7 Steps to Owning Your Hospital Birth

You're about to give birth in a hospital.  Perhaps you're a bit nervous about how you will be treated, or about what kinds of things the health care providers are going to do with your body while you are in the throes of labour.

As a doula, I attend birth in every setting: from home births, to births in free standing centres run by midwives, to births in hospitals with family doctors or obstetricians.  A beautiful birth experience can be had anywhere.  In a hospital, however, there can be a seemingly endless sea of unfamiliar people tending to you.  Many only know your name by looking at your chart.  Fewer have time to get to know what you truly want or don't want for your birth.  This is where your need to use your  voice to stand up for your wishes (whenever possible) becomes important.

These are some tips to help you feel like you have some influence within a situation like childbirth, which can be so very unpredictable.

1)  Know Who Delivers

This is not about knowing the person who will deliver your baby when it is time.  In many hospitals, you will have no control over this, and likely, this person will be a stranger.  What it means is knowing who the power of birth giving belongs to.

A prevailing attitude among birth givers in our highly technocratic birth culture is: "Women have been having babies forever, so I'm sure it will be fine.  I trust my doctor to get my baby out."

There is a dangerous discrepancy in this statement. There is the intuition to" trust my body", but then the responsibility left entirely in the doctor's hands to "get my baby out".

Though it is acceptable to say that doctors and midwives deliver babies, if we look more closely at the truth of that, if all is going well, all they really need to do is "catch" or "receive" your baby as you give birth.  Most health care providers admit that in a normal birth, aside from a little vigilance, encouragement, and a few reasonably simple safety measures, it is you who does all the work.

After the blood, sweat, and tears of birthing a baby, the glory of delivery belongs to YOU!  Nobody can have your baby but you. Step into and deliciously own YOUR power and agency in bringing forth life.

2) Don't Leave it to Chance

The "whatever happens, happens" attitude towards childbirth does have its benefits in some ways.  It is important to be flexible when it comes to giving birth. You can certainly have a goal. Relaxation, a trust in your birthing magnificence, and positivity lend beautifully to the crafting of and realization of your birth vision. Sometimes, though, your little passenger within calls some of the shots regardless of your hopes. Finding the balance between your expectations vs the reality of your birth's unfolding will leave you ready for unpredictability.

Leaving it all up to your hospital care providers and luck, however, can set you up to feel quite discombobulated if you're not prepared for certain things. You don't want things to be shock on the big day,  like the reality of the sensations of labour, or the fact that anesthetists (if you want an epidural) aren't always available when you call them. You also don't want to miss opportunities to feel more comfortable, and should know that in many places you CAN eat if you're hungry and NOT lie on the bed if you're not happy there. Just because you're led to do something, doesn't mean you have to do it if you don't like it. Ultimately, if you don't know your options, you don't really have any.

It is so important as a pregnant person to take the time to explore how you would feel most powerful and satisfied giving birth.  It doesn't really matter how, as long as you feel GOOD about it! Envision yourself giving birth. What might you like or not like? What makes you feel better when you are stressed out and in pain?  What are your values about giving birth? Do you want to to allow your birth to unfold as normally and naturally as possible, or do you feel like pain relief would be a great option for you? So many things to think about!

How do you begin to look at these options?

3) Educate Yourself

Nothing beats good childbirth education which focuses on your empowerment. A prenatal class that spends more time on describing the sensations of labour and how you and your partner (if you have a partner attending your birth) can cope with the experience is an excellent idea. This is important even if you plan on having an epidural early on. Why?  Because it is not feasible to expect you can co-opt all your sensations to be relieved by drugs as soon as you want that to happen. Not because you shouldn't want that if that is your comfort zone, but because in a busy hospital, things don't always go that way. Many birth givers have to wait much longer than they wanted for their pain relief, some having their babies come before the pain relief got there. Sometimes they receive a desired epidural, only to have it not work as well as they'd hoped. So having a few solid coping skills under your belt can ensure you can navigate the sensations of birth no matter how things happen. This can reduce the incidence of shock and birth trauma.

A good childbirth education series should not push any kind of agenda, but be open and inclusive to all your potential choices, informing you the important things to expect, and how to speak up for yourself.

