It is true when they say that the second pregnancy is very different from the first. The difference for many is in the fact that your life is already packed with one child to mind the other one coming. If not for the daily reminders of the changing silhouette in the mirrors and some increasing signs of discomfort commonly associated with pregnancy I honestly tended to forget that I was pregnant, because I was plain busy. Busy with my firstborn daughter, busy with work - doula clients, placentas for encapsulation, DNA keepsake jewelry and busy with the household in general. While during my first pregnancy I went to the extent of traveling once a month to the reservoir in Mindanao to swim with the dolphins in order to work through my fears of childbirth, some Spinning Babies routines performed every other day (instead of daily) would be at best my outmost effort for my childbirth preparation during the second one.
Well … not quite true, I actually put a lot of emphasis on physical preparations. Natural birth champion Ina May Gaskin said “squat 300 times a day, you are going to give birth quickly”, so off I went and enrolled myself in the nearest CrossFit box. Eventually I might not have done 300 squats a day and not even daily, but I did do more squats in the six months I was working out in the CrossFit gym than I ever did altogether up to that point in my life. However, even though my gym membership was partially motivated by childbirth preparations, it still felt like I was working out for health and well-being in general and not so much as a conscious effort towards giving birth. Compared to the mothers I was working with as a doula, who were laboriously reading books, creating birth plans and watching inspiring birth videos, I was surprised to observe myself not doing any of the above. I guess there is a limit as to how much information one can take, especially when attending real life birth is part of your daily reality.
Yet, despite the general sense of business and not minding the state of pregnancy too much, I knew that birth was important and some conscious effort to envision it and make it happen was needed.
The first thing that needed to be figured out was the location. Having given birth to my first daughter Delphina at home, the daunting reality that it wouldn't be possible the second time around because of the home birth ban ordinance in Quezon City was a bitter pill to swallow. I understand the ban was passed in an effort to curb maternal and infant mortality rate among the most underprivileged communities by encouraging mothers to seek skilled prenatal care and promoting facility based deliveries, but there is always more than one side to a story. So here I found myself restricted in my birthing options and wondering what to do. What I also realized with increasing clarity is that I only wanted to work with my midwife Deborah towards my second birth. I think I could have worked something out with other QC based midwives regarding home birth, but not with the Shiphrah team who is based in Taytay. As long as the ordinance is in place they will not attend a home birth in QC, period. In practical terms it meant that if I wanted Deb to be my midwife I had to give birth in Shiphrah. As a doula I always emphasize that the choice of your main care provider as one most important decision you can make in your birthing journey. It should be someone whom you connect with on heart to heart level, who is completely aligned with your birth vision and whose professional skills don't leave any room for questioning. Deborah is the person whom I can entrust my life to, and it meant I was going to give birth in Shiphrah.
Secondly, a doula needs a doula!!! The choice of my doula was also an easy one. I've known Betty for more than four years ever since I embarked on the path of natural birthing during my first pregnancy. She and her husband Manny were essential in equipping Brady and me with knowledge and confidence for our first home birth, an experience that in itself spurred me to become a doula myself shortly after. Betty's and mine doula journeys are closely interrelated as we serve as each other's back up in case births overlap and often debrief on tricky birth situations. I love Betty's motherly touch to everything she does, so without any hesitation I proceeded to book a slot in her calendar for myself as soon as I transitioned to the second trimester. I remember we were on the phone discussing something related to the recent births when I breached the subject to her saying that I had a client to refer to her for April, that she was pregnant with her second child and was herself a doula. Also that “the client” was of Russian origin. It took Betty a while to crack the riddle until she finally caught up with the meaning of my message and laughingly accepted the "referral".
Now fast-forward to the days before the birth and the birth itself. Approaching term pregnancy I felt that something important needed to happen before I go into labour. I felt in excellent shape thanks to CrossFit training, I already amassed sizeable professional knowledge on the physiology of birth as a doula even before getting pregnant with my second child, what else needed to be done? Given that we, as humans, are three-dimensional beings - body, mind and spirit - I realized that it was the “spirit” part of my being that was yearning for attention. There was something very subtle that was bothering me and that something needed a space to be articulated, processed, clarified and let go if needed. I did not know what it was, but I knew how I could bring it out.
