Getting Ready For Giving Birth: One Moms guide to preparing your mind for birth (and why

thats way more important than you thought)

by Jessica Poundstone

INTRODUCTION: The Importance of Mental Preparation

If you were going to do a triathalon, rigorous physical training would definitely be a part of your preparation. But even someone in top physical condition isnt necessarily the best candidate for winning a triathalon. People who win triathalons have done something more than physical preparation theyve done some pretty significant mental preparation. So no matter how many Kegels you do or how long you can hold a piece of ice in your hand, you still might be missing out on one of the most important parts of preparing yourself for birth: mental preparation. I didnt get this either until about halfway through my second pregnancy. My first child had been delivered by Csection, which I believed should have been avoidable. The surgery and recovery was, to put it mildly, not cool. I was prepared to do everything within my power to avoid a second Cesarean. (Note to those unfamiliar with the concept of vaginal birth after Cesarean or VBAC: VBACs are a very tricky business, medical malpractice insurance-ly speaking. Many hospitals wont even allow women to try a VBAC anymore, even though the major risk, uterine rupture, is extremely slight. I found hospital-based midwives who were extremely supportive of VBACs.) Giving myself the very best chance of a successful VBAC meant going drug-free. So I was coming at unmedicated or natural birth from a very different angle than a woman who chooses to have a natural birth so she can have a, well, natural experience. I had no philosophical reason not to take medication. I had no hippie dippy notions about unmedicated birth being an amazing spiritual experience. I was in no way under the impression that natural birth was going to be a pinnacle achievement of womanhood. Nope, avoiding going under the knife for major abdominal surgery (again) was a powerful incentive to figure out what it was going to take for me (someone who was not necessarily on friendly terms with pain) to do this birth naturally. And guess what. I did it. And it turns out it was an amazing spiritual, physical and emotional experience. And it did make me think about being a woman, and what all these lady parts are made to do in a whole new way. (And they are freaking amazing, I must say.)

PART 1: Things To Consider As You Mentally Prepare For Giving Birth

So, back to my point. The stuff I learned and did to prepare mentally to have a birth with no medication totally worked for me. And if youre interested in trying out a natural birth, you totally should. Because if I can do it, so can you. And even if youre just toying around with idea, or your plan is an epidural, but you want to have a really great labor experience right up until you have that epidural, read on. Triathalon IS TO running, swimming and biking AS Having a baby IS TO pregnancy, pre-labor, active labor/birth. Sorry about the SAT flashback. But the comparison is valid. Triathalons are long and require physical and mental strength. Same with having a baby. Each phase of having a baby is a different kind of challenge. And each one is worth your attention. Its also worth remembering that, of the whole process of having a baby, the actual birth is by far the shortest stretch (no pun intended). Focusing too heavily on the finish line isnt a good idea for triathalon-ists or pregnant people.

