to you), and got my cervix checked. I was at 5 centimeters. (Good body. Now why hadn't you started yet, silly?) It was at least a good start. With it being my 3rd baby, no epidural planned, having gone unmedicated before, a great coach/birth partner, and two supportive midwives, things looked good.

For the first hour my contractions felt only like Braxton Hicks, nothing more. But they were steady, and they were a start. During the second hour they increased the Pitocin. The contractions became more powerful, but I could still move around easily. I got up and down to use the bathroom a few times, and the rest of the time I spent on my side breathing deeply. During the third hour, the deep back-pain started and the contractions increased in strength. Midwife J functioned almost as a free doula by pushing on my back during those contractions and being a second support person with my husband. I felt very grateful for both of them.

The progress between the hours was very fast, and there was tension in the room as the baby's heartrate continued to have his variables. Though if I understand correctly, they were more frequent than at the start. During the final 30 minutes of dilation, the contractions had peaked in strength, and it was hard not to vocalize during each contraction. My husband was my hero, holding my leg up for me during each contraction (it helped - I couldn't have a pillow propping it up, because the monitor was right where a pillow would've been). I can't say full out that the surges in my abdomen were painful, but the back-pain was very strong. I was so grateful to still have midwife J pushing on and massaging my back during these contractions.

Suddenly I felt something like a water-balloon popping inside me, and I knew that my bag of waters had broken. We checked and the midwife confirmed it. There was a little mechonium in the fluid, but "not much" reassured midwife M. I asked if I could have a bath. I guess our baby's variables had become consistent enough that they didn't feel good about a bath. Instead they checked my cervix, and midwife J thought at first that I was at a full 10. "Do you feel an urge to push?" No, was my answer, but I wanted to push. They decided to let me try pushing. Then midwife M checked my cervix. It turned out that there was a lip on the cervix.

Okay, only a woman who has had a lip on the cervix knows this one. The contractions are no worse. It's just that, if you are anxious to start pushing instead of waiting a little longer for it to just go away, then what the midwife needs to do is push on the lip while Mom pushes with the contraction. It hurts.

It took two tries to get the lip out of the way, and the second time I literally grabbed midwife M's wrist as she pushed on the lip because it hurt so much (she backed up and suggested that we recollect ourselves). But the lip was gone. I declared that I wanted a mirror, and they propped one right up where I could see it. This was it. Time to push him out. Here he comes.

Except he didn't come as I pushed. This made me more tense. I pushed and did my best, but I was frustrated that he wasn't there. At this point, the room was filling up with people, including Dr. P, one of the nice OB's connected to the midwife practice. At the time, I wasn't thrilled to see him, but it was good that he was there just in case he was needed.

They realized that the baby was posterior and that was why he wasn't emerging. Midwife M was about to turn the baby, but then she said, "No, let's have Dr. P do it instead." I didn't know what to expect in having the baby turned. More pain? How much more? Dr. P walked up with his gloved hand, and midwife M said, "Don't push on this next one." I took a deep breath, didn't push, Dr. P barely reached inside with two fingers, turned his hand, and the baby was turned. I hardly felt a thing. Wow. That guy had magic hands.

For the next 10 minutes the pushes were more successful, and I could see the baby's head emerging. Now here's a challenge in labor that is really unavoidable, but can hurt more in unmedicated labor. Crowning and birth requires stretching. The slower and more gentle the birthing, the easier the stretching and the better it is for both mom and baby. Unfortunately, I had two problems. One, having so much scar tissue from my first labor tear, my body can only stretch so far. Two, once our baby was crowning, his heart-rate dropped and didn't come back up. It didn't stop, but it had dropped. At this point, an oxygen mask was placed on my face.

I was tired. It was after 1:00 AM, and this labor had been more stressful and hurt more than my last labor. I had been humbled by the pain. I was also staring at a mirror where, as I had pushed during the less productive phase, large amounts of brown fluid were coming out. Mechonium fluid meant serious distress to me. And there my body was during the crowning, looking as if it might tear apart as I tried to get this baby out. I was not fully present, to be honest. I was tired, confused, afraid of tearing, and feeling the tugging, stinging pain of crowning.

As I previously mentioned, midwife M approached me and said, "If he's not out on the next push, we'll have to perform an episiotomy." I had been such a bad patient, I felt. I had resisted everyone's advice, and I wanted it clear that I would comply of course. Then I heard the exchange that midwife M had with the doctor where she explained that I'd had a 4th degree laceration before. I realized that I was wearing an oxygen mask and I heard the heart-beat, steady but slow. I felt the next contraction, and this time I really pushed. He still didn't come out, so I kept pushing after the contraction and suddenly he slipped out.

What happened next was almost comical if it hadn't been so scary. Midwife J, who was waiting to receive the baby, reached out and caught him, and her eyes unconsciously widened as she started to unwrap the baby. His cord was tied in 4 different directions - around one arm, two or three times around the neck, around the opposite arm, and around his waist. What had he been doing???? It was amazing that he had only variables in his heartrate. He was completely white, long and slender, and very still. The cord was quickly cut and he was transferred to the incubator and table for examination.

My husband and I were so sure that, if the baby was still with us, he must've breathed the fluid. How could he not have? As the cord continued to come out of my body, we all stared in shock at a tight knot - technically referred to as a true knot. Our little Rambo had not only wrapped himself every which way, but somewhere along the line, he had swam a knot into his cord. What on earth?! Everyone was amazed and grateful that he was out and safer. Knots, if baby gets too big and isn't born soon enough, can mean the very worst, which I won't even say. You know what I mean, though.

People asked me how I was, and I could only stare over at the table. The baby was moving slowly. "Is he okay?" I kept asking. "Did he breath it?" There was very little relief at this point. My husband approached the doctor examining the baby and asked if the baby had aspirated the mechonium. He answered that he was unsure. The baby sounded a little funny, but not very bad. "Let's get him some IV's" and they could tell then.

I told my husband that he could go with the baby, but he was kind and stayed with me. I don't know if it's because he knew that I needed him or because he didn't want to be without me. I delivered the placenta shortly after the baby was born, and then the midwives stitched me up. I completely stopped liking midwife M at this point. She was giving midwife J pointers on a cool way to stitch me, and it felt like I laid there for at least 30-45 minutes shivering to death. I did need a couple of shots of local anesthetic since I'd had none until then. The stitching ended, and I was transferred to the recovery room. Just before or after I was transferred, we were informed that the baby hadn't aspirated the fluid. It was such a miracle to us! He just needed one more IV, and then he'd be good to stay with us.

