Normally I like to fill this blog with reflections on my journey through faith and motherhood, and while this is still my favorite, I wanted to take a break to get some nitty gritty off my chest. I’ve had several conversations with several mom-friends lately which has reinforced to me how much misinformation is out there and convinced me that so many women would have fewer regrets about their births if they simply were told more about what was normal and what was not. So without further ado:
1. The Natural Alignment Plateau (NAP)
Here’s a phrase you’re probably more familiar with: “failure to progress”. You may have even heard it in the context of your own labor, possibly immediately before you were put on Pitocin to “speed things up” or were whisked off to the operating room. This concept of “failure to progress” is based primarily off of something called the “Friedman’s Curve”, which assigns time limits to laboring moms as they progress, requiring something in the vicinity of 1 cm dilation every two hours for first-time moms or 1 cm every hour for subsequent deliveries. But the Friedman’s Curve was never meant to diagnose “normal” vs. “abnormal” or “safe” vs. “dangerous” — it was meant to illustrate an average. The problem with diagnosing based on an average, however, is that some (most? all?) moms have the audacity to not fit into a mold! What we often see is a normal, easy progression of a centimeter or two every hour, and then suddenly the last three, four, five hours have passed without a budge in dilation, and everyone’s faces get very stern and serious. “It looks like what we’ve got here is a failure to progress,” they say. “If we don’t see some change in the next hour, we’re going to need to talk about our options to get things moving and get this baby out.”
Marjie Hathaway, one of the co-founders of The Bradley Method®, coined the phrase “Natural Alignment Plateau” to illustrate the normalcy of this phenomenon. We don’t know exactly what causes this temporary stall in dilation, though it could be anything from the baby adjusting himself into a better position for birth, the mother having an emotional hurdle to work through before her body can relax and move forward (such as fear of motherhood, conflict with her partner, trauma from a previous birth, etc.), an internal physical process that hasn’t finished yet such as the widening of the pelvis or the breasts preparing for the production of colostrum as soon as baby is born, the baby’s head still molding for a smoother passage through the pelvis, the mother feeling stressed or tense due to her environment or the people around her (see “The Physiological Effects of Mental/Emotional Stress” below) or even just that mom is exhausted and her body is taking a mandatory break to store up energy for the big finish. What we do know, however, is that it is normal and common and nothing to be afraid of. This doesn’t mean that there aren’t genuine reasons to intervene in a labor, but without further evidence of a problem, the “stall” in and of itself may not be reason enough. Often a stall at one dilation for what seems like a long period of time can suddenly end with a huge leap that takes your body all the way up to 10 cm, and wouldn’t you know it, you feel like pushing!
(For more information about the Friedman’s Curve and NAP, click here or enter the following link into your browser: http://allaboutbirth.net/pdfs/Failure-to-progress.pdf)
2. The Emotional Signpost of Transition
“Transition” is the stage of labor that comes at the very end of the dilation stage, right before the body begins pushing the baby out. While every labor is different, transition usually encompasses the period from about 8-10 cm and is characterized by being quick but very intense, physically, emotionally, and mentally. This is the period of labor during which moms might find themselves burping, shivering, throwing off all their clothes in a hot flash, or vomiting. (Side note, at the risk of being gross: throwing up in labor is not such a bad thing when you consider the amount of expulsive power your body produces to vomit. Have you ever had a stomach bug that meant you had to be sitting on the toilet with a bucket in hand to vomit because you weren’t going to be able to help the pushing on the other end? Well, think about that and how it might help move that baby along…just sayin’! ;)) And aside from the physical characteristics of transition, there is the emotional element. While early labor is characterized by excitement and enthusiasm and active labor by seriousness and focus, transition is often accompanied by a sense of apprehension or self-doubt. Particularly in a natural birth, the intensity and frequency of the contractions at this point can feel completely overwhelming, and this, my friends, is the stage of labor in which so many women who dearly wanted a natural birth find themselves giving up and asking for an epidural. I feel for you, my friends, I do, because labor is HARD. I’ve been there and remember it well. I didn’t have either of my babies at a hospital so there was no anesthesiologist waiting in the wings, and let me assure you, this does not make me a rock star any more than accepting an epidural makes you a failure! When I hit transition, both times, I don’t know what I would have done if I’d been in the hospital, but I sure can tell you that I would have been sorely tempted to receive medication. Natural childbirth is many things, many of them glorious, but for most women, “easy” is not one of them! My goal isn’t to tell you how hard labor is, however, but to tell you that for most women who wanted a natural birth but accepted an epidural or IV narcotics after putting in a valiant effort, there is a good chance you were in the home stretch and never even knew it. While it’s much easier said than done, when we reach that place where we feel the panic rising and the sense of “there’s no way I can do this any more”, we should remind ourselves (or, better yet, make sure your partner and birth team are poised and ready to deliver the encouragement!) that the self-doubt doesn’t mean you can’t go on, it means you’re almost there!
