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.

My experience of Prodromal Labour

Experiencing Prodromal Labour can be frustrating and confusing!
Here is the story of my experience with Prodromal Labour taken from my Week 38 Pregnancy Diary for Baby #2

Image by Karen E Photography

Week 38 was certainly a memorable one! In week 37 I was experiencing mild nausea on and off, some lower backache, menstrual type cramps and the like - well, they only got worse! In terms of baby's vital statistics: At week 38, baby is approximately 50cm long and weighs about 3kg, although those guesstimates get less accurate as time goes on. Baby is considered 'term' from 37 weeks, but there are many great benefits to sticking around until 40 weeks so we'll see.

Saturday

On Saturday morning I had a bring-and-share continental breakfast with some lady friends - a great idea for an easy get-together - especially if you are 9 months pregnant. I struggled to sleep since Wednesday night because of the back pain and cramping. Through Saturday and Sunday, twinges and such seemed to get worse and the sense of downward pressure increased. I was just over 37 weeks pregnant but even as a second time mom it felt like labour starting to me, albeit quite slowly.

On Saturday evening I had some pretty strong, regular contractions...

On Saturday evening I had some pretty strong, regular contractions - about 30s each every 5-7min, but they happened quite soon after a cup of red raspberry leaf tea and an unusually long toddler breastfeeding session, which I have since discovered is the result of some unknown ailment currently causing a fever. I wasn't sure whether I should encourage the process with some red raspberry leaf tea, speed walking, stair climbing, breastfeeding and of course, conjugal intimacy, or if I should try to slow things down - resting, warm baths and the like - so I just carried on as usual.

...I had all relevant parties on standby all weekend!

Image by Karen E Photography

Sunday

By Sunday afternoon, my midwife Arlen thought it best that I try get a good night's sleep, rather than encouraging the process and ending up exhausted and not progressing, so I took a warm bath and went to bed. It was the most restful night I'd had that week! I had genuinely thought things were happening and I had the relevant parties on standby all weekend!

...I honestly believed I was in labour...

Monday 

Monday morning rolled around and things were getting going again - I honestly believed I was in labour - I had definite, reasonably regular contractions that I had to concentrate on and breathe through. The toddler and I were washing dishes and every couple of minutes I would have to lean forward onto the sink and focus on my breathing to get through each one. So I called in the troops. My mom drove up from Durban, my friend Janine excused herself from work while another friend Kerry brought supplies (chocolate!) and Hans went to collect the birth pool.

...things seemed to have slowed again...

By the time Janine arrived, things had slowed again, so we took the toddler in the stroller for a walk around the block. On our 2nd, and last circuit, a friend of Janine's caught up with us and we spent some time chatting. She had had two homebirths with my midwife as well so it was great to chat to her! As our paths diverged she mentioned she had quite a strong impression from God that our baby would have a particular character trait, which will remain confidential for the moment. I started crying right there because that was precisely the meaning of one of the final two names on our shortlist, which we hadn't shared with anyone. So the name of our little girl was decided! I was very encouraged!

By this time things had completely slowed down...

Last few days of being an only child...

My mom then arrived and started washing some dishes and the photographer who did our preggie shoot was in town so she popped in as well. We set up the birth pool and did some last minute prep for the home birth and sat down to chat. A little later another friend Kate joined us. After some more chatting they went off to get some lunch, and then we went for another walk. By this time things had completely slowed down and I was feeling a little 'moedeloos' (Afrikaans for discouraged - but the translation doesn't do it justice).

...I had started having my strongest and most regular contractions yet

My mom-in-law also popped in with some snacks and a little later everyone went home saying we must just phone if they need to come back. Kate and her husband brought us a feast for dinner, which I was really grateful for as I was quite bushed and, lo and behold, I had started having my strongest and most regular contractions yet. Again, they were about 30s long, about 4min apart for about 3 hours altogether and with each one I was on the floor on my knees with my head on my arms on the couch to focus so I could breathe through the pain. "This is really it!" I thought. Wrong again! I had a warm bath, things slowed down and I had another great night's sleep.

