Friday, July 22, 2011

The Emotional Signposts of Labor

Nicole here for your post today!

Did you know that for most women it's completely possible to have a baby and never have a gloved hand in your vagina the whole pregnancy?

In this world of routine cervical examinations starting at as early as 35 weeks in some practices and hourly progress assessments in the hospital it's easy to forget that! But an experienced and knowledgeable birth attendant or supporter can make a pretty accurate guess of how close the birth is by how the mother is feeling and behaving. These indicative behaviors and feelings are widely called the "emotional signposts of labor" and all it takes for someone who has spent a fair amount of time with the mother is to watch her for a few moments and her labor progress becomes pretty clear.

Today you get an inside scoop to what birth workers know. Handy, right? Especially for you dads out there!

Unlike the stages of labor, there are five, instead of three, major emotional signposts.

1. Excitement. When labor starts many women think "FINALLY!" They want to walk or move to encourage contractions, they glow with anticipation and enthusiasm. Smiles come easily, some women want to tell everyone, others worry that this isn't really "it", and keep the news to themselves for the time being. This usually lasts from wherever labor started off at dilation wise until about 4-6 centimeters, which is when active labor kicks on. Best thing a supporter can do? Help distract mom with conversation, jokes are especially effective, since laughter helps sphincters open up (which is essentially what the cervix is). Make sure to keep it away from anything that offends her, and stop when she gives signals she wants you to stop!

2. Acceptance. Mom becomes more introverted, quieter. She still smiles and interacts between contractions, but during contractions she likes to concentrate. Many are still excited about the upcoming birth, others, especially if labor has been long, start to feel a little anxious. Wow, it's really happening, the baby really will be here soon! As this stage progresses, most women want to call in their supporters, though others will want to retreat into dim lighting, silence and solitude. This is active labor, from about 4 centimeters dilation until about 7-8. The best thing you can do for mom now is to follow her cues. If she wants quiet and dark, give it to her. If she wants lots of physical contact, give it to her. She's really working hard here, and stress or too much outside stimulation can make labor more difficult, longer or even reverse.

3. Doubt. For many women labor gets even harder. She may be thinking "Can I really do this? This is too much, I can't take it any more." This is transition, from about 7-8 cm clear to 10. She communicates in one-word sentences, grunts, groans, even screams and curses much of the time, as talking takes too much of her focus away from what her body is doing. There are powerful forces at work and mom starts to wonder if she's up to the challenge. Many women cry out that they can't do it, for someone to take the baby out of them. They can't get comfortable, and many want to run away. You may see a lot of squirming, position changes and hear a lot of vocalizations, or mom may become completely silent. For many women this is the most intense part of labor. The best thing supporters can do during this signpost is respond to mom verbally when she tries to communicate, praise her efforts (those are good sounds, that's a good position), touch or don't touch as she wants (many women can't stand to be touched during this phase), and remind her that she IS capable of this, she IS doing it and labor WILL end!

4. Second wind. Out of the ashes of transition rises the birth phoenix. Slowly or all at once, mom gets a surge of adrenaline and like magic she comes down from the cloud that labor took her to, and she can move and speak again. She is more cognizant of what is going on around her. Some women are astounded by the change in their mental state, others accept it calmly and make the switch from passive participant to active force in their labor more slowly, but the change comes. She goes from riding the contractions to using them and puts all her energy and focus into getting the baby OUT. Many women report that the pain of labor greatly diminishes during this phase, which is the second phase of labor, or the "pushing phase". The whole energy of the room changes and you can see it in the mother's and your birth team's faces. Eyes are bright, the face is focused and calm, the birth is near! The best thing for you to do now is to help support her in whatever position she feels most comfortable in and encourage her verbally as she pushes. Talk prenatally about whether she wants you to coach her pushes (counting to ten, for example) or if she wants to listen to her body. If you plan on catching, now is the time to prepare for that.

5. Lastly, after labor has ended, the baby is born, mom's hardest work is done, relief and joy expand and fill up the whole room. Everyone is smiling, some are crying. This is the 5th signpost. Afterglow :)

Enjoy your birthing experiences, everyone!

