I've given birth twice.  There are moments of both of my births that feel somewhat unsettled and disempowered, moments that feel triumphant and strong, and moments that are simply amazing.  While I feel mostly at peace with my birth stories, something in me wants to share what I did differently from one birth to the next, or what I could do differently, if I could do it again (note: two children is just the perfect amount for Adam & I!) Maybe it’s the birth activist in me.  Or, the natural-minded mama.  Or maybe it’s simply that hindsight is 20/20. I just wish that every woman could feel successful and glorious and proud no matter how she gives birth.  I’m hoping that by sharing some of the things I’ve learned, I might help another woman reach that place of peace with her birth.

So, with no further ado… the things I’d do (or in the case of my 2^nd birth, did) differently:

#1 – Study up on & practice birth positioning. 

I think one of the most important factors in an easier labor is having optimal fetal positioning.  That is, having a baby who is heads-down, facing mom’s back, with his back lying along one side of the front of mom’s tummy – in other words, Left Occiput Anterior.  Why is fetal positioning so important? A baby who is occiput anterior will have his chin tucked to his chest, and be able to present the smallest part of his head to the cervix.  What this means is that a baby in the right position will likely be born more quickly and more easily – less pain for mom, and less stress for baby.  A baby not in the correct position (malpositioned) won’t put as much pressure on the cervix, so labor may not start naturally.  Malpositioning may cause labor to be more painful, and baby may have a difficult time exiting, because their head isn’t presenting in a fully flexed position.

Case in point:  My first baby was Occiput Posterior after being frank breech for the vast majority of my pregnancy.  She turned in the week before she was born.  My labor was long, extremely painful, and ended in a c-section for failure of decent – due to malposition (posterior brow presentation). I understand now this is a very rare position.  Online I found an interesting case study in which the baby was previously breech, turned via ECV (external cephalic version – which was attempted with my daughter, unsuccessfully), the mom went into spontaneous labor, the baby descended in a forehead presentation, and was delivered using a vacuum & repositioning. I found this study interesting because it was done in Australia in 1998, and even then the author mentioned that the decision to rotate baby & deliver via suction (as opposed to c-section) was a tricky one, not easily reached.  In my case, I’d gotten to 10cm (or nearly so – my midwife indicated that I had an anterior lip) pushed for hours in many different positions, and my midwife had attempted to reposition my daughter, but she was “stuck”. A c-section was decided on after much deliberation – part of which included my doctor not being comfortable with suctioning due to my daughter’s forehead presentation, and the other part being that my water had broken 31 hours previously, and I had developed a fever.   

I want to clarify that I do believe, after much research, in spite of the best efforts given by myself, my midwife, the nurses, my husband, and my doctor, the c-section was warranted.  Unfortunately, I still feel a lingering sense of disappointment and “what-if-itis”:  what if I’d been able to hang on just a bit longer and try a few more positions again (we’d tried hands & knees, standing, birthing stool, lying back with stirrups, half-sitting with a birthing bar, kneeling & leaning forward on my elbows on the drop-end bed… you know, everything), what if I’d waited a little bit longer before getting an epidural (I got one somewhere around 20hrs after my water had broken – my detail memory is spotty throughout my birth story with my first – because it was so long, because I was in so much pain, because my midwife didn’t do many internal checks, and because I don’t have my medical records in front of me), what if I’d stayed home a bit longer (I headed in when my contractions were about 5 minutes apart for an hour – the hospital was 45 minutes away), what if we’d hired a doula who could have helped me understand that staying home a bit longer was okay, or who could have helped me hold out a bit more before getting an epidural, what if baby had been correctly positioned in the first place… the latter the cause for my listing optimal fetal positioning as my #1 do-over.

There are many ways to affect fetal positioning before labor starts – walking regularly, practicing prenatal yoga (which I did the 2^nd time around), chiropractic visits, doing inversions, sitting on an exercise ball, sitting forward instead of lying back in the couch with feet up,  doing regular pelvic tilts.

Some awesome resources, which I found during my second pregnancy, after learning about the importance of baby’s position in-utero:

http://www.homebirth.org.uk/ofp.htm

http://www.spinningbabies.com/

Take your baby’s position seriously.  It really can mean the difference between an easier or a more difficult labor and birth.

