VBAC attempt-a birth story

I wanted to post the birth story of my latest doula client.  This is from her own blog.
http://mlruiz.blogspot.com/2011/05/maxs-birth-story.html

From my perspective, I probably would have made different choices, but I feel comfortable in knowing that I was able to be her advocate once I was there and all the decisions made were her own.  The only thing I wish I had done differently was come a lot earlier.  She went into the hospital not contracting and told me she'd call me.  She had a hard time doing that, though, so I finally just went in:)  I don't know if I would have been able to change the outcome, but I could have made her more comfortable:)  I think she did such a great job and had to make some hard decisions.  I applaud her for that.

You should stay home

"If you plan to go totally natural and don't want much intervation why would you go to a hospital? I don't understand the mentally of granola. They should of stayed home and have a home birth."

This is a quote from someone in response to a new TV series about birth. I found this interesting because I would hear this when I worked at the hospital a lot. It kind of implies that a hospital cannot provide the same environment for minimal interventions as the home can. There were nurses that would be offended by a patient saying they don't want anything done. I would often hear a nurse say to the other nurses, "why don't they just stay home".

Here's the problem with that sort of attitude. #1) women go to the hospital because they know that something may go wrong, even if it is a small chance, and they want the quick access to medical care #2) even women who want minimal interventions should be able to have that peace of mind if they want it, without interference or back talk #3) if the hospital cannot offer a safe, quiet place to birth that respects all women's wishes, it should be offered.

Bottom line...a hospital should be able to provide both low intervention and high technology if needed. That's sometimes hard to find because many people have the same attitude of the lady whom I quoted above....hospitals are for high tech, hi intervention...stay home if your expecting otherwise. It really doesn't have to be this way...sigh:) I waiting for the day when we can have all wrapped into one...

Mothers bring forth life

"Mothers bring forth life; medical corporations do not. Birth can be simple, powerful and loving."

I recently took care of a mom that had not been able to get pregnant for 9 years. For her, this process of pregnancy and birth had been very medical, and there was a great deal of fear involved. I understood that her fear was coming from the fact that this had been a much desired child that had taken medical care to conceive. But through her fears, I saw the face of a great love for this child come through. It was amazing, to say the least.

This birth was also very medical, due to how the physician preferred to practice. The baby was also experiencing some difficulties and needed to be born quickly. It was a birth that could have been traumatic.

I encouraged mom, to focus on what she could do. Staying focused on her baby and staying calm to allow her placenta to be able to perfuse her baby more(stress can cause the blood flow to deviate away from the uterus to support other vital organs). Her husband was so fabulous at helping her to stay calm and focus on what she was doing. After baby was born, she was taken away to make sure things were OK, but all other procedures were delayed and she was back with mom within a few min. tucked in skin-to-skin. This was something the mom requested and I loved the delight she had in her eyes as she did this. It was neat too to see how the baby really did do better sitting right next to her mom.

The reason I mention this instance with this quote is because this was absolutely the moms birth. I felt her strength and abilities take over when they needed to, and her desire for her baby to be with her was neat to watch. This was a birth that was very medicalized, but I still felt the truth of these words from this quote. We did not bring forth this life, the mom did. I hope she realized this.

Natural birth in the hospital

I wrote this for a friend of mine...you can find her blogging at
http://birthwithconfidence.blogspot.com/

I have seen all sorts of births and all sorts of birth plans. I have seen women do fabulous going natural on pitocin, laying in bed, and in all sorts of other situations. I have also seen some women who have been doing great soaking in a tub, but ask for an epidural. I have seen some who I would have thought regretted not getting an epidural, but when asked, said they appreciated the experience. Any way it happens, a natural birth(going without pain medication) is something that you need to have a reason for wanting. To me, that has been the key ingredient. Also, your desire may change further down the road through labor, and that's OK. So, I would say the first step in having a natural birth in the hospital, is to decide if you really want to and why. These are not questions that anyone can really give you an answer too, but yourself, but I'll attempt to start you on your path.

