How and where to learn neonatal resuscitation

I've received some inquiries about how to gain neonatal resuscitation skills, especially for non-health professionals. If there's one kind of preparation I'd recommend for all pregnant women, it's learning the basics of neonatal resuscitation. Just like we all (should!) know how to perform infant resuscitation or adult CPR or the Heimlich maneuver, we should know the basics of neonatal resuscitation. Because--as Inga's birth story illustrates--you never know when you're going to need it.

Most likely your baby will be born healthy and will breathe on its own. Most likely you'll make it to the hospital or birth center on time, or your midwife will arrive before the birth. Most likely your baby won't be born in the car, or in the subway, or on your bathroom floor when you were planning otherwise.

But...what if the birth doesn't happen as planned? That's where having some neonatal resuscitation training can be a lifesaver.

So how and where can you learn these skills? If you can afford it, take a Neonatal Resuscitation Program (NRP) workshop. Before the course, you study the textbook and take an online exam. Then you come to the workshop--typically one full day--for hands-on instruction with life-size dolls and medical equipment. Since maternity care providers are required to stay current with their NR skills, the workshops are fairly easy to find. One problem a lay person might encounter is being able to register for the course; some are limited to health care professionals only.

In the States, the Neonatal Resuscitation Program is sponsored through the AAP; click here to locate a course or instructor. Canada's NRP program is sponsored by the Canadian Pediatric Society; click here to locate courses. Many instructors do not list their courses online, so also make inquiries through your local hospitals, birth centers, or home birth midwives. 

I highly recommend Karen Strange's Newborn Breath workshop. She travels all over the States teaching NRP from an out-of-hospital perspective. You'll learn everything you need to know to pass the exam and become certified, but you'll also learn these things with the assumption that you'll be in a home or birth center setting, that you won't be cutting or clamping the cord, that you'll be resuscitating on or near the mother, etc. Karen Strange is a quirky, fun instructor and keeps the class very lively. If you want her to come to your area, you can sponsor a workshop. Her workshop costs $220, plus the textbook (~$38 used/$55 new) and online exam fee ($23.50).

What if there is no NRP class in your area, or if you can't afford one? Hook up with local midwives and learn the skills from them. Buy or ILL textbooks and study as much as you can. At a bare minimum, learn how and when to perform mouth-to-mouth and chest compressions on a newborn--before your third trimester. Still, nothing can substitute for up-to-date, hands-on training, which is why I strongly suggest taking a NRP workshop.

My NRP baby...now in pigtails!

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Thoughts on birth plans

Desiree of Hitting My Stride recently asked about birth plans--should she write one? If so, what to put in it? Is it too presumptuous to plan for an event that includes a lot of unknowns and uncontrollable factors? (She has two rare blood clotting factors that make hospital birth a necessity and induction fairly likely if the baby doesn't come by 38-40 weeks.)

I was thinking about what I'd say in response, and my first thought was: let's back up a bit first. Before even thinking of writing a birth plan, or list of birth preferences, or whatever else you want to call it, you need to know what is routine practice at your specific hospital. The last thing you want to do is write up a birth plan full of things that are totally irrelevant at your hospital. That will make the staff laugh or roll their eyes or label you as a control freak.

So first off, before you even think of writing up a birth plan, head to your hospital and talk specifics with the L&D nurses. For example, if you really want immediate, uninterrupted skin-to-skin contact after the birth, ask the nurses how likely it is to happen. What about skin-to-skin after a cesarean? If the mom or baby needs additional attention after the birth? If something is not routine practice, ask them what you need to say or do to make it happen. Go through all of the things that really matter to you. Ask the nurses which things won't be an issue and which you'll need to clearly communicate ahead of time.

Some things will need advance planning, such as wireless and/or waterproof telemetry. Some hospitals have telemetry, while others do not. If you know you'll be having constant monitoring (for example, for an induction) but want to have more freedom of movement, ask about wireless monitoring now, while you're still pregnant. If they don't have it, insist they order it! Ask to speak to the person who is in charge of ordering equipment and see what you can do to ensure they have the proper equipment in time for your birth. Or let's say you want to have access to nitrous oxide (aka gas & air or laughing gas) or TENS units for pain relief. These are both rare in the United States, although quite common in other countries such as Great Britain. You'd definitely need to inquire about them in advance.

