Waiting It Out

I am so very pleased to say that I know several woman who are pregnant right now! I am so excited to watch them transition into the motherhood phase of their lives and to support them in this transition however I can. As I follow their progress I am reminiscent of my own pregnancies. I often ask myself, "What were the most helpful pieces of information that I received during pregnancy?" Lately, one thing keeps coming into my mind: Patience.

It is a common assumption that pregnancy takes patience. After all, we wait in anticipation for months to meet our new little bundle. Throughout those months there seem to be endless changes happening in our lives and our bodies that require us to exercise patience: the crazy mood swings, the limitations on our physical abilities, the searching for clothes that fit, and on and on. All of this patience practice is in service to what is required of us upon the birth of our baby: more patience.

But what about during labor and delivery? Patience can seem an odd request during this seemingly stressful time. After all, everything happens so fast, right? Or at least it should. We get this notion from watching the depictions of labor and delivery on television or film.

Here is the standard popular culture rendition of labor and delivery;
1. water suddenly breaks in a large whoosh all over the floor of an inconvenient place - mother seems to be taken by surprise
2. hail a taxi or jump in the car - there is only a few minutes to make it to the hospital before baby arrives
3. in the hospital, intense pain insues followed by baby's birth
4. celebration, rest and relief

If this is our expectation of a birth, it is easy to see how women could become frustrated or disappointed when faced with what actually happens. The truth is that each woman experiences labor and delivery a bit differently. The pace of labor and delivery can be very fast - like in the movies. But many times it is slower and less frantic. AND it slows even more when a mother changes locations thanks to the fight or flight response.

The fight or flight response is an automatic response to a threat that is either real or perceived. The body releases stress hormones in preparation for either a fight or a flight as a response to this threat. What does this have to do with labor and delivery, you ask?

Mothers generally begin laboring at home - a place of familiarity and comfort. Often, contractions progress quite nicely at home. When contractions become closer and more intense, mothers commonly decide to transition to the hospital or birthing center. The anticipation at the hospital is tangible - mom is finally very close to meeting baby after so many months of waiting. Patience becomes a challenge at this point!

During the transition to the hospital  the mother's sense of familiarity and comfort is interrupted. The body perceives this change as a threat and labor stalls as stress hormones are released in preparation for a fight or a flight. This used to be a very helpful response, meant to ensure that the mother was in a safe place for labor and delivery by stalling labor until that place was found. However, in today's culture the stalling of labor often results in impatience, frustration, anxiety, stress and the administration of pictocin or other drugs to stimulate contractions. Often, these interventions lead to further interventions.

Understanding this natural, automatic response during labor can help women cultivate patience with themselves and their partner during such an exciting event. Patience can help reduce stress in the body and created a more peaceful sense of a hospital environment. This sens
e of peace will lead to an increased sense of comfort and safety, allowing labor to progress. There are several things laboring mothers can do to increase the level of comfort and safety perceived in the hospital environment.

Dim the lights. Turn the heat up in the room (I had my hospital room at about 80 degrees!). Soak in a hot bath to relax tense muscles (this can also quickly increase dilation of the cervix!). Choose a position in which YOU are comfortable for labor rather than a position that is convenient for your doctor. Practice breathing techniques. Turn on some music.

And be patient.

This Just In...

Relating to the previous post, I thought readers might find this one interesting:

http://www.sciencebasedmedicine.org/autism-and-induced-labor/

Can you manufacture love?

If you've been in love, experienced "warm fuzzies," or given a hug, then you've experienced the hormone oxytocin and all of the positive effects that accompany its release. Often dubbed "the love hormone," oxytocin is responsible for the intoxicating gaze between two lovers as well as the trust felt in a relationship. Oxytocin is, in part, responsible for conceiving your baby!

Oxytocin is also an important ingredient in the labor and delivery process. It is the baby's production of oxytocin that initiates the mother's labor response by the production of her own oxytocin. This hormone is responsible for the contraction of the uterus during the third trimester, during labor, delivery and postnatal contractions. Oxytocin also stimulates milk production for breastfeeding and acts in conjunction with a myriad of other hormones to prepare mother and baby for life together.

