Little Biggs Baby: how we prepared for an unmedicated birth
I wanted to talk a little bit today about what I did to prepare for Griffin’s birth. We planned an unmedicated, physiological birth from the beginning, at a location where an epidural and most other forms of medical pain relief were not options. While, of course, the birth did not go precisely as planned, our preparations were nonetheless a big contributor to the sense of calm I had as our plans unraveled. Thus, I want to share them today.
With Logan, I received pretty standard care, especially for an American mom-to-be: I went to my local OB/GYN practice, cycled between three doctors, and gave birth in a hospital after having an epidural. We made this choice for a variety of reasons: we were comforted by knowing we were working with specialists, wanted to give birth in a hospital, and I have no opposition to pain relief via epidural for people who want them. Ultimately, though, we had some issues with our care: the OB/GYN didn’t spend adequate time with me during labor or after delivery (she was in the room less than 30 minutes before Logan was born) and some medical oversights occurred that eroded my trust in the staff at the hospital. When I found out I was pregnant with Griffin, I wanted to explore another route to birth. And, since I’m a scientist, it became time to collect data: internet searches, research studies, and lots of interviews. We talked at a local family practice physician, as well as two midwives: a hospital-based nurse midwife, and a certified professional midwife with a stand-alone birth center.
Ultimately, we opted for the certified professional midwife, for a variety of reasons. First, my husband and I both connected well with the CPM and felt immediate rapport. Second, midwifery care as a whole was very appealing to us. We love the overarching philosophy that pregnancy and birth are normal events in a woman’s life, and low risk in the majority of cases. It’s so nice to see someone whose training fits within this philosophy: emphasizing normal physiological birth, clearly delineating low-risk v. high risk pregnancy, and providing care that is physically and emotionally supportive during this big transition for our family. We also love the continuity of care. I saw the same midwife for every appointment. She scheduled an hour for every appointment we had with her, instead of the 15 minutes that my OB/GYN had scheduled. This gave us time to truly get to know each other, to build a trusting patient-provider relationship, and to feel confident and comfortable with who we were choosing to have present during our birth. This felt like a stark contrast to our OB/GYN, where the doctor present at our birth was whoever happened to be on call. This was all the right choice for us.
Choosing our midwife was, in reality, the first step in our birth preparation. I had initially attempted an unmedicated birth with Logan, but plans changed when I ended up undergoing an induction that resulted in extremely intense labor. This time, we had made a choice that limited my medical pain relief options, so I felt a strong urge to prepare more intensely than I did when Logan was born. Here are some of the other ways we prepared:
Pick a provider you trust - I went into some detail about this above, but it’s worth saying again: trust is the most important aspect of your relationship with your care provider. This is not to say that a Licensed Midwife is the right choice for every family, or every birth. It was the right choice for my family, for this birth, and a big part of why we felt so comfortable with this choice was trust. We knew that our midwife respected us and our birth preferences. We trusted that she could provide us with evidence and research to support her recommendations. And most importantly, we trusted that her training would allow her to safely help us bring our baby into the world, or refer us to a specialist if the need arose. Ultimately, this level of trust let Tyler and I enter into this birth experience more confident and relaxed than we ever felt regarding Logan’s birth - which was a really great feeling. So, when choosing a care provider, choose someone you trust, and a location where you feel safe - for some people, this means an OB/GYN at a hospital. For others, this means a midwife at home. For still others, it’s something in-between. And that’s okay - other people’s preferences don’t matter when it comes to your birth. Yours do.
Build big toolbox - when your birth plan doesn’t include an epidural, it means you’re going to need other coping strategies to manage during labor. For my first birth, we opted to take a birth preparation course to help build this toolbox. This time around, it meant a lot of reading, hiring a doula, and practicing labor positions, massage techniques and meditation in the weeks leading up to the birth. I also packed some tools to use during labor - essential oils (neroli, peppermint, and lavender) to diffuse, a homemade rice sock to use as a heating pad, tennis balls for massage, a woven wrap to use as a rebozo, and a birth tub available at the birth center where we planned to have the baby. It’s also important to get your spouse/partner/support person in on this preparation - a woman in laborland is not exactly able to say “there’s a tennis ball in the bag please massage the lower left side of my back with it” but she can say “yes I like that” or “no that’s not working” to a partner who knows how to use the toolbox that has been prepared. Finally, the practice of compiling a birth toolbox with your partner is a great way to build confidence about labor for both of you, which can be really crucial to a relaxed, empowering birth experience.
Read all the books - when I prepared for Logan’s birth, I read Ina May’s Guide to Childbirth, the quintessential choice for a first-time mom curious about natural birth. And it’s a great book. The first half is filled with women’s unmedicated birth stories, written in their own words and almost always moving, emotional, and profoundly positive. The rest of the book discusses some common birth-related medical interventions and the evidence for or against them, which can be a useful tool when making decisions for your own birth.
While Ina May’s Guide is a great book to change your attitude and approach to birth, it doesn’t actually provide a lot of insight into building your own coping strategies. For that, I read Birthing from Within and Mindful Birthing. Both books emphasize birth preparation through self-reflection and mindfulness, which are awesome life skills that extend so far beyond birth. They also suggest preparation through actual practice of these skills - typically by holding on to ice cubes for set intervals to mimic the discomfort of a contraction. Mindful Birthing also includes numerous guided meditations to practice as you build your own meditation practice - personal favorites for me included the loving-kindness meditation and body scan meditation.