My next advice--which Desiree seems to have down already--is don't worry about including any of the little things that you shouldn't even be asking permission for. The don't ask, just do kind of things. Eating and drinking if you're hungry, moving and changing positions, music, lighting, unhooking yourself from the monitors to move/go to the bathroom/etc (especially if, like most women, you have no specific reason to be on constant monitoring). Just do these things and don't take any flak from the nursing staff. Make sure your birth partner knows about these things and can buffer you from the nursing staff if you deviate from their policies or routines.

A third suggestion would be having two separate plans: one for the hospital staff with your most important preferences, and a longer, more detailed one for your partner, husband, or support person. Write down all of the things you want your support person to remember for you, so you don't have to remind them when you're in the middle of labor. Things like keeping the room lighting low, keeping you hydrated, helping you into different positions, asking you if you've had enough time to make X or Y decision, reminding both you and the staff of your preferences.

Now let's get back to the birth plan for hospital staff. Once you've eliminated all of the things that are irrelevant to your specific hospital and/or provider, write down the most important things in the briefest possible way. Keep it short and easy to read. Use lots of bulleted points, rather than long, wordy sentences. Don't go into any long-winded preambles. When I say short, I mean short. If you can make it fit onto an index card, all the better. Here's an example of how to communicate your pain relief preferences:

Pain relief:
~ Do not offer or suggest pain medications. If I want something, I will ask.
~ Do not ask me to rate my level of pain; please make up a number if required for your charting.
~ Please offer or assist with non-pharmaceutical comfort measures (showers, warm baths, birth balls, movement, changing positions, etc).

Instead of going into detail over every separate procedure, think of writing a general directive to ensure you are giving full informed consent. Something like this:

Please ask for my permission before every procedure, examination, medication, or intervention (including vaginal exams, AROM, episiotomy, routine infant procedures, etc).  If it is not an emergency situation, ask if I have had enough time to consider my options and review the alternatives before consenting to the procedure. 

When you arrive at the hospital, you can request a nurse who has experience with unmedicated labors (if, like Desiree, this is important to you). Have your birth partner talk to the admitting nurse and say something like "She really wants to labor without pain medications and labor and push in upright positions. Could you assign us a nurse who would be excited to help make this happen?" They might be too overstaffed to meet your request, but they might also be able to arrange nursing assignments to give you a nurse who loves working with unmedicated moms. This doesn't mean you are locked into having a "natural birth," just that you'll have more support for your initial desire to labor without pain medications.

My final thought is that planning for birth is like preparing proactively for breastfeeding. There are the individual choices you make and have control over during pregnancy, such as provider or place of birth. There are the institutional protocols and provider preferences that will influence what happens to you during labor and birth. And then there are the unpredictable, uncontrollable events that may throw you a curveball during labor. Birth plans are primarily for the second category of events--navigating institutional routines and employee protocols that may or may not be what you want, and may or not be beneficial for your or your baby.

Birth plans also help ensure that you remain more in control over your individual, personal choices. Because if you really want an unmedicated birth, but the hospital staff and routines all push you towards having an epidural, you're going to have a hard time accomplishing your goal. Or if you want lots of uninterrupted skin-to-skin contact, but the hospital routinely takes babies to the warmer and only returns them after examining, weighing, bathing and swaddling, you'll probably find your arms empty after the birth. The birth plan itself does not ensure that your wishes will be followed. But it is a starting point for communicating what is most important to you. 

Labor and birth have unpredictable, uncontrollable elements. We cannot make these magically disappear simply by waving a birth plan around. But a lot of what happens to women during labor doesn't occur because of Mother Nature, but rather because of hospital routines, employee protocols, liability protection, and providers' preferences and training. This is where planning and preparation can make a difference.

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Why does birth matter?

