9 Reasons I Chose Not to Get an Epidural

...including Side effects, Catheters, and Control Issues et cetera 

Here is the short version of my 9 reasons not to get an epidural for the birth of my first child:

1. The Urinary Catheter
2. What if it doesn't work?
3. Control Issues
4. For the Experience
5. We've come so far
6. The Natural High
7. Breastfeeding
8. Caesarean Section
9. Cascade of Interventions

Like many moms I thought: 'Will I be able to handle the pain? Why would a woman needlessly and willingly subject herself to the most excruciating torture ever experienced?' 

Good question!

At first the whole idea of an epidural sounds like a win-win-win situation, no pain, no pain and no pain! But no procedure is without risk. Learning about the risks of an epidural helped me make my decision to avoid an epidural as far as possible!

I've heard women say they'd rather give birth than pass kidney stones...

To start with, many women find the intensity of labour is actually not the worst pain in the world, despite what movies would have us believe. I've heard women say they'd rather give birth than pass kidney stones, for example. But every woman's experience is different, and I can only speak for myself and tell you why I decided to avoid an epidural as far as I could.

So, what follows were my reasons for not getting an epi, based on what I knew when I gave birth to my first daughter. There are others, but these were mine at the time:

1. The Urinary Catheter

...because when you're numb from the waist down, peeing by yourself poses a significant challenge.

Do you know how many women are unaware that an epidural is not just a needle in your spine and that's it? The moment you choose an epidural, you need an IV line, if you don't have one already, and you need a urinary catheter, because when you're numb from the waist down, peeing by yourself poses a significant challenge. Yeah, I know they usually only insert the catheter after you're numb, but just the thought of it makes me squirm.

On top of that you have to have a blood bressure cuff, and if you didn't have it already, and an electronic foetal monitoring device, and contraction monitor strapped onto your belly, or placed internally. I mean, are there any other orifices you'd like to invade? I may have one or two left that haven't been poked or prodded in the last couple of hours... So yes, we can have all the studies about side effects and neonatal and maternal morbidity in the world, but this was a biggie for me! So lets count those wires / tubes:

1. Epidural Catheter
2. Urinary Catheter
3. Blood Pressure Cuff
4. IV Line
5. Contraction Monitor
6. Baby's Heart Monitor 

The idea of 6 wires and tibes going into or stuck onto my body was a big part of my decision to exhaust any and all alternatives before resorting to an epidural!

An epidural catheter kit. (Link)
Those stripes on the needle are each 1cm wide.

Besides that, the idea of that big needle burying itself 4-6cm into my spine freaked me out more than the idea of pain did. (To be fair, the needle itself doesn't stay there, but still. For interest's sake, see how an epidural is done here - opens a new window.)

2. What if it doesn't work?

I didn't want to set my heart on an epidural and then have it not work sufficiently, which happens in about 5-20% of women.[1,2] Since I had my first baby a friend of mine had one that wore off as she was just reaching the peak of transition phase, and they generally won't top up the medication at that stage as it is much better for you to have sensation while pushing. She went smack bang into the most intense part of labour without warning and without any chance to stay on top of the pain psychologically or give her body a chance to build up its own endorphins naturally. Not fun!

As a doula I've had clients whose epidurals only took on one side - so they still had full sensation on one side without the option to move around to help relieve the discomfort.

3. Control Issues

Ok, so I am a control freak. Also, I'm a dancer, so my mobility is really important to me. I absolutely hate feeling restricted in my movements. If you were to watch me trying on clothes you'd think I was more than a little strange. I squat, touch my toes, do high kicks, swing my arms, and if I feel too restricted I don't buy the item.

I also dislike getting drunk and the whole idea of ingesting mind-altering substances irks me because I can't stand the thought that I won't be in control. Psychoanalyze me if you like, blame it on the fact that people used to hold me down and tickle me as a child, whatever, but don't give me an epidural! Actually, being a control freak was a major factor in my decision to have a home birth with #2!

4. For the Experience

In all honesty, I secretly wanted to know if I could handle the pain. Some people want to climb Everest, or run a marathon or some other strenuous yet satisfying experience just to have the satisfaction of achievement. So why go look for one, and have to pay for it, when I have a potentially life-altering event barrelling towards me?

My dad summiting Mount Kilimanjaro at age 60...
Maybe being a sucker for punishment runs in the family ;-)

You know what, it was hard work, but I can honestly say that I see the births of my three children - all without drugs, one at hospital and two at home - as three of my greatest experiences ever. They were by no means easy, but it was so completely worth it to be there, fully and wholly there, not sedated or nauseous or dizzy or disorientated as I could have been under the influence of drugs, but really and truly present! The sensation of a baby moving down the birth canal where you can actually feel your child squirming and working with you to be born - that is truly miraculous!

5. We've come so far

I could never understand why I would avoid caffeine, sushi, painkillers, swordfish, hair dye, blue cheese, alcohol and chicken liver pate for 9 months and then pump myself full of powerful drugs that do cross the placenta and have not been tested on babies, without being informed of the risks. It made no sense to me whatsoever, especially considering there are alternatives that don't carry the same risks or side effects. How can you make a choice, and take responsibility for that choice, if you aren't aware of the benefits and the risks of a procedure?

6. The Natural High

Yeah, the epidural can take away the pain, but they don't tell you that it can also take away the pleasure. Did you know in the natural course of labour you and your baby produce beta-endorphins in response to the discomfort experienced? Mom's endorphins cross the placenta as well, so baby gets an extra dose.