Hope had returned, but I was humbled. Though Mr. Handsome had aspirated the mechonium in labor #2, the labor itself had mostly gone so well that I had left the hospital almost cocky. It wasn't really an "I'm so cool for going natural" thing. Actually, it was more of a "It's too bad more women don't give this a chance" thing. This time, however, with all of the fear and anxiety, the power, speed, and discomfort of this 3rd labor, the pain with the lip on the cervix, and the whole hour of pushing, I was humbled. Grateful, but humbled. Incidentally, I could walk, but I couldn't pee just yet. :) Too much local anesthetic, I guess.

Two and a half hours after our labor, the final miracle of Mr. Rambo's birth came - he was with us and doing just fine - at 2 1/2 hours! With my daughter, I wasn't ready to hold her until at least 4 hours after birth. With Mr. Handsome, I didn't even hold him until the next day. I nursed Mr. Rambo, and we both held him lots. He was so cute, and we were so happy and humbled to have him. It was a truly blessed event. He had a little jaundice during his second week, but I nursed him a ton, it passed, and there was no hospitalization necessary. His birth weight was 8'1" - a skinny dude in our family, but by the time he was 3 or 4 days old, he was 9'1". That was more like it.

He is such a cutie! He is also completely busy and completely exhausting when he's awake. He is just about 17 months old now, and I cannot leave him in a room for more than a minute unattended, or disaster occurs. He certainly keeps me on my toes (or humbled if I'm not). Of course, I'm 24 weeks pregnant, 35 years old, and have never been pregnant with such a young toddler. But it's all good. We are truly blessed.

Am I glad I skipped the epidural on this one? Well, to be honest, with how he was doing when I was on the Pitocin, I don't know if they would have even let me have one had I asked. I wonder if that's saying something. But I am glad that I didn't have one. Again, my recovery was better, I eluded the episiotomy again and my tearing was less (this time only 1st degree), and I was able to push him out unassisted once he was positioned right. I have a feeling that, had I opted for the epidural, our scary vaginal birth would have turned into a c-section. And I'm grateful it didn't have to. Again, he probably would have been in similar condition, but I wouldn't have been in such good shape.

Needless to say, I'm grateful and humbled that we were in such good hands and that all ended well. Now it's time to be grateful, let go of the fear, and send our little girl positive messages to come safely and peacefully into the world. :) And I'll encourage her to put off passing stools, knitting, or Chinese jump-rope experiments for later. Much later.

Taking a Moment....

I feel the need to share my labor with my third child, but I want to take a moment to say that I'm not trying to dwell on the negative. I have been dwelling on the negative, I admit it. That's part of the reason I've been pretty emotional lately. I felt so good about my preparation and caregivers on my last two deliveries, and yet there were unavoidable problems that arose anyway, and it's been a little hard to come to peace with that. The fact was, the babies and I were in good hands each time, and they did very well despite their challenges. So that's a positive thing to focus on.

Another important thing to remember is that, unless you have a major medical condition that always recurs with pregnancy, each pregnancy, baby, and delivery is different. And that's SO important to remember. What happened with baby #2 wasn't quite the same as baby #3, and the complications just happened and were not a result of neglect, abuse, or poor care. They just happened. There is no reason for me to fear that this next baby will face the same issues. My current "project" is to focus on the positive, have some faith, and let go of the issues of the past. They were resolved and don't need to haunt me anymore.

That goes for anyone who reads this too. Don't let my labors haunt you. The biggest reason I feel to share my experiences is 1) to be honest and open about my labors and not romanticize them, and 2) to show examples of labors when I didn't need an epidural and was happy about it. But my labors are my labors, and they are not going to be your labors. If you're expecting and are having a normal, healthy, low-risk pregnancy, you have every reason to believe that your labor will go FINE. :) See yourself having a good, healthy, comfortable birth everyday, and you will. I'll do the same, okay?

Just reminding you of that before I share this next story...

My First Bradley Birth, or my " Really?" birth...

Well, now that I've stated my case somewhat, I'm ready to share my glorious birth experience with my Handsome friend, son #1. By the way, my sons like to pull stunts, and they start early. When I share about baby #3, you'll see that this is a trend. That's why I'm slightly hopeful that since this next baby is a girl (have I mentioned I'm pregnant again?), we might be in better shape. But as we all know, anything is possible.

Anyway, my oldest son was due on January 1, 2005. I didn't mind not coming early, as I new it would make the holidays even more stressful, and my son might not forgive me having him right around Christmas Day. It sounds frustrating for some people.

I also didn't mind him not coming early, because I was in total "natural" mode; and "natural" mode prepares you to go a week or two past your due date. By the way, did you know that a huge percentage of babies come at 41 weeks? I bet this bugs some OBs. With how big mine tend to be, that would bug me. But lots of women go "overdue," and their babies do alright. So let that be encouraging to some mom out there who is 40 1/2 weeks along and feels like she's going to burst. Or she could throw rocks at me.

Anyway, after a fun New Year's Eve of dinner and watching "Napoleon Dynamite" with my husband's parents, I woke to an invitation from my groovy neighbor to take our daughters to see "Sharktale" at the dollar movie. We rode over together, and by the time we got there, I was starting to feel pretty uncomfortable. I had been having plenty of Braxton Hicks all week (well, all during the month of December, to be honest). But these contractions were pretty steady. I will admit, though, that timing contractions is not one of my strong-points. So I can't say how far apart they were. What I can say was that as the movie progressed (with my daughter, then almost 3, popping in and out of the theater for drinks and potty breaks - even she can spot a bad movie a mile away), I felt more and more sensitive to my stomach. My friend commented that her family had gotten over a stomach flu pretty recently, and I wasn't excited to think I might be coming down with something. She kindly offered to take us home, and we returned in time for me to lay down for a second and then get up and empty my stomach completely. I did this a few times, and in stomach flu form, I could not hold anything down for the rest of the day. My kind husband let me rest, and I took a long nap or two. At about 6 or 7ish, my husband woke me from a nap, declared that he was worried about me, and suggested that we get me to the hospital for an IV. I agreed.

Now I must break to share that I had a birth contract, and it was so beautiful. A birth contract, for those unfamiliar, is essentially a wish list. It always starts with something like, "If baby and I are doing well, these are my requests," and they usually include requests for no IV, episiotomy, etc. My birth contract had all of the above - no IV, only intermittent fetal monitoring rather than continuous fetal monitoring, permission to eat and drink lightly in labor, and a "Please don't suggest pain meds - We'll ask if we need some" plea.

My husband and I packed our bag in case the baby was coming. I took a look at my lovely green pallor, and we headed to the hospital (a different, smaller one than the first one in my daughter's birth). We dropped off our daughter with a nearby relative, got to the labor and delivery ward, entered, and I said to the admitting nurses, "I think I need an IV." See what a good girl I am?

