32 Weeks Pregnant: Birth Prep Class

January 26 – February 1: 32 Weeks 0 Days – 32 Weeks 6 Days.

This week, Richard and I are starting to feel like we need to have everything ready to go for the baby’s arrival. I have a couple friends who’ve given birth six weeks before their due dates, and I think I subconsciously set 34 weeks as the time to have everything ready.

I finally bought the crib mattress. It’s a foam core mattress that is so light I can lift it effortlessly, which made me feel good about myself in the store. It was so exciting to get the crib all set up! It made it feel more real for Richard too, and on his suggestion we order several starter items for the nursery (wipes, diapers, butt cream, etc.)

Crib ready to go!

Woodland-themed everything ready to go for when baby arrives! Thank you Mindy for the mobile, Dad for the sheets, and Hope for the clothes.

The biggest milestone of the week was finishing our childbirth preparation class. Early on, a friend recommended I take a third-party birth prep class instead of the one the hospital offered to get less biased education. She also suggested a class that spanned several weeks instead of one packed all into one day so we would have time to digest the information and identify questions. Upon the suggestion of my doula, Richard and I chose to do Rachel Yellin’s 4-day childbirth preparation class, which focuses on the use of relaxation and hypnosis techniques during childbirth. Rachel’s class is definitely geared toward women hoping or an unmedicated birth, but more than that, it’s focused on empowered, conscious birth—on teaching couples about their options so they can make informed choices.

My doula told me that Rachel’s class was experiential rather than just providing a bunch of information about birth, and this was definitely true of the first and last days of the course. We tried out several birthing techniques that involved breathing, relaxation, visualization, affirmation, and intimacy (I wont go into specifics and give away her trade secrets). I’d already read several books about childbirth, so doing a birth prep class that focused more on practice and experience than information and facts appealed to me. Her homework assignments involved bonding time between partners, listening to her hypnosis and relaxation audio program, and checking out other resources she provided. I’d previously been listening to the audio tracks from the Hypnobabies self-study course, and something about Rachel’s tracks was more soothing and relaxing for me. I think it’s partly because her dialog moves along more quickly (without feeling rushed), which makes it easier to follow when I’m feeling restless (That said, I love some of the Hypnobabies techniques and tracks, and hope to incorporate them during my birthing time). Richard enjoys Rachel’s tracks too. After falling asleep to the Relaxation and Affirmations for the Birth Partner track, he says he “inexplicably” wakes up in the morning feeling more affectionate toward me and wanting to help me out and support me in any way he can.

The middle two days were more informational. My favorite part of these days was hearing birth stories from Rachel’s years working as a doula. We also went over many of the interventions the hospital could do, the rationale behind their protocols, what the evidence had to say about these protocols, and what our options were. To some, it may seem overly cautious to question hospital’s protocols, but historically medicalized childbirth doesn’t have the best track record. It is well known that for many years doctors routinely performed episiotomies (cutting into the perineum to make the vaginal opening larger) because there was a theory that this would reduce tearing and other complications. Then they actually did some research and found out that in most cases episiotomies don’t prevent anything and often lead to a challenging recovery.

I’d read about the big ticket items like labor induction techniques and pain medication before, but I’d never thought about whether I’d want to automatically be fitted with an IV upon arrival at the hospital (instead of waiting to see if I’d actually need it) or if I should go along with routine hourly vaginal exams (which arguably aren’t that informative and increase risk of infection every time). Rachel also talked about the interventions hospitals do with babies. Finding out that I could opt out of these procedures was less interesting to me than hearing Rachel’s suggestions for making these procedures gentler and more comfortable for the baby (e.g. have hospital staff calibrate the scale with a blanket and cap so the baby doesn’t have to lie on a cold, hard, paper-covered plastic. Or, hold a warm washcloth over the baby’s foot before the PKU test to improve blood flow enough that the nurse doesn’t have to turn the baby’s heel into a pin cushion trying to get a blood sample).