Is this true for you? : Whatever you need to learn in your inner, spiritual life is what youll learn from your pregnancy. That truism that floats around the natural birth community seemed crazy to me. But then that kind of happened to me. I learned two things during pregnancy that I needed to learn in my life: 1) Its important to be vulnerable. Because recognizing and admitting that I felt vulnerable made it possible to reach new levels of intimacy with many people in my life. 2) I dont really have control over much of anything that happens. (Yes, this was actually a surprise to me.) Those are big lessons. Im still learning them. But I experienced these lessons in a deep and indelible way during pregnancy. And I learned them in part because I was open to accepting pregnancy as a unique, limited, time of imbalance and beauty and uncertainty that, in its magical concoction of craziness, can trigger and foster personal growth. There are all kinds of reasons not to do natural birth but its pretty hard to argue its not a better way to go for all kinds of reasons. There are mountains and mountains of scientific and medical evidence that show that a medication-free birth is better for babies and moms. This is not a judgment of anyone who chooses not to go drug-free. Its just a scientific fact. As Ive already mentioned, I did not choose a natural birth for altruistic, idealistic, or philosophical reasons. I chose it so I didnt have to get gutted like a fish again. But its still true that natural birth really is the Cadillac of birth options for moms and babies for more reasons than you can shake a stick at. If youre just toying around with the idea of going drug-free, just consider thinking about maybe committing to it. Not giving yourself the mental out of an epidural will make a material difference in your preparations for giving birth. Wait - dont stop reading! Im just saying. Because when youre actually in labor, its not the practice test, its the test. Youve really only get one shot at it. Your mental preparations are your practice tests. And you can take as many of those as you want before the big day. No matter what happens, your active labor (more about this later) is not going to last more than 24 hours. (And just a note here, I honestly did not even once think of asking for medication of any kind during my labor and delivery. Id been worried that I would want it, and would have to be convinced not to get it. But the idea of asking for drugs of any kind truly never entered my mind. Which was pretty surprising to me later. Frankly, I was just too busy concentrating and working to think about asking for drugs. I honestly have no idea how long my labor was. It seemed all at once forever, and like a blink. It was like being in an alternate reality where time was the very least of my worries.) Active labor versus whatever other kinds of labor there are. Epidural or not, there are, sadly, a lot of women who really like to talk about how long they were in labor. Its some kind of badge of honor. As though enduring pain over a long period of time will earn these women our.envy? respect? pity? Plus, heres the thing these ladies dont mention: From the moment you get pregnant, your body is preparing for labor. Labor is just a word for the work your body does to move your baby the inside of your body to the outside world. So if you want to be all technical about it, women are in labor for at least nine months. Try that one out. I was in labor for NINE MONTHS! The length of labor is a lot less important than the quality of labor. And active labor is not the same as pre-labor. Active labor is over within a few hours. Its the main attraction, the big show, the finish line.

But pre-labor is a large and long portion of labor. It can go on for days. And this is what some women who wear the duration of their labor like a badge include in the calculation of their total labor time. I call B.S. on that. Which is not to say that those women were not having a tough time during their pre-labor. But I am guessing thats because the quality of their pre-labor was probably pretty low. Because they didnt do the mental and spiritual preparation to create a high quality pre-labor or active-labor experience for themselves. For me, prelabor was fun. Yep, I just said the f-word in relation to labor. Can you believe it? But I am not even kidding. (More on this later.) Americans are weird about childbirth. You know how we all think French people are weird about other people trying to speak their language? Or Germans are weird about punctuality or whatever? Americans are weird about childbirth. Major interventions in the birth process like chemically inducing labor and scheduled Cesareans are common, as is having prenatal care delivered by surgeons (obstetrician/gynecology is a surgical specialty). These are cultural norms around birth in America. As this medicalized birth approach is part of the reason 1 in 3 babies are delivered by C-Section. This is insanity. (1 in 3, people!!!) Note this in the back of your mind as you bump up against what your friends are telling you about their birth experiences, and/or what does or doesnt seem normal or familiar to you. Our cultural myths around childbirth in this country are primarily negative. Thats a huge bummer. Because childbirth is an effing amazing thing to get to do. Talk to yourself and/or others to understand your feelings about giving birth. Take advantage of the emotionally vivid state of pregnancy to think about whats going on in your heart and mind. If youre feeling free-floating anxiety about labor and birth (or anything, actually) where is it coming from? Youve got to feel it - you cant just think your way out of it. (If youre me, thinking your way out of it is totally preferable to actually having to feel vulnerable or out of control. See above for my lessons learned.) Be as specific as you can. Think of each fear or anxiety as a bowling pin you need to knock down to get into the best emotional, mental and spiritual state you can be in to give birth. Im a pretty reserved person emotionally, and I realized I was going to need to be willing to be a bit more in tune with what was going on in my heart and mind. Because The mind-body connection: Holy crap, it is so real. The mind-body connection seemed like something for new age-hippies to me. (Sorry about all the dissing on hippies here. I dont hate hippies. Im just not one.) Not that I discount the brains ability to make things happen in the body, like my brain telling my fingers to type this (magic!). But a womans body takes this to a whole new level during pregnancy and delivery. Reading Ina Mays Guide To Childbirth both the birth experiences women relate in the first part of the book, and Ina Mays own experiences and insights detailed in the rest of the book one thing became absolutely clear: When youre trying to have a baby, fear is your enemy. Birth is about opening up your heart, your mind and your body. Fear closes you down. Fear closes your heart (hard to feel love when youre feeling fear), your mind (fear shuts down your ability to think) and your body (stress chemicals and muscle tension are a terrible double whammy when youre trying to have a baby). Evidence via Ina May: When adrenalin rises, oxytocin levels (the chemical that causes contractions) go down. That means when fear kicks in, labor stalls. And stalled labor is the opposite of what you want when youre, you know, trying to have a baby.

