Tuesday, January 4, 2011

Some childbirth book reviews...

I know, right? Childbirth. Not exactly a light topic. But I thought I'd write about the books I read as I prepare for my baby's upcoming birth in May.

I read two over the holidays, and both bear discussion. One of those warning again: lots of body parts going to be tossed around in this post that I normally wouldn't use in everyday conversation. You'll see why when I get to the second of the two books.

I'll write about my previous birth experience in a separate post, but in a nutshell, with Henry I had a vaginal birth in a hospital with epidural anesthesia. It wasn't a bad birth experience, but there are some things that ideally, I'd like to go differently this time. The main thing I'd like different is in regards to Pitocin augmentation (Pitocin is a synthetic hormone that can be used to stimulate strong labor contractions; it is used in labor inductions and augmentation). I don't want it unless absolutely necessary. And I don't consider "Oh Honey, we just don't want you to be here all day!" to be absolutely necessary. Pitocin creates contractions that are immediately stronger than what your body would produce on its own, with no gradual buildup. It makes labor much more painful much more quickly, with little to no natural adjustment period.

I think it's important to state up front that I see nothing wrong, morally or otherwise, with pain relief medication in labor. I don't regret using it, and if I feel the need at the time, I'll use it again. I firmly believe that this is a woman's prerogative and a benefit of modern medicine (who is the patron saint of anesthesiologists? God bless that person).

That being said, last time I did want to labor without it, and for a number of different reasons that I'll discuss in that other post I mentioned, I ultimately chose to receive the epidural. This time, once again I'd like to try for an unmedicated birth, although I will again be delivering in a hospital environment. I really don't like the phrase "natural birth" because it makes it seem like giving birth with pain medication or via cesarean section are "unnatural" and that is simply not the case.

So, this time I'd like to do my homework and actually prepare myself with some knowledge and techniques that may assist me through birth without pain medication. I just want to feel less fear about childbirth, and find some ways I can manage my hospital birth actively on my own. Last time, I did not put much time into preparation at all. I was afraid, and thinking/reading about it made me more afraid, so I just figured I'd wing it.

I'm not planning to take a course (Bradley Method, Hynobirthing, that sort of thing) because I'm not sold on any one of those methods enough to pay a substantial fee and spend a number of weeks in class. Not that I think they don't work. I'm certain they do for many women, I'm just not sure that any one of those methods is right for me. I'd just like some guidance on simple things I can do in labor to help myself. I'm a reader, so books seem the logical choice to me. And in the end, if I want an epidural, I'm going to get one. I don't feel strongly enough about unmedicated labor to deny myself this if I truly feel it is warranted.

Plus, my doctor told me during my labor with Hank that second (and plus) babies come out faster than the first. If she was lying, someone is going to PAY.

Ok, so, on that note... On my first foray to the library, I was looking for Ina May's Guide to Childbirth, and happened upon a real gem: The Big Book of Birth, by Erica Lyon.

This is a practical book that describes every stage of labor, common interventions and cesarean birth, and simple pain coping techniques. I was VERY impressed. I can be a little turned off by real "crunchy" natural birth books that are very biased against hospital birth and obstetricians. Everyone is entitled to their opinion, and I see nothing wrong with midwife assisted homebirth for those that choose it, but that's not my choice. And I don't want to feel hopeless about my choice, that inevitably I'll end up tied to my hospital bed, unable to move around, or with an unplanned cesarean section.

This book was just very uplifting and perky, and gave you the facts. For me, it helps *tremendously* to see a chart with the different stages of labor, what they entail, and how long each lasts. Last time? Didn't know this stuff. Early labor (your cervix dilates from zero to four centimeters) will last anywhere from a few to eighteen hours, but is not very painful. Active labor (your cervix dilates from four to seven centimeters) will last anywhere from four to eight hours, on average, and while more painful, is usually manageable on your own.

Transition is where things get dicey. I remember this stage well, and I had HAD the epidural. Let's just say it wore off at the end. And with the Pitocin? I remember wanting to crawl up the walls of my hospital room. All I could manage was to writhe in agony on my side (still couldn't walk, despite the waning epidural) and grip the rails on my hospital bed. NOT a happy camper. What the author tells us in this book is that transition (your cervix dilates from seven to ten centimeters), while the most painful, is the shortest of all the labor phases. It will last anywhere from thirty minutes to two hours. I can't tell you what a relief it was for me to read that. Very comforting to have some solid facts in front of me.

I also liked her suggestions for pain management on your own. Importantly, move around. Change positions. Stay upright as much as you can (squat, sit on a birth ball or stool, rock from side to side on your feet, lean on your husband, take a shower, as warm water will immediately dull some of the pain), but if you need a rest, even switching sides, or moving to your hands and knees on the bed can make a difference in helping labor progress. She gave some simple suggestions for handling intense contractions: they should only last about a minute or so, and will include a buildup, peak, and slow down. Pick a visualization to help you through. A boat going up a wave of water and then coming back down, water washing over you, or whatever you like. The contraction should only last a minute, even in transition, and then you should get a break. The breaks will get shorter in duration, but even in transition they should be long enough to catch your breath and gear up for the next one. Pitocin denied me that, which is why I hate it so much. :) Practice relaxation breathing, which is simply breathing deeply in through your nose and out through your mouth.