First off, you can do a natural birth. Women have been doing them forever. So the real question is do you want to. The main reason for getting an epidural is the obvious: pain relief. Labor is hard work, and can be very painful. But, pain tolerance is not really an indicator of whether or not you will want an epidural. What you need to decide is if your reason for wanting one is greater than your reason for not wanting one. A few case examples. Many women are afraid of the needle in an epidural, or the pain of the epidural itself. I have had one woman tell me that when her contractions are so intense that she no longer is afraid of the needle then she gets the epidural. She always gets them. Therefore, for her, the labor is worse than the epidural. On the other hand, another woman I took care of felt like her fear of the epidural was greater than her fear of labor. Therefore, she always went natural. Some other factors to think about when it comes to reasons for/against getting epidurals: 1)you ability to move is greatly reduced when you have an epidural. Once you have one you are in bed, with a tube to drain your urine, and the nurses have to help with movement of the legs. This may be OK with you, and may be worth it, but again, it's just something to think about. Many people are worried about drugs being introduced. From what I have researched, the drugs given in epidurals will not cross into your babies body, but it does effect immediate breastfeeding(though not long term). It does tend to slow down labor, and there is an increased use of forceps or vacuums with them. For those who are experiencing exhaustion or can not relax, though, it may be useful. These are just some of the factors involved, and I would suggest thoroughly researching them.

So onto how to work through a natural labor in the hospital.

Request a hep-lock(where the iv is in you, but not connected to any tubing), or no iv at all if you feel comfortable with that. If you are not receiving iv fluids, make sure you are eating and drinking. If your hospital only allows ice chips, eat as many ice chips as possible and add sugar:) I would even bring some Gatorade pre frozen just for you to suck on. As long as it's ice, it fits in the policy. Some research I have read suggests that a woman needs at least 125-250 ml of water and hour. That's 1L of fluids every 4-8 hours. If you have to have an iv, you are still capable of moving. Request that you have an iv pole for the fluids to hang on so that you can walk around with it. If you do have any fluids running in, keep in mind that you can also get too much. Especially if you are on pitocin as that tends to increase water retention. One bag of iv fluid equals a liter, so keep that in mind when gaging how much you are drinking. Make sure you are going to the bathroom often, at least every one or two hours. An empty bladder will facilitate labor. Sitting on the toilet is also a comfortable position:) An iv pole can actually be very useful to hold onto during contractions. When you are feeling weaker, but still want to stand, an iv pole makes a good brace to pull down on. It is also useful during pushing. If you are wanting to squat, the pole can be used to hold onto.

Request intermittent monitoring. Keep in mind that this may only be possible if the nurses aren't busy, and your babies heart rate is looking OK. Intermittent monitoring has been shown to be safe and effective in monitoring the heart beat of the baby. ACOG guidelines suggest listening to the babies heart beat every 15-30 m while in active labor. This also needs to be done during a contraction and immediately after. This allows the nurse to check the heart rate while you are in different positions or different places. If you have to be connected to the monitors, you can still sit up and move around. You can stand, squat and walk. The difficulty in this comes from making sure that the heart rate stays on the monitor. It is helpful to have someone hold it on tighter during contractions, while sitting up, or squatting. Anyone can do this, it doesn't have to be a nurse. If you notice that the babies heart rate isn't picking up at different times during your labor, try having someone hand hold it. While I normally, don't like internal monitors, for someone who is going natural and having to be on the monitor, they can be useful. With internal monitors, the babies heart rate is picked up much easier and movement is not restricted as much. This would be something that I personally would like at on a case by case basis, and only if the mothers bag of water is already broken.

Which leads me to the bag of water. I would suggest not getting it broken as a matter of policy. Research shows that it does tend to decrease labor time, but only by about 20m. Once your water is broken, contractions tend to be stronger and harder. If you want to shave off time in labor, I would suggest having your water broken during transition or after(around8-10cm). At this point, your labor is already pretty intense, and shaving off time at this point is usually very welcomed. This really is just my opinion. Also, once the water is broken, it allows for germs to be introduced. So often the water is just broken, without a thought as to the individuals preference. Just make sure you at least think about it.

The bed in the hospital can actually be very useful. There are a lot of different positions that it can help you obtain. If you want to kneel, you can kneel over the top, bring the bottom down and kneel on that, or just be on your hands and knees on something soft. During pushing, you can bring the head all the way up and the feet all the way down to simulate a squat or birthing chair. I would play around with it and see how you might find it the most useful. It is also useful to use to kneel on, or put a birthing ball on and lean on.