When mom experiences no pain as a result of anaesthesia or other drugs, the baby doesn't get those endorphins and it stands to reason that the baby then experiences birth as more traumatic than a baby receiving the full dose of endorphins. Also, as soon as the baby is born and you are no longer in pain, you experience the endorphin rush as euphoria.

The levels of oxytocin in a woman's body in the hour after an undisturbed birth are the highest they will ever be in her whole life. Yes, even higher than they could be after the best multiple extended super ginormous orgasm ever.

An epidural also disrupts the production of oxytocin, known as the love hormone, which is the same hormone that causes contractions, the hormone released in orgasm, and the hormone that is necessary for successful breastfeeding. The levels of oxytocin in a woman's body in the hour after an undisturbed birth are the highest they will ever be in her whole life. Yes, even higher than they could be after the best multiple extended super ginormous orgasm ever. Who would want to miss out on that? Not me!

7. Breastfeeding

Getting an epidural affects your central nervous system. Epidural drugs cross the placenta. Epidural drugs affect your baby's central nervous system. Sucking is a reflex action. A compromised central nervous system can result in a compromised sucking reflex. Compromised sucking reflex impacts breastfeeding success. Capiche?

I wanted to give myself the best chance possible.

Unfortunately, pethidine and other intravenous drugs have a similar effect, so no help there! I was so passionate about breastfeeding that even the thought that the epidural could possibly be related to a decrease in my chances of breastfeeding was enough to put me off completely. [3] I felt that having an AA cup to start with put me at a disadvantage so I wanted to give myself the best chance possible.

8. Caesarean section risk

I was desperate to avoid a caesarean. Epidurals are known to increase the chances of needing a caesarean because of something known as the cascade of interventions. When an epidural is given before active labour starts, the risk of needing a caesarean section more than doubles. [4]

9. Cascade of Interventions

An epidural often slows labour down, so you may need medication (usually Pitocin) to speed things up. Use of Pitocin is known to cause respiratory distress in babies, often causing the doctor to suggest a caesarean section. Even if you don't end up having a caesarean, getting an epidural increases your chances of the baby being in a bad position (because the muscles in the pelvic floor relax too much and you are on your back) and increases your chances of requiring forceps or a ventouse (vacuum) to get the baby out. It also increases your chances of needing an episiotomy, which, like me, you may want to avoid.

Having said all that, if you think I would never get an epidural, you are mistaken. There are times when the risks of getting an epidural are less that the risks of not getting an epidural. (See Use Your Brain for tips on assessing relative risk).

Our bodies produce catecholamines in response to discomfort, stress, bright light and noise. While a certain level is helpful toward the end of labour, when catecholamine levels are too high, labour can be inhibited. Sometimes an epidural can give mom a break so that catecholamine levels can drop and labour can continue.

So while there are other reasons not to get an epidural, these were the biggies for me. Before you get upset with me, I don't judge ladies who do choose to get an epidural, but I do believe that many of them go into it without knowing any of the risks or the alternatives, and then afterwards say they wish they had known. So now you know!

Now that you are considering not getting an epidural, I'm sure you'd like to know about some alternative methods of pain relief! I have a post on that in the pipeline so make sure you subscribe to the blog via email or like our Diary of a Durban Doula Facebook page so you don't miss it when it hits the press!

References:

This is not an exhaustive list - but include the most comprehensive / specific links I could find on each issue.
1. Agaram R, Douglas MJ, McTaggart RA, Gunka V. Inadequate pain relief with labor epidurals: a multivariate analysis of associated factors. International Journal of Obstetric Anesthesia, 2009, Vol 18,10-14.
2. Le Coq G, Ducot B, Benhamou D. Risk factors of inadequate pain relief during epidural analgesia for labor and delivery. Canadian Journal of Anaesthesia, 1998, Aug Vol 45(8),719-23.
3. Riordan J, Gross A, Angeron J, Krumwiede R, Melin J. The Effect of Labor Pain Relief Medication on Neonatal Suckling and Breastfeeding Duration. Journal of Human Lactation, 2000, Vol 16(1),7-12.
4. Klein MC. Does epidural analgesia increase the rate of cesarean section? Canadian Family Physician 2006 Vol 52,419-421.

Eloise's Birth Story - My Second Child's Home Water Birth

The Durban Doula's very own birth story!
The almost unassisted home water-birth of our second daughter.

(Lots of pics at the end!)

After a week of erratic prodromal labour, I woke up just after midnight on a Friday evening. This was nothing unusual. For the last month or so I had been waking sometime in the middle of the night, wide awake that is, only to fall sleep about 2 hours later.

The contractions were also not unusual; I had been having prodromal labour consisting of rather painful, somewhat regular contractions on and off for a week. This time the contractions carried on for another 12 hours which was admittedly a bit unusual, but after the week I'd had, I wasn't getting my hopes up! So I tried sleeping between surges, and managed to get a couple more hours in.

We took a leisurely stroll...

We took a leisurely stroll to the Farmer's Market nearby at about 8am, and oddly the contractions actually calmed down quite substantially while I was walking. Side note: The fact that I could get them to go away by moving apparently indicates 'false' labour. Whatever!

I was over it!

I didn't keep track, because I had been timing contractions all week and I was over it! But they were pretty irregular, some 3 minutes apart, some 15 minutes apart - no pattern I could discern.

'Another false alarm,' I thought.

We got back and Hans looked after the toddler while I tried to nap between contractions, thinking they would go away like they had been doing the whole week. They did. At about lunchtime they stopped. 'Another false alarm,' I thought.

I didn't want to try and get things moving before my body was ready...

