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Failing to Progress or Naturally Aligning

Posted on June 1, 2012 at 4:52 PM Comments comments (7)
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson  We have had a couple of students have had textbook “NAPS” in the last two classes…and since we still have several couples waiting for their babies, I thought this might be a reminder and an inspiration to them for their labors.  NAP – no, they didn’t take epic naps in labor (although I am a big advocate for sleeping in labor)…what it means is that they were very patient in their labors.   

One of the cornerstones of The Bradley Method® is a Healthy Mom, Healthy Baby outcome.  All of the discussion below only applies if Mom and Baby are not showing any signs of distress through labor.  Mom is maintaining a healthy temperature, heart rate and blood pressure, and Baby is also showing that it is doing well as per the monitoring that is being done.  If Mom or Baby are starting to demonstrate that their health is compromised, then parents are encouraged to make the best choices for their particular situation.   

The words “Failure To Progress” are the sound of doom to some of us (I say "us" because I heard this three times!).  They very often mean that interventions are going to start being suggested.  How a couple acts upon those suggestions is very individual.  Marjie Hathaway coined the phrase “Natural Alignment Plateau”, or “NAP” as an answer to the dreaded “diagnosis”: “FTP”, or “Failure To Progress”.    

Failure To Progress is based on the Friedman’s Curve*.  It looks like this: 
 As human beings, it is in our nature to see this neat, explainable graph and say, “It’s a rule!” This can have dire implications whilst in labor if you really want a natural birth.  There are no averages in the midst of a labor – each labor on is unique and individual.  

Mathematically, it’s unfair for all labors to be expected to fit the average.  That brings in another concept we teach in The Bradley Method® classes: consumerism and informed consent.  If there is time: ask questions, ask for time, and then communicate and evaluate what you have heard with your partner before you decide on a course of action.   

  • It is important to remember that the graph is AN AVERAGE representation of labor.  It indicates that a mom should dilate 1 cm per hour, and push an average of 3 hours – for an average length of labor that is between 12-14 hours long.    
  • Math class reminder:  The average number is the number you get when you add all of the data in a set of information, and then divide that total number by the number of units that provided the data.  Applied to laboring mothers: That means that there will be some people that have labors much shorter than 14 hours, and other people that have labors much longer than 14 hours, more will be around that number…and then a few will be right on with the average.  


When a mom does not progress in dilation from one vaginal exam to the next, or between several vaginal exams, she may be diagnosed with “Failure To Progress”, and along come the string of possible interventions.  They can include any or all of the following, along with other interventions: an Amniotomy (intentional rupture of the bag of waters), augmentation of labor with Pitocin, an Epidural to take of the edge of Pitocin-induced contractions, a Cesarean.  

A cesarean may also be suggested if the care team suspects that the baby may not fit through mom's pelvis.  Diagnosed as "CPD", this is the subject for another post altogether.  For now, check the link I listed below* for more information.

Instead of accepting the words, “Failure To Progress”, Marjie decided to suggest a new phrase to her students: “Natural Alignment Plateau”.  NAP instead of FTP.  Natural Alignment Plateau is a different way of approaching that point in labor when dilation does not change.  What we teach in class and hope that our students will remember when they face this crossroads is, "Labor is much more than dilation."   

Labor can be slow to start, dilation can stop and/or contractions can slow down for many reasons.  Here are some to consider: 

  •  Did you change locations where Mom is laboring? 
  •  Is Baby posterior? (Click here for ideas to move baby)
  •  Is Baby trying to figure out how to line up in the birth canal? 
  •  Is there an emotional component that hasn’t been dealt with? 
  •  Is Mom tired and does she need a nap? 
  •  Is Mom making more hormones for labor? 
  •  Is Mom's pelvis still stretching (and using the extra hormones) for baby to fit?
  •  Is the Baby's head still molding for the passage through the birth canal?
  •  Is Mom making more colostrum for baby? 
  •  Has Mom surrendered to the birth? 
  •  Has Baby accepted the birth process?  


If your labor has been slow to start after a spontaneous rupture of membranes, or if you are seemingly “stuck” at a measurement of dilation, it might be time to evaluate what could be going on and change tactics: 

  •  Try a new labor position. 
  •  Go for a walk to clear your heads. 
  •  Take a nap to conserve your energy (It’s hard for a care provider to argue with a dad or doula who is protective of a sleeping mom.)  
  •  "Talk" to your baby and encourage them that you are ready to meet him/her. 


If Mom and Baby are doing well, you can ask for time.  There is not a medical reason for an intervention if Mom and Baby are doing well in labor and your care team confirms that Mom and Baby are okay.  Here are two examples for you to consider and think about if you face a point in labor when there is no measurable progress.   

We had a mom from our Winter class go from 6 cm dilated (usually considered Active First Stage – not yet in Late First Stage) to holding her baby in 21 minutes.  Yes – you read that correctly.  She went from what most care professionals would consider mid-range in labor to holding her baby in 21 minutes…that meant she pushed within that time, too, folks.  Hers was an emotional component.  She was waiting for her mom to arrive.  Once her mom arrived at the hospital and stepped into the room where she and her husband were laboring, her baby and her body got busy.  They dilated a total of 4 cm from 6 cm to “complete” at 10 cm, then pushed, and they were holding their baby in 21 minutes.   

Our other story is from our Spring Class.  Mom had a slow start to labor.  She had started seeing some clear fluid on Sunday, noticed some more on Monday, and went to the hospital on Tuesday.  They tested her fluid and it was amniotic fluid.  Although they were in triage and barely 1 cm dilated, the couple was strongly encouraged to be admitted.  Now they are into the hospital and the expectations of “Friedman’s Curve.”  