Friday, July 15, 2011

Including siblings at the birth

In the years that I've been serving women at birth, some of my favorite birthing experiences are the ones that include siblings. Early in my career, it was much more common- if the baby had older siblings, it went without saying- they would be at the birth.
Well, that was in the 70s and times have changed. People have different ideas regarding what is best for the laboring mamma, what is best for baby and what is best for the family. But if you have older children, I would encourage you to think about including them at the birth.
When children are included in the experience of pregnancy, and birth, I believe that it validates and empowers their position in the family. It sends the message that they are important enough to you that you want them with you during life's biggest events. When you share the experience together, it reinforces the roles you play as parents and solidifies the family bond in a powerful way. And the children seem to immediately feel that connection with the baby. I believe that decreases problems with jealousy and sibling conflicts.
On the other hand, some parents worry that the older child may be traumatized , and no one wants that.
While many children express a desire to be involved and to witness the birth, others are simply not interested. They're just not into it, and that special time away with a friend or relative instead is the treat they prefer. Like the rest of us, children bring their individual personalities into the equation. Some get excited and blissed at the mention of the baby's coming. Some kids seem to act as if they're getting a brain scar just talking about it, and to others, believe it or not, it's boring. So we need to look at each child individually.
Many moms feel that experiencing a natural childbirth is enough of a challenge on it's own and they don't want to be distracted by the needs of their older child ,or to feel that they should control their expressions of the labor experience. These are valid concerns and need to be examined and weighed as you make your choice. Sometimes including children is just not the best option for you.
If you do want to consider this option, but you are unsure of whether it would be a positive experience for your child, you can get a feel by watching their reactions when you talk about the upcoming birth, or talk to them about their own birth.What do they express- what do they have to say about it?
What about the age of the child? Many parents express concern that their child is too young to prepare. I actually believe these very young children know more than we think. They often do very well and act as if they knew it all along.Older kids and teenagers may feel awkward. Too much information, Mom and Dad! Others feel that their maturity lends to a wonderful bonding and learning experience.
Check out some births on youtube. For starters I would recommend hypnobirths and waterbirths. You can google the hypnobirth channel and you can pretty much be guaranteed that you will find gentle peaceful births there. If she wants to watch more, that's a good indication that she might do well at your birth. If she gets up and walk away or expresses fear or disgust - that's your sign.
If you do decide to include your child, there are few ways to prepare to make it go better. Let them know what the process is like. Mom will have sensations or pain in her belly and that's normal. Older kids will want a more detailed explanation. For young kids, keep it simple. The sensations come and go away. Mom will need you to stay kind of quiet and still. Then it feels like going to the bathroom. Mom might say funny things. If your child(ren) are small, you can tell them mom might make sounds like animals. Sometimes it sounds like a cow, or a bear or a tiger. They can practice those sounds with you. Older kids may want a job to do, such as cold cloths for mom's face or giving mom a drink. Small kids can hold a flashlight or guaze square. Sometimes they like to help us with the newborn exam, or help Dad to cut the umbilical cord.
One busy little boy held the flashlight at a water birth. After mom and baby were tucked into bed, he would kiss the baby, then go back, shine the light into the pool, and demand, "More Baby!!"
Be sure you explain that there will be blood, and that the placenta will come out and that babies cry. Let them know blood doesn't mean that mom got hurt. I like to explain to little children that since baby can't eat food in there, the blood coming through the umbilical cord is what keeps baby healthy. That, and the placenta , will come out when baby doesn't need it anymore.So when they see baby with some blood on him it's almost the same thing as when they're eating pizza or spaghetti and get sauce on their hands and face.Except that it comes from what will be baby's belly button and not missing his mouth!
If you do decide to have your child with you at the birth, I would recommend that you consider having someone at the house specifically to see to your older child's needs. Someone the child enjoys and feels safe with. She or he can be sure your child is fed and entertained and sleeps if the labor is long. She can offer reassurance and support, and if you should end up needing to go to the hospital, this is the person who can stay home with your child, or bring him or her to you, as needed.
At the birth, know that your child will look to the adults present- he will be aware of the looks on our faces. If mom is making noises and everyone's face is showing joy and anticipation, this is all that's needed to remind him or her that all is well.
If just as the baby is born, your older child starts to cry, don't assume he's traumatized. Look around the room; is anyone else teary-eyed? As one little girl said, "No, I'm not sad! I'm crying because I love you Mommy!! I love you Daddy!"
No matter whether you decide to share this experience with the older siblings, or to arrange another alternative, be sure to communicate that their position in the family is as strong as it always has been. Your love will be stronger than ever as your family starts on this new beginning.