The previous week I experienced various odd sensations, from mild backache to serious contractions. I rested as much as I could rather than trying to get things moving before my body was ready as that might only exhaust me, without having made any ‘progress’.

...at 6:45pm I had 2 very strong contractions quite close together...

Warm baths had helped me to relax so at about 6:30pm that evening I went to bathe and at 6:45pm, after about 6 hours of no contractions at all - nil, niks, nada - I had 2 very strong contractions in the bath, quite close together, probably the strongest I'd had. The next one followed just as I got out and I could feel my legs trembling. In my previous labour, that had been a sign that I was already in transition.

My mom wanted a time estimate; I think I said, 'Soon!'

I yelled for Hans, things were finally happening, and happening fast. We phoned Arlen our midwife first, and then my folks, who had just arrived at a formal dinner 45 minutes away. My mom wanted a time estimate; I think I said, 'Soon!' We called Hans's folks to come and help with the toddler just as they were finishing their dinner at a restaurant - impeccable timing this baby has! We also texted those who wanted to know, and those whom I had invited to join us for the occasion.

Most of everything had already been set up since Monday...

With all systems go, Hans did some last minute prep clearing my sewing gear out the lounge with cranky toddler in tow while I went upstairs and put on 'Classical Music for Meditation' CD while I breathed and huffed and snorted through contractions. Most of everything had been set up since Monday, so it was only some last minute clearing to do.

That time alone to gather my wits and breathe and focus was precious.

I was most comfortable on my hands and knees, or bent forward with my hands on the bed and my knees slightly bent - as comfortable as you can get in transition that is. That time alone to gather my wits and breathe and focus was precious. Between contractions I sat cross legged on the bed and relaxed as best I could but as I felt each new wave coming, there was absolutely no way I could stay still! I tried, and felt I was going to crawl out of my skin!

...instead of fighting each contraction and tensing against it, I surrendered to it...

On my hands and knees, rocking forwards and backwards, and side to side, I felt power surging through my body with each contraction and instead of fighting it and tensing against it, I surrendered to it, understanding that this was all working to get my baby out. At the end of each one, I experienced a warm glow through my entire body – like that feeling when you stand under a hot shower or lower yourself into a warm bath – an afterglow of sorts.

While I was upstairs, the midwife, hubby's folks and two of my friends who had been constant companions throughout all our ups and downs that week arrived. I don't remember the order!

...thank the Lord for laminate flooring!

Arlen the midwife checked my blood pressure and baby's heartbeat between surges which were coming thick and fast by that stage. Hubby's mom took over with the toddler who promptly threw up on the floor in our bedroom. I'm not sure if it was all the excitement or overdosing on milkshake earlier that day, or a combination of the two, but thank the Lord for laminate flooring! We had all the supplies for mopping up on hand in any case, so no stress there. What it did mean though, was that the in-laws waited downstairs for a while, loathe to put the potential vomiter in their car, and so they fortunately ended up sticking around until the baby was born. But I'm getting ahead of things now.

I do think the kettle was enlisted at some stage...

We hadn't checked for pipe-tap compatibility concerning the birth pool, but hubby made a plan and our two friends, Janine and Kate, worked on getting the pool filled. To be honest, I didn't think we were going to make it, and I don't think the midwife did either! Even though our hot water pressure is dismal, the geyser is set quite hot so it doesn't take much to warm things up. I do think the kettle was enlisted at some stage, but I wasn't noticing much of that.

I swear the smell of his hair was better than any drug!

Once the pool was well on its way to being filled, Hans joined me and things turned a corner. I could let go, and I swear the smell of his hair was better than any drug! One or two contractions later I felt the fronts of my thighs burning and aching - somehow in that moment I remembered reading that this was a sign of full dilation. Transition had been much longer with my first, and to be honest, when I first started getting those intense contractions in the bath, I was fully expecting a few more hours! Relief!

People often think that pushing is the most intense stage, but for me transition was the hardest with the pushing stage like a downhill run by comparison. I found pushing much more satisfying than transition as it finally felt like I was getting somewhere!

...I could feel the baby's head...

I was most comfortable in a wide kneeling position on a little mattress we had next to the bed, leaning forward on Hans sitting on the bed. My waters broke, and I felt baby moving down. What an incredible feeling! I did an internal check myself (the only internal check for this birth) and I could feel her head! I loved being the first person to touch my baby. As contractions happened, I worked with them and waited and rested quietly between.

Far away in labour land in the birth pool!

The midwife knew I wanted to catch the baby myself, and so right then she mentioned to me that I might struggle in the position I was in, and that the pool was ready. I was already in 'the zone' and not keen to do anything other than stay put, but fortunately I listened!

So I got into the water...

So I got into the water and it was heavenly. I wasn't resting on my sacrum, but rather supporting myself on my knees or in a squat as I felt comfortable. Soon after I got into the water the midwife checked the heartbeat and all seemed fine.

...I grunted, groaned and growled that baby out!

I thought I made a lot of strange noises, although my in-laws said they barely heard a thing from downstairs! Some women breathe their babies out, and I was kind of hoping I might do the same, but when it came to it I grunted, groaned and growled that baby out! Making a noise helped keep my jaw soft while working with the contractions. Soft up top means soft at the bottom! Again I checked for baby's head, and it was right there, just out of sight.

My folks arrived while I was in the water and my mom rushed upstairs. With a fuel stop along the way, they had apparently engaged in some low flying to get there. Even then, they made it only about 5 or 10 minutes before she was born!

