Information & Inspiration for Pregnancy, Birth & Parenting. Hi! Welcome to Better Birth Blog, where I share information and inspiration for the childbearing year as well as love and help for breech babies. I offer evidence-based, hands-on birth classes in Maryland and online.
Thank you to Katie and Michael, who took my natural birth class, for sharing this birth story. First, a word from Michael. Then the story from Katie.
The Dad’s View of Birth
Michael says: A side note I must share with everyone. My wife is by far the strongest and toughest woman I know now. To witness what she went through was just unbelievable and the overwhelming wave of emotions I felt can and will never be duplicated. I definitely have a new outlook on birthing and applaud every woman who has experienced it. She is and will forever be my rock.
An Low Fluid Surprise
On Friday March 10th, I went to my normal 40 week appointment at Special Beginnings. I was checked and the midwife said I was not dilated and her guess would be that I would be about a week late. I was measuring small, so she decided to send me to maternal fetal medicine for an ultrasound to check on the baby’s size. I was able to get a same day appointment.
While there, they completed an ultrasound where they found the baby was at perfect size but I was low on amniotic fluid. The OB there then recommended that we be sent to labor and delivery at Anne Arundel Medical Center. We were both caught by an overwhelming feeling of shock. Before that though, they wanted me to do a non-stress test where she did well, but there was reason for concern, so they recommended that they call Anne Arundel Medical Center and see when they could get us into labor and delivery. Our simple day of a routine appointment had done a complete 180 and had us both in shock. They said that we could go home but that one of the midwives would call us and give us further instruction.
I talked with the midwives and decided to be induced Saturday morning. Friday night I worked on mourning my birth plan. That included tears and re-writing what was important to me.
We received the call at 6:30 a.m. Saturday morning to head to the hospital. We took our time and ate breakfast and took a few more moments to prepare ourselves for our hospital birth. When I asked for the method of induction the day before they were unsure of how we were going to begin.
Induction with gel
We arrived at the hospital around 9 a.m. We discussed options with the midwife. She recommended we to start with Cytotec. We had not wanted to start off with cytotec or pitocin, so knowing some of our options, we discussed instead of starting with an application of prostoglandin gel. Neither the nurse or the midwife were insistent on using cytotec, so we began with the gel. We did 3 treatments of the gel with minimal progress. We were hopeful that maybe it would send me into labor. But we were not so lucky. After three treatments I was about 1-2 cm dilated.
We then re-discussed our next options as moving forward and agreed to try the foley bulb. It was a bit new to us, but we had done some research the night before and had educated ourselves on the process and effectiveness. We tried the foley bulb at 12:45 a.m. Sunday morning. My cervix was too far right and they were unable to get it in. Later that Sunday morning, Michael and I asked if we could go home. After a night of monitoring, all that was done was three treatments of gel and the baby was looking great.
The midwife wanted us to have a second ultrasound before sending us home. Maternal Fetal Medicine refused to do the second ultrasound because they doubted there would be any change in levels of amniotic fluid to constitute sending us home. We could have left against medical advice, but decided to stay for the safety of our baby. At 9:30 a.m., the midwife talked with us to explain our next options and why it would be best for us to stay.
Foley bulb induction
At 9:50 a.m. Sunday morning, I reluctantly agreed to begin cytotec orally. We had three doses of this as well over the course of Sunday. I had to stay in bed for 2 hours after each dose. After the second dose of cytotec, we agreed to try the foley bulb. They were able to get it positioned right and so the foley bulb was inserted at 4:19 p.m. Sunday. They said the foley bulb should normally dislodge itself after a few hours once the cervix reached a dilation of about 4cm. At 6:30 p.m. Sunday, I had my last dose of cytotec and was hopeful that this would help the foley bulb finally dislodge itself. I woke up the next morning (Monday) without it having dislodged itself.
After discussion, we came to agreement on what we had hoped to avoid all along: pitocin. This is when my back labor began. At 8:10 a.m. Monday morning, they started me on a slow drip of 2ml of pitocin and hoped that would help the foley bulb finally dislodge. At 8:50 my dose was increased to 4ml. Foley bulb still not out. At this point we were on our way for setting a world record for length of time that a foley bulb had been inserted and not yet dislodged itself. It finally came out at 11 a.m. on Monday. It had been in for almost 20 hrs.