This couple did a great job of asking, “Is Mom okay? Is Baby Okay?” After getting their “Yes” answers, then they followed up with, “That’s great!  Then let’s wait a couple more hours and see where we are.”  And sure enough, the next time the staff and their care provider checked in, they were a little further along in labor.  Once things got going, this mom went from being 4 cm dilated to 8 cm dilated in one hour!  Within two hours of that point, they were holding their baby.   

The great news about hitting the NAP is that once the Mom’s body and Baby “get organized”, labor seems to progress very quickly.  Again, remember what I said at the beginning – things go well when a Healthy Mom and a Healthy Baby are given the time they need.  If Mom or Baby start to indicate that “healthy” is losing out, then a family needs to make the best choice for their situation.   

What has been your experience – have you had a NAP in your labor?  What choices did you make?   

For a full explanation of Friedman’s Curve click here or enter this URL into your browser: http://allaboutbirth.net/pdfs/Failure-to-progress.pdf    

Disclaimer:  
 The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®. 

Common Factors That Influence Labor

Posted on April 3, 2012 at 7:52 PM Comments comments (101)
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, ScottsdaleWe have now had 28 students complete our Bradley Method® classes and birth their babies through seven class series – pretty awesome to know that 28 youngsters are blessed with parents who took the time to give them healthy pregnancies and Healthy Mom, Healthy Baby births.
 
Each birth has been unique, and they have varied from intervention free to cesareans to everything in between.  What they all share is that the families made the choices they had to make for a Healthy Mom, Healthy Baby outcome.  What are the elements that are consistent across the birth stories we have heard?
 
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, ScottsdaleUnknowns:  There are many things that are unpredictable about birth…when will labor start, the manner in which labor will progress (consistent dilation vs. ebb & flow in dilation), how long it will take from the first contraction to holding your baby, how baby will tolerate labor.  If they are birthing away from home: when will they go to the birthplace, will they be sent home?  The procedures and interventions offered – those all depend on the birthplace and if there are standing orders once they arrive.  And the list goes on…who will be their nurse?  Which provider was on call?
 
Listed below are four things that are in your control through pregnancy and labor.  By making a realistic evaluation of your circumstances, you can influence your outcome in a positive direction by making good choices in the following areas.
 
Rest:  The biggest factor between couples that need or choose interventions and those who do not is how rested Mom is towards the end of labor.  If Mom and/or Coach have stayed aware and awake from the very first contraction and have been timing most of them, they will be spent when the hard work of labor comes. 
 
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, ScottsdaleMost of labor is spent working up to the hard contractions that the body needs to have in order to push out a baby.  Active labor prepares the baby and the body: contractions function to align the baby in the birth canal, and to dilate and efface the cervix.  The length of the active first stage depends on how baby and body work together.  Then comes the work of pushing phase – again, this can take a few minutes to a few hours – it all depends on the baby and the body.
 
We know it’s exciting to be in labor.  We know you want to believe it’s going to go quickly.  We know you need to be rested, no matter how long your labor ends up being.  Trust me – we learned the hard way with our first birth and ended up with Pitocin and an episiotomy because I was exhausted.  We never want our students to repeat our mistakes, which is why we are so adamant that couples take a nap when they think their labor has started.
 
Our families that slept in early labor have had the energy to manage the latter part of labor with less intervention or prodedure(s) to augment labor.  If they have a fast labor, they have the energy and they emotional wherewithal for the “sprint”.   If they draw the “marathon” labor card, they have the energy reserve to say no to Pitocin avoid an episiotomy.  And for those that do say yes to Pitocin, they manage to continue to labor without an epidural.
 
So even when it’s their first baby, we encourage couples to sleep in spite of the excitement.  There is no way an unmedicated mother will sleep through the birth of her baby – they body will wake you up when it’s time to pay attention.  We have not heard, “We shouldn’t have slept” when a couple comes back to share their birth story.  What we do hear is, “We wish we had taken Krystyna and Bruss’ advice to sleep”. 
 
Support System:  We ask families to think about who can be an assistant coach, or to consider hiring a doula.  Wherever you give birth, be it at home, at a hospital or a birth center, there will come a point in the labor where Coach needs to go to the bathroom, or maybe eat something even if Mom has lost her appetite, or maybe Mom really likes counter-pressure – and if any of these are true, Coach can benefit from an extra pair of hands and eyes on Mom. 
 
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, ScottsdaleWhen choosing an assistant coach, couples need to evaluate if the person they are inviting to their birth supports their natural birth choices.  If the person they ask is going to fret over every decision, or tell them that they just don’t why they won’t take the drugs, it will cause tension and that in turn increases the amount of pain and discomfort Mom will feel.  On the other hand, if the assistant coach has come to a couple of classes with the couple, and they have read the workbook or some of the books on the recommended reading list, or even if they just believe in what the couple is trying to accomplish and are willing to serve the needs of the couple, they provide an incredible gift of compassion and energy that helps the couple accomplish their goal of a natural birth.
 
Hiring a doula is a decision that merits thought and reflection as well.  My friend Rachel wrote a great post about factors to consider when choosing a professional labor support person.  The most important thing to ask before you hire someone is if Mom and Coach are willing to share the vulnerable and intimate experience of childbirth with the person they hire.  If you don’t feel completely comfortable or trust in the person you hire, you will experience unwanted tension.  So don’t hire the person that your friend used or the first person you interview just because it’s the easy thing to do.  Hire the person that you would be comfortable crying, doubting and being naked in front of.  If you have an unmedicated or even a less medicated birth experience, you will be sharing these emotions and lack of modesty with your doula as well as with your Coach.
 