With each surge, Hans supported me in the water. I could hear encouraging murmurs from around me, but it was his voice that pierced through everything and his words that wrapped around me and kept me going. I was truly an intimate experience for us. I wouldn't change that for anything!

...like pulling a door with one hand and pushing with the other...

I realized I had been working too hard with the contractions, like pulling a door with one hand and pushing with the other. I consciously ‘let go’ and felt her head start crowning on the next contraction! One more contraction after that and her head was out.

'Is there anything I'm supposed to do now?'

 'Is there anything I'm supposed to do now?' I asked. "No, just wait." So we waited patiently for the next surge. We were still in the water all this time, which is safe as the baby hadn't yet started to breathe, with her body being so compressed in the birth canal, and wouldn't try to take a breath until she felt the cold, which she would only feel when I took her out the water.

Also, the baby would only try to breathe if she was in distress, which we knew she wasn't. Tickling her head and waiting for the surge that would push the rest of her body out was another moment I will never forget!

Her body rotated and emerged with relative ease and I lifted her up out of the water myself at 8:24pm, just under 2 hours after those first contractions in the bath. What a flood of emotions and sensations! The pictures say it all...

Straight into mom's arms...

That first sqauwk!

We did it!

The midwife dabbed her face with a cloth and she let out a squawk but was otherwise very calm. She was covered in vernix, millimeters thick in some places, probably because she was 2 weeks early. I held her close and kept her body under the water to stay warm and we rested like that for a while. I don't remember the exact sequence of events, but I do remember confirming that she was a girl, and we announced her name - Eloise: Famous Warrior!

The toddler Amelia came up to say hello and her first remark was, 'Lotsa tweam!' (Lots of cream!) She was utterly fascinated! In retrospect I would have liked her there a little earlier so she could see the baby coming out, but I just didn't think of it. She had watched birth videos with me before and was completely enthralled! Maybe next time...

Lotsa tweam!

After some quick hello's, we were left alone with our little one, resting in the pool. When she looked ready to feed I let her do her thing and she latched like a pro first time! We had been in the water about half an hour, enough time for the cord to stop pulsing, when Hans cut the cord and I got out as I was starting to feel uncomfortable.

A comfy sling scale...
much nicer than cold metal or plastic!
See how beautifully pink she is!

We delivered the placenta, and later the midwife weighed and measured her and checked her hips and her reflexes. I dressed myself and our newest little human, Eloise, and we drank tea downstairs with the grandparents in the wee hours of the morning. There is nothing quite like that first cup of tea after baby is born!

...all so intensely sacred but so terrifically normal!

So that was that! No internal checks other than my own, no needles for me or for baby, no suctioning, no chemicals, no plastic box and no loud noises other than squeals of delight! - all so intensely sacred but so terrifically normal!

In retrospect, recovery has been so much easier this time! I had a drug-free birth with my first, and I know that the second one is usually easier, but this was way better! Another big difference is that my first labour was 12 hours start to finish – not this on-again-off-again for a whole week business! But, of course, I’d do it again in a heartbeat!

So, in summary, our home water-birth included a week of prodromal labour, or pre-labour, or early labour - whatever you want to call it - then a solid 12 hours of totally irregular contractions - then nothing for 6 hours - then straight into transition and baby born less than 2 hours later!

I think if I hadn't been with a midwife I would have had induction recommended at least three times that week, and would probably have ended up with a c-section because my body wasn't ready yet. I would have been diagnosed with 'failure to progress' when the problem was simply a case of 'failure to wait'.

Fortunately, we waited, and the experience far surpassed my expectations! I tell people I had an unassisted birth with the midwife in the room because that's how it felt. Honestly it was one of the highlights of my life and that experience played a huge part in my wanting to be a doula.

For the record, Eloise is now already almost 7 years old, but I felt this incredible story deserved sharing! She is a delight to everyone she meets and she loves it when I tell her the story of how she was born.

Find more birth stories here.

Isaac's Birth Story - Our quick, intense, didn't-make-it-into-the-water home birth...

Announcement by Sarah-Jane Photography

Isaac Johan's Birth Story

Another great home birth with our fantastic midwife!

The last you heard from me was my pregnancy diary at 38 weeks. Since then I finished off my last few work tasks and enjoyed some fun time with the girls while they were on school holiday. We went on a picnic one morning, and to the beach another day. It was great to have a few days where my time was (mostly) my own! 

(And if you're confused because you thought his name was Johan Isaac, and now my blog says Isaac Johan, your memory is correct! That was our original order, but over the last week, we have just felt that Isaac 'sticks' better – we, parents and grandparents, just seem to be gravitating towards using Isaac as a first name, Zack for short, so we made the change.)

Source

We were kind of hoping that baby would come before Easter weekend. And considering that it was my 38th week, and baby #2 arrived at 38 weeks on the dot, it wasn't too much wishful thinking. Easter weekend just seemed an awkward time for everyone. My folks run Fever Tree Guest House in Hluhluwe, just over 3 hours' drive away, and my friend Shelley, who agreed to be my doula was going to Underberg to spend the weekend with family from Joburg. We had known there would be a clash of dates from the beginning, and all just had to be okay with the idea that things might not work out how we want them to and get on with it. 

Source

I wasn't going to stress myself out – while washing dishes on Friday morning I felt God acknowledging that I spend so much of my life accommodating the needs of others, this time I just needed to let things be for me – whether things happened soon or not, I didn't need to stress. I felt free!

A friend had the girls over the play on Friday morning so Hans and I, despite all good intentions to clean the fridge and sort the pantry, went and had brunch, just the two of us. I even got my 'push prezzie' in advance – little did we know!