(on my birthing ball during my labor with my daughter – still smiling)

#2 – Hire a doula. 

With my second pregnancy, nearly the first thing I did after realizing I was pregnant was hire a doula. The first time around, I didn’t really understand what a doula did, why they were so important – so CRITICAL – to birth – particularly when you have no previous birth experience yourself, and you’ve chosen a hospital birth.   I remember wondering why a doula was necessary if you had a supportive partner.  Wouldn’t your partner feel left out?  What exactly would a doula DO if you already had a husband there?

I now know differently.  Firstly, a doula is familiar with birth – with the stages, the process, the pain and how to cope.  She’s familiar with hospital staff and policy (and which “rules” can be bent or broken). She’s there to help navigate the turbulent and unfamiliar waters of anxious soon-to-be parents, impatient doctors, pushy nurses, and crowding friends & family members.  She can help a mom dedicated to a natural birth plan remember, in the midst of the worst pain of her life, why she wanted to go natural in the first place.  She helps a dad know how best to help.  She’s able to help the laboring mom clarify and state her needs and desires to staff.  She can help a new mom latch her baby on – and this is critical, especially in hospitals who don’t have full-time lactation consultants on staff.  Perhaps best of all, and what I missed the most by not having a doula the first time around, is the certainty with which an experienced doula can tell mom in the midst of a very long labor: “yes, this is normal”, and “yes, you CAN do it”.  Though my second birth ended with a necessary emergent cesarean (olighydramnios + breech + previous C) at 36 weeks, I was still grateful for my doula.  She helped me make clear my needs post-surgery, and helped me with nursing. She set the stage for making me feel empowered in my birth, even while the best laid plans for a natural VBAC were quickly and unexpectedly unraveled. Hire a doula – you won’t regret the money spent.

(me and my doula - before my son's birth)

#3 – Put EVERYTHING in your birth plan. 

Not just the good stuff, but the not-so-good stuff too.  From early labor right through to the days after baby is born.  While creating my first birth plan, I barely scratched the surface of things I didn’t think would ever happen (i.e. an IV, constant fetal monitoring, pitocin, nubane, epidurals, and a c-section).  Naively, I really didn’t imagine anything would go any way other than as planned. While that type of thinking may have set my mind for success, by doing so, I unfortunately missed out on educating and preparing myself for the “what ifs”.  I didn’t fully research the process of c-sections because I assumed I’d never need one.  I didn’t look into alternatives to pitocin, nor the side effects of it, because I assumed labor would move along just fine.  Yes, I’d read about the “cascade of interventions” and how consenting to meds could lead down a path more likely to culminate in a c-section.  Yet, in my head, I wasn’t going to have a cesarean section, and I wasn’t going to need any interventions, so I needn’t put any further thought into it.  Why plan for a disaster when it’s not even on your horizon, right? Except… when I hadn’t slept for 24 hours, and hadn’t made any progress… in spite of my “birth planned” walking, standing, bouncing on a ball, showering, breathing, visualization, all without continual monitoring… and when the pain in my back from my daughter’s posterior position became unbearable… only then, I realized I really had no game plan.   I hadn’t thought of the what ifs.  Because they weren’t going to happen.  Yet… there they were.

To put it simply: being informed of the side effects of pain meds when you’re nearly out of your mind with pain and anxiety and tiredness isn’t really being informed. It’s certainly not the optimal time in which to be making decisions. And being completely immobilized on the operating table doesn’t lend itself well to making your desires and needs known for post-surgery care for yourself and your new baby.

So make your plans – all of them – ideal birth AND less than ideal – beforehand.  Put them in writing, and share them with your support people.

(getting sewn up, with my son on my chest)

#4 – Be ready with lactation support. 

