Medicated Labor Impacts Breastfeeding

I recently came across this video which compares babies who were born without medication and those whose mothers were medicated during labor, and how well they instinctively latch on to breastfeed.

How Would Men Handle Childbirth?

A TV show host has labor contractions simulated using electrodes to see how he can handle the pain of labor. This is really fun to watch! It's also fun to see how they have him try distraction techniques (self-hypnosis), positioning, sitting on the birth ball, and even taking in "gas and air" (laughing gas for those in the US). It's worth watching!

As a side note, I can't imagine how well non-pharmacological pain relief methods would work on simulated labor. Unfortunately for the man in this video he didn't get to experience any hormonal interplay or rise in oxytocin which provides a natural buffer and feelings of well-being. It just isn't the same as real labor.

Labor Doula, Childbirth Preparation, and Gentle Birth

I'm happy to announce that three more of my articles were published on the Pampers website:


Why I Love my Labor Doula - My personal tribute to my amazing doula!


A Birth Doula Supports Women in Labor and Birth - This discusses the many roles of birth doulas, including supporting women with epidurals and c-sections.

Preparing for Labor and Delivery - This covers a little of each of my 5 birth experiences, emphasizing the need for proper childbirth preparation.


Is Gentle Birth Possible? - My experience in discovering gentle birth.

The Essential Ingredient: Doula

From DONA International

Touch in Birth

This is a great resource for partners, doulas, midwives, and birth supporters everywhere.

I've been supported in birth by my husband (as licensed massage therapist), a doula, and midwives.  All of them used physical touch in supporting me, and I can personally attest to the great comfort and importance of touch in labor and birth.

I found this video through Enjoy Birth

Vaginal Exams: Useful Tool or Unnecessary Intervention?

Vaginal exams are something that women have come to accept as an uncomfortable part of being pregnant and having a baby. Before the onset of labor, a care provider may put their gloved fingers into the vagina of the expectant mother to check her cervix and see if it has opened up, and how much. During labor vaginal exams are routinely used to determine how much progress a woman has made in labor.

Effacement is the thinning of the cervix, and is expressed generally as a percentage. 80% percent effaced, for example, indicates that the cervix has thinned out 80% and still has another 20% to thin out completely. Effacement can precede or accompany dilation.

Dilation or dilatation (depending on your preference of terminology) is the opening of the cervix. Generally 1 fingertip-breadth (of the provider who is checking you) equates to 1 cm of dilation, 2 fingertips equals 2 cm, and so on, all the way up to 10 centimeters (or "complete"). The provider actually sticks their fingertips into the cervical opening to check this measurement.

Many times the vaginal exam is used to guess how much longer a woman may have left before the baby will be born. Unfortunately, this is a poor indication because every woman dilates and progresses at her own pace. There are many factors that affect labor progress, and it's unrealistic to rely on cervical checks to predict the future. I believe vaginal exams are a small part of our modern world's effort to control labor, combined with the use of medications to start and speed up labor to try and fit it into our schedules and what we think labor should look like.

Vaginal exams are uncomfortable in the least, and sometimes downright painful. At times during labor the provider may want to do a vaginal exam at the height of a contraction, which makes it even more uncomfortable. From my experience, it can also interfere with the laboring woman's focus and coping techniques and make it harder for her to work through the contraction.

Vaginal exams can be harmful. Yes, you read that right. Downright dangerous. When anything is inserted into the vagina (gloved or not) it brings bacteria from the outside of the body into the birth canal. Our bodies have different types of bacteria in different places, and they're not meant to be mixed up and put in places where they aren't normally found. This can cause maternal infection and fever, particularly if the bag of waters has already ruptured.

If your has water broken (before or during labor) and you want to avoid the risk of infection, AVOID VAGINAL EXAMS.

The reason hospitals have time limits on labor (baby must be born within 12, 24, or X number of hours after rupture of membranes) is because of this risk of infection. If you avoid vaginal exams (or anything that could contaminate the birth canal) you may virtually eliminate this risk, and you can safely wait for labor to start and progress on its own.

I've covered the risk. Now let's talk about the alternatives.