At 10:35 a.m. pitocin was increased to 8ml and at 11:25 increased to 10ml. My water broke at 12:02 a.m. By 12:45 p.m. Monday, my pitocin was upped to 14ml and my labor became more and more intense and I begin using our relaxation techniques. We had essentials oils diffusing to create a more home like atmosphere. Michael played the music playlists we had discussed. My doula and Michael helped me position myself on the hospital bed and on the ball. They made sure to keep me changing positions frequently so that I wouldn’t become uncomfortable. I was also allowed to get in the shower twice which made all the difference. The hot water really helped with the back labor I was experiencing. Labor was extremely tough and at times felt like contractions were coming right on top of each other.
It was very reassuring when the midwife checked me at 3:30 p.m. and informed that I was dilated to 6-7 cm. That gave me extra strength and fight to not give in to an epidural. After about 3 more hours of back labor, the midwife checked me once again and said words I will never forget, “Would you like to meet your baby?” After that she told me that if I wanted to I could begin to push with each contraction.
Meeting the Baby
By 7, I was beginning to push. By 7:40, she was crowing and I was able to feel her head for myself. And at 7:50 I gave it all I had and at 7:55 p.m., our little girl was born and immediately was able to hold her, skin to skin.
I had amazing nurse that tried to do everything she could to keep constant monitoring while I was moving around. (Anne Arundel staff was absolutely amazing with us). After 12 hours of back labor and every means of induction, I gave birth without pain medication at 7:55 p.m. Monday night. Aurora Lucille Chappell was born 6 lbs. 14oz. and 19.5 inches long.
Even though plan A, B, C, D and E did not work out, I still got my amazing little lady.
Awhile ago, I interviewed Elina Patler from Astoria, NYC about her vaginal twin breech birth. Here are the girls, Mari and Mila, at birth. Thanks so much for sharing your story!
Tell us a little about your pregnancy.
I got pregnant in June 2014, and was totally surprised when I found out I was expecting dichorionic diamniotic (DCDA) twins. DCDA twins have their own placentas and their own amniotic sacs–they only share the uterine space.
Did you always plan a vaginal birth?
I really wanted a vaginal birth, but I knew the statistics were not in my favor, and carrying multiples automatically made my pregnancy high-risk, which limited what I could even hope for. I hired a birth doula who had experience with multiples who I thought could advocate for me in the hospital. A home birth was out of the question, because generally, no one is willing to assist. And hospitals require twins to be delivered in the operating room rather than a regular labor and delivery room in case of emergency. What sometimes happens is that the mother will vaginally deliver the first baby (Baby A, the baby closest to the cervix) and then has to have an emergency C-section for Baby B. But despite these obstacles, I was hopeful that I could deliver vaginally.
What were you concerned about?
My primary concern was premature birth of my babies. An average twin gestation is 35 weeks, five weeks shorter than a normal 40-week singleton pregnancy. NICU time is not uncommon for twins, and I read as much as I could to prepare myself for any outcome. I was also concerned about a C-section. The rate of C-section with twins is very high, and getting higher.
How did the maternity care providers support you through your decisions?
I’m very lucky to live in New York City, where I have access to many excellent doctors. My doula recommended a maternal fetal medicine (MFM) practice in Manhattan specializing in high-risk pregnancies. About 15 percent of their patients are women pregnant with multiples, which is very high. They also support vaginal deliveries. I was assured that as long as there was no emergency and my Baby A was head down, Baby B could be any position and they would support me in a vaginal delivery. They also allowed me to have my doula in the OR with my husband and me.
Was breech position an issue at any point?
Yes. My Baby B was breech.
How did the birth go?
It didn’t go exactly as I planned, but overall it was great. My blood pressure started to creep up a little around 33 weeks, and by 35 weeks, the MFM doctors felt I should deliver the babies. We discussed it and decided to go for an induction at 35w2d. It went really well, and with my husband and my doula by my side, I labored for 19 hours in the labor and delivery room. I was even allowed to start pushing there, before being moved to the OR for the delivery. I delivered my Baby A—who had actually moved into the posterior (“sunny-side up”) position—just a few pushes and a few minutes after getting to the OR, and Baby B was born via breech extraction by my OB three minutes later. Because they were early, I couldn’t hold them right away, and Baby B ended up spending five days in the NICU for feeding and growing. But Baby A was in the room with me within about half an hour.