This is one response to my earlier post Thinking, No Conclusions Yet, from Jenny Parratt's PhD research about how birth affects a woman's embodied self. 

~~~~~

I found this post and all the comments very interesting. I'm a mother and a midwife and I feel passionate that the actual birth experience does matter. I have spent the past 9 years researching women's experiences for my PhD with Professor Kathleen Fahy (at Newcastle Uni in Australia). My focus has been on how women's embodied self changes during childbearing. The 14 stories I collected for the research give a very detailed picture of women's experience before during and after birth. I've recently published them (called Feelings of change: Stories of having a baby). I don't give any commentary with the stories because they are pretty long the way they are, but I plan another book that shows my findings.

Briefly, here are some of the findings from my PhD (cited below). My findings indicate that any woman can experience an improved sense of embodied self as a result of childbearing generally and childbirth more specifically. Embodied self change that is most empowering occurs when a woman uses her own power during labour and birth. This process of change is facilitated by a sense of self-trust and by being inwardly centred. A woman’s improved embodied self is then manifested by an increased awareness of and capacity to use her inner strength. This has the consequence that a woman who experiences a sense of improved embodied self feels more confident in dealing with other challenging life circumstances. I therefore conclude that when a woman uses her own power during labour and birth she is most likely to feel an improved sense of embodied self during childbearing.

Parratt, J. (2009) Feeling like a genius: enhancing women’s changing embodied self during first childbearing. PhD Thesis. School of Nursing and Midwifery. The University of Newcastle, NSW, Australia
Parratt, J. (2009). Feelings of Change: Stories of having a baby. Raleigh: Lulu.com.

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Thinking, no conclusions yet

I like reading things that make me think, hard. That make me examine my assumptions and evaluate what I'm doing and why. Things like one day in a life by Sweet & Salty Kate. I have a lot of complex responses to her post.

I fall somewhere inbetween the "you can't plan or control anything; birth is just one day and mothering the baby afterwards is the most important thing" camp and the "your birth is the most important event in shaping your life as a mother" camp. I think it's because birth itself is so complex and multi-faceted. There's the unpredictable, wild, ferocious nature of birth--sometimes generous, sometimes harsh and unforgiving--that we can never adequately plan or prepare for. That's where Kate, and many of her fabulous commenters, are coming from.

But there's also the reality that certain choices generally--not always, but often--lead to certain consequences. If you choose an elective induction at 38 weeks with a closed cervix...chances are you'll end up with a highly interventive labor and a c-section because of the failed induction. If you seek care with a midwife or physician who has a low cesarean and intervention rate...chances are you'll have a smooth, uncomplicated, spontaneous labor and birth. If you seek care with a busy OB practice with an assembly-line approach to pregnancy and birth...chances are you'll be sent down that assembly line too.

But in all of those cases, there will always be exceptions and surprises. And there's where it can be so hard to make any kind of generalization about birth. Because there are women who have elective inductions at 38 weeks with a closed cervix and their baby pops out after a quick labor. Because some women will have highly complex, complicated births even when they're planning for it to be as natural as possible. Because some women are extremely satisfied with their assembly-line care and rave about how fantastic their OB was. So whenever you try to say anything definitive about birth, someone will always pop up with an exception.

In Jan Tritten's case, the sentence that prompted Sweet & Salty Kate's post was poorly worded. I understand, though, why she might have said something like this. After all, her life's work surrounds birth. She's a midwife and editor of Midwifery Today. In her world, birth is highly significant, often the pivotal event in a woman's life.

I was wondering: how would I say that my children's birth ranks in importance in my life? It's hard to quantify. My own journey wasn't just about "the birth," but the entire process of thinking and researching and planning--not just for the tangible, physical birth itself, but also for the spiritual process of becoming a mother. I deeply treasure the memories of my children's births. I love that my labors were experiences predominantly of love, peace, and calm. I love that I was able to meet and overcome the challenges of labor and birth and find strength in other areas of my life, knowing that if I could give birth to a baby I could certainly do ___ (run a half marathon, finish my dissertation, etc).

Making a woman's birth as positive and empowering and enriching as possible is important. Why not strive to make every birth as good as it can be? Why make anything unnecessarily difficult or painful or traumatic? But of course giving birth isn't the one definitive moment for all women, even though for some women it is. If you speak to the women at Solace for Mothers, you'll learn how a traumatic birth experience can haunt someone for years. If you were at the International Breech Conference, you heard women still deeply affected by their birth experiences, years after the fact.

