A better birth naturally. Del Mar Birth Center South Pasadena provides a safe & supportive environment for women’s health care and complete prenatal, labor, birth and postnatal care. Follow this blog to know more about freedom and support for women to give birth.
Circumcision is one of the most controversial topics in newborn care. Parents of male newborns are tasked with making a decision about their baby’s foreskin – to leave it intact or to remove it by way of circumcision.
What is foreskin?
The foreskin (or prepuce) is a double layer of skin that folds in on itself, forming a covering for the glans (head) of the penis. The outer layer is a continuation of the skin of the shaft, while the inner layer is a unique type of mucous membrane. The foreskin serves several purposes: to protect the glans from feces and foreign bodies, to protect the glans from friction and abrasion, to moisturize and lubricate the glans, to provide sufficient skin to cover an erection by unfolding, to aid in masturbation, foreplay, and intercourse, and to serve as erogenous tissue due to its rich supply of erogenous receptors (Bullough & Bullough, 1994).
What does a circumcision involve?
Circumcision is the surgical removal of the foreskin. It involves estimating the amount of skin to be removed, dilating the preputial orifice (the opening at the tip of the foreskin), separating the inner layer of foreskin from the glans with surgical instruments (they are adhered in infancy), placing a device (devices reviewed later), leaving the device in place long enough to staunch bleeding (several minutes to several days), and surgically removing the foreskin (either by cutting it off with a scalpel or tying it so tightly that it necroses and falls off) (American Academy of Pediatrics (AAP), 2012).
The rate of circumcision of newborn males has been declining in the United States and vary widely by geographical region, race/ethnicity, and payment method (public vs. private). A current review estimates that an average of 55-59% of male babies born in the United States in 2010 were circumcised, with rates as high as 74% in Midwestern states and as low as 30% in Western states (AAP, 2012).
In 2012, the American Academy of Pediatrics revised their policy statement on newborn circumcision to state that the “preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure… Although health benefits are not great enough to recommend routine circumcision for all newborn males.” They go on to state that “parents ultimately should decide whether circumcision is in the best interests of their male child… in the context of their own religious, ethical, and cultural beliefs and practices” (AAP, 2012).
So what does the research show about the health benefits of circumcision?
HIV and STI Transmission
It must be noted that the majority of data comes from studies conducted on the circumcision of adult males in regions with high rates of heterosexual male HIV and STI transmission (mainly sub-Saharan Africa), thus there is debate on the applicability of this research to newborn males in the United States (Boyle & Hill, 2011; Earp, 2015).
Research on adult circumcision conducted in African countries shows a relative risk reduction of 40-60% for circumcised vs. uncircumcised heterosexual men (AAP, 2012). In these studies 1.18% of circumcised males contracted HIV, while 2.49% of uncircumcised males contracted the virus. This translates to an absolute risk reduction of 1.3% for circumcised males (Earp, 2015). The CDC attempted to extrapolate this data using a mathematical model to estimate the risk reduction for males born in the United States. When considering differences in overall HIV transmission rates, timing of circumcision, and differences in culture and hygiene, the CDC study estimated the relative risk reduction in U.S. to be 15.7% (AAP, 2012). This would translate to an absolute risk reduction of <1% for U.S. born male infants. It is also important to note that many studies show no difference in HIV transmission rates for circumcised vs. uncircumcised men, while a few actually show that circumcised males have an increased rate of HIV transmission (Boyle & Hill, 2011; Earp, 2015).
Similarly, studies of rates of syphilis, genital herpes, and HPV showed circumcision to have “some protective effect” in African studies (AAP, 2012). Again, the applicability of this data to male newborns in the U.S. is questionable (Earp, 2015). Circumcision has shown no effect on rates of chlamydia or gonorrhea transmission (AAP, 2012).
Essentially, research suggests that circumcision may be protective against transmission of HIV and some STIs; however, these “health benefits are not great enough to recommend routine circumcision for all newborn males” according to the American Academy of Pediatrics (2012).