Before taking this course, I certain things as completely out-of-my-control when there’s actually a chance some of them aren’t. For example, hospitals test for Group B Step (GBS) around 36 weeks (a strain of bacteria that’s benign in the mother, but may be harmful to the baby), and the hospital tells you that you either have it or you don’t, and you can’t do anything about it. It’s true that there isn’t definitive, hard evidence that you can do anything about GBS besides taking the antibiotics they’ll recommend during labor; however, there are other things you can try, like taking probiotics or eating yogurt.

Similarly, if the baby is spending a lot of time head-up in utero (not promising for vaginal birth in the hospital), there are some easy, harmless techniques you can attempt yourself to encourage the baby to turn head down before the hospital recommends medical interventions to try to flip the baby in the last month (like walking up stairs). As it turns out, I would have to put up a fuss at the hospital to officially find out which direction my baby is facing before 36 weeks, so I’ve chosen to pick my battles and wait. I often feel kicking under my ribs and hiccups in my lower belly, so I’m fairly certain the baby spends at least a chunk of her time head down.

Earlier in pregnancy, after reading through the manual for the Hypnobabies Self-Study course (reviewed here), I felt like if I didn’t have the ideal birth situation—with the baby head-down, facing my back, and a pitocin-free labor—I could no longer expect the techniques to be successful. The Hypnobabies affirmations are specific and concrete, relating mostly to that one ideal type of birth. I didn’t get this sense with Rachel’s course. Her affirmations are more vague and focus mostly on intuitively cultivating a healthy, powerful, relaxed internal state, regardless of what type of physical birth occurs. Although it was clear which choices Rachel would make if she were giving birth (which, of course, meant the information was a little biased), I didn’t feel obligated or even expected to agree with her. She seemed genuinely interested in giving parents-to-be the resources to make their own decisions for their bodies and babies.

22 Weeks Pregnant: Pregnancy Book Reviews

November 17 – November 23: 22 Weeks 0 Days – 22 Weeks 6 Days.

Bu(m)pdate for this rainy week:

22 Weeks Bump

22 weeks, 5 days. (Maternity clothes courtesy of my H&M shopping spree a couple weeks ago)

I’ve officially burnt out of reading books about pregnancy and childbirth, and am now moving on to reading about newborn care. Here’s what I thought of the books I read:

Natural Hospital Birth: The Best of Both Worlds by Cynthia Gabriel

Natural Hospital BirthThis was my favorite book I read about childbirth because it’s well-written, non-repetitive, and focuses on exactly the type of birth I’m planning to have. I did my research and have chosen to give birth in a hospital, so it’s tiresome to read books and articles about natural birth that push me to do it at home; home birth is a great option with several benefits, but it’s not the option I chose. Natural Hospital Birth clearly and concisely lays out birth options, and offers written exercises to help the reader make good guesses about what they’ll want during labor and childbirth. (Several weeks ago, I blogged about some realizations I had while reading this book). After reading this book I felt much better educated about my choices and I felt prepared to navigate having as natural a birth as possible in a hospital setting.

Ina May’s Guide to Childbirth by Ina May Gaskin

Ina May's Guide to ChildbirthI read this book years before I got pregnant for my prenantal yoga teacher training. The first half is full of empowering natural birth stories, and the second half is a detailed explanation of labor and birth, and evidence-based information about what helps and what hurts (different birth positions, medications, interventions). Before reading this book, I didn’t really get why anyone would go through the ordeal of having a natural birth. After reading it, I concluded that my baby and I would have the best chances at a good outcome having as natural a birth as possible (leaving room for medically necessary interventions, of course).

However, the book has such a strong agenda toward promoting natural home birth, that I felt some interventions are presented in a overly negative light. For example, after reading the chapter “What You Least Expect When You’re Expecting,” I felt scared of pitocin (a drug that stimulates labor) because of the potential side effects, but that fear is not going to serve me if pitocin ends up being medically necessary for me.