Water....this has been shown to be one of the most effective pain relief measures for those who are going natural. If you find yourself getting tired, afraid you can't go on, or just needing to try something different, try a hot bath. Some hospitals do not allow this. If this is the case, bring a heating pad that you can use to sit on on the birthing ball, use with counter pressure, or just relax muscles and tension.

If you need to have pitocin, don't sell your selves short and feel like it's impossible to have a natural birht. I have seen many women do fantastic with pitocin. Some key things to remember...you can do it. You have to have a reason for wanting to do it, but it's OK if you don't want to. Ask your provider if you can do low dose pitocin. This will add the pitocin more gradually. You can also request that your pitocin be turned off once you have reached active labor. At this point, your body will sometimes take over and you will no longer need pitocin.

For some it is useful to try not to think about the contractions in terms of pain, but just intensity. If you prefer this, make sure you ask your nurse not to ask you your what level your pain is at. But let her know whether or not it is getting more intense. This is an important indicator of how your labor is progressing and how well a woman is coping.

One last point, when you first arrive at the hospital there is a whole admittance procedure. If you are not in too much pain, it's not that big of a deal. But if you are having to work hard through contractions, appoint someone else to answer the questions that are needed.

Woman centered care

As I've been thinking more about why I appreciated my birth centered births, I realized that it had a lot to do with how the care was centered around me, not the staff. So, I've thought about what that means and what might improve that for hospitals...so here's my modest thoughts on that issue.

1)Options. Women need to given information on the options and choices available to them before they even enter the hospital, and it should be provided to them by their chosen providers. It is unfair to expect women to have to go out and find their own information, especially if they don't even know that there are options. For instance, intermittent monitoring is a option for women...do they know that? Most don't. A hep-lock or no iv at all is an option for women who don't have an epidural at the time. Even if they plan on getting one eventually, they should at least have that option to begin with. If you are able to move, why not take full advantage of that. But it should be something that is discussed before they arrive at the hospital.

2) Informed consent for procedures. This should also be given before a woman arrives at the hospital.

3) Admissions. We've got to fix this for laboring women. For those who are induced or come in for a scheduled c-section, it is not a big deal. For a woman in labor, though, having to answer the questions is difficult. It's not impossible, but to really be centered around a woman and her care, we should find away to get the information we need without distracting a woman from her task. At the birth center I went to, this was not even done, because they had my records on hand with them from my pre-natal appointments.

5) If procedures are needing to be done(like iv, breaking the water, admissions questions), other personnel should be on hand to simply provide labor support or emotional support.

6) Interventions should be minimized unless requested or needed.

7) Please take that BP cuff off between blood pressures(unless the mother would rather it stay on).

8) We need to take a look at how we do c-sections. Why not allow the support person in earlier? Why do we have to tie down a woman's arms? Why not allow her to see the baby right after it is taken out? Why not let the mom and baby stay together as long as the baby is ok? More emotional support is needed during the mothers stay at the hospital.

9) Nurses need be trained in labor support. I use these skills even with those who have epidurals. For instance, did you know that the uncomfortable pressure at the end of labor can be helped by sitting up in bed? Or if the epidural only works on one side, you can use counter pressure to alleviate some of that pain. Wet washcloths are great for moms who are pushing for a long time. These are things that nurses aren't taught. And of course, this knowledge would be a huge benefit to those who are choosing not to get an epidural.

10) The room layout should be made with a laboring woman in mind, as well as the nurse and doctor. The beds should be made for the convenience of the laboring woman, not the doctor.

Why can't the hospital be more like a birth center?

I was thinking about my first two birth experiences in Tucson Arizona and how much I truly loved them. It's funny, but I think it's because of those experiences, that I have come to appreciate and, yes, even look forward to labor and birth. Here's a few pictures of where I had my first two:
http://www.tucsonbirthcenter.org/why.htm

I love the idea of birth centers. A place that is women/family centered, yet equipped to provide quick medical care. This particular birth center was just across the street from the hospital. Had I needed to, my CNM could come with me to the hospital and continued my care there, or I would have been given care by a physician that worked with her.