So how do we reconcile the complex natures of birth--the parts that you can't plan for, and the parts that you can?

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Top birth and breastfeeding books

I recently received a request from a blog reader for books on birth and breastfeeding. She's trying to narrow her list down to just a few and wanted to know which ones I'd recommend. She is 24 weeks pregnant with her first baby and is planning to give birth in a freestanding birth center. Her husband is a 3rd year medical student and is on board with her birth plans.

I am trying to think what my super short list of must-reads would be for a woman in her situation. Let's see...

Birth:

• Ina May's Guide to Childbirth: I like it for its inspirational stories that make me go, "yes, I can do this!" and for its information on the birth process.
• Sarah J. Buckley's Gentle Birth, Gentle Mothering (recently released in an updated, North American edition). I love the chapters that review the science & the hormones of labor, birth, and breastfeeding.
• Peggy Vincent's memoir Baby Catcher. This gave me an understanding of what birth really looks, sounds, and feels like. Hilarious, gripping, great read. And because reading only advice books gets a bit dull when you're getting ready to have a baby.

Breastfeeding:

• Jack Newman's The Ultimate Breastfeeding Book of Answers (or another comprehensive, problem-solving book), plus make use of his fantastic website, especially the videos about good and bad latches.
• The Food of Love: The Easier Way to Breastfeed Your Baby by Kate Evans. Hilarious cartoons and drawings, full of great information, will help keep you sane and smiling in those early postpartum days of leaking milk and torpedo breasts and floppy, milk-drunk newborns.
• Breastfeeding with Comfort and Joy by Laura Keegan. Perfect for showing breastfeeding in a visual, lyrical style. Read my review here and Feminist Childbirth Study's here.

I might recommend different books for a woman planning a hospital birth, but I think this is a good start for someone going to a birth center.

I'd like to hear your suggestions if you had to list your favorite birth and breastfeeding books. Which would be better for women planning hospital births? For women using birth centers or having home births?

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"Straight out of a horror movie"??

Judit's post about two births in the headlines illustrates the value of a little knowledge and preparation when it comes to giving birth, no matter where you are planning to have the baby. It also shows how perception and expectation can color an experience entirely differently. Thanks Judit!

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BRAINED (aka Fun With Acronyms)

Pregnancy, birth, and parenting are filled with decisions: some vitally important, some trivial, some heartwrenching, and some enjoyable. When I was working as a doula, I would often show my clients the following acronyms for making decisions about their pregnancy and birth care. I believe that women are smart enough to make their own decisions. There is no need for coercion, manipulation, guilt trips, threats (subtle or otherwise), or appeals to authority (including mine!). They should research their options from a variety of sources and then carefully weigh their options.

BRAINED
Trying to make a decision? Get BRAINED!
Ask yourself, and your caregivers, these questions:

Benefits - How could the recommended course of action help me or my baby?
Risks - How could the recommended course of action harm me or my baby?
Alternatives - Are there any other courses of action I could consider?
Intuition - What are my gut feelings about this?
Nothing - What happens if I do nothing?
Evaluate - Can you give me some time to consider my choices? Then...
Decide - Now that I have the information I need, I'm ready to make a decision.

BRAINS

Benefits- How will this procedure benefit me and my baby?
Risks - What are the risks to me and my baby?
Alternatives - What are some other things we might try instead?
Instinct/Intuition - What is your gut telling you?
Now/Never/Nothing - What if we don't do the procedure right now? What if we never do it? What if we do nothing?
Safety/Satisfaction - Will this procedure increase the safety and satisfaction of the birth for me and my baby?

To give credit where it's due: the BRAINED acronym comes from a handout that someone gave me from "Lucina Birth Services." The BRAINS acronym was passed around on a doula list serve.

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Labor and marathons

Disclaimer: In case anyone feels inclined to post a huffy comment about how childbirth and marathon running are NOT the same in every respect, please read this. Of course they are not identical. Of course the analogy breaks down at a certain point. I think the biggest difference between birth and marathons is that birth is something within every woman's capability, while marathon running is admittedly an extreme endurance sport.

I’ve often wondered why we don’t approach pregnancy, labor, and birth like we do marathon running. Pregnant women encounter so much negativity and fear: your baby might be too big or too small. You might develop toxemia. You are gaining too much or too little weight. You might hemorrhage and die. Your pelvis might be too small. Your baby’s head might become trapped. Your baby might go into distress. You probably won’t be able to handle the pain so you should consider an epidural. You don’t get a medal for having an unmedicated birth. All that matters is a healthy baby anyway.