In many cultures a birth of a child is regarded as a rite of passage for a woman. It is one crucial event in her life, which can repeat several times with each child she conceived, that gives her an opportunity to transcend, reach deeper inside herself for strength and rise above her fears. This is why childbirth in traditional cultures is surrounded by a ceremony, which in the days leading up to labour and birth commonly involves a circle of women who share their wisdom, serve as a sounding board for her fears and anxieties and offer support to their sister’s birthing. I realized that I needed a ritual space, a ceremony with women sisters during which we would share our fears and anxieties, where we would find healing and accept blessings for our pregnancy and birthing journeys. Fortunately, soon after this realization I had a reunion with my doula Betty at the end of which we had a plan for a very unique one of the kind event – The Blessingway: A Journey into Motherhood.
The Blessingway event turned out to be my answered prayer. It is truly miraculous to observe what happens in a ritual place. We were joined by six other beautiful women mostly all pregnant mamas, some seeking a first time gentle birth experience and others a healing VBAC or simply a birth on their own terms. I had a double role, that of a co-facilitator and a participant myself. During the first part of the three-part ceremony, we let things go. With the symbolic help of the salt bowl and water we had an intimate sharing of our worries and concerns in regards to pregnancy and birth and life in general because everything is interconnected. I had to search deeply within myself for my deepest worry in order to offer it to the salt bowl and luckily it came out to the surface.
Having attended close to 70 births ever since embracing my calling as a doula I witnessed a lot of different birth scenarios. The majority resulted in beautiful gentle deliveries but some for one reason or another required medical interventions and eventually Cesarean births. This usually happens after we have tried out everything under the sun to correct a complicated situation. So many factors play out during the birth – baby’s size, position, angle; mother’s anatomy, spirit, mobility, endurance; gestational age, medical history, the way labour started; location – time limits in the hospital are different from the sense of time in a birthing center or home; attitude and support of the medical care provider and so much more. It is a great honour and joy to accompany each mother through her birthing journey, however approaching my own birth I realized that the births I had attended as a doula did change me and my perception of birth. Inevitably it became more nuanced and accommodating of different birth scenarios, even less desirable ones. I had to learn how to separate myself from my projected ideal birth scenarios for the mamas I am working with and accept what is being given in the journey of a particular mother while supporting her in her birth vision as much as possible. However, while acceptance of the changing birth scenarios in light of the difficult circumstances during birthing is great for professional work, what I needed for myself was a reaffirmation of my steadfast trust in the ability of my own body to give birth. In this regard dwelling on the complicated birth scenarios I witnessed as a doula was not helping me to find it. Through the ceremonies and rituals of the Blessingway I was able to unravel these very subtle doubts, bring them to the surface, articulate them and let them go. And not only this! The Blessingway also offered replenishment of positive energy through a special session of sound healing, reaffirmation of my birth vision through creation of my own power rocks and a shift of energy in my spirit when walking the symbolic birthing labyrinth surrounded by candle lights and women sisters. This process was a huge relief and a blessing!
Surprisingly, the very same night after the event I developed high fever, the first one in years! My body got covered with rashes and the next three days I was miserably sick. Mind you at my 38th week running high fever and practice contractions was no fun. I do believe, however, that the process of getting sick and getting better was a continuation of the purging of thoughts and feelings that did not serve my highest purpose, they literally had to leave my body through sweat and tears provoked by an unexpected viral infection. Once fever and rashes cleared I felt physically and spiritually ready to give birth to my baby.
April 13, 2017
38 weeks and 6 days
When I woke up in the morning, it felt like it was going to be another busy pregnant day. Just a few days ago I received a piece of extra equipment I needed for the breastmilk jewelry processing, so the plan for the day was to process around ten remaining breastmilk orders for preservation in the morning and to conduct a postpartum mama care session with a client in the afternoon. It was going to be a busy hot day and I was up to it!