One thing that was quite funny that night was that the toddler was curious as to why I was burying my head in my arms every few minutes - so I told her that I just needed to close my eyes and invited her to come and join me, so for a couple of contractions she was next to me, head on her arms 'closing her eyes' with mom. Then she saw hubby stroking my back and started stroking and tickling my back too. At one stage when I was breathing through a contraction, she told me to 'wake up' so she could put her head on her arms and 'close her eyes' and told me to tickle her back!

Checking dilation in early labour can only tell you how far dilated you are...

I hadn't yet had a 'show' - which is when the mucous plug at the cervix comes out - often an early sign of labour as it shows that the cervix is effacing (thinning). I had also chosen not to have an internal exam to check dilation, unless absolutely necessary. Checking dilation in early labour can only tell you how far dilated you are - it doesn't actually give an accurate idea of how much longer things are going to take, or how long it took you to get there. Some women can be stuck at 2 or 3cm dilated for days without realizing it. So it can be encouraging to find out that you are further dilated than you thought, but it can also be discouraging to find out the opposite - and knowing me that would stress me out and hinder the process even more.

Tuesday

I think, "OK, today is the day!" Wrong again.

Tuesday morning rolls along. I go to the toilet in the morning, and I have a 'show'! (Apologies if this is TMI for the casual reader - you want real life, you got it!) I text the midwife to let her know and I think, "OK, today is the day!" Wrong again. I walked to our usual Tuesday morning mom's group close by, contemplated having a go on the trampoline but thought better of it. I had reasonably strong menstrual pain for most of the day, like I would for the first or second day of menstruation, but that was about it! (It was a weird sensation, having not menstruated in what felt like forever!)

I am choosing to trust my body and embrace the process!

Despite all the weirdness, I was feeling great - I was not as discouraged as I had been on Monday. We women so often assume that our bodies are somehow defective when something about us doesn't fit in with the 'average', but with birth the range of normal is very wide, and  Maybe I'm doing too much and I just need to rest, maybe baby isn't in quite the right position yet and all these contractions are squeezing her into the right spot, maybe I just need a little longer to dilate this time, and maybe it's none of the above. Baby is still moving well and I'm feeling fine.

Wednesday

...I woke up feeling stiff and irritable.

I woke up feeling stiff and irritable, despite having rested the whole day Tuesday. Alternative arrangements had been made for my ballet classes so I went from pretty-active mode, to couch-potato mode. Frustration! I decided get some last minute supplies at the mall. Even with extra walking there was no change - nothing - it was the quietest day since Wednesday last week. Arg!

The fact that it was a full lunar eclipse that night too didn't seem to impress little one at all - it would have been so poetic!

I was hoping that something might happen on Wednesday night considering that it was a full moon and there are many old wives' tales / urban legends and one or two studies that show that more babies are born during the last quarter of the moon than at any other time of the lunar month, but no such luck. The fact that it was a full lunar eclipse that night too didn't seem to impress little one at all - it would have been so poetic! This was my Facebook status for that day:

Thursday

Thursday was also quiet...

We had a laugh on Thursday morning when a friend of ours (an out-of-towner to give him credit) phoned to congratulate us, thinking the baby must be born by now! Thursday was also quiet, so I spent much of the day pondering the whole idea of a 'ripening' process. Later that night I was in the bath and discovered that I could barely move; even turning on to my side was painful. Something in my pelvic / sacral area was out of whack - it felt like it was in pieces that simply refused to work together!

Friday

And so the sun rose on another Friday morning - a full week after I first mentioned that I was starting to feel twingey. I must admit, I was feeling a little emotionally overwhelmed, not about all the false starts but about things in general, like my back. I took the emotional-ness as a good sign that my hormones were kicking into high gear, or so I hoped! My back was even more uncomfortable than before and it was really upsetting me.

I also got a great back massage for the first time in months...

Because I've danced all my life, my physical mobility is really important to me so limping about because my pelvis didn't want to hold me up was very distressing. Fortunately I managed to get an appointment with the chiropractor - what bliss! Apparently my pelvis was slightly twisted as my pubic symphysis was out and she got that fix in 5 minutes flat. I also got a great back massage for the first time in months because I could actually lie on my stomach on that fancy table of hers! Joy!