After my little revelation over the dishes, I shared some other thoughts about the birth with Hans – I didn't want to be bugged with 'How far are you?' and 'How much longer do you think it will be?' questions while in labour. Asking questions of a lady in labour aren't helpful for that ideal 'labour-land' brain state so typical of true physiological birth as they activate the language centres of the brain, the 'higher' brain. 

Questions about time also add in the whole idea of pressure and performance which can also distract from the task at hand – so I gave Hans the firm instruction to field those questions and comments for me, because we did have the reality of people travelling from up to three hours away to join us. In retrospect it was odd that I felt so adamant about these things right at that moment – but maybe I knew something was going down. Pardon the pun.

I honestly hadn't had any prelabour symptoms this time – no loose stools, no 'show', no major burst of energy – and I was kind of grateful about that. With my second birth I had a rather exhausting bout with prodromal labour that I wasn't keen to repeat. I think that being diligent about getting enough magnesium in really helped prevent that!

So that afternoon I coloured in another of my birth affirmation pages – and just went on with life as usual.

Some more colouring!

At around 8pm, lying in bed watching Netflix, I had what felt like a slightly uncomfortable Braxton-Hicks (BH) contraction. Now I'm a veteran on downright painful BH contractions – I know they aren't supposed to be painful, but mine sometimes are – so I didn't stress too much. Halfway through the program I was watching, I realised I'd had three of them at seemingly regular intervals, so I half noticed the time and true as nuts, ten minutes later I had another, and then another ten minutes after that. I told hubby on Skype - 'OK!' he replied and came through to help get things ready in case.

I let the midwife know, because we both know my history, and I told her I was going to get in the bath to try calm things down so I could get some sleep – because that was what I did for a whole week before my second little one was born. I also let my birth team know – just so that if it was for real they would have some warning.

By the time my bath was over, surges were 5 minutes apart, and definitely not BH anymore!

So we gave the go-ahead for those coming from far away – Hluhluwe, Underberg and Pietermaritzburg… Our midwife Arlen was the first to arrive, then my hubby's folks. Fortunately the girls were asleep by that stage and I was directing last minute details between surges – checking we had a bucket for laundry, making sure the birth pool was ready, putting birth supplies out so they could be found easily, getting some labor-aide mixed and ready – and a myriad of other minor tasks that needed doing. It was a warm evening so I was pacing and doing my thing in my undies while all the action happened around me.

Molly keeping an eye on proceedings once baby was born...

Arlen took my blood pressure when she arrived, and checked baby's heartbeat – all good. We had agreed, as with my previous births, that we wouldn't do internal checks unless necessary, so it wasn't even suggested. Internal checks can only tell you how dilated your cervix is at that moment, it gives no indication of how long it took to get there, or how long it will take to reach full dilation. I've had clients go from 6cm to baby in 45minutes, or 3-10cm in an hour, so really – to have to lie down so someone can examine your cervix via your vagina, to get information that may or may not be helpful, just felt unnecessary to me. But that's just me!

I was in labour and that was all I needed to know! Each surge was slightly more intense than the last and I absolutely had to keep moving through them – they were getting longer, stronger and closer together, so we knew things were progressing. At this stage I was doing lots of figure 8's with my hips – that felt amazing!

I honestly felt a bit like cat in labour - I was pulling all sorts of crazy stretches. Later on Arlen said she had never seen anyone in labor do stretches quite like that. If you know anything about dancing – think very slow, gentle 'bouncing' in a wide second position, knees out, body forward, back arched, left elbow on knee, right hand pushing right knee out, then lunging side to side in that position as needed. 

Actually I nearly did do that once -
this was me in labour in hospital with #1.
I'm smiling because even then
I thought all those wires were ridiculous...

If I had been birthing in a place where you are expected to stay in or on the bed, I think I might have begged for drugs of some kind. Not that there would have been time. I honestly can't imagine how women do the labour thing without being able to move about. Actually I can, because I did it with #1 - but never again!

During this time hubby and mom-in-law were filling the birth pool. If it was a 'normal' home birth, the timing was perfect for getting in to the pool, just as the surges felt like they were starting to become overwhelming, the warm water of the pool would do its endorphin thing and I would be set to go for the last stretch… but my body seemed to have other plans.

I was getting down onto the floor with each surge. The cold tiles were just what I needed as the room was quite warm. What seems crazy is that I distinctly remember checking the time to find out if he would be born on the 25th or the 26th. When I checked my phone it was 12:04am

On what must have been the next surge after checking the time, I got down on the floor again only to feel an intense downward pressure which continued with each surge following – not an urge to push, but rather a sense that my body was pushing something anyway.  Actually, it felt more like gravity had concentrated itself tenfold in the area of my pelvis, as if that part of me was being pulled down with a G-force I could do nothing to resist.  I was doing low cleansing breaths with each surge – making 'hah, hah, hah' sounds – it just seemed the right thing to do. It was distinctly uncomfortable and then pop! - my waters broke. Oddly, it felt so good!

At this stage I wasn't getting up between surges, just lying with my face down on my arms and my butt in the air because that seemed to relieve the intensity for a few seconds. Graceful mental image I know, but it felt great! At some stage we put a bright pink towel under my knees. The pool was ready, and had been ready for a short while, but there was just no way I was moving anywhere. I remember reaching a similar point in my previous labour, and having the mobility and awareness to get in the pool, and I was so glad I did, but this time seemed considerably quicker and much more intense – like a condensed version of the previous labour. So I stayed put.