4) Know Your Rights

Hospital birth givers have rights. Often, you can find these rights published. This is what we have here in Quebec:
Women's Rights in Pregnancy and Delivery in Quebec

Here are some examples:

a) You have the right to eat and drink as you please in labour.
b) You have the right to be informed of the benefits and risks of all medications and procedures
c) You have the right to informed consent and informed refusal.
d) You have the right to labour and deliver in any position that suits you.

Research the rights in your area!

5) Use your BRAIN

When making decisions about your care, keep the following in your mind so you can make the best decisions for yourself.  It is important BEFORE you give birth to have an idea of what you want or don't want so self-advocacy is easier, but if you are presented with something you're not sure about, use the following questions as a guide:

B-What are the BENEFITS of the medication/procedure being offered?

R-What are the RISKS?

A-Are there any ALTERNATIVES to what you're offering? (example: having a snack and going for a walk up and down stairs to try to move labour along instead of medication)

I-What does your INTUITION say? Your motherwit, meaning your innate, practical intelligence and common sense can be more active than you imagine in labour. What does your gut tell you?

N-NOW? Health care providers are usually really open to giving your body a chance to do its thing normally, so don't be afraid to ask. Also, the word NO is allowed to be said! Even if you choose something the caregivers aren't fond of, if this is your conviction, you have the right to say NO. "I do not consent." is a phrase that holds a lot of power.  Parents often worry that a doctor or nurse will walk out of the room and abandon them if they make unpopular choices, but this is not the case.  Practicing in pregnancy how to deal calmly and effectively with other people's reactions to your choices can give you confidence. Most often, you will find your caregivers on your side and will be very happy for you if you have the birth experience you were hoping for.

6) Get Your Partner on Board

As many birth givers realize when the heat of labour is on, all of the above gets very difficult to implement because the brain goes from think-y to primal. Even just talking, never mind intellectual discernment, becomes challenging as the waves of contractions sweep you off into the hormone- hazed mind trip that is Active Labour.

Ensuring your support person knows your wishes allows them to do some advocating for you.  Nobody can ultimately speak for you in labour, however, they can relay the wishes you communicated to them prenatally, "Pat was wanting a hep lock for the Step B treatment instead of the whole IV setup," for example. Your partner is generally your strongest ally, and often being one of the child's parents, they have a say.

Many people create Birth Plans or Birth Preference Sheets to articulate their desires in labour. This can be helpful IF you have the type of hospital in which caregivers have the time to read them.  Many don't.  Personally, I have never seen a birth plan make the difference between a good birth and not.  Birth Preference Sheets or Birth Plans are more effective as prenatal tools to help you explore your options and clarify your values than something to actually bring to the hospital.  They don't "protect" you from anything. Only your voice really does that.

7) Hire a Doula

"If a doula were a drug, it would be unethical not to use it." -John H. Kennell, MD

While a doula cannot and will not assume to speak FOR you in labour, they will respect and uphold your sovereignty as a birth giver. They have spent  a fair bit of time with you prenatally, getting to know your hopes and fears, gathering ideas of how to tailor their support techniques to suit your own individual style. They also know what your partner needs to feel safe and supported.

If your doula knows, for example, that you expressed a strong desire prenatally to push your baby out in the hands and knees position, and when the time comes you find the nurse turning you onto your back and putting your feet on the pedals, your doula will probably gently ask you, "Are you comfortable like this?  Is this how you want to deliver?"

Your doula will not jump in and say to the nurse, "Hey, don't put my client on her back!"  Why?  This will create tension in the room in a big way, which is the last thing you need.  Your doula will not say, "Let's get on your hands and knees.  That's how you wanted to be, so let's get you off your back now."  Why?  Because you might have changed your mind.  There is a possibility you are actually super comfy the way the nurse is positioning you and find you want to be this way after all.  Your doula will not assume.

A question like, "Are you comfortable this way?" gently nudges your hormone besotted mind to remember what you valued prenatally. It is okay if that value has changed, but the doula wants to make sure things are going how you want.  The question allows you to say, "Yes, I'm good like this." or "No, Nurse, this is not what I want."  This is the subtle, elegant way doulas serve as supporters of your self-advocacy, leading you to use your own voice whenever possible.

While experienced doulas are experts in informing, comforting, and supporting a birth giver and their partner/s, they don't generally claim to offer "expert advice".  Why?  Because their job is to shine a light on your personal power and have you claim your own expertise as the one who makes, carries, births, and parents this baby/ies.  Your doula supports your work to step into this power that is already yours, and celebrates you as you own your birth.