How Dilated Am I? Assessing Dilation in Labor WITHOUT an Internal Exam.: This is a really good blog post outlining multiple ways of checking labor progress without an intrusive vaginal exam. These methods include closely observing outward signs from the mother including the sound of her voice, smells, irrational thinking, feeling the top of the uterus, and more. I've found it to be extremely helpful.

Checking dilation without a vaginal exam: I love this post, as it outlines very specifically how to use touch to measure the space between the top of the fundus (uterus) to the breastbone:

"During a contraction and with mom on her back, determine how many fingerbreadths of space are between the fundus [top of the uterus] and xiphoid process [the triangular tip of the breastbone] at the height of a contraction.

5 fb = no dilation

4 fb = 2 cm

3 fb = 4 cm

2 fb = 6 cm

1 fb = 8 cm

0 fb = complete"

My understanding is that it's best to use the fingerbreadths of the mother herself, but someone else can check the measurement as well.

Isn't that great?! These posts give great information that can help empower women to stay comfortable and safe in labor, and also arm them with tools to help them in the process.

Here is another article outlining The Dangers of Vaginal Exams if you want to learn more.

What Triggers Spontaneous Labor?

Yet more proof that nature knows best, and why it's generally best to avoid induction and wait for labor to start spontaneously.

As published on Science Blog

Fetal lungs provide a signal initiating labor, UT Southwestern researchers find

Dr. Carole Mendelson, Dr. Jennifer Condon and Dr. Pancharatnam Jeyasuria have found evidence that a substance secreted by the lungs of a developing fetus contains the key signal that initiates labor.

DALLAS – March 22, 2004 – A protein released from the lungs of a developing mouse fetus initiates a cascade of chemical events leading to the mother's initiation of labor, researchers at UT Southwestern Medical Center at Dallas have found.

The research, which has implications for humans, marks the first time a link between a specific fetal lung protein and labor has been identified, said Dr. Carole Mendelson, professor of biochemistry and obstetrics and gynecology and senior author of the study. The paper appears in an upcoming issue of the Proceedings of the National Academy of Sciences and is currently available online.

The initiation of term labor is carefully timed to begin only after the embryo is sufficiently mature to survive outside the womb. Previous studies suggested that the signal for labor in humans may arise from the fetus, but the nature of the signal and actual mechanism was unclear, Dr. Mendelson said.

In their study, UT Southwestern researchers found evidence that a substance secreted by the lungs of a developing fetus contains the key signal that initiates labor. The substance, called surfactant, is essential for normal breathing outside the womb.

"We found that a protein within lung surfactant serves as a hormone of labor that signals to the mother's uterus when the fetal lungs are sufficiently mature to withstand the critical transition to air breathing," Dr. Mendelson said.

"No one really understands what causes normal or preterm labor. There may be several chemical pathways that lead to labor, but we think that this surfactant protein, which is also produced by the fetal lung in humans, may be the first hormonal signal for labor," said Dr. Mendelson, who is co-director of the North Texas March of Dimes Birth Defects Center at UT Southwestern.

In humans the signaling protein, called surfactant protein A, or SP-A, also helps immune cells, called macrophages, fight off infections in the lungs of children and adults by gobbling up bacteria, viruses and fungi that infiltrate the lung airway.

"Women who go into preterm labor frequently have an infection of the membranes that surround the fetus, and the number of macrophages in the wall of the uterus increases with the initiation of preterm labor. When women go into labor at term, they also have an increase in macrophages in the uterus," Dr. Mendelson said.

This led the researchers to investigate whether there was a connection between what happens during normal labor at term and in infected mothers who go into early labor.

"This also raised the question: If bacterial infection can cause increased macrophage infiltration of the uterus in preterm labor, what is the signal for the enhanced macrophage migration to the uterus at term?" Dr. Mendelson said.

In mice, the developing fetal lung starts producing SP-A at 17 days gestation; full-term delivery occurs at 19 days. The developing human fetus starts producing SP-A in increasing amounts after 30 to 32 weeks of a 40-week normal gestation, at which time the baby's lungs are essentially developed. As the fetus "breathes" amniotic fluid in the womb, the protein is released into the fluid.

"The SP-A protein binds to macrophages in the amniotic fluid, macrophages that come from the fetus itself," said Dr. Jennifer Condon, a postdoctoral researcher in biochemistry and the study's lead author.

