Choosing Waterbirth: Reclaiming the Sacred Power of Birth (6 page)

Of these three stages, the first, the dilation stage, is the longest and the one women often experience as the most painful part of labor. Once you realize what is happening within your body, this makes sense, as that much squeezing of such a large muscle is bound to produce some pain. Learning to recognize this pain as a natural byproduct of your contracting uterus, instead of viewing it as an indication of something wrong, will help you to approach your birth more positively. The dilation stage of labor is also divided into three parts—prelabor, early labor, and active labor.

Prelabor can last for days, even weeks. This is the preliminary contracting of the uterus that exercises and prepares it for the work ahead. Prelabor also does the beginning work of early labor, softening and thinning the cervix so that it is ready, once true labor starts, to begin opening. Prelabor can be exhausting and frustrating.

The closer your due date, the

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more precontractions you will have. Sometimes these contractions become so strong and so regular that you think you already are in labor. At that point only a midwife or doctor can tell for sure by checking your cervix. Of course this is not always failsafe. The day before I had my fourth baby, the midwife said she thought it would be another week. Only your baby knows for sure what day it wants to be born.

When you get a series of these contractions, it is a good idea to rest. Go to your quiet space and lie on your left side. When a contraction comes, try to experience it without judging. Feel the sensation of the tightening and focus on relaxing all of your muscles and on breathing slowly and deeply through it. You will find this very restful as well as being good practice for the birthing. After a while, if it is only prelabor, your body should slow down and the contractions should stop. If they don't, don't worry about it; just get up and go about your day, doing whatever you need to and rest whenever you need to.

Prelabor moves gradually into early labor. Sometimes the difference is not easily detected. You may or may not notice the change. When mine switched over to true labor, I noticed that I began having what felt like a cramp in the lower half of my stomach as an accompaniment to the contractions. Before I had my third baby, I had this cramp off and on all day. I didn't know I was in labor because, on checking me that morning, the midwife said that nothing was happening, but that my condition could move into labor at some point. All day long, the cramp came and went. Late that night when I couldn't sleep, the midwife checked me again and found I was definitely in labor and already six centimeters dilated. So, it is not always easy to know when it is true labor and when it is only ''practice."

True labor differs from prelabor in that the contractions you feel are now beginning the job of birthing your baby. Every contraction you get in true labor helps to soften and open you up so that the baby can come through.

In order to understand this process better, it might help to think of your uterus as a large blownup balloon made up of Page 36

very strong, flexible muscle fibers. Pearshaped, it narrows down to a long neck that is your cervix. Tightly closed at the end is the cervical opening that leads to the birth canal.

During each contraction of true labor the muscles at the top of your uterus tighten up, bunching together, causing the muscles along the sides of your uterus to be drawn up, shortening or "thinning" the long neck of the cervix. This process is called "effacing."

Imagining your balloon again, if you were to squeeze the top of the balloon together, it would push the air inside down, making the neck of the balloon shorter. If you continued squeezing, the long neck would eventually disappear and the pressure from the air inside the balloon, along with the shortening sides, would then cause the end to begin opening. This is what your uterus does during the first part of birth. Each contraction squeezes the top of your uterus, making the cervix thinner, or

"effacing," and finally begin opening or "dilating." A fully dilated cervix will be ten centimeters, approximately four inches, across, or about the same size around as a Planters twentyounce peanut container.

It is usually during the dilation stage that the amniotic sac breaks, although this is not always the case. Sometimes it breaks before labor begins, and sometimes it doesn't break until after the baby's head is born. It is common practice in a medical birth to have the amniotic sac broken by the practitioner sometime during the dilation stage. In a natural birth, they usually let nature take its course unless there is a compelling reason to break the sac, such as labor slowing down, because breaking the sac can stimulate contractions.

In the very early stages of true labor there is still no need to do anything special. Hang out around your house, get things set up, take a walk, rest, watch a movie, do the dishes, do whatever you feel like doing to pass the time. The first part is a lot of waiting without the need to be focused on the birthing.

Active labor begins once you are between four and six centimeters dilated. Once it kicks in, you will know it. The energy Page 37

of your labor will shift and the contractions will become stronger and more regular. Once my active labor started, I began pacing, walking back and forth, breathing deeply during the contractions, focusing on relaxing and opening. The tub would be filling and I could hear this, and soon all I wanted was to get into the water. I knew instinctively that it would help me to feel better.

When my cervix was dilated to six or seven centimeters, I would get in the water. Getting in any earlier seemed to relax me so much that my labor would slow down.

For the next few hours when the contractions grew intense, I labored in the water. Squatting, breathing, focusing on opening, relaxing.

The third part of the dilation phase of labor is called transition. Widely considered the most difficult time of birth, "transition" refers to the relatively short period of time that it takes for your uterus to dilate the last two or three centimeters. Characterized by contractions that are very painful, close together, and longer than they had been, it is during transition that you are most likely to feel that you can't do it. These contractions can feel like you are riding a wave and it's all you can do just to keep your head above the water. Expect to feel overwhelmed at this stage. As your cervix opens up to the full ten centimeters, your body and mind are opening up to allow this new soul to enter the world. I believe that is why the last stage is so intense: it is a surrendering and opening.

During these contractions, it is helpful to breathe very deeply and fully and to make sounds. Opening your mouth and just expelling a sustained "Ahhhh" during the contractions can help to keep you from tightening up your perineum. "Ooomm" is also good, though it takes a little more thought. Whatever sound you make, let it be an opening and expanding sound and one that works with the birthing energy, instead of fighting against it. By the time you have reached transition, your labor is almost over. It is important to try to remember this, as it can help you to get through this intense period.

