Prenatal Yogini

A Doula's Thoughts on Cesarean Birth

When you think of a doula, what comes to mind?

Hopefully, you have a picture of a compassionate, non-judgemental, professional labor support person whose focus is on helping you through labor and delivery.  You may have considered the prenatal education that many doulas offer - pointers on books, local classes, breastfeeding preparation, or whatever else interests you.  Maybe you thought of how wonderful it will be to take the pressure off of your partner/spouse as your sole support during what may prove to be a physically and emotionally challenging experience.  This will allow him or her to focus on the process and delight in the adventure with you in a way that only your intimate partner can.  Perhaps your vision ends with a photo of happy faces clustered around you holding your baby - tired, elated, and falling in love with this new little person.

This is a wonderful image of doula support, and one that I think gives the impression of what is termed "normal" birth.  That is to say, vaginal delivery.  In the U.S., however, Cesarean rates have risen above 30%, which means that many women are choosing surgical delivery, or the circumstances of their pregnancy and labor are sort of choosing it for them.  If a woman has contracted with a doula, planning a vaginal delivery, and the circumstances change to a Cesarean, one may wonder if or how the doula continues to be needed.

 

Me with clients while baby is checked by pediatricians.*

First, let's be clear:  it is my belief that if a woman chooses a Cesarean, then it is necessary...for her.  In the birthing community, there is an ongoing bruhaha regarding Cesareans:  what's "necessary", what isn't, whether people should be allowed to elect them, whether the method is being pushed by the medical community.  As a doula, what matters to me is that my client feels like she is making the best decision about how to proceed with her baby's birth, whether it is what I would choose for myself is irrelevant.  I believe that women and families should have options, and that we must safeguard their right to choose what they feel is best for them.  I see those options as a spectrum, with very medical on one end, and unattended childbirth ("UC") on the other.  The spectrum includes all manner of things, such as epidurals, IVs, vertical birth, water birth, homebirth, elective Cesareans, birthing with the dolphins, whatever a woman feels is appropriate for the health and safety of herself and her baby.

So, first, let's look at a fairly common scenario - let's say I'm contracted with a woman who is planning a vaginal delivery at a hospital birth center.  She spends early labor at home with her partner, and calls me sometime in the morning to say that they're ready for my support.  I go to their home, or meet them at the birth center if they've already transferred.  I massage, dance, hip-squeeze, wipe her forehead, hold hot compresses, coo, encourage, and whatever else is needed for as long as she needs it.  Now it's late at night, and something has occurred that makes everyone believe that the best option is a Cesarean delivery.

Everything changes.  Bright lights are turned on, mama is prepped for surgery, partner is shown how to don the surgical frock, I am told whether or not I will be allowed into the OR (ultimately it's the anesthesiologist's call).  My client is wheeled away for more prep.  I wait with partner, offering continued support and encouragement.  Partner is escorted to the OR.  I wait.

If I am allowed into the OR, I continue to offer support to my client and her partner.  Now it's mainly verbal, or perhaps stroking her head to help her stay calm and relaxed.  Perhaps her partner needs a lot of support in order to stay present.  If baby is already out, I may be requested to go to baby or to stay with mama while partner goes to baby.  I'm probably handed a camera.  I move around discreetly, doing what I can to help while staying out of the way of the medical staff.

If I am not allowed in, I simply wait.  I tidy up the birthing suite.  I make sure that there is a cup of ice chips for when mama returns, as it may be all she's allowed for awhile and she will be thirsty.  I make sure there's food and drink for partner.  I go ahead and gather my labor support supplies, to help me be ready for my departure when the time comes, and to help create a clear transition between the laboring time and the "baby's here!" time.

In a non-emergency Cesarean the time from incision to baby out is about ten minutes.  From baby out to mama all closed up is about 45.  The post-op recovery may take place in the birthing suite (which is my experience thus far), so that's where I continue my support once mama and baby are wheeled back in.  The nurses will be busy with charting, taking readings, etc.  I focus on the family's well-being in other ways.  Is baby nursing?  How's the latch?  Is mama nauseous or shaking (from the anesthesia)?  How can we help her?  If mama feels talkative, we might discuss the day she's had, as I check in with how she's processing the experience.