What if we were as pessimistic about marathon running as we are about childbirth? Here’s my imagined scenario for a hopeful marathon runner, Ann:

Ann was in reasonably good shape and could run several miles, although at a fairly slow pace. She ran cross-country in high school and enjoyed it, even though she was usually one of the last to finish. She was inspired by several friends who had recently run marathons and decided she’d prepare for one.

Ann started researching how to run a successful marathon. She wanted to find training schedules, nutritional requirements for runners, and advice on good running shoes. She went to her local public library, which had a shelf of books that focused on the risks of marathons. Most discussed in great detail the various injuries common to marathon runners and only included short segments about success stories. They warned that although marathons can be empowering, most people cannot successfully train for or complete them. The books also emphasized the tremendous amount of pain that marathon runners experience. Ann knew that certain injuries were possible and although she appreciated the information, she preferred to have more information about how to prevent the injuries in the first place through proper training, stretching, and nutrition. She also wanted to read books that motivated her and assumed success rather than failure.

She knew that there must be more useful information out there, so she pulled up a chair to the library’s computer. She waded through pages of results, but she finally stumbled upon a small but vocal community of marathon runners who had successfully completed the race and who raved about the experience. Their stories were generally ones of triumph, confidence, and exhilaration. They talked about the hours of mental and physical preparation, the extensive research they did into ensuring they were in top physical condition, and the ways to prevent common injuries such as shin splints or knee problems. They supported each other when a runner didn’t reach her desired time, or when physical problems forced her to drop out of the race. They cheered each other on as race day grew nearer.

Ann posted her training schedule around the house so she would see it every day. She decided to maintain a positive outlook, knowing that top athletes considered mental preparation as important as their physical training. She dedicated time every day to meditation and visualization. She imagined what it would feel like to line up, waiting for the gun to signal the beginning of the race. She visualized her heart beating strongly, her blood supplying oxygen to her muscles, her breath even and steady. She repeated positive affirmations to herself, such as “It will be exciting and hard at times but I know I can do it.”

A few weeks later, Ann’s training was going well. She had missed a few days, but usually accomplished her daily goals. While the running itself was sometimes tedious and uncomfortable, she loved how she felt afterwards. Ann mentioned to a friend that she was training for a marathon and was surprised when her friend told several horror stories of marathon runners who suffered lifelong injuries—even one about a runner who drank so much water that he died during the race. Ann replied that she had carefully researched both common and rare injuries and that she was sure that she could either prevent them, treat them herself, or seek help if something serious arose. Her friend said, “But how can you be sure? You might die of a heart attack while you are running—you’d have no way to know it’s going to happen until it is too late. It’s just not worth the risk.”

Ann’s family thought she was crazy. Shouldn’t she be doing something more useful with her time? What if something went wrong? What if during the race she is in too much pain and can’t finish—then how would she feel? Anne told her family that she had done her research and that it was an important goal. She asked that they either speak positively about her upcoming race, or that they refrain from saying anything at all.

Ann noticed that the media always focused on the sensational stories of marathon running turned ugly. When TV crews covered races, they showed runners limping along, looking like death warmed over. They usually interviewed runners who had to drop out, giving them several minutes to tell their stories. Then, almost as an afterthought, they would give 30 seconds to a successful runner who looked exhilarated, if a bit tired and sweaty. Of course, after that runner was done speaking, the TV host would remind the audience that most people cannot complete marathons and that it was best not to get your hopes up. Good grief, Ann thought. I know plenty of people who have completed the race without dying or breaking a leg or permanently injuring themselves.

Somehow—maybe it was when she ordered a few pairs of her favorite running shoes—marathon support companies got hold of Ann’s address. Almost every day her mailbox had a new glossy ad for “pain-free, effortless marathons.” One company’s slogan was: We do all the work—you just come along for the ridetm. Inside the brochure, Ann learned that:

Marathons are a lot of work. The pain is excruciating. The risks of running so many miles are numerous. Why suffer when you can do it the Pain-Fretm way? For only 12 monthly installments of $199 each, you can finish your marathon in comfort and style in our patented Pain-Fre(tm) motorized vehicle. Our chauffeur will personally pick you up as soon as you feel too much pain. Once you are settled in your EZE-Ridetm seat, you will enjoy the view in comfort and luxury as you are driven to the finish line. You will receive a complimentary photo of you crossing the finish line on foot. Beverages not included. Runners will be assessed a $10/mile fee for any miles they run themselves. The fee is waived if you take the EZE-Ridetm in the first 5 miles. Due to liability concerns, rides are not available the first 4 miles or after mile 23.