I was lucky the first time around. The hospital where I gave birth was working on “baby-friendly” designation at the time, so, there was a lactation consultant on staff at all times.  Rooming in was strongly encouraged – they didn’t even have a nursery set up for non-urgent care infants.  There were no free formula samples, no bottles or pacifiers given, and all the neonatal nurses were educated and supportive about breastfeeding. But personally, I had only read a few things online and in books about breastfeeding.  I knew my mother and mother-in-law had breastfed, and I planned to do so myself.  But that was the extent of my preparation for breastfeeding. Again, like with the c-section, I never imagined that things could or would go other than “as planned” – so I didn’t have any alternate plans. Had I not had the amazing support of the staff lactation consultant, I’m not sure I’d have been able to make it through delayed milk coming in, an extremely jaundiced baby (due to ABO incompatibility) in the hospital for a week, and the complexities and frustrations of using an SNS and pump.  At the time, I didn’t know anyone in La Leche League – in fact, I’m not sure I’d even heard of LLL.  I didn’t have any friends in real life who had breastfed.  So, really, in the case of successful breastfeeding, I was just plain lucky.  The second time around, I was prepared with a doula, my LLL contact, a lactation consultant, and friends in my phone.  Not to mention the experience of successfully breastfeeding my first.  Don’t leave your breastfeeding relationship to luck.  Be prepared.  

(my milking machine & SNS - my constant companions in the hospital after my daughter's birth)

What I’ve learned through two pregnancies and births is that you can’t control everything.  There’s always an element of the unknown; the unknowable.  Yet the more information you have, the stronger you will be.  The more able you’ll be to make real informed choices; to feel empowered; to have a plan and make your plan known.  There’s a sense of calm that comes from preparation, and with that you’ll be better able to craft your birth in a way that is more altogether more comfortable, safe, and satisfying in the end. Here’s to better birthing!

I’ve been lactating now for nearly 6 years.  Six years of being able to nourish and nurture my children with my own breast milk.  I feel lucky. 

Because although the U.S. government indicates that “Breastfeeding is Ideal for Infants”, according to the CDC’s Breastfeeding Report Card from 2006, only 73.9% of US babies have ever been breastfed.  Only 43.3% of U.S. babies were still breastfeeding at 6 months, and a mere 22.7% were still breastfeeding at 12 months. 

The exclusively breastfeeding numbers are even lower (and much more startling, considering the American Academy of Pediatrics recommendation for exclusive breastfeeding for the first 6 months of life – meaning, baby needs no additional foods or fluids other than breastmilk) at 33.1% exclusively breastfeeding at 3 months and only 13.6% exclusively breastfeeding at 6 months.

So, even though the American Academy of Pediatrics, the CDC, and the World Health Organization recommends breastmilk ONLY for the first 6 months of life, only one seventh of the babies in this country are doing so. When you look at the individual states, the numbers are even more shocking.  In Mississippi for example, of babies born in 2006, only 4.6% were still exclusively breastfeeding at 6 months. Only 4.6%.  A tiny fraction of infants. In spite of the recommendations.  In spite of the fact that human milk is species-specific (meaning, our human milk is tailor made for human babies, whereas cow milk is tailor made for calves), in spite of research that indicates human milk feeding decreases infectious diseases such as bacterial meningitis, respiratory tract infections, UTIs, ear infections; in spite of studies indicating reduced rates of SIDS, insulin dependent type 1 and non-insulin dependent type 2 dibetes, cancer, obesity, and asthma (both in older children and adults who were breastfed compared with individuals who were not breastfed); in spite of the association with enhanced performance on tests of cognitive development in individuals who were breastfed; in spite of maternal health benefits – like decreased post-partum bleeding and decreased risk of breast and ovarian cancer. (Source: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496)

What’s wrong?  Why aren’t more women breastfeeding their children?  And why are so many supplementing with formula so early on, or quitting altogether?  I believe it’s a combination of factors. Perhaps foremost is the lack of understanding and support from the general population with regards to normal infant feeding and sleeping habits.  How many articles have you read which indicate women should breastfeed only under cover or in private, should have their infants sleep separately, should feed them on a specific schedule, should give them pacifiers instead of the breast for comfort?  How may advertisements in parenting magazines are there for formulas? How many free samples of formula are sent home with new mothers, instead of easy, free, consistent, and friendly access to breastfeeding counselors and lactation consultants (both in the hospital and at home)?  Far too many.

In combination with the lack of public support for breastfeeding is the general feeling towards the act of breastfeeding.  I believe that while many people may feel “breast is best”, in reality, breast is just normal.  Breastfeeding shouldn’t be seen as an ideal (which makes it difficult to reach for some), rather as a normalcy.  Unfortunately, breastfeeding is often seen as shameful.  When new mothers feel they have to put their breast milk into a bottle, or to nurse under a tent in order to feed in public, the act of breastfeeding, and with it the breastfeeding mother herself, is marginalized; not normalized, not supported.  How can a new mother stand up to that? 