My Friday afternoon colouring.

I started to feel that unique sensation of a baby navigating his way down the birth canal. I can't imagine choosing to miss this part of labour as it seems to be the moment where you and baby are both working towards the same goal as he wriggles along with the rhythmic massage of those powerful uterine surges. I remember instinctively reaching down to be there to meet him, and saying, 'Baby's coming!'

As I remember it, I would be on my hands and knees and allow the pressure and stretching, but as soon as it felt too much, I would duck my head down and put my bum up to relieve the pressure a little. I think I did that through the pushing stage (in which I didn't actually do any pushing) until his head emerged. Every now and then I felt his little head moving this way and that as we worked together to bring him through. Other than that, it was just me and my hands guiding the process – so empowering! By this stage Arlen and Hans had set up some towels and linen savers behind me on the floor, Hans on his knees, waiting to catch his son. 

Once his head was out we waited for another surge, while I felt his shoulders turn in preparation for the emergence of the rest of his body. That was somewhat more uncomfortable than his head actually as I remember saying, 'Don't pull!' No one was pulling – it was his shoulders moving through. So with a sound of rushing water and great sense of relief, our little boy made his way into the world. 12:16am, 12 minutes after I last checked the time. He took a few moments to gather himself together as we welcomed him with enfolding arms and encouraging words. I sat back as they passed him to me and wrapped us both in towels. He gave a little roar of indignation to announce his acceptance of our welcome.

Within a few moments, I felt strong enough to get into the water and Hans joined me. It was lovely to sink into the warmth and weightlessness of the pool. We could get a good look at our newest family member without worrying about getting him getting cold, and my somewhat fatigued body could get a little rest too!

Our eldest passed out on the bed after saying hello.

Things get a little blurred after that, you would think it would be the other way around! I remember relaxing in the water together for a while, with an extra contraction or two every now and then to get the placenta moving, and I remember him rooting about looking for my breast, and latching quite strongly and decisively when he found it! Peaceful and unhurried – just beautiful. 

I remember Hans getting out the water at some stage – our girls were brought through, in a sleepy stupor, to come say hello, after which they promptly passed out on our bed. My mom-in-law came through, the photographer arrived, as did my parents and my doula – though I don't remember the order. I was grateful for the water then as it forced us to stay put and kept things warm and private. There was a great atmosphere of celebration throughout!

After over an hour in the water I was ready to get out – so the cord, now limp and white, was clamped and cut and littlest was placed in his father's arms. We delivered and checked the placenta, got me cleaned up and dressed. Arlen took all the vitals and did all the newborn checks - I was quite chuffed that after needing a few stitches with my firstborn and her 33cm head, I managed this 36cm head with nary a graze! Go me! He weighed 3.56kg - my biggest baby by nearly 300g, and was 56cm long, so also my tallest baby.

We had everyone come in for a little name announcement, beause as you know we had kept our final choice a secret until he was born. Once all that was done, I got him back on my chest, skin-to-skin, covered with a few extra blankets, where he stayed drinking for the next while, and we all went through to the lounge to have tea at nearly 2am in the morning! It was lovely!

Morning meetings...
The girls have a good cuddle with
their baby brother for the first time.
You can see the pool in the background.

The girls slept on mattresses in our room as their rooms were occupied for the night. I watched as the eldest woke up and I got to see the realisation on her face as she remembered her baby brother had been born. They just couldn't get enough cuddling and snuggling in and it seems they still can't! They argue over who gets to hold the baby next, and are already stars at collecting all the bits necessary for baths and nappy changes and the like.

I've got some other thoughts to share on the whole postpartum experience - but I'll leave that for another post.

Thanks for reading...
Please add any thoughts, questions or queries below!

The day Kate called the Midwives...

Being the birth junkie that I am, I couldn't avoid all the press about the newest princess in the British Royal Family, especially considering that Kate Middleton is reported to have had a lovely, quick, uncomplicated birth.

View image | gettyimages.com

We'll never know all the details. I'm assuming it would be considered untoward and most certainly inappropriate to share whether a member of the Royal Family required stitches or gave birth in water or any of the other details so savoured by those who read birth stories.

But actually, it's not those details, or the lack thereof, that inspired this blog post. So in celebration of International Day of the Midwife... Here goes!

Let's start with the good news:

Duchess Catherine chose to be attended primarily by midwives, and the midwives worked as a team with the gynaecologists and perinatologist and various other designated officials.

But, what irks me is how patriarchal ideas about birth are being perpetuated in the press surrounding the event.

I hear you sigh - 'Grouchy Feminist on the loose!'

Actually, even my husband was appalled at the language used about the Duchess' birth. Let's have a look at some quotes and take it from there:

About her birth team, a headline from 'The Telegraph':

Royal baby: meet the doctors who delivered Kate Middleton's second child

Alan Farthing and Guy Thorpe-Beeston led a team of four that delivered the royal baby at St Mary's Hospital in Paddington (Ref)

This headline was followed by 11 paragraphs, or around 358 words describing their respective Curriculum Vitae and detailing how and when they met and married their wives. There was also a mention of the gynaecologist who wasn't there this time around, and even a quote by aforementioned absent gynaecologist to round things out. Interspersed in the quagmire of qualifications and dates, was one line, in the second to last paragraph:

They over saw a team of midwives looking after the Duchess in the Lindo Wing. (Ref)

Names? Qualifications? Families? Quotes? Nil. Zip. Nada. Nope.

