The last year or so we have listened to moms talking about their upcoming birth. For the most part, the moms we meet are pretty well informed. They know what they want when they go into the hospital, which is very important. Participating in your birth is the difference between the positive birth story and the birth story where mom is wondering what just happened to her. It seems, however that there are a lot more women going into childbirth with the idea that trying to do it vaginally unmedicated it just pompous and absurd.

“After all, I’m not superwoman” is a phrase I have heard over and over again, and in fact I recently had a client tell me that she was in an all moms group of about 8 or so that all said the same thing. She had a difficult time facing that entire group and saying the unthinkable: “I am going to have my baby vaginally and I don’t want to use any meds…and I have a great team so I am pretty sure I can do it”. I was shocked at her story. When did vaginal, unmedicated birth become all about the ego? If a mother tells other mothers that she birthed vaginally without medication, does she have to apologize and humbly look away? Does that same mother risk being called “superwoman” behind her back and being shunned by the epidural moms?

We are at a place in time when more people are questioning unneeded medical intervention and with good reason. Yet, somehow in all this realization of how birth can be it seems there are more moms out there doubting themselves out loud than ever. While it is true that labor has levels of discomfort for everyone, trying to guess how it will feel before even experiencing it makes very little sense. We have all had various discomforts(aka pain), but labor is the only time you are going to be able to have resting periods throughout, do something about it, and predict when it is going to end. It is the only discomfort that brings forth someone worth every effort to cope through contractions regardless of the road taken.

 Vaginal birth with a positive outcome is good for everyone involved, and it should not be about whether or not a mother considers herself a “superwoman” or not, but should be more focused on the choices she was given along the way. The ones she makes are the best ones for her, and if at the end, she feels it was the best experience of her life, then she is going to feel like a “superwoman” anyway.

I recently supported a birth client at St. Joseph’s hospital who needed to birth her baby by Cesarean section after a failed induction. While I was sitting in the recovery room waiting for her to come out of surgery, a nurse came in and started chatting with me. I have seen her before; she is an older woman, has been in nursing for over 20 years and is a very kind woman.

She said to me, “At the end of the day, it doesn’t matter how it went as long as we have a healthy mom and baby.”

And then it struck me. Before I could think about what I was going to say, I just said it all. “Yes, it does.” I said. “Healthy mom and baby should be an unspoken given.”

“The whole experience does matter”,  I continued. “Women come to our clinic, sit on our couch and recount their traumatizing past birth experiences. They cry.  They come to us for help.”

She nodded and smiled, gathered some supplies and said, “Well, we try our best.”

Nurses are with their patients all throughout delivery, clean them up after birth, help them initiate breastfeeding and then send them to the postpartum unit. They never see those patients again. They don’t get to see them days, weeks, months–even years after delivery. It’s not their fault–they don’t even have a chance to know the impact of the birth experience on the mother. We see these women though. They walk through our door years later, pregnant with their next child and have a whole lot of processing to do.

When I support women in birth, I am part of their experience. I know that it matters. I see and hear everything going on around them. I tend to women directly and am usually quite connected with their feelings and emotions. Lately, I am hearing things from medical staff that are disheartening, non-supportive, contradictive and sometimes completely uncalled for.  As a doula, there isn’t anything I can do about that, except continue being the support my client needs.

It’s not always like that though. The client I spoke about in the beginning of this post had a positive experience despite her birth going in the complete opposite direction of the one she had been imagining for 41 weeks. It helped that she had medical staff that truly informed her of her circumstance, and explained options to her in an unbiased way. She had nursing staff that reminded her that she ALWAYS has a choice, regardless of what the OB resident’s recommendation was. She was reassured and empowered; and able to make the right choice for herself.

In the end, I agree with the nurse about it not mattering if your child was born by cesarean section or vaginal birth. It doesn’t matter if you had an epidural or not. What matters is the experience as a whole. When a woman KNOWS the medical team is on her side and that they are giving her the BEST chance at the birth she prefers, it sets her up for a positive experience regardless of how she has to give birth.

The bottom line is:  Birth experiences stay with women until they die. They tell their birth stories forever.  So yes, it does matter.

If you’ve had a baby before, you may or may not have been graced with excrutiating back pain in labour, or often called “back labour”. Perhaps you are a first time mother-to-be and are constantly being told by your friends, family and random people on the street about their terrible labours where “the back pain was just so horrible”. Lucky for you, there are several things that can be done in labour to relieve back pain, but I’ll be focusing on sterile water injections in this post because… well, chances are you haven’t heard of them.

So what are they used for and who can administer them here in London? Sterile water injections are used to dull or diminish back pain while in labour. I have seen these work time and time again. A small amount of sterile water, just 0.1 ml, is injected into four places around your lower back near the sacrum–usually during a contraction (which ends up taking the pain of that particular contraction away). Sounds kind of painful, doesn’t it? Well, they are, but they have wonderful results. They feel a bit like bee stings going in, but once they are done the effects last for about an hour and can take away that excrutiating edge of back pain during contractions.

How does it work? As long as your pain is at a high enough level, usually an 8 or above with 10 being the highest on a pain scale, the injections will be effective. They work because of the “gate control theory” of pain.

The traffic controllers (chemicals) which man the ‘gates’ preference skin signals over internal signals because the skin is monitoring the outside environment and lets the brain know when there is immediate danger.