More evidence from Ina May: Your cervix is a sphincter muscle. No kidding. A sphincter is a special kind of muscle. And it behaves differently than other muscles. It closes up like a clam if youre scared or threatened or too self-conscious. And guess what happens when contractions are slamming a babys head into a brick-wall, closed tight cervix? One word: ouch. So in my mind, the most important thing I could do to contribute to a quick, efficient, and successful natural birth was staying in a relaxed, open state throughout labor and delivery.

PART 2: Some Ways You Might Consider Helping Yourself to Stay Relaxed and Open Throughout Labor and Delivery.
Figuring out how to keep myself (and therefore my cervix) in a relaxed state throughout labor and delivery was the main focus of my mental and physical preparation for giving birth. Here is an overview of what I did: Did my best to figure out what would make me feel safe and secure. Music. I suspected that if I could really get into focusing on a certain sequence of songs, I could close my eyes and shut out everything else, and just be inside that music stream. Thats something I can do in my regular life its a sensation Im used to. So I created a playlist of 10 songs. These were heavy hitters - songs that I know really deeply. (You know, the kind that almost hold secret messages for you? No? Well, anyhoo) I listened to this song sequence at home frequently, and practiced feeling safe, secure, and relaxed during the song set - relaxing my jaw, my shoulders, breathing deeply, etc. I also knew that, at the end of that 10-song playlist, around 25 minutes would have passed. It was appealing to me to have some sense of how much time had passed during labor without watching a clock. Imagining/visualizing the environment I would be in. That meant seeing the rooms in labor and delivery in person so I would have an extremely clear mental image of where I would be, and could imagine myself working and laboring and relaxing in that environment. My blankie. Early in the pregnancy I bought the softest, coziest, blankie ever. I used my blankie every evening when I was relaxing with my husband on the couch, zoning and watching tv, as an extra blanket to hold in bed at night, etc. I wanted to associate that blanket with comfort and relaxation so much in my mind, that when I took it to the hospital with me, it would hold all of those warm, happy, relaxing thoughts and memories. (And then I forgot it. Ha, ha, just kidding! I didnt forget it. And it really was a comfort to me, just as I had hoped.) Staying home as long as possible Unlike every single movie or television show where youve seen it portrayed, going into labor is 100% not an emergency. (Why does this bizarre conspiracy of labor-related lies continue in the movies? Seriously, its really, really, weird.) As weve already covered, labor is a very long and gradual process. The place you probably feel the most comfortable is your own home. So stay there. Stay there as long as you possibly can before heading to the less-familiar environment of the hospital. The transition from home to hospital is a prime time for labor to stall out. So wait until labor is like an unstoppable train before heading to the hospital. Resist, resist, resist the urge to go early. Being at the hospital before labor has really set in can create a problem the nursing staff feels they need to solve - by giving you drugs to speed up your labor or other interventions that you wouldnt have needed if you had just stayed home and let labor really, really, really get underway. (Um, did I mention you should stay home as long as you can?) Once youre at the hospital (if youre going to a hospital). Figure out what its going to take for you to be as comfortable, relaxed, and un-self-conscious as possible. If you arent clicking with a nurse (he or she is saying or doing things that bug you) have someone ask if he or she can switch to a different room. Youll remember the crummy nurse forever the nurse wont remember you at all. I wanted to block out hospital crap as much as

