by Cynthia Gabriel, 2018
Excellent book about how to go about having a natural childbirth in the hospital. Adam recommended it. Very easy to read. It started out with writing a birth plan, and then went into detail on the stages of labor and what could happen to thwart your plans for a natural childbirth in a hospital. Again, the most important way to prevent the medications and the interventions is to not arrive at the hospital too early, especially if your waters have broken.
I still prefer Susan McCutcheon’s, Natural Childbirth the Bradley Way. This book is a kinder, gentler version of that book. Cynthia Gabriel provides you a way to prevent interventions – “We’d like to wait an hour.” That is a brilliant line. Again, it is best to forgo every single medical intervention in labor! Each one leads to problems and more interventions! Listed in the Appendix, here are the interventions to avoid and how to avoid them. The main reasons our medical establishment pushes these interventions are that either you’ve gone past your due date, or your waters have broken, neither of which is typically a medical emergency:
- Induction by Chemicals (prostaglandin gel, then Pitocin by IV). “Almost 40 percent of American women have inductions. Yet about a third of all inductions do not work…Women whose labors are induced are more likely to have C-sections than women who begin labor naturally.” To avoid this, recognize that “going past your due date is not a serious medical reason.” Try to start labor naturally: “long walks, nipple stimulation, sexual intercourse (but not if your waters have broken), acupressure points, herbs such as black or blue cohosh, homeopathic remedies, or, as a last resort, castor oil.” (Also, try eating dates and spicy food.)
- Breaking the bag of waters. This can cause infection which will result in needing to do a C-section. Avoid this by saying, “We’d like to wait an hour.” Also, avoid this by trying natural methods of starting labor.
- Foley Bulb – if you truly need to be induced, this is the best option because there are no chemicals or hormones involved. However, it sounds like it hurts. Again, going past your due date and your waters broken are the two most common reasons for induction; neither of which is a medical emergency.
- Vaginal Examinations – they can cause disappointment because you might not be as far along as you’d hoped. They can cause infection if your waters have broken. You can say, “I’d like to wait an hour.” It sounds like the only time you might really want one of these is in late labor. “…and especially if you have been pushing for a long time…By touching the bones of the baby’s head, your caregiver can determine whether the baby is in a favorable position.”
- Electronic Fetal Monitoring – all I can say about this is NO! They screw an electrode into the baby’s head! It requires you to lay flat on your back. It provides way too much information that can be alarming, leading the staff to think there is an emergency when there is actually nothing wrong. It also causes your support people to start watching the machine, rather than you. Ask the hospital staff to use a handheld Doppler or better yet, a fetal stethoscope that does not use ultrasound.
- Epidurals – this is a shot of pain killer. This procedure can cause temporary (or permanent) paralysis and/or intense headaches that last for days or weeks. It requires you to lay on your back for the rest of your labor. You may not be able to push effectively so the baby will be delivered by forceps or vacuum. To avoid this, in your birth plan, write, “Please help me achieve the most natural birth possible” and “Please do not offer any pain medication during labor, even if I look like I am in pain.”
- Episiotomy – this is the incision they make in your perineum to keep you from tearing. It actually causes worse tears and they take longer to heal than natural tears. Use hot compresses and push slowly or not at all when the baby crowns.
- Routine Pitocin after the placenta is delivered. Unfortunately, this is done often without your knowledge “to help the uterus clamp down and stop bleeding.” You may need this if you had a long labor, are low in iron, or previously experienced a hemorrhage after birth. To avoid this, avoid induction with synthetic oxytocin (such as Pitocin), do eat and drink during labor, make sure you are not anemic during the last trimester. However, if you have had a long labor (longer than 24 hours), you may decide you want this intervention.
Cynthia Gabriel researched for a year in Russia and in 66 births in the hospital, all were natural except for one! In the U.S., it is extremely rare for a nurse or doctor to see two natural births in a row.
Chapter 2 is all about feeling safe. It’s important for a woman to feel safe during labor. If you don’t feel safe, your natural oxytocin will stop and adrenaline will flow and your labor will stop. There are meditations to help. One is “Mindfulness Meditation for Pain Relief.”
