Choose Wisely: How to Select a Care Provider

Choosing the right care provider is critical to having your best birth.  This week we are so excited to feature writer Meagan Church who discusses the importance of aligning your birth ideals with your care provider.

Shortly after I discovered I was pregnant with my first, I met with my family doctor. He had stopped doing obstetric care a few months prior, so I knew he wouldn’t be my care provider for my pregnancy. Even still, I felt compelled to meet with him. I believe that meeting shaped my journey to finding the right provider for me and set the course for a more desirable birth experience.

During the visit, I asked if he had any recommendations for a care provider. Since my husband and I wanted to wait to share the pregnancy news until after the first trimester, I couldn’t turn to family or friends for advice. My doctor simply asked, “What kind of provider do you want?” I hesitated for a moment, not knowing how to respond. Basically I wanted someone who would be covered by my insurance. What else was there to know? He then said he sometimes recommended a certain OB/GYN, but I should first consider that he takes a very patriarchal approach. Then he asked if I’d ever considered a midwife. My doctor said his wife had an at-home birth with a midwife, so perhaps I should consider whether a midwife would more closely match my desires. Essentially what he was asking me to consider is what my birth philosophy was.

Before that conversation, I had never thought of there being such a thing as a birth philosophy. But in the days and weeks after that appointment, I soon learned that practices and philosophies definitely do exist. I needed to understand my thoughts on birth and find a provider who matched those, and not base my choice solely on my HMO. Thankfully my research led me to a great midwifery practice.

As I’ve talked to more and more moms, I’ve come to realize that many women enter pregnancy with the same misconception that I did, not realizing that differences other than personality quirks separate providers from one another. It’s not until much further along in the pregnancy and sometimes even after a traumatic birth experience that some women have realized their birth philosophy and their provider’s did not align. Unfortunately, I have a good friend whose story is precisely that.

From the outset, my friend’s provider showed signs of being very keen on intervention, which concerned me since I knew my friend wanted a natural birth. Throughout her low-risk pregnancy, she had more than five ultrasounds. During one of those, the doctor felt the baby looked too big and that a c-section should be considered. This was a few weeks prior to her due date. My friend called me, asking for advice. I told her to seek a second opinion. She did not want to do that so late in the pregnancy, but after doing her own research and soul-searching, she knew she could not consent to her OB’s assessment. So she sought a second opinion. She took her research and second opinion back to her doctor and said she did not feel a c-section was necessary at that time. The doctor permitted her to wait. Spontaneous labor finally did occur, but it came with the stress of timelines and interventions that my friend had hoped to avoid.

Now, of course every labor is different, but with more research and introspection up front, those last few weeks and even labor could’ve been less stressful and more empowering. So what can you do to avoid a similar situation? First of all, don’t look to an insurance company as the main way of choosing a provider (as I nearly did). Instead, understand how you hope to experience labor (with or without drugs, for instance) and how active a role you want to take in the process—the difference between a team effort and a patriarchal provider. It is not necessary to go as far as to create a birth plan in the first month, but even a general idea of how you feel toward birth can help. The more you ask questions up front and interview providers before making a choice, the better understanding you will have of not only the provider’s philosophy, but also your own. If things go south even at the very end, seek a second opinion. Unless the baby is crowning, it’s not too late.

A midwife once said to me, “You never forget having your baby, so it should be the best experience ever.” And it all starts with a first-trimester decision that could have lasting impact beyond the delivery room. Choose wisely.

Meagan Church is a writer, a reader, a black coffee drinker; a runner, a golfer and a lover of nature; a wife, a mother and a wanna be world changer. Meagan is currently working on a book about the realities of birth, babies and beyond. To learn more, visit www.Unexpectant.com. She also writes about her experiences of motherhood outside of clichés and inside the reality of it all at www.DefiningMotherhood.com.

Did you feel supported by your care provider? Who made up your labor support team?