Now there are times at the hospital, where I have felt like "there, now that was a great birth center birth":) But so often that is not the case. So much of what happens centers around the needs of the institution and staff/doctors needs. So much of how we move women through, centers around what is the easiest way for the hospital and staff. To be sure, it is a difficult job to handle 1200+ births a months. I don't envy my nurse managers job, but how come our hospitals can't be more like a birth center?

There's a great blog here

I loved this midwifes suggestions. It's not really about natural vs epidural either. It's about working with the women to find the best plan that fits for her.....

A sacred trust dissolved

I had a really hard birth the other night, and I'm having a hard time processing it, so I thought I'd write it out here. Sorry for the semi-rant upfront:)

I came on to shift with the nurses talking about one particular patient and moaning and groaning about it. She was a hypnobabies birther and had come in with a birth plan. Usually those will solicit groans from nurses:) So, I immediately spoke up and said I would take her, to the surprise of all present. I think many were grateful:)

So I read through the plan, which seemed perfectly fine to me, but some of it was drawing comments from the other nurses. Here's the two things that bothered me most....one of the doctors there started talking about how some of her patients who start requesting things like what this couple was bothered her, because she didn't feel like that was her job and it shouldn't be the job of her nurses. Mostly that just bothered me because what some women request is just the right to have labor support, and move, and receive help to make it through it. I certainly think that's in my job description along with making sure the mom and baby are safe.

Another thing, though, is what really bothered me. The mom's water had broken, and so of course infection is an issue. The midwife that I was working with sat down with them and talked to them about what she felt they should do. I felt like she did a very good job with this and the decision to use pitocin was well thought out and discussed with the patient. So, we started pitocin, but the patient wanted it to be slow. I walked out of the room to tell the midwife this. When I called the midwife, she kind of balked at that. She did not want to do the pitocin slow. So she told me to just turn it up without them knowing.

And this is what bothered me....do we have the right to force a woman's body to do something against her will, without even telling her...NO! We have no right to assume that responsibility. Regardless of the reason. I choose to disregard this counsel and let the woman know everything I was doing and why, and asked her permission, but the idea that this medical professional would take a woman's trust like this and throw it out the door just tears me up inside. It tears me up the way people judged her and her decisions and it tears me up the way her decisions could have easily been tramped over without her knowledge and without her consent.

This is not the first time something like this has happened. I have seen episiotomies given without consent or knowledge until after it is done. Pitocin is started and increased without a woman understanding why, or the doctor even taking the time to discuss it with her. I think this is the first time I have been blatantly asked to do something behind a mother's back, though, and this is what is so hard for me to process.

Because what we are doing, is tearing down a sacred trust between caregivers and patients. A trust that a woman gives to us. She says I am placing myself, my body, and my baby in your hands, and we have no right to lie to them. We have no right to talk about them behind their backs or discredit them, or make fun of them. Even if we feel like their decisions are wrong and we are right. We have no right.

Guest Post-Cherylyn Douglas:My Birth Transformation

I credit my mother for instilling in me a desire to give birth naturally, without pain medication. She was having babies in a time when women were being confined to bed and separated from their husbands, and even being knocked out with ether or chloroform during labor and having their babies delivered by doctors with forceps. Often they would wake with no memory of birth and wonder if they had a boy or a girl. My mom felt strongly that birth is a natural process and she could do this without the medical interventions of the day. She took Lamaze classes with my dad and went on to give birth to 6 healthy babies, each without pain medication other than a paracervical injection to numb the cervix for the pushing stage. She spoke openly about this with me and my sister when we were growing up, and I wanted to have that experience for myself.

When I was pregnant with my first baby my husband and I took a childbirth class at the local county health department and they taught us some basic breathing techniques and comfort measures. However, the majority of the class was dedicated to educating us about the actual function of birth, complete with diagrams and charts and explanations of the stages of labor and when to go to the hospital. I joined online birthing websites and read books and tried to educate myself as much as possible about birth. I felt if I could be well-informed then there was no need to be afraid. Unfortunately, I was still not prepared for what I would experience.