The macrophages, "activated" by the protein, make their way through the amniotic fluid to the wall of the uterus. Once embedded there, they produce a chemical that stimulates an inflammatory response in the uterus, ultimately leading to labor.

The researchers also found that injecting a pregnant mouse with SP-A before day 17 of the pregnancy caused the mouse to deliver early. Injection of pregnant mice with an antibody that blocks SP-A function caused them to deliver late.

Identifying the receptors on the macrophages to which the SP-A protein binds will be the next step, Dr. Mendelson said.

"We think that bacteria may be binding to the same receptor on the macrophages to cause preterm labor in women. The bacteria mimic the function of SP-A, initiating the chemical reactions that lead to premature labor. If we knew more about this receptor on amniotic fluid macrophages, we may be able to design therapies or inhibitors to block preterm labor," she said.

Other researchers participating in the study were Dr. Pancharatnam Jeyasuria, a research fellow in internal medicine and former fellow Julie Faust, now a medical student at Texas A&M University.

The research was funded in part by the National Institutes of Health and the Texas Higher Education Coordinating Board.

Thoughts About Labor Support and Unassisted Birth

I've been thinking a lot lately about unassisted childbirth. I must admit that the idea is becoming more appealing to me the more I think about it, and I'm starting to consider this as an option for my next baby's birth.

Don't worry, I'm not pregnant again... yet. We want another baby, but we're not trying to conceive at this time. I'm always thinking and planning for the future.

My childbirth experiences have been a journey. I feel I've been on this road, and I keep growing and learning as I go. My journey from fully medicated birth to unmedicated birth in the hospital, then to birth at home, has been a progression for me. I'm always wanting to find something better and more fulfilling, and possibly more challenging as I go.

I like challenging. It stretches me, helps me grow.

"When you're through changing, you're through." -Bruce Barton

What's the next step? Is it freebirth?

Don't get me wrong. I'm not going to put myself or my baby at risk just because I enjoy a good challenge. I don't make any big decisions without doing my homework and knowing all the ins and outs, exactly what I'm getting myself into.

I also believe in divine personal inspiration, and I'll pray about my options and move forward with what I feel is right and best for my family. I prayed about home birth with my last baby and felt such overwhelming peace that I knew that's what I should do.

Right now I'm researching and considering my options, and I'll pray about them when a decision is needed.

I'm all about labor support. I'm a doula. I DO labor support. I feel it's important to have the right support for birth. But what is the right support? I think it can be different for each birth.

When it comes to unmedicated, natural, spontaneous birth without unnecessary interventions, I've always felt that with the right support and care I can do anything. I love my doula and midwife who each worked with my husband to provide encouragement, comfort measures, and a level head to help me through what's always been for me a somewhat long process of labor and birth.

At one point during active labor with my planned home birth I found myself alone. My midwife was in the other room. She had left my husband and I alone because I was coping well with his support and she was respecting our private space. My husband had to go to the bathroom, and just as he was gone a strong contraction hit.

I had been depending on my husband's support, and it suddenly occurred to me that I was alone! Panic hit, fear set in, and I experienced the worst pain of the entire birth experience. It's the only part of Liam's birth that I consider to have been actually, truly painful. Even transition was nothing compared to the pain I felt at that moment.

I learned two things from that experience:

1. The Fear-Tension-Pain syndrome is REAL. When we experience fear our muscles invariably get tense, which causes pain. This is definitely true in labor and birth, and I experienced it first-hand in stark contrast to the rest of my otherwise relaxed and peaceful labor.
2. I have had the belief that I can only handle natural labor if I have support from others. Whether my belief was true or not, it was real and it affected me completely in that moment.

I've reflected on that experience a lot since then. What about women who experience spontaneous precipitous labor and have no support, but still have an amazing and beautiful birth? What about those who plan unassisted birth and handle it just fine without any outside support (other than that of their partner)? Why would I only be able to handle labor well with support, if others could handle it just as well on their own?

If I plan an unassisted birth I would still have my husband's support so I wouldn't be completely alone. Do I actually need the support of a doula and/or midwife or others in order to have a beautiful birth experience?