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Motherhood: The Evolution of a Survivor

To conclude our series on giving birth after sexual abuse, we’ve decided to share the story of Erica, a survivor who contributed to Mickey Sperlich’s advocacy. Erica shows the evolution experienced in her four births, and shares how each progressively moved her through the healing process, and to a place of true empowerment.

The atmosphere I grew up in was wide open and sexually supercharged. I don’t remember ever not knowing about sex, and based on my parents’ behaviors, it seemed to be the entire goal of adult life. My father was by far the most powerful person in our home, so for survival, I adopted his view of the world. I learned to see my body as my currency — it was what I had to surrender to be wanted. My mother taught me to be careful of the tender feelings of men, but no one taught me that I had the right to say no to sexual advances, or that I might actually want to. As a result, I began experimenting sexually when I was 10 years old. It began with pornography magazines my older brother gave me, and moved into partners who were boys and girls my age or a little older — usually my parents’ friends’ kids.

When I was 12, I was seduced by an older man — a med student who was the son of my parents’ friends. Years later, he nonchalantly shared with me vivid details about the experience, commenting on how none of his girlfriends ever “let” him do such things — though I don’t even remember all of these “things.” It was all very antiseptic, very calculated, and I had no frame of reference to know that it should be different. I had my first pregnancy scare when I was 13, and continued to live the only way I knew — seeking the attention of men.

The summer after my sophomore year in college, I became pregnant. I didn’t think I had any other choice but abortion. I believed that once I had given birth, I would no longer be desirable to men. So, I dutifully marched myself down to a clinic and aborted my baby. The unexpected outcome of having an abortion was that I stopped caring so much if a man wanted me. In fact, I stopped caring about pretty much everything. Given my mental state, it is not surprising that I didn’t give the next guy I met a lot of thought. Nor is it that difficult to understand why it took me years more of running to realize that he was the man I wanted to marry. Or that it took me a few more years after that, even into the marriage, to realize that I really did love him.

Almost immediately after marrying Bill, my desire to get pregnant became overwhelming. I wanted a baby so badly, but he wasn’t ready. When I finally did get accidentally pregnant, I was ecstatic. I thought I knew so much about pregnancy — I assumed that if I told my doctor I wanted natural childbirth, I would have a natural childbirth. I wanted to deliver my own baby more than anything, to finally feel like I was a real woman — to finally heal the wounds that had accumulated over the years.

Four weeks before the end of a healthy pregnancy, my doctor discovered that my baby had turned breech. A c-section was quickly scheduled. Once again, I climbed onto a table and let a doctor cut my child out of me. I came home with my baby and a frozen heart.

By the time I became pregnant with my second child, I had already embarked on the long, exhausting process of revisiting my past through counseling — I had let the tears out, and was set on planning the birth I had always dreamed of. Twenty hours of active labor and four hours of pushing would have in most cases earned me another trip to the surgical suite, but I was lucky to have wonderful, caring midwives who believed in me — and instead of another cesarean, I gave birth to my child naturally at home. As I held my sweet son, a surge of something came over me that I’d never felt before: true power. Power that came from having done something difficult and important, not the false power that I had experienced in the past as men used my body.

I believe that God used the birth of my first child (and the loss of a lifetime of dreams that came with it) to take down the walls that I built to survive my childhood. My second birth — it began the reconstruction process.

My third labor and birth was the sort that women would forfeit body parts to experience. I had learned something from the previous two births. I had learned to relax into it, so much so that I was able to doze between contractions. I essentially woke up ready to deliver, and the midwife didn’t even get her coat off before my daughter slid into the world. I was the first to notice she was the daughter I had longed for, that I had wondered if I was too unworthy as a woman to deserve. Again, fear too deep to name dogged me, but each birth restored a damaged part of me. I sat in my rocker for a month straight with my daughter, so incredibly delighted I didn’t want to move.