They agreed, but suggested that they check my dilation just in case this was a sign of labor. I was shocked to find that I was dilated to 5. Those really were some mild contractions. We decided to do the IV and check me again in hour, and then we'd decide from there if I should stay and have a baby. I got my IV, drank some apple juice, threw up a bit (so much for eating and drinking in labor), and took a brief walk down the hallways.

About halfway through my walk, I knew that I was pretty sick, because my "flu" was causing gastrointestinal discomforts, and we scurried back to the room just in time to avoid a very embarrassing situation. Unfortunately, for the next several hours, my vomiting slowly subsided while my gastrointestinal challenges increased. Yikes and oh so embarrassing! The good news was that between having a nice dim room, some relaxing music, and regular back-rubs during my tougher contractions, my husband and I were having a positive time laboring for our baby. I started out with intermittent fetal monitoring, because the guy's heartbeat was looking fabulous and no one was very worried about him. But when the nurse kept bursting in every 15 minutes, she suggested we just go with continuous fetal monitoring so that I could have some privacy. Happily, she knew that I wasn't planning on an epidural, and she expected that I'd be moving around quite a bit. (It's good when they expect lots of movement, or they could get really panicked if the readings look bad every time you switch sides).

I stepped in and out of the shower here and there, sometimes for relaxation and sometimes because I felt icky with all of the flu symptoms I was having. When the contractions came, I closed my eyes, relaxed my body, breathed as deeply as possible, and my husband firmly massaged a spot on my lower back where I felt a deep, burning pain. It was uncomfortable, but not too tough. Each hour the nurse came in to check my dilation (by the way, I don't enjoy cervical checks), and we were pretty hopeful at first that my dilation seemed pretty steady. At entrance (8:PMish), 5 centimeters. Around 9:00, almost 6 centimeters. Around 10:00PM, 7 centimeters. 11:00 PM, about 8 centimeters. 12:00 AM - 8 centimeters. 1:00 AM - 8 centimeters.

Wait, what's happening?! I thought we were progressing. Oh yeah, well, my water hadn't broken. The thing was, I had a wonderful family practitioner - a doctor - who was at home sleeping. The nurse was so sure that with my steady contractions and my, up until then, steady progress, once my water broke, I'd be pushing the baby and my doctor would still be home sleeping. At least, that's what she explained to me on the 6th cervical check. At this point, I stopped liking the nurse. I burst into tears, curled up in a ball, and asked her why she was checking me so often. She explained her concern, and I insisted that she call my doctor and ask him to come and sleep at the hospital. She returned shortly after and explained that he was headed over to sleep there. Then I have to admit that I felt guilty, though I don't now. I was still grateful, though, because from that point on, the nurse stopped checking my dilation (perhaps in fear for her life).

By 6:00 AM, my flu symptoms had slowed down, and my water still had not broken. My husband and I were pretty tired. We had learned in our class that transition typically occurred around the time a woman got to 8 centimeters, and when transition hits the bag of waters typically breaks. (I say "typically" because I have a friend who's bag actually didn't break once - the baby was born in it. Haha!!) A new nurse came in who I trusted less but appreciated more later on, and she declared that once that bag of waters broke, I'd be pushing soon after. I scowled at her. I was afraid to have my water broken medically for a few reasons: I feared the possibility of infection, that my dilation would regress, or that my contractions would become more painful than I could manage (all possibilities that come with breaking a bag of waters too soon). At about 6:30, my doctor, who I'll call Nice Dr. J (as opposed to Evil Dr. J, who strips your cervix without telling you), came in and cheerfully asked how I was doing. I said that I was feeling kind of grumpy and I didn't understand why I was still in labor. At this time I was hunched over a birthing ball, which helped a little. My contractions had grown pretty strong at this point, and it was hard to ignore that they had become painful. He complimented me on having a good bag of waters and suggested that we consider breaking it. I asked for a few minutes to ponder.

My husband was bushed, and I was pretty exhausted too. I didn't feel like I could go on much longer like this. We decided to have the bag broken. Looking back now, I was headed right into transition. Again, I'm not good at keeping track of my contractions, but they couldn't have been more than 90 seconds apart. It seemed that every time someone asked me a question, I needed a minute to breath through a contraction. I'm still glad that we broke the bag, because it gave the doctor and nurses a heads-up of what was coming. I climbed up onto the table, and before I laid back to have the bag broken (why, oh why do you have to lay back for such things?!), I had to roll over onto my side for a contraction. I breathed through the contraction, laid back, and felt another come on just as the doctor broke the water. Then things changed instantly.

I couldn't relax. I knew I needed to get off of my back, but I couldn't relax. My son had gone from having his head pressing against my cervix and the bag of waters to sliding right down to a bearing down position. It was painful and very scary. I grabbed the railing, raised my voice, swore like a German (there's a word they use a lot when frustrated), and raised my bottom off of the table. I couldn't relax. In the meantime, the doctor said, "Wait, get the lights on. That fluid was brown," and he started giving instructions on how they could get some saline into me to clean out the environment the baby was in.

The baby had clearly passed mechonium and had been floating around in mucky fluid. If he ingested some, it wouldn't be good for him. If he breathed it, it would be very dangerous. Mechonium aspiration leads to major respiratory issues and, if unchecked, could kill a baby.

What a shock this was to everyone, because the baby's heart rate had been great all the way up until that point! He clearly had not been in fetal distress, a common cause for passing mechonium prematurely. It must've just been because he was such a big baby. Either way, Nice Dr. J's hopes of getting saline into the womb to clean up quickly passed, because after what had seemed like a 5 minute contraction (though it was more like 90 seconds), I yelled out that I needed something in my IV and then declared that I needed to push. (This was a little embarrassing 30 minutes later, but I laugh now, because it's pretty normal to hit a panic spot). Nice Dr. J announced that the baby was coming too fast, so "Let's get a good respiration specialist in here." The room suddenly filled up with people.

I realized that I needed to push, which meant that my job of relaxing through contractions was over. I was home free!! (Well, sort of). But I could push! I calmed down, got my second wind, requested a mirror, and got ready to push. I first tried to squat (I'd seen a short film of a squatting birth, and it looked amazing). But the nurse could tell that I'd do better in a C-squat - slightly sitting up, legs pulled back - position. Though their mirror had broken off of it's stand, a nice lady stood behind the doctor and held it up for me to see how the pushing was going. It amazed me.