Woman Sings While in Labor

This is absolutely beautiful. The laboring woman used hypnobabies during labor and sang beautifully, even through 2 strong contractions. You can also read her birth story, and the story from her doula's perspective.

Nitrous Oxide for Labor Relief?

Why haven't I heard of this before?

Consider the Source: An Interview about Nitrous Oxide with Judith Rooks

European countries use nitrous oxide regularly and safely as a form of labor relief, but it's a practically unknown as a labor option in the US. This is possibly because only two hospitals in the United States currently offer nitrous oxide to laboring women. There is a shortage of equipment as more hospitals are trying to acquire them and be able to offer it.

When you read the article you may be as stunned as I was to find:

• Nitrous oxide is safe to both mother and baby with none of the ill side effects associated with other forms of pain relief.
• It can be self-administered by the laboring woman, which allows her to use it as-needed and also avoids over exposure.
• The gas is expelled quickly from the mother's and the baby's bodies. A newborn infant expels the gas from its body with its first few breaths and is completely free of it within 5 minutes. This means no NICU admissions from adverse reactions to medication.
• For women who want to avoid an epidural, the use of nitrous oxide can take the edge off in the moment she feels she needs it. Because it's self-administered, she can start it or discontinue it at any time.
• Women wanting an epidural can use nitrous oxide in the early stages of labor and while waiting for the epidural, and avoid the use of opoids (which carry a risk to the baby).

For much more in-depth information, along with scientific evidence, please read the full article linked to above.

For demonstration purposes, please check this video of a woman using nitrous oxide while pushing her baby out. Please ignore the cheesy commentary from the producer.

What do you think?

Thoughts on Preterm Labor & Birth

This is a topic I've thought a lot about over the past few months. A friend of mine was experiencing contractions at 34 weeks gestation. She went into the hospital and underwent some tests. It was confirmed that she was actually in labor. It was also discovered that she had a urinary tract infection that triggered her body to start contracting. She was given antibiotics to resolve the UTI and was told that her labor would subside as a result.

I wonder how often an underlying infection is the cause for preterm labor?

When there's an infection, the pregnant woman's body has a defense mechanism to protect the baby from the infection: start labor to try and get the baby out.

It doesn't matter if it's 40 weeks into the pregnancy, or 20. The woman's body is designed to protect the baby.

Infections can be tricky things. A woman can have a UTI and not realize it because the symptoms can be subtle. I think many women in our culture are so busy that they're not tuned in to their body's signals. If we slow down, take care of ourselves and pay attention to how we feel, we can often sense when there is a problem and catch it before it becomes serious.

There are ways to prevent preterm labor, and scientists are feverishly trying to pinpoint them, particularly because preterm labor is becoming more common in this country. The United States recently received a "D" on the March of Dimes 2009 Premature Birth Report Card, and it's important that we do something to change the trend of preterm labor and birth. One study found that a woman's DNA can predispose her to preterm labor, but there are other factors as well.

For one thing, you can do your best to stay healthy and low-risk through proper nutrition and exercise. This can help you avoid an infection that could trigger early labor. Proper nutrition can also help avoid preeclampsia and toximia, which are often culprits for prompting early induction resulting in possible preterm babies.

One thing I personally believe would make a big difference is for women to tune in with their bodies. Take some time each day to check in with yourself. How are you feeling? Do you have energy, or are you struggling to get things done? What did you eat, and how did that affect how you were feeling? Did you drink plenty of clear fluids? Did you do something for you today? Are you happy? Do you have an overall feeling of well-being, or does it feel like something may be out of balance? Often, how you feel emotionally can be a signal of how things are going in your body, and a woman's intuition can really clue her in to some possible problems. I'm a true believer in intuition, and I've personally been working on listening more closely to my intuition and acting on even the smallest promptings I feel. I'm finding my life goes a little smoother and I'm better able to handle things when I pay attention to what my body and my feelings are trying to tell me.

This process of checking in with yourself can take as little or as much time as you have. It can be 2 minutes, or 2 hours. It can involve deep, focused breathing and meditation, or just a quick mental checklist. Find what works for you, and try it.

What do you think? Does any of this seem to fit together, or am I way out there?

Position Change and Movement During Labor

It's important to be active during childbirth. Change positions every 20 minutes, even if it's a small shift from one side to the other. These movements help the baby shift and descend into and through the birth canal, and they can even help give the laboring mother comfort during labor.