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, ScottsdaleCare Provider:  The care provider is one of the most critical choices a couple can make during their pregnancy.  I wrote about this before, and you can read the considerations here.  In summary, if there are any red flags during prenatal appointments, pay attention to them.  If a care provider is not completely supportive of the options you want available to you as you prepare for an unmedicated labor, then be open to the idea that you will probably end up with unwanted interventions, medications or procedures; ones that are not necessary for a Healthy Mom, Healthy Baby outcome. 
 
The other reason to change, even if you feel that your choices are supported, is if you don’t have that level of comfort that I mentioned should be present when you are choosing a doula or assistant coach.  If there is any question in your mind about laboring with or in front of your care provider, then you may want to seriously consider interviewing other providers.
 
The couples that switched care during their pregnancy have all been happy with their outcomes.  One couple even switched as late as 39 weeks; and that gave their son the three extra weeks he needed for his birthday because their second doctor did not push for a non-medically indicated induction.
 
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, ScottsdaleListen to your instincts:  The capstone of having the labor you want is to listen to your God-given gift of intuition.  There is no explanation for it, other than it is Mother Nature’s way of helping you make the best decisions for your children. 
 
Do you want to eat or drink?  Then eat or drink.
 
Is something being suggested that you don’t feel like you should do?  Then tell your support team and have them help you advocate for what you do want to do. 
 
Is there a position you feel like you should be laboring in for no apparent reason?  Then get into that position and stay there as long as it is comfortable.
 
Which brings us back to where we started.  There are so many unknowns in labor, trust your instincts – they are your primal connection to your baby and your body.  As long as Mom and Baby are doing well in labor, there is very little that they can’t do while laboring. 
 
There are a multitude of things that can be done to help achieve the natural birth the family is striving for.  A solid childbirth education like The Bradley Method® offers information on the many options available to birthing families today, relaxation techniques to practice, and labor rehearsals to become familiar with different positions that are beneficial to a laboring mother.  We also encourage all of our students to keep lines of communication open between themselves and their care team to make sure every one is supporting the couples choices and committed to the ultimate Bradley™ outcome: Healthy Mom, Healthy Baby birth stories.
 
Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

 

More Homebirth Secrets

Posted on March 2, 2012 at 7:32 AM Comments comments (342)
Here are two more herbal therapies we used in preparation for our homebirth.  As I commented in my first post about the things we did differently as a result of our choice to have a homebirth, I have no idea why these are not more widely used in pregnancy.  The only idea that has occured to me since then is that since these are not pharmaceuticals, there is no money to be made from promoting them.
 
Herbs have been used as “medicine” for countless years.  As such, I must put on my Bradley® instructor hat here and say that these worked for our family; each family must do their own research and decide if any of these herbal therapies are suitable for them.
 
Red Raspberry Leaf
The most common way to use this herb is to make a tea and drink 2-3 cups per day.  I learned about it from our first doula, who recommended I drink a tea made from Red Raspberry Leaf in the third trimester for uterine toning.  I wasn’t sure about using herbs since the FDA regulates none of them.  Since then, I have learned to do research and trust my source if I am going to use herbs, especially during pregnancy when everything we consume passes on to the baby.
 
“Most of the benefits ascribed to regular use of Raspberry tea through pregnancy are traced to the nourishing source of vitamins and minerals found in this plant and to the strengthening power of fragrine - an alkaloid which gives tone to the muscles of the pelvic region, including the uterus itself. Of special note are the rich concentration of vitamin C, the presence of vitamin E and the easily assimilated calcium and iron. Raspberry leaves also contain vitamins A and B complex and many minerals, including phosphorous and potassium.”
 - susunweed.com
 
Red raspberry also turns out to be a source of calcium, and some mothers find that it helps with milk production.
 
Read more about red raspberry leaves here
 

Polly-Jean Five-Week Antenatal Formula
This was another recommendation from our midwives.  Not having used herbal therapies like this in our other pregnancies, Bruss and I decided to trust their expertise and take the herbs.  The following is an excerpt from birthjunkie.com.  I have commented on the benefits below – they are in the purple text and NOT from the website:
 
"Polly Block, a midwife, writes in her book, Polly's Birth Book--Obstetrics for the Home:

"We have found the Polly-Jean Formula--an herbal combination that gravidas begin taking five weeks prior to anticipated date of delivery--to be a boon to the home birth movement. It assists in the following ways:
 
  • Much easier labor and delivery – ours was easier in the sense that the active phase was very short…if you have read our homebirth story, you already know that our early first stage was almost two days long.
  • Longer and easier labors for women who tend to have precipitous births – I wish!
  • Shorter and easier labors for women who tend to have long labors – if this made my labor shorter I am very grateful.
  • Bigger dilation before discomfort arises – yes!  I could feel my cervix popping open with the easier contractions; our active phase of labor (late first stage-transition-pushing) was only about three hours out of the 44 total hours of labor.
  • Minimization of postpartum bleeding when taken in conjunction with the “Good Program” (the “Good Program” is spelled out in Polly’s Birth Book) – I don’t know what the Good Program is since I didn’t read the book; I have not lost a lot of blood in the past, and there was definitely very little blood loss with our homebirth.
  • Shorter periods before lochia stops – we found this to be true; the period of postpartum bleeding was much shorter this time – I was also taking my placenta pills, so that may have factored in as well.

Other formulas on the market have helped many mothers, but over the years midwives have found that these formulas did not assist enough in preventing hemorrhage in women with borderline anemia, the Rh-negative factor, and other conditions. We found that when pennyroyal was included in the formula, bleeding continued to be heavier than it should be. We also found that black cohosh seemed to increase the normally stepped up production of estrogen, adding to the hemorrhage problem. Jeannne Johnson and I eliminated both these herbs when we developed our formula.

