I’m really torn on the idea that a natural birth “just happens.” In some respects, a natural birth does just happen… in cultures where natural is the norm. But in our culture where the vast majority of moms have some sort of pain medication during labor, and 32% of babies are being born by cesarean(1), does it sound like a natural birth “just happens?”
So as an independent (read: out-of-hospital) certified childbirth educator and birth doula, here are my top 29 ways to have a natural birth. Why 29? Because that’s how many I came up with! Sorry I didn’t pick a “rounder” number.
1. Take a good class.
What qualifies as a “good” class? For starters, make sure the person teaching the class is not being paid by a hospital. I hate to sound all conspiracy-theorist this early on in the post, but unfortunately hospital childbirth educators are often given guidelines regarding what they can (and can not) teach. Whether those “guidelines” are actually written, or just implied is another matter. In the hospital class offered where I had my first baby (before I had a clue), the instructor spouted off crap like “Pushing on your back is probably the worst position to push in, since it makes your pelvis so small the baby pretty much can’t come out on its own. But it’s what the doctors want you to do, so it’s what you have to do.” Present-day Mandi would stand up and say “Ex-squeeze me? Did you just say that’s the worst thing for us to do, but we have to do it anyway? What the hell you been smokin’, hospital educator lady?” But unfortunately past-tense Mandi had no clue, so past-tense Mandi wound up with a slew of unnecessary interventions and a cesarean. An out-of-hospital class will generally equip you with the knowledge and skills that enable you to ask the pertinent questions to ensure that any procedures proposed are for a true medical need, and to know the drawbacks of the routine use of interventions.
2. Hire a doula.
I can’t even begin to stress the importance of this! According to DONA.org:
“Numerous clinical studies(2) have found that a doula’s presence at birth
• tends to result in shorter labors with fewer complications
• reduces negative feelings about one’s childbirth experience
• reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
• reduces the mother’s request for pain medication and/or epidurals
Research shows parents who receive support can:
• Feel more secure and cared for
• Are more successful in adapting to new family dynamics
• Have greater success with breastfeeding
• Have greater self-confidence
• Have less postpartum depression
• Have lower incidence of abuse”
3. Have a grandma who gave birth naturally.
So, do you have any control over this one? Nope. But it does help to have a family member of very close friend who gave birth to her baby(ies) naturally. Why? For the sheer “if she did it so can I” factor. After my first birth went so lame, this was one of my main driving factors while I planned my second. My grandma had all three of her babies naturally in the knock-em-out, drag-em-out era. My mom had both of her babies naturally in the 80’s. Knowing that they did it five times between the two of them helped to convince me that I could do this, too. And I did. Good birthing genetics isn’t so much the goal here (although it sure doesn’t hurt) as is knowing that countless other women have done this, and so can you!
4. Eat your protein.
Your body needs protein on so many levels. The basic functioning of your own systems. The building blocks for your baby’s body. But also for your own body to be able to produce albumin, which helps facilitate the massive increase in blood volume that a pregnant woman experiences by the third trimester. 80 grams a day is a well-agreed upon base for pregnant women. How do you do it? There’s no other way but to track it! It will take several weeks of tracking, but you will eventually get the hang of incorporating 80+ grams of protein into your diet each day. How do you know? Check the label on packaged foods, or visit http://www.calorieking.com/ for protein counts of unprocessed foods.
5. Choose wisely.
Does your provider support your desire for a natural birth? Or does he/she say helpful things like “It’s fine if you want to try, but don’t get your hopes up. Hardly anyone ever actually does it!” Just FYI, that’s not supportive. Nor is “I only do episiotomies when they’re absolutely necessary, and they are only necessary on 80% of first-time moms.” Just sayin’. That crazy old knight in Indiana Jones and the Last Crusade knows what’s up – “choose wisely.” If your doc has a 50% cesarean rate (like my first did before I had a clue), what do you think your chance of cesarean is?
6. Where are you going to give birth?
Are you going to a hospital/birth center with a reasonable intervention rate? Or are you going to Los Angeles Community Hospital(3) with their lovely 67.5% cesarean rate? What are your odds of having a cesarean at L.A. Community? Think that one over. Where does your birth place rank?