I continue to offer verbal encouragement, and physical support as needed (More pillows?  Need socks back on?  Want more ice chips?).  My role is to be a calm, familiar presence.  I offer a counter-balance to the hectic process of surgery and strange faces - they have known me for months, I was helping throughout the labor, we have a connection - this is very reassuring as the mama tries to get comfortable with a huge change of plans.  In a nutshell, there is still a lot for me to do, and it isn't all that different from what I do after a vaginal deliver, when my support is less about "breathe, look at me, let is wash over you", etc. and more about becoming a non-intrusive helper to the new dyad.  At some point, usually an hour or two after birth presuming initial recovery is going well, I excuse myself and go home.  Just as with a vaginal delivery, I check in the next day either in person or by phone/text.  I may go and visit at the hospital, I definitely plan to visit a week or so after they get home (it depends upon my availability and the family's desire).

Papa holding baby on Mama's shoulder.  (Doula = photographer)

Even though the baby's transition from womb to air was different, the support I offer remains more or less the same.  A doula is still a vital help to the family, no matter how they end up welcoming their baby to the world.

This is getting long, so I'll discuss elective Caesarian in my next post.  Please feel free to leave any questions in the comments section!

 

* Pictures posted with clients' permission.

My Birth Bag

As a doula, I never know for sure how long I will be with a client.  Birth is unpredictable, after all, and my time with the family can be as short as a few hours, or as long as a couple of days.  I have to have a well-stocked bag of supplies (1) to keep me going, and (2) to keep mama well supported.

Many clients bring the essentials for their comfort with them to the birth center or hospital.  Of course, homebirth families have the convenience of home and comfort without packing!  Most birth facilities also offer a lot of support products, such as birth balls, hot/cold compresses, etc.  This is great, because it means I can focus on the little things that help me give a personal touch to the labor support that I provide.

I like to have my rebozo with me, as it can come in very handy for comfort measures or "sifting".  I also have a bottle of lovely body lotion from Earth Mama Baby Angel for rubbing mama's hands and feet.  It is lightly scented and has no toxic ingredients, which is essential.  I tote along a copy of Pregnancy, Childbirth, and the Newborn, and a copy of the family's Birth Plan.  I keep it pretty simple, preferring to focus on using my presence, voice, body, and heart to offer the bulk of support.

Then there are the items that *I* need.  My contact lens case and glasses, toothbrush and toothpaste, a Lara Bar or some other quick and easy food, change of clothes & shoes, extra ponytail holder, some cash for more food and/or parking, and an easy knitting project (for when mama is sleeping and papa is having a break).

This morning I got a call that a client's contractions had started during the night, so hopefully we'll be meeting her baby girl sometime today.  I'm putting my bag together now, with one change - instead of knitting I'm taking study material for the *three* tests I have next week!  If she dozes, I can sit for a bit and go through my flashcards.  Ah, the life of the doula-student!

Areas of Tension - the Throat

Today I'm going to talk about a major area of tension for pregnant women - the throat and neck.  Now, anyone who works at a desk or drives a lot (just two potential causes) knows about neck tension.  It may creep up into the back of your head, sneak up and into your jaw, or even slide across the tops of your shoulders.  As your baby and your body grow, the added weight "up front" can cause your shoulders to slump forward and down, causing even more tension.

What's a mama to do?

Prevention comes first.  Ask yourself:

• Am I staying warm enough?  If I'm cold most of the time, am I scrunching my shoulders up as I try to warm up?  Is my bedroom warm enough when I sleep?
• How's my posture throughout the day?  Do I slump forward at my desk, letting my upper back collapse?  When I'm standing, does it feel like my heart-center (just behind your sternum) is caving in?
• Do I grind my teeth or clench my jaw?  Jaw tension can aid and abet neck and throat tension (it's a chicken-or-the-egg situation).

Now that you've assessed, here are some suggestions to remedy the situation:

• Stretch throughout the day!  When it comes to stretching, it is really helpful to do a little bit here and there.  Give yourself a "body break" - make it simple by doing a shoulder, upper back, or neck stretch every time you get up to use the bathroom.  That way you don't have to schedule your stretching, and you know you'll have lots of opportunity!  ;)
• Notice if your muscles feel tense.  Practice observing how your muscles feel.  You can touch them to assess if they feel hard, even when you think you're relaxing them.  Neck muscles are notorious for staying tense even when we lie down for sleep...they know their job is to hold your head up, and they seem to "forget" that they, too, should rest!  If at first you can't relax your areas of tension, keep practicing with kindness and compassion.  These are muscles that work hard, and they're responding to many changes over little time.  Be patient, but persistent.
• Take time every day to relax.  If you're noticing that your muscles are tense even when you think you're at ease, and you're practicing relaxing them but the going seems slow, make sure to add in a 15 - 30 minute period of relaxation to each day.  Make it a time when you can lie comfortably (legs up the wall pose, side-laying Shavasana, whatever is comfortable for you on that day), tune in to your heart and your baby, and let go of the business of your day.  This will train your nervous system to relax, which will help your muscles get the relaxation message better, too!
• Gently rub raw sesame oil into your sore muscles at least daily.  This will not only feel good, but the raw sesame is a safe and useful anti-inflammatory.  You could also try applying warmth to the area, using a heating pad that you heat up in the oven or microwave.