Also, in the years since this book was written many hospitals have shifted away from the dismal scene Ina May presents: a fluorescent-lit room where you’re strapped down on your back, denied food and drink, and cut open (via C-section of episiotomy) so the doctor can yank the baby out of you. At my hospital (Saint Luke’s in San Francisco) the labor and delivery rooms are dimly lit, you’re allowed to give birth in any position (they provide a squatting bar, birthing ball, and birthing chair), they let you eat and drink (unless you’re getting an epidural or C-section), they don’t do routine episiotomies, and they recommend hiring a doula. Despite these qualms, overall this book is amazing. I’m planning to reread the birth stories a my baby’s birth nears.

Having Faith by Sandra Steingraber

Having FaithThis book incorporates elements of memoir and informational non-fiction. This format makes it slower to read and harder to reference if you’re looking for a specific piece of information, but I enjoyed it anyway. The book is a detailed discussion about how what we eat, drink, breathe, and touch can affect babies’ development during pregnancy and breastfeeding. With my dry background in science, the author’s vibrant, metaphor-rich descriptions of embryonic development were refreshing. I found the detailed information about various environmental teratogens (substances that can cause birth defects) fascinating. This book inspired me to take the risk of heavy metals more seriously—lead and mercury can be devastating for a baby’s brain development. One caveat: Many of the harmful conditions that can affect the baby’s development can’t be changed easily or immediately, so some of the take-aways may be a little depressing (unless you have time to become an environmental activist, elicit a change in governmental regulations, and wait for the benefits to take effect before you get pregnant).

Other resources I used:

The Business of Being Born Documentary

The Business of Being BornIf you’re okay with shaking your trust in the medical system, watch this documentary. The track record of medical interventions in normal births over last 100+ years has been kind of horrifying (for an example, read up on Twilight Sleep). It will also give you a window into the types of things you’ll read about in much more detail in Ina May’s Guide to Childbirth. Side benefit: Rikki Lake is the interviewer, which is a fun blast from the past.

Hypnobabies® Home Study Course

This was recommended to me by a few different friends, and there are several things I enjoy about it:

  • The track of joyful pregnancy affirmations (psychological factors have a huge effect on how women experience pain during labor, so positivity throughout pregnancy is key).
  • Positive rewording. In Hypnobabies, “labor” is called “my birthing time” so it doesn’t sound as hard), “contractions” are called “pressure waves” (which sounds more positive and productive), and the “due date” is called the “guess date” (so the baby isn’t considered “late” if it’s born after that). I’m all for anything that makes my perception of pregnancy and childbirth positive.
  • The recorded self-hypnosis sessions. Due to issues with my hypermobile joints, I haven’t been able to practice much yoga during pregnancy (so poses, anyway), so these tracks have been like my meditation. They are each 30 minutes long, which drives me crazy on fidgety days, but practicing everyday has helped me refine my ability to completely relax. Some of the tracks include visualizations that helped me connect with my baby before she starting kicking and feeling real.

The overall course is pretty time-consuming. If you do everything the manual says, you’ll spend over an hour a day on it for six weeks (and, of course, the course author says that if you don’t do everything they tell you to it wont work for you). I started my course early, and am going through it much slower than recommended.

Beyond the instructions on self-hypnosis, I’m not a fan of the content in the manual for the course. The dialog in the manual also seems to implicitly blame the mother if the Hypnobabies techniques don’t work for her (i.e. it must have been because the mother wasn’t dedicated enough in her preparation). It’s also got pretty single-track education about childbirth, which made me feel like if my birth went any differently than that one ideal way, all the techniques I’d learned would no longer apply. I want to feel positive, prepared, and accepting no matter what happens.