I found this great blog post on At Your Cervix (written by a Labor & Delivery Nurse):

Getting in position -- making changes to shake, rattle and roll

"Up. Move. Lean forward. Lie on your far left or right side. Squat. Walk. Dance. Hands and knees. Modified lunges. Sway from side to side."

The author discusses the common issue of back labor, which most often is a result of a posterior or otherwise malpositioned baby. She explains how position changes during labor can help move the baby into a favorable position, make labor less uncomfortable for the mother, shorten the duration of labor, and even avoid a c-section.

"Why so many posterior babies? Simply put - we're a reclining society. We sit back in our recliners, couches, office chairs, dining room chairs, rocking chairs and more. Our babies get into these funky positions from us lying back...This is why it is so very important to get up and move in labor"

She also explains that even with an epidural position changes during labor are possible, and important.

Please read the post.

Here are some more resources for information about positions during labor:

One With Child: Labor Positions

Positions for Labor and Birth

Doing the Labor Dance

How to get baby in the best position for childbirth - no back labor!

Non-pharmacological methods of pain relief for childbirth

I know I can post more than this. If you're interested in more information about positions during labor, please post a comment.

Preventing Preterm Labor and Birth

Preterm labor and preterm birth are increasing dramatically in the United States, and we don't really know why.

"A preterm baby has a 120 times greater risk of death than a baby born full term, and survivors are at risk of breathing difficulties, bleeding into the brain, and having a significant neurological handicap such as cerebral palsy."

"Preterm birth costs the United States $26 billion per year. It is one of the most serious and significant challenges to medicine and society and one whose importance is not fully recognized,"

This article discusses findings that genes in mothers and babies can predispose them to preterm labor:

Genes in Mother, Baby Raise Risk of Preterm Birth

The risk is not completely genetic. "'We have established that one of every three premature babies is born to a mother who has an intra-amniotic infection,' an infection in the normally sterile amniotic fluid that surrounds the developing fetus."

Even expectant mothers who are genetically predisposed to preterm labor can take precautions to stay healthy and low-risk through a healthy lifestyle and diet, including plenty of fresh whole foods and lots of vegetables that contain vital enzymes to aid in proper digestion. This will help ensure that the mother will stay free of infection and reduce her risk of having preterm labor.

Scoliosis and Epidurals Don't Mix Well

I don't have scoliosis, so I had never really thought about how it might impact a woman in labor, or the effectiveness of an epidural. This post is really informative about scoliosis and labor:

Birth Faith: Curvy

I also never thought about how scoliosis could affect fundal height (what the doctor measures to see if your baby is growing properly), and how it could cause an inaccurate estimate of the baby's size.

If you have scoliosis, read this blog post and talk with your doctor or midwife about it.

Labor Pain Relief: Massage

A Doula's Perspective on Midwives

by Samantha

"I have not personally given birth, but am a DONA birth doula and working on becoming a CBE (Child Birth Educator). Where I grew up (southwest NH) midwifery and natural birth is the norm and it is what made what to get on this path. I grew up thinking childbirth was a normal event. Not one that needed to be induced or numbed. There was a free standing birth center at the end of my street and my favorite thing was to go on walks and see if the "new baby" sign was up and the info on it. All gynecological care I ever received as a teen and young adult was by a CNM, and she made me want to be proactive in my own health, instead of fearful. When I was 17, I went to a DONA training to become a doula and fell in love with birth.

"I moved to Chicago to get my Bachelors in Nursing and to attend midwifery school. Since being in IL I have worked with mostly OB's and it has been very disappointing with one exception. There is one OB I have worked with multiple times who is part of a group with four midwives. The way he practices compared to other OB's is night and day. He allows pushing in any position, he does not rush mom and lets her do things at her own pace. He allows dad to catch the baby all by himself if he wants, he is anti-circumcision and applauds parents for opting not to cut. C-sections are only for women and babies who are in true distress and he doesn't believe in pushing pain meds or time tables. When I asked him if this was his normal practice or only the practice when he is a CNM backup, he said that the CNMs showed him what birth should look like and he never looked back."