You may not be familiar with the hormone oxytocin. How about its synthetic cousin, pitocin/sintocinon? Synthetic oxytocin is used to augment or induce labor, bypassing baby's signal of readiness to mom in order to start or speed up labor. While oxytocin is produced and released naturally in bursts throughout labor and delivery, synthetic oxytocin is administered continuously through an IV, making contractions longer and stronger, potentially placing the baby in distress. Many of these labors end with a caesarian section. Synthetic oxytocin also interferes with the mother's natural production of oxytocin and minimizes the love response of mother to her new child. The result can be a depressed mom and a distressed child.

Recently, one of my prenatal yoga clients commented that she'd previous been induced twice out of the three births she has experienced. The first because her baby "was too big to delivery" and then second time because she'd been induced previously. My client expressed her extreme dislike of being induced and hoped not to be induced for her upcoming birth. She also commented that she thought "pitocin is overused." I tended to agree with her, based on what the birth stories I've listened to over the years. My feeling - and hers - was confirmed with a bit of checking.

The rate of induction in the United States in 2008 according to the 2012 U.S. Census Bureau was 23.1%. This is for all singleton gestations. This rate rose to 24.3 for gestations over 37 weeks (term). Almost 25% of babies born in the United States are born before they naturally signal to their mother that they are ready. Almost 25% of the initial bonding between mothers and babies is usurped by intravenously administered synthetic oxytocin. What effect might this have on the delicate hormonal dance between mother and child? What effect does this have on the warm fuzzies? Science is beginning to study this very question (for more information, click here).

Medicine has saved lives. There is no doubt about it. Medicine has saved mothers and babies and families. This is true. But when medicine disrupts the hormonal love dance between mothers and their babies we need to begin asking the question: Can you manufacture love?

The Birth Plan Debate

Birth plans are under fire. I did not realize this until doing a bit of research for this blog post, only to find a barrage of discussion about the effectiveness of birth plans.

In a nutshell, some OB/GYN's are offended that a woman without a medical degree would be so bold as to insult them with a laundry list of demands concerning medical treatment during labor and delivery. This perspective often highlights the use of out-dated information included in these demands, such as the request to avoid shaving which has not been a standard hospital procedure for decades. Likely, birthing women do not have the depth of information offered by almost a decade of study and daily application of knowledge as OB's enjoy. Clearly, this vast informational gulf deserves respect.

On the other side of the proverbial fence, mothers have ideas about how they would like the birth of their child to go, based on their understanding of childbirth either from literature, filmed births or previous birthing experience. The birth plan is an attempt to communicate these thoughts to healthecare providers. It seems reasonable to make a plan for such an important life event. After all, I make a plan just to go to the grocery store. Surely childbirth is a more significant event than that, deserving of some undivided attention.

Complicating this matter, recent research suggests that a birth plan can create disappointment for mothers due to unrealistic expectations. We all know what it is to have a plan that goes awry. The more important the event, the more disappointing an unexpected turn of events can become. This can have a dominoe effect in the delivery room, as a mother experiences higher levels of stress as a result of unplanned interventions which can lead to futher interventions. The last thing that women want is to feel like a failure as a result of the birthing experience. Yet, that is the caution surrounding birth plans - if things don't go as planned, woman may find that they only have themselves to blame.

I'd like to reach for some middle ground in this debate.

Some women have been led to believe that they need a medical degree in order to understand the very natural process of child birth. I'd like to point out that women's bodies were designed for the specific purpose of reproduction of the human species. Our position as birthing mothers is the result of evolutionary millenia. The task of the OB/GYN is one of support and understanding as well as medical expertise. I am not suggesting that doctors are unnecessary - not in the least. I am merely suggesting that a pregnant woman need not have a medical degree to understand the process of child birth and be confident in her plans for labor and delivery. Women DO have choice in the process of labor and delivery. One role of medical providers is to help women understand their choices rather than to make choices for them. I suggest that women ask their doctors about the standard practices during labor and delivery at their hospital of choice (if they so choose to go to hospital) and then develop a plan, taking these standard procedures into consideration.

When women deveop a birthing plan, it is also important to note that plans change. It is an important lesson for mothers to learn to be flexible - to be able to go with the flow. Understanding the process of child birth means understanding unpredictability. As a recent blog post from Dr. Amy Tuteur suggests, there are so many things about child birth that can not be planned or controlled. We don't know when labor will begin. We do not know how long labor will last. Sometimes there are unforeseen birthing problems. Women need to be open and understanding towards these possibilities, trusting their doctors to act in the best interest of the mother and child should these situations arise - letting go of "the plan"without labeling the birth as a failure of their own. It is this attitude of acceptance and openness that will serve women well in the rest of their years as a mother.

