Saturday, August 6, 2016

How to have a Natural Birth in the Hospital

This post will explain how to have a natural labor and delivery(L&D) in a hospital. I was able to have two by doing these things. My previous post was about all the reasons why I chose to have natural L&Ds.

I will add a big disclaimer here, both my pregnancies and L&Ds were low risk. I was an average weight, I was young (19 with Rose, and 21 with Heather), I had healthy pregnancies, and didn’t have any serious complications. If you are high risk for any reason or become high risk, take all of my advice cautiously. A natural L&D for a high risk pregnancy is very possible but I have no experience attempting it. In certain high risk situations attempting a natural L&D might put you and your baby’s lives in much more danger than necessary. Be careful.  

Disclaimer number two. I am not a healthcare professional. Childbirth, in rare circumstances can be life threatening. This is why we have doctors who can save lives. Realize that if something goes to shit, your birth plan is going out the window. That’s ok, shit happens. Just know that it’s a possibility.

Photo my doula took of Heather.
Here are a few things I would recommend if you want to have a natural birth at a hospital.

The first thing you need is a supportive partner. If your partner is not behind you one hundred percent, you might not be able to convince yourself a natural L&D is something you can accomplish. During both my L&Ds I had an “oh shit I can not do this” moment. My husband, RJ was the person who got me through those tough contractions. With Rose (Rose's birth story) it was a while they tried to keep me in bed, strapped to the monitors (I had slightly high blood pressure that was fine when lying down). With Heather (Heather's birth story) it was one single intense contraction, RJ held me up and told me to breathe. If your partner is not supportive of a natural birth plan, find someone who can support you. A doula, your mom, a sibling, a friend who ever you feel comfortable with. Having a strong support team is very important to your success.   

The next thing you need to do is find a good practitioner. Find a practice that supports natural L&Ds. The practice should have both CNMs and obstetricians. If something goes wrong you want a great obstetrician around if necessary. Make sure the obstetricians at the practice you choose support natural birth. Chances are they will if there are midwives in the practice. The practice I go to has great Obs. A few of the midwives where I go are a bit odd but there are so many I rarely see the few I dislike. DO NOT be afraid to fire your doctor. They are providing a service for you. You are paying them. If there is anything about them you do not like go find a new practice. This is another thing I love about a practice with both midwives, and obstetricians. There is always one of each on call and if I dislike one the other can help.

When choosing a practice, look at c-section rates. Be cautious of high c-section rates, but they are not always a bad thing. The practice I go to has somewhat high c-section rates. The head OB is a very good doctor and deals with a lot of high risk pregnancies. This means his c-section rate is artificially high because he cares for the moms and babies with the highest risk of c-section. That means he’s a good doctor not a bad one. Just make sure to do your research.

Another photo my doula took. Heather
seconds old, before her first cry. 
It is important to prepare yourself, both physically and mentally. Having a baby is painful. It’s important to know and understand this, but not to be afraid. Women’s bodies are made to make and push out babies. Your body knows what to do. For the past 9 months your body made a tiny human! It knows how to get it out without injuring itself. Listen to your body. My absolute favorite book that helped me KNOW I was capable of having a natural birth was "Ina May's Guide to Childbirth". Ina May Gaskin started one of the first birth centers in the United states. She has attended around 1200 births and is incredibly knowledgable. Her book does a really good job explaining what a woman’s body can do. There is great advice in her book about hospital birth as well.      
The biggest thing I learned from Ina May’s book, was to not be afraid of childbirth. Ina May talks about a doctor named Grantly Dick-Read who wrote a book called, "Childbirth Without Fear". In his book he talks about the “fear-tension-pain cycle”. This happens when a mother is fearful of the pain during labor. Fear creates tension in muscles. Tension in muscles causes pain. Then pain causes fear and the cycle goes around and around.

I read “Ina May’s Guide to Childbirth” just before I gave birth to Rosalie. I reread it just before I had Heather. It really helped me get my mind in the right place to go through L&D again. If you are expecting it is a must read.

Another must if you want to have a natural birth is a doula. A doula is a extra support person who will help you in any way you need. She can help you find comfortable position to labor, remind you to sip water, go to the bathroom, help you with breathing techniques. Our doula caught a few amazing photos of Heather’s birth. The things doulas do are endless.

When interviewing doulas choose someone who you relate to and get along with. Choose someone who has helped other moms at the hospital you will be delivering at. They might know some of the policies and loopholes to help you get the birth you want.