Ann stacked these fliers beside her fireplace. After her long runs on Saturday, she’d run a hot bath, start a fire, and toss the fliers into the flames, watching the edges curl and twist. She imagined all of her fears melting away with those glossy advertisements.

Ann’s training continued. She enjoyed her changing body—seeing her leg muscles become more toned, noticing the articulations of each muscle group. Preparing for the race also gave Ann a heightened appreciation for good, nutritious food. Her body craved proteins, fresh fruits and vegetables, and complex carbohydrates. She ate sweets every once in a while but no longer enjoyed them.

Several months into her training, Ann heard of a disturbing new trend in marathon running: elective bone breaking or EBB. She knew that stress fractures were a common injury among runners, not to mention the rare but drastic broken bones from accidental falls. Apparently some people were advocating a new “preventive treatment,” which consisted of wearing bone fracture monitors while running. The monitors were touted for being able to predict bone fractures. Using information from the monitors, surgeons could then carefully finish breaking the bone (to ensure a clean, even break) and repair it in a controlled setting. The monitors were quite heavy and occasionally caused runners to fall and suffer extensive injuries. However, they were the hot new thing in running, touted as “every runner’s safety net.” One surgeon promoted the new technology as making the leg bones “better than new.” Has the world gone mad? Ann wondered. Why anyone would choose to have their bones broken before a serious problem even developed was beyond her. Fliers started arriving in her mailbox describing EBB. Ann had to smile when one company named itself EBB—Even Better Bones.

As race day grew near, Ann experienced a mixture of confidence and trepidation. She knew she had prepared thoroughly for the race, but she had never run 26 miles before. She decided that if something “went wrong” during the race and kept her from finishing, she would accept it calmly, knowing that she had done everything to ensure success. She continued her daily visualizations, imagining how empowering it would be to finish. The race would end in a beautiful river valley. Ann often swam in the river and knew that the cool water would feel incredible after the race. She kept this image in her mind: lying on her back floating in the clear water, her body suspended between water and sky.

On race day, Ann was surprised how crowded it was around the registration tents. There were almost as many marathon support companies as there were runners. She talked to a seasoned runner who warned her that it was just as bad even when the running began. Motorcyclists would drive alongside runners, asking them how much pain they were in, if they would like to drop out. Bystanders would hold signs saying “It’s never too late to give up.” “Drop out or drop dead.” “You don’t get a medal for finishing.”

One of Ann’s running partners, who had finished her first marathon a year ago, handed Ann a package while they were standing in line to register. It was a t-shirt with the slogan Drug-Free Zone. “You’ll need it,” her friend said, “especially around mile 22 where the race’s sponsors are handing out morphine pills. They know better to stay away from people with these shirts on, otherwise they’ll get an earful and the occasional well-aimed punch.” Ann grinned.

While she stretched, she turned inward, visualizing the stages of the race and repeating her affirmations. I can do it. I am strong. I am ready.

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Reuters article on Freebirthing

This just came out today via Reuters: "Freebirthers dismiss fear and bring babies home."

I like the quote the article ended with, from Mary Siever:

I can't claim to know why they feel this way, but my belief is that the majority of them -- doctors and health authorities -- truly do not think women are intellectually capable of making their own decisions when it comes to birth.

I dedicated nearly 4 years of my life to researching and preparing for my birth. This was not a decision made out of selfishness, ignorance, or irresponsibility. I wish that more women would put as much effort into preparing to give birth. The knowledge I have gained over those four years has had a transformative effect on the way I view the world and how I make decisions.

Giving birth unassisted is not for everyone. But learning about it, and every other birth option, is. More women need to ask "Why do we do the things we do at birth? How can we make it better? Are the practices in my country, or state, or hospital, really necessary? What is the true physiology of birth? How can we facilitate, rather than hinder, the process?"

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What's in your "emergency" birth kit?

list updated April 10...

Tomorrow night I am giving a short presentation about emergency birth kits, as part of our church women's meeting about emergency preparedness. I will be displaying my birth kit and explaining what the items are for. I'll probably be giving a longer presentation about emergency birth preparedness in the next few months.

Here is a list of items in my kit:

• 3 Emergen-C packets