Some studies have shown a reduced relative risk of penile cancer in circumcised men. Because penile cancer is a rare disease (estimated between 1/200,000 and 1/1,000,000), and because rates of penile cancer are declining worldwide (in countries with both low and high rates of newborn circumcision), it is difficult to determine the actual effect of circumcision on the development of penile cancer later in life (AAP, 2012; Earp, 2015). Some research estimates that 909 circumcisions would need to be performed to prevent one diagnosis of penile cancer, while other studies estimate that 322,000 circumcisions would be required to prevent one case (AAP, 2012). This is an incredibly wide range of very small numbers of actual reduction in penile cancer rates.
Urinary Tract Infections
Research has shown a reduction in the rates of UTIs in circumcised vs. uncircumcised infants under 2 years of age. Studies estimate that 1/100 uncircumcised infants will have a UTI before 2 years old, while 1/1000 circumcised infants will have a UTI (AAP, 2012). It is estimated that 100 circumcisions will prevent one urinary tract infection (AAP, 2012).
What are the risks of circumcision?
The true incidence of complications due to newborn circumcisions is unknown due to a lack of data and varying definitions of complications and adverse events. It is estimated that “significant acute complications” (occurring during or immediately after circumcision) occur in about 1/500 circumcisions (AAP, 2012). Hemorrhage from excessive bleeding occurs in about 1% of circumcisions, infections occur in 0.06-0.4%, and penile injury occurs in about 0.04% (AAP, 2012). Late complications of circumcision include incomplete circumcision, excessive skin removal, adhesions, meatal stenosis, urethral damage, phimosis, and epithelial inclusion cysts. The prevalence of these complications is unknown due to inadequate data. Severe complications of circumcision are rare and difficult to quantify. These include amputation of glans or penis, herpes transmission after mouth-to-penis contact by a mohel, MRSA infection, urethral fistula, glans ischemia, and infant death (AAP, 2012). One study suggests that the rate of infant death attributable to complications from circumcision is 1/50,000 (Earp et al., 2018). Other possible complications that have been inadequately studied include impacts on sexual function and emotional trauma.
Important Considerations for Circumcision
There are three methods of circumcision that are commonly used in United States: the Gomco, the Mogen, and the Plastibell.
The Gomco clamp is used by many practitioners. A slit is cut in the foreskin to allow space for the device, the bell of the device is placed over the glans of the penis to protect it, the foreskin is pulled over the bell, and the arm of the clamp is fitted and tightened. The device remains in place for 3-5 minutes to staunch blood flow before the clinician cuts the foreskin off with a scalpel. The device is then removed. The Gomco method protects the glans of the penis and produces good cosmetic results. The overall complication rate (including bleeding, infection, redundant prepuce, and phimosis) is 1.9-2.9%. However, some studies suggest that there is an increased risk of bleeding and removing too much skin compared to other methods (AAP, 2012; Bullough & Bullough, 1994).
The Mogen clamp is the oldest technique still commonly used. It consists of two flat blades with a small slit. The foreskin is drawn into the slit, the blades are locked together to crush the skin and staunch blood flow, and the foreskin is removed with a scalpel. The device is then removed. Studies suggest that the Mogen method is the quickest method and causes the least bleeding and pain. However, the Mogen is the only method that does not protect the glans of the penis, allowing the possibility of partial or total amputation (AAP, 2012; Bullough & Bullough, 1994).
The Plastibell device places a plastic ring under the foreskin and a tie around the outside of the foreskin to staunch blood flow. The device remains in place for 7-10 days until the foreskin dies from lack of blood flow, necroses, and falls off. The overall complication rate for this method is 2.4-5% and includes bleeding (0.8-3%), infection (2.1%), urinary retention, and “issues with the Plastibell ring” that may lead to swelling and compression of the penis (3.6%) (AAP, 2012; Bullough & Bullough, 1994).
According to the AAP Task Force on Circumcision, “adequate analgesia should be provided whenever newborn circumcision is performed” and “nonpharmacological techniques… are insufficient to prevent procedural and post-procedural pain and are not recommended as the sole method” (AAP, 2012). There are three commonly used analgesic options for circumcision: topical lidocaine, dorsal penile nerve block, and subcutaneous ring block.
