The Four Preventative P's

I was reading a blog called Academic OBGYN and found a fascinating article about handling slow labor. After the article, I always read the comments....sometimes just a handful of opinions since a lot of these blogs will boast hundreds of comments. Near the top I found a comment by Amy Romano, who is a pretty well known and respected midwife who writes a blog for Lamaze International called Science and Sensibility. In her comment she took a moment to talk about what she calls "The Four Preventative P's":

I give a talk on optimizing labor progress and talk about “Four Preventive P’s” rather than the 3 P’s and other variations, all of which I think address how to treat rather than prevent dystocia.

Briefly, the four P’s are:

Permission – freedom of movement, autonomy in decision making, freedom to vocalize, throw up, ask for help, or whatever it is the woman needs to do to get her baby out.

Physical environment – there are some intriguing pilot studies showing beneficial effect of simple alterations like removing the labor bed and/or giving women freedom to rearrange furniture and props in her own room.

People – continuous support from a doula or other trained labor companion has many documented benefits and should be the standard of care.

Practices – avoid routine use of interventions that slow labor down. Avoid arbitrary time limits, etc.

Of course, you don’t get the Four Preventive P’s in most hospital environments.

I had a thought after reading this that this could be a birth plan for any mother planning a natural childbirth. Its short, easy to read and gets right to the point. If her doctor or midwife has problems with any of these four things, it would be a good indication that she isn't going to get the birth she wants and should look for a new provider. Also, I like how it simplifies the requuests to four items. Sure, there are a lot more than four things asked for here, but since it basically bullet-points four things, it doesn't look like such a long laundry list of requests.

What do you think? Would this work as a birth plan?

Watching Your Due Date Come and Go

Preparing for Cade's birth, with two births (including my very powerful VBAC) under my belt, I felt like I knew everything I needed to know to have him. I was convinced he would come a week early. I went into labor with Gavin 3 days before my due date. Alayna came 5 days before hers. So, naturally I assumed that each baby would come earlier and earlier and Cade was bound to be a good 7 days early......I was WRONG!!!

I remember scheduling a "40 week" appointment with my midwife and we both joked that it would most likely not be necessary....we were both convinced I'd have Cade before that date. Knowing everything I knew that babies come when they are supposed to and as against elective inductions as I was (am), I must admit it was disappointing to not be in labor and a temptation to "take matters into my own hands". There were definitely things going on externally that made me feel pressured to have this baby SOON! My mom was in town and although I knew she'd be there for several weeks, it definitely felt like everyone was waiting around for this baby to come.

In some ways, I felt responsible that he wasn't here yet! I know that sounds silly, looking in hindsight, but I did have those feelings at the time. My dad flew in on my due date! Again, we had convinced ourselves that he'd come early and my dad would come for a week to see us. That's probably the biggest pressure I had. I *so* wanted my dad to meet his newest grandson. It would have killed me for him to come and go and not see Cade. Because of this, I did agree to have my membranes stripped (but not broken!) at that 40 week appointment....something that I didn't think I wanted to do originally. It didn't really do anything for us right away, but Cade came in his own timing, 5 days past when he was predicted.

That brings me to why I'm posting this today. "The Unnecesarean" has a new guest post about being Postdates and does a great job talking about what that really means. I think when we're in the situation, tired of being pregnant, family is waiting for baby and we're really, really, *really* ready to get this show on the road, I think its a great idea to get our head back in reality and know that our babies really do know the best time to come....its not always when we think it should or will be. I was so grateful to my midwife for her encouragement, assuring me that I was healthy, Cade was healthy....we just needed to wait and not hurry him earlier than when he's ready. I'm reminded that not all women have someone in their life who will encourage them this way. In fact, many women have the exact opposite....a provider who is feeling rushed, wants to induce or schedule surgery, plants seeds of fear that something might be wrong with her baby and pushes for decisions to speed things up. During these times, the best thing we can do is pray for peace. Non-stress tests for the baby are great at easing our worry that something is wrong.

A friend just had a beautiful baby girl at home at almost 42 weeks. Baby was posterior, but she had a fast labor (an hour and a half!) and she jokes that the experience was "almost orgasmic"! That makes me smile! In the mainstream obstetric world, she would have been put through the system, probably induced, who knows what else. Her head would have most definitely been filled with seeds of doubt that her baby would be healthy, that she'd start labor all on her own. But as it was, with a knowledgable and caring midwife to care for her at home, she kept a positive attitude the whole time and it certainly paid off in the end!