Monday, July 11, 2011

Preparing a sibling for the new arrival

I think that for the vast majority of the families we work with,joy and bliss are the the driving emotions when you find out you are pregnant again. But when it's your second baby, you might also experience a bitter-sweet emotion, because this pregnancy signals a kind of beginning-of-the-end of the honeymoon relationship you've had with your first born. Your first child has been the center of your world and has enjoyed all of your undivided attention. You may wonder how s/he will adapt to being an older sibling, and how will you split your time. Can you ever really love any one- even your own child, as much as you love your first ? Yes- you can. You will find that your love multiplies.
But there are a few helpful tips to make things a little easier.
First of all, remember that young children are generally more aware than we give them credit for. Sometimes you'll see changes in behavior, or they say things , that lead you to believe they knew a new baby will be making the scene even before you knew it.
Some parents want to know when to tell an older child. Some parent feel that their child would be traumatized if there were to be an early miscarriage. Others don't want the whole world to know about the pregnancy and they know that if the older child knows, soon everyone will know :) I would say that if you are asking that question and you aren't of the mind to tell your child as soon as you know, wait until you have heard a heart beat. I would even suggest that you bring your child in for a prenatal exam so that he/she can hear the heart beat, too.
Talk to your child about it and share your love for the new baby with them.
When you are far enough along, let them feel the baby's movement in the womb.
As you are sharing with joy, don't be alarmed if your child expresses negative emotions. This is normal, and maybe even good. It gives you an opportunity to listen and support, rather than reprimand and make him feel guilty. It's okay to say something like, "yes, sometimes mommy feels the same way. I really like the times we have just you and me" or "just you and me and Daddy". This will give your child the sense of security that you truly do accept her for who she is, unconditionally. And then later you can turn the conversation again to how lovely it will be to share the experience together and how lucky baby will be to have him/her as big brother or big sister.
If your older child is very young, say 2 or less, it will be very helpful if you can find a way to spend time around younger babies. At first you'll just want her/ him to see the baby and learn from just that. Later, as time goes on, be sure to spend some time holding other babies; hopefully you can allow your child to touch the baby so that when your baby arrives it won't be the first time she/he gets a lesson in being gentle around the baby.
There are also lots of books to read to your child about becoming a big sister or brother. Point out the kids you know who have little brothers and sisters.
Beyond the psychological and emotional preparation, there will be a need to look a logistics.
If you are planning to wean your child, or train him to sleep in his own bed, or potty train, timing is important. It's helpful if you don't time these challenging shifts in such a way that your older child associates them with the pregnancy or new baby. I like to suggest midpregnancy to your 6th or 7th month. That generally leaves enough time that big brother or sister will be well adapted and not angry with the new baby for cutting him off.
As you get nearer to the end of the pregnancy, involve your best friends and closest family members(or have them read this blog ;) I think it's nice when someone bringing a present to the new baby brings something to the older sibling, too. It doesn't have to be much. Remind your friends that people come over and their first request is to see the baby. It's lovely if some of your friends and family can initially focus attention on the older child before the oowing and aaahing over the new baby begins.
It's also nice for mom and dad to have a new toy or two, even a baby doll, maybe or a stuffed toy, stashed in a closet to open when big sibling is introduced to the baby. Some parents will give the gift as a present from the new baby. It's also nice if close friends or family take your older child on special play dates, maybe for a movie , ice cream or a trip to the park. That will make him feel special while it allows you some time for undisturbed bonding with your new one. Maybe you can switch it up with Dad once in awhile so he gets the same bonding and you get undisturbed time with number 1.
When it's time to get your home ready for the new baby, you might want to set things up differently than you did for your first. Many moms set up a rocking chair as a "nursing station" with the things you'll need on a table within reach. I recommend snacks like fruit, protein bars. Lots of moms keep the phone, a burp cloth, the tv clicker handy. With a second child consider setting up a cozy corner of a couch or a big overstuffed chair instead of the rocker or glider. You might have books to read to your bigger kid as he shares your lap, and quiet toys, like puzzles crayons and paper to have on the floor right beside you.
If your child is a little older, it helps to start well before baby arrives with developing more indepenence. Start fairly early lifting and carrying your child a little less as time goes on.If he's old enough, he could start dressing himself. You could move snacks to a shelf in the kitchen he or she can reach. Encourage her with entertaining herself a little more all the time.
Always remember how tuned in to you your child is. If you are ready to move forward with the changes and shifts in your family, big brothers and big sisters will take it all in stride.
Most importantly - know you'll have good days and bad days. We always want perfection when it comes to our children. But it's okay to be human. Be gentle and kind with yourself.

Tomorrow -- Including Siblings at the Birth