Topical lidocaine prevents pain better than a placebo but is less effective than injectable analgesic options. Topical lidocaine needs to be applied 60-90 minutes before procedure. Complications occur in 8-14% of cases and include redness, swelling, and blistering. These complications are more common in premature or low birth weight infants. For these infants, topical analgesia is not recommended (AAP, 2012; Lemer, 2018).
The dorsal penile nerve block involves two injections of lidocaine to the base of the penis. It has been shown to be more effective than topical analgesia in reducing pain. Complications include bruising (11% of cases) and hematoma (0.2%). This method only takes 5 minutes to be effective (AAP, 2012; Lemer, 2018).
Subcutaneous ring block involves a series of injections around the base or mid-shaft of the penis. Studies show that it is more effective than topical analgesia and dorsal penile nerve block. However, there is up to a 5% failure rate. No complications have been reported from this method (AAP, 2012; Lemer, 2018).
Who Can be Circumcised?
According to the Task Force on Circumcision, “elective circumcision should be performed only if the infant’s condition is stable and healthy” (AAP, 2012). Contraindications to circumcision include significant prematurity, blood dyscrasias, a family history of bleeding disorders, and congenital abnormalities of the penis. Circumcision should be delayed for any premature, low birth weight, or ill infant. Additionally, babies should receive vitamin K supplementation before being circumcised to help prevent excessive bleeding (AAP, 2012).
The decision of whether or not to circumcise is complex and personal. Parents of male newborns should exam all the evidence and have a discussion about the importance of culture, religion, and ethics before making such a decision. The AAP states, “parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.”
American Academy of Pediatrics (AAP). (2012). Technical report: Male circumcision. Pediatrics. (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Boyle, G. J. and Hill, G. (2011). Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. Journal of Law and Medicine, 19, 316-344.
Bullough, V.L. & Bullough, B. (1994). Circumcision: Male – Effects upon human sexuality. Human Sexuality: An Encyclopedia. Garland Publishing: New York, NY, 119-122.
Earp, B.D. (2015). Do the benefits of male circumcision outweigh the risks? A critique of the proposed CDC guidelines. Frontiers in Pediatrics, 3(18). doi: 10.3389/fped.2015.00018.
Earp, B.D., Allareddy, V., Allareddy, V., & Rotta, A.T. (2018). Factors associated with early deaths following neonatal male circumcision in the United States, 2001 to 2010. Clinical Pediatrics, 1:9922818790060. [Epub ahead of print].
Lemer, H.M. (2018). Eight common questions about newborn circumcision. MD Edge: ObGyn. https://www.mdedge.com/sites/default/files/document/january-2018/obgm0300127_lerner.pdf.
Many women assume they need to be seen right away after finding out they are pregnant. But there’s not much to do in monitoring the baby until about about 10-12 weeks gestation. This is when the baby’s heartbeat can be heard via a Doppler (a hand-held ultrasound) and when genetic screenings are offered.
If you want to be seen earlier, you can get an early ultrasound (between 6-8 weeks) to confirm the viability of the pregnancy and to better estimate your due date based on the size of the baby. You can also have your pregnancy hormones assessed (aka Human chorionic gonadotropin) via a blood draw to confirm the levels are appropriate for how far along you are. Until then, try to remain relaxed and let your body continue to nourish and care for your growing baby.
Let’s do a quick review of the early physical development in utero. A baby’s heart begins to beat during week four. An ultrasound won’t be able to pick it up until week six to seven. There are arm and leg buds with facial and neck structures. At this stage, a baby is a quarter of an inch long.
At week 5-6, the nose, mouth and palate take shape. The arms and legs have developed and by the end of the seventh week the baby has clearly defined wrists, elbows, knees, fingers, and toes. A baby at this age is one-half inch long.
At 10 weeks, the baby’s essential structures – both internal and external have been formed and just require further growth and development. This is when you will begin prenatal care. (Romm)
‘What can I expect from my first appointment?’
Your vitals will be taken i.e. blood pressure, pulse and weight. This will serve as a baseline to compare to throughout your pregnancy to ensure your body is adapting well and you are healthy.
