Riding the Waves for a Great Hospital Birth
CIC’s most recent Healthy Birth Choices Workshop was on a popular topic which resonates with almost all expectant parents. With the vast majority of births across the US taking place in hospitals, how can we set ourselves up to have the birth experience we want? We are grateful to have been joined by midwife Katherine Roeltgen CNM, as well as new moms Sonia, Casey and Emma, who shared their experience giving birth in three NYC hospitals.
Sonia had originally considered planning a cesarean section and been afraid of the birth process. Through reading, conversations with others and Bradley childbirth education classes, however, her approach changed. She gained confidence in her body and came to realize she wanted an active, natural birth. When conversations with her OB made it increasingly evident that they were not on the same page, she knew something had to change. 28 weeks pregnant, she switched to midwifery care at an in-hospital birth center.
As they lived an hour and a half’s drive from the hospital, they planned to check into a nearby hotel in order to labor in privacy as long as possible. Her baby, however, had other plans. Sonia felt contractions begin around 1am. Over the next few hours they grew closer and by 5am were feeling quite intense. She followed her midwife’s and doula’s advice to have a glass of wine, soak in the tub and try to sleep as much as possible, but suspected her labor was progressing faster than they realized. Laboring in bed, in the tub and on her birth ball, she found comfort in moaning as she worked through contractions. The glass of wine “was like an aspirin”, she told us, raving about how effectively it numbed the intensity of the pain. Her doula’s back massage felt “like the most amazing thing in the world”. By 7am, her body was bearing down during contractions. She didn’t realize she was pushing, but was fairly certain she wouldn’t be going to the hotel. Later, she experienced a strong urge to push, and felt her waters bulge and then burst. With their doula’s help, they realized it was time to leave for the hospital. Sonia arrived fully dilated and pushing. With her midwife, doula and husband at her side and encouraging her to push her baby “through the door”, she gave birth to her son just 30 minutes later.
Sharing her story with us, Sonia emphasized the importance of trust. Trusting her body could do this and being able to trust her care provider were integral to her ability to achieve the birth she hoped for. Her childbirth education classes and reading helped her to understand the physiology of birth, replacing her fear of the process with confidence and trust that her body could do this. In labor, she was able to trust and follow the advice of the midwives she had actively chosen because she knew they supported her wishes. With trust and preparation, she told us, “no matter where you are, you can do this”.
When she learned she was pregnant, Casey decided to stay with the regular OB practice she loved for prenatal care. When labor began, it initially felt milder than the Braxton Hicks contractions she had felt all month. Around 4.30am, however, she felt a sudden strong contraction with which her water broke. From there things quickly intensified and by 7am she felt ready to go to the hospital. As she had tested positive for Group B Strep, she needed to be there in time to have two doses of antibiotics before her baby was born. She experiencing eight strong contractions over the 26 minute cab ride to the hospital.
Her doula (a back-up, since her own was at another birth) arrived just when Casey needed her – confined to the bed for her first dose of IV antibiotics, she had already been asked twice whether she’d like an epidural and was struggling. As Casey’s birth plan said she wanted to be mobile in labor, her doula encouraged her to stand up and use the bathroom, taking the IV with them. Told to lie in bed, Casey had not known this was an option! Her contractions on the toilet were an intense turning point. When they returned, her doula raised the bed and Casey leaned forward onto it, raising one leg to make more space as she felt her baby move lower. Asked to get back on the bed for her second dose of IV antibiotics, Casey asked to have it while in her current position, which unfortunately was not permitted. However, soon after, her OB arrived to perform a vaginal exam which confirmed that Casey was pushing her baby down. She encouraged Casey to try squatting, kneeling or all fours if she wanted to, telling her: “I can catch the baby in any position”. Her husband’s assurances that he could see their baby’s head coming down energized and encouraged her as she pushed him into the world. Just 3 pushes and 17 minutes later, her baby was born.