Your Body is *Not* Broken

I found this blog post by Birthkeeper over at Midwifery Ramblings and wanted to share it. The post is a bit old, but the advice will never be so. I think this is so wonderful because I know so many women who have a "failed induction" and they feel like a failure....like their body doesn't work right. They may even sign up for a cesarean next time since they don't believe their body knows how to go into labor. Isn't it great to know that your body isn't broken? Your body is doing exactly what it is supposed to.....exactly the way God made it to work. I just love it!

"Christ Centered Childbirth" by Kelly Townsend

For anyone who is pregnant or might become pregnant in the future, I would like to recommend the book "Christ Centered Childbirth" by Kelly Townsend. I read this when I was pregnant with Alayna and found it not only informative, but it transformed my apprehensiveness into peace. It brought the focus back to God where it belongs. It helped me not "worry" so much and trust that God will take care of me and my baby. I saw this review of the book and thought it was so well said, I'd include it here. The author makes a reference to Romans 12:2, so I looked it up. The verse is familiar to me, but I'd never thought about it with birth in mind and I'd like to share it with you.

"Do not conform any longer to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God's will is - his good, pleasing and perfect will." Romans 12:2

What is the current "pattern of this world" in the birthing world? Go to an OB, do whatever they tell you to do, conform to their standards and protocols regardless of whether or not what they are advising is (a) true and (b) in the best interest of you and your baby. I would encourage all women to not be afraid to challenge their doctor....ask questions like "why are you advising me to be induced?" and "Am I healthy? Is my baby healthy? What is the reason for this intervention?" Also, pray for discernment that you will know when there really is a medical need and when your doctor is not thinking in your best interest.....c-section because the baby is "taking too long" or might be "too big", induction because you're two seconds passed your due date or the doctor isn't going to be on call this weekend. You can always ask "is this the only option....what are my alternatives and what are the risks/benefits to those alternatives?" Someone I know would always ask herself "what is the next best thing?" if what she wanted turned out not to be a possibility.

I honestly do believe that my mind has been renewed by everything I've learned about birth in the last 3 or so years. God wants us to draw close to Him and I think for many women (me included) he uses childbirth to reinitiate that relationship.

Depending on Christ through Childbirth ~Part 2~ To VBAC or Not to VBAC....That is the Question!

Now that you know the story of my firstborn, you can understand why was quite apprehensive to have another child. I always thought that I'd want my first two children two years apart, but as Gavin approached the age of 2, I knew I wasn't ready. I just needed some more time, though, because shortly after Gavin turned 3, Chad and I were ready to add the next member of our family. The big question for me this time was "Am I even going to try a vaginal birth or should I just have a repeat c-section?" I wouldn't even allow myself to consider a VBAC (vaginal birth after cesarean...pronounced V-back) until I had a doctor's appointment and got a green light. With all of the complications and additional surgeries after my cesarean, I wasn't even sure if I would be a good candidate. A friend recommended an OB who was known to be supportive of VBAC and I made an appointment and told him my story (the cliff notes version, lol!). I then asked him what he thought and he said, "well, I'll definitely need to see your medical records and surgery notes to make sure there aren't any surprises, but from what you've told me I don't see any reason why you couldn't have a trial of labor....BUT....you should only go that route if you *really* want to have that vaginal birth experience. I used to do VBACs all the time in the '90s, but times have changed and its become a lot more controversial....not because of safety concerns, its because of legal issues....really its complicated but you just need to know that not as many doctors allow VBACs any more so unless you *really* want it, I'd advise having a repeat c-section...of course (he chuckles) having a scheduled c-section would be much easier on me so of course that's what I'd recommend. You just think about it and we can talk about it next time." Looking back, I am so thankful for the honesty and integrity of this man. I have heard of so many women who have been lied to and told they couldn't or shouldn't VBAC for a number of reasons, many of which have turned out to be bogus. I personally know women who were told that their pelvis was just too small for that 9 lb 8 oz baby and then they go on to VBAC a 10+ lb baby. If you are not considering VBAC because you have been told this, please do some research and find out how baby's position actually has much more to do with how easily he comes out than does size.

I went home from that appointment with mixed feelings. On one hand, it would have made my decision-making much easier if he had told me it would be too dangerous for me to VBAC, with my previous scar issues and all. I remember how he pointed out that "that was your skin....not your uterus" when I expressed the concern that if I'd already ruptured once, doesn't that make me high risk for rupturing again. Scheduling a cesarean would make planning my mom's visit from Michigan much easier. Chad was definitely in favor of me having surgery "just because we know what to expect." However, there was this little part of me that knew if I didn't try.....if I didn't at least try a vaginal birth, I'd never know what it was like. Would I wonder if I could have had a positive experience and a quicker recovery? Later down the road, would I regret it if I don't at least give it a shot? So, after lots of thinking and praying and through tears, I decided I would try this VBAC thing.