My water broke spontaneously and I had no noticeable contractions. Of course, I had been told to immediately go to the hospital if my water broke, so I did as I had been told to do. The hospital staff immediately started me on pitocin to get my labor going. It was a long, hard battle. The pitocin did indeed get my labor going, but it also made the labor so intense and difficult that I didn't know how to handle it. I forgot everything I had learned in our childbirth class about breathing and working with the contractions. I had told myself that I wanted to birth naturally, but if it got too hard then I would get the epidural, and that's exactly what happened. The epidural slowed my labor, and then the baby's heartbeat was erratic. The doctor explained that they would stop the pitocin to give the baby a break from the onslaught of contractions and give him some time to recover. They would then start the pitocin again and see if my labor would progress after that. He used the dreaded c-word and explained that if my labor did not progress at that point, they would do surgery. My greatest fear was materializing and I was terrified. I cried, and my family comforted me.

Thankfully, the plan worked and a c-section was not necessary. My epidural wore off just in time to start pushing, and I went from feeling completely numb to feeling absolutely EVERYTHING. I was not prepared for that kind of pain, and I endured it for 90 minutes while I pushed my baby out. It was traumatic. He was born in the middle of the night, healthy, after a full day of hard labor, and we were both exhausted. The nurses told me they would take the baby to the nursery so that I could rest, and I complied because I thought they knew best. I slept fitfully, and then woke up around 6am in a panic without my baby! I paged the nurses and had them bring him in immediately, and I did not calm down until he was with me. Breastfeeding was a challenge because he was so sleepy. I hadn't had the chance to establish breastfeeding immediately after birth and the baby was tired and sluggish, and I didn't know what I was doing! The lactation consultant was not helpful, but thankfully we figured it out and I went on to breastfeed my son for over a year.

Three years later I was pregnant with my second child, and I had decided that childbirth was just too much for me to handle without an epidural. When my doctor told me we could schedule an induction, I thought it was wonderful that we could plan it out and know when the baby would be born! I didn't know anything other than induction and epidural, and this was my way of taking control of the situation. It was a wonderful experience, and I remember chatting and laughing with my husband and the obstetrician while I was pushing. It was 4 ½ hours from the time they started the pitocin until my beautiful baby boy was born, compared to over 14 hours with my first. I was in a smaller community hospital this time, and the atmosphere was calmer and I felt I got more attention from the staff. I was able to hold my baby very soon after he was born, after the staff had checked him out and weighed and measured him. I had him latched on and breastfeeding before the doctor even left the room. I didn't like how long it took for my epidural wore off after he was born. I wanted to be able to move around and enjoy my baby and the birth being over, and that was an annoyance.

Two years passed and I was expecting our third baby. My husband, Matthew was in massage therapy school and he worked at the front desk of a massage clinic. He told me that one of the therapists there was a doula and she wanted to work with me and provide support for me at the baby's birth. I didn't know what a doula was, but I wanted to talk with her because I had many questions and I thought maybe she could help me. Mandy and I immediately bonded. I told her I had always wanted to give birth without medication but I didn't know how to do it! She told me she would help, and she answered all of my questions and helped me feel at ease about approaching birth in a new way. She helped me write a birth plan, outlining my wishes for childbirth. I realized that I had choices and could let the doctor and hospital staff know how I wanted to handle things rather than let them take the lead and tell me what to do. My obstetrician was very open to my wishes and willing to work with me, and I checked with hospital policies to ensure that my desires were feasible within their limitations.

I didn't know what to expect because I had never experienced my body starting labor on its own. I was sent home from the hospital three times because I wasn't progressing enough to be admitted, but I was determined not to be induced. I had early labor for about two days, and Mandy taught me how to breathe with the contractions and work with my body. The third time I was sent home from the hospital I decided to go home and sleep. My labor stopped for about a day, and I rested as much as I could. The next morning, my water broke while I was in bed, and Mandy met up with us at the hospital. It was beautiful! Because of the practice I'd had with my early labor, I knew how to breathe and focus.