3. The “40 Weeks” Myth
The delightful Kate Middleton, Duchess of Cambridge, recently gave birth to the heir to the throne of England, but what caused arguably almost as much of a stir as the royal significance was the fact that she had a natural birth…and at 41 weeks! *gasp!* (Okay, I’ll admit it. I am a total Kate Middleton fan. She is amazing.) Classically, “full-term” has been deemed 40 weeks, though some caregivers will allow a pregnancy to go as long as 42 weeks, though this is far more rare than I’d like to acknowledge. All too often the estimated due date is viewed as an expiration date.
What many people may find surprising, however, is that the 40-week gestation measure was established in the 1800s, whereas studies done in the 1990s determined that the average length of pregnancy falls at 41 weeks and 1 day. That’s right, folks. At 40 weeks, you are still early. Yet despite this new research, every day women are being told that once they have passed their 40-week due date, they are “overdue”, that the baby “doesn’t want to come out”. Bottom line, they’re being told they’re broken, and that only our doctors can save us from ourselves.
Let me be clear: there is such a thing as an overdue baby. But actual symptoms of post-maturity happen so much more infrequently than we’re led to believe, and often when labor is induced or baby is delivered by c-section at or near the 40-week mark, a baby is born not with signs of post-maturity but instead with signs of prematurity! Due dates can be wrong, and not all babies need the same amount of time. Simply being past your due date does NOT mean your baby is necessarily post-mature. There are a number of non-invasive tests that can be administered to determine if the baby is in any danger or if he’s simply just not quite ready yet. If your doctor wants to hand your baby an eviction notice based solely on the calendar, consider asking what your options are, and don’t be afraid to get a second opinion.
4. The Physiological Effects of Mental/Emotional Stress
If you know me at all, you know that I’m a huge fan of out-of-hospital birth, specifically for low-risk moms who don’t want to be in the hospital. One of the primary reasons for this is that feeling safe, comfortable, and trusted during labor and birth are not just happy things to have in a perfect world — they actually have a real effect on the safety of your baby’s birth. Tension not only causes greater pain in labor, but it produces adrenaline, which can slow or stop labor. This is a clever built-in feature harkening back to times past or more primitive civilizations where the threat of attack was very real and could happen at any time, even in the midst of labor. Other mammals share this quality for the same reasons. If a laboring mother of any mammal species feels threatened or unsafe in her environment, her labor pauses to give her the chance to flee to a safer location where labor can resume. The problem is that even though in modern society few women will encounter surprise attacks in the middle of labor, those same fight-or-flight hormones can be triggered by feelings of tension or fear due to your environment, the people around you, or your feelings about labor, delivery, or parenthood.
