TRYING TO GET PREGNANT: 14 FERTILITY MYTHS DEBUNKED

Posted in Health by woman2womenblog

We live in the era of informatics. Knowledge is easily accessible to us: we can learn virtually anything by just googling it. But paradoxically too