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Book Review: Natural Hospital Birth: The Best of Both Worlds

Natural Hospital Birth: The Best of Both Worlds

by Cynthia Gabriel

 

This is the essential book for families desiring a natural birth in the hospital. It informs readers of everything I wish I had to time to review with my doula clients. It does not scare or shame parents about their birth environment choice, instead gently and honestly reveals what you can expect when you arrive at the hospital and how to prepare yourself & your birth team to maximize your chances of a natural birth. Gabriel manages to cover the normal birth preparation topics such as stages of labor, pain coping techniques, & birth stories clearly and yet differently than any other author before her. Additionally she includes in-depth examples of what birth teams can say to tired, frustrated mothers during birth & what to say to hospital staff encouraging interventions. This review will cover a few of the books’ highlights.



Finding out how your care provider really feels about natural childbirth & if they will support you

Gabriel suggests these 5 questions to learn about your providers’ attitudes about natural birth. She goes on to unpack possible answers and points out red flags that may not be obvious to parents who aren’t birth nerds.

  • Can you tell me what kind of birth you chose for yourself (or what kind your wife chose), and what did you learn from it?
  • Can you tell me about the most recent natural birth you attended?
  • In your opinion, what helps omen achieve natural birth? What can a woman do to prepare?
  • In your professional opinion, what are the main reasons that women who want natural births do not have them?
  • What do you think birth pain means to women? What is the value of birth pain?

 

Inductions, Large Babies, & How women describe labor pain in natural childbirth

Interventions, drugs or the unplanned, unwanted cesarean birth is the fear that lurks in the back the mind of most women desiring a natural birth but who are the in hospital. As a doula myself I witness three of the most common reasons that natural births transition to medicated or surgical births: inductions, ‘large babies’, and pain.

A woman being induced and hoping for a natural birth has a long, difficult road ahead of her. A natural birth is still possible with the right baby, the right body, and the right birth team. “Almost 40 percent of American have inductions. Yet about a third of all inductions do not work.” I hadn’t realized inductions numbers are that high or that they are so often unsuccessful. It makes sense to me though, birth is a dance between the mother and the baby, it’s impossible for the dance to begin unless both partners are ready.

I wish I could openly roll my eyes when an OB tells a woman, “Your baby may be too big to come through your birth canal. Look at how tall your husband is! And you know we let you go until almost 42 weeks, babies really grow in those last few days.” Or I wish I was in a position to say, “Deformed pelvic bones were much more common is the 1700s, when our foremothers suffered from vitamin deficiencies. Most North American girls today get enough calcium and vitamin D to prevent rickets, the most common cause of pelvic bone deformity, so it is now extremely rare to find a pelvis that not able to birth a baby.”

Gabriel points out that most of the time the ‘large baby’ excuse is used to convince a family to agree to a surgical birth the problem is the position of the baby. Unfortunately, I haven’t seen many OB’s work with women on the position of the baby, this is where having a good doula and following the authors’ advice of ‘Eat, Cry, and Move’ can come in handy.

Pain is often a huge factor when births shift towards medication. The author sites her own research in the United States & Russia about pain intensity levels, the percent of women who experience them, and possible reasons and connected factors. According to Gabriel 85-96 percent of women report that labor “pain is intense and requires effort (usually, a focus on breathing and relaxing) to get through. Most would agree that labor has been their most painful physical experience. Many compare it to running a marathon.” The good news is only 1-5 percent (the number jumps appreciably if labor is induced) described labor as, “Excruciating, unbearable pain.” The important message here is: labor is hard, AND you can do it, here is the proof.

 

Eat, Cry & Move

Labor is not a straight line from first contraction to birth. While each and every contraction is indeed helping to prepare your body, it is possible for your cervix to open and close and open again. Contractions may increase or decrease in frequency and duration. Labor may ‘plateau’, the author recommends to Eat, Cry, & Move if this should happen because each of those activities helps to change physical, emotional and baby caused plateaus. ‘Cry’ is short hand for emotional release; which could be laughing or screaming if that is what feels right.

I appreciate that Gabriel suggests eating. While most hospitals don’t allow women to eat once active labor has begun it is unfortunate because I have seen eating give a woman the energy she needs to get through a difficult stage of labor.

 

Distinguishing Emergencies from Non-Emergencies

A primary difficultly of birthing in the hospital is keeping your calm. “Much of today’s medicine is about evaluating risk, so even normal labors are continuously assessed as potentially hazardous.” The language, attitude, and experience of hospital staff is that danger could always be just around the corner. Part of this is because the hospital is not designed for natural birth, the staff are not trained for a natural birth, design and training is focused around responding when something goes awry, this is why you’ve chosen the hospital.