Around 10 am I started having regular surges. They were of the same intensity as my practice surges for the last month as I was having lots of Braxton Hicks starting at the 30th week of my pregnancy. A few times they got really intense and regular that I thought it was already labour, but somehow I managed to slow them down with the change of position. On Thursday, however, the change of position no longer worked. With a tinge of excitement I continued working on the milk. Soon the process of work came to alternate with regular breaks every five minutes to breathe, moan and move my hips from side to side.
At 12 noon I am done with the milk. The reality of the immanent birthing time is sinking in and I message Deborah, Betty and Aisa, my birth photographer. “Yes, having regular contraction; yes, can still talk and smile through them; most likely later today”. As their “ready for duty” answers roll back in, I decide to get myself comfortable and that means stop working. With a bit of disappointment I cancel my afternoon postpartum mama care appointment with a client. I arrange a nice pillow nest on the bed and to my surprise hear myself moan as the next surge rolls in. It is still very tolerable, so I decide to stream the first episode of the mini-series “The Truth about Vaccines”. Care as I do about the vaccine safety issue I was looking forward to the release of the series and was not intending to miss a single episode, each only available for 24 hours for free viewing. Comfortable in my own bed I take in the pieces of valuable information in the documentary and hear myself moaning with an increasing intensity every five minutes. Delphina is getting fidgety with every moan and covers me in thousand of kisses to help me ease the discomfort.
At 3 pm my midwife Deborah is checking on me through text. My response: “Doing well. Can’t talk through the surges anymore, but can right after!” She points out that the roads to Taytay will be closed in a few hours because of Alay Lakad – a special procession to the churches located in Antipolo that takes place every year on a Maunday Thursday. I heard about those processions before but never for a moment have I considered that the traffic information in connection to Alay Lakad would be of any relevance in my life. Well, on that day it was and Deborah was strongly suggesting that we would move towards Shiphrah as soon as possible.
4 pm – the surges are getting stronger and I am hanging for my life on Brady and not letting him take his hand of my sacrum. His massage is such a sweet relief to now real discomfort in my back. Oh dear, I am having a back labour!!! It means I am having a baby in a posterior position. Gosh, all these spinning babies inversions every day did not help me to turn the baby into a neatly occiput anterior presentation. Again!!! The memory of my three hours pushing marathon with Delphina because she was a posterior baby does not give me any comfort.
The household is in commotion - our house helpers are loading the car, Delphina is asking one million questions about what is going on and where we are going, and whether it hurts and what more. Why all these questions to me? Can’t someone else talk to the four-year old child? But everyone is busy packing the car and I keep hanging on Brady for my life …and massage. All over sudden the prospect of him driving and no longer being in position to massage my back becomes the picture of hell.
5 pm – the car is loaded and we set off to Shiphrah birthing home. I assume an all-four position at the back seat surrounded by the pillows from home. I instructed my helper to bring all my pillows to the birthing center as to make it even homier. No massage on my back does indeed feel horrible, so my moaning becomes a sort of squealing while I try to soothe myself. Delphina in excitement crawls over to me and tries to comfort by kissing and stroking. It is very sweet but it’s not the back massage that I badly need, so I squeal again when the next surge rolls in. “Mama, I already kissed you, can you stop screaming now?!” “My sweet big girl, thank you, but NO I CAN’T” and I moan again to my heart’s content. Surprised, I take a mental note that I am much more into vocalizing my discomfort this time around and it feels good to make these sounds.
6 pm - we walk into Shiphrah, me with a pillow in one hand and a huge stuffed pig toy in my other hand. Betty, my doula is already there and meets me by the gate. We pass by the water birthing room and I notice the works of inflating the pool in progress. Automatically I turn left to the next room and thanks God, it’s empty and it feels like my sweet spot where I am going to labour. Contractions come in strong and it is nice to have Betty by my side. Deborah follows shortly after and checks in on how I am doing and feeling. I request her to assess the baby’s position and check me internally. For this I have to lie down on my back. If there is one least comfortable position for a birthing woman with a back labour, it is precisely that – laying down on her back. How do they do it in the hospitals? Of course it would be unbearable and epidural would be the sweetest drug in the world! Deborah assesses the baby’s position and as the next surge come in I jump on my feet, it would be impossible to stay on my back a second longer. In the vertical position the sensations are very bearable but no longer fun. For the internal exam I get positioned vertically on the birthing stool. Deborah tries to reach the cervix but it is far away, posterior and dilation can’t be assessed accurately, but it feels like 4-5 cm to her. And yeah, the baby is in transverse posterior position. With my suspicion confirmed we work out a plan of doing Lift and Tuck routine for ten contractions as suggested by Spinning Babies to help the baby rotate in a more favourable position and hopefully apply better pressure on the cervix.