There were some nuggets of wonderful information in the manual, so it was worth reading for me. However, despite what the author writes (that Hypnobabies should be your only childbirth education course lest the other courses sully your positivity), I would recommend that you read more than only the Hypnobabies® manual to prepare for childbirth. Maybe doing just that will water down the effectiveness of the techniques for me, but that’s okay—I’m not attached to having a brand name childbirth.

BabyCenter My Pregnancy Today App

This is a fun app to have to keep track of what week I’m in, what the baby is up to, how I can alleviate discomforts, and how I can prepare for what’s to come. BabyCenter’s write-ups compare the baby to a fruit or vegetable every week, which is cute (but can also be confusing: A carrot? Like how big of a carrot?). I mostly enjoy checking this app, but sometimes I feel like it can be an overload of information that isn’t easily verified. For example, this article about herbal tea during pregnancy made me worry about drinking herbal infusions my doctors said were fine (like chamomile tea). The article has no citations so it would take a ton of independent research to assess the quality of all the information. After doing some half-hearted research on my own, I decided to stop stressing about it and drink my favorite herbal teas in moderation.

What Richard read:

The Birth Partner by Penny Simkin

The Birth Partner A friend who had a baby about a year ago recommended this book. I can’t give much of a review on it, because I didn’t read it, Richard did. From my perspective, reading the book made Richard feel more comfortable and confident about supporting me during childbirth. Some days he’d come home after reading his book on the bus and ask if I needed him to make me a snack or anything. He’d explain that the book had reminded him to take care of me in any way that I needed it. It’s a tough read though. Even though Richard is a fast reader, it took him a while to get through. He also didn’t like reading the sections about complications—I felt the same way in all the books I read—but if any of that stuff does end up happening, at least we’ll be informed about what’s going on.

The Missing Pieces:

What To Expect When You're ExpectingBetween my prenatal yoga teacher training, the reading material the hospital gave me, and a human growth and development course I took during university, I had solid understanding about how babies develop and the discomforts I would face during pregnancy, however none of books listed above covers these topics in depth. Also, all of the books I read went over the medical aspects of childbirth in some way, but none covered the medical aspects of pregnancy. I didn’t have a book that explained what to expect at my first prenatal appointment, what my prenatal screening options were, or when I would be getting ultrasounds. A midwife I know recommended against reading the mainstream bible on pregnancy, What to Expect When You’re Expecting, because it apparently uses language that’s disempowering to women and pathologizes pregnancy and childbirth. Even so, since I’m going the hospital route, I think it would have been nice to read an overview book like this early on so I knew, for example, that the transvaginal ultrasound was coming in my first prenatal visit (I didn’t even know that thing existed!).

Next in my queue:

Baby 411 by Ari Brown and Denise Fields. (I’ve already started this, and it is slow going).

The Baby Book by the entire Sears family, I think. (I’ve tasked Richard with reading this one)

15 Weeks Pregnant: Beginning to Plan for Birth

September 29 – October 5 : 15 Weeks 0 Days – 15 Weeks 6 Days.

Up until this week, I haven’t had the wherewithal to think much about my birth preferences. When I was going through the first trimester, I remember having thoughts like, This is baby had better stick, because I could absolutely not start this process again from scratch, and, We’re going to have to adopt our second child, because I can’t do this again. My nausea has faded so slowly that I didn’t even notice my days getting easier, but I’m not having thoughts like that any more so I must be feeling significantly better. The only times I seem to get nauseous now are when I get hungry and when I overexert, so as long as I adequately snack and laze, I’m golden. Now I can see why people like being pregnant so much.

In the first trimester, I did enough investigation to figure out I wanted to get prenatal care and give birth at a hospital with a low-intervention philosophy, and settled on Saint Luke’s. I also knew I wanted to try for a natural birth. But that was about it. This week I started to explore my options for birth.

Doula or Do not (la)?