The Polly-Jean Five-Week Antenatal Formula tends to create a balance in the stepped-up hormones toward the end of pregnancy.  Over the years women have reported that they have found no better 'female corrective' than the Polly-Jean formula, pregnant or not."
  - Except from www.birthjunkie.com
 
As I researched for this post, I found that the Polly-Jean Five-Week Antenatal Formula contains a blend of herbs that lend the following properties: uterine stimulant, uterine toning, hormone balancing, anti-nausea and anti-vomiting, galactagogue (increase milk supply) and pain relief.
 
Allow me to reiterate that as a Bradley® instructor, and as a consumer and research driven mama, I strongly suggest that you do your own research and decide if either of these herbal therapies are right for you.
 
Our midwives at Freedom and the Seed have an herbalist in their office.  If you have any questions about using herbal therapies for pregnancy, postpartum or for breastfeeding support, you can start by calling Juliana Soderberg at 602.482.5544. You can also visit her website at www.herbaljules.com.

What has been your experience with herbal therapies for pregnancy, postpartum and breastfeeding?
 
Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

One More Thing

Posted on February 28, 2012 at 3:34 PM Comments comments (25)
The night arrived again – when we say farewell to our students and wish them the best for their birth and the journey of family upon which they are about to embark.  Bruss always tells the first-time parents that he is jealous of them because there is nothing else like the experience of welcoming your first child and discovering parenthood for the first time.
 
I reflect and wonder if we have told them everything, showed them everything, practiced everything – which is of course, realistically, impossible.  I take heart in the fact that in some classes, some babies arrive a few weeks earlier than the estimated due dates.  Even though the parents do not complete the series, the births have all gone pretty well.  We are covering enough material to allow these families to have Healthy Mom, Healthy Baby outcomes, and at the end of the day, that is the most important aspect of the classes we teach.
 
Before we complete the last class, the phrase “one more thing” is said a lot in that final session.  Here are the impressions we want to leave our students with…
 
On teamwork:
  • They have learned several strategies for positive communication. 
  • There are several places in their class materials to find the questions for informed consent.  If they remember nothing else, the first questions to ask are, “Is Mom okay?  Is Baby okay?  Then they can ask for the benefits, risks, expected results, alternatives to the suggested procedure, and a timeframe to think about it before making a decision.
  • If there is time, it is always okay to ask for the privacy to talk things through before making a decision.
  • Always evaluate any decisions that need to be made with the Healthy Mom, Healthy Baby filter on.  As long as they remember the ultimate goal, they will be able to make peace with the decisions they make in labor.
 
On managing labor:
  • The amount of sleep a couple gets can positively or negatively effect their outcome.  Against the odds, try to sleep in spite of the excitement.
  • Eat if you are hungry, drink if you are thirsty.
  • Fast labors are indicated by a rapid progression of duration, intensity and frequency of the contractions.  If you notice that things are getting longer, harder, stronger and closer together over the course of a couple of hours, you need to get to your birthplace sooner than later.
  • Long labors are indicated by little or no change in the duration, intensity and frequency of contractions over the course of several hours.  If your contractions start ten+ minutes apart, and they are still ten+ minutes apart two hours later,  you are in for a marathon – stop timing, eat something, hydrate, shower and go to bed!  Although we do not wish this labor on anyone, if it is your birth story, you will be happy you rested early on, because you will definitely have energy when you need it later.
  • It is possible to sleep between contractions or even through contractions.  Surrender to the process and allow Mom to rest.
  • Relaxation is on physical, mental and emotional levels.  There are several summary pages we cover so that they can find and refer to what they need at different points in their labor.

  (To read in more detail about evaluating your labor, click here.)
 
On Motherhood:
  • They are about to embark on one of life’s greatest gifts.
  • It’s called “mother’s instinct” for a reason – it is unexplainable and a mystery how we are all connected, however, if they have any feelings or sense anything as it applies to their baby or their family, go with it – they are invariably proven to be the right decisions to make.
  • They are not alone – reach out for help if they are feeling overwhelmed, tired or just need another adult to talk to when Coach goes back to work and they are home alone with baby.
  • Nursing should not hurt, and it is also a learned behavior.  Each breastfeeding relationship is unique with subsequent children.  If they experience any pain, difficulty, or as questions arise, there are several free options from which to find answers: La Leche League, hospital support groups, community support groups.  If they experience any fever or lingering pain, get professional help from a medical care provider: it is best to be told how to find a solution early on, than to let things go and get into a situation where the breastfeeding relationship is compromised.
  • They cannot spoil or hold their baby too much.  It is okay to ignore people who tell you otherwise!  Your baby is designed to be with you and a part of you – they are cute, sweet and cuddly for a reason!  The time in our lives when they need us is so short compared to the time they are independent, so savor every moment of their infancy and hold them as much as you want to!
  • The sound of your child's crying makes your heart hurt for a reason – you are supposed to respond to them and meet their needs.  If the basics of wet, hungry and tired are satisfied and they are still crying, there may be other reasons why they cry: lonely, scared, in pain, over-stimulated…all of them good reasons to hold them and reassure them that it is okay and you will find a path together.
 
On Fatherhood:
  • Mom and Baby will continue to be an exclusive unit for a little while longer.  Until Coaches are allowed into the “Inner Circle”, there are many ways to support that MotherBaby unit so that they thrive and succeed: support the mother’s decision to breastfeed by bringing her food and water every time she nurses, hold the baby so she can sleep and build her milk supply and stay rested to avoid postpartum issues, change the baby’s diaper so mom can take care of her personal needs, keep telling her that she is doing a great job and you appreciate everything she is doing to take care of your child.
  • Even if you feel you are outside of the circle, there are special things that only Coaches can do.  You can soothe the baby when mom needs a break.  Coaches have a different energy that babies respond do.  One mom shared a tip they learned in breastfeeding class:  Moms always smell like milk.  If there is fussiness at the breast, Dad can take baby and calm him/her since he doesn’t stimulate their sense of smell for food…and when everyone is in a better place, they can try nursing again.
  • The time will come when you become part of that “Inner Circle”.  Your baby will recognize you and crave your attention – enjoy it!  You can sing to them, read to them, snuggle with them even before you feel completely “in”, and by the time you are “in”, baby will be confident and comfortable with you; the rewards of taking a vested interest in your child are immeasurable.
 