It probably sounds crazy, but seeing the baby coming down as I pushed was very motivating. The exercises and stretches were all paying off, and now I could see this person emerging. As I pushed at the peak of each contraction, Nice Dr. J folded his arms, stood back and declared, "That's how you have a baby." If I wasn't so focused on pushing, I would've laughed out loud. But it was amazing. I could see and feel the progress. What a difference it was from my first baby!

The baby quickly crowned, and then it started to sting. Unfortunately, the nice lady holding the mirror completely switched positions, and I had to take my eyes off of the mirror. So I couldn't see what was happening. I did feel burning and stinging, and then I complained, "Oh, that hurts!" The nurse reassured me that it would sting, but it's okay.

Then the nurse told me not to push with my next contraction. I moaned, "Oh no," but I listened and just breathed. Then my little guy came sliding out with his arm tied right up to his side in a make-shift sling created by a wrapping umbilical. Little stinker!! It was such a relief to have him out, and I couldn't believe what a wild feeling it was. My husband burst into tears and kissed me as they cut the cord and hurried the baby over to the respiration specialist. It was such a mixed moment. We were happy that it went so well and that this terribly beautiful guy came out, and yet we were terribly confused over what to expect now. As you can guess, the prognosis wasn't very good. He wasn't dying, but he had clearly aspirated mechonium, lots of it, and he was struggling breath well.

The specialist said that he wanted the baby in the ICU, but first he laid the little (well big - 9'4") guy on my chest, where I leaned forward to kiss his filthy back, and then they hurried him off to the NICU.

The next part, since I've been so graphic already, is very important. I looked down and realized that Nice Dr. J was looking at the cord and gently pulling on it. I insisted on pushing so as to improve the chance that it would come out fully intact. Then this greenish/greyish thing came sliding out of my body. Ick and weird! The placenta was almost unrecognizable. What was later speculated by the respiratory specialist who analyzed the mechonium in the baby's lungs was that Mr. Handsome had passed mechonium, ingested it, and then passed it again about 24 before he was born. Yucky! It was also suggested that if the cord hadn't wrapped and pull taut, he might not have aspirated it. But you cannot predict cord issues, especially when you have 6-8 hours of perfect fetal monitor readings.

Another speculation that a lay midwife friend of my mother-in-law (say that ten times fast) made was that, rather than my sickness being a flu that kicked me into labor, it's likely that Mr. Handsome's mechonium fest was making me sick. And from the image of that placenta which will be forever locked in my mind, I'm thinking she was probably right. So I was being slightly poisoned by the little guy.

The rest of the story was dramatic, but miraculous as well. I had that euphoric "Wow, I just had a baby feeling" for a few hours after the baby was born. I was amazed to be able to walk and use the bathroom so soon (I know it sounds silly, but it's just neat to have control over your body). Incidentally, I did tear with the baby, but it was only a 2nd degree tear - so much better than the first tear. When the nurse reached over to massage my abdomen, I flinched but was amazed that it didn't hurt very much. In fact, as I previously mentioned, the only pain medication I needed was Motrin.

All of this good recovery feeling was a great blessing, because it soon became clear that our son wasn't doing so great. He just didn't breath well, and the first x-ray of his lungs after birth was pretty ugly. He had aspirated a great deal of mechonium, was suffering with a kind of baby pheumonia, and it was clear he'd need to be life-flighted to the big hospital nearby for their NICU, which is an excellent NICU. They let me come in and see him, and he looked so beautiful and frustrated laying there with all of those tubes in him. I wanted to hold him, but instead I just touched his little fists and wondered why he had to be so uncomfortable.

About an hour later, the respiration specialist offered to join my husband in giving the baby a priesthood blessing (familiar mostly to Latter-Day Saints). My husband later shared that he felt good about how the baby would do. The Life-Flight people arrived shortly after and explained what we should expect from our baby's trip and stay at the NICU. They wanted to prepare us for all possibilities, but told us that we had to be patient. "Mechonium can make babies pretty sick." It was very sobering, though just seeing our little man so intubated had been sobering enough already.

Not long afterward, the same Life-Flight people came brightly into the room with positive looks on their faces. They took a second x-ray, and the baby's lungs looked so much better. Not clean - he'd still need to be Life-Flighted - but much better, almost like a different baby. Whatever the cause of the improvement, he was clearly fighting a good fight. (Go, Tiger!) My husband and I settled in, I requested a pump to get going ASAP on lactating, and we got some food and rest. I awoke during the night to pump, and when I was done, I couldn't sleep right away. Where was my baby? Why wasn't I with him? I got out of the hospital bed and climbed into the bed and cuddled into my husband's back. We laid there and cried quietly, wondering if it felt worse than it was or if we weren't worrying enough.

The next morning, 24 hours after my delivery, I was released from the hospital. Thank goodness I could go and see my baby. He was so beautiful and strong. Long ending made shorter, in 4 1/2 days he was home. We had been told to expect at least a week and a half. He had a night with a little stress, but some oxygen and a medication which I can't remember set him right. They had expected him to need a respirator, but he only ever needed oxygen. He seemed tiny to me, but at such a size he was huge next to the others. I pumped consistently and nursed him the second day when the doctor said he was ready. I continued to nurse him until he was 4 months old, when my own health issues made it clear that I should probably stop.

As I mentioned before, Mr. Handsome is healthy and...well, handsome. He has grown well (huge - along the trend of his sister), and he's bright and happy. So all's well that ends well indeed, and we feel truly blessed that, when all is said and done, all of our kids are healthy.

You might even wonder why I started this blog. This is therapy for me. (The check is in the mail, and thank you for the hours). But seriously, I'm now expecting our 4th (and final) child, and Mr. Handsome's birthday surprise was the first of two stunning deliveries. I can't approach childbirth without a lot of anxiety - not over the pain, but over what surprise will come with the baby. And there are few people I can talk to who understand my concern for the safety of the baby coupled with a hope that I can deliver unmedicated. They don't see how there could be any relation between the two.

I wish I could say that Bradley birthing eliminated complications in my sons' deliveries (that was part of the point - to make it safer for them too), but I can't. I was still glad that I eluded the epidural, because I feel in my heart that it helped them to be unmedicated at such crucial times. Of course, it might just have blessed me at a time when I needed to be in pretty good condition to focus on their needs. Either way, it was the right decision.

I'm also so grateful that we had learned so much in our class about possible complications and medical interventions and their risks and benefits, because it reduced our confusion and helped us give our consent with a clear head. That alone was worth the class that we took.

I'm also grateful Mr. Handsome is such a good fighter (for now). It's good to have him with us.

A Controversial and Emotional Topic

One thing that life repeatedly teaches me is that when you've had and share a difficult experience, there is always someone who has had worse than you. I don't mean this in a bitter "Let me have my pity party" way. I mean it as I said it.