6.30 pm - 7.15 pm - a matrass is thrown on the floor, candles are lit, my birthing altar with power rocks is in place and the labour is truly on-going. Deborah positioned herself behind me and wrapped my tummy with a rebozo. As the surge comes she pulls my tummy up and then in, oh dear God, this is so intense!!!! Betty pulls out her essential oils and I feel my back and neck massaged with something hot and spicy smelling. It feels good and the heat producing properties of the oils take my mind of the sensations in my abdomen and my back. The next surge comes in and with Lift ‘n Tuck in action it feels like triple force. Aisa, my birth photographer walks into the space gently. Two and a half years ago, I was her doula during her amazing home water birth, now she is there on the other side of birth witnessing her doula in labour. Click, click - goes her photo-camera. My birth team is complete. My train of thoughts is disrupted by the next contraction. Holy cow, that’s strong!! Surge, Lift ‘n Tuck, massage and me listening to a calming voice in my Hypnotracks. I am still alive, it all goes well. Then two or three more surges of the same intensity or more, NO it does not go well AT ALL! Then the memory of Deborah’s assessment comes back to my mind. 4-5 cm???!!! This is way too intense for 4-5 cm, this is just not fair!!! We are only starting and there is no way I can take another Lift ‘n Tuck, so I plead Deborah to stop. “No, this is too much for an early active labour. I need some rest. I need to go home. I will go home, have some rest and then we can resume the Lift ‘n Tuck” reasons the mind of a woman in labour, fortunately just in my mind without actually uttering it. Barely having finished this absurd thought the next surge storms in which feels like a tornado with the wind speed of 200 miles per hour, but instead of sweeping off the rooftops and uprooting the trees, the tornado contraction was about to permanently dislodge and carry away my perineum never to be seen again. At the same time I let out a sound that everybody in the room knew meant only one thing – the baby is coming.
“I wanna go pooooo” - the next thing I hear myself saying. Deborah: “Are you sure it’s poo? It might be the baby’s head pressing”. “No, it’s pooooo!” screams the birthing woman me, while the doula me chuckles “Don’t be silly, Irina. When you attend a birth, you would be the first one to reassure the birthing mom, that it’s not a poo, but merely a baby’s head pressing on the same nerve endings near the anus”. “Would you like to transfer to the room with the pool?” My birth team accompanies me to the opposite room where a professional birthing pool with a brand new lining is waiting for me to submerge in all its glory. “But the water is still cold!!!” I hear a panicked remark from ate Grace, Debora’s partner midwife for my birth. “Really?!! Well, then I will give birth sitting right next to this beautiful professional birthing pool” and I squat on the birthing chair near the pool. My doula Betty kindly offers her support at the back. While waiting for the next surge to come I decide to do what I often encourage other mothers to do when they start pushing – reaching out with a finger into vagina to feel the baby’s head, it must have an encouraging effect on the mother’s spirit. So I slip my finger in and to my surprise I find out that it doesn’t go any further than one centimeter into my birth canal bumping into the ballooning amniotic sac. Wow! That’s station +3 already, one step away from crowning. And then the next surge comes in with double tornado power shattering my female anatomy to its foundation. I am grasping my perineum with both hands trying to prevent it from being ripped from my body by this merciless force while at the same time I am feeling that a huge object is being pushed along my birth canal. By the end of the surge the object rests just on the surface. “The baby is crowning” I hear Deborah say. “But how come I am not even pushing?” a question pops in my mind, but I decide to let it rest for now having zero willpower to verbalise it. Still holding my perineum with both hands for dear life the next surge brings the head out. I feel it in my hands, but I don’t feel the hair or the skin, what I feel is the amniotic sac! What’s going on?? At this point I take my hands off while Deborah is taking over the situation. While she does the baby slips out entirely. “Born “en caul”, completely posterior with one cord coil around her neck” – I hear Deb’s quick assessment and after a few seconds I am holding my daughter in my arms, all in one piece with beautiful pinkish skin and dark hair. Welcome to the world, baby Daphne!