Can you tell me more about that? Why was baby B born by breech extraction?
My doctors told me that a breech extraction is the most successful for a vaginal delivery of the second baby. Using other techniques can result in an emergency C-section, which we obviously wanted to avoid. My OB was very skilled and experienced (she has delivered triplets vaginally!) and I had no complications or damage from the delivery. My recovery was fast and smooth.
What would you say to other women pregnant with twins?
Do your research and prepare for any outcome, and seek out doctors who specialize in high-risk pregnancies. Twin pregnancies are vastly different from singleton pregnancies. You need more calories, more rest, more visits with your OB/MFM team. Pre-term labor is a real concern, and complications like gestational diabetes and pre-eclampsia are much more common. Still, you can have a vaginal birth, even when one of the babies is breech.
Anything else you want to add about your experience?
The pregnancy and delivery seem easy now compared to the first few months of caring for and nursing two infants at the same time!
I’ve been slow about the blog lately. The perils of paid work: It’s hard to get to the unpaid work, even if you love both. I did write this poem for my mom’s birthday and thought I’d share because, well, motherhood.
I’m doing a series on my feelings concerning the gravitas of parenting. The pressure, the responsibility. The way babies stick to you. The way toddlers orbit your ankles in the kitchen. Ad infinitum. You may be subject to reading them as well.
Happy Birthday, Mom!
by Lauren McClain
for my mother, my daughter, and their mothers
My book says the Pacific Ocean was born
Billions of years ago when a piece of the Earth
Came out and became the moon.
The rough moon-child unfolded, winging through atmosphere
And is still out there, not far, walking around–
Around and around as we watch, turning.
Kept close with an invisible weight, an anchor
A root, pulled true and fast to home–
The rhythm of the stars breathes a reaching path.
Having a child is like this: a piece of self in orbit
A piece of yourself that doesn’t belong to you
But is made of you, made by you.
Inside, an empty place is dug out and
Everyday, a piece of your heart pulls in–
The tide pulsing with life, beauty, salt and deep.
When someone we care for is working through something difficult, one of the best means of support is “holding space.” Effective labor companions know (from learning or experience) how to hold space for someone in labor. But what does that mean?
Holding space is like holding the fort. You protect the people inside the space–that’s the shield. It’s also like building scaffolding for a fragile tower. You build a safe, supportive place for work to be done. Doulas and others who regularly support people in labor learn that being useful often involves—or is even mostly about—holding space.
How can you “hold the space” in life and labor?
First, Learn to Recognize Your Own Feelings + Responses
You can “hold space” only when you’re aware of the other person’s emotional landscape while you track your own. You track your mind’s workings by noticing your own feelings, thoughts, and opinions. This noticing is essential because it allows you to prevent yourself from reacting outwardly to their feelings, thoughts, and opinions. It means not letting their difficulties become yours.
A sad person should be able to be sad without making you sad and then perhaps feeling responsible for (and sad about) your sadness.
A hurting person should be able to work through their hurt without spreading anger or causing you to act affronted, blamed, or upset. Sometimes it feels right to join in and talk about how awful your friend’s ex is, but it’s not holding space and doesn’t create healing. It certainly doesn’t work in labor.
A struggling person may want your help with the difficult situation—they may want physical support, ideas, or someone to just fix it. More often, they just need to vent. Of course many situations cannot be fixed at all and must just be lived and worked through. They just are.
Childbirth is one such special situation. In labor, you may be struggling, hurting, and sad. You may just be in another world, on another plane of consciousnesses. What you need (besides competent care, food and water) is a safe space to open up. Literally open up.
Partners, doulas, dads, mothers, sisters, and friends can all create this space.
How to Build Scaffolding & Hold the Shield Your ability to hold the fort involves following these five steps, which you can use in any situation where you’re the supportive one.
Your needs, your ego–they don’t matter here. If you can’t check them at the door, don’t go through. Your phone also takes a back seat.