Our medical practitioners are trained for all the interventions and rarely see a natural childbirth. Midwives and Doulas see hundreds of natural childbirths.
To have a natural childbirth, it is important for your labor to start naturally. If you go past our due date, that is not an emergency. If your waters break, the only time that requires medical intervention is if the color of the water is tinted brown or green. Then it’s possible the baby pooped and that would require intervention. She has a special section on if you’ve tested positive for group B Strep and your waters break before contractions. This is a controversial area. She advised seeing the “Evidence-Based Birth” website. What happens when waters break before contractions, if the medical world is involved, is a lot of fear. “Heavily influenced by a nurse’s or doctor’s use of the chilling words possible life-threatening infection, clients agree to an induction. Induction with synthetic oxytocin (Pitocin) or misoprostol (Cytotec) typically leads to stronger, harder, and longer contractions than the woman would experience naturally. Some women manage to labor on Pitocin without needing an epidural, but the majority opt for pharmaceutical relief from the pain. These synthetic hormones mimic the ones our bodies make, but they do not prompt our bodies to release endorphins or decrease the production of adrenaline.” Once you get an epidural, you have a good chance of a fever, and then they don’t know if the fever is from the epidural or an actual infection. So, you get a C-section. Therefore, if your waters break before contractions, don’t get induced and don’t get an epidural. Then, you’ll know if you have a fever, it’s not because of the epidural.
If your waters break, try to avoid looking at the clock. If the doctor and nurses don’t know how long it’s been, it’s better. They often have rules – and these are not proven – that a woman must deliver within 12 hours or 24, or 48 hours – after her water breaks. “The typical twenty-four hours wait for induction developed as a rule of thumb in the 1960s. It has withstood neither the test of time nor the test of scientific scrutiny.” She advised staying at home or only going to your caregiver’s office rather than the hospital. She also advised to drink a lot of water.
There is a section on Doulas. They are the answer! They are worth the money! There is a video on Kanopy called Woman to Woman by Aminata Maraesa that is about doulas.
Here are the possible reasons a C-section is necessary:
- Placenta attached to the uterus in such a way that vaginal delivery is impossible. I think this is called placenta Previa.
- The baby’s heart rate indicates severe distress.
- The baby’s body has an abnormality making it difficult to be born.
- The baby’s position is making vaginal birth impossible, for example, the baby is lying cross-wise.
- The baby’s head is too large to fit through the pelvis.
- There are twins, but only sometimes this requires a c-section.
- Triplets or more.
- The mother’s body has structural abnormalities.
- The mother has an active genital herpes infection.
- The baby has heart problems.
- The mother develops high blood pressure (preeclampsia).
- Labor is prolonged.
- The umbilical cord slips beneath the baby or through the cervix.
- The mother had a previous C-section with a vertical incision.
I think Susan McCutcheon’s book listed fewer situations requiring a C-section: the umbilical cord being pinched, placenta Previa, and baby’s position cross-wise.
A lot of times, the medical interventions have failed, and that is why you have to have a C-section. “Avoiding interventions to augment labor is important because these interventions in and of themselves often lead down the path toward a cesarean section. The most common scenario is that a woman experiences a plateau and feels discouraged, so her caregivers decide to augment her contractions with Pitocin. Pitocin can cause abnormally painful contractions. Because it is administered intravenously, it requires a woman to lie in bed. Fetal monitoring is also required. If the Pitocin does not speed things up, caregivers often recommend breaking the bag of waters. This, too, can cause labor to feel more painful. It also puts the woman on the clock. The combination of extra-painful contractions and lost mobility can quickly lead a woman to request an epidural. An epidural plus the loss of mobility can slow labor, and it can also create a fever. No one knows why epidurals cause fevers, but repeated studies have shown they often do…Because these fevers tend to get worse the longer the woman receives the epidural, and because there is no way to know during labor whether the fever is caused by the epidural or an infection, a woman who develops a fever in this situation can easily end up with an unnecessary cesarean.