Casey took a meditative approach to her labor, focusing particularly during more challenging moments on observing her thoughts and sensations, then trying to let them go without judging them. At one point, her husband placed his hand on her forehead and reminded her to relax and smile, something she had wanted to do in labor to help her cervix relax, as per Ina May Gaskin’s teachings on “Sphincter Law”. She was also inspired by an image she had come across in an online birth video, in which she heard Gisele Bündchen describe surfing and riding the contractions like waves. This image stayed with her during her labor, reminding her that each contraction would crest and fade, and then would come a break: “I knew it was going to come down, and that was a relief to me”.
When Emma was pregnant, she decided to take childbirth education classes with her prenatal yoga teacher, feeling both were important aspects of her self-care in preparation for birth. She learned not only “what a normal birth would look like” but also to trust her body and that it would “do its own thing” in labor. She very much wanted to avoid an induced labor, particularly pitocin. However, the day after her due date she learned her cervix was not at all effaced or dilated. In tears, she called her doula, who reassured her this by itself was not necessarily meaningful. The range of “normal” is wide and some women are partially dilated for weeks, while for others change happens quickly once labor starts. Emma decided to try acupuncture focused on encouraging labor and, after treatments 2 days in a row, felt labor begin.
By midday, her contractions had become very intense and close together. Her doula suggested she take a shower, which may help to slow down the short, painful but not necessarily productive contractions she was experiencing. The shower helped Emma get on top of her contractions, retreating into her own zone and breathing through each one. She feels her doula’s support and advice helped them avoid going to the hospital too early in labor. Instead, she was able to labor at home for another seven hours, moving between kneeling and leaning forward on the couch (which, with her doula’s back pressure, helped relieve the intense sensation in her sacrum) and hanging from and “birth dancing” with her husband and doula. “It was intense”, her husband Zak told us. “Looking back I’m really glad I took the time to know what Emma’s wishes and priorities were,” he said, adding: “you’re going to love having a doula – it takes so much of the pressure off you”!
By 9pm, she was feeling very ready to move to the hospital. They called their midwife and made their way in. On arrival, the midwife in triage checked her and told her she was “only 5 cm dilated”. Deep in her labor, Emma was discouraged and noted to us how just one word or sentence can really encourage or discourage a laboring woman. Still, she said, being in the hospital made it feel very real that her birth was really happening. A new midwife came on duty and Emma felt a refreshed, positive energy from her. She felt safe and ready.
Over the next two hours, she dilated all the way. Towards the end, with a little cervix still left, she was told not to push while feeling an overwhelming need to: “It was like holding back a sneeze!”. 20 minutes later, she told her midwife “I can’t wait any longer”. Her midwife was able to push the lip of cervix aside and Emma began to push. Partway through her baby experienced some decelerations in his heart rate, which was extremely frightening for Emma and her husband, but quickly resolved by turning on to her hands and knees. She described her profound relief on hearing her midwife say, “oh, the baby really likes this position”. She also felt connected again with the time she had spent in cat/cow positions in prenatal yoga, preparing for these moments in labor, learning to move with her baby as he worked his way out. Finally, after over two hours of pushing and with her consent, her midwife cut an episiotomy. Emma’s son “came flying out – it was the most amazing feeling I’ve ever felt”! Laid on her chest after a few moments, he crawled to her breast and latched on.
Now more than ever, as so many hospitals and their patients are suffering the aftereffects of Hurricane Sandy, it is important to know your own birth preferences beforehand, discuss them clearly with your maternity care provider and make sure they are supportive of your wishes. Prepare a birth plan and be confident (particularly as the partner of a laboring woman) to voice your preferences and wishes to hospital staff on the day. Remember that you have the right to refuse vaginal exams or other care from a resident and can request that only your own care provider or their partner perform them. Similarly, if you feel your nurse is not a good match, you can speak to the head nurse and request to be assigned to someone else more supportive of your wishes. Perhaps the most important decision you can make is to become educated about birth and about your options for managing labor, interview several care providers and choose one whose philosophy matches your own.
For more valuable tips and advice, please see our Resources page on How to Have a Great Hospital Birth.