Your care provider will review you and your family’s medical history along with any surgeries you have had in the past. He or she will also go over your gynecologic history including when your last menstrual period was to confirm your best estimated due date. A thorough discussion around work, relationship status, stress, nutrition, and exercise are all very important aspects in maintaining a healthy pregnancy that will be reviewed as well.
There will be blood work and other labs performed to assess iron and thyroid levels, immunity to infectious diseases, and/or the presence of sexually transmitted diseases. There is also the option of screening for genetic abnormalities in the baby.
A physical exam will be performed. This includes listening to your heart and lungs as well as feeling your throat and neck for thyroid abnormalities or inflamed lymph nodes. Lastly, an examination of the breasts and pelvis will take place.
You will return for routine check ups monthly until 28 weeks. Then, you will be seen more frequently of every 2 weeks until 36 weeks. In the final weeks, you are seen once a week (or sometimes more frequently) until you have your baby.
Here are some things you can do to support your body in developing and growing your baby until you meet with your care provider.
Take a prenatal vitamin for the folic acid. Extra folic acid (found in leafy green vegetables, eggs, whole grains, lentils, nuts, milk, and liver) is needed in pregnancy to prevent anemia, miscarriage, premature birth and birth defects. I recommend a food-based vitamin so it is better digested in the body.
Rainbow Light is a great brand. If not this one, I recommend choosing a brand that requires consuming multiple pills a day versus one a day. The pills are usually smaller in size and better digested. When one large pill is consumed this can make your digestive system work harder causing stomach upset, nausea and constipation. Plus, your body doesn’t need all those nutrients at once, so you may end up flushing out much of the benefits of the extra vitamins. Rainbow Light makes a prenatal petite mini-tablet that you take three times a day. If you are someone who doesn’t like taking pills, then at least take one in the morning and two at night.
Avoid toxins such as alcohol, cigarette smoke, foods that are high in mercury and nitrites/deli meat. Also beware of environmental toxins i.e. pesticides and chemical fumes, toxic cleaning products, prescription and over-the-counter medications. This is especially true from weeks three to seven as it is the most vulnerable phase of development for the baby.
Combat nausea during weeks 6-13.
– Eat small meals every two hours to prevent low blood sugar
– Eat something protein-rich as that will sustain blood sugar levels longer
– Eat before rising in the morning
– Rest (take extra naps)
– Don’t take prenatal vitamins on an empty stomach and/or stop taking prenatal vitamins during this time
– Moderate exercise will help mobilize toxins and high levels of hormones coursing through your body
– Avoid spicy or greasy foods
– Drink ginger or peppermint tea
– B6 is helpful in maintaining blood sugar levels. As much as 50 mg can be taken every 4 hours along with 400 mg of magnesium. In more extreme cases of nausea and vomiting, intramuscular injections of B6 can be very helpful. (Frye)
Don’t Google symptoms as it always leads to worst-case scenario. Instead, contact your care provider, if possible. Otherwise pick up a current, non-fear based book about pregnancy, birth and early motherhood. Nurture by LA-based doula, Erica Chidi Cohen is informative, comprehensive and non-judgmental (of birth plans or desired birth settings).
Try to live life ‘normally’, unless specifically indicated not to by your care provider. While avoiding toxins as mentioned above, keep up with your routine of exercise, sexual intercourse, travel, work, etc. If something doesn’t feel right then modify the activity and contact your care provider.
Keep a journal to help process all of the new physical sensations and emotions that can arise. There is a lot of change with pregnancy and what that means as a woman, partner, mother and person in the world. Thus, experiencing a range of feelings is normal. Please reach out to your care provider if you are concerned.
Enjoy and have fun getting to know your body and baby!
Frye, Anne. Holistic Midwifery: A Comprehensive Textbook For Midwives in Homebirth Practice. Labrys Press, 2010.
Romm, Aviva Jill. The Natural Pregnancy Book. Ten Speed Press, 2003.
By Laura Gimbert, Mother, Business Owner and Influencer
Motherhood and work are two big life roles, and each deserve a lot of attention and dedication. And although balancing both can be challenging, it can also be satisfying – helping you maintain your identity through postpartum (if working was a big part of your life pre-baby), and keeping your mind stimulated. So, what are some top tip and insights about balancing your business and baby?