Nurturing the calm and reassuring atmosphere women laboring naturally need is not the strength of your hospital team. You must be prepared to maintain your relaxation and trust the process while staff around you has some fear in their bodies.

No one said birthing is easy! In a true emergency you will know, otherwise assume the tasks of the staff are not connected to an emergency.

Finally I’ll leave you with one of the most poignant parts of Natural Hospital Birth, Gabriel discusses her experience of relaxation during childbirth:

“The only way I know to get though labor pain is to surrender to it. Achieving surrender is the hardest part. When you feel overwhelmed by contractions you have not yet surrendered. Your are in pre-surrender. A miracle happens in the instant that you yield. Labor stops feeling so hard. You stop feeling overwhelmed. As soon as you accept that labor is overwhelming, it ceases to be so. Relaxing during painful contractions changes the feelings of those contractions. This is just one of life’s paradoxes”.

Prenatal Upper Body Conditioning

Upper Body Strength, It’s Everyone’s Problem

I’m calling this a prenatal workout but really anyone who sits at a desk or has neck and shoulder pain will benefit from this workout. It is important, particularly if you are planning to breastfeed, to have your shoulders strong before birth. Think about it, how often do you carry around 10lbs of wiggling weight with you everywhere?

Post Partum Pain

The number one area of pain for post partum mom’s is their shoulders, their whole chest almost caves in from holding baby all day. Nighttime feeding is really where good ergonomics falls apart, and rightly so, get as much sleep as you can! However, it can be hard to get back into good ergonomics in the morning. However 10 minutes daily for 7 or 8 months will change your posture and give you a good foundation for strength.

Do It!

If you don’t have weights grab a water bottle or some canned food! I really like resistance bands because they fit in a drawer. Also, if you don’t have a balance ball this can be done in a chair. Although I recommend having a ball for stretching, ergonomics, bouncing baby to sleep and being playful!

 

 

Coming next: Lower Body Conditioning…





Temporomandibular Joint Disorder or TMJ or Bruxism or Teeth Grinding or Clenching

Ever wake in the morning with sore teeth, a headache, or ear pain? This could be due to TMJ Disorder. Imagine, at night instead of laying in repose you are actually re-living and relieving the stress of your day by clenching or grinding.  The worst part for many is that they really have no control over what they do all night.

Clenching is when the mandible, or jaw, is drawn up to press against the upper teeth with force. Grinding is when the mandible is slid back and forth over each other. It is common to clench during the day as well, it is less common to grind during the day.

Muscles Involved:

TMJ1
Areas affected by TMJ

There are 4 main muscles involved in these activities, or 8 if you account for your right and left sides. Most people are familiar with themasseter, that big muscle on the back part of your cheek, many TMJ suffers unconsciously massage. Less familiar may be the temporalis, a muscle that originates on the side of your head just beyond your forehead and eye and inserts, almost secretly, on the top of your jaw bone passing under your cheek bone. When a client is on the table and I begin digging around in these muscles clients are often surprised at how painful and tight their masseters are.

pterygoids

More obscure muscles that get deep towards to root of teeth grinding are the pterygoids. The pterygoids often hide trigger points thatperpetuate TMJ Disorder, these are guitar string like muscles accessible only inside your mouth! I’m not going to sugar coat this, working on these muscles is almost like torture. However, I can attest from personal experience that getting this work done can reduce the servility of your TMJ for at least a couple weeks. Massage professionals can take continuing education classes about working on these muscles and receive an Intraoral Massage Certification. I haven’t gotten this certification, partly because, really, your mouth is a personal place and I’m not sure how many of you would really want me to do that. Another reason is that you really need to be on top of reciving this treatment regularly to see changes, obviously this is another great self care segue!

Self Massage for TMJ

While not the most professional presentation, this is a great video uses accessible language to get you started:

Stress Management:

Create a good bed time routine that includes sometime to let go of whatever stress from the day you haven’t let go of yet. Deep ‘let it go’ sighs, accepting what you can’t change before it’s time to crawl into bed (at least until tomorrow morning), and contemplating what you have to be grateful for are good practices to try out.

Mouth Guards:

I can’t stress enough the need to get a good mouth guard to protect your teeth from your grinding. It is possible to grind away the surface of your teeth, to crack them under the repeatedly nightly pressure over years, and to develop tooth sensitivity to hot and cold. Generally, mouth guards reduce the impact of grinding. There is one mouth guard, the NTI, claims to prevent grinding, it’s custom made and not inexpensive. About 50% of people I’ve spoken with have said it’s worth it, others say it hasn’t changed their symptoms much. NTI requires a visit to your dentist for a proper fit.