Yawning is a great way to relax and stretch your throat and jaw!

Energetically, the throat is closely related to the pelvic floor and up into the birth canal.  You could think of your birth canal as another throat.  If your throat/neck is tight, chances are you also have tension in your pelvic floor/birth canal.  This is why it is so important to relax your throat during delivery!  We often don't realize the tension that creeps up, but the sounds you make will give it away.  If you're making high-pitched sounds, there's tension.

Try it now.  Make an "eek" noise, like a little scream, and notice how your throat feels. 

Now make an OM sound, nice and low-pitched.  If you aren't familiar with OM, then make a low-pitched humming sound.  Do you feel the difference?  Did you notice that the sound vibrates in your head, throat, chest, lower abdomen, or maybe all of those areas?

During delivery, making low-pitched moans and groans helps keep tension out of the throat.  This, in turn, facilitates the opening of the birth canal as your baby descends.  You may have experienced support people (such as a doula) who encourage you to make lower sounds as you get closer to delivery.  Now you know why!

As with any physical preparation for childbirth, it is helpful to practice relaxing your neck throughout pregnancy.  If you have persistent neck tension, talk to your yoga teacher, prenatal massage therapist, or chiropractor about additional ways you can treat it naturally.

Safety note:  There are pressure points along the tops of your shoulders, just where a friend's thumbs would work as they massage your upper trapezius, which can trigger contractions.  That is why I recommend avoiding deep massage in that area during pregnancy.

Standing Poses in Pregnancy

Today in my Prenatal Yoga class we worked a bit on standing poses.  This family of poses is excellent for maintaining and building strength in the legs, torso, and arms.  In Purna Yoga we use standing poses to create a stronger sense of "rootedness" - that feeling of being solidly present on the earth, and in your life.  This is very useful for pregnant women, who can feel tossed about by ever-shifting emotions, hormones, opinions, advice, etc.  In addition, standing poses offer a wonderful opportunity to stretch the hips, sides of the waist, and leg muscles.

There are some important considerations to apply during pregnancy:

• Keeping Your Balance - Many things affect balance, from hydration levels to hormone shifts, so it is important for pregnant women to feel that they are steady on their feet during standing poses.  Depending upon how far along the pregnancy is and how you're feeling during the practice, you may choose to simply adjust your foot position (wider gives better balance) or to stand with your back against a wall.

• Avoid Pelvic and Belly Pressure
  • Some poses, such as Virabhadrasana II (Warrior II), are not recommended until after you have felt your baby move.  Then, it is great to do until or unless you feel too much pressure in your pelvic floor.  In that case, it's time to move to a chair for support.
  • Other poses, such as Parsvottanasana, would put pressure on your belly (and therefore your baby) if you were to do the full pose.  Modify by placing your hands on the wall, with your torso angled to whatever degree allows you to feel the opening without putting pressure on your belly.

• Easy Does It on the Lower Belly Lift - It can be hard - and inappropriate - to properly support your spine with a lift of the lower belly when you're pregnant.  When you're pregnant, rather than lifting the lower belly in and up, focus on a strong lift of the pelvic floor, accompanied by a mild lift of the lower belly (no inward movement, though).  Remember, you're trying to avoid putting undue pressure on the belly.

• Don't Overdo It - Whether you practice a flowing style of yoga (such as Vinyasa), or an endurance-style (such as Iyengar), remember that pregnancy is not a time to challenge yourself.  Practice each pose for three to six smooth breaths, giving yourself permission to come out of the pose early if your body tells you to do so!  Develop your understanding of your body's signals so that you can differentiate between wanting to come out of the pose, and needing to come out as a way of caring for your body.
  • Some indicators that it's time to rest include feeling hot, shaky, dizzy, lightheaded, or simply fatigued.

Remember to use your practice as an opportunity to care for yourself, body mind and spirit, while connecting to your baby.  As you do your standing poses, you may notice your baby is lulled to sleep, or she may wake up, roll around, and do some yoga of her own!  Notice those trends, just as you notice the changes in your body, and your prenatal yoga practice will become an even more memorable part of your pregnancy.