I believe that everything starts during pregnancy. Planning and prepping for postpartum is a must. When the baby comes you want everything to be ready. This not only includes baby must-have items and having the home ready to welcome your little one, but also your work-world must be prepared. This means that during pregnancy, you should train whomever will be taking over your work, talk to all your clients and colleagues about your postpartum plans so they don’t bug you unless it is necessary, and get ahead of the game taking care of as many projects as possible so you have the least amount of work once the baby arrives. I personally had no maternity leave (business owner life!) but, I prepped perfectly and was able to work while enjoying my daughter since day 1.
Knowing where to delegate is another must. We moms are superwomen, and can do it all. But to do it all RIGHT we need to delegate and invest! Since the day Sofia was born I have managed my business and daughter all on my own. My husband works away all day, our families live across the country/world, and I personally decided I didn’t want a nanny until she goes to preschool because they grow up so fast and I don’t want to miss a thing. So, where do I delegate? I don’t have time to go to the groceries: I grocery shop online (farm fresh direct). I don’t have time for cooking: I order a meal prep delivery service that brings us healthy dinners fresh not frozen. I don’t have time to deep clean the house: I have maids come in regularly. I have no time to run work/personal errands: I have a personal assistant. You choose what works for you and where to delegate!
Balancing both roles can be hard mentally too, so prepping your mind is equally important. You should know that some days you won’t get anything done, that work will constantly be interrupted, that you won’t feel as rested, and that you may have to work more from your phone/laptop on the couch instead. But if you understand that this is your new life and learn to be okay with it, if you adapt to this new way of living quickly and with a positive attitude, then you will balance everything the best way you can. After all, remember babies are only babies once, and if we get frustrated at these changes we won’t enjoy this short and special stage as much. They will change again in the future, so we must learn to enjoy and embrace all the changes!
And finally, if you are thinking about balancing motherhood and work, you will be BUSY! So please stop and think about self-care activities that you will do for yourself, every single day. A relaxing bubble bath with candles, reading a book cuddled with a blanket and a tea, going for a hike with your favorite music, getting a massage… Whatever it is, taking care of yourself and feeling good inside and out is also key to having a positive attitude and feeling more relaxed. This will help you balance it all! Sit down and write a list of things you will do for yourself at the beginning of every week. Just as business goals, you should have personal goals set up too. You deserve it.
You can read more on my mom boss life tips & tricks, and personal experiences at www.mombosslife.co
I had a really great pregnancy. Minus weeks 5-10 when I was extremely nauseous and exhausted and eating snacks constantly at work to try to keep from throwing up, I actually really enjoyed being pregnant. I loved talking to my little girl and bringing her everywhere with me. I wasn’t scared about the birth process at all. Mostly I was excited to have what I envisioned to be the powerful experience of bringing my baby into the world and just couldn’t wait to meet her Leading up to my due date, I enjoyed visiting the midwives at Del Mar, I drank lots of date shakes, ate super well, went for long walks, and was generally really motivated to do everything I could to keep myself and baby happy and healthy and in shape for a natural birth.
About a week and a half before my due date, one of my best friends, Sara, who is about to become a certified nurse midwife, arrived at our house to stay for a month. She was going to be my doula and basically everything-support during this whole exciting time. The same day she arrived I also had friends over to our house to eat Indian food and draw henna patterns on my belly in anticipation of the birth. These friends also wrote and brought me birth affirmations to save for when I needed to hear them during my labor. After that day, I really felt “ready” for whatever happened next!