Our parting wish is for them to have a very Happy Birth-Day; and to come back to share their beautiful babies and their birth stories with future classes.  The most fun of all is to meet again at their Bradley® Class Reunion – it is always fun to see all the Bradley® babies “earthside,” and hear all the new families exchanging stories and experiences.
 
Which parting thoughts resonate with you?  Please add your own words of wisdom in the comments section.
 
Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

Positive Communication

Posted on January 24, 2012 at 6:08 PM Comments comments (66)
Communicating with your Care Provider  

Tonight’s class was about Variations & Complications of Labor.  The Bradley Method® believes in teaching this topic so that parents are prepared for the outside possibility of a variation of labor.  We strive to introduce these in an informative way while leaving out the flashing sirens of fear and doubt.  

In previous posts, I have written about choosing your care provider and your rights as a patient consumer of health care in a hospital setting; both will affect your outcome when faced with critical decisions during the birth process.  Bruss suggested I write about communication since it’s tied to making a good decision if you face decision points in your pregnancy and/or labor.  So let’s expand on a related topic: talking to your care provider so you can assess the recommendations they are making at any point in your pregnancy or labor.  

There are many variations in labor.  Some women will labor quickly, others slowly.  Some women dilate continuously, other women dilate a centimeter or two every few hours, some women might even experience what is termed “reverse dilation”.  Women manage the pain of labor differently – some moan, some chant, some scream.  Some women have the water break early, other women have the water break as they are pushing, and rarely babies are born “en-caul”, having their bag of waters intact and then it’s broken after delivery.  

Possible complications in labor are things like placental abruption, uterine rupture, a baby in a transverse position, a baby in fetal distress that has been determined by having the doctor listen with a Doppler or fetoscope…we aim to cover the things that are true medical complications when a cesarean is medically indicated.  

I like Henci Goer’s definition of informed consent.  It means that any time an intervention is suggested, you have the legal right to know what is being recommended, and that it must be conveyed in a language that you understand.  You must also know why it’s being recommended, the potential problems and side effects, alternatives to handling the problem, the pros and cons of the alternatives, including doing nothing.  (See page 105 of Thinking Woman’s Guide To A Better Birth)  

Your frame of mind going into these situations needs to be focused on a Healthy Mom, Healthy Baby outcome.  The person in front of you is not the enemy – they are a person who is trained and is trying to do their job.  If there perception of a situation is different than yours, then it’s vital to clarify where you are in labor.  The most important questions to ask when you are faced with a “fork in the road” as Bruss calls them, are, “Is Mom okay? Is Baby okay? How much time do we have?”  

We tell our students to gauge the amount of time not only by words, but by actions.  If you have time, you will only see the nurse and maybe your main care provider, or the student midwife and maybe the main midwife in a homebirth.  If you are facing an emergency, there is markedly more activity.  There are teams of people monitoring both mom and baby, as well as maybe getting ready to move them.  

One of the reasons it is so important to take care when choosing your care providers and birth facilities is that sometimes there isn’t time to ask all these questions.  If Mother and Baby are already compromised and there is no time to ask questions, you must trust that the care providers and the birthplace will do the best for your family.  Do you have this level of trust with your care provider?  Do you have this level or trust with the birthplace?  If you answered “no” to either of these questions, it’s time to seriously consider making a change.  Although true complications are rare, if you are part of the small percentage, you want to ensure that you have the best chance for a good outcome despite any complications that may arise.  

I am going to pull from my post on Patient Rights for the rest of the conversation you can have with your care team once you establish there is time to talk and consider your options:  

If both are well enough and there is time, then you can continue with questions such as:
 - “What is the problem?”
 - “What are the symptoms or test results causing concern?”
 - “Could this be normal?”
 - “What is the most likely cause?  Are there any other possible causes?”  

If the care provider agrees that Mother and Baby are well enough to let labor proceed and let nature take her course, continue to trust that Mother and Baby are working together and that you will be meeting your baby in due course.  You can address other probable causes – is mom hydrated?  Is she emotionally ready and relaxed enough to accept her labor?  Are you using the best positions in the appropriate stage of labor to allow gravity and physiology to move things along?  

If after asking this series of questions Mother and Coach decide that further action is worth exploring, then you can continue with these questions:

“What exactly are you recommending?” – Paraphrase it back to ensure you understand what the recommendation is. 

“What are the benefits of this procedure or drug?”  - You want to listen well, and paraphrase again.  You can also ask if their opinion is based on fact or observation.  

“What are the risks and known side effects of this procedure or drug?” – Ask to see the insert if it is a drug and there is time to read it – you may be surprised at what is in the fine print and the care provider fails to mention. 

“Is this an established procedure (or drug) or is it being offered as part of a trial?” – This is very important to know, especially if it is something whose short-term or long-term effects on an unborn child or a newborn are unknown.  

“What are alternatives to this procedure or drug?” – Again, care providers have routines based on what their protocol is – sometimes there are other options that they don’t mention, not from malice, it could be simply because they are not accustomed to being asked for alternatives. 