Angry messy baby.
We should have hired a doula for Rose’s L&D but we never found the time. We did hire a doula for Heather’s L&D. Our doula made it in the nick of time but Heather’s birth was so quick it was perfect. RJ got to catch Heather and it was great to have someone else who was there just for me by my side. Doulas are amazing and very helpful. I appreciated my doula most when RJ was with Heather after she was born (she was whisked away because of meconium). After my placenta was delivered I started shaking/shivering uncontrollably. My doula was there telling me it was a common side effect of all the hormones from L&D wearing off. It was great to have a familiar face near when it was a little scary. I will never give birth without a doula again.

Do not let your doctor induce you unless absolutely necessary. Pitocin makes contractions stronger and longer. Very few women give birth naturally on pitocin, most get an epidural. I know being pregnant the last few weeks is miserable, but your baby might not be ready to come out at 40 weeks. My doctors wait to induce till 42 weeks. Babies come out when they are ready. I have had friends recently who opted for a early induction for one reason or another. They either ended up with a c-section, and/or their baby had health issues because it was forced out too early.

Try to labor at home as long as possible (If you hire a doula she can help you labor at home). This is something I wish I would have done longer with Rose. When you labor at home you can do whatever you want. There is no one to boss you around or hook you up heart rate monitors. It’s much more comfortable. When I had Heather we timed it perfectly I was in full blown active labor and 6cms when we got to the hospital.

Before you get to the hospital get something to eat. I also recommend sneaking in food! If your labor is long you will need something more than ice chips. We went to REI and bought a ton of high calorie energy bars, for both me and RJ. They are a great way to eat four to five hundred calories in a few bites. These were super important for RJ because he could eat a whole meal without leaving my side.

When you do get to the hospital the first thing to do is tell everyone you want a natural L&D. Remind your midwife or doctor too. Keep reminding people. Write up a birth plan, keep it short and precise and hand it out to everyone. Even if they don’t want it, make sure they get a copy. I know someone who taped her birth plan to the door of her L&D room. I think that’s a little over the top but if it makes you feel comfortable, go for it. At my hospital triage is usually pretty quick. They have you get in a gown, and strap you to the monitors for a few minutes. Then the midwife on call will come in and check to you see how dilated your are.

RJ cutting the cord. I love Heather's toes
in the bottom right corner. 
Hospitals have lots of “rules” and “policies” to cover their asses if something goes wrong. Their “rules”, like electronic fetal monitoring, (which some hospitals try to require, it’s ok to refuse any procedure at any hospital) actually increases the risk of c-section. Be prepared to be stern and straight forward with your nurses and doctors. Make sure your support person is ok possibly being rude to nurses to get what you need. Don’t start off rude, start polite but firm. Only get rude if you have to. This might be hard, because we have been taught to blindly listen to health professionals. When it comes natural birth they do not know best.

In triage, if you do not need antibiotics for strep b, do not get an IV. With Rose I was positive for strep b so I needed antibiotics during my L&D. With Heather I didn’t need antibiotics, so I refused an IV. They weren’t too excited about it, but there was no reason I needed one. RJ said it was much easier supporting me without an IV, he didn’t need to worry about hurting my arm or pulling it out.

Once you are admitted, refuse to sit in the bed unless they are checking your dilation. Bounce on a birthing ball, sit in the chair, go to the bathroom. Labor in the bathroom (the toilet was a very comfortable place for me to labor for both my daughters). Your nurse will try to tell you she HAS to strap you to the monitors but she doesn’t. You are allowed to refuse any service the hospital tries to give you. Most hospitals have a policy that requires you to be monitored for a few minutes out of every hour. I personally have never tried to insist they use intermittent auscultation, but it is possible. Intermittent auscultation is much better than electronic fetal monitoring. Read all about it in my last blog post. It is something I would recommend discussing with your provider before your due date if you want it. I pretty much had it with my deliveries because the nurses had chase me around the room with heart rate probe.   

The only intervention that happened during my L&Ds was both times my midwife needed to break my waters. With Rose I was about 8cms and labor had slowed down a bit but as soon as she broke my water I progressed to 10cms very quickly. With Heather, my midwife broke my water while I was pushing and it relieved so much pressure. If you do not feel ready for them to break your water, don’t let them. If they break your water a 24 hour clock is started. After 24 hours if your baby is not delivered you will get a c-section to prevent infection, there is nothing you can do to stop it. I was well into labor when my water was broken.

I have never been to a birthing class. I know people who learned methods that saved them during their L&D in classes. I didn’t feel like I needed that, I just read a lot of books, and listened to my body.

Natural labor and delivery is not for everyone. We live in a time when it’s not the only way. I am very proud of my body. This probably sounds crazy but I cannot wait to have another baby and give birth again. Birth is amazing. I hope if any expecting mommies are wanting a natural L&D this helps. Thanks for reading!

If you have any specific questions, I am more than happy to answer them. Feel free to comment or email me!

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