What it comes down to is commuication. Communicate your understanding and your birth preferences with your partner, your doctor, your midwife, your doula. In turn, those assisting with your birth should be able to communicate openly with you about said preferences. Have these conversations EARLY ON in your pregnancy - the labor and delivery room is not a good place begin the discussion. The tone of these conversations is a good indicator of the relationship you have with your birthing partners. If you feel uneasy about the tone of these conversations, if your doctor is unhappy with your preferences, talk MORE! Understand each other. Then, make a personal decision about what is best for you and your baby. You may need to change doctors. This is better to discover sooner than later.

I was lucky to have very open practitioners for the birth of both of my children. We had discussions and then we had more. I did my homework - finding out hospital procedure to compliment my understanding of my doctor, the maternity nurses and my birthing preferences. My doctor or midwife was always willing to schedule extra time to talk to me about my concerns and answer my questions. Using this knowledge, I made a birth plan with an understanding that labor and delivery may take a different route. I had to be open to that possibility.

Both of my births went well. Did they go as expected? No. Becasue I didn't "expect" anything other than to have a new baby at the end of it. Did I have preferences? Yes, with the caveat that they are just that - preferences. They may or may not be available depending on a given situation.

You can't always get what you want. But if you try sometimes, you might find, you get what you need (Rolling Stones). The birth plan is a good step in this direction.

My old jeans

We all know that exercise is recommended as a key component in a healthy lifestyle. We've all heard that exercise during pregnancy is good for mom and good for baby. But what happens after baby is born? The information does not change - exercise is still healthy - but the life of a mom does.

Prior to the birth of my oldest child I was active - to say the least. I enjoyed an almost daily yoga practice, followed by a bit of surfing, perhaps some running or biking and rounded off with an evening session at the local climbing gym. I had trained for my first triathlon and attended graduate school. My assumption was that I would return to some truncated form of this lifestyle after the birth of my son. Afterall, I'd managed to continue most of these activities throughout pregnancy.

The demands of motherhood first became a reality when tried out my old jeans after my first son was born. They were the largest jeans I owned and had fit me into the first 5 months of pregnancy. Fully expecting to wear them again, I pulled them out from the back of my closet within days of his birth. Sure I had gained weight during pregnancy, but I reasoned that 7 pounds of it was the baby and several more were amniotic fluid and placenta. All pounds shed during childbirth. How surprised was I when those old jeans didn't stand a chance in covering the lower half of my body! My mind shifted into high gear, developing potential schedules for my new family centered around time for me to "get back out there." I put my plan into action.

Baby boy was breastfed and cloth-diapered. He ate every three hours - meaning three hours from the beginning of his previous feed he was due to eat again. I reasoned that if I woke up to feed him at 6am and did diaper duty straight away, I could be "out there" riding, running or practicing yoga by 7am. Return by 8-ish for a quick shower, a bite to eat and hanging out the nappies before settling in for the next round of breastfeeding. Whew! What a way to begin the morning. And my supportive husband did what he could to help me in this manic effort. This worked for my ego but didn't do much for any other aspect of my life. Beginning my mornings in this way made me anxious to keep on schedule, cranky for lack of sleep and feeling guilty for leaving the prescious new life I had born.

Looking back, I see this time as a desparate attempt to deal with the unknown frontier that is parenthood. It was a defense mechanism to preserve who I had been by preventing the journey towards who I now am. The schedule was demanding, rigid and separated myself from my new baby first thing in the morning in order to live out the storyline I'd had in my head for years about who I am - atheltic, determined, capable, strong, adventurous.

I assume most mothers have this struggle. Recently several of my friends have birthed new babies. They are involved citizens with personal pursuits struggling to reconcile their past with their new present.They look for "me" time. They want to participate. They long for fellowship. They want to wear the old jeans.