“What are your qualifications for making this recommendation?” – Who are you talking to?  Student midwife or Professional Licensed Midwife?  Nurses come in many varieties: a student nurse, an LPN (one year of schooling), an ASN nurse (two years of schooling), a BSN (four years of schooling).  Beyond that, how long have they been working as a nurse?  If you are talking to a doctor: are they a resident (student) doctor, or an attending (more experienced) physician?  How long have they been a resident or an attending?  

“Who would be performing this procedure?” – This is an especially important question to ask if you are in a teaching hospital or at home with the professional + student midwife.  Every family needs to make a decision regarding their comfort level with students literally practicing on you based on their individual preferences.  On a personal note, while I am all for students learning, when it come to my body and our child, I want a trained and experienced professional to work on us.  I am okay if a student wants to observe, however, only someone with extensive experience and knowledge is going “to do” something or administer something to us.  

“What else can we expect to happen, or which other interventions typically follow as a result of this drug or procedure?” – In the interest of full disclosure, this is a very important question.  1.) You want to know how they will measure the efficacy of the intervention.  2.) When you accept one intervention, it is likely that other interventions or compromises will follow.  If there is time, you want to hear all of the other interventions or protocol they will have to follow that may be a result of the first intervention you agree to have.  

“What happens if we choose to do nothing at this time?” – Back to full disclosure – there are ways to phrase things that force you to make an immediate decision.  If you ask this question, it tells you the other side of the story, or the whole story in regards to their recommendations.   

You have a couple of options in the event that you want to choose differently than your care providers are recommending and/or if you feel like your concerns are not being heard by your care provider. 
1.  If you have done your research and you have heard the benefits and the risks of a procedure or drug, and you are confident in your decision and want to refuse, hospitals have documents called “Against Medical Advice” that you can sign.  You accept the risks inherent in your decision and relieve the hospital of liability.  I have no idea if midwives have a  similar document…I will have to ask!
2.  In the hospital setting, you can ask for an Independent Patient Advocate.  This person acts as a liaison between the patient and the care providers.  It puts someone in between you and the care provider, and it is implied that they would convey information in a neutral way.  Sometimes taking away the “authority” of the person conveying the information relieves the pressure and lets a patient make a decision without feeling the pressure of “The Doctor” or “The Nurse”.  

Whether you are experiencing a variation of labor or a true complication, effective communication with your birth partner, with your doula, with your midwife, with the nurses and doctors will directly affect your outcome.  If you are knowledgeable about what normal variations of labor are, then you can have conversations about your care to determine the best positive outcome for your situation.  If you are not confident or trained in what to expect during the labor process, you may wish you had known a little more.   

Do you have any communication tips to share?  What are they?

Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.  


We are now enrolling for our
Spring Series
March 5, 2012 to
May 21, 2012  

For more information or to register,
please call us at
602-684-6567
or email us at

Energy for Pregnancy and Labor

Posted on January 10, 2012 at 9:37 AM Comments comments (0)

Energy in pregnancy and energy for labor I made the mistake of serving sweet gooey treats for snack in class tonight.  It got really quiet after we did our labor rehearsal – oops.

So what are ways of increasing your energy during pregnancy, or additionally, your labor, if you are feeling low energy?   

Abdominal Breathing 
 We talk about it often in class – deep abdominal breathing is one of the best ways to increase oxygen in your body while still maintaining a deep level of relaxation.   

 Chest breathing wastes a tremendous amount of energy.  
 “Chest breathing is inefficient because the greatest amount of blood flow occurs in the lower lobes of the lungs, areas that have limited air expansion in chest breathers. Rapid, shallow, chest breathing results in less oxygen transfer to the blood and subsequent poor delivery of nutrients to the tissues.”  
  - From http://www.amsa.org/healingthehealer/breathing.cfm  

 Abdominal breathing can also eliminate the vicious circle of the fear-tension-pain cycle.  By relaxing, you can stop the chest breathing that causes tension that causes pain; the pain causes fear; fear causes more chest breathing that winds up until mom and/or baby are showing signs of distress that leads to more intervention.   

Trace Minerals 
 Birth is an athletic event, whether you have a sprint, marathon or something in between.  The more vigorous your labor is, the more important it is to restore your body’s supply of minerals. Exercise and stress, both of which may be present during labor, can drain the body of electrolytes and trace minerals, elements needed to maintain proper fluid balance and recharge energy levels.   

 In addition, energy is passed through the body via electrical charges.  In order to work well, properly functioning electrical cellular communication is essential.  Minerals act as catalysts for the biological processes in the body, including muscle response, the transmission of messages through the nervous system, and the utilization of nutrients in food.  All of these are essential if you want the most efficient labor possible.   

 Strive to find a trace mineral supplement with a flavor you can tolerate.  At the very least look for an electrolyte drink that will help replenish the minerals you need and might be using up through the course of late pregnancy and delivery.   

Take a Nap 
 Whether you are tired during the day when you are pregnant, or feeling exhaustion set in during labor, a nap is a great solution to help mom and dad face their labor with renewed energy and confidence.  A twenty-minute nap is a very effective tool for increasing alertness.  If you can get a 30-60 minute nap it helps with decision-making skills.  Both of those would be beneficial in labor.   

 I wonder what students picture as the length of nap when we encourage them to sleep during their labor. I think most of them must imagine a 2-3 hour nap, think it is impossible and cross it off the list since so few of them have been able to nap in their labor.  We know from experience that sleeping can be incredibly restorative during labor.  If Coach can convince Mom that just twenty minutes will do her well, remind Mom she doesn’t have to hunker down for a long time.  Mom will not miss out on anything by sleeping just twenty minutes; in fact, you can drastically change your outcome by being rested.   