7.15 pm – 12 am My birthing angels are calling my family in the room. My unsuspecting husband was just thinking of putting his swimming trunk on to join me in the birthing pool like he did during our first home birth, but to his huge surprise Daphne was already here while the pool remained untouched. The wide-eyed Delphina approached cautiously to meet her sister while chewing on her favorite crackers. The next four – five hours pass by quickly in the oxytocin induced bliss. Placenta gets born some forty minutes after the baby. May be it could have been born earlier with the active third stage management, but we did not mind waiting. Daphne remains attached to her cord and placenta for the following two hours, making it three hours in total to complete her gentle semi-lotus birth. The roads of Taytay and Antipolo are completely blocked by now, so no one is in a hurry to leave, except for Deborah whose daughter was praying hard exactly at about 7 pm for the birth to finish quickly so that her mother could join the family for the pilgrimage walk. Her prayers have definitely been heard!!!
Amazed at the speed of the events we keep laughing and reminiscing on the recent intense moments. Yes, the second time births do tend to be much quicker and easier. One of my power rocks that I created during the Blessingway featured this magic work – “Easy”! I was sincerely hoping that it would be much easier the second time around and fortunately this visualization paid off. I got to experience the "spontaneous ejection reflex". Instead of intentional pushing, and in the hospital settings it is often times pushing with people around coaching you how to the count from one to ten. The spontaneous ejection reflex is about timing when the body is ready to release the baby, which consequently it does. Physiologically birthing is like voiding the bowels, it's an involuntary process, something that your body does for you no matter what. When the mother is relaxed during labour and well supported, her natural hormonal cocktail will enable her body to release the baby when her body and the baby are ripe for this moment.
And bravo to the Lift and Tuck routine from Spinning Babies! Up to the day of my own birth I did not use much of this technique in my practice, but I will definitely do from now on. It is often recommended for the situations when the baby is not yet engaged in the pelvis, but can also be useful to turn posterior babies. What it did to me was to turn a transverse posterior baby (the baby’s back towards the left side and back instead of towards my tummy) to completely occiput posterior (baby’s back aligned straight to my back). Apparently this was the most favourable angle for the baby to come out, more so without the rupture of membranes. Movement at birth matters a lot!
By 10 pm the pain was all gone, only the contracting uterus reminded of what just happen with a few periodic surges. If a tornado had after-blows similar to aftershocks in the aftermath of an earthquake, this is how the after-birth surges would feel. Close to midnight feeling stable and well tired we headed home discovering previously unknown ways around Metro Manila to get around the religious processions back to Quezon City. Having fallen in sleep in our own bed with a brand new baby by our side still felt almost like a home birth!
My Birthing Story: Delamar Arias
Delamar Arias, radio jock
Fiancée to musician/BPO executive Tyler Ashby
Mom to Cooper, 4, and Parker, 8 months old
Excerpt from Delamar's interview on Smart parenting:
My doula Irina asked me ‘what do you want?’ and I said ‘Irina, I want to own this pregnancy, this might be my last’ and we already talked about it. "I want to be awake, I want to be part of this birth, I want to be there, I don’t want to be sedated and I want to make sure that all hormones that are needed for breastfeeding start."
During my labor, Irina put this musical piece on loop and told me, ‘Remember when I was meditating in one of my pre-natal visits to your house and I told you to close your eyes and look for a word that will empower you, will make you feel safe, that will guide you through the pain? Call on that word now. You don’t have to say it out loud, just say it over and over in your mind’. That really calmed me down as she held my hand. Irina was like my lawyer; she’s the one telling everybody in the hospital, ‘This is what she wants’, because I couldn’t say it for myself. During the delivery she was telling me what was happening beyond the curtain so it made me feel part of the birth.