I’ve done a fair amount of research about the materials used in retail night guards. With growing awareness about the hormone disrupting effects of plastic many people don’t want to suck on a piece of plastic all night long every night! As far as I can tell Sporting Smiles’ formula is the safest, it’s made from EVA which doesn’t use chlorine or plasticizers like BPA or phlatates.

Braces & Invisalign:

I recently went to a talk by Dr. Huggins who is a pioneer in the Holistic Dentistry world, along the lines of Weston A. Price. He said that any mistakes made when your teeth were realigned, or failure to wear your retained and maintain proper alignment can contribute to TMJ because your body is literally trying to push your teeth into some kind of alignment. He recommends Invisalign because it is more hypoallergenic than the metal in braces.

 

Side Lying Comfort

As pregnancy goes on most woman experience difficult sleeping due to either acid reflux or hip and shoulder pain while sleeping on their sides. It’s important to get good sleep during pregnancy because fatigue can put you at risk for complications.

 

Acid reflux, or GERD (Gastroesophogial Reflux Disease) is common during pregnancy because of a slowing of the muscles that control swallowing. Often the acid reflux is worst at night, after dinner,when you are trying to find an agreeable position. A supported reclined position can be a comfortable position to sleep in. One of the most critical aspects of finding a safe and comfortable position is ensuring the angle of your body. A 45 degree angle is ideal because it ensures the weight of the baby is not on your Vena Cava reducing blood flow to the baby and placenta.

Generally if your position is causing the baby stress your body will wake yourself up. Many women are viscerally aware when the uterus is pressing on their vein so use your awareness and trust your intuition when getting settled.

Many women find the best compromise for them is a combination face down/side laying position with a small pillow under their belly similar but not exactly like the picture at the right.

 

Sleeping on your left side is the recommended safest position during the second and third trimesters because it allows the most blood flow and nutrients to get to the placenta and the baby. However, this position puts a lot of pressure on your shoulder and hip and can result in painful aches. This results in a lot of restless nights changing positions and moving pillows. Regular massage will help to relieve some aches and can relax you into peaceful sleep.

I invested in an OakWorks Side Laying Positioning System for maximum comfort during prenatal massage. Most of the massage is done in the side laying position but there is a torso pillow that takes the pressure off of your shoulders and hips while supporting your head and keeping your top leg just above hip height. There is also a little wedge pillow to support your belly. Depending on your needs during the massage we may move you to the supported reclined position to work on your neck or give a gentle belly massage.

 

A number of clients wish they had pillows this comfortable for every night sleeping. I am considering buying a second set to rent to clients for the final months of their pregnancy. Please let me know if this is something you might be interested in.

Living Life Fully with Fibromyalgia

Massage schools try and touch on as many pathologies as possible to give students some ideas about how to work with myriad of clients with unique lives and bodies.

Since every body truly is different and each body differs from day to day it can be challenging for a massage therapist to give the right massage for the person on the table.

I had been a massage therapist for about a year when I realized there was a pattern among some of myclients. I had a few who loved the really deep, deep tissue techniques, but then we’d get to some spots where even gentle pressure sent them jumping off the table. Often these spots were just inferior and posterior to the greater trochanter and the inferior portion of the adductors, or in plain English the hips and the inner thighs. The same clients would sometimes report that they felt “out of it”, “slugglish”, or really tender for a day or two after their treatments.
I thought, “Huh.” And I decided to keep paying attention to how this client group progressed.

These clients became regulars, their massages were the times they felt their best. They wanted that deep table time even if they had to pay in the form of brain fog, achiness, or low energy.

One day one of my clients mentioned starting the Abascal Diet at the recommendation of their naturopathic doctor.

This new tidbit was hungrily filed into these clients’ folder in my mind.
I thought, “How could inflammation connect to these symptoms?”.  A few things floated around and due to the power of the Internet I found this article, published in 2004. I asked this client pool to do an experiment with me and try the techniques. Many of them had talked before with other health care providers about inflammation being related to their health issues, especially their pain. We had good success in terms of short term pain relief. We learned a lot and we found great hope and deeper body awareness.

Quelling Inflammation is like Herding Cats

Connective Tissue Massage, the techniques described in the article, is designed to turn off the sympathetic nervous system. You’re probably heard of this nervous system as putting you into a ‘fight or flight’ state. New research points to women’s unique response to this cascade of hormones more as a ‘tend and befriend’ stress reaction.