Based in the US, the 'Boston Newstime' also published a rather extensive article detailing every aspect of the birth. In their section on the medical team, give or take 350 words are again devoted to the achievements and qualifications of the non-midwife medical team, including around 130 words about, or by, Sir Marcus Setchell, that same guy who wasn't even there. To his credit, his words did include a description of the nameless midwifery team at Prince George's birth as 'perfectly wonderful'. (Ref)

That full quote: Sir Marcus described the midwifery team as "perfectly wonderful" but added: "There are certain situations when someone is giving birth that it's important not just to have a specialist sort of available at the end of a telephone, but actually in the same room to deal with anything that's immediately going to be wrong." (Ref) (Emphasis added)

Are midwives not specialists then? Something 'that's immediately going to be wrong'? Let's give him the benefit of the doubt and assume this was just a slip of the tongue and that he didn't intrinsically see birth as an emergency waiting to happen that only someone with a Doctor's qualification could solve.


'Midwifery Team' - Names? Qualifications? No? Ok. I suppose the only qualification necessary is that the good doctor felt they were 'perfectly wonderful' - no names needed.

Princess Charlotte of Cambridge already has her own Wikipedia entry - but according the entry as it stands today (5th May 2015), there were apparently no midwives involved:
The baby was delivered by Alan Farthing, surgeon-gynaecologist to Queen Elizabeth II, and Guy Thorpe-Beeston, an expert in high-risk pregnancies and surgeon-gynaecologist of the Royal Household; both were present at the birth of the Cambridges' first child, Prince George, in 2013. (Ref)

But wait, 'The Inquisitr News', among others, reported on the 2nd of May that even though the 'suited surgeons' got most of the press coverage, they 'simply looked on to ensure that everything was going as planned ... the midwives were the ones that actually delivered both Prince George and the new Princess' (Ref)

So 'The Daily Mail' comes to our rescue, with the following headline:

Call the midwives! The calm duo who delivered the Princess after striking up close rapport with Kate

I'm so grateful they were calm. Not like those hysterical midwives you usually get...

At least here we have a mention of their qualifications:

Midwives Arona Ahmed and her boss, Jacqui Dunkley-Bent, Professor of midwifery at Imperial College Healthcare NHS Trust (Ref)

Professor of Midwifery! How delightful! 'Perfectly wonderful'! But not a 'specialist' according to the absent gynaecologist. 

The other qualifications of the midwives were summed up in the following sentence:

Both women are experienced, unflappable and have the full confidence of the obstetricians. (Ref)

Ah! There it is! You see, they had the full confidence of the obstetricians. Professor of Midwifery notwithstanding. Perfectly wonderful!

And don't get me started on how Kate was 'delivered of' her baby, as though she just lay there while someone else did all the work, or as though she was possessed rather than pregnant.

P.S. So in case you can't see what bugs me about this - it's the whole issue of gatekeeping - how is it that the men who weren't there and or didn't do anything except 'oversee' get the praise, the press and lists of qualifications and full biographies, while the midwives who did the work, whom the Duchess chose, are, on the whole, invisible, nameless and voiceless, and are qualified by the opinions of the doctors above anything else.

And then there's that line I haven't mentioned - where a number of news outlets state that Kate had opted to be seen first by midwives, and apparently a 'source' had qualified this with 'What the duchess wants, the duchess gets.' (Ref)

Like a child that wants ice-cream for breakfast.
Not like a rational adult woman with an actual choice in how she gives birth.
Perfectly wonderful!

Thoughts?  Please comment!

Enjoyed reading? Please share!

Birthing Day...

When a baby is born, so is a mother. 

Photographer: Karen E

I always thought that was a cute, if not trite, little saying. Until I had my own babies.

I have come to realise that having children entails a massive core identity shift for many women - more so than getting married or a first menstruation or any other of life's transitional experiences. The shift often takes us by surprise in its nature and its magnitude. 

Ask any mother which she remembers in greater details, her wedding day or the births of each of children. Almost all the women I have asked have far more acute memories of the triumphs or tragedies of their birthing days than their wedding days. (I'm not sure of the equivalent life experience to ask about for women who haven't been married - if you have any ideas let me know!)

Three years ago my youngest daughter was born and even though we celebrate this day, the 18th of June as her birthday it was, as cheesy as it sounds, a birth-day of sorts for me too. 

I birthed my first daughter in a drug free natural birth in a private hospital in Pietermaritzburg. I was on my back doing purple pushing, but for most of the nurses there it was the most natural birth they had seen in many months - especially considering the number of nurses who came in to congratulate me with awed whispers of 'We heard what you did!' 

My gynae told me it was one birth out of a thousand and that totally freaked me out! To me it was a normal birth, an 'average' birth, an example of how most women could and did give birth but I have since discovered that there is far too much hospital policy, often not evidence based, and not enough support for moms (read: doulas) for this to be the norm.

It was an intense experience for me. I have never broken a bone or dislocated anything or had kidney stones or anything like that, so it was the most painful thing I had ever experienced. But I felt confident, I felt supported and at no point did I feel as though I was suffering. 

I learned a little more over the intervening years and chose to have a water birth at home for the birth of my second daughter. That was an utterly life altering experience. Here is a link to the full story: Eloise's Birth (will open in a new window)

I essentially had an unassisted birth with a midwife in the room. I had said to my midwife, Sr Arlen Ege, that I wanted to do as much myself as I could, unless I asked for help or unless she could see that intervention was necessary, and she gave me the gift of respecting my wishes. So I had an exquisite physiological birth after a week of on-and-off labour (check the link for more details) and it was a highlight of my life. 