One thing I try to make clear when I talk about my advocacy for home birth is that I genuinely don’t believe it’s the best choice for everyone, even among low-risk women, because what’s arguably more important than the location is the environment. If you don’t feel safe, your body will not respond the way it was made to. Some women (like myself) don’t like hospitals and have difficulty relaxing in them, and as I’ve said, this has a real, physiological effect on the way labor will progress, both from a experiential standpoint as well as a safety standpoint, and this is one factor in evaluating the safety of home birthing (which is not to mention risk of infection, the pressure for unnecessary interventions, etc, but that is another post altogether). However, many women, particularly in America, feel much safer in a hospital, and if that’s the case they should be where they feel safest. What’s the point of having a planned home birth if you feel panicked about your baby’s safety in that environment? Wherever you feel safest, it’s also key to have a support team that supports your process and decisions, that loves you and believes in you, and that will stand up for you and your baby. Hiring a doula is a great way to encourage this atmosphere and is associated with better outcomes, fewer requests for pain medication, shorter labors, fewer cesareans, and happier mamas!
Bottom line, tension can lead to stalled labor which can lead to medical augmentation or an unnecessary cesarean due to failure to progress (as we discussed earlier), leading to the greater safety risks associated with augmentation and cesarean section. Tension can also lead to greater pain which can lead to requests for pain medication even among women who wanted a natural birth, which leads me to my last point:
5. Pain Medication Actually Does Put You and Your Baby in Greater Danger
There are real, actual, statistical risks associated with the use of pain medication, including epidural anesthesia. I want to be clear that I believe strongly in personal freedom and a woman’s right to have the birth she wants, whether that’s an ultra-crunchy unassisted lotus birth in a meadow or an ultra-medical super-modern designer planned c-section with a tummy tuck finish, or the whole gamut in between that encompasses the vast majority of us. But let’s not be ignorant about the fact that just because something is common does not mean it is harmless. It constantly amazes me how many people argue for the use of epidurals based on ideas like “What’s the point of having modern medicine if we don’t take advantage of it?”, “My mom/sister/best friend/etc. had an epidural and everything was just fine,” “I’m a total baby about pain so there’s no way I’d want to go through that!” or “You must be some kind of rock star to want a natural birth!” As I’ve already stated, I am not a rock star for wanting a natural birth — I’m pretty much just a big baby who hates hospitals and doesn’t want the temptation of pain medication dangling like a carrot in front of me. Plus my midwife is the best thing since sliced bread, and I didn’t want strangers looking at my lady bits. And also it’s crazy safe. Did I mention home birth is super safe?
That said, let’s talk about pain medication used in labor. (Note: this will be a very brief and basic overview. There are many more thorough studies out there on each individual drug and its risks to mom and baby, but I’m willing to bet this post has already gotten way too long for the average reader as it is!) All medications have potential side effects, and while the placenta was once considered a reliable barrier between the mother’s blood stream and the baby’s, it is now known that this is not the case; the baby will receive some of any medication his mother receives. This fact alone carries a wealth of implications, and the wise consumer should take these into account with a great amount of gravity. (Does it not give us pause to consider that with all the warnings about any drug use during pregnancy, even drugs as common as over-the-counter pain relievers and cold medications, the whole thing goes out the window the moment labor begins? Is the baby not still connected to the same placenta via the same umbilical cord and have the same fragile little developing body?) Among the more common side effects on both mother and baby is the fact that these drugs dull the senses, which has its benefits, i.e. dulling the pain, as well as its risks, which include restricting the mother’s ability to respond to her body in the way of movement and position changes which could be a crucial element in the baby’s ability to position himself for birth. The dulling effect also carries into the post-birth introduction period, where medicated babies are statistically shown to be more sluggish and sleepy immediately following birth, restricting the initial bonding period that is so crucial as well as the first breastfeeding session, which can determine the tone of the entire breastfeeding relationship. For a list of reported side effects of epidural anesthesia, click here.
I love motherhood and the process by which it begins (for most women — adoption and parenthood via marriage are awesome too :)), and I mean not to shame anyone, only to inform. And also, for the record, I am not a medical professional and do not intend this post to replace medical advice or treatment, only to enhance the mother’s experience and fuel her fire to educate herself on her body’s natural process. May your motherhood journey be safe and fulfilling, whatever your route.