“Equally important as these physical issues, submitting to an intravenous drip, an artificial rupture of the bag of waters, or an epidural has the psychological effect of making a woman feel that other people are in charge of her labor. It becomes easier for her to imagine and agree to a C-section, the ultimate manifestation that other people are in control of birth.”
Pg 110: “A diagnosis of CPD is usually nothing more than guesswork. No one knows exactly how much your baby’s head can change shape to fit your pelvis or how far your pelvis can open with the hormones of labor and with optimal position. Squatting, for instance, provides about 10 percent more space for the baby than the semi-reclining position.” CPD stands for “Cephalopelvic Disproportion” or “large baby.”
The key to being able to manage the pain during labor is to stay in the moment. Don’t think of an hour from now, just take one contraction at a time and stay in the moment.
In early labor 0-3 centimeters, you can walk around, cook, clean, watch a movie. You should definitely stay at home during early labor. The pains may last 10 seconds to a minute and be five to fifteen minutes between contractions. Her advice is to “Ignore Early Labor.”
The next phase of labor is still early labor, 3 to 5 centimeters: this is when you lose your sense of time. “Hormones flooding our system disconnect you from the real world, not just during but even between contractions….You will start to get annoyed when your support team asks you questions that require any thought on your part.” Stay relaxed during contractions, don’t tense up.
Most hospitals will not admit you until you are 6 cm or more. But the contractions may feel like active labor.
Active labor from 6-7 centimeters: finding your rhythm, going deeply inward between contractions, maybe keeping your eyes closed. To manage pain naturally: massage, hip squeezing, back pressure, change of position (all fours seems to be really helpful), walking, water, heat and cold, words of encouragement, visualization, breathing, crying. “Any anxiety or fear that causes you to tense can make contractions feel unbearable…Your brain has only a tiny thread of a connection to the outside world. If the connection is full of fear, your pain will get out of control. If your connection to the real world is full of calm reassurance, you can go about your task of letting go.”
In Transition Labor, 8 – 10 centimeters, some women may cry out that they are going to break in two, or they are going to die. Surrender to that – you are almost there!
Then comes the pushing phase. “The sensation of pushing is exactly what the word describes You have an overwhelming urge to bear down. To grunt. The vast majority of women experience this as similar to the feeling of having to expel a large bowel movement.” And, a lot of women do poop–I did when Adam was born. I felt humiliated but she says it happens a lot and the nurses just remove the pad quickly and go on. That’s exactly what happened with me. “Many women expel small amounts of poop when they push. This is often something pregnant women desperately fear; in reality, they are usually completely unaware of it happening in the moment. Nurses and caregivers just fold the blue pads over or put a new one down. Voila! The problem is solved in one second and most mothers and partners never even know.”
Pg. 166 – Initial Vaginal Exam – ask for the information the nurse has gleaned because sometimes they won’t tell you. But realize that the measurement they take of the cervix is done with fingers, not a ruler, so is prone to error. “Measuring dilation is not a precise science. Every person who measures a cervix does so with fingers, not with a ruler. It is therefore in your best interest to have the same person do all your vaginal exams.”
Her best advice once in the hospital is to remember these words:
“WE’D LIKE TO WAIT AN HOUR.”
Doctors and nurses are trained to look for possible complications. They are not trained in normal labors. “You have hired them to monitor the physical progress of your labor and uncover potential problems. They are experts at this job. Often, what they find is ambiguous: perhaps there is a developing problem; perhaps there is not…”
Clues that it is not really an emergency:
- you need to take advantage of this while the anesthesiologist is here – they may not be here an hour from now
- the test/intervention is not necessary but we need more information. “WE’D LIKE TO WAIT AN HOUR.”
- the doctor/nurse takes the time to argue that the suggested procedure is a good idea. “In an emergency, there would be no time for lengthy explanations.”
- They say ‘you could wait but we don’t advise it.’
She also recommends eating and drinking during labor to keep your strength up. She recommends honey sticks.
She also talks about the words, “I love you,” and how powerful they are to helping a woman in labor get through it. She wanted her husband to say them over and over and over. He finally did say those words over and over like a broken record during her labor on their 3rd baby. “Holding his hand and hearing them over and over in my third labor helped me more than anything else.”