My doula friend, Heather Charmatz, has been incredibly helpful in giving me advice and recommending books during my pregnancy, so I was already feeling good about doulas. I want to give birth with as few medical interventions as possible. Hiring a doula increases a woman’s chances of doing so, both via the doula assisting with non-medical comfort measures and advocating for the mother in an intimidating medical setting. I reached out to friends on Facebook asking for thoughts on birth with or without a doula. There was unanimous consent among both the mamas that had had a doula (or doulas) and the ones that hadn’t: definitely hire a doula.

I searched online for suggestions for questions to ask doulas, and made a shortlist of the ones that were most important to me:

  1. What is your training? Are you certified?
  2. Can you tell me about your experience as a doula? Do you have any stories you can share?
  3. Can you give me a snapshot of the care you provide before, during, and after birth?
  4. Do you have experience attending births at my hospital? Do you get along with the staff there?
  5. How will my husband be involved?
  6. How do you feel about the use of pain medication and other interventions?
  7. What is your fee? What does it cover?
  8. If you don’t attend the birth do you have a refund policy?
  9. Do you have anyone else due near the time I’m due?
  10. Do you offer any other special services? (e.g. massage, photography, aromatherapy?)
  11. Do you have references we could talk to?

So far, Richard and I went to a Meet Local Doulas night at Saint Luke’s (the San Francisco Doula Group does a few of these around the city every month) and we also interviewed Heather and her doula partner, Joy. The Meet Local Doulas night helped us establish expectations about a doula’s scope of practice, how much they cost in the Bay Area, and what their packages typically include. We didn’t see ourselves working with any of the doulas at the Meet Local Doulas night, but Heather and Joy were great! Instead of making an automatic decision between a good choice and a bad choice (well, not bad—just not a the right fit for us), I wanted to be able to make a thought-out decision between two good choices. Based on some online research and recommendations from friends and other doulas, Richard and I have one more doula interview lined up in a couple weeks. Then we’ll make our final choice!

How Do I Know My Birth Preferences with No Previous Experience?

Heather lent me a great book called Natural Hospital Birth by Cynthia Gabriel. Even though I’m only halfway through, I’d recommend it to anyone planning a hospital birth. The book outlines some exercises that get the reader to think back to experiences planning big ritual events (like a wedding) and participating in endurance events (like a marathon), which helped me make some concrete decisions about what I want for my birth.

My number one advice for people planning a wedding is, “Get a wedding planner!” That’s what I would have done differently. I enjoyed and took pride in planning my own wedding with the help of friends and family, but on the big day, rather than relishing in the experience of being the bride I felt like I was also playing the wedding planner. As my lips parted from my new husband’s after our first kiss, one of my hands lovingly caressed the back of his neck, while the other discretely gestured to music person to start playing our exit song. When I give birth, I want to have my birth plan written up with plan A’s, B’s, C’s, and have someone else there to coordinate and orchestrate, so I can just focus on bringing my baby into the world. This is where I see a doula fitting in. Richard could be play this role too, but as much as it’s my day to experience becoming a mother, it’s his day to experience becoming a father. Also, when discussing doulas, Richard brought up a past experiences to illustrate his apprehension about supporting me through pain.

When Richard and I were vacation to Cabo San Lucas. I got stung by a horrid little jellyfish—I think it was a Portuguese man o’ war. In excruciating pain, I insisted that Richard try to suck the venom out with his mouth. In a much more rational state than me, he refused repeatedly. I was horrified to see the blue venom under my skin slowly being absorbed into my body. After enough relentless and desperate pleading, Richard caved and tried to suck the venom out. In less than a second, his whole mouth was in stinging pain from contact with the venom. Whoops. Needless to say, Richard fully supports having a third party present at all times to protect him from the ill-advised demands of a laboring wife.