A few good friends have taken some time to read from this blog, and I appreciate the interest very much. In at least a couple (if not all) of their cases, their labor experiences were even more difficult than mine, or they had more complicated pregnancies and deliveries. From my heart, I mean it when I say that it always humbles me to hear their stories. I am grateful that, though I've never had a complication free delivery, a cesarean section hasn't been necessary (so far - fingers crossed). I'm also grateful that, of our 3 babies, so far only one had to do NICU time. (Though our third baby gave us enough of a scare just in labor).

With all of that said, it raises the question in my mind of whether I should even share these thoughts and experiences on a blog, or should I just keep them to myself. My quick instinct, however, is that it's good to blog them.

First of all, when I was pregnant for the first time, I would've appreciated hearing all of these things. I had mentioned to a few people that I was interested in unmedicated childbirth, and I had very little positive response. It's no one else's fault that I didn't go out and get myself and my husband better educated, but I would've appreciated more support. I can honestly say that, had my friend and neighbor not shared her birth experiences with me, I would probably have just stayed with my controlling doctors and had another miserable birth experience. Yet my baby would still have had the same complications he had with his birth, and then we both might have been in terrible shape. Or it might have been better and I wouldn't have been the wiser. But then I wouldn't have these groovy experiences to encourage other women with... :)

Seriously, though, if my blog stresses anyone out, please don't feel obligated to read it. I'm not trying to tell people how they should be laboring or what they are missing if they don't do it "my way." I'm just sharing some thoughts, feelings, and information in hopes that it'll help me not have an anxiety attack everyday for the next 4 months leading up to my next delivery. I'm also hoping that some curious or hopeful mom might benefit from hearing these things in some way.

So if you dare, read on...

Bradley Births and Epidurals

Before I charge into describing my son's delivery, I should probably explain what the Bradley method is. If you are interested or just curious, I highly suggest that you check out the Bradley website. In short, however, the Bradley method involves comprehensive childbirth education, specific nutrition and exercises during pregnancy, discussion and practice of the various pushing positions, and the use of deep breathing and relaxation as a means of having a drug-free labor. An ideal Bradley birth involves as little medical intervention as possible, but Bradley teachers take the time to discuss the various complications which may occur as well as the medical interventions mothers may be offered. Bradley couples come out understanding childbirth and it's various stages in great detail, have a good understanding of what is normal in childbirth, and are well prepared for any difficulties that may arise.

I think Bradley training is so cool, by the way. :)

Bradley births occasionally, but do not always, involve a doula (a paid childbirth coach). In fact, Dr. Bradley, who fostered the Bradley method, probably didn't think doulas were that great. (This is pure speculation, by the way). He referred to his method of birthing as "husband-coached" childbirth. He felt that the coaching experience between a husband and his laboring wife can be a powerful, emotionally intimate bonding experience for both. In his book entitled Husband-Coached Childbirth, he relates a story about when a husband was unavailable during the labor, and Dr. Bradley stepped in as the coach as well as the delivering doctor. While he was happy for how well the mother had done and how well her labor went, he expressed a feeling of almost embarrassment that he'd been playing a role that belonged to the woman's husband.

As a wife who has had two Bradley births, I can attest that having your husband coach you through such a challenging job is a great bonding experience. That's not to say that epidural births aren't great bonding experiences too. A loving husband's support and being able to share in witnessing this wonderful person's arrival can bring couples very close together. But a Bradley mom depends upon her husband's emotional and even physical support, and the husband essentially becomes the woman's "knight in shining armor." Trauma bonding, you might ask? Not really. Just equal involvement.

The biggest reason a woman needs her husband's support so much is because natural childbirth is very difficult to do, especially in this day and age. Even if a woman has done all of the research, taken a class, and goes in prepared to have an unmedicated birth, there is bound to be a point (usually when the woman goes into "transition") when she feels unsure that she can do it anymore. At this point, there is often a nurse ready to offer meds at Mom's request. If, however, the husband has also done all of the research, taken the class with Mom, and prepared and educated himself, he can offer reassurance and moral support through the difficult, and usually brief, period of discouragement. He becomes her advocate in a challenging time.

It might sound insensitive for a husband (who is not in labor) to discourage his wife from getting an epidural when she's in pain. It is very compassionate for a man to not want his wife to suffer needlessly. But epidurals bring with them risks and challenges as well, and when a woman has decided that she wants to avoid those risks and challenges, she needs that kind of positive encouragement. Again, from my own personal experience, once it starts to feel too difficult, the pushing stage is usually only minutes away. I've now had two epidural free labors, one of which was very painful at times, and I've never regretted avoiding the epidural. I am acquainted with a number of women who've also had at least 2 or 3 Bradley births, and they have been grateful each time that they avoided the epidural.

I was thinking to put off an epidural vent for another post, but it feels necessary to explain why I personally feel so strongly about avoiding an epidural. First, I'd like to include links to the American Pregnancy Association and Babycenter on epidural. Both of these articles seem to be pretty objective - neither completely for or against. A third article, which I thoroughly enjoyed as well, is from iVillage. This one is quite good, because it acknowledges the variance between studies and the hot emotions surrounding the debate. Most of all, I appreciate the conclusion it makes that epidurals are an "excellent option for some women." Notice the use of the word "some." Not "most." Not "all."

You see, I want to make it clear that I don't believe that epidurals are evil or something. They just aren't for every woman, and yet so many women who desire to avoid them are mocked by other women when the subject comes up. I am unabashed about sharing my enthusiasm for a mom-to-be who is contemplating unmedicated childbirth. But I have learned that, in a group of women who have epidurals with all of their labors, if you make the mistake of saying that you prefer unmedicated childbirth, the word "crazy" often comes up. So many women who've had epidurals in labor feel the need to defend their choice. I think that's so unfortunate, because I'm going to let you in on a little secret: You don't ever have to defend an epidural to me. I've had three babies - one with epidural and two without - and I get how painful and scary it can be at times. I've just enjoyed my unmedicated births (and recoveries) better than my epidural birth.

The problem I have with the epidural is how much they are encouraged in the medical community with very little discussion about the risks and challenges that often come with an epidural. I thought of including a link to Web MD about epidurals, but the one minute video of a MALE doctor arguing that MOST women have a more satisfactory experience with epidural just bugged me too much. :) Who is he to argue how satisfactory a woman's birth experience is? What is a woman, who has just brought a baby she already loves into the world (possibly in a very miserable way), going to do when she sees her little bundle of joy? Yell at the doctor because she tore badly or because she came down with a fever?! (Imagine incredulous look on my mysterious face) Doctors don't know exactly what is going through a woman's mind or how well a woman is going to recover after he leaves the hospital. I remind you of my labor with my daughter. When it was over, I felt euphoric - that is until the recovery stage began. Then I felt awful. So, this man's "testimonial of the epidural in labor" (which he has never actually received) means nothing to me.