So I calmed down, and the next thing I know, they had pulled the baby out and he was crying so loud. Still I was so afraid that the doctors would tell me bad news. It can really drive you crazy.
When they laid the baby, I saw him and he was so big, he was so white and he looked like...an alien! They made him latch and he had a good latch, I remember, then they took him away. I was aware the whole time. I didn’t fall asleep from the time that I gave birth to the time that I was in the recovery room. Irina was there and we were talking. I felt all that adrenaline.
Read the FULL INTERVIEW on Smart Parenting website
My entire life, I have been scared at the thought of giving birth. I was scared of the pain, and I was scared of dying while giving birth. My father’s mother died giving birth to him, and something my mother said became ingrained in my mind: “Nasa hukay and isang paa pag nanganganak ang babae, pero pag binigay niya buhay niya para sa anak niya, dederetso siya sa langit. (One foot is in the grave when a woman gives birth, but if she gives her life for her child’s, then she’ll go straight to heaven for sure.)”
So when I found out I was pregnant, I studied birthing topics as if I’ll be taking an exam after the supposed 40-week period. In my pursuit of knowledge, I became confused and more scared, so I tried searching for people who can help me understand birthing. I learned about doulas and chanced upon Irina Otmakhova’s (Conscious Birth Manila) website where I learned about her workshop on Hypnobirthing and Fetal Positioning Techniques. This workshop changed my perspective about childbirth. Before, I was dead set on getting an epidural, and even considered a voluntary C-section. By the end of the day, I was 90% sure that I want a medication-free birth. A couple of months after that, Irina became my doula.
So for this birth, I had a doula, studied Hypnobirthing (Hypnobabies 6-week self-study course), adjusted my diet to what was specified in Hypnobabies, and did my best to exercise. I kind of failed in the physical fitness area. By the time I found a prenatal yoga class in our seventh month, I was placed on a fourteen-day bed rest due to spotting and contractions. When that period was over, I just shied away from physical activity, except for one pre-natal yoga session in my ninth month with Yogini Sonia.
T I M E L I N E
4th November — Irina came over in the morning for our second pre-natal session. Here, she taught us birthing positions, and some exercises to help with the waves (contractions) where we used rebozo and birthing balls. She also e-mailed me an acupressure manual for pain management and stimulation of labor. We even discussed the next appointment with my OBGYN where Irina will accompany me, and rounded up a couple of questions to bring up regarding my Birth Plan. We ended the session with a rehearsal of the birthing time, summing up all the techniques she taught us.
After the pre-natal session, my next goal for the day was to show our new maid the ropes around our apartment. My mom also arrived on the 2nd of November to keep me company whenever Ralph (my husband) is at work. After dinner, Ralph and I went to the grocery to stock up on food, and to purchase last-minute items in our Hospital Bag List.
Read the FULL STORY on Roxanne's blog.
If you’ve been following me on Instagram, you probably know I’ve been preparing for a normal (vaginal delivery), natural (unmedicated) birth.
As I always say though, I am aware that sometimes, things don’t always happen as planned, though what’s important is that you worked for it and tried your best.
Of all things I did not in any way consider nor expect, it was how my labor started.
This is my story with my firstborn, Pablo.
37 weeks – We visited our doctor for our checkup and it was the first time she did an I.E. (internal/vaginal examination) on me. According to her, my cervix was already about 50% effaced and I was about 1-2 cm dilated. I told her I was not sure but there seemed to be a little blood in my underwear the previous night, but I was wearing a black underwear (big mistake! lesson learned: do not wear dark underwear when on your 37th week onwards) so there’s a chance it might be a false alarm. She told me to just observe, asked me if I felt any contractions, told her not yet, but that I would keep an eye on them. Everything looked great so far! When we got home, a series of events happened that led me to thinking I was going to be in labor soon: I had diarrhea all day even though I was eating the same food, I also had irregular contractions for about 2 days, and I would have discharge every once in a while (which I never had throughout my pregnancy prior to this week).