 So turn off the lights, wrap her in a comforting blanket and stroke or talk her to sleep with your soothing voice.  If Mom responds to music, find some relaxation tunes to play for her.  Maybe use an eye mask to block out light – it seems to be easier to fall asleep when it is dark.  

Go for a Walk 
 We encourage all our students to be walking at least twenty minutes per day from the first day of class until the day they have their baby.  Regular physical exercise not only increases stamina, it also helps energize the body.  During the day or during a low-energy point in labor, a walk might be in order.   

 A change in pace or scenery can help restore energy.  I am not talking about constant walking to speed labor, especially if you start with contractions that are more than ten minutes apart.  If your contractions start that far apart, a good meal and rest are in order to conserve energy.   

 My first question to a tired couple is, “Can you get mom to sleep?”  If that doesn’t work, it is possible that a walk around the building or around the block doing abdominal breathing will oxygenate and wake up your body when you need to restore energy.   

Eat protein-rich snacks 
 Click here to read my list of good choices for labor snacks.  They are high in protein and complex carbs.  I try to avoid processed sugars or starches that rapidly convert to sugar – no need to repeat the effects of a quick sugar up and down that we saw in class tonight!   

Drink water 
 If you are thirsty, you are already dehydrated and it’s time to get mom some plain water to get her fluid level back up.  In labor, the body is working in ways that you cannot measure.  Water is crucial to get the hormones that stimulate and regulate labor circulating effectively throughout the body.   

 Early signs of dehydration include thirst, loss of appetite, dry mouth and head rushes.  If Mom has a desire to eat, she needs to be eating to store energy for the point in labor when she is no longer hungry.  If this suppressed due to dehydration, she will miss out on her opportunity to store energy.  Head rushes can lead to an untimely fall, which could potentially change the course of your labor depending on the severity of the fall.   

 Continued dehydration can lead to increased heart rate, increased temperature, fatigue and headaches…which could also be construed as the mother going into distress.  You can absolutely head off a false distress warning in labor by making sure Mom is drinking eight ounces of water per hour, or chewing on ice if that is what she prefers.  If Mom is hydrated and this happens, then you know it’s time to pay attention and alert your care provider.   

 A side note on hydration: if Coach is good about getting Mom the necessary water, Coach also needs to be good about getting her to the bathroom.  A full bladder can lead to unnecessary pain in labor if the baby’s head is pushing against a full bladder.  It might also impede the progress of labor if the baby’s head is blocked from entering the vaginal canal by a full bladder.   

Figure out what works for you. 
 Conserving energy is extremely important because you don’t know how long you will be in labor.  There isn’t much we can control about labor if you follow the course for a natural birth.  You can influence how rested you feel.  It would be unfortunate to end up with medication, an episiotomy or a cesarean if the only factor for that choice is being too tired to make it through with the energy you needed to meet your baby.   

What are the energy saving or energy restoring methods that you use?  

 Would you like to read more about today’s suggestions?   

 For information on the minerals you need and how your body uses them: 

 Start a Walking Program While you are pregnant, focus on walking for energy and stamina.  After your baby is born you can consider the suggestions on walking for weight loss. 


Disclaimer:  
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.  
 


We are now enrolling for our Spring Series 
March 5, 2012 to 
May 21, 2012   

For more information or to register, 
please call us at 
602-684-6567 
or email us at 

What Type Of Labor Are You Having?

Posted on November 22, 2011 at 12:44 PM Comments comments (1)
We had the privilege of completing our sixth series as Bradley Method® instructors last night.  It is humbling to have couples trust us to help them prepare for the birth of their child – we always wonder if we did the best we could and break down every class on the way home.  We feel honored to have these wonderful people choose us as their childbirth educators given the variety of classes available to birthing couples today.
 
For labor rehearsal last night, we did an exercise in which we read out two scenarios: the “sprint” birth and the “marathon” birth.  It was interesting to hear some of the reactions our couples had to the scenarios.  Some of them felt anxious at different parts of the birth stories, or realized they weren’t prepared for the circumstances in the stories.  These reactions are exactly why we do this exercise.  As their due dates approach, we want them to consider and address any situations that might cause them anxiety.  By resolving these ahead of their own birth, we hope that they avert a ride on the fear-tension-pain cycle.
 
So how can you tell if you are having a sprint birth?  What does a coach need to be aware of in this situation?
 
The first sign might be that mom’s contractions start at ten minutes apart and last 60+ seconds.  The second indicator is that they continue to get closer despite a change in mom’s activity or position.  The third indicator is that she goes from wondering if it’s labor to acting serious and concentrated, totally skipping over the “putsy-putsy” and/or excitement that most mom’s experience.  The fourth indicator might be that her modesty changes from her usual modesty to losing it completely within a few hours of her first contraction.
 
If this is how your labor seems to be progressing, the coach needs to make a decision: how does he best support mom’s comfort and choices in labor while getting her to the chosen birthplace?  If you are having a homebirth and you want your midwives present at the birth, it would be a good idea to call your midwives when two or more of these indicators start lining up. 
 
If you are driving to the hospital or birth center, talk now and discuss what your ideal birth situation is: would you want to get there at transition with just enough time to check in and push?  Would you want to arrive with enough time to monitor the baby for a little while before the pushing phase starts?  Does mom need or want to make it in time for any medication (antibiotics, analgesics, anesthetics) to be administered before the birth?
 
In consideration of making a car trip, talk about how you can best get mom in the car – what will motivate her to move from her “zone” and get to the birthplace with the timeframe you want?  Know what your options are to get her to the hospital or birth center before you find yourselves delivering the baby with 911 on the phone line. 
 