I am feeling strong... I promise I'm not putting it on just to get the attention!

Besides the fact that we keep expecting this baby to pop out, our one car won't start, I have developed a cavity and the toddler has had a reasonably high fever for the last two days - we are doing well! I am feeling strong and really empowered actually. I've said elsewhere:

If at any stage it seems as though I am in pain, please do not pity me. I am not suffering. I am doing what I was born to do.

And I would add to that: I promise I'm not putting it on just to get the attention!

...what I am experiencing is generally referred to as prodromal labour...

If you want a name for it, what I am experiencing is generally referred to as prodromal labour (also known as pre-labour, or false labour). The thing about it is that it can be very difficult to distinguish from the real thing. You can generally find an exception to anything anyone says about prodromal labour. When people say real contractions should get stronger and more regular but prodromal contractions don't - you'll find someone whose experience contradicts that. So really, prodromal labour is generally only recognized in retrospect!

I've got a more technical post about the various forms of prodromal labour and how to cope with it in the pipeline, so please do subscribe to the Blog or like the Durban Doula Facebook Page to keep updated when I post it!

So that's the long story about I'm learning to embrace the process and trust my body! Looking forward to sharing again next week!

UPDATE: So it seems all that prodromal labour was leading up to something! Here is the story of our Quick, Almost Unassisted, Home Water Birth

UPDATE:
Well, it turns out this was the last week of our pregnancy diary! It seems all that prodromal labour was heading somewhere and our little girl was born the Saturday night. You can check out the story of our amazing beautiful ecstatic home water birth here.

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.

Top Doula Tip: Et cetera, et cetera, et cetera!

The longer I work as a doula the more I realise my work is not about solving specific problems with predefined solutions, as if every stalled labour requires the same position changes, and every massage oil requires the same mix.
It's more about defining the philosophies and motivations that underpin my work as a doula, and learning how to apply those in each situation.

Doula training can be quite overwhelming in that you learn a large variety of tools and techniques but in truth no one can really teach you precisely how and when to use each one - that is where experience comes in.

Imagine these tools and techniques are like the notes of the musical scale. They are of no use to you unless you know when to use them, for how long and at what intensity, and which to use together, and most importantly, when not to use them. Silence is the other half of music.

But what is more important than know all the right tricks for all the right moments, is your demeanour, how you carry yourself. Let me explain further.

The root word from which we get the word doula means 'servant' - as a doula, my power is in my service. I am at a birth to serve the mother and her family and no one else.

I was thinking about this one day and remembered this clip from the musical 'The King and I'.

"You shall observe care that head should never be higher than mine. When I kneel you shall kneel, when I sit you shall set, etcetera, etcetera etcetera!"

Problematic aspects of the movie aside, I got a picture in my head of the birthing mother as the 'King' (or rather the Queen!) and myself as Anna, and as a servant of the Queen, I resolved to not allow my head to be higher than hers.

This has physical and psychological implications. Obviously it's not always physically possible; sometimes my head is by necessity higher than hers as I'm helping her, usually when I'm beind her applying counter pressure or doing some belly-sifting. But what I try to avoid is that sense of 'looming' over a birthing mother which so often happens when she is on a bed in even in a birth pool.

Our human brains tend to associate vertical height with power and authority. We tend to see taller people as stronger and as inherently carrying more authority. In public forums, the most important person is often isolated on some sort of raised platform so that they are the tallest person in the immediate vicinity. To 'look up to' someone is to admire and respect them; climbing the hierarchy is an 'upward' movement.  We 'lift up' the downtrodden. Up is somehow stronger than down.

Let's take this to the birthing room - it's hard to feel powerful when you are on your back, and possibly exposed, surrounded by fully clothed persons, sometimes wearing face masks, looming over you and telling you what they are going to do to your body. This is not an easily defensible position and I wouldn't be surprised if our human brains read this as a dangerous situation and start releasing adrenalin accordingly.