7. Do the friggin’ exercises.
Yes, I know you work 50 hours a week and it’s a million degrees outside. So just hypothetically, let’s say you knew your ass was getting dropped off at the starting line of a marathon in a few months. You had no say – you were most definitely going to be forced to run in this marathon. But even though you were being forced to participate in this marathon, there was a prize. You wouldn’t have to come in first, you’d just have to make it to the finish line. And the prize is a million dollars. Tax-free. How hard would you train for this mandatory million-dollar marathon? Pretty dang hard, right? Well, your baby is worth more than a million dollars, and like it or not, you are signed up for this marathon. Better get to training.
8. F*** negative friends.
Which is ironic, since that’s incredibly negative of me to phrase it that way, am I right? But why the hell does common courtesy get thrown out the window just because someone’s pregnant? If you wore a tee-shirt that said “I’m going for my doctorate in electrical engineering,” everyone would congratulate you and wish you the best of luck. Yet somehow, the big belly gives everyone permission to tell you how excruciating their own (medicalized, pitocin-laden) birth was, and how horribly you are going to fail at your planned natural birth. WTF?!?!? If people don’t have the common courtesy to give you a high-five and keep their negative shit to themselves, then F ‘em! Maybe they can be a friend again after you have your kick-ass natural birth.
9. Smile and nod.
Okay, so you can give negative friends a swift kick to the ass, but what about strange old ladies in the grocery store? The ones talking about how they “slept” (read: were drugged to the point of unconsciousness) through their birth and wonder why anyone would want to feel it? Just smile and nod. In one ear and out the other. Obviously you can’t kick a random old lady in the ass, so just smile, nod, and ignore.
…don’t do it
When you want to go to it…
Okay, now that we’ve all had that Fankie Goes To Hollywood interlude, seriously, relax.
Tensing your muscles during contractions will make what would feel like a period cramp suddenly feel like a stabbing pain. Relax. How? A comprehensive childbirth class (see item 1) will show you how. The key – actually doing the relaxation homework every day during pregnancy, instead of hoping it will all magically just come together the day you go into labor.
11. Never fear…
Your uterus is here! Okay, it rhymed. I had to use it. But seriously, fear is the first step in tensing those muscles, which is the exact thing we want to avoid in labor. How do you abolish fear? Take a comprehensive childbirth class so you understand everything that’s happening (see item 1).
12. Understand the process.
This is a continuation from above. When you understand the process of labor and birth, you are not going to tense up at each contraction. So how do we come to understand the process? Take a good childbirth class (see item 1). I’m sensing a recurring theme here.
13. Have birthy friends.
Whether IRL (in real life) or online, having the support of other natural birth mamas can make a huge difference in how you view (and thus handle) the idea of natural birth. If you are the only person that you have ever known who has considered natural birth, how do you think you will do? How about if you are in an online community with hundreds of natural birthers cheering you on? It makes a huge difference. Ideally a local natural birth group would be the best, but even a national one will have a huge impact in the level of support you feel.
14. Have a supportive partner.
Again, this might be one of those things that, depending on circumstances, you may not have much control over. Or do you? I’m not gonna pretend that everything is all sunshine, farts, and roses for all expectant moms. Unfortunately, some bio fathers are douchebags. But mom can choose someone else to be her “partner” during the birth if dad is a dip-shit. Mama’s mom, aunt, sister, friend or doula can be her constant support during pregnancy and birth. It is so important to have a reliable, loving person to support you during this time. If you have no support and can’t afford to hire someone, consider a doula in training. She can offer an immense amount of skills and support for often little or no fee as she gains experience.
15. Eat the rainbow.
Not Skittles. I’m talkin’ veggies, fruits, whole grains, and (if you eat them) eggs, dairy, and lean protein! A healthy diet is the single most important thing you can do to stay healthy and low risk. The Brewer Pregnancy Diet(4) is a great, common-sense way to make sure you are getting all of the needed nutrients for you and your baby every day.
16. No more crack sandwiches.
In my very first class, way back when, I was covering harmful substances during pregnancy and my very funny student quipped “Damn! No more crack sandwiches!” I still crack this joke in every class where I cover harmful substances, and it always gets a good laugh. We all know that crack sandwiches are not cool, but there are lots of other “social” drugs that are probably best avoided during pregnancy. Namely, caffeine(5), alcohol(6), and food additives(7).