For about four days leading up to Philippa’s birth, I was noticing my contractions more than usual. I had been having plenty of Braxton Hicks contractions throughout my pregnancy, and while I knew that while BHs were generally mild and “real” contractions much more intense, I wasn’t quite sure when I would start to know “the difference”. My friend/doula Sara assured me that I would know. Several people I talked to compared real contractions to really bad period cramps, which I have more than a little experience with, and I’ve always thought of myself as having a high pain tolerance. I wondered- when my contractions began in earnest, should I expect them to be like MY period cramps at worst possible level, or more mild cramps that others experienced as painful? Or was this just a poor analogy in the first place? It would be impossible to know until it happened! Either way, I took comfort in knowing that the ramping up in number of contractions meant that my body was in some way beginning work towards birth and was a positive sign! My job now was to soak up as much oxytocin as possible until baby decided to come; the plan for her due date (Friday, June 15th) was facials in the morning and The Incredibles 2 at night, with plenty of games and pool floats before and after. I had been reminded many times that most first time moms give birth after their due date, and I didn’t want to think too much about when exactly little Pip would arrive, although I hoped that it would be soon (after 42 weeks, the birth center would no longer have been an option…plus, I believed it would be in my favor for baby to continue to gain weight outside of me rather than inside…I’m a pretty small person!)
On Wednesday the 13th, my husband Levi and I had our 40-week appointment at Del Mar at 12:30. After talking with midwives Hayley and Taylor and meeting nurse Anna, we left saying, “See you next week…or hopefully sooner!” and went out for a nice lunch and tea date (oxytocin!). I was craving a burger, which is pretty unusual for me, and ordered a delicious grass-fed burger at True Food Kitchen–it really hit the spot. Now I’m pretty sure my body wanted to give me a mega-dose of iron before the big event! We bought Father’s Day cards at the tea shop and wondered if Levi would have his baby before Sunday. After we got home, I went straight over to my in-laws house to hang out at the pool with a few friends. Nothing like the anti-gravity effect of swimming when 40 weeks pregnant!
Plans for the evening evolved and we ended up picking up pupusas and bringing them over to our friends Jason and Ruth’s house for dinner (Ruth was 38 weeks pregnant at the time, her little girl was born just 9 days after our daughter!) As we were playing a game, I noticed that the contractions I had been having on and off seemed to be getting slightly more regular and a little more “period cramp”-y. I was sitting on Ruth’s birth ball while playing and there was one contraction in particular that I remember breathing a little more intently through and bouncing on the ball just a little bit. Ruth got excited about this (being a fourth time mom I think she was much more clued into the signs than I was). I was still thinking that there was no way this was the night.
By the time we got home though, I was beginning to reconsider. It was already late-ish (10:30?) and I thought I could go to bed and sleep through what were now mild but undeniably regular contractions. Sleep didn’t come right away and I soon got up to make sure that I had a small glass of wine and two Benadryl on my bedside table…this was the midwives’ suggestion for if it seemed like early labor was starting but it was bedtime and rest was needed. I laid back down again, and shortly thereafter wanted to take the Benadryl and wine. At this point Levi also called Del Mar for the first time–we were connected with an answering service and then with Hayley, who was on call for the night. It was funny since we had had our appointment with her earlier that day! She told us to keep an eye on the contractions, making sure they were getting longer, stronger, and closer together. Levi also texted Elisabeth Millay, our birth photographer, letting her know that I was having contractions and that the birth could be in the morning (at this point we still had no clue how quickly everything would move). Elisabeth responded saying that she would keep her phone next to her and to call her any time. (By the way, all the pictures that follow were taken by Elisabeth. I can’t even describe how thankful we are to have these precious moments recorded. If anyone reading this is deciding whether or not to have a birth photographer…please do it!!)
From here, my memories are a little blurrier. The time frames are rough estimates.
12:00-1:00 am. I laid in bed dozily, I was able to rest and be peaceful during that time thanks to the wine combo, so I’m glad I took it. The contractions had begun to need focus and I would breathe through them like I’d practiced in our classes with Julie from Two Doulas. Levi could hear me start to breathe at the beginning of each one and would hit “lap” on his phone stopwatch. I remember thinking it was funny because he seemed sound asleep to me other than timing and I didn’t know how he was managing to do that. I could see from the screen that the contractions were really just about 5 minutes apart, if that. At some point towards the end of this I wanted to plug in an electric heating pad and put it against my back.