She also explained pushing and delivery in a way that took the scary mystery out of it for me. Ever wonder how that big baby head comes out of such a small seeming place? Picture pulling a tee shirt over your head. There's plenty of room at first, but then the collar at the top, small and flat, seems to present an obstacle. But once your head gets to that point, and you exert gentle pressure at the opening, it stretches for your head to gradually come through. That's how a baby is born, and that mental picture really helped me.

I really liked this book. In fact, I'm considering purchasing my own copy so that I have it for reference closer to my due date.

The next book that I read was the well known Ina May's Guide to Childbirth, by Ina May Gaskin. Ina May Gaskin is an extremely well-respected midwife who practices in Tennessee. She has a place called "The Farm" where thousands of women have delivered their babies, and boasts a cesarean section rate of less than two percent. The book contains a good number of birth stories, all from women who ultimately experienced unmedicated birth, explanations of the birth process and common interventions, and some tips on positioning to help in labor.

This is definitely a "crunchier" book, but it does not present a negative attitude toward obstetricians and hospital birth, which I appreciated. But it's definitely a book that is more, hum, how to say... well, sexual. The author feels strongly that birth is a normal, natural process that we shouldn't be ashamed of (I completely agree), and that while it takes a sexual act to get the baby inside, sexual acts can also aid in getting the baby out. Well...

In many ways, I appreciated her candor. There are some photos in the book that include women who are undressed. This isn't shocking to me, and it shouldn't be to anyone. Our bodies are a beautiful thing, and if a woman wants to be uninhibited by clothes in labor, good for her. I on the other hand, am extremely modest. I prefer to be clothed at all times, unless in the privacy of my own bedroom. But I am very grateful that she took the "ick! scary!" factor out of vaginal birth for me. There is nothing gross about a baby crowning out of a woman's vagina, it is the most natural thing in the world. And seeing the pictures really brought that home to me.

That being said, while I can understand that nipple stimulation can aid in labor progression, I don't plan to ask my husband to implement it in the middle of my birthing room. Or for us to start kissing... you get the picture. That may be appealing to some people, and if that's you, you will love this book. :)

She also had some great pencil drawings of historical birth positions which I found helpful. Many American women give birth in what is called the "supine position," meaning lying on her back with her legs pushed back. This may be convenient for the doctor, but is actually the least efficacious position to give birth in. Gravity is our friend here. Squatting, standing, even sitting up would all make pushing easier for the woman. I think many hospitals have squatting bars now, and while hospitals often reel you in with the fetal monitor and an IV pole, you can still stand up by your bed, sit on a birthing ball, rock back and forth, all by your bedside. I plan to ask about it at my hospital refresher class. As well as about intermittant monitoring to permit short walks and trips to the shower. We'll see. But rest assured, I'll fill you all in. :)

So, that's my long childbirth tome for the day. More to come!


  1. Standing really worked well for me and pacing. I wasn't allowed more than two feet because of being monitored which I will not do again. I've already told hubby. No hospitals. No monitors. Just let me endure the pain by walking around and squatting. When the put the epi in they made me sit and that was when I cried. Before that it was painful but not that painful. I wasn't into the dicey stage so I couldn't tell ya about that.

    Hated petocin. My doctor told me to get it because HB was five days past due and she's not one for waiting. I think that I'm not going to do that. Even if I time out at the birth center (they have strict policies for how long they will let you go for before making you go to the hospital for the birth), I plan on finding a doctor who will let me go two weeks if necessary.

    My cycles are such that I ovulate much later than the 14 day chart they use at the office (sometimes as long as anywhere from a week and to a week and a half later is normal). So in reality HB was would have been on time for his real conception date, but do doctors believe you about that, nope. This time I'm putting my foot down. We're going to make them write down the conception date and due date based on that as well as the standard one. And I will go by that one instead of the standard. Stupid doctors.

    Okay...sorry for the rant. I honestly didn't think I would.

  2. I always love your comments! This time, I too plan to labor at home for as long as I can stand it. Hopefully, by time I get to the hospital, active labor will be fairly far advanced, and it won't be too long before I just deliver. That way, they won't have too much time to tick me off. :)

  3. Ooh, you should read my favorite birth book, "Pregnancy, Childbirth, and the Newborn: the Complete Guide" by Penny Simkin. It sounds like it's just your style -- more scientific than crunchy, but explaining a lot of ways to avoid intervention, even in a hospital. I should have studied it a lot more carefully before going to the hospital ... ;P Actually, you know, I should have brought it with me. It has diagrams and everything of helpful positions and things the husband can do.

    If you can talk your way out of the IV, do it. I managed to, thanks to a sympathetic nurse who talked to the doctor for me. Instead, I drank a LOT of clear fluids. Even though I was hooked up to the monitors, I had the ability to move around a bit more, which was really nice (and I should have taken greater advantage of it). And that way, baby and I didn't have any swelling. (Babies whose moms have IV's sometimes lose a lot of water weight in the hospital, causing doctors to freak out unnecessarily.)

  4. Shelia, Thank you! This sounds like exactly what I'm looking for. My library system doesn't have it, but I added it to my Amazon cart for my next purchase. :)


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