When formula companies suggest feeding formula offers “healthy growth patterns similar to breastfed babies” (Infamil) or their formula contains “unique blend of prebiotics, nucleotides and antioxidants nutrients naturally found in breast milk” (Similac) and offer “$250 worth of free gifts” (again, Infamil), breastfeeding is further marginalized, and formula feeding becomes more accessible and more normalized.  When formula feeding is presented as just another way of feeding infants instead of something to be offered only when medically indicated by a physician (as per the AAP policy on breastfeeding), when its presented as easy, healthy, and free; when real breastfeeding support is lacking, what else can a mother do but formula feed?

So why aren’t more women breastfeeding their children?  Because society and big business says formula feeding is easy, bottle feeding is normal and acceptable anywhere & everywhere, and breastfeeding is difficult and something to be hidden or kept private. 

So, here I am, breastfeeding for nearly six years. But I understand that this is primarily because I was lucky enough to have had support from day one in the hospital – a hospital which was working on “baby friendly designation” which meant all of its lactation consultants and nurses and doctors were familiar with and fully supportive of making the breastfeeding relationship work. Lucky enough to have had no bottles or pacifiers offered to my newborn, even while in the nursery.  Lucky enough to have my baby room in with me when possible, and brought to me each & every time she awoke to nurse (when she was in a special care nursery due to ABO incompatibility jaundice).  I was lucky enough that when I had to supplement with formula, the formula was given to me with an SNS (supplemental nursing system) so that I could keep baby suckling at the breast.  I was lucky enough to be given a free pump and consistent instructions and encouragement to bring my milk in and get my baby off of formula and back on to breast milk.  I was lucky enough to have support at home from my husband, parents, and phone support from the hospital’s lactation consultant.  I was lucky enough to have had support from other mothers in La Leche League.

Yet, it shouldn’t be luck for women to have support in breastfeeding. It should be normal. We need to work towards normalization of breastfeeding in this society so that more than 22.7% of the population of new babies can get the benefits of breastfeeding to (at least) one year, as recommended by the American Academy of Pediatrics. 

Please tell me your stories of support.  How you were able to be successful in breastfeeding.  Or, if you weren’t successful with breastfeeding, please share what circumstances led you to formula feed.  Thank you so much for listening & sharing.  I believe we can all learn from each others’ experiences in order to better support all women and babies.

“The secret is that you are already a completely whole, perfect person.” – from The Secret by Mavis Karn

In 2004, while in my 9^th month of pregnancy with my persistently frank breech daughter, I was in a chiropractor’s office, waiting to be seen.  I couldn’t believe I was there, but there I was. Up until that point, I’d tried everything under the sun to encourage my daughter to turn around: elephant walking on hands & feet, standing on my head, doing somersaults under water, putting cold peas on her “head”, playing music to & having Adam talk to her “butt”, shining a flashlight from the top of my belly down to the bottom, doing shoulder stands for entire lengths movies, visualizing optimal fetal position, moxibustion, praying, begging, hoping, and wishing she’d turn, even 2 failed external cephalic version attempts (don’t try this, ladies, trust me – its horrible). I’d done everything except seeing a chiropractor. In my 38 weeks, I was beyond the time that I was told she’d even have a chance of turning on her own, and with a heavy heart, I’d even consented to seeing an OB at my last midwife appointment, and scheduling a c-section. I felt defeated. We'd planned a natural birth.  We'd done everything right.  But things just weren't going as planned.  So, feeling I had nothing to lose, I decided to call this chiropractor.  I’d read something about the Webster Technique but, I’d never in my life been to a chiropractor. I didn’t really know what they did, and had this feeling that it wasn’t “real” medicine (just so you know where I was coming from 5 years ago), so I’d just been all around hesitant to see one.  Yet, I tried moxibustion – a smoldering herbal stick millimeters from my little toe while standing on a block – go figure.  Anyhow, the week before the section was scheduled, I looked online for a chiropractor in my area (which, at the time, was extremely rural) who also happened to be certified in the Webster technique, who would also accept a patient who was about to have a baby any day now, and lo & behold, I found one right away, and she told me to come right in. So there I sat, in a state of doubt, disbelief, and nervousness.  Couldn’t believe I was there, didn’t believe it would work, and worried about what she’d do to me. As I was obsessively mulling my thoughts, I looked up, and there was a yellow poster on the wall:  THE SECRET By MAVIS KARN it read. 