17. Have a birth plan.
This is not a magic wish list that guarantees a perfect birth. However, it is a wonderful tool for solidifying your preferences that you wish to discuss with your provider. I understand why it may be tempting to keep your fingers crossed and just hope that everyone is on-board when you go into labor, but that’s not reality. It is so much wiser to discuss your desires well beforehand and work out any kinks that may exist. What if it’s more like the Grand Canyon than a kink? If it’s early enough you can switch providers to one that’s more in-line with your hopes. Hence the importance of completing the birth plan as soon as possible. My tips:
• Keep it to one page
• No 8-point font to fit more into one page. That’s cheating. 12 is fine
• Phrase things in a positive way. “I would prefer to have a hep-lock” vs “I hereby REFUSE IV fluids! May God help your wretched soul if you dare ask to administer IV fluids!” You still have the final say either way, but you catch more flies with honey.
• Include a brief few sentences at the top introducing yourself and conveying that this is your plan for a normal low-risk birth, and that you are flexible and open to discussion if medical complications arise.
18. Let that belly go!
I already covered relaxation, but I think special attention needs to be paid to the abdomen. It is utterly crucial that the abdominal muscles remain limp and loose, especially during contractions. No matter what position you are in, you should be able to just let your belly go. This is where good classes (item 1) and a supportive partner (item 14) come in handy.
19. Water, water everywhere… and you must have a drink.
I’m just gonna say it – ice chips turn into friggin’ water about a nano-second after you eat them, so what’s the big deal? Water is off limits, but ice chips that turn into water in the esophagus are somehow okay? WTF gives? In a case where mom is vomiting and can not keep down fluids, IV fluids can be a wonderful thing. But what about the other 98% of moms who are fine, yet are still told NPO (nil per os – nothing by mouth… yet somehow ice chips are okay… figure that one out…)? The alleged “concern” is that if mom ended up needing general anesthesia (which is rare), she might aspirate stomach contents. In the rare event of general anesthesia, when proper anesthesia protocol is followed aspiration is unlikely to happen. Although I have yet to find an “official” source, I have seen it quoted as less than 5% of cesareans (1.6% of all moms) who will need general anesthesia. So because of 1% (the vast majority of which would have no aspiration complications), we are denying the other 99% the right to water, the most basic of human needs? This makes no sense. The drawbacks of IV:
• Being tethered to a pole
• Fluid being pumped directly into your veins can dilute labor hormones, thus slowing labor
• Makes mom and baby swell. For mom, this may cause breastfeeding difficulties from swollen breasts. For baby, this may lead to an artificially inflated birth weight. When baby begins losing said “water weight,” to the untrained eye it seems that baby is loosing too much weight, leading to formula supplementation. All because mom had an IV instead of sipping water.
20. Snacks are your friend.
You will most likely still feel like eating during early first stage. Not so much during late first stage. Carb (and protein) up during early first stage. If you are getting fatigued during late first stage, it may be worth it to snack. Low blood sugar will only fatigue you and make your labor unproductive and more painful. Try light things, like a honey stick, plain yogurt, toast, or applesauce. Many women are told NPO at this point (see item 19). There is no scientifically justified basis for a blanket NPO order, so this is yet another reason to choose wisely (see item 5) and discuss your wishes ahead of time (see item 17).
21. “I’d prefer not to.”
This is a concept I didn’t grasp with my first birth. If there is a procedure proposed, and you are not given a valid medical reason, you always have the option of politely declining. Now I’m certainly not saying forgo interventions when there is a medical indication. But if something is just routine and not based in science (routine IV, anyone?), and if the staff can’t give you a medical reason pertinent to your personal situation, then you always have to option to politely decline. Calm and mature is the best way to handle these instances, as opposed to being the crazy screaming pregnant chick that no one is taking seriously. Just FYI.
22. The anti-Kegel.
I can’t stress this enough. We Kegel during pregnancy to tighten the muscle. This helps position the baby, encourages flexion, and helps to avoid injuries to the PC muscle during delivery. However, it is just as important to do the ANTI-Kegel during delivery. As the baby descends, you must be able to relax the Kegel area. I have seen moms holding their babies in (literally) by clenching the Kegel as they pushed, and as soon as I whispered “do the anti-Kegel,” baby starts descending like you wouldn’t believe. So, Kegel during pregnancy = YES. Kegel during 2nd stage = NO!
Immediate breastfeeding helps with bonding and provides the baby with immunities, but it also helps the uterus to contract, reducing the need for postpartum Pitocin, which may interfere with the intricate hormone balance needed for breastfeeding. Can’t breastfeed immediately? First off, I feel ya! My third baby was in the NICU for 10 days and couldn’t even eat per os for 5 days. I pumped like mad, and she had only my colostrum from the time when she could finally have a feeding tube, and eventually nursed (and by eventually, I mean that she is 26 months and still demanding “buboo!” So it all worked out okay.).