38 weeks – No signs of going into labor. No contractions of any sort. My OB did another I.E. and I was about 2-3 cm dilated. She told me it’s impossible to be dilated without contracting, so maybe I just really wasn’t feeling it. I had a biophysical scan profile (a kind of ultrasound that measures the health of the baby) to make sure the baby was fine, and everything was going as planned. I was happy to reach at least 38 weeks! I wanted to give birth somewhere in between the 39th and 40th week because that would mean full term, but reaching 38 was good enough for me.
39 weeks – Still no signs of labor. No contractions. ...
READ the full story on Paula's website
Originally written for Glam-O-Mamas blog website
You are pregnant and you want to have a special experience with the birth of your baby. May be you psyched yourself up for an un-medicated normal delivery or you would like to go for a water birth. You might have read other women’s stories who consciously chose no medical interventions in birth or feel inspired by one of your friends who seem to be raving about her Hypnobirth experience. You might have a very clear idea of how you want to birth your baby or you might be still in the searching mode and rely on the help of your care provider to assist you with the gentle birth plan.
But then you have your next appointment with your doctor and bring up some points from your gentle birth plan, you notice they are met with a blank stare. It is even more discouraging when the blank stare is followed by remarks such as “Are you sure you do not want any epidural? You will be in so much pain, why do you want to do that to yourself?” or “No episiotomy? I always perform an episiotomy because I do not want you to look ugly down there”.
Big red flags here! An OB-GYN who shows no interest in your birth preferences or openly discards them during the prenatals will most likely not respect them during your birthing time. Given that most women give birth nowadays in the hospitals it is really your doctor who can make all the difference in your birth experience by being part of your gentle birth team or directly opposing it, thus leaving you in the mercy of the hospital protocols.
As a doula I always start working with my clients by asking if they are happy with their main care-provider – do you feel supported in their vision of birth? Does your doctor really listen to you? How much time do you spend with your doctor discussing your pregnancy progress? Does your doctor show openness to accommodate your birth preferences if they divert from the conventional medicated approach to birth? If you feel somewhat ambiguous or not completely sure in the support of your doctor in your gentle birth plan, it is a reason to seriously question if your doctor is the right person to be on your birth team.
Members of The Gentle Birth in the Philippines community share that it sometimes takes interviewing three to five doctors to find the one who is fully supportive of your birth plan. The group has also a growing list of highly recommended care providers that have a proven track record on gentle birthing.
Here are some main questions that you may want to take up with your care provider before settling for the RIGHT ONE:
1. “Under what circumstances would you suggest an induction to start the labor?”
Some doctors will only start labor artificially for genuine medical indications such as sever high blood pressure or pre-eclampsia, which is indeed a warrant for intervention. Judging by the accounts of the average hospital birth experience a large number of doctors routinely suggest induction on the due date or a few days after. Some doctors of Chinese descent even tend to pull out a “lucky calendar” suggesting the “lucky day” to give birth, meaning to be induced to give birth. The truth is that every doula and birth professional knows that getting your labor induced is the first step towards a Cesarean birth. Inform yourself well about the notion of term and due dates so as to be equipped with arguments and not be bullied into the Pitocin drip on your “Estimated Due Date”. The article “Evidence on inducing labour for going past your due date” by Evidence Based Birth is an excellent resource for this.
2. “What are your views on time limits during each state of labor?”
If you have given birth already and felt pressured through the process you might recall your doctor conveying to you after yet another internal examination (IE) that you are only dilated X amount of centimeters while you were supposed to be already fully dilated at most or hitting the transition at least. You would wonder – what is that golden standard of dilation you are being held to? The fact is that till the day of today the majority of OB-GYNs expect all women to dilate according to the “Friedman’s Curve”. Friedman’s curve is a graph that obstetric care providers have traditionally used to define “normal” length and pace of labor. If a woman’s cervix does not dilate according to this schedule, she may be diagnosed with “failure to progress” and taken to the operating room for a Cesarean. Mind however that the Friedman curve was originated as a result of the study conducted back in 1955 when most women in labor were sedated into unconsciousness by the “twilight sleep” and most babies were delivered by forceps. In the modern time most researchers came to the definitive conclusion that we can no longer apply Friedman’s curve to women of today’s world. Too many things have changed since 1955 in terms of the physicality of mothers (age, weight) and other medical interventions in birth. For more insights on Friedman’s curve read the article read the article “Friedman’s Curve and Failure to Progress: A Leading Cause of Unplanned C-Sections” by Evidence Based Birth.