When I was 42 weeks pregnant with my fourth child, the midwife did a heavy-duty manual exam to see if we could get things going, and discovered that I was having another breech baby. We were living in Dallas at the time, had no back-up doctor, and not much time to make any decisions. We went through with the birth as planned, since we both thought this baby would be relatively small. I remember this labor as a time of song — I was overwhelmed with a supernatural peace. While it wasn’t quite as fast as my previous baby’s birth, the breech birth was in some ways less difficult. When it was all over and we weighed my “littlest” baby, she was a full pound heavier than my firstborn breech — the one who doctors said I could never have delivered myself. I laughed such a laugh of freedom, of pleasure, and yes — of power.

Each birth brought back a piece of me that had been distorted by the fear and shame that resulted from my turbulent sexual past and abuse. Each birth reaffirmed, in a way much deeper than just knowing so, that women are powerful — extremely powerful.

Erica’s story was repurposed with permission from Mickey Sperlich’s blog, Survivor Moms Speak Out.

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Survivor Moms: The Healing Power of Birth

Mickey Sperlich, well-known midwife and childbirth advocate, speaks about post-traumatic stress disorder (PTSD) in sexual abuse survivors this week. Mickey shares with us her experiences with “survivor moms,” and provides hope that post-traumatic stress can become post-traumatic growth with a safe, healthy, fulfilling birth.

MA: Many women who experience sexual abuse suffer from post-traumatic stress disorder, or PTSD. Can you tell us about your experience with PTSD?

MS: I’m a semi-retired midwife. I had a home birth practice for 20 years, and my interest in working with what I call “survivor moms” really grew out of my practice. So, some very powerful experiences that I had with my clients caused me to realize that survivor moms were bringing particular issues to the whole childbearing process, and needed care and attention that I wasn’t necessarily educated to give them [at the time].

I can give you the example of working with a woman who was pregnant for the fourth time. I’d helped her with three babies prior to that, and they were all boy babies. Everything had been super smooth for her first three pregnancies. This time around, she intuitively sensed that she was carrying a girl. We ended up having an experience late in pregnancy where I was examining her, and she suddenly flashed back to being a little girl. I was no longer her supportive, loved midwife that she knew really well — I was her abusive mother. And, that was a really challenging experience, not only for her obviously, but for me too — to be cast in that role where it certainly wasn’t my intention. Thankfully, I had enough trust established with her that we really worked on this and what had happened. … What she had experienced, that re-experiencing or flashback, that’s one of the hallmark features of post-traumatic stress disorder — which I found out later, in the process of trying to educate myself about this. This happens quite frequently to women, so I just determined — I’m going to find out everything I can.

MA: Speaking of survivor moms, tell us a little bit about your book, “Survivor Moms: Women’s Stories of Birthing, Mothering and Healing After Sexual Abuse.”

MS: I started a survey project around the country where I began asking women, “How do you feel that your history as a survivor of sexual abuse has affected your pregnancy, or your birth, or the post-partum period, or how you feel about yourself as a mother?” I got hundreds of responses, and then I invited those women to write their story in a narrative form, and eventually published a book on that — which is the result of their stories. More than 80 women reported their life story to me within this context. … I was [then] fortunate to hook up with my co-author, Julia Seng, who is a certified nurse midwife, and got her Ph.D. looking at post-traumatic stress disorder and its affects on childbearing outcomes.

For more information on “Survivor Moms,” please visit Midwifery Today.

MA: How would a pregnant woman or her care provider recognize PTSD?

MS: One of the hallmark features would be the re-experiencing … it may be that they feel as if the trauma is happening all over again. A classic example during pregnancy might be if a woman has to have an internal examination for some reason, and in the midst of that, feeling as if she’s triggered back to a rape scenario. And even some of the terminology we use, like telling her to relax and all of that — it seems like a good thing for us to say, unless you consider the [possible] context. When was she told that before? So, some of the language we use can really be triggering. Women, when they’re pregnant, can [also] feel sort of invaded by the baby — out of control. One of the features of having been traumatized, especially sexually traumatized, is feeling like it [the situation] was out of your control. Being pregnant for some women is just a very wonderful, rosy situation, and for other women, they feel like: “Here’s my body — not under my control again.” That would be an example of the re-experiencing.