Recognize your feelings throughout
You can’t control something you can’t name. Notice and name your feelings so they don’t control you. When your reactions are not controlled inside, it’s harder for the person you’re supporting to keep the tenuous hold they have on control. You’re supporting. You’re the scaffolding. You can’t bend and sway; unstable support makes unstable people feel worse! And it makes your support untrustworthy.
Respect the other person’s feelings Her feelings don’t have to make sense or be right or kind or what you think of as normal. Give her the space to have whatever feelings or response to the situation she has. People going through something hard have the right to go through a range of emotions and reactions without being judged. You don’t have to agree. You just have to allow the feelings to be there.
Reflect back the experience
It’s not sympathy or validation we need in labor. Feeling pitied doesn’t help. We need someone to be in the space with us. Again, you don’t have to agree or like or understand why. You’re the steady, stable one, but you have to connect with the feelings. Show that you notice how she’s feeling using your eyes and tone.
Radical trust Your job is support. Not remodeling. Don’t start sanding or get out your chisel. People have to fix and help themselves. The best we can do is give them an environment of support, trust, and reduced resistance. It’s the person in labor who has to erect the flag. You can hold the post hole stable or shield her from attackers. But you can’t do the work or change the work. You “hold the space” because you trust she can do it. You believe in her. If you get out the chisel or start surreptitiously sanding, you’re expressing distrust and taking power away. Pointing out someone’s limitations, failures, or blind spots is decidedly not supportive. A good labor support person can recommend fixes or helps, but their primary job is in not-fixing, in letting childbirth unfold.
People Build Around Each Other
Many people are involved when a baby is born. Unless you’re planning an unassisted birth, others will be around. If you are the other parent, the partner, this birth will be intense for you as well. You need support, too. Choose your birth team (provider, birth place, doula, etc) and which family and friends will be involved based on who will offer the kind of support you both need.
Each person builds the scaffolding support and then holds the shield for the people inside their circle. This diagram shows how the central person doing the central work isn’t supporting or helping anyone. The partner builds support around them, the birth team (including and especially the doula) around the two of them and so on.
Offer Unconditional Support
Even if the she yells, swears, gets combative, can’t stop crying—you stay with her physically and energetically. Even if labor lasts 28 hours.
This profound respect for her and what she is doing has long-lasting effects on her self-esteem and parenting.
Very few of us have ever been cared for in such a way for such a time—at least not since our own infancy. Despite being exhausted or overwhelmed yourself, you can hold the space completely without judgement, stay with her and love on her. This is the ultimate gift.
Rent the Right Tools
Doulas are trained to hold space. They also know when to offer the parents a tool. You may be the best shielded scaffolding available, but you may need a hand. Having an experienced birth-scaffolding builder with you makes building easier and better. Think of it as renting the perfect tools and lifts instead of having to climb and lift it all on your own. The right doula comes equipped with exactly what’s needed. They know what’s needed and how to stack the deck for an easier birth. The scaffolding is more likely to hold.
When you and a doula hold this space for someone who is doing a hard thing, it’s doubly powerful. With the right support all the way out the circle, both parents can meet their baby in an environment where they felt unconditionally loved and trusted. They’re then able to provide that love to the baby.
The love and support given during labor brings up subconscious memories and hormones that serve the capacity to love the baby. Parents who feel the flow of love and support make more love, protection, and caring hormones and are then able to provide the shielded scaffolding the baby needs to transition to this world. What goes around comes around.
The parents’ hormones learn (remember) unconditional loving presence and then are better able to offer that to the baby. Studies show that parents who had loving care during labor are less anxious, less depressed, more able to understand and care for their babies.
A Skill For All Seasons
Practice holding space in daily life. If someone comes to you with a problem they want to hash out or vent, use the five steps above. It’s especially good to practice with the relationships that matter most. So when your partner expresses difficult feelings or is having a hard time, practice holding space by going where they go, monitoring your feelings and trusting. Learning to do this will be valuable in all your relationships. The control you have and empathy you’re able to provide will establish you as trustworthy, strong, and-if we’re being honest- very sexy.
All of those traits are valuable to a woman in labor and to new mothers as they recover from birth and learn about their babies.