3. “How often do you find it necessary to cut an episiotomy?”
There is a lot of misconception about how you will look like “down there” after giving birth and it seems like a lot of doctors capitalize on the fear of tearing by offering routine episiotomies (surgical cut of the perineum). Episiotomies can be indeed helpful in case of long or obstructed labor, however, when performed routinely they pose a risk for a mother’s well-being. The studies show that selective episiotomy policies appear to produce less perineal trauma, less suturing and fewer complications compared to routine episiotomy policies.
I recall when I accompanied once a first-time mother to the appointment with her OB-GYN we were discussing the birth process, when the doctor raised her hand and twisting her two fingers in a scissor like gesture she said: “…and then we deliver you from your baby!” Well, that was obviously a clear physical sign of a doctor with a routine episiotomy policy before the question was even asked. For more information on the topic read “Evidence Based Medicine: Episiotomy” by Mother of Fact.
4. “How will you feel if I want to be off the bed during labour and for the birth of my baby?
Imagine an elephant or a cow mother being laid on her back and her legs tied up on the stirrups. I guess anyone who would dare to come near the animal in this position should fear for his life. How come we have a situation where human mothers are forced to stay put on their back during one of the most athletic exercises of all times which is birth?! If you look closely at many traditional cultures you will rarely see a portrayal of a woman giving birth laying on her back. She will most likely be squatting or on her fours or leaning against her support person to let the gravity work with her body in order to release the baby. These same positions are possible in the comfort of your birthing room. You have the right to labor and give birth on the bed, near the bed, in the pool or on the floor if you like to.
Once I coached a second time mother in hypnobirthing techniques to make her second birth a more pleasant experience. The mother was disgruntled with her first birth experience where she was forced to lay on her back while the staff coached her to push. The second time around she was determined to claim back her power to birth the baby the way she wanted. So when the time came to push the baby out she jumped off the bed to utter dismay of the attending resident, found her comfortable squatting position supported by her husband and her baby was out in a few deep breathes. The resident had no choice but to squat together with the mother to catch the baby.
5. “How will you feel if I want to have my husband and/or my doula during the entire process of birth?”
Multiple studies have shown that the mere presence of a dedicated female companion other than the medical staff drastically improve the birth outcomes in terms of mother’s satisfaction and in terms of the decreased rate of interventions. Doula, a professional birth companion who provides emotional, psychological and informational support will stay by your side for the entire duration of your birth tending to your needs and guiding through the process where needed. A doula does not replace your husband but works in synergy with the birthing couple as a whole. Whether you decide to employ services of a doula or not, you have the right to a birth companion of your choice at all times, be it your husband, sister or mother. Unfortunately not yet all hospitals in The Philippines are on board yet in terms of allowing a birth companion inside the labour and delivery rooms, but the leading establishments such as Makati Med, both St Lukes, Medical City, Asian Hospital, Cardinal Santos hospital have all been welcoming of partner assisted births including the presence of a doula.
The bottom line is that the choice of facility and more so your main care provider is crucial for the success of your gentle birth plan. Make sure that your doctor is guided by the most updated evidence based research and not by the protocol for the sake of the protocol. Each birth even if you have given birth to several children is unique and sacred, and most importantly it is YOURS! Therefore, be critical and choosy with people you get on your birth team making sure they reflect and embrace fully YOUR vision of the birth of your baby.
Irina is a birth
keeper, mother and an advocate. As a certified Childbirth Doula and
Hypno-Doula she accompanies mothers through pregnancy, birth and postpartum to
ensure a joyful, balanced and pleasurable experience. It is her greatest joy to
see mothers to come out of birth feeling empowered, proud and honored.