possible. I asked my doula and my husband to make sure that the volume was turned off on all hospital machines that beeped; kept the room lights low; brought my own pillow and blankie, etc. Expanding my ideas about intimacy. As I explored what emotional or mental blocks or tensions I thought I might be susceptible to and therefore run into during labor, I had a few realizations. I needed to drop any self-consciousness I had about my body. Some people say Oh, once youre in labor you wont care who sees what. That was not true for me. I was very thankful that I had taken steps during my appointments with my midwife to stop caring what she might have been thinking about my body. I also - and this might sound odd - started leaving the door open when I went to the bathroom at home. (I was formerly a very strict door-closer - and I have gone back to my door-closing ways now, thanks for asking.) Just pushing my own boundaries of what I was comfortable with in my body was an important mental shift for me. Especially since I knew there would be plenty of strangers around in the hospital room where I was laboring. I needed to allow myself to be emotionally intimate with my husband, my midwife and my doula. For me, just allowing myself to cry in front of someone, and admit that I was feeling scared and vulnerable was a really big deal. Not feeling competent and in control was not a happy place for me to be. The deepened intimacy I experienced after allowing myself to do that was amazing. Driving out fear. Reading positive birth stories. As Ive mentioned, Americans are weird about birth. Id say in my life, about 99.9% of all of the birth stories Id ever heard were negative. The first section of Ina Mays Guide To Childbirth is filled with positive birth stories that made me excited to get to do childbirth. Reading descriptive accounts of how labor really feels in the body. Another upside to the positive birth stories in Ina May books was that reading these stories, and womens descriptions of how having a baby really truly felt in their bodies in their own words, was amazing. These descriptions were also unbelievably helpful during my own labor. They helped me to not be worried or afraid of what I was experiencing. Instead, I felt a strange sort of mystical solidarity and kinship with all those women from the Ina May book while I was giving birth. Hey, crazy, it felt that way to me too! Not watching birthing videos. Reading accounts of births worked for me. I watched one birth video that I liked. Beyond that, I watching other births on video was too indelible to me it seemed too intimate a thing to witness, and I found myself having to fight off replacing my mental pictures of my own birth with the images Id seen in the birth movies. No birth movies for me! Maybe theyd be extremely helpful to you! Talking to people who had had natural births. Once I started asking around, I discovered that more and more women I knew had had natural births. Only one of them was someone I would have considered physically tough and brave enough to do it. All the other ones were pretty much wusses like me. I knew if they could do it, I could do it. Being willing to consider that this might be fun. Fun is just about the last thing most American women will tell you they had while they were giving birth. But fun is a possibility. And I had some during active labor. Actually I had a lot of fun during active labor, joking around and singing songs. I did not have any fun during transition or delivery. Just keeping it real here. Coping with pain. Some childbirth books try to tell you that you can have a pain free birth. Or that by simply re-framing the idea of

pain in your mind you dont have to experience it. Or some other crap about how you can escape/ignore the pain. Well, I was suspicious of all of those books. I wanted to go into the birth with the idea that there was going to be a tremendous amount of pain. Without thinking that even my very best attempts at mental acrobatics were going to make the pain go away. So for me, the question was how was I going to cope with pain? Making a list of the wide variety of coping techniques. Breathing, counterpressure, touch, meditation, relaxation, laughter: there are so many techniques for coping with pain. Research your options, and then Use every encounter with pain as a chance to practice. If I cut my finger, stubbed my toe, did acupuncture or got a Charlie Horse in the middle of the night, I used that pain as a chance to practice coping techniques, and to explore which ones worked better for me. Relaxing through pain is a weird skill to practice. And yet! It can be learned! Its super-fascinating, and yes, fun to learn how to do it. Doing what Ina May Gaskin told me to do. Ina May has all kinds of tricks and techniques that help laboring mothers cope with pain. For instance: When your jaw is relaxed, so is your cervix. Isnt that crazy? So if you can focus on relaxing your mouth and jaw, you can be pretty sure your cervix is relaxed too. Which is super-conducive to letting that babys head do the work of opening it up. When your cervix is not relaxed (because youre scared spitless or just cant loosen up) each contraction is serving to shove the babys head down.into that proverbial brick wall I mentioned before. Not good. Other tricks of hers include kissing through contractions, making what she calls horse lips, breathing techniques, thinking of contractions as surges of energy and lots and lots more. Read her book, and note what sounds and feels right and good to you. Rely on your midwife or doula for the rest. About doulas Hiring a doula. Little known fact: if you have a hospital birth, its highly unlikely that your OB or midwife is going to be with you through the entire birth. Doulas, or labor assistants, or whatever you want to call them, are, bottom line, like an external hard drive/encyclopedia of information and techniques for making your labor more awesome. They are also an absolutely invaluable source of pain coping helps. Theyll think of things you hadnt considered, and can help you get through moments when your own bag of tricks seems empty. And they are with you for your entire labor, focusing only on you, your partner, and your baby. There is overwhelming evidence of the benefit of doulas attending births. One British study showed: Over a 5-year period, 224 of a group of 420 pregnant women in their third trimester were randomized to have a doula accompany them during labor, and 196 women did not receive this intervention. Cesarean delivery rates decreased by 12%, the need for an epidural dropped by 11%, and the need for a Cesarean after induced labor decreased by 46% when a doula arrived shortly after hospital admission and remained with the woman throughout her labor and delivery when compared with the group without a doula. http://www.sciencedaily.com/releases/2008/05/080529162613.htm If you are having a hospital birth, whatever a doula costs, it will be cheaper than what you would pay for a Csection surgery even if you have insurance. (Those things are super-spendy.)