Home Birth Transfer Under a Midwife's Care - Emily's story

by Emily

"With my first son, I was twenty weeks pregnant before I found a homebirth midwife, an LM (Licensed Midwife) educated in Washington State. Previously, I had been seeing a group of midwives and OB's who were affiliated with my local hospitals birth center. Every time I went there, I was weighed, measured, and told my BP was too high. It would take several checks before it would come down. The first time I had an appointment with my MW, she had me weigh myself in the bathroom down the hall, then trusted me to tell her, and my BP was lower than it had been my whole pregnancy. I knew I'd found "the one."

"She was great during my labor. I had several family members there, but she didn't mind at all. When my water broke at 10 cm it was stained with meconium and my boys heart rate dropped significantly. We ended up transferring to the hospital. Her assistant rode in the back of her subaru with me, assuring me it would be fine.

"My MW ended up seamlessly taking over the role of doula once we got to the room. She would give suggestions for positions to push, and thought that having me push with every other contraction would help with the baby's HB. It helped immensely. She even whispered in my ear that the OB was looking at using the vacuum and to make my pushes really count. I can't imagine pushing for 2 1/2 hours without her there. After my Samuel was born, she stayed and helped me breastfeed. She and her assistants went back to my house with my mom and sisters and cleaned up my house.

"With my second son, we were able to rent a birth tub through her, though we didn't use it much. She had some great herbal remedies for when my blood pressure began to creep up a bit. She was fabulous during my labor when I had a OP(occiput posterior) baby, and my labor dragged on and on. I felt like I had put my whole self in her hands. And she took wonderful care of me. Sometimes people talk about not relying on anything but their own bodies during labor, but I never feel like that, I feel like I need some one with me who knows what they are doing, because I'm 22 and don't know anything but what I've read in books!

"When Matthew was born, I was standing up against the headboard of my bed and birthed his big body over an intact perineum. He came out and was floppy and white. My MW was amazing, immediately called 911 and began administering oxygen. His heart rate was strong and steady but he was reluctant to come around. I'd almost say it was like he passed out as he was born. He perked up just as they arrived. She had it under control, even when the EMT's arrived and completely ignored her authority and essentially "stole" my perfectly healthy son and transported him to the ER for an hour. The next day she went and gave them a lecture on home birth and her role versus theirs. She was awesome.

"She was a great mixture of professional and warm. She was like a doctor, in the way that she was full of information and had such a direct and strong way about her, but she was a midwife at heart, warm and willing to be leaned on."

Why a Doula is Better Than Your Best Friend

This article by Birthing Hands of DC on facebook is really good! It discusses why sometimes family and medical staff are not enough support or the right kind of support a woman needs in labor and birth.

Why a Doula is Better Than Your Best Friend

In my own experiences I've found what this woman writes to be absolutely true. I've had some friends tell me "I don't need a doula. My husband is a great labor coach, and he is all I need." My response to that is that my husband is a fantastic labor coach as well, but it always helps to have another set of hands and an unattached, unbiased, knowledgeable person there to support me.

Men At Birth - First Male Doula Certified by DONA

"Keith Roberts is unfazed by the attention given him as the first man to be certified as a doula by DONA. He has has spent over 30 years in the field of holistic care, specifically focusing on pregnancy massage therapy and birth support for the last fourteen. The prenatal massage work he does was a segue to following one mother right into labor where he found expert massage therapy was extremely beneficial to her in labor. She was the first of fifteen more mothers he supported in labor before he determined to pursue certification as a doula."

Men At Birth: Yes, He's My Doula

This is a really interesting article about a male doula, and how he feels his support in labor is so helpful. The article also lists some really good advice for expectant parents.

Breath-Taking Photo Slide Show of Home Birth

I realize I post a lot about home birth on my blog. I support hospital birth as well as home birth, but I feel we see enough about hospital birth in the media and in society in general. My goal is to inform people of the safety and beauty of home birth to offer a wonderful alternative to those who may be looking for such.

The Birth of Amerlyn Grace

This site has a breath-taking slide show of a home birth. I love how the photos accurately portray the progress of labor, and you see that the birth is not necessarily easy but it is beautiful and miraculous. In the slide show you see how the birthing mother and her support team work together in the birth of a healthy baby girl.