It seems to set up a combative atmostphere, rather than a communal one - telling the mother that we are here to do this to you rather than with you, or for you. To comfort someone, or empathise with them, or listen to them, or even get their attention, we sit, stoop or squat down beside them. This is how we serve.

Psychologically, keeping my head lower than hers reminds me that 'the Queen' is the highest authority here. She is the mother of the child, and it is from her body that the child emerges. It would do birth attendants well to see themselves as 'advisors' to the Queen, rather than the highest authority themselves. Like any Queen she employs advisors to supply information so that she can make an informed decision. No one is more invested in the health of her baby and herself than she is - her word is paramount.

So that's it, my top doula tip - or should that be my bottom doula tip? Generally equivalent doula tip? Whatever - I'm sure you get the idea.

If you are a doula, have you thought of this before?

If not, do you think it's something you'll use?

If you've given birth, how did you experience the demeanour of your birth attendants?

Tell us below, then share and follow us on all the socials!

Etcetera, etcetera, etcetera!

Stop all the clocks, cut off the telephone... Birth Bliss and Funeral Blues

Coming home from a birth I am often struck by the contrast between that sacred moment where a baby takes its first breath and is welcomed into its mother's arms, and the indifferent bustle that continues outside. I feel almost indignant. How could they miss that shift the moment this little soul joined the ranks of the born? How could they not feel the moment this mother's heart expanded again even as her womb emptied itself?

In my sunrise musings, I realised we feel this way when a loved one dies too. How does the world just carry on as if there isn't an empty space where her laughter used to be? Don't they see his impression on the bed they shared for so many years?

Every birth, every death pierces someone deeply, leaves its mark, its scar; but somehow neither seems to pass as weightily as it should. I think the poet W. H. Auden felt that when he wrote 'Funeral Blues':

Stop all the clocks, cut off the telephone,
Prevent the dog from barking with a juicy bone,
Silence the pianos and with muffled drum
Bring out the coffin, let the mourners come.
Let aeroplanes circle moaning overhead
Scribbling on the sky the message He Is Dead,
Put crepe bows round the white necks of the public doves,
Let the traffic policemen wear black cotton gloves.
He was my North, my South, my East and West,
My working week and my Sunday rest,
My noon, my midnight, my talk, my song;
I thought that love would last for ever: I was wrong.
The stars are not wanted now: put out every one;
Pack up the moon and dismantle the sun;
Pour away the ocean and sweep up the wood.
For nothing now can ever come to any good.

I'm reminded of a somewhat trite little truism: 'To the world you are just one person, but to me you are the world,' although Auden seems to express the sentiment so much more eloquently. In one of my more audacious moments, I thought to write my own version expressing that same disappointment. What seems so momentous to me, goes unrecognised by those not directly involved.

I'm still working on it, and I'm not usually one for writing rhyming poetry, but I think it gets the message across...

Birth Bliss

Stop all the clocks, cut off the telephone,
Let all the birds sing, our little one is home,
Fling wide your windows and beat your drum,
Bring out the champagne, let the people come.
Let aeroplanes do loops in the sky up above,
Calligraphy announcing: 'Here is my love'.
Tie streamers on the tails of the public doves,
Let the traffic policemen don their very brightest gloves.
You are my North, my South, my East and my West,
No more working week, no more Sunday rest,
At noon, at midnight, we talk, we sing.
I thought that love would burst my heart, instead it's growing.
I see the stars now, reflected in your eyes;
The moon watches us, calms your midnight cries.
I'm certain the oceans responds to our dance,
Because now that you're here, grace and hope have a chance.

If you enjoyed this post you might also enjoy 'The Doula as Witness'

 'I witness a birthing mother glowing serenely through yet another wave; the gentle interactions between a mom and her partner; the dad's face as he marvels at what he and his partner accomplished. I witness the mother's triumph as her dreams and expectations are clothed in flesh.'

Please share if you've ever felt this way!