Once you have made it through transition and your uterus is fully dilated, the energy of the birthing shifts again, marking Page 38

the beginning of the pushing stage. Now, at the peak of each contraction, you will feel the urge to push. The first evidence of this shift is the tightening of the muscles at the back of the throat as you close off your windpipe and bear down. It is common to make a grunting sound or a tight holding sound followed by a release. Many women feel a very distinctive change in their contractions and in their mental state once this stage begins. Differing from dilation contractions, pushing contractions are longer in duration and usually farther apart. Many women find them less painful and, after the helpless feeling that often accompanies transition, they often welcome this more active phase where they can actively participate in the birth of their baby.

During the pushing stage, both the uterus and the mother work hard in conjunction to push the baby through the cervix into the birth canal, down between the pelvic bones and to the opening of the vagina where the baby's head first appears or "crowns." The length of time it takes for the baby's head to crown varies but is typically shorter if you are having a waterbirth and typically longer if you had an epidural. The average pushing stage for a waterbirth is 25 minutes; the average for a woman who has had an epidural is 60 to 90 minutes. It is just as the head crowns that an episiotomy, a cut in the wall of the perineum to prevent tearing, is usually given. In a waterbirth, as the warm water has helped to soften the perineum tissue making it more pliable and able to stretch, episiotomies are rarely needed.

In most cases, a baby's head is presenting and comes out first. As you push the baby out, you will feel a lot of pressure as the head moves down and a burning, searing pain as your perineum stretches. Stay focused and breathe. At this point it is almost over and the baby will be here at last. Birthing the baby's head is the most intense part as the rest of the baby is smaller and more pliable. Once the head comes out, if you are having a waterbirth, you can reach down and feel it, welcoming your baby. I always loved this part, being able to have the first contact with my baby even before it was fully born.

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Once the head is born, the baby turns slightly to allow each shoulder to come out, one after the other. While this happens, do not push too hard, instead breathe fast and light and allow the baby's shoulders to come out one at a time. This will reduce the risk of the perineum tearing, the risk of which is already considerably reduced by your being in the water. If you are having a conventional hospital birth, the doctors will probably have already given you an episiotomy.

Once the shoulders have been born, the rest of the baby will slide out easily.

If you are birthing in water, once born, the baby must be brought up out of the water either by yourself or the attendant. There are some people who like to let the baby stay under water for a while after the birth, but I never had the patience for that. After nine months of waiting, I wanted to see and hold my baby.

If you are birthing in the hospital and do not want your baby to be taken from you immediately after birth, be sure to let them know beforehand that that is what you want. In most cases they will allow you to keep the baby with you on your bare skin for the first moments after birth. They will at some point want to take the baby away to clean and weigh it, but try to preserve as much time with your infant after the birth as you can. There is no need to weigh the baby immediately; it will weigh the same an hour after birth as it does at birth. And the baby doesn't care if it is clean; all it wants is the closeness and security of its mother.

If you are waterbirthing, your baby is already washed clean of blood and is weightless, and you can remain in the tub for as long as you like.

A short while after your baby is born, you will feel the urge to push again. This signals that you are ready to deliver the placenta, which may be birthed directly into the water, or into a bowl while you remain standing in the water, or you may get out of the tub altogether to deliver the placenta. During the births of my first four children, I got out of the tub to deliver the placenta. After my fifth baby was born, I delivered the Page 40

placenta into a bowl while I remained standing in the tub. This was a nice change as I was then able to sit back down in the water and play with my baby.

Sometime during your delivery, the umbilical cord will be cut. Attached to the placenta at one end and the baby at the other, the umbilical cord acted to bring nourishment to, and to remove wastes from, the baby while
in utero
. In a medical birth, the cord is cut almost immediately after the baby is born. In a natural birth, it is generally not cut until after the cord has stopped pulsing, signaling that the nutrient rich maternal blood is no longer flowing to the baby.

This completes the birth process. After this, you will be cleaned up and settled wherever you wish in order to rest and to begin the lifelong process of motherhood.

The final thing to learn about birth is that there are many things you can do to make your experience of birth less painful and more rewarding. Some of them are learned, such as the breathing and relaxation techniques taught in prenatal yoga and other childbirth education classes. Others are instinctual, which require your recognizing and respecting them, such as honoring the urge to walk or squat or sway during contractions. Other aids are topical, such as warm pools of water, hot showers, massage, and counter pressure to your lower back, which help to directly ease the pain and remind you to relax. Others, still, are environmental like having an appropriate place to give birth where you feel safe and secure, with family and close friends around you for support.

Each of these can contribute to easing the pain you may feel during your labor, offering you a solid support system should you choose to give birth naturally. This moves us into the next stage of planning for your birth: The Preparation.

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PART II—

THE PREPARATION

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Chapter 10—

Yoga for Pregnancy

During your birth your resources are going to be tapped out, much as if you were running a long marathon. Everything you know and everything you are will be utilized to see you through this challenging experience. However you decide to meet this challenge, at home or in the hospital, with pain reduction from drugs or from water labor and delivery, you are going to benefit from having learned a few techniques to see you through. In the same way you would train for a marathon, you can train for your birth.

Prenatal yoga, by teaching you to be aware of your body, and how to breathe effectively, and how to consciously relax, is one way for you to train for your birth. The poses themselves, by gently strengthening and stretching the muscles most commonly used during birth (those of the abdomen and pelvic region), prepare your body for the stress of the birth. The relaxation effect produced is used both during the pregnancy to keep exhaustion at bay and during the birth for rejuvenation. The breathing techniques show you how to use your breath as a focal point during labor to produce a calming effect, or as a powerful energizer to keep your strength up.