She gives the phrases some women say during labor: I’m going to die, I hate you, Don’t touch me, I can’t do this, I’m so tired, It hurts so much, Help me. A good support person will say back: You’re doing it, honey. Just focus on this one contraction. You’re doing it! You can do it! It’s really painful and you’re getting close to the end, baby is going to be here, breathe! This is harder than you expected. You’re doing a great job.
If your active labor slows, focus on the here and now. “Focus on this contraction, not the next one or the one after that or, God forbid, on the one coming in the next hour.” “…a plateau is not a crisis. It does not require any hurried decisions.”
“WE’D LIKE TO WAIT AN HOUR.”
“Eat, cry, and move.” That is her advice on how to get labor moving again, naturally. Also, release your fears.
If the doctors and nurses start whispering about possible fetal distress, recognize that their getting you all worked up will only do more to stop labor because you will release adrenaline which stops the oxytocin needed for labor. Ignore them and stay in the moment. Let your support person take care of the doctors and nurses. Sometimes, the following can be the cause of so-called fetal distress, and these are “not-so-serious problems:”
-the baby’s squeezing the umbilical cord
-the baby’s position makes it hard to pick up their heart beat
-the baby is asleep
-they’ve mistaken the mother’s heartbeat for the baby’s
-the mother has eaten recently, causing a spike in baby’s heartbeat
You can eat something, you can move, and you can ask the nurse/doctor to use a handheld Doppler, and/or rub the baby’s head. “If the baby’s heart rate responds well to the head rubbing, everyone’s worries should be allayed. Studies show that checking the baby’s well-being by rubbing her head has practically the same level of accuracy as using an internal fetal monitor.”
“Your primary responsibility is to labor on, even in the midst of a possible crisis. The fact is that I have seen, and so have many other birth professionals, situations like this that are not real crises. In fact, scientific articles about the management of this situation are all about the problem of “false positives.” Women give birth vaginally to pink, healthy infants, even after hours of nonreassuring heart tones. They are never explained, but they also never led to a problem.”
I love this paragraph:
“No matter what complication arises during labor, whether it is a labor plateau, overwhelming pain, or a nonreassuring fetal heart rate, you will do best to remain anchored in your body, focused on your labor. The time to think rationally about tests, procedures, and medications is before labor. Any complication in labor can provoke you to feel scared and unsafe. Remember the importance of feeling safe, discussed in Chapter Two? To increase your feeling of safety, take charge of this part of labor that you can control: your focus. By focusing positively on your labor, you may have the power to resolve problems that your medical caregivers can do nothing about.”
After the baby is born and you are home, you begin your “fourth trimester.” She recommends staying in your pajamas for 2 weeks. “…cocoon for two weeks and nest for six weeks.” “Babies have often barely adjusted to Earth’s night-day rhythms at the end of three months…I explain much more about how newborn babies have unique sleep patterns and need virtually constant human contact and access to breastfeeding in the first three months of their life.” (She is referring to her book, The Fourth Trimester Companion.) “Advocates of babymoons recommend that during the early cocoon phase, the new family should accept offers of meals and gifts, but they should not socialize.” Don’t stimulate the thinking side of your brain too soon. “Participating in ordinary life too early stimulates the rational, thinking side of our brains. This stimulation can cause us to lose access to the parts of ourselves that have been opened up by birth. Lynch recommends staying in pajamas for two weeks after birth and avoiding touching money or credit cards for the same period. Dressing in pajamas signals that you are in a dreamy, otherworldly state, not quite ready to participate in daily chores or conversation.”
The fourth day postpartum is a good day for the doula to schedule a visit. The mother may be overwhelmed by this day because baby is finally waking up, hungry, and nursing may not be going too well. Let the woman reflect on the birth experience. Let the mother and baby be alone to nurse. But give support by doing laundry, dishes, cooking meals, returning phone calls, etc., rather than offering to babysit the infant. Listen without giving advice, give encouragement. This two week period is a fragile period. It’s a period of adjustment. It’s normal and transient.