Okay, I'm backing off a little now and am going to try and be objective. For the record, I'm laughing and smiling, and I hope you are too. :)

Epidurals bring risks. Not everyone reacts the same to an epidural. Not every anesthesiologist is the same. Compared to how much pain medication was once used during labor, epidurals use much less; but it's still medication in labor, and some studies indicate that babies might not latch on as well if they were born in an epidural labor. Other studies disagree. My daughter was a sleepy little slug and latched terribly from day two (because she wouldn't latch on during day one). But who knows why that was. I personally think it might have had something to do with the epidural (and the fact that I was in too poor condition to hold her during the first hour of her life).

One thing that I believe it is completely irresponsible to deny is that pushing is more difficult with an epidural. Pushing out a baby is tough work. It requires a lot of strength, and the better the pushing position, the easier and more doable it is. The best positions require you to pull your knees all the way up to your armpits - no joke. This is not easy when your legs are warm, numb blobs of flesh. It is tough.

You also cannot feel the muscles that you are pushing with very well (or maybe not at all). Don't worry, the baby still comes out with an epidural, especially if he/she is in a good position, isn't too big, and if the body is pushing some great, heavy duty contractions behind that baby. BUT, you may end up needing an episiotomy if that baby is crowning long enough to worry the doctor, and you don't want to get me started on episiotomy.

But I must get started on episiotomy, so my apologies. Episiotomies are not a bad thing. You can even find an article on website as recent as 2007 which argues that episiotomies "prevent tearing." I didn't include this link either, because I again found it annoying. When we took our Bradley class in 2004, I did extensive research on episiotomies and was amazed and impressed to find that the current consensus (and again, this was back in 2004) was that episiotomies are best saved for babies in distress. If you read the above babycenter link (on "episiotomy") you'll find the same kind of information.

Episiotomies involve cutting the perineum, and muscle which separates the vagina and the anus, to enlarge the vaginal opening and ease the birth of a baby. It used to be routine, especially when many moms were knocked out at birth and babies were routinely delivered by forcep extraction. In recent decades, they have still been used fairly routinely because doctors have wanted to prevent Mom from tearing. Now doctors are realizing that, unless we have a baby in distress who needs to be born NOW, it's better to give Mom some more time. For one thing, she just might not tear. For another thing, if she tears, it is not any worse, and it's usually better, than if she has an episiotomy. When a woman tears naturally, it might be a pain for a doctor to sew up (to which I respond, "I'm paying you big bucks to catch a baby. Shut up, and sew me." Too intense?). In a naturally occurring tear, however, less tissue tends to tear, and Mom usually recovers a little better than if she had an episiotomy. Believe it or not, it's true.

But here's the worst thing about elective (and when I say elective, I mean "no baby in distress") episiotomy: There is always a chance that Mom will tear beyond the episiotomy. These are ugly tears, either to the anus or the even the rectum. Ouch!! (Believe me, I know.) You do not want to have to deal with a 3rd (anal) or 4th (rectal) degree tear unless it's in the name of saving your sweet baby. So, as you can tell, it KILLS me that most of my friends have episiotomies with ALL of their labors. I've wondered at this weird phenomenon. Why would all of these doctors keep cutting their patients, thereby guaranteeing that they'll HAVE to have stitches when there is a chance that they might not tear or that their tearing would be minimal and easier to recover from? I pondered this allowed to my husband the other night. I had an epiphany.

Well, actually I had two epiphanies. First, I think doctors in my area might not be keeping up with the times on episiotomy. I live in Utah where tons of babies are born every year, and doctors out here are very busy and probably have little time to consistently spare for medical journals (or bossy moms). In some ways, it's fabulous to have such experienced doctors. In other ways, it stinks, because they're SO busy. I don't want to be conspiratorial, but I think that a lot of doctors (and some midwives) are a little impatient with how quickly a baby should be born. I guess you could argue that getting them here quicker to avoid fetal distress is better than waiting for the fetal distress, but I still think Mom should be taken into consideration on this. I also think that some busy doctors might be rationalizing cutting for their own convenience and schedule. And finally, with so many patients and having delivered hundreds of babies already, some doctors are just used to cutting their patients in labor. Unfortunately, the only ones who have to suffer for it are the patients.

The other epiphany was this: It's pretty hard to push out a baby with an epidural. Maybe that's why most of my friends get episiotomies every time. Between their busy, slightly routined doctors and the slow progress that comes with an epidural, it might just seem necessary to cut the mom most of the time. It still makes me a little sad. I have a few friends who go naturally like me, and they sometimes don't tear a bit. Imagine not tearing during childbirth!!! What a wonderful thought!

I daydream about not tearing, but I'm afraid that once you've had a 4th degree laceration in labor, you have lots of scar tissue where you once might have stretched. The chances of not tearing are pretty slim. BUT, I still have an agreement with my midwives that if the baby has some time to spare, please let me get him/her out without cutting. I'll probably tear, but it's nothing to a 3rd or 4th degree (which practically never happens without an episiotomy). In fact, in my last delivery (baby #3), the baby did start to struggle while he was crowning. My wonderful midwife, who realized that I was tired and needed a second wind, gently asserted, "If he doesn't come out on this next contraction, we'll have to do an episiotomy." I was exhausted and wanted to make it clear that I would comply if needed. Then I heard the OB in the room ask her, "Why wait?" Her answer: "She's had a 4th degree laceration." It snapped me out of fatigue and back into reality. He was struggling. We could lose him. I doubled my effort. When he didn't come out on the contraction, I kept pushing, and a few seconds later he slid out in all his glory. I tore, but only - get this - 1st degree (less than/equal to an episiotomy). Cutting me would not have changed his condition, but it would have changed mine. And, I know that sounds selfish, but a healthier recovery blesses both the mom and the baby.

So before I return to epidurals and finish my little rant there, I just want to encourage you to discuss episiotomy with your doctor and see if they'll hold off on the scissors unless it's really necessary. And do a lot of kegels.

So though I haven't discussed the obvious benefits of epidural (do I need to?), I can say with confidence that it is not without it's risks and challenges, and not every woman loves her epidural birth. (You hear me, Mr. WebMD?) So it's possible that epidurals might not be the answer for everyone.