Developing my own little sayings. Okay, fine, just call them mantras. To get all of that American cultural stuff about childbirth out my heart and mind required putting new stuff in. Below are a few of the phrases, quotes, and ideas that resonated with me. Find or write the ones that resonate with you! Mantras Thinking is scary, feeling is not. I want to open up. I can integrate this. This will not last forever. Surrender. Relax, let go, go with the flow. Dont fight this: its bigger than you. My body is made to do this. Women all over the world do this every second of every day. Ideas

Take one contraction at a time. Relax completely between them. Breathe slow and even, slow and even. Contractions as waves rushing in and out of a cave. Be amazed by the power of your body to birth this baby. There will be an incredible amount of power in your body. Your body will help you birth the baby. Your body knows exactly what to do. Dont get in its way. Life force: you are only a part of it. It will be out of your control. You can ride the waves, but you cant control them. Out of control is okay. Letting your uterus do the work - relaxing all parts of the body while a contraction is happening. Relaxing by touch - when someone touches you, practice letting that part of your body relax. Contractions: interesting sensations that require all your attention. Slow deep breathing aids opening. To relax your mouth and jaw, take a deep breath, and when you exhale, make an audible sigh, or a lowpitched sound to vibrate the chest. Or just sing! Cervix actually relaxes when someone is speaking loving positive words. Pretend to be an animal.

PART 3: So Did Any Of This Actually Work???

It totally, totally did. I felt completely calm and fear-free throughout my entire labor. I felt unbelievably powerful. I even had some fun. I also felt extraordinarily intense sensations, and experienced moments of despair and confusion. But with help and support from my husband, my midwife, my doula and thanks to the mental preparation work Id done I recovered from those moments, and kept working. Because heres the thing: that baby is coming out. And your baby knows how to get out. Most of my work was staying cool, and letting that impossible, miraculous, crazy thing happen.

In addition to feeling really pretty calm throughout the labor and delivery my birthing dream team worked together to meet just about every emotional and physical need I had during labor and delivery often before I even knew I had it. I have never felt so intimately and deeply cared for in all my life. It was an incredible experience. Other surprises and notes from my birth: Someones hands were on me during just about every moment of labor: deep tissue massage was a surprise hit. It made me feel strong and in control. I was so calm and relaxed that my midwife didnt really believe I was in active labor. I had my eyes closed almost the entire time. I was really, really in my own mind and body. I sang along to English Village Christmas Carols. Loudly. At some point in time, while laboring in the tub, I had a crying/sobbing breakdown. I felt like Id had enough of being out of control of my body, and was exhausted from dealing with each new contraction. My midwife assured me that the crying was a pathway for getting out of my head and into my body. To cement the movement from mind to body, she told me to make low ooh sounds. So I did. If I hadnt yet, at that point, I stopped caring about what anyone would think of me making these sounds and did what she said. (Hey, I was just doing what she said its not like it was my crazy idea.) It focused my attention on my breath and my voice, and off the intensity of the contractions. I knew transition was coming. I started to feel disoriented. I said, This is the part where I say Im not sure if I can do this anymore. I asked my midwife to talk about what was going on. She said we needed to let the baby come down in the pelvis, let him get lower and put more pressure on my cervix, and open me more. She suggested I say the words down and open low and loud. So I did. I actually felt the baby slip down further in my pelvis. That was a crazy, crazy feeling. Kegels paid off: they called me a pushing rock star. After the birth, I felt exhausted and exhilarated and deeply, deeply satisfied.