I read on:

…I have a secret to tell you.  Nobody meant to keep it from you… it’s just that it’s been one of those things that’s so obvious that people couldn’t see it… like looking all over for the key that you have in your hand….

Intriguing, right? Anyhow, I read the whole thing through, waiting there. And reread it. And as I read, I felt a lightening of my heart. That maybe everything really was going to turn out okay.  

I was called back to the exam room, and over the next hour (it seemed) the doctor talked to me, listened to me, educated me a bit about chiropractic, and eventually performed the Webster Technique.  She told me of other patients she’d had who experienced immediate turning of their babies, some whose babies turned soon afterwards, some who took a few visits, some who didn’t. When my visit was over, I thought to myself, at least I can now go into my C-section in three days knowing for certain that I’d done everything I could do.

And as I was leaving the office, the poster caught my eye again, and again I read:

… The secret is that you are already a completely whole, perfect person.  You are not damaged goods, you are not incomplete, you are not flawed, you are not unfinished…

I asked the receptionist if she knew where I could get a copy – which she didn’t, though she offered to send me a copy (which I remember not really believing she would). 

As I climbed back in my car & headed home, I remember feeling my daughter move around.  A lot. And if you know what it’s like in those last weeks, there’s not much moving going on anymore.  Movement that does occur is more contained, crowded, confined.  But let me tell you, she was MOVING on that trip. And moving all evening long.  And all night long. 

Two days later, the evening before my scheduled C-section, I went to my OB’s office for a final check of position.  Lo & behold, my daughter was HEADS DOWN.  She actually was so excited for me, she told me she’d put her knives back in the closet & go away & I can have my midwives back (yes, she did actually say this, ask Adam)!

My daughter ended up being born only 2 days shy of her “due date”, 31 laboring hours after my water broke.  I made it mostly naturally & then later medicated (and let me tell you oh doubters, it IS possible for an epidural NOT to work, and for the needle to cause MORE pain than a contraction) to 10 cm, and had pushed, and pushed…  But she was posterior for my entire labor (OW!) and was presenting her forehead to the world.  My midwife said she could feel her eyebrows with every push, but just couldn’t get a good hold of her. Vacuum was out of the question due to position, and forceps were not used in the hospital where I delivered. So she was delivered via C-section after all. The doctor actually got the vacuum out during the section because my daughter was so completely stuck in my pelvis (though in the end, it wasn’t used, thankfully).

The birth of my daughter was the most amazing, scary, and incredible experience of my life.  She was so perfect & just how I'd dreamt how she'd look.  But I’d say my transition from pregnancy to parenthood wasn't exactly a smooth ride. She was born with ABO incompatibility (basically, she was allergic to my blood; Dr's were stymied & no one seemed to know exactly what was happening).  My milk didn’t come in for several days, we were in the hospital for a week, and the C-section made just sitting up hard work. But with the help of a wonderful lactation nurse (she's definitely gaining points in her karma bank), I was able to work out a system to keep my daughter & her incubator in our room, wake her every 2 hrs (extremely jaundiced babies have a hard time waking & latching, and need around the clock light therapy in addition to timed waking to feed in order to move the bilirubin out of their systems so as to avoid a transfusion or other serious complications), nurse her with the help of an SNS filled with formula & whatever miniscule amounts of colostrum I could produce (liquid gold, I tell you.  Even 10 drops was worth celebrating.  I recall the joy I’d feel each day being able to put just a bit more of my milk in the SNS, and just a bit less of the formula in), put her back in to the isolette, hook myself up to the pump, and perhaps catch a couple moments of rest before the next waking.