Now do I think that moms should suffer in anguish and agony in order to bring their babies into the world? Not if it can be avoided! Sometimes I meet women (typically older than myself) who had at least one or two babies without medication because they had been made to feel guilty about considering an epidural. This makes me just as sad for them as for one who is bullied into having an epidural and then has a bad experience. It should be a woman's choice when possible. They are the ones having the babies, and they are the ones having to recover. Their choice should be respected.

Of course, there is always a slight possibility that Mom's labor will fly by so fast that she'll have a car birth or the anesthesiologist won't get to her on time. That happens, and it honestly sounds pretty scary. Considering that possibility, I think it would be wise for ALL moms to do some deep relaxation exercises just in case. (I mean, you really never know how fast your labor will progress).

If a woman truly desires to go unmedicated, however, with proper education, training, preparation, and relaxation, childbirth does not have to feel like anguish. It doesn't have to be scary. It will always be work - very focused, challenging work - but it doesn't have to feel like pain. A majority of contractions, under deep relaxation, will feel more like pressure in your abdomen and possibly some burning back pain. It's not an easy feeling, but it doesn't have to "hurt". Of course, especially during transition, when the baby exits the uterus and/or when the contractions come so strong and fast that it's hard to relax, there will be minutes of pain, even fear possibly (and maybe even some swearing). But they pass sooner than you know, and when you feel the urge to push your baby and have all of the power and control of your muscles behind those pushes, it is AMAZING. I can't tell you how amazing.

Okay, I'm getting ethereal here. Now I'd be a liar if I said that it never hurts from that point on. Actually, when a baby is crowning, it's pretty stingy and ouchy. Gotta fess up there. But it's also short-lived when you have good control and good coaching. And then it's over, and your little guy/gal is laying there all slimy being checked out and placed on your belly. (Or, in my cases, being checked out, laid on your chest for 30 seconds, and then whisked away to the NICU for an IV or something... yeah, another post, my friend). Then, sometime in there you deliver your placenta and get stitched up (if needed), and while baby is having a bath (or an IV), your nurse starts cleaning your room, and you get up, walk into the bathroom unassisted, sit down, and pee... now that, my friends, is cooler than you can believe. Just saying...

So, if you love your epidurals but have a friend who has a genuine desire (or even remote interest) in going unmedicated, can I make a request? Don't tease them. Don't defend your decision to have an epidural. (It needs no defense.) Don't say something like "They're not handing out trophies or anything." (Please please don't.) And please don't reassure them that they should never feel bad if they decide to change their mind. There are plenty of people, their doctors included, who can give them that reassurance.

When a woman is hoping to go unmedicated, she has enough self-doubt of her own to deal with, especially if it is her first pregnancy. Instead, encourage her and wish her the very best and, if it seems appropriate, let her know that you've heard that a good Bradley class or a Hypnobirthing class can make all of the difference. It's a just a little food for thought from someone who has been where she is...

Becoming a Natural Childbirth Mommy, part 2

Well many women who read the account of my first labor would notice much to criticize, and it does not all have to do with the epidural. For one thing, as I pointed out, my doctors were very controlling. Now I will admit that the hour of pushing my daughter was such a blur, and it's possible that Dr. G rushed because he feared the baby was in distress. It would definitely be understandable that having a mother run a fever for over 6 hours might not be good for the baby. But if that was the case, it was not made at all clear to me or to my husband (who was under no influence of drugs and had actually slept a little the night before). All we knew was that the doctor was not satisfied with how I was pushing, and there was no discussion of whether to cut and vacuum or to give me a few more minutes of pushing.

Another naughty OB behavior was when the other OB, Dr. J, stripped my cervical membranes without consulting with me. Stripping the cervix can present many risks, including leaking waters or even occasionally a full-on breaking of the bag of waters. It's an optional procedure that can effectively kick a woman into labor, but it should be a procedure to which informed consent is actually given rather than something snuck up onto a patient.

As far as my hospital care went, many complaints could be made about the nursing staff. Considering I was a first time mom and was receiving a great amount of IV fluids, it was unwise to decatherize me so soon, and the post-partum nurse (the young, well-intentioned one) should have been mindful of that and at least catheterized me again before going at my abdomen the way she did. She was also such a novice and should've considered that a brand new mom in terrible pain might be frightened by hearing so much detail about her loss of blood. (Don't get me wrong - this was at least more disclosure than I'd received much of the morning, but perhaps it was done in an unprofessional and insensitive manner).

I could go on and on. The biggest problem with the entire situation - the prenatal care, the labor, the delivery, and the post-partum care, etc. - was my lack of knowledge. As I previously mentioned, I had purchased and made a valiant effort at reading What to Expect While You're Expecting. The book is difficult to read, though, and is set up in a way that you won't really learn about something unless it occurs to you to look it up and study it. It is also a book that makes a great effort to avoid having an opinion on anything, and so it waters down much of the information. An excellent example of this is the entry on "episiotomy." I'm not sure if a new edition of the book has changed the view (I hope so), but it essentially states that episiotomy assists birthing, prevents tearing, and in order to avoid 3rd and 4th degree tearing, the best option is a "hockey-stick" cut. Now, at the time when my edition was published, "hockey-sticks" might have looked great on paper, but most doctors in my area still wouldn't consider doing them for one very big reason - that's a lot of cutting that might not be necessary. Midline cuts (a small cut straight toward the rectum) might carry a risk of tearing into the rectum, but they were still minimum cutting. Mediolateral (a cut toward the side at an angle) automatically create too much tissue damage, some of which is irreversible. And there is plenty more that I can say about episiotomy, when it's right and when it should be avoided, but it deserves it's own post. At any rate, I did not learn what I now know about episiotomy from What to Expect, I'll tell you that.

So having purchased a slightly useless, difficult to read book (which for some reason made me extra nauseated for my first few months) was the bulk of the my education. The other resources I had were the internet (again a "look it up when it occurs to you" resource), a one-day prenatal class offered through our doctors' office (more of an orientation than a class intended to educate couples), and a lot of intimidating conversations with friends and family. There was so much that I did not understand about pregnancy and labor. It was no wonder that I took poor care of myself during the pregnancy and was terrified of childbirth.

Here's a funny punchline though: Even after my horrible delivery with Dr. G and his practice, upon learning that I was pregnant with my second baby, I returned to the same practice. I had no idea at the time how much a part they had played in my "bad luck" labor.