Finding birth books that resonate with you is a really personal endeavor, though - if you are reading ANY childbirth book and find yourself thinking “this is silly” or that it’s just not resonating with you - that’s fine. Move on to something else, because you will find something that works for you. I remember telling my midwife that I was reading Grantly Dick-Read’s classic Childbirth Without Fear and that it kept making me angry - I didn’t want to read a book where a man told me that childbirth wouldn’t be so painful if only I would stop being scared of it. Some people love this book and love his perspective, but it didn’t work for me, so I moved on to books that did make me feel confident.
Hire a doula - If #2 above is an intimidating prospect for you, seriously considering hiring a doula. Doulas are basically the entire toolbox wrapped up into a kind human’s body who can be with you for your entire labor. Specifically, though, doulas are non-medical birth support people who take the time to get to know you and your birth partner before labor begins so that they can act as support, provide advice, and be your advocate when you’re actually in labor. They are trained in labor and birth positioning, massage, counterpressure, and breathing/meditation techniques to help enhance your comfort and coping in labor. They also learn your birth wishes, and can act as a sort of human birth plan to make sure your wishes are respected as much as possible. Doulas can be pricy, of course, but when you consider the numerous positive outcomes associated with doulas (including decreased rates of epidural, emergency cesarean, and hospital transfer in the case of planned home/birth center births) they can be well worth that expense in terms of avoided additional medical expenses. Additionally, doulas believe that any person who wants a doula present at their birth should be able to have one, so if affordability is a factor for you it may be possible to work out a reduced rate, scholarship, or payment plan.
It’s also worth considering how your birth location plays into your need for advocacy - for instance, if you’re planning a birth at home or in a standalone birth center, your care providers are likely much more aware of your wishes and intentions than if you are planning a birth in a hospital. Your care providers are also much more likely to spend extended periods of time in the room with you, providing emotional and physical support as you labor, especially compared to OB/GYN or nurses in a hospital setting (which is not to say that doctors and nurses don’t care or aren’t available - they’re often just juggling the care of numerous patients and have a lot to do. It’s just one of the unfortunate by-products of hospital culture when it comes to birth.) This tends to make doulas more helpful in hospital birth settings, or with first births, where the emotional support and advocacy needs are stronger than in other environments or in subsequent births.
Visualize your ideal, then release judgment and expectations - This is a hard one. We spend a lot of time during pregnancy imagining how labor will go. Visualizing what it will be like to meet our child for the first time. Romanticizing the whole damn experience into a sea of candlelight and rose petals. And this has strong benefits - building confidence, helping cement birth preferences, and creating a narrative of capability and preparedness we will take into parenthood.
We’re often told that birth plans are useless because labor unfolds in unpredictable ways. This is true - birth and labor really can’t be “planned”. However, I think that birth plans framed as a list of preferences are still extremely useful because it allows us to visualize how we’d like labor to go under ideal circumstances. This visualization builds confidence, helps our care providers understand our vision, and asks us to acknowledge contingencies that we may not have considered otherwise. So, go ahead and make that birth plan! But try not to be too attached to it - think of it more as a list of preferences than a set in stone plan about the way things are supposed to go. And think about how your preferences will change with some unforeseen circumstances - a long labor, a breech presentation, or a need for induction, among others. Make those preferences known too. Learn about the processes and procedures that usually accompany those circumstances. Remove any shrouds of fear or unknown so that if your plans change, you’re prepared and empowered and can ask the questions that help you feel like you’re running the show - because you are.
Additionally, releasing judgment and expectation puts us in a receptive mindset, open to growth. Which is, fundamentally what birth is all about - your body has grown, your love for this baby you’ve never met has grown, and now, your family will grow. And it’s so important to accompany this physical growth with emotional and psychological growth as well. Remember that, even when things don’t go to plan, you have a team that you trust and you are in good hands.
Take care of yourself - Pregnancy is a time of huge transformation, and processing that transformation can require a lot of self-care. I’m not going to tell you what your self-care looks like, because that’s different for everyone and can vary from day to day. What I will say, though, is to ask yourself “does this serve me?” on a regular basis. You can ask this question about that uncomfortable pair of shoes, or that relative who always has negative things to say about her birth experiences, or the type of exercise you’re choosing to engage in that day. If the answer becomes “no” - stop doing it. Stop wearing those shoes. Stop listening to Auntie Paula’s horrific birth story. Stop running and try yoga instead. This is a powerful practice in boundary setting, with yourself and with the world around you. And boundaries are only going to become more useful after your baby is born, so these small acts of self-care now will pay huge dividends when Grandma Bertie starts telling you to put bourbon on your baby’s pacifier to help them sleep.
Taking care of yourself takes a lot of other forms, too - try to get some movement in most days of the week. Emphasize good nutrition as much as possible. Give yourself enough rest and sleep. Treat yourself the way you’d like your child to treat themselves down the line.
Overall, I feel like I entered into Griffin’s birth far better prepared than I did the first time around, largely because I really took the time to cultivate a growth mindset, learn practical preparation techniques, and dedicate time to preparation that included my husband. All of these factors contributed to an overall sense of calm and confidence that helped cement the knowledge that my body was capable and my mind was ready to welcome a new member into our family.
What did you do to prepare for an unmedicated birth? What books did you read? What classes did you take? How involved was your partner/doula/birth team? Let me know in the comments!