PART 4: Bottom Line

I think the thing I say about birth that is most surprising to others is this: If I could go through labor and delivery again without having to take care of that pesky baby at the end I would do it in a heartbeat. It was an honor and a privilege to experience the miracle machine that is a womans body in action. And an amazing, fantastical, surreal, deep, spiritual, transformative experience. Maybe like Burning Man. Or a triathalon (which Im far less likely to participate in than Burning Man). So as that dude in that movie Memento keeps saying, dont believe their lies. And by lies, I mean all those well-meaning ladies who want to tell you in excruciating detail about their birthing bad news. Or our American culture around birth that tells you anyone who wants to go drug-free is a masochist or has something to prove. I say birthing naturally is an amazing a big deal. So let it be an amazing big deal.

Even women who are exquisitely well-prepared can have really tough births. And ultimately, the way a baby comes into the world is out of everyones control. But by doing your mental preparation homework (its never too soon or too late to start); working through your fears and anxiety; and building a pain-coping plan that works for you, I think youll have a satisfying birth experience no matter what happens on your birth day.

PART 5: Resources I Loved

Here is a list of the resources I used and loved. I did not necessarily connect with every word of each of them, and I did not use any one methodology. But each of these resources was a part of getting me where I wanted and needed to be. (In addition to these resources, I also had my midwife, doula, husband, and friends who had natural births. Building yourself a supportive, optimistic, awesome group of folks is a really, really, really good idea.)

Ina Mays Guide To Childbirth, Ina May Gaskin Birthing From Within, Pam England, Rob Horowitz The Thinking Womans Guide to a Better Birth, Henci Goer The Business of Being Born (film) The Birth Book: Everything You Need to Know to Have a Safe and Satisfying Birth, William and Martha Sears HypnoBirthing: The Mongan Method: A natural approach to a safe, easier, more comfortable birthing, Marie Mongan Coping with "Pain" in Labor, Breith thas (online only: http://www.birthingjoy.net/resources/nopain.html) VBAC Companion, Diana Korte (Note: at the time Im writing this, it doesnt look like there is an updated version of
this book; online resources or other books may be a better bet at this point in time.) The Blue Jays Dance: A Birth Year, Louise Erdrich Mothering the New Mother: Women's Feelings & Needs After Childbirth, A Support and Resource Guide, Sally Placksin

Resources I Definitely Would Have Checked Out These were either not published in 2008 when my son was born, or I didnt know about them at the time.

Birth Matters: A Midwife's Manifesta, Ina May Gaskin Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience, Ricki Lake, Abby Epstein Orgasmic Birth: Your Guide to a Safe, Satisfying, and Pleasurable Birth Experience, Elizabeth Davis, Debra PascaliBonaro

About the Author Jessica Poundstone is a writer, mother, reader, jewelry designer, and a whole bunch of other stuff. She gets all riled up about birth choices, respectful parenting, public health and healthcare delivery issues, and building strong communication skills for kids and grown-ups. She lives in Portland, Oregon with her husband, Ben, and her kids, Sophie and Henry.

Copyright Jessica Poundstone, 2011. Feel free to post, pass around or otherwise spread the word! Just keep the copyright notice on there and Id love it if you let me know! Im excited to hear how this info might get spread around! Be in touch at jpoundstone@gmail.com.