1:00-2:00 am. I got out of bed, the contractions were getting more painful and were by now more like four minutes apart. By now I realized that this was labor and that we would likely need to head to the birth center in the near future. I was moving around, thinking about what else I’d practiced besides breathing…leaning on a birth ball, having Levi “belly sift” my belly with a long scarf…I wanted to do each of those once…instinctively when I got out of bed I pulled out my yoga mat and started moving around gently on the mat (Philippa being no stranger to yoga! I am so happy about all of the great yoga classes I attended with her in the belly…Thanks to Carol Corpuz at Yogaraj!.) Hayley had suggested at some point when things got really intense that I get in the shower, which I did around the same time we called her for the third time and got Sara out of bed. Levi was holding me through a contraction before I got in the shower and I said “I’m going to throw up,” then got in the shower and got on my hands and knees and did just that. Easy clean up at least. The hot water felt good on my back but at this point nothing felt “good”. The pain was getting more real. I got out of the shower and sat on the toilet at Sara’s suggestion. She sat in front of me and put my feet up on her legs and helped me adjust my breathing (which was now much louder, like a moaning) so that I was making lower-pitched sounds. Hayley said we could come in if I felt like it was the right time, after listening to me through a contraction. I had always pictured being in “early labor” at home for hours and hours but something told me Philippa didn’t have that kind of time, and I asked to start getting ready to leave. I didn’t want to be alone with the contractions ever, so Sara and Levi took turns getting the car loaded, finding my blue nightdress, and getting dressed themselves, until we were all ready to leave the house.
3:00-3:45 am. We drove to Del Mar. Levi put Sara Groves on right away (my favorite artist, her music has a calming effect on me like no other). Sara sat in the back seat with me while Levi drove. We tell Pip now that she picked a good time to avoid traffic!! The car ride is kind of a blur to me but I don’t think it was as bad as I expected it to be. Somehow the darkness outside calmed me down. The contractions were very painful but I still had several minutes in between each one to catch my breath and relax.
3:45 am. We arrived to South Pasadena, Hayley was already there. I had my vitals taken and peed, stopping to hold onto whoever was closest for contractions every few minutes. I don’t know exactly what I pictured a cervix check would be like but I had definitely never thought about how uncomfortable it would be! The report was that I was 4 cm dilated, 80% effaced, and baby’s head was in the -1 position. Technically the birth center doesn’t admit before 5 or 6 cm dilated, but Hayley assured me that I was making progress quickly and that I could go straight to the room we had chosen ahead of time to see what took place in the next hour or so. At no point was I worried about being sent home or felt that was an option for me. I couldn’t see this being a false start, I was well into a rhythm by now and I knew Philippa was well on her way. Elisabeth the photographer arrived by 4:00 am.
4:00-5:00 am. I went straight to the big jacuzzi-like tub. The playlist that Levi and I had made the afternoon before while waiting for our lunch order went on (mostly Sara Groves, some Audrey Assad, Rivers and Robots, and other comforting, familiar spiritual songs). The birth playlist had been sort of my last real “to-do” that needed to happen before baby came, so the timing on this was perfect! Lavender oil went into the diffuser. I asked for these things to happen, but part of what was so lovely about the whole experience is that I felt everyone around me already knew exactly what I wanted…even things I didn’t know that I would want…like the cold rag on my head and shoulders as laboring in the tub made me hotter and sweatier but I still couldn’t picture getting out….and the orange Recharge drink in a glass with a straw and ice cubes that tasted so much better than water could have in the moment…I would motion for it throughout labor by bringing my hand to my mouth. I became aware very quickly that I needed every ounce of my energy to bring Philippa into the world and I didn’t want to waste a bit of it. I switched positions in the tub several times…most of the time my back was to the edge of the tub and I held onto Levi’s or Sara’s arms above me as each contraction came. Some of the time I was on my hands and knees or in more of a squatting position. Levi read a few of my birth affirmations to me. Some made me laugh if I wasn’t in the middle of a contraction. At some point it was too hard to even focus on or listen to these. I had prepared phrases for myself to motivate myself if I needed them, like “Your body is not a lemon!” from Ina May’s Guide to Childbirth…but everything was so intense that I really wasn’t thinking about much besides taking each moment as it came, the sounds I was making and keeping them low (I didn’t know I was capable of making sounds like this. Sara referred to it as the birth song). Hayley was in and out of the room for this first hour and would say comforting and quiet encouragements to me and check baby’s heartbeat with the Doppler intermittently.