An assistant coach or doula would definitely be an asset in this kind of birth story – they can help coach convince mom that all signs are pointing to the fact that they are having a sprint birth and it’s time for action in regards to calling the birth team to your home or making the trip to your birthplace.  As the labor is also intensifying quickly, they can help the coach support the mom through the sensations.  With a slower labor, the mom’s body has time to ease into the intensity that produces a baby.  If you are progressing quickly, mom is going to need a different level of emotional support to encourage her that she can see this labor through without pain medication although the pace of the sensations she is experiencing is possibly overwhelming.
 
Let’s look at the opposite scenario – the marathon.  We are experts at this type of labor.  Although it breaks my heart to write it, if you are on pace for a long birth story, nothing will speed it up unless your baby and your body are ready.
 
If your contractions start more than ten minutes apart and they continue in a very random pattern, you are likely to have a longer birth story.  The second indicator is if you change activities or your position and the intensity of the surges decreases and/or the frequency spreads out.  The third indicator is that walking doesn’t seem to speed the frequency or intensity of your contractions.  A fourth indicator is that you hold at one frequency of surges for two+ hours, and then when you establish the next pattern, you hold there for another two+ hours…and the mom’s body doesn’t seem to speed up the process no matter what you do to make labor progress.
 
If this is the birth story you seem to be having, there are two things we have learned from our experiences:  getting sleep, at a minimum quiet rest, is crucial to having enough energy once you get to the pushing phase.  The second factor is to have a coach who is emotionally strong for mom: they never show her any doubt.  The coach completely believes in mom’s abilities and conveys this with every ounce of their energy and their being.
 
Getting sleep is much harder to do when it’s your first baby.  There is the excitement of meeting your baby soon; the anticipation tied to discovering what you don’t know about labor…and the list goes on.  My point is that there are lots of reasons not to sleep.  If your contractions are very far apart and you are easily talking, walking and there are no physical or emotional signs of late stage labor GO TO BED.  Instead of watching the clock for contractions that are twenty minutes apart for two days, build and save your energy.  Eat if you are hungry, sleep if you are sleepy.  Trust birth and know that your baby and your body are figuring things out and enjoying the scenic route to active labor and the pushing phase.
 
Our experience with this labor pattern is that although baby and body are taking the scenic route, once they arrive at active labor and pushing, they decide to cruise at high speed into your waiting arms.  After two days of an easy, lazy pattern I would suddenly switch into high gear where I needed to chant and focus my energy to handle the intensity, and within a couple of hours of this switch would come the announcement that it was time to push.
 
It is of utmost importance that the coach reminds mom that her body is not "broken" and that you will be meeting your baby when the time is right.  It is easy to get discouraged even when you know what to expect.  For me it was always the hope that maybe this time would be different…and then it wasn’t.  Remind mom that there is a reason that you can’t see that is causing the slower labor and that it will all be revealed when the baby is born.  Our two longest births produced babies with umbilical cord issues – neither of them life threatening, nonetheless the cord had restricted movement during labor.  Bryan had his cord wrapped around his neck several times; Angelika had hers wrapped around her tummy.  As long as mom is okay and baby is okay, encourage mom to embrace her journey and sleep so that when you do hit the sprint to the finish line, she has the energy to run that sprint with all her might.
 
An experienced assistant coach or doula can help the couple recognize the signs that they are having a marathon birth and urge them take appropriate steps to conserve their emotional and physical energy.  They can help encourage mom to eat and sleep, and everyone should sleep when mom is sleeping.  They can read a relaxation script while dad does massage to ease mom into deep relaxation if she can’t sleep – at the very least she won’t be expending energy if she is resting quietly in bed.  They can help coach watch and assist mom in shifts if she refuses to sleep, because both dad and doula will need their full energy to encourage mom when she gets tired and wants to give up later.  When the time does come and labor finally starts to intensify quickly, they can help mom embrace the stronger sensations and help with any counter-pressure or assisted positions to ease the intensity. 
 
This scenario brings up the importance of having a back-up assistant coach or doula.  With our marathon hospital birth, we called in a second doula to help on the second day we were in the hospital.  She lent us all her fresh energy, and she came with new ideas and most of all, her encouragement that we were doing the right thing in letting our baby come, as he needed to come – slowly.  This also allowed our first doula the chance to go home and see her family – she came back refreshed and energized.  We all needed the sleep and recharge.  When our whole team was together again, we were working intensely – Bryan was born two hours later.

A last thought on a long labor: your birthplace will make a difference in your outcome.  In our hospital marathon, we were very blessed to have this birth with our third child.  We had history with the providers at our practice, and the two we saw on-call were happy to give us the time we needed since both baby and I were doing well.  You have to know that you know that your birth team will support your choice to have the birth you and your baby need, and that they will not tell you that you are "failing to progress" and you need to start taking interventions or head to the OR for a cesarean.  However, just being in the hospital added a level of stress to the whole situation - we were afraid that hospital policy might trump our doctor's evaluation of the situation.  I have a feeling many first time parents in our situation might start to be pressured to have a cesarean.

With our home birth, it was a completely different experience.  We were home with our children, so we were able to interact and love them the two days we were in labor.  Our midwives would check me and check the baby's heart tones, and reassure us that we were fine to keep going on - no vaginal exams, no threat of intervention - we just did what we needed to do.  On the third day when their sister was born, they got to enjoy the joy of the hard work with us.
 
I will close this post by saying that a good way to handle either of these scenarios is to encourage mom’s emotional relaxation.  If she is having a sprint, she will need your reassurance that she can do it despite the quick onset of intensity.  If she is having a marathon, she will need your encouragement that she is not broken and her body is doing exactly what it needs to do.  With loving support, we can and will do amazing things to welcome our children with power and confidence.


Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.
 


Now enrolling for our
Winter Series
December 5, 2011 to
February 20, 2012  

For more information or to register, please call us at
602-684-6567
or email us at [email protected]