Mandy and Matt worked together to provide comfort measures for me, including acupressure points and counter pressure on my hips, knees and lower back. I wasn't hooked up to an IV pole or monitors, and I could move around as I wanted to, leaning on the birth ball or walking around. I even got into the tub in my room for a little while, but it was too shallow to give me much comfort. I focused through the contractions and enjoyed the company of my husband and my doula between them. Only once during transition did I feel I couldn't do it, and Mandy told me “You ARE doing it!” She kept me focused and helped me through it all, and the hard part was relatively short. My healthy baby boy was born within a few hours of arriving at the hospital, and I felt like a super hero! I was energetic and happy, and I had never before experienced such euphoria after giving birth. I was able to breastfeed my baby immediately after his birth, and we spend some quiet time with him in our room without any interruptions from hospital staff. The nurses were very curious and asked me which birth method I preferred (epidural or no medication) and I told them I would do natural birth again without a doubt!

When I got pregnant with my fourth baby, I knew what I wanted. I had been permanently converted to unmedicated birth. My husband had a client who was a home birth midwife, and she offered her services if I wanted to have my baby at home. I politely declined, explaining that I had my OB, my doula, and my birth plan and I knew what I wanted. This time I was determined not to be sent home from the hospital, and I intentionally labored as long as possible at home. Again I had two days of early labor, and the labor stopped for a few hours while I attended my baby shower and then started up again later that night. My husband and I were watching TV, and when I got up to use the bathroom I felt a leak. I told him that either I had wet myself or my water had broken.

We called Mandy and made arrangements to meet her at the hospital. I was admitted in the middle of the night and labored for a few hours, using focused breathing and trying to rest between contractions. The doctor arrived in the morning and suggested that he could break my water to get labor going faster. It turned out the leaking I had was a forebag and not the actual bag of waters. I was ready to have a baby, so I agreed and he ruptured the bag. After that things went quickly and our beautiful baby girl was born within a few hours. Once again my husband and my doula worked together to give me the support I needed, and it was a wonderful, empowering experience. The baby latched on immediately and we bonded. My baby was beautiful, and I was thrilled to finally have a little girl, but there was a subtle nagging feeling in the back of my mind. I felt like something was missing.

When my daughter was still a newborn I decided to become a birth doula. I wanted to help other women as my doula had helped me. I felt she was indispensable in my achieving the beautiful natural birth experience I had always wanted. I started reading all the required books and took the doula training. I couldn't get enough information about birth! I watched The Business of Being Born, and learned that some women still safely give birth at home rather than at a hospital. Within a year I found I was pregnant, expecting my fifth child. I felt that I had some different choices to make, and I started thinking about planning a home birth. I researched it and thought about it and prayed about it. I felt peace, and it was a wonderful overwhelming peace. I knew I wanted to have this baby at home.

I called the midwife whose services I had declined for my daughter's birth, and started going to regular prenatal visits with her. I went to my obstetrician's office a few times during the pregnancy for certain things like an ultrasound, blood work and screenings, but the rest of my prenatal care was provided by my midwife. I trusted her and her 15 years of experience with home birth. I also met her birth attendants who were all doulas and midwives.

I had early labor, on and off, for over a week. I was anxious to meet my baby, but I had to practice more patience than ever before. I used the time to prepare things in our home for the birth. Four days past the due date, my midwife brought the birthing tub to our house and did a brief check for the baby's heartbeat, with my four children watching. Later that evening, my contractions were coming closer together and stronger. My midwife came over and set things up and we settled in to have a baby. I was focusing and breathing through the contractions and leaning on my birth ball. I labored in the bed and rested between contractions, and in the birth tub immersed in water up to my neck. The water dissolved the discomfort of the contractions and my husband pressed acupressure points while I breathed through them. We chatted with the midwife and enjoyed the quiet and peaceful atmosphere. I have never experienced such peace in the hospital.

As things progressed, a second midwife came to assist, and she cleaned my kitchen and helped get the kids settled when they started waking up in the morning. At one point while I was resting in bed, my water broke in a small leak and my midwife ruptured the bag the rest of the way. The kids went to play at grandma's house and things really picked up! We called the two oldest boys to come home and I as I was pushing we realized the baby was coming out breech! His bottom was coming out first. I was in the birth tub, and it felt really good to stretch my body out as I pushed. His bottom came out, then one leg, and then the other leg. Then his torso was delivered, followed by an arm, and then the other arm. And then, as my 6 year-old described it, “he put the hands and the feet on the bum cheeks, and he pushed his head out!” I only pushed for a few minutes, and my beautiful baby boy was here! He was healthy and perfect. I held him in the tub with me for a couple of minutes before the midwives helped me out to deliver the placenta, and then into bed. We cuddled and bonded as a family, and our oldest son cut the umbilical cord.