Have a strong and wonderful birth!

Lesley Everest
MotherWit Doula Care
www.MotherWit.ca

A Doula's Daily Practice

Fellow doulas and friends often ask me how I find time to have a daily Personal Practice. I sometimes wonder that myself! But the cost of not having one is far greater than finding the time to sit with myself each day.

What is a personal practice?

It can be anything that allows you to focus your energy inward and observe the musings of your mind in an unattached way. Sitting quietly and: breathing, listening to mantras, reciting mantras, and listening to music that inspires you. It can be done while doing yoga, stretching, running.

What will happen during this time?

The reality of starting a daily practice is that in the beginning it will feel like your brain is firing off fireworks, spinning, jumping from one thought to the next like a slippery fish you are trying to catch and wrangle into your net. This is very common and a wonderful place to observe your patterns and inclinations to control, or give up, or surrender.

When I was growing up by the sea in Costa Rica, we were always warned about the power of the ocean. We were left to our own devices most of the time, and as a consequence we were very strong swimmers. However, the tides and currents of the Sea have their own intentions and plans. It was common to be caught in a current that would drag us away further and further from the safety of our friends, and the shore. If this happens, the adults would tell us, allow yourself to be taken, do not fight, and eventually the current will bring you back.

This is, of course, easier said than done. The first instinct is to panic, to struggle, to cling to the familiar, to fight to stay in the safety of what you know. But we were all dragged out to sea at one moment or another, and as promised, the currents would bring us back.

It is the same thing with taking some time to have a Personal Practice.

At first, your mind will feel that it is drowning. Let me make that shopping list while I’m sitting here instead of observe and listen. What may pop up? I don’t want to hang out here with potential feelings of discomfort, or pain, or God forbid grief. I don’t really want to sit here and “be grateful” for things, geez, I AM grateful! Ok, is it done? Has 10 minutes passed? I need to MOVE. How much longer? I have things to DO.

And the inner dialogue continues. But eventually, like with the currents of the sea, you realize that you will be in this place for a while, and that perhaps observation is a good way to pass the time. Stay afloat, and feel the sunshine, listen to the birds, to the silence of being in the ocean. Sit quietly, focus on your breathing, and allow your thoughts to be a movie that plays in your mind’s cinema. Find a place of stillness.

Eventually 10 minutes extends to 20 and pretty soon you are sitting for half an hour, in stillness and silence.

Why is this important and relevant in my life as a doula, or as anything else, really, to find the time to sit with myself?

The short answer is, because we never do. Because we live our lives from moment to moment, and in between those moments we are looking at our phones, or answering emails, or rushing to get to the next moment. This is simply the reality of life in 2015. I know that no matter which of my “hats” I have on at any given moment, I am often moving quickly and efficiently to achieve any number of goals I may have for that day. Some of it is the nature of my life, and some of it is ME. I thrive on the work I do, and I am passionate about being a Mom to my kids, a friend to my friends, a wife to my husband, a doula to my clients.

As a doula, when I get “the call” or when I am visiting clients prenatally or postpartum, or teaching, I have to have a way to arrive efficiently and often quickly at my deepest inner core where I find that “still point”. Because it is here where I find my best self, and where all my stash of resources and strength are stored. By finding even 10 minutes of time in a day to go there, to that place, I replenish my resources and make sure that I am always fully stocked. Because I don’t know if I am walking into a 30 hour birth, or into a traumatic postpartum situation that will require much of my stored resources. When I arrive and begin doing the job I love, I bring resources for everyone, extra, to share and go around. The way I see it, that is my job. Holding space no matter how the tides may pull.

Having a Personal Practice grants me the opportunity to check in with myself and asses how I am doing that day: am I tired, stressed, is there something on my mind, am I distracted, or do I feel amazing, happy, excited? These are observations, without judgment. Learning to observe the patterns of “you” is a great gift you will give yourself. Observing without judgment and with great compassion for your tender self is also a beautiful gift you will give to yourself. Replenishing and stocking the “warehouse of your soul” and cleaning house once in a while is a gift as well, to yourself and to those whose lives you touch.

Start today. Take 5 minutes. Set an alarm if you that helps you. And go inside, like a peeping Tom, to take a little look. You’ll be hooked.

Millie

Millie Tresierra
is a Birth and Postpartum Doula
with MotherWit Doula Care