The lessons of yoga can be especially helpful for mothers. Motherhood is the time where the "rubber meets the road." A time to put all of those practices on the mat into our daily life off of the mat. Letting go of our past, letting go of what used to be or how we used to be by taking one breath at a time in this new present with a new little life in our hands.We may not make it onto our mats as often as we would like, substituting a forward fold on our mats with a forward fold to pick up a toy. We may skip a run or a bike ride more often taking time instead to walk with baby and explore the world with him. This is our new practice.

We are practicing all of time. Breath by breath, we practice patience. Breath by breath we practice love and compassion. Breath by breath we open ourselves to grace, moving into our current life and letting go of the old stories that we used to tell ourselves about ourselves. We throw out our old jeans. And we become.

The Power of Presence

The truth is that birthing a baby is a paradox of the largest joy coupled with a deep, physical pain. It is a mental mix of desperation and determination. The commitment of a mother in the moment of labor is complete. The starkness of reality is loud and bright in the moments of contraction. These are the stories  women tell about their birthing experience. The fear. The pain. The joy. The relief.

There is an in-between. There are moments during labor and delivery full of breath and tenderness marked by a pause. During these moments all labor stops. Time hesitates. If we learn to relish this respite we can find a gentle calm in which to rest between the storms of contraction. To catch our breath. But we will need to practice being present. If we allow our mind to hold on to the previous contraction or to fear the next one, we will lose the opportunity to be presently aware and pleasantly at peace if only for a moment.

Contractions are unlike any other physical pain. When we work our muscles through exercise we often experience a fatigue lasting for hours or even days. We feel achy, tired or depleted. When we experience contractions during labor they come and then they go completely and without residue. The achy, depleted feeling does not follow. We are offered a break in between each physical effort to birth our baby. We can relish these moments in between by coming into our breath, one inhale at a time and one exhale at a time. Letting go of the past and surrendering the future. We can be present with our baby and this birth.

Practicing presence requires us to sit with our breath. To bring our mind into our body. We can practice mindful breathing daily in preparation for childbirth.

Take a comfortable seat. Close your eyes. Bring your mind into the four corners of the room. Begin breathing in through the nose and out through the nose. Feel the body begin to calm. Feel the mind begin to quiet. Follow your breath, saying to yourself, "I know that I am breathing in." And then, "I know that I am breathing out." As you inhale, know that you are breathing in all that you and your baby need for Life. As you exhale, release any tension you feel in your mind or in your body. Let go of  anything that is not of service to you or to your baby. Be here and breath, presently and peacefully.

Leg Cramps

I teach a weekly prenatal yoga class at a local fitness venue and a monthly class through the local hospital. I love working with this demographic. These ladies are full of excitement and joy and are ever so happy to find that yoga can help with many of the common discomforts of pregnancy.

This past week there were several questions about leg cramps and restless legs through the night, waking tired and pregnant moms out of sleep. Well, here is some information that might be helpful in remedying these painful interruptions Remember to check with your doctor before making any changes.

Proper hydration tops the list of things to do for leg cramps. I am sure that many of us walk around with a water bottle of some sort because we've all learned about the importance of water, especially during pregnancy. But are you drinking anything other than water? 

Carbonated drinks can have a negative effect on your ability to absorb calcium. Calcium and magnesium are healthy minerals that grow strong bones and are calming for the nervous system. Limiting fizzy drinks will benefit your body and may help to decrease those pesky leg cramps. So, even if you enjoy fizzy water, switch it for flat.

Other minerals that are important during pregnancy and prevent leg cramps are potassium, sodium, as well as calcium/magesium. Eating foods rich in potassium, sodium and calcium/magnesium can also help with leg cramps. Try bananas, oranges, grapefruit, yogurt, cottage cheese, dark green leafy veggies, salmon, sardines, almonds and many others. 

Restless legs are also common during pregnancy. Be sure you are getting enough iron in your diet, as low iron could be the reason the legs are restless.

I like eating kale, which is very high in calcium and iron. Here is an easy way to cook kale as an evening side dish. 

You will need:

A big bunch of kale

2 cloves of garlic

1/2 cup water or chicken stock

balsamic vinegar

salt and pepper

Method:

Roughly cut kale

Sautee garlic until soft

Add kale and liquid and bring to a boil

Turn down heat and cover for 5 minutes

Sprinkle balsamic vinegar over kale

Salt and pepper to taste

Enjoy!

I hope this helps.

Namaste

Tammy Magness

Prenatal Yoga Instructor