Last weekend, my husband and I had the opportunity to do a birth refresher course with our doula and a few other expecting couples. It obviously wasn’t as intense as the eight week Bradley Method course we did with her during our first pregnancy, but it was just as important. It reminded us of some of the key parts of labor like comfort measures and labor stages, and it also gave us a few hours to focus fully on this pregnancy and this labor, something we realized we really haven’t been able to do in all the mayhem.
For me, those three hours also reinvigorated my passion for birth and informed consent about the process. We’ve become so obsessed with what the body “should be” doing that we neglect the fact that it KNOWS what to do throughout this normal physiological process. Left uninterrupted and undisturbed, the vast majority of births would take place with no need for medical attention.
The following five points were some of my favorite highlights when we first went through the Bradley course, and I was reminded just how fascinating they are during this refresher.
FER
Every so often, you’ll read a news story about a woman in a coma who gave birth. How? Fetal Ejection Reflex. A woman’s body intuitively knows how to push a baby out without any coaching or coaxing. Left alone, the uterus will literally eject the baby. This is why you also hear stories of women who just breathe their babies out. They’re not crazy; they’re just listening to their body, and allowing it to do what it naturally does when a mama feels safe and supported. It is a completely involuntary reflex and wildly powerful.
FER, like all parts of labor, can be interrupted by interventions, constant intrusions, or discomfort in the birth setting. These things can force mama to start using her prefrontal cortex rather than her primitive hindbrain, the part of the brain responsible for innate reflexes. When a mama is pulled out of her primitive mind, reflexes can be overrun.
Cervix is not a crystal ball
“I’m only a one.” “I’m a 7! But nothing is happening.” We’re constantly given this narrative that as labor progresses, the mama will slowly dilate from one to ten, and at 10, we’re “allowed” to push. While there is some truth to this narrative, the oversimplification of cervical dilation often creates damaging expectations. Birth is not linear. In reality, dilation means little to nothing in determining length of labor or time until baby is born.
So often, we’ll see dilation used against a laboring woman, hearing things like “ok, you’re at a 4. If you’re not to a 6 in the next 2 hours, we’ll start you on pitocin to move things along.” Think of the stress and anxiety this kind of time limit puts on a mama. A cervical check can be so defeating to a mama if she’s not as far along as she has been told she should be. It can also be used as an opening for unnecessary interventions in the birthing process, from a small drip of pitocin all the way to a c-section. It puts a woman on an unnecessary and arbitrary clock. It can even be used before labor begins to push a mama into an induction as the cervix can start dilating long before labor even begins. I’ve heard too many stories of women saying “well I was a 3 at my 38 week appointment, so my OB said I should be induced.” What providers leave out it that you can walk around at a 2 or 3 or 4 for weeks before any other signs of labor occur! More telling than dilation is effacement – or thinning – of the cervix, but that rarely gets as much air time as dilation, and it’s also still not a crystal ball into how far along a mother may be in labor.
This is a big reason why I declined cervical checks my entire pregnancy and had only one during labor. Beyond the increased risk of infection and PROM (premature rupture of membranes), I didn’t want the pressures that come with “knowing” where my body is. I trusted my body to open as my baby progressed. There are also so many stories of women who go from a 4 to a 10 in a matter of minutes just based on their positioning, a chiropractic adjustment, or baby’s position. Birth is wild and unpredictable. Trying to put it on a clock or into neat, 1 through 10 steps can cause anguish, frustration, and disappointment.
Outward signs of progress
Mamas give a lot of messages about where they are in labor according to demeanor, activity between contractions, and vocalizations. There are also a few physical signs such as the number of fingers that can fit above mama’s uterus and a purplish line that can appear on a mama’s back above her bottom that both correlate to dilation.
My first labor followed a pretty textbook outward progression of labor. At the beginning, I was easily able to talk, joke, move around, and eat or drink between contractions. During active labor, I was concentrating during contractions, but I would recover somewhat between. I eventually reached the point that all laboring women reach in transition when I said “I can’t do this anymore” and took off all my clothes – transition. And pretty immediately thereafter, I got reenergized, felt the urge to push, and got my baby out! The whole time, my birth team knew approximately where I was in labor because of how I was acting, how I was sounding, and honestly because of how much clothing I still had on (loss of modesty is very common the later in labor you are).
Power of position
When it comes to giving birth, position matters! This is true for both baby and mama..
A malpositioned baby can lead to painful labor, labor stalls, and long labors. Two great remedies to ensuring a well-positioned baby happen long before labor begins: seeing a Webster-certified chiropractor throughout pregnancy and practicing Spinning Babies. Both of these can help make sure baby is in a good birthing position, and it also helps find space in mama’s body for baby.
When in labor, mama’s position matters a lot! Movement matters! Being stuck on your back in a bed is not ideal for labor progress. Standing allows baby and mama to use gravity to work baby down and put pressure on the cervix. Same goes for sitting on a birth ball. One very popular position during my first labor was the Captain Morgan which we used to open my hips, put pressure on my cervix, and break my water. If labor stalls, it’s often due to a positioning issue with baby’s positioning which means mama needs to move!
Importance of birth team
Having a birth team you trust and that trusts you is vital. Being able to completely let go mentally and allow the physiological process of birth to occur is key. That can only happen when you have no doubts or questions about who is in the room with you. Doing this refresher course reminded me so strongly of the reasons we chose the birth team we did the first time around and why we did everything possible to ensure we would have them at subsequent births. We work together with our team, we aren’t told what to do. We bring an idea, and they say “let’s try it.” The confidence that I won’t be forced or coerced into any medical procedures during labor is freeing. But this doesn’t magically happen. The model of care my midwife provides allows for this relationship of trust to develop. We have hour long appointments all throughout pregnancy; we talk about birth scenarios, fears, concerns; we plan together, and she trusts us to be the decision makers. The same is true with our doula. She’s not there to replace my husband’s support or to tell me what to do (usually…sometimes that’s what I needed from her though, and she steps right up!). Surrounding yourself with those you can trust in your most vulnerable moment allows you to actually get to that vulnerable state, release, and submit to your body.
~
Of course we covered other items, played fun games to remind ourselves the stages of labor, and ate a lot of snacks (it was a room full of pregnant women….food was a must). My husband and I left the class excited to labor again, remembering the raw power and beauty that awaits with number two.