New Prenatal Yoga Class!

I am so excited to announce my new Prenatal Yoga class at Purna Yoga Centers in Bellevue.  I've taught the Wednesday evening (5:45 - 7:15) prenatal class there for many years, and now we finally have two weekly classes again!  The lovely Zofia is taking over the Wednesday class.  My new class is on Sundays from 1:30 - 3.  This is such a great time slot - after Sunday morning activities, but leaving plenty of time to enjoy the benefits of your practice for the rest of the day.  It's also a great chance for Moms with a child at home to get away for a little while with (hopefully) fewer childcare challenges.  Moms who have recently delivered and are ready to practice yoga again are more than welcome to come to the prenatal classes!

Prenatal Yoga is a wonderful way to care for yourself and your baby during pregnancy.  We teach techniques to help you deal with the common discomforts of pregnancy while preparing you for childbirth.  These include gentle stretches and toning exercises (what you might imagine when you think of yoga) and also breathing techniques to calm the body and mind and guided meditations to help you connect with your baby.  We have short discussions at the beginning of class to give each woman a chance to connect with herself, her baby, and the group.  Each time you practice yoga, you learn to listen to your body's needs and connect with your inner wisdom.  People are constantly offering unsolicited advice to pregnant women; it's so important to take time to "just be" and learn what feels right for you and your baby.  The connection you practice during yoga helps you do just that!

As a doula and childbirth educator, I look for opportunities throughout class to share the kind of valuable information that will help you be an informed, empowered Mom.  I teach many comfort techniques that are very useful for handling labor and delivery, giving you time to practice them before you need them.  I welcome questions and feedback, and always look forward to supporting women through this amazing transition.

If you have questions about the class, the New Student Special, or Purna Yoga in general, please contact Purna Yoga Centers at 425.746.7476.

If you would like to speak with me specifically about how I teach or about my other services, you can reach me through my contact information listed here.

Happy New Year!

Arya

A Baby Catcher is Born

 

One of the realizations I made during my springtime quietude was that it is time for me to become a midwife.  On some level I have known this for a long time, but I didn't want to know it.  I thought it was the forgotten dream of an ardent eighteen-year-old, no longer applicable to my life.  It was at that age that I first learned about some of the common interventions used in childbirth.  I was appalled, and outraged that birth seemed to have become something that happens to women, rather than something that they themselves do.  I wrote a paper for school entitled, "The Dangers of the Medicalization of Childbirth" (this was in 1995) and learned about the midwifery model of care, which views pregnancy and childbirth and normal and healthy.  Then I realized that I didn't actually know any midwives, it was illegal in many states at the time, and I had no idea how one became a midwife.  I wasn't interested in becoming an activist, I wanted to be a midwife.  I shrugged off the fleeting dream of what I might do when I grew up and continued going about the business of being a college student.

And yet...my course of study continued to focus on women, empowerment, the body, health, reproductive issues and rights, sexuality education, and eventually Purna Yoga, specializing in prenatal yoga, and becoming a doula.  This move to become a midwife feels like a development of, not a diversion from, my current work.

This morning on our local NPR station the topic of the 9am show is Natural Childbirth.  The ad stated that less than 1% of couples choose a non-medicated, little to no-intervention birth (they didn't state whether that was local, state-, or nation-wide).  That means that less than 1% of childbearing women have faith that they can do this thing that our bodies are, with few medical exceptions, perfectly capable of doing with zero "help".  What has happened to our sense of strength, our power, our confidence?  What keeps the other 99% of women from choosing a way of giving birth that maintains the sanctity of this journey, the well-being of the infant, and the mother's sense of unmitigated confidence in her abilities**?

I want to become a midwife because I believe in birth, I believe in women, and I believe in babies.  My path holds challenges, to be sure, but I am finally, happily, ready to face them.  I will be the change I wish to see in the world.  I will be part of the movement to ensure that families have choices when it comes to where, how, and with whom they welcome new little people to the world.  I will be an activist, if that's what it takes.

You can follow more about this particular journey at my sister-blog:  Prenatal Yogini

** Disclaimer:  I am thankful that we have so many choices when it comes to prenatal care and labor/delivery options.  My bias is clearly toward "natural" childbirth, but please do not take that as an indictment against those who choose other methods of labor/delivery.  I am not judging those women.  I may, however, judge the practices that have become so commonplace - often in spite of clear scientific evidence that they are not safe or effective.