Our Bodies, Ourselves (85 page)

While preparing is important, labor itself is unpredictable. You can't know in advance what you will experience or what you will want or need. Your labor may be easier or more complicated than you imagine. You might plan to give birth without medication and then find yourself needing greater relief, or you might plan on having an epidural but then find you don't need one.

I was determined to have a total “medical buffet” during my delivery. I'd start with Nubain and then move to an epidural and be blissfully pain free. However, when I arrived at the hospital, my OB told me that it was too late for any medical intervention and it was time to push. In fact, I had been lucky not to have had him in the car on the way. I had to throw my “imagined delivery” out of the window and have this baby. I labored for sixty-four minutes in the hospital, and he was born. I was swearing like a sailor and yelled at everyone within a two-foot radius, including my husband. (I swore at my OB so atrociously that when I returned to the same hospital three years later for baby number two, the nurses remembered me.) At one point my OB nonchalantly said, “If you focused that energy on pushing instead of yelling at us, you'd have a baby by now.” I got all huffed up at her and my husband, and then my son crowned. She smiled and said, “I told you.” It was the most powerful moment of my life; I delivered him, cut the cord, and held him in my arms . . . all before breakfast
.

Because it is often challenging to make specific decisions about pain relief before labor, and because all pain-relieving medications can have adverse effects, it is generally best to approach normal labor with the idea of using no-risk or very-low-risk strategies first and then proceeding to the next higher level of intervention if needed. It's also helpful to rest as much as possible during early labor and conserve your energy, as exhaustion can diminish your capacity to tolerate pain and thus increase the need for pain medication. The “Pain Medications
Preference Scale”
can help you clarify
your feelings about pain and pain management during labor.

Your choice of birth setting and provider can affect your options for pain management; for more information, see
“Choosing a Provider,”
and
“Birth Places.”
For more information on specific coping strategies and pain relief methods, see “
Coping with Pain
.”

Learning about our options for coping with labor and working with a knowledgeable support team can help us feel less anxious as we anticipate labor and birth. We can arrive at informed decisions about the approaches we prefer, recognizing that we may need to make changes based on how our labor unfolds.

I was scared of the pain. I wanted to avoid interventions if possible, but I also wanted my limits to be respected. I wanted to see a midwife because I believed that her philosophy of birth, practical techniques, and continuous support would help me have the kind of birth I wanted. But I needed to know that if my labor was really hard or lasting forever, or if I was totally exhausted, she would support me in getting an epidural
.

The first midwife I interviewed when I was pregnant didn't seem to hear my fears; she just said that women's bodies were designed to give birth and that my body would do so also. The second midwife, the one I chose, was more reassuring: she said she knew lots of nondrug techniques to help me cope and manage with the pain but that she was committed to helping me have a good birth, whatever that meant to me. She said that there were times when epidurals were extremely helpful. In the end, I didn't have an epidural, but knowing that it was an option—and knowing that my midwife wouldn't see me as a failure if I had one—may have been part of what helped me avoid one!

Breast milk is the best food for babies; it provides all the nutrients your baby needs to grow, as well as antibodies that protect against infection. Nursing also provides numerous health benefits to you. Whether you are undecided about breastfeeding or committed to it, take time to talk with midwives, childbirth educators, and other mothers and to read available books during your pregnancy. Having good support and plans in place before you give birth can help smooth the way. (To read more about breastfeeding, including how to get off to a good start, see
“Breastfeeding Your Baby.”
)

The transition to motherhood can be challenging, both physically and emotionally. Learning as much as you can and listening to other women's stories will give you information and inspiration to face the challenges of pregnancy and childbirth with greater confidence.

A woman planning a home birth said:

My mother gave birth to me at home. Her mother had given birth to five children and had considered her labors her finest, strongest moments. I know I can give birth and it is hard work, but I trust my body. At night I sit still, close my eyes, breathe deeply, and picture myself opening up. . . . My birth will be unique
.

CHAPTER 16
Labor and Birth

W
omen's experiences with labor and birth vary widely from woman to woman, from one phase of labor to another, and from one labor to the next. Your labor will be unique, influenced by many factors: the size, position, and health of your baby; your health and medical history; your expectations and feelings; the people who support and attend to you; and the place in which you labor and give birth.

But despite the variations, there is a common theme: the natural flow of labor. This process involves interplay between you and your baby. During your pregnancy, your body has held and protected your baby. Now, under the influence of hormones that you and your baby release, your body will soften, open, and yield to allow the baby to pass through. Labor contrac
tions,
your body movements, and your pushing efforts will guide the baby down while the baby flexes, stretches, and rotates to navigate the birth canal. The birth process progresses from the softening (ripening) and opening (dilation) of your cervix to your baby's descent and birth to the delivery of the placenta.

Giving birth was life-changing for me and for many of the women I have attended as a midwife. In a world in which we may often feel ineffective and pessimistic, working through labor under our own power can transform our sense of self. We experience ourselves as strong, sturdy, resilient, and able. We tap on inner strengths we may never have tapped before and are amazed by what we are able to accomplish. Once we become aware of how powerful we can be in giving birth, we can call on this throughout our lives, in all sorts of situations
.

A woman who gave birth in a hospital birthing center says:

The day before she was born, I'd done everything: cooked, mopped, even put up a new mailbox in the bitter cold weather outside. At three a.m. my waters broke. We didn't sleep much after that. We had an already scheduled appointment with Lucy at ten. Since I was only 1 centimeter dilated, she said, “Go on home.” . . . Off we went, and all of a sudden, there I was in hard labor, doubled over. Back we drove to the hospital birth center. No one was expecting us; the place was empty
.