24. Complications, schmomplications.
Sometimes shit happens. I know that’s not very “positive” of me, but it’s reality. Sometimes you do everything right and something happens where it’s just not a good idea to have a natural birth anymore. Knowledge can have such a huge part in how you end up feeling after your “natural” birth ended up legitimately needing to be not-so-natural. If you had a sucky doctor and got steamrolled into a bunch of unnecessary interventions and a cesarean and perpetual self-doubt (past-tense Mandi with 1st baby), it is likely that you will be pissed after your birth. If you were knowledgeable and did everything right (present-day Mandi with 3rd baby), but your baby just really needed to be born by cesarean, then you will likely feel much more satisfied. I know I did! After my third birth, I was slightly bummed because I would not have necessarily picked a cesarean, but it was only a minor bummer because that was just how she had to be born. There wasn’t a single thing I could have done differently. Thank God we have cesareans, because she was just not doing anywhere near well during labor. Although I didn’t hope for a cesarean, I still felt like this was a great birth. It was the best possible decision with the hand I was dealt. And I honestly feel great about that. Damned empowered, in fact, because I understood what complications were happening and I was in on the decision process.
25. Cesarean can be our friend.
Again, this isn’t what you would normally read in a fluffy, feel-good natural birth post, but it’s reality. Sometimes cesarean is the only way to a healthy baby and healthy mom. My first birth was most certainly an unnecessary cesarean, and I was pissed. My 2nd was an all-natural VBAC (go me!), and my 3rd was a truly necessary cesarean. It happens, and it’s okay. Sometimes, no matter how “right” your choices are, cesarean is the safest bet. And although it sucks, it’s still okay. And it’s okay that it’s both sucky and okay.
26. A healthy baby is not all that matters.
It is the most important thing, closely tied with a healthy mom, of course. But it is not the only thing that matters. It’s okay for you to feel sad that your birth didn’t go as planned, for whatever reason, whether medically justified or not. There is nothing inherently wrong with being sad that your birth did not go as you had hoped. It can be beneficial to seek help if your feelings are impacting your life negatively.
27. It’s okay if it’s not natural.
Especially if you made educated decisions. Sometimes natural is not the best option in a particular case, and it’s okay. One of the most important factors is how you feel about your birth. If you made wise choices, but just happened to be dealt a lame hand, it’s much more likely that you will feel proud of your birth!
28. Know you did good.
So far, 86% of my clients have had a natural labor. Yet, as a doula, I have also been at births where an epidural was a great idea. Not often. Most births go natural. But natural is not the best for everyone. And I truly feel like my clients and students who have needed an epidural made a wise decision for their particular situation. I only urge you to look at the percentages. My clients go unmedicated 86% of the time. So when local hospitals have a 95% epidural rate, doesn’t that show the gap? Most women don’t have a need for an epidural. But a few do truly need it, and that’s okay if they were educated about the benefits vs drawbacks.
29. The family unit is key.
Bond! Bond immediately, bond often and bond well! Certified baby-friendly hospitals have rules about leaving the new family alone during the first couple of hours, but luckily even most non-certified hospitals have similar policies as they work toward certification. Skin-to-skin is the best option for warming the baby, as well as for comforting and breastfeeding. Baby knows mama and daddy’s voice at this point, so get to chatting! Even in a less than ideal birth situation, skin-to-skin and verbal bonding can be extremely beneficial to not only baby, but mom and dad as well.
Unfortunately, there is never a guarantee that you will have a 100% natural birth. But by following the rules above, most of my students do have a natural birth, and those that need interventions are confident in their choices. My students are overwhelmingly having satisfying experiences and entering into healthy loving relationships with their little ones.
Your choices in pregnancy make a huge difference… choose wisely!
Peachy Keen Birth Services
1 – http://www.cdc.gov/nchs/data/databriefs/db35.htm
2 – http://www.dona.org/resources/research.php
3 – http://www.theunnecesarean.com/blog/2011/7/19/california-cesarean-rates-by-hospital-2009.html
4 – http://www.drbrewerpregnancydiet.com/id96.html
5 – http://www.marchofdimes.com/pregnancy/nutrition_caffeine.html
6 – http://www.marchofdimes.com/pregnancy/alcohol_indepth.html
7 – http://www.livestrong.com/article/117114-additives-avoid-during-pregnancy/