It was only when my husband, daughter, and I moved into our new house that doors opened for me learning more about natural childbirth. In the years following our daughter's birth, I had many conversations with other moms about labor, and very occasionally I had an exchange with a mom who enjoyed having "Bradley" births with her babies. I knew nothing about Bradley, only that when I met a mom who had experienced a successful Bradley birth, she was extremely enthusiastic about it and would talk your ear off about how great it was (if you let her). When I met my new, very cool neighbor and learned that she had done a Bradley birth, I was very curious. She shared her first birth experience with me, which was very similar to mine with my daughter. Then she shared about her second birth experience after she and her husband had attended a Bradley class together. It wasn't without it's challenges, but the experiences were night and day, and she was so grateful to have been able to birth that way. It peaked my interest big-time. I couldn't ignore the fact that most of the women I met or knew who had planned and prepared unmedicated births were very happy about them, even when the experience wasn't complication free.

The next part of the story is history, as they say. My husband and I arranged for and attended a Bradley class (he was reluctant at first, but soon after enjoyed being so well informed and prepared). I read all of the suggested material, kept a diet log, and did prenatal exercises like crazy. Preparing for natural childbirth became one of my great goals in the coming months and weeks.

The most difficult and sobering part of the journey was the realization that many of my complications in my first labor, delivery, and post-partum were not simply a case of terrible luck. Many of them were the offspring of procedures I had been subjected to or consented to. For example, as I stated, stripping the cervix brings a risk of premature rupture of membranes and possible infection. It might still be the best choice for a woman, but even if the doctor chooses or suggests it, it is not "risk-free." The epidural, which I'd like to discuss/vent about another time, has a risk of a negative reaction (i.e. fever) for some women. The use of antibiotics during labor or afterward with baby brings a risk of yeast over-growth in the milk or thrush infection in the baby's mouth. These procedures are not necessarily bad and are sometimes necessary for a safe delivery, but they always bring risks with them. And women deserve to know about those risks in order to give truly informed consent. I mean no offense to other women when I say that I believe a large percentage of birthing moms are not well-informed on the risks as well as the benefits of medical intervention in childbirth.

After several weeks in the Bradley class, I couldn't NOT think about my labor with my daughter, and when I thought about it I was angry - at my doctors and nurses, at every mom who had ever frightened me away from pursuing natural childbirth, at my husband for shooting it down once when I expressed an interest in natural childbirth, and mostly at myself for not taking control of my pregnancy, taking a good prenatal class (ideally for me, a Bradley class), and having the courage to consider better care-providers. I'm not saying that it was healthy to become so angry at everyone. I just was, and one thing was more clear than anything - if I didn't change doctors soon, I might end up repeating my first labor experience or having one similar to it.

This might sound silly to some people, but one of the biggest things I learned in my class is that the provider is half of the experience. If you are with a provider who understands and respects your desires, communicates well with you, and wants you to be a part of the decision making, you stand a better chance at a positive, safer labor experience regardless of whether you plan to go with or without an epidural. But if your providers are unwilling to consult with you and are willing to take your entire labor into their hands, you could end up the way I did - confused, in terrible pain, and with a difficult recovery.

Okay, some might ask, "But isn't the safety of your baby the most important thing?" Of course it is, and if the safety of my baby was unimportant to me, then I wouldn't be going to a health-care provider and delivering in a hospital at all. Actually, even saying that is somewhat unfair, because I know a few mothers who always birth their babies at home, unless it's medically impossible to do so, and they are very conscientious about the safety of their babies. One of them is a registered nurse who even chooses not have a doctor or midwife at all, and it is her husband who delivers the baby. Sounds crazy? Well I wouldn't feel comfortable doing it, but she is extremely well educated about childbirth, as is he, and they have had at least 1 or 2 excellent home births just this way. The need for an ambulance, midwife, or doctor hasn't arisen and hopefully never will.

This doesn't mean that I'm advocating unassisted home births. I just won't condemn them. For some women, it's the right decision, and it honestly sounds amazing. I just haven't ever felt right about it for myself.

So, back to the issue of a baby's safety - of course it's important. I don't know a single woman who is willing to carry a baby for 9 months just to gamble their safety away like it's nothing. And yet, it is slightly debatable what could be considered a "safer" delivery method/locale. You could definitely argue that a hospital and an OB are the safest - best equipment, highest qualified, etc. During most hospital labors, however, the doctor is not present during the labor and is not visually supervising the patient in their labor. The laboring portion is left in the hands of the labor and delivery nurses on staff, and let's hope they're great! Chances are, however, they are dividing their attention between at least two or more women (especially in Utah county!).

On the other hand, with a lay or nurse midwife, either in a birthing center, hospital, or home birth, the midwife is supervising not only the delivery of the baby but mom's labor. Once it's clear that mom is in labor, the midwife comes to her side. Attending so many labors with typically undivided attention makes for incredibly expert eyes (between experience and training), and, in my opinion, you have the absolute best authority on how the labor is really progressing. The midwife is much more likely to notice if something is not right. She is also more likely to have "seen it all" so to speak, and she'll know if it's a normal part of the unpredictability of childbirth (and if there's anything consistent about childbirth, it's that it's unpredictable), or if it's something that merits medical intervention. Some people panic at the thought that a midwife is not licensed to perform cesarean sections. This might sound like a big red-flag. As one who has delivered with midwives in a fairly complicated delivery, however, I can attest that they are not insensitive to the possible need for cesarean, and they will have a qualified OB in the room during the pushing stage to ensure that a cesarean can be safely performed if necessary. (Happily, in my case, it wasn't necessary! Though that OB had magic hands and turned my posterior baby like a charm!)

Returning to my experience with the Bradley class, at 32 weeks into my 2nd pregnancy, I contacted my Bradley teacher, gave her permission to say "I told you so" (she had warned me against staying with my OB's), and asked for some suggestions. After considering a couple, I decided to try and get the wonderful family practitioner who had delivered my sweet relative's baby years before. He was very popular even as just a family practitioner, but he was only accepting obstetrics patients on certain recommendations. He accepted my reference from my Bradley instructor, and I enjoyed the remainder of my visits very hopeful that everything would go better with this delivery.

I will not go into great detail in this post on the birth of my 2nd child (my first son), but I will say upfront that I did not receive an epidural. My husband and I enjoyed this labor more and felt like active participants. That alone was a blessing and a confirmation that my personality is better suited to unmedicated childbirth. I'm not joking when I relate that my husband actually said to me at one point during the labor, "This is actually a lot more fun." Of course, he was pretty exhausted by the time our son was born, but we both felt good about how our labor went.

I will also be plain and point out that it was not an uncomplicated delivery. I had hoped that a labor free of unnecessary intervention would minimize the complications in the delivery, but there are some things which you cannot prevent - like passing of and aspiration of mechonium. (More on this next time). I will say that, in light of the challenges my handsome boy faced during his first trying hours and days in the real world, I believe that it served him well that he came into the world drug free.

By the way, that same boy is still ridiculously handsome and has a passion for Legos and Wii, which I swear we only let him play on the weekends...