• energy bar
  
• bottle of water
• bendy straw
• 4 Chux pads
• 4 packs sterile gauze pads (useful for misc. cleanup/wiping)
  
• umbilical cord clamp
• sterile razor or scalpel blade
  
• 2 pairs non sterile latex gloves (for handling the placenta, etc)
• receiving blanket
• old hand towel for drying baby/mom off
• 1 pair cotton underwear for mom (preferably a dark color)
• 4-6 sanitary pads
• 2 newborn diapers
  
• anti-hemorrhagic tincture (Wombstringe or Hem-Halt)
• emergency birth manual
• gallon-sized Ziploc: for the placenta
• quart-sized Ziploc: for misc items
• large trash bag

All inside a gallon ziploc bag.

Any other items I've overlooked?

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Some reflections

A week ago I gave birth to my daughter, a glorious culmination of years of research and preparation. Here are some reflections on the labor and birth:

1. Nearly everything I had specifically visualized about the birth came to pass. I was careful not to put time restrictions on my birth affirmations. For example, I would say to myself, “my birth will go smoothly and at just the right pace” rather than “my labor will last 5 hours.” Here are some of the affirmations and visualizations I used. I didn’t ever write them down or say them out loud; I would just let them play through in my mind:

- My body will go into labor when the baby is ready.
- The baby will get into the perfect position for birth: head down, chin tucked into her chest, her back facing my stomach, and the umbilical cord tucked safely out of the way.
- I will move my body to help the labor progress smoothly and to help the baby get into the best position.
- I will feel joy, anticipation, and excitement as my labor begins.
- My husband will be exactly what I need him to be during labor. He will be calm and collected, and be able to watch me labor without feeling fearful or anxious.
- I will embrace every sensation of labor, without judging them. I will also let go of the sensations once they are finished.
- I will take one contraction at a time, and will remember that “I can do anything for one minute!”
- My cervix will thin and open at just the right pace.
- I will enjoy the rest periods in between contractions.
- I will ease the baby’s head out with my hand as it emerges.
- I will give birth to my baby kneeling down, cradling her head and body with my hands as they emerge.
- After the baby’s head is born, her head will rotate and her shoulders will slip out easily with the next contraction.
- My uterus will clamp down quickly and firmly after the birth.
- My placenta will release cleanly and all in one piece. After the placenta is out, my uterus will continue to clamp down.

2. I hate to give my birth experience a label, because it’s not just one of many ways to give birth. It is THE true standard of normal. There were no outside influences to disrupt or derail the physiological process. Just pure, raw, spontaneous, instinctive birth. This is a tricky thing to say without slipping into Mommy War mode: My birth was better than yours. Nah nah nah boo boo. The kind of birth a woman has is sometimes beyond her control, so I do not mean to say that a person is any less or more of a woman if she birthed unassisted, or via cesarean, or with an epidural. This is not about personal judgments. However, a spontaneous, autonomous birth is an unparalleled experience and should serve as the standard against which we judge and measure all other births. How can we know if a birth practice is healthy or harmful unless we know what birth REALLY looks like, stripped of all interference?

3. Giving birth seems like a dream. If there weren’t a beautiful little girl nestled on my chest (okay, and a sore bottom too), I would almost think it never happened. I wonder if the endorphins I felt played a role in making the memory hazy and distant. I have had a few times where I remembered the birth physically, in my body, almost as if I were reliving the sensations. Once I felt the endorphin-induced buzz. Another time I relived the sensations of pushing. What makes these windows of clarity appear?

4. While preparing to birth unassisted was definitely a difficult path, birthing the way I did was the easiest possible way. There was nothing any person or institution could have done to make it better or easier or more satisfying. I am willing to do the hard work of preparation and planning. I am NOT willing to make the labor unnecessarily difficult!

5. A perfect birth does not occur by accident. It is something you work for. I poured almost four years of my life into preparing for this birth. I have the luxury of being a PhD student in American Studies, which means I could choose my course of study. I focused on...big surprise...childbirth, and my dissertation is about unassisted birth. I have read hundreds of birth-related books, journal articles and birth stories; trained as a doula; apprenticed as a midwife; attended many home and a few hospital births; read tens of thousands of entries on various internet birth groups. I educated myself about variations of normal. I examined the assumptions I held about birth and found that many of them needed changing.

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Preparing for Labor

A woman on one of my internet birth groups recently posted these thoughts about how she prepared for labor:

When we decided to have a homebirth with a midwife, I (being an intellectual) bought as many books as I could, went to my childbirth class very early, read the corresponding book to the class, went to homebirth meetups, watched every video I could, including the ones on TV with hospital births. I wanted every possible tool in my bag for when the time came, uncertain which method would ultimately prove beneficial once in labor.