Then you also have the numbing — that’s another feature. So, feeling like you’re not there, like you’re not connected to what’s going on. Some women might report, “I don’t really feel pregnant,” or just feel really disconnected from their bodies. … Also, just anxiety, fear, anger, irritability — those things come along, as well.

MA: In the wake of PTSD, how can women empower themselves to move forward — specifically during pregnancy and birth?

MS: Something that I’ve found while practicing midwifery is that pregnancy is a wonderfully gestating transformative time — just in its very nature — so it actually is a really good time to work on your psychological issues, and to seek help. Many women reported to me in the narrative project that they saw a great opportunity to stop the cycle of abuse. They were like, “Oh my gosh, I’m going to be a mother. I know that I don’t want to be this kind of a mother — that’s real clear. I know what that looks like, so how can I envision how I do want to be?”

And they’re going to need a lot of support, so reaching out — that’s where maternity care providers can really be helpful, by modeling healthy relationships, listening to women — that’s key, being listened to. When you look at the data about who is resilient or not growing up in an atmosphere of abuse, a little girl or a little boy needs to have one adult in their life who they trust, and who they know really deeply cares about them and wouldn’t harm them. And it doesn’t have to be a parent. It can be a teacher, it could be a friend — it doesn’t matter, but we have to be able to connect in that way. And so, being able to connect in that way is one of the things that allows us to connect with the infant, to be able to attach with the infant.

MA: Is it actually possible to move beyond PTSD?

MS: Absolutely. There’s a lot of talk now about post-traumatic growth. One very cool thing is that many women have reported to me how utterly healing becoming a mother was. Especially for women who had been sexually abused, and that’s how they developed PTSD. To take this space that was formerly violated — a violated space — and to have this beautiful transformation of the baby coming through. Growing a baby, and then birthing that baby, and then having this precious life that you fall in love with — that that in and of itself was transformative, and healing, and fostered their growth — their post-traumatic growth in ways that they had never dreamed possible, actually. And that’s a wonderful opportunity we as midwives have, to foster that, to protect that space for the woman so she can have the kind of pregnancy and birth experience that would allow for something like that.

This interview, originally video-taped for Mindful Mama, was transcribed and re-purposed with permission from Mindful Mama.

Mickey Sperlich, a certified professional midwife with nearly 20 years of experience, helps women on the journey of pregnancy and birth. Mickey is the mother of two grown children, and has been married since 1980. She appreciates being a midwife and mother, and learning so much from the women and families she has served, and also from her own children. Mickey is recently retired from full-time midwifery, but continues to focus on women’s health issues. She currently manages various research projects that look at the effects of post-traumatic stress on childbearing at the University of Michigan’s Institute for Research on Women and Gender. Read more on Mickey’s blog, Survivor Moms Speak Out.

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Supporting the Emotional Challenges of Birth

This week, we want to hear from you!

For many women, labor and birth can give rise to strong emotions — from common fears about the unknowns of labor to the re-emergence of traumatic wounds from the past. What are the common and more difficult emotions you have worked with in the context of birth? How did you — or your caregivers help you — navigate through this challenging experience?

To join the discussion, simply write in the comment field below.

And… stay tuned next week (January 17th) for a guest post by Mickey Sperlich, author of “Survivor Moms: Women’s Stories of Birthing, Mothering and Healing After Sexual Abuse.”

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“The Importance of Labor Support Cannot be Overestimated.”

With optimal labor support, women can birth with a sense of pride, confidence and fulfillment. This week, Penny Simkin, inspirational author, childbirth educator, birth counselor and co-founder of DONA, joins the Mother’s Advocate blog to discuss the value of love, encouragement and support during labor.

MA: Can you speak to the importance of having supportive loved ones present during labor?

PS: Women need to feel safe during labor, and in today’s maternity care climate, the hospital is a rather strange place for most people — full of machinery and beeping machines. But also, there isn’t much continuity of care. She may not have a doctor that she knows, or may not have a midwife that she knows if she’s having a hospital birth — the nurses come and go. And so, there’s not continuity. Having her loved one nearby gives her that continuity.