Second to the man o’ war, my next most painful experience was running a marathon, for which I was sorely under-trained. My running shoes went missing the morning of the race, and I was running in an old pair that were half a size too small and slowly turning my toe nails purple. The funny, encouraging signs people held or posted along the course were wonderful, because they gave me enough of a mental distraction to let my willpower recharge slightly. However, in the last six miles, I just could not run any more and slowed down to a walk. My outer hip muscles immediately went into a spasm that wouldn’t let up unless I started running again. I was determined to finish, and I realized that whether walking or running I was going to be in pain, so laboriously, clumsily, and dejectedly, I started running again. Shortly thereafter I came to an aid station that had more than the standard water, Gatorade, and gel packs—they had RealFruit gummy candies. People emotionally eat for a reason—it works! In the short term anyway, and the short term was all I needed. That handful of corn syrup and gelatin that I savored over the next mile was all that kept me from collapsing into a pile of tears on the side of the road and calling a cab. After I ran across the finish line, I grabbed some more RealFruit gummies and continued jogging over to the massage tent to get that spasm worked out of my glutes. My take-away: I’m going to want some little treats and joys for the most challenging parts of labor to give me the emotional boost to keep going. No need for a massage as a reward at the end though, the baby will be enough!

Should I Dwell in Distraction or Awareness?

Upon the recommendation of many friends, I bought the Hypnobabies Home Study course, and have been enjoying it. The hypnosis recordings I’ve listened to have included visualizations that have helped me connect with the baby—something that’s been hard for me since I can’t yet feel the baby moving and don’t have much of a bump. The course also includes a 30 minute track of positive pregnancy affirmations, which is so up my alley. I mentioned to the doulas I interviewed that I was thinking of using hypnosis techniques, and they advised that some women like hypnosis because it distracts them from the experience of giving birth, some women don’t because they want to be completely present to the experience.

This may be committing yoga blasphemy, but I think that distraction may work by better for me than complete presence and awareness in this case. When I was at the height of my nausea, although it was hard to drag myself out of the house to teach yoga, teaching made me feel better because I was focusing on others’ bodies rather than dwelling on the discomfort of my own. After I got stung by the jellyfish in Cabo San Lucas, Richard and I somehow made it back to our hotel room where he read a book to me. It distracted me enough from the pain that I could sleep the afternoon away until the pain had softened. On my marathon, the only things that kept me going were the yummy and humorous ones that distracted me from the sensation of running. Using distraction can still be meditative—just as we may use the breath as a drishti (focal point) for our meditation, we may similarly use any of these other distractions as a drishti.

I teach yoga and meditation to people who suffer from chronic pain, and one of the most important techniques we master is to halt the pain-tension-pain cycle. When we feel pain, we automatically tense up. That increased tension creates more pain, which causes us to tense up even more, and the cycle continues. If, at that first sensation of pain we can soften instead of hardening, we stay at that base level of pain instead of initiating an ever-escalating cycle. I think little distractions like inspiring or funny affirmations, hypnotic visualizations, or gummy worms will help me do just that.

How Attached Should I Get to My Birth Plan?

Most people have told me not to get too attached to my birth plan because birth is unpredictable, and if it doesn’t go my way I’ll feel like a failure. Natural Hospital Birth gives some alternative advice that I loved. Get attached to your birth plan, the author encourages. Just as with any other goal, the clearer, more insistent, and more determined you are about it, the more likely it is to happen. “Don’t get attached to your birth plan,” is essentially saying that it’s better to never try at all than to try and fail. That’s no way to live! The book acknowledges that the risk in becoming attached to your birth plan is that you may feel disappointment if your birth doesn’t happen exactly the way you wrote it down. The author’s response is a little punch of tough love: disappointment is a part of life. Anyone who is used to setting the types of lofty goals that are worth achieving knows that some of them don’t pan out. That’s disappointing, and feeling disappointment is okay. It doesn’t mean we’re failures, it doesn’t mean we stop setting goals, it’s just a part of the process and of life. Besides, as long as nobody’s stopping by postpartum to rub the discrepancies between my birth plan and what actually happened in my face, certainly any disappointment will be overshadowed by the immense joy of holding a happy, healthy baby in my arms.