I've realized since my home birth that if I had planned a hospital birth for my breech baby, it would have ended in a cesarean section. If that was the only benefit of having him at home, it was definitely worth it, but there were many other blessings of having our baby at home as well.

I don't consider my home birth to have been a painful birth. I felt intense pain with my hospital births, and there were moments of discomfort during my home birth but never what I would describe as pain. I think it had to do with the peace I felt and the confidence I had gained from my previous birth experiences. I am no longer the meek woman willing to submit to whatever the doctor tells me I should do. I know exactly what I want and how to achieve my goals. I know what I am capable of, and I feel stronger than I ever have in my life.

I used to regret my earlier birth experiences, wishing I had experienced unmedicated birth from the first rather than the traumatic experience it was. Now I'm grateful for those earlier experiences for the way they've shaped me as a person and as a mother. My first birth experience was an important catalyst in motivating me to find a better way for me to give birth. I don't feel that there is one birth choice that is best for every woman, but I hope that each woman can know that birth is beautiful and empowering, and if you don't experience it that way then find out how you can.

H1N1

I got a few questions sent to me, so I thought I'd post them here as I'm sure a lot of people are wondering about these things.

"What are the hospitals doing to protect mothers and babies from H1N1?"

To the dismay of many, hospitals all over are limiting visitors and not letting children into LD units. While this may seem harsh, one of the biggest problems at hospitals is infections. If you are choosing to have your baby at a hospital, I think that this is a good way to limit the amount of germs that are spread around. At the hospital I work at, they are making anyone who comes in with flu symptoms put on a mask. They are also trying to keep the sick moms in a completely different area than those who are not sick. I work for a corporation that owns three hospitals in my area. If there was to be a huge outbreak, one of those hospitals is designated as the sick hospital. I would assume that those who are caring for sick patients will only be with sick patients. That means that if someone is healthy, they won't get a nurse that is also taking care of someone who is sick. If someone is sick, the nurse is required to put on a gown, gloves, and mask. While I didn't really want to be vaccinated:), all the nurse were required to be. As you can spread the virus before symptoms show up, I was ok with that.

Do you think there is an increased risk to newborns in the hospital because of this outbreak?

Anytime there is virus' and germs around, newborns are at risk. As there are many people coming and going at the hospital, there are more germs there. That has always been the case though. Chances are, with the way this virus is spreading, the newborn would be exposed to it pretty much anywhere. The problem with hospital bugs, though, is the mom hasn't had a chance to develop an immunity to it and thus pass it on to baby. At home, the mom is exposed to all the germs there and has passed on the antibodies to her infant already. Therefore, I couldn't say for sure if there is an increased risk. I think it would depend on what is already in your community. As far as I know, though, no newborns have died from this virus thus far.

What would you suggest (to help prevent infection)?

Breastfeed!:) Whatever mom's body produces to fight off the virus will be passed on the infant. Try and get a good first feeding in. Colostrum is amazing stuff. I would also make sure that whoever walks in that room with mom and baby are washing their hands or using hand sanitizer. Make sure your nurses and doctors do this too. I personally would also keep baby with you as much as possible instead of taking it out to be exposed to others germs. I would ask for the nurses to do all the stuff they need to do in the moms room. I'm not sure if this would be accepted, but it wouldn't hurt to ask. I just think that limiting the exposure of baby to other people would be the best thing in the hospital. Moms should also make sure they are getting enough to eat and are limiting their stress. These things make a huge difference in our ability to fight off disease. I know these aren't used that much, but I think a post partum doula would be so helpful with this.

Now here's the tricky part for mom in labor...fear and stress can lead to a more difficult labor, therefore, I feel like it is essential that we don't let these emotions take us over. Just know that there are always things we can do and have control over, and there are somethings we can't control. The trick is learning to do what you can and letting the rest go.