Well, maybe we had a really great session and the client felt awesome at the end. This client then arrives home to a disaster and has to do some heavy lifting that sends him into a “flare”. He feels low back pain that night, and the next morning has a migraine. The migraine goes away after 2 days but his neck is stiff. When he’s finally feeling better he picks up his toddler in a funny position and the whole cycle starts over again!
If it’s not one thing it’s often another.
Or maybe it’s a gluten intolerance that creates a lot of inflammation for another client. She dutifully avoids gluten and then a coworker snaps at her, causing a stress reaction. She has to cope with a few days of reduced mental acuity and some grumpiness.
And, sometimes stress is unavoidable. Your parent gets sick, your child isn’t doing well in school, you’ve got a deadline at work, all at the same time! Stress is a part of life and some of my clients’ internalize this stress into inflammation. They get a flare even though they’re doing everything else right.

Goldilocks Rule

My client group all found exercise really difficult. They would have the same kind of brain fog and low energy symptoms they got after massage, only more often accompanied by achiness. Many of these clients worked with a Physical Therapist to strengthen their bodies. Finding a PT that was experienced working with inflammation was important to building muscle without sending them into pain.
Goldilocks Rule applied to our massage sessions too. We could go pretty deep in some areas to bring pain relief but not too deep or else we’d trigger the sympathetic system and induce a pain response.

Acceptance

My clients who had the most success with the technique could accept that some days would be painful and other days would be blissful. They took each day as it came and didn’t feel doomed to pain for the rest of their life. Good luck with this one!

For more information on massage and inflammation email me!

Preventing Premature Birth

In the US 1 in 8 babies is born prematurely. Premature birth can have serious and consequences and often changes how parents imagined the first few weeks of their baby’s life. November is Premature Birth Awareness month; I decided to devote a blog post to what mothers can do to help ensure a healthy full term birth.

The causes of premature birth are not clear. We know that previous history of premature birth, carrying multiples, and conceiving at very close intervals can increase a woman’s chance of going into labor. Also, there are other factors that are out of our control such as accidents, stressful events, and physiological differences.

Some factors that we can influence to reduce the chances of early birth are:

Being in good health before conceiving

Chronic conditions like high blood pressure, diabetes, being over or under weight before conception are three conditions that increase chances of early delivery. If you are a woman of child bearing age it is wise to devote time and energy to being in the best health you can be in. This will not only decrease your chances of preterm delivery but also from complications to your pregnancy, and is likely to make it easier to bounce back after birth.

Positive Nutrition

Eat the Foods you want Baby to Love

It’s important to practice healthy nutrition during your pregnancy. Many mothers are surprised as their baby grows into eating solid foods that their baby loves the same foods they love. It’s no surprise though,

baby learns in the womb what foods are good foods, that is, the food you eat during your pregnancy will affect your baby’s taste preferences later.

Epigenetics has shown that the foods you eat during pregnancy significantly impact your children’s  future diet choices. Never really been into quinoa? Baby probably won’t either.

Do Not Diet

Dieting in the months before and just after conception has been linked to premature birth. “Even modest restrictions in maternal nutrition can lead to premature birth”. It appears that this may be due to acceleration in fetal adrenal gland development.

Include Vitamin Rich Foods

Two nutrients linked to healthy full term pregnancies are zinc and calcium. It’s important to eat foods that are high in bio available calcium and zinc. Zinc is most bioavailability in the form of red meat and poultry. In plant based foods much of the zinc gets bound to phytates and does not get absorbed.

Zinc

oysters

peas

oatmeal

almonds & cashews

chickpeas

Calcium

mustard greens & kale

broccoli

dairy products

nettle tea

Abstaining from tobacco

Smoking during pregnancy can lead to birth defects like cleft palate or lip, low birth weight and preterm birth. Smoking stunts growth, especially growth of the brain and other neurological development, by reducing the amount of oxygen to your fetus.  Babies born to smokers are more likely to have ear infections bronchitis, slow lung growth.

The risk of SIDs increases as the baby’s birthweight and gestational age goes down, babies born to mothers who smoke are two to five times more likely to die of SIDS.

Sources:

http://www.marchofdimes.com/mission/prematurity.html

http://www.cdc.gov/reproductivehealth/tobaccousepregnancy/

http://www.newscientist.com/article/dn3660-mothers-poor-diet-linked-to-premature-births.html

http://www.nutraingredients.com/Research/Poor-nutrition-associated-with-premature-births

http://birthbliss.wordpress.com/2011/11/02/natural-ways-to-stop-and-prevent-pre-term-labourlabor/

http://www.ncbi.nlm.nih.gov/pubmed/9751940

http://diabetes.diabetesjournals.org/content/60/7/1859.full

http://www.susunweed.com/Article_Pregnancy_Problems.htm