Needless to say, were we ever so happy to be given the green light to go home at the end of that week!  But getting off of formula & the SNS over the next couple weeks, and getting on to nursing certainly wasn’t a party.  I spent HOURS in my rocking chair.  Literally hours. Reading & rereading Dr. Sears. And my dear baby was colicky as well. And wouldn’t lay down without waking (What is a crib used for, again?  I really don’t know, though at the time we thought that's where babies were supposed to sleep - silly parents!). So if I wasn’t marathon nursing, I was walking, and bouncing, and shushing, and singing, and doing every possible thing one could do to soothe a screaming baby.  It wasn’t pretty.  I don’t remember much very clearly in those early days.  Except that I didn’t sleep. At all. Until I figured out how to nurse side-lying, and cosleep.

One day I remember sitting in my chair, feeling more than a bit sorry for myself & how my life had changed so much & how hard it was being a new mom, and thinking I should go get the mail, but not willing to move, because, oh thank all that is good & holy, the baby was ASLEEP, and she did have ultra Mommy is moving radar. But this day I risked it, and there, in the mail… Well, that receptionist, she DID actually send me a copy of “The Secret”!  And that simple poster did SO MUCH GOOD for me in those early weeks of physically recovering from a C-section, emotionally recovering from not getting the natural birth I’d planned on, learning to breastfeed without an SNS (and without family or support - we lived hundreds of miles away from our families, and in the middle of the woods), and adjusting to life as a mother of this amazing little person, no longer just a woman & wife who can do whatever she wants whenever she wants, but a MOTHER (this deserves all caps) of someone who depends completely on me and doesn’t care one lick about my routines or desires (nor should she).  It was an amazing, difficult, and not always happy or smooth transition. But reading that poster always managed to bring me back to what was important in life: my beautiful daughter & my wonderful husband.  Brought me back to the realization that I had the ability to change my thinking; to feel good instead of bad, to appreciate all that was amazing about our new journey into parenthood instead of lamenting over what life used to be like or how I thought my birth could have gone. I realized that I was, and am, every moment, in control of choosing to feel positive & grateful over negative & unappreciative. I wish I knew Mavis so I could thank her.

I still have that photocopy hanging on my desk to this day. I’m writing it word for word here because I truly think it’s worth sharing (forgive any typos, please – they are entirely my fault).  Thanks for reading & hope you enjoy:

Dear Kids (and former kids),

I have a secret to tell you. Nobody meant to keep it from you... It’s just that it’s been one of those things that’s so obvious that people couldn’t see it... like looking all over for the key that you have in your hand.

The secret is that you are already a completely whole, perfect person. You are not damaged goods, you are not incomplete, you are not flawed, you are not unfinished, you do not need remodeling, fixing, polishing, or major rehabilitation. You already have everything you need to live a wonderful life. You have common sense, wisdom, genius, creativity, humor, self-esteem... you are pure potential... you are missing nothing.

The only thing that can keep you from enjoying all that you already are is a thought. One thought. Your thought. Not someone else’s thought. Your thought... Whatever you are thinking at the moment that feels more important to think than feeling grateful, alive, content, joyful, optimistic, loving, and at peace.... that’s the only think that’s between you and happiness.

And guess who’s in charge of your thinking... guess who gets to decide where your attention goes... guess who gets to write, produce, direct, and star in the moment you’re in the middle of ... you. Just you. Not your past (stored thoughts), not the future (did you notice that it never, ever, shows up?), not your parents (they all think their own thoughts), not your friends (ditto), or school or television, or situations or circumstances or anything else. Just you.

Thinking is an awesome capability. Like any capability it can be used either as a tool or as a weapon against ourselves and others. And just like with any other tool, we can tell whether we’re using it for or against ourselves by how it feels. When we think against ourselves or others, we get in trouble. When we don’t, we usually say out of trouble.

FEELINGS EXIST TO WARN US AWAY FROM USING OUR THINKING TO CREATE TROUBLE IN OUR LIVES AND TO GUIDE US BACK TO OUR NATURAL, HEALTHY ABILITY TO LIVE OUR LIVES TO THE FULLEST.

So,… please remember that your thoughts are not always telling you the truth. When we’re in low moods, feeling down, our thoughts are not to be trusted… Our IQ’s drop. When our thoughts pass we lighten up, our thinking is once again creative, positive… our IQ’s go up. The only way you can feel badly about yourself and your life is if you think badly about them… it’s up to you, every single minute you’re alive. It’s always up to you! This is the best, most liberating secret I ever learned, and I want you to know it too.

With Love,
Mavis

(1999, Mavis L. Karn)