Back to work... (Postpartum Musings)

I have a little obsession with baby toes

My maternity leave ended this week... I'd been approaching this day with mixed emotions. Being able to quantify my productivity is something I appreciate, but I also love being around to cuddle with my little squish at every opportunity. It goes by so quickly. You are just starting to emerge from the fog of the first 12 weeks, and the mini one is showing a real little personality and you're back at work again. (Super Quick Didn't-Make-It-Into-The-Water, Caught by Dad Home Birth Story here.)

My belly on the second day.

So how is little Isaac? Well, he is living up to his name (Isaac means 'he laughs') - he smiles and gurgles and coos at all and sundry, although his dad seems to have been relegated to 'not-the-momma' status as of late. He is a super chunkalicious 7.5kg at 14 weeks, very different from my girls who were quite petite.

While I love my ring sling that I made (using this tutorial), because once you've got the hang of it, it's quick to set up but also functions much like a hitchhiker's towel.  Well, it is no longer comfortable and my stretchy wrap is also just holding on. I have an ABC (African Baby Carrier) somewhere in our house, but in the various 'cleanups' I just can't find it anywhere... The catch-22 is that I won't be able to sort out more boxes without a back-carrier, but I'll need to sort those boxes to find my back-carrier - we'll just have to make a plan until then. Even with all the slings and wraps and carriers, it feels like every day is 'arm day' in our house! Who needs gym?

First time in the sling.

Breastfeeding has gone well. Even third time around I experienced those moments of frustration in the middle of the night, wondering if he was getting enough milk as he got frustrated at the breast, massaging plugged ducts and putting cream on tender nipples. Oh yes, and we survived the growth spurts too! We just took it one day, even one feed at time, and my favourite advice is to never quit at your lowest point. After all that I am pleased to say that even with my usual AA cup, we have not resorted to even one drop of formula. Yayness!

My husband has been incredible as always, waiting on me hand and foot when he could and feeding me through growth spurts, and keeping the older kids fed and watered so I could concentrate on the littlest. I love that he doesn't see himself as mom's sidekick, but as a co-parent. He doesn't do me any favours in the sense that we are a team working together to get our family where we need to be. He never babysits, or looks after the kids 'for me', no, he just parents them, like I do. 'Cos we're both parents. Fancy that!

I'm also particularly grateful that I've been able to go back to work at 6 hours instead of 8 hours a day, and we have someone at home who will be looking after him. I've been expressing a small stash so he has enough while I'm at work. While my supply is adequate, expressing is something I've always struggled with - the most I've ever been able to express was one time I got 180ml from both sides with a fancy double pump, where some women can get up to 500ml from each side. I feel like it's worth it though.

Another struggle is that my milk apparently has high lipase content, so smells 'off' quite quickly after being expressed as the lipase starts digesting the lipids. It doesn't damage the milk, but sometimes baby isn't too keen on the  taste. If I scald it on the stove before I store it then it wouldn't be a problem, but scalding 60-80ml of milk at a time seems pointless, so it just means I'm going to have to be diligent about keeping track of expressing and storing so I don't have to freeze too much.

Dimpled baby sausage fingers...
almost as cute as baby toes!

I just recently took down my birth affirmation posters from around our room. I was thinking of getting "Psalms in Color" to replace them, but I honestly haven't had time to do much colouring in the last three months. Any moment in which I had both hands to myself was usually spent taking care of personal hygiene and food needs. Having said that, it was amazing how many of the affirmations were still relevant... 'The only way out is through' and 'I can do it because I are doing it' being two specific examples.

In terms of physical recuperation I was thankful that my in-laws took the girls to stay with them for five days after Isaac was born. I was able to stay in bed and cuddle with my baby without interruption, and most of all, to rest as much as possible. As I wrote before, I was intending to do as little as possible for the first while, and I really did, until I reached a point where not getting out of the house was more depressing than staying at home to rest. I did manage to watch a whole lot of Netflix documentaries which I thoroughly enjoyed!

I have enjoyed having more energy than I had during pregnancy and co-sleeping has meant that I'm feeling more rested now than I felt during pregnancy. Because I birthed on my hands and knees I was able to control the descent of his head quite well, so didn't have any tearing or even much bruising, so that has helped I'm sure! I tried some belly-binding when I did start to be up and about, and I must say it did help me to feel supported and also to not get tired so quickly.