When a woman has back pain in labour, the pain signals are slow, internally generated signals. Some back pain is normal when the baby’s head is decending in the pelvis, it presses on the sacrum, pushing it out as the head turns on its way down. That is nature’s signal to the mother than the birth of her baby is imminent. When a woman has intractable back pain, because of the baby being in the posterior position, then the water injections may be useful. If a woman has the water injections into her skin, it stings for about thirty seconds. That sting switches on the fast fibres.

The fast fibre signals from the skin come racing up to the gate, the traffic controlling chemicals recognise an immediate threat, close the gate to the slow pain messages and let the quick skin related message through. The internal pain signal is stopped in its tracks and the woman no longer feels that internal sensation.
Source: www.bellybelly.com.au/articles/birth/sterile-water-injections

These are a “tried and true” trick-of-the-trade administered primarily by midwives. Several years ago, I was told there was a nurse at St. Joe’s that could do them, but I decided to investigate and find out what the real scoop is.

First, I called and spoke with the birthing unit at LHSC Victoria Campus. No nurses there can do them. Then, I called in to St. Joe’s where my question was passed around only to end up at the Care Coordinator’s voicemail, where I have yet to receive a call back. If you want this option for your labour, you’ll have to choose midwifery. Hopefully you’ve made the choice early on, because midwives fill up very quickly here. Midwifery care should be sought out as soon as you see two lines on the pregnancy test!

Remember that back labour can be caused by a malpositioned baby, so practice your optimal fetal positioning techniques. Toward the end of your pregnancy, let your belly hang forward rather than slump back with you on the couch (lying on your side is good too). Sitting on a birth ball 20 minutes a day doing wide hoola-hoop circles with your hips can also help the baby into a favorable position. Sometimes back pain can come with prodromal or early labour, and sterile water injections can be helpful to catch some much needed rest.

If you have back labour be sure to ask your midwife about sterile water injections – they are safe, no drugs are used, and they can be done as many times as you like to help you through your labour. Oh, how I wish all of the nurses at St. Joe’s and Victoria Hospital would be able to offer these to their patients, too. I will leave you with a quote from another article I found online, and a couple links for further research of your own:

The researchers looked at eight trials, involving 828 women, that compared sterile water injections with placebo (injection of saline), acupuncture, or stimulation of nerves using electricity.

In all eight studies combined, sterile water cut the Caesarean section rate by half: about five percent in the sterile water group and ten percent in the comparison groups.

Based on the findings, the authors call for a large trial to clarify the best approach to back labor.

Source: www.babycenter.com/204_sterile-water-injections-reduce-pain-of-back-labor_10316817.bc

P.S. I spoke with a midwife last week about possibly getting some photos of the actual procedure, so I may go in and get to take some pics of a student midwife receiving sterile water injections! I wanted to get this post up sooner than later, so I’ll add the photos when I get them.

Recommended:

• VIDEO: Study finds sterile water injections beneficial for pain relief in labour
• ARTICLE: Science-Based Medicine, Sterile Water Injections for Pain Relief
• ARTICLE: Nonpharmacologic Approaches to Relieve Labor Pain: Intradermal Water Blocks

There are so many things I love about being a doula, and one of them is that I get to witness some pretty amazing moments. Of course, the look on a woman’s face when she gets that first glimpse of her newborn baby is priceless, but there are so many other moments during labour which tend to swirl through my mind even years later.

The first birth I ever attended as a doula was for a young woman who was placing her baby with adoptive parents. She laboured naturally, never asked for any pain medication, and never complained about the pain she was clearly in. She didn’t have to do that, but she did. I watched as her own mother helped her through contractions, held her hand and hugged her. They worked through the process together with minimal help from me and the nurses. Knowing she was doing all this hard work and that she was not going to be raising the baby made me realize the intense amount of emotional strength she had.

Later that summer I attended a birth that made me immediately think I wanted to quit being a doula. I supported a lovely couple during a VBAC (vaginal birth after cesarean section)  that went on about 20 hours. This lady did not want pain medication and handled her contractions beautifully. Her labour stalled out around 7cm and with some position changes she dilated to 10cm. She pushed about 3 hours when the nurse called in the doc. Doc said she could push for 2 more days and this baby wasn’t going anywhere. Repeat cesarean section.

In that moment she looked up at me, crying, and said,  ”I just did all this for nothing”. I remember feeling like I couldn’t walk anymore; my heart sank, my lips started quivering and I just felt completely broken. Then I pulled it together and helped her through the urge to push while they got things ready for surgery. All the while her husband had been there for her, and he was doing his best to keep himself together. I started telling them that this was not a failure, that she achieved her goal of making it to 10cm without any pain meds and how amazing she was for doing so great. The labour was good for her baby and she did everything in her power, so now it’s just about getting that healthy baby.  Seeing that realization in her eyes was something I will never forget.

Also in that year, I attended a birth with midwives for the first time. What a huge eye-opener to finally get to see what midwifery was all about. The care these women provide is outstanding, and the birth options that come with them as a care provider is even more impressive. One of the most amazing moments at that birth was watching the midwives huddle together and discuss what to do for the client. Collaboratively, they provided her with unique suggestions for the progression of her labour.  That is when I realized more women needed to know about midwifery, and their partners need to be educated about them too. I can’t believe how often–in this day–I hear women haven’t sought a midwife because their partner didn’t think it was a good idea. More on that in another post, perhaps?

I’ll have to make a “Part II” since there is so much to choose from! Hmm, what to leave you with? Ah, a recent amazing moment was to see a loving partner literally “push” with all his might while our lady in labour pushed for nearly 5 hours. He would lean into her at the start of every push, make sure a cold cloth was on her head and neck, and sometimes press his face against hers. She did it, and there was a beautiful baby–and so much love in that room.