What “Holding the Space” Might Look Like in Labor
Holding her hand and whispering I love you
Asking for a new nurse if the one you have is negative
Dimming the lights, spraying comforting scent, or closing the door
Being there, being calm, and smiling when your partner looks at you
Nuzzling, kissing, hugging
Saying “You’re doing it. You’re amazing. This is incredible.”
Helping her walk around
Being something soft and strong to lean on
Saying “I’m right here.”
Asking the staff questions you know she might want to ask
Watching for when she needs to move or starts to seem more uncomfortable
Having positive, encouraging thoughts throughout
Insisting (calmly but seriously) that the staff stick to the birth plan
These images were taken from my post about the 10 Personalities of Dads at Birth, which lists the varied ways that the typical dad will help in labor. Thanks again to the families for letting me use their pictures.
Looking for a birth plan that incorporates personality, emotional preparation, and more? Look no further. Better Birth Graphics introduces this template as a way for couples to think about the upcoming labor and consider how their provider plays into their wishes for birth day.
It’s two-sided and simple yet thought-provoking.
Simple check boxes and empowering wording get couples on the same page and encourage provider converstaion.
Use this birth plan template to consider options, start conversations, and be sure your provider understands and can accommodate the kind of birth you’re planning.
Pain relief options
In case of cesarean
If you’re looking for the bible on how to treat your body during pregnancy, look no further. Lily Nichols, RDN, CDE, has written a well-researched compendium of advice, tips, and information on what we eat and do in pregnancy.
Experts recommend a whole-foods diet high in protein, calcium, iron, folate, and other nutrients in pregnancy. Nichols tells us the details, the research, and why and how to get those nutrients.
For example, most of us know we need increased protein intake during gestation. What few families and few providers know are the specifics of this physiological requirement. Nichols walks us through all of it.
The mystery of glycine + other nutrient secrets
One fascinating aspect of the protein rule is her discussion of certain amino acids that are more crucial in pregnancy than they are otherwise. One of these is called glycine.
Glycine is indicated in the formation of your baby’s DNA, organs, blood vessels, skin, and joints. It is essential in keeping your uterus and placenta growing and healthy as well as supporting your stretching skin. Normally your body can make enough from the foods you already eat, but during pregnancy you need more than your body can make. Some research suggests that problems we normally associate with inadequate protein intake are actually symptoms of inadequate glycine.
Gelatin and collagen are the two richest sources of glycine. You can get it from bone broth, slow-cooked tough meat like pot roast or pulled pork, poultry with the bones still in, sausage, bacon and ground meat (usually made with tougher cuts). You can also add pure gelatin powder or collagen powder to other food.
In Nichol’s book you will find more details about the recommendations for pregnancy and the latest research–or lack thereof–concerning common dos and don’ts.
Lists, Recipes, and More
I’m fond of her list of healthy snack ideas. There’s plenty here to just take away without having to go through the whole book, including how to resolve common pregnancy complaints with food, moderate your stress levels, and avoid toxins.
She encourages lab tests in early pregnancy to test for nutrient levels. Are you actually getting enough vitamin D or magnesium?
Another great aspect is the postpartum and breastfeeding section. So often what to do and how you can make postpartum easier is overlooked.
I like this book because of how well-researched and specific it is. I like to know the specifics of why I am doing something, not just that I should. If that’s you, too, you will find that here.
It can be overwhelming to know all this information about optimal living and eating. You just do your best. If you tend toward anxiety on these topics, please read any advice with that in mind. Anytime you feel yourself following a recommendation out of fear, stop and take a breath. You can’t follow all the recommendations and avoid all the stressors.
Unless you live on an isolated, self-sufficient organic farm and you don’t much like food, it’s impossible to do everything. If it raises your anxiety to think about all the things you should be doing or ways you’re potentially harming your baby, take a step back. The anxiety and compulsion to control are not healthy or fun for either of you.
Eat the best, most wholesome food you can stomach and afford. This is a great time to start good habits for yourself. If you’re ever going to buy and eat organic or more wholesome food, do it now. But you can’t control everything and the benefits to you and baby don’t outweigh making yourself miserable or broke.