The last video I watched was at my childbirth class. It was, yet again, another South American video. I was disappointed with this after so many videos, because I couldn't understand what was being said in labor. I knew everything I felt I needed to know about the actual birth by then, but I wanted to know more about a natural LABOR at that point.

Well, as was typical in the Latin videos, the woman had her family there with her, both in and out of the tub, and she QUIETLY gave birth to her baby while her children watched her normal, natural birth. Then suddenly the video switched to an American home birth in a blow-up pool in the family's living room. The woman moaned and cried and wailed and had that typical wild-eyed, American labor look of "Who Is Going to Rescue Me Now????"

The stark contrast was what helped me know that every tool in my bag was completely unnecessary and useless. I was looking to trust everything but my baby and my body. I threw away my bag of birthing tricks. I understood then that we Americans are heavily convinced that birth is super difficult and have been indoctrinated into the mindset of we weak women need to be saved by the knight in shining armor. I was NOT going to be that. I believed thoroughly in the natural process of birth. I believed that my body was made to give birth. And, most importantly, I believed that just as my baby and body knew when it was time for my body to labor, my baby knew how to be born.

I was very quiet during the three days I was in labor. My midwife did not even come over until late the third morning. By then I was finally in active labor. I was quiet throughout the entire day until transition. After an hour of transition, during the last 30 minutes of transition I began to ask if I could really do this. My husband and my midwife's apprentice talked to me after every contraction and reminded me that I could and to stick with just one contraction at a time. (The transition contractions were the worst for me, because I thought I would throw up. What they didn't know was that I would rather have contractions any ole day than be forced to vomit. Just a personal preference thing.)

All at once I felt a wave start from my head and flow through my body and out of my vagina, and my body pushed with it. It did it again on the next contraction, and I felt the ring of fire. I jumped up out of the bed and headed for the tub. My midwife reminded me that I didn't have to have a waterbirth just because that was what I had planned, but I didn't even listen for a second. I KNEW the water was where I needed to be.

The water eased the contractions remarkably. My friend, husband, midwife, and midwife's apprentice were all in the bathroom talking to each other while I was in the tub with my head at one end and my feet touching the other end. Absolutely NO ONE knew I was pushing (actually not even I knew). I asked for a rag that I instinctively held with my hand between my legs.

Suddenly I felt a "pop" and asked my midwife what it was. She turned around and looked down at me and said, "Oh! The head is out!!" She insisted that I pull my legs up then (my knees were still together when the head was pushed out), and Ania was born a few seconds after.

My point is that I turned into myself. I listened to my body. Found the position that worked for my body. Walked when my body knew I needed to walk.

It was the closest I've ever been to God. The world went quiet and faded away. I was in touch only with each breath of each second of each contraction. Two months of third trimester discomfort and swearing I would never ever never have a baby again had me wanting another almost immediately because of the childbirth.

Was it painful? Yes, in all honesty it was painful during that 1-1/2 of transition. Was it my mindset that got me through it? Absolutely. I welcomed the pain, knew it was natural, knew it was not permanent, knew labor pains would not be listed as the cause of my death. I just fell into labor, didn't fight it, didn't question it, didn't question the process. I trusted birth. THAT is the only real tool you need.

Posted with permission from M. Morrow.

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Birth supplies

Here are some supplies I have gathered in preparation for the birth. To be completely honest, I don't really "need" most of them. I think the most important birth supply is lots & lots of towels.

Towels
Chux pads (rectangular absorbent pads, aka incontinence pads or puppy training pads)
Placenta Out tincture (for bleeding before placenta releases)
HemHalt & Wombstringe tinctures (for post-placenta bleeding)
Afterease Tincture (for relieving afterbirth pains)
Herbal afterbirth bath: great for healing tears & sore bottoms
Placenta bowl (aka a large, shallow stainless steel mixing bowl)
Emergen-C (a powder you add to water, to make a fizzy, energizing drink)
Bendy straws
Various massage tools
Microwaveable rice packs
Electric heating pad (for keeping towels warm)

Things I have but will probably never use:
Plastic cord clamps (I plan on tying off the cord with shoelaces or braided embroidery floss--much more comfortable for the baby)
Bulb syringe
Nonsterile latex gloves (mostly for when I am at someone else's birth and examining the placenta)
Sterile 4x4 gauze pads

I plan to put all of my birth supplies in a basket that I can grab and bring anywhere in the house. I will layer the supplies with things I will need first towards the top, and afterbirth/baby items towards the bottom.

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