MA: What roles can familial labor support play?

PS: The role that the partner, the father or loved one would play really depends on how the two of them perceive his or her role, but also how comfortable he (or she) is. It can be anything. From being a companion who is assisting her with every breath she takes — in terms of being present and being in the rhythm of her breathing. To sitting by and encouraging maybe a doula or someone else to do most of the labor support. But as far as I’m concerned, a woman who is alone in labor feels alone. Even with a partner who isn’t very present for her. She’s very unlikely to feel very fulfilled in her birth experience.

MA: How does labor support affect birth outcomes?

PS: The importance of labor support can’t be overestimated. We have studies of doula support — many of them — like 17 of them. Randomized control trials comparing women — the outcomes of women who have a doula with them with women who have no doula but usual care. In a nutshell, all the studies have found benefit — benefit in shorter labors, less requirement for pain medications, more satisfaction with the birth, and in some cases, better newborn outcomes. Some have also found less postpartum depression six weeks later, and better breastfeeding incidence. And, it seems strange that some of those postpartum outcomes would be improved by having a doula present during the birth, or having excellent labor support during the birth. But I think what we find is that a woman has great emotional needs during labor. If those are not met, she’s depleted. She may become depressed — we’ve found that there’s more depression in women who have not had adequate labor support. So this can have ramifications that go far beyond the birth experience. When she feels well supported, valued, respected, cared for, nurtured, guided — she feels empowered. And after a birth like that, she’ll say, “I did it.” She knows that she has that strength. I would hope for every woman, however she chooses to give birth, that she comes out of it feeling the sense of power, capability — accomplishment.

MA: Your DVD, “Comfort Measures For Childbirth” offers more than 40 ways a laboring woman and her partner can work together to achieve a comfortable birth. Can you one of these measures with us?

PS: I’ll show you an easy but very appealing hand massage. This is something that might be particularly useful if a woman has been gripping the sheets, or her partner’s ears (laughs), or the side of the bed in the need to fight through the contractions — it isn’t a good way to use her energy. So, her partner or her doula might say, “May I massage your hand?” — because she’s getting something out of this squeezing of her hands together. So, have her relax her arm. Place your two thumbs above her wrist and the rest of your fingers below, in (clasping) her palm. Put pressure on her palm, and increase pressure until she says it’s enough. Now, do a friction rub over the top of her hand, maintaining pressure on the palm and stroking firmly over the top of her hand. Many women will say that when you do that, the tension just kind of — you can feel it going away right up your arm. And so, that’s something that could be done during contractions or between, but I always look — if a woman is gripping, there is a purpose for that. There’s stimulation of her palms, but (with this massage) I can do it for her and she can relax.

MA: Any words of wisdom for expectant mothers?

PS: The birth of a baby is a lot more than the birth of a baby. It’s the birth of a mother, father, grandparents, siblings, etc. When a woman approaches birth, I think she probably has very little idea of how important that’s going to be to her, in her development as a human being. But the birth experience brings the woman to some of the deepest, most profound physical sensations and emotions that she’ll ever have. It’s a mix of joy, anticipation, excitement, pain, exposure, vulnerability. And, I think in going through that rite of passage and coming out on the other side, a woman is transformed. She’ll never be the same. And of course, we’re all hoping for every woman that she will have a satisfying, fulfilling birth experience that she can look back on with great joy, but also one that will give her a sense that — well, some women have said, “I can do anything after having a baby.” So that’s what I hope that we can look forward to for many women, and that’s what I see as part of my role is — to be a part in preparing her for that.

Penny Simkin, PT, is a physical therapist who has specialized in childbirth education and labor support since 1968. She estimates that she has prepared more than 10,000 women, couples and siblings for childbirth, and has assisted hundreds of women and couples through childbirth as a doula. She is the author of many books and articles on birth for parents and professionals, co-founder of DONA International, and member of the editorial staff of the journal, “Birth.” Today, her practice consists of childbirth education, birth counseling and labor support, combined with a busy schedule of conferences and workshops. Penny is married, the mother of four, and grandmother of eight.