My biggest fear was actually not uterine rupture (the major fear doctors have). My biggest fear for this birth was that of disappointment. Would I get all hyped up for a VBAC only to fail and end up with a repeat c-section? I decided that I was going to read everything I could get my hands on and do everything possible to avoid a c-section. I quickly learned that because of the fear of litigation, doctors will call a c-section much sooner on a VBAC mom than they might otherwise for a non-scarred mom. I was going to have to have a "textbook labor" (with not even a hint of complication) if I was going to be successful at avoiding the cesarean.

I went to my next OB appt. feeling great now that the weight of decision-making had been lifted. I informed him that I had made a decision (he smiled as he anticipated what he thought would be my decision to have RCS) and that I'd like to try the VBAC. As soon as the word left my lips, his smile vanished and he let out a sigh. I wondered where my VBAC-supportive doctor went, but he recovered, smiled again (although it was a much more forced smile) and said "Ok, no problem. We will just make sure we induce you early and.... (I interrupted him). "Um, why would I be induced?" "Well, we'll need to make sure I'm on call when you go into labor. If you go into labor during the week, I'll be there to deliver your baby. But if you go into labor on a weekend, I share call with 5 other doctors, so I'm only on call every 6th weekend. Some of the doctors would probably let you deliver vaginally if you presented in labor, but other doctors aren't so supportive of VBAC and might force you to have a cesarean." I was completely caught off guard. Not wanting to be disrespectful, I just told him I'd have to "think about it." I went home, did more research on the risks of being induced and went back to my next appointment with reasons why I wasn't so keen on being induced. "Doesn't it increase my risk of a uterine rupture?" I asked. "Well, technically yes," he said, "but it doesn't increase it that much...we're talking less than a percent difference". Side note: I just love how doctors pick and choose which risks to downplay and which risks to scare the living *** out of their patients.....sorry, had to go off about that a little bit.

So, since Dr. S pretty much gave me an ultimatum (be induced or else...) I decided that at 20 weeks (halfway through my pregnancy) I needed to find a new provider. Like I've already said, I do respect Dr. S for his integrity and I'm sure he's a great surgeon, but he wasn't the right provider for me if I wanted the best chance at a successful VBAC. My friend (who was feeling horrible by this time that she'd recommended someone who wasn't quite as VBAC friendly as we first thought) found a new doctor for me to try. Dr. K was known to be supportive not only of VBAC, but natural childbirth as well.

So that brings me to my introduction to natural childbirth. I always giggle when someone uses the term "natural childbirth" when they really mean "vaginal childbirth". Different people have different opinions of what actually constitutes a "natural childbirth" but for my definition, I'm going to define it as an approach to childbirth which believes that your body knows how to give birth and if mother and baby are healthy, it is wise to let labor start on its own (no induction of labor), continue on its own (no augmentation) and generally requires little medical intervention. We who believe this are thankful for the life-saving technology that exists, but don't think the majority of healthy women really need it. Also, most women opt to not take pain medication as it has been known to slow down labor and in many cases leads to other interventions that wouldn't be necessary if the pain medication had not been given.

I need to add at this point that my reasons for deciding to go drug-free with Alayna were vastly different than they were with Cade. With Alayna (being my first VBAC) my only reason was to assure a successful VBAC. I know an epidural doesn't slow every labor down, but I would have been so disappointed with myself if it affected mine and I could have prevented a c-section. Once I had my first VBAC (and I survived it!) I realized all of the added benefits. Alayna was so alert....I'd never seen anything like it. I know this will sound unbelievable, but she practically crawled (scooted really) from my belly (where they placed her right after birth) up to my breasts, looking to nurse. She looked like a baby bird with her mouth open looking to latch. It was a 180 degree difference from all the suckling problems I had with Gavin. I also couldn't believe how incredibly good I felt immediately after birth....not the drugged haze I was in after my c-section. Granted, the amount of drugs given for a c-section is huge compared to what is given for a vaginal birth in an epidural, but for me, not feeling drugged was worth it. And then there's that rush of endorphines that flooded my body at the moment of birth that filled me with love and tears of joy....the best feeling I've ever had.....I'm so glad my body was fully alert to experience that. You can read all the details of Alayna's birth in my family blog.

Almost two years after Alayna's birth, I had my third child, another boy whom we named Cade, my second natural VBAC. The only difference this time was that I'd decided that midwives are much better than doctors at attending a natural delivery (doctors are great when there are problems, but midwives are the experts at natural childbirth!) and so I signed on with a practice of midwives instead of finding an OB. Cade's birth was a bit more traumatic (you can read the details by clicking on the link) and I had a rougher post-partum period, but I had an awesome labor.....one that I'll remember and cherish always.