We have a great church community that brought us meals, and of the meals I cooked to freeze, we used the last one when he was ten weeks old. That was a win for sure. And, we somehow manage to fit three kids in our 5-seater car safely, although the first time I had all of them in there I was quite nervous... Precious cargo indeed!

He slept through his first visit
to the beach

Our cloth nappy stash seems to be holding up well. I loved having the newborn nappies for those early days, but he outgrew them quicker than I expected! We have moved onto his OSFM (one-size-fits-most) nappies, many of which I used with his older sister. We only just used up the disposables I got at my baby shower. Yay for budget babies!

I did get intensely lonely at times while on maternity leave, so I got involved in a moms group that meets once a week, and also met with some other moms on an ad hoc basis, some I had known before and others I had never met previously. In some ways I am sad that I won't be seeing them every week, as it feels like we were just getting over the small-talk period of a friendship, but with some we have arranged to meet up again, so I'm looking forward to building those new friendships.

One thing I discovered in the last two weeks which I'm sure will help, is something called 'Adventure Clubs' (On Android here)- it's a South African app you can download which shows you 'adventures' in your area, based on your GPS position. You can also sign up to lead adventures. It's been a lovely way to find relatively cheap things to do with my girls during their school holidays, along with other moms.

Taking advantage of the moms and tots parking!

About the girls, they just adore their little brother, and I haven't experienced any huge signs of jealousy with them. The younger of the girls especially loves hugging and kissing her baby brother, and it is beautiful to see how they are so loving towards him, gushing about how adorable he is and how they just love him so much. Long may it last!

Fortunately hubby has been able to take them to school in the mornings, so I have had that time to be with baby, but with the new school term starting again this week, I've had to be up for work too. Afternoon school runs are a challenge with different finishing times and various extramural activities, and in typical third child fashion, Isaac gets dragged / worn along to everything, from school plays to ballet concert photo shoots, sports days and many and various birthday parties.

The beginnings of that gummy grin.

As much as you try to be kind to yourself, life doesn't go on hold when you've had a baby, and while I've been on maternity leave, we've been dealing with some serious family health struggles, relational conflict situations, organizing kids' birthday parties along with unexpected financial setbacks - aren't they always unexpected though? - and another little person in the mix does seem to eat into one's capacity. I feel simultaneously less capable and more capable all at once.

He is a pretty easy baby, and even then, 

One getting teeth and the other losing them...

I must admit I'd forgotten how time consuming these little ones are. Having had a horribly colicky baby and a reasonably easy baby, I feel like they take similar amounts of time and effort physically, but the time spent on an easier baby seems less fraught while the more challenging baby seems to take more emotional energy. But that's just me. It could also be that my brain has blotted some parts of those early days with baby #1 out as some way of ensuring I would actually consider having another one...

I've given up eating dairy products with this little one as he started showing signs of colic / reflux. (I already eat a totally wheat-free diet) and it made a significant difference, as it did with my second child. I just wish I'd known with my first baby that dairy protein (specifically casein) can pass through breastmilk and cause colic and reflux, and even eczema. I think life would have been a bit easier way back then!

Drinking coffee on my own while Isaac has his trial with his carer.
I even wore a dress that I couldn't possibly breastfeed in.
Like coffee, bittersweet.

So after all that, even though I think I've had a well-supported, well-planned postpartum period, having done this three times now I can say for certain that those first few months after giving birth are always intense... From aching joy to biting loneliness, from the heights of pure delight to feeling utterly overwhelmed. 

It's amazing how you can feel full to beyond bursting point and echoingly empty and depleted within split seconds of each other. I'm not sure there are any emotions you don't experience in that first while. 

And so begins that long process of separation, from utter dependence to adamant independence. From that moment of the severing of the umbilical cord we're preparing them for a big wide world. The messy and fierce and squishy and rocky path of nudging them towards that independence that breaks our mother hearts even while we know that this was the point all along... 

What was your postpartum experience like?
Is there anything you would do differently if you were to have another child?
Anything you'd like to know about what to expect in the postpartum period?