This interview, originally video-taped for Mindful Mama, was transcribed and re-purposed with permission from Mindful Mama.

Who was on your labor support team? What comfort measures did your loved one(s) and/or doula provide?

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Labor Induction: Exposed

This week, Mother’s Advocate is proud to present well-known and respected childbirth educator and author, Nicette Jukelevics. Nicette is blogging on behalf of the Coalition of Improving Maternity Services (CIMS), and has given us a straightforward, detailed look at labor induction.

Although there is no evidence to show that non-medically indicated inductions improve outcomes for babies, inductions for non-medical reasons have been on the rise in the U.S. Increasingly, labors are being induced for psychosocial reasons and for medical convenience. What’s more, the majority of expectant mothers are not aware of the risks of elective induction when they request one or when their caregiver schedules it.

We are learning, however, that with a healthy pregnancy, not waiting until labor starts on its own may have far greater health consequences for babies than we knew. Research shows that when births are induced or cesarean sections are scheduled — especially before the 39th week of pregnancy — newborns may appear mature, but they are at greater risk for short- and long-term complications.

Labor Induction: Alarming Statistics

In 2005, 22.3 percent of all U.S. births were induced — a 50 percent increase since 1990. A national survey by Childbirth Connection showed that 21 percent of U.S. women who gave birth in 2005 tried to self-induce labor because they were tired of being pregnant. They wanted to induce to avoid a medical induction, to control the timing of their birth, or because their caregivers were concerned about the size of the baby.

Elective induction rates vary widely among hospitals (12 percent to 55 percent) and among individual physicians (3 percent to 76 percent). But more than four out of 10 mothers (41 percent) reported that their caregiver tried to induce labor. For some women, an elective induction can almost double the risk for a cesarean, depending on the individual physician’s practice style and medical specialty. And all of these statistics are even more frightening when compared to the World Health Organization’s recommendation that appropriate induction rates in any geographic region should not exceed 10 percent.

Labor Induction: The Risks

With an elective induction, babies are more likely to suffer from hypoglycemia, to be admitted to a special care nursery, and to need ventilator support. A recent study of a U.S. healthcare system showed that babies born at 37 weeks were 22.5 times more likely to need a ventilator at birth, and babies born at 38 weeks 7.5 times more likely, when compared to babies born at 39 weeks. Babies born too soon are also more likely to experience serious complications, including fever, infection, respiratory distress syndrome (RDS), and transient tachypnea of the newborn (TTN).

These babies may look normal, but have an increased risk of difficulties with vision and hearing, feeding and digesting their food, regulating their body temperature, and are more likely to need phototherapy to treat jaundice.

The newest research on babies born before term indicates the potential for neurological problems and learning difficulties that may not show up for years. The March of Dimes is educating healthcare professionals and mothers alike about the important brain growth and fetal neurological developments that take place in the very last weeks of pregnancy. At 35 weeks, a baby’s brain weighs two-thirds what it will weigh at 39-40 weeks. At 37 weeks, the brain weighs only 80 percent of its weight at 40 weeks. The cerebral cortex — the part of the brain that controls functions such as cognition, perception, reason and motor control — is the last to develop. Researchers have found that babies born pre-term are more likely to have learning difficulties at school age. It’s essential for baby’s brain development that the pregnancy goes to full-term.

Labor Induction: Consider This

An induction of labor is a complex process that often requires additional medical interventions to keep the mother and baby safe from successive potential complications. Inducing labor with pitocin when the cervix is unripe (long and closed) sometimes causes the mother to labor for long hours with little progress. Subsequently, confining the mother to bed, using continuous fetal monitoring and IVs, and administering an epidural for pain are commonplace with an induction. Shoulder dystocia (when the baby’s shoulders cannot fit through the pelvis), and the use of forceps or a vacuum extractor are also increased with induction. All of these interventions and complications can lead to higher risk of cesarean section — failed inductions are not uncommon.