I was high on endorphins and oxytocin for what seemed like weeks afterwards and I truly felt like I could take on the world! 

And so I firmly believe that when both my babies were born, new facets of who I am today were birthed at the same time. 

Photographer: Karen E

My babies showed me how to think of someone else before myself, how to nurture and how to love. They showed me reserves of strength and patience that I had no idea I had. They also showed me my limits and my weaknesses - and I have been able to grow through those times. They brought out the fierce mama bear in me - the wild woman who roars in the face of danger and hardship. 

They have also drawn out my softest tear-blurred gazes and inspired my proudest heart-busting moments. 

One thing that I adore about being a doula is that I have the privilege of walking alongside women as they make this transition. I get to witness the birth on so many levels!

So today everyone celebrates my daughter's birthday, and rightly so, I have had many of my own! But on this day I secretly celebrate my own birthing days, those hallowed moments of encountering the exquisite juicy rawness of human life. 

I give them gifts, as parents do, but no book or toy can come close to the gifts my daughters have brought me - the gift of becoming more fully myself, the gift of finding my calling, the gift of becoming a mother.

Hindrances to Natural Birth #37: Mobile Phones

(This is the second post in a series on Hindrances to Natural Birth. The first was a post on how tickets specifically, and time pressure generally, can get in the way of natural birth.)

If you have a mobile phone, cellular telephone, or any other kind of mobile device that you can receive messages on that beeps or buzzes or whatever - then this post is for you.

Even if you aren't pregnant yourself... actually... *especially* if you aren't pregnant yourself - please take note!

Mobile phones can be great. I love my mobile! It helps me keep in contact with my clients, stay on top of emails, do research on the spot, listen to music, take pics of my kids, make to-do lists... I think I'd be lost without it. Mobile devices make our lives easier in many ways - but constant connectivity can have its problems too.

We've read the blog posts about being present in our actual real-life flesh-and-blood lives, we've watched the videos about 'looking up' - that is not everything this post is about.

I can't tell the number of times I have been with a mom resting beautifully between contractions, breathing splendidly through them - serene, undisturbed - and the mobile phone goes off. Buzzing or beeping - both intrude equally on silence.

As if the noise wasn't enough, someone feels compelled to check - to reply - to repeat the question the sender is asking - How far is she? How long to go? How is she doing?

Someone tries to answer the impossible questions - within earshot of a mother who previously was utterly self contained and calm.

'She's only 4cm.'
'It will be at least another 6 hours.'
'She seems to be coping well at the moment.'

Every statement is innocuous on the surface, but carrying an undertone of measuring her up against some fictional standard of how birth happens.

I get that labour can take a long time. It can get boring. Dads can feel awkward and useless in the labour process and checking the news on an iPad helps pass the time.

But like I said in my previous post - oxytocin - the hormone that initiates labour and keeps it going - is a shy hormone. Its release is hindered when a mom feels like her performance is being measured. Those messaging her do so innocently out of concern for the mom and baby. Everyone is understandably excited when a baby is on the way - especially grandparents! But often messages, even the loving and encouraging ones, can be perceived as pressure to do well, to perform.

I know how I am whenever I hear someone is in labour! I'd love a contraction by contraction update. But I also know the possible negative consequences.

Imagine if you had to give a moment by moment update of your honeymoon night... Such an exciting time! A night of new beginnings! Still not keen? I don't blame you.

But what if everyone with an interest in the birth knew that their excitement, and their incessant messaging and even calling could be hindering the mother's intentions for a natural birth? Mothers and close female friends and relatives often bring their own baggage around birth into their interactions with a birthing mom - their own bad experiences, their own cultural anxieties - both of which are unhelpful.  

Every mom needs her team to show their unwavering confidence in her ability to do this birth thing. You are responsible for the energy you bring into your interactions with her. Remember that.

As soon as baby is born, partners are often so busy messaging everyone all the vitals that they can miss out on some of those precious moments of witnessing a baby experience gravity and texture and temperature and light all at once for the very first time.

Image by George Ruiz on Flickr

It's not the partner's fault. He is the link between the mom and the outside world - rather him than her - and there is absolutely nothing wrong with spreading good news! He is meeting all sorts of expectations from family and friends to make sure they are the first to know every bit of progress as it happens. And they have even less of an idea of how long birth takes than he has!

This is a sacred moment. Be there. Whether you send the message now or in an hour's time - it won't make a huge difference to them - but it can make a difference to you and your baby.

Some solutions:

• Set up a messaging group on something like Whatsapp. Any and all labour updates and questions go through the Whatsapp group. No exceptions.
• Warn people beforehand that you will be totally out of contact during labour - and even during the last few weeks of pregnancy - outside of the messaging group.  Set the expectation that you will give information as things happen - no news is good news. When a mom is feeling uncomfortable at the end of her pregnancy, getting 15 messages a day asking her is the baby has arrived yet is just not helpful!
• Set any mobile devices to silent *without* vibration. Check your mobile device/s when it is convenient for you. Make sure technology is your servant and not your master.
• Get a doula. Some partners think that having a doula there will give you less to do, but doulas often help dads to feel far more relaxed and less likely to feel the need to 'escape' into Candy Crush or Minecraft - and doulas help partners to anticipate mom's needs and give ideas on how to help her. Most doulas are also really good at taking pics so dad's hands can be free to help mom.
• Be okay with waiting. Sitting holding the mom's hand for 2/4/10 hours straight may seem boring to you but just your quiet presence can mean the world to her. You only get one chance at this. Be there.

Please share your thoughts and solutions with us!