Labor Induction: When it’s Helpful

Regardless of all the risks, there are several medical indications for inducing labor — when the mother or the baby’s health would benefit more from the induction than from continuing the pregnancy. These may include diabetes, pre-eclampsia (high blood pressure), or a uterine infection in the mother. Or when a baby in utero is not growing at a normal rate (small for gestational age) or the pregnancy is post-term (more than 42 weeks). Induction may also be favorable when the bag of waters breaks prematurely (also known as PROM, premature rupture of the membranes).

Labor Induction: Questions to Ask Your Provider if it’s Suggested

• Why are you scheduling an induction of labor?
• What are the risks of inducing my labor?
• I know that my due date is only an estimate. What precautions will you take to make sure my baby is not born too early?
• How do you plan to induce my labor?
• How will an induction affect my labor and the health of my baby?
• I know that compared to waiting for labor to begin on its own, an induction is more likely to lead to a cesarean section. What measures would you take to reduce my odds for a cesarean?

If both you and your baby are healthy and stable, don’t hesitate to take time to consider your caregiver’s recommendations and explanations. Feel free to leave the appointment, with a follow-up scheduled — or to get a second opinion. After all, this is your birth.

The last week or two of pregnancy may be difficult. Priorities at work, or scheduling maternity leave to accommodate childcare or family needs may be a priority. However, waiting for labor to begin on its own is safer for you and your baby — and safety is of the utmost importance!

Nicette Jukelevics, MA, ICCE is a childbirth educator, researcher and author of “Understanding the Dangers of Cesarean Birth: Making Informed Decisions.” She is also the founder and publisher of VBAC.com. Nicette is past-chair of CIMS, and now serves as chair of the CIMS Coalition Building Committee. She has also served on the Board of the International Childbirth Education Association and DONA International. For more than 25 years, Nicette had the privilege of helping thousands of expectant families prepare for childbirth, VBAC and early parenting. She has presented on cesarean and VBAC issues at national conferences, and for advanced doula trainings across the U.S. With co-author, Henci Goer, Nicette recently published “The Risks of Cesarean Section & Expectant Mother’s Checklist,” a Coalition For Improving Maternity Services (CIMS) Fact Sheet.

Other resources: California Maternal Quality Care Collaborative

Tell us about your labor. Did (or will you let) your labor begin naturally? Was (or are you planning on having) your labor induced? We’re looking forward to hearing about your experiences!

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Prenatal Stress: Why it Matters And How to Cope

You have done everything possible to ensure a smooth, healthy pregnancy — but what about labor and birth? Mary Oscategui, baby planner, birthing options advocate and mother herself, joins us this week to share ways pregnant women can cope with the stresses of an approaching birth. She encourages mothers to acknowledge their fears — for the health and well-being of both themselves and their babies.

As a health practitioner, baby planner and single mom, I understand the challenges and stressors that can affect an expectant mom in preparation for birth — trust me, I’ve been there! Your baby is soon to arrive and the excitement is present, but along with that excitement can come many different emotions — some easy to cope with, and some not. You may be feeling anxious and stressed with a lot of questions and uncertainties weighing on your mind. Will I feel pain? How long will my labor last? Will my baby be OK? What if he/she is not breathing? What if the cord is wrapped around his/her neck? What if I have complications? Will I be able to handle motherhood?

As an expectant mom, your first reaction may be to hide these uncomfortable feelings — you may feel ashamed or embarrassed to share them. Giving birth is our natural birthright, however, that does not mean we also don’t have the freedom to experience some fears or doubts. Suppressing such feelings of anxiety and stress can not only take a toll on your body, but on your baby as well. It’s important to be aware of your fears, anxieties and stressors — and to address them. Doing so will only improve the health of you and your baby, and the outcome of your birth.

How do stress and anxiety affect a pregnant woman and her baby?

When an expectant mom feels anxious and stressed, her nervous system causes physiological changes in her body. Adrenaline and the stress hormone, cortisol, release into her bloodstream, causing her body to react in a fight-or-flight response. As a result, her digestive system slows down, which prevents essential nutrients from being absorbed into her body and passed on to her baby. Her muscles become very tense, making it difficult to think clearly and relax. These physiological changes can lead to premature labor, or even complications during labor.

Babies exposed to a variety of stress hormones, toxins and malnutrition inside the womb may develop a host of problems during their fetal growth and after they are born. Their bodies have to undergo certain biological changes in order to cope with a high-stress environment. In October of 2009, The UK Times reported new research that shows exactly how stress can harm a baby’s development, and how that stress can lead to long-term problems.

According to research by Vivette Glover, a professor of perinatal psychobiology, maternal anxiety affects the placenta by reducing the activity of the main barrier enzyme that hinders the hormone cortisol from reaching the fetus. The babies of women who were stressed during pregnancy had lower birth weights, lower IQs, slower cognitive development, and more anxiety than those born to the other women in the study.

How can women cope, and prevent stress and anxiety?

When I was pregnant, I found a few things essential to my (and my baby’s) well-being.

Acceptance

I had to accept and feel comfortable with my feelings, and not to try to resist them. It is perfectly normal to have some doubts or fears surrounding labor, especially if you are a first-time parent. Once you allow and invite your feelings to be present, you will be able to take the steps you need to take care of yourself and your baby, while reducing — if not eliminating — stress all together.

Support

I sought support. This could be through an expectant mom’s group, a childbirth education class, or a qualified professional — such as a birth doula. By working with a birth doula, or attending a birth education class or expectant mom’s group, you can prevent or reduce stress levels dramatically. Birth doulas are trained to provide expectant moms emotional and physical support in preparation for labor, and are also present during labor for support. Childbirth education classes are designed to inform expectant mothers of their options for labor and birth, and prepare them for the journey. An expectant mom’s group can also be another great resource, as you will be able to relate to and share all the uncertainties and fears you are going through with other women who are going through the same process.

Sleep and Relaxation

I made it a priority to rest. It is so important to make sure you are getting as much sleep as your body needs, as well as taking some down time throughout the day. Your body repairs itself during sleep, and also works to restore any imbalances that are occurring. When you compromise sleep, you become more susceptible to stress, as your immune system has to work harder to maintain proper levels of functioning throughout the day. Also consider taking some down time through a yoga or meditation class, a brisk walk, bubble bath, or even by lightening your workload.

Nutrition

I found that nutrition played a very powerful role in both coping with and the prevention of stress while I was pregnant. Caffeine, sugar and processed foods can trigger stress, so it is best to avoid them. Eat whole, fresh organic foods: fruits, vegetables, protein, and healthy fats that are easy to digest, and contain bio-available nutrients that are especially high in B vitamins and minerals. Exposure to sunshine for a few minutes of day will help your body absorb these nutrients. Of course, be sure to consult your midwife, doctor or nutritionist for your specific dietary needs.

Should you seek medical help?

If you have tried everything and find yourself helpless or depressed, it’s always best to seek medical attention. There are many professionals who are dedicated and committed to supporting you through your journey, and can provide you and your little one on board with the necessary help.

Mary Oscategui, CBP [IABPP], CPT, is the founder and CEO of The International Academy of Baby Planner Professionals (IABPP). She is an international business consultant and educator specializing in maternal health, fitness and going green. She is also the founder of TheBabyPlanner.com, EcoFit Mom and Physical Awakening. Mary is a writer, speaker, coach, author and birthing options advocate. She enjoys empowering, educating and supporting expectant and new parents to know all their options, so they may confidently make the best decisions for themselves and their baby in the most objective, healthy, safe way. Through IABPP, Mary introduced a new approach to the baby planning industry by focusing on the needs of her clients through parental education and emotional support.

How did you cope with the stresses of anticipating labor? Did you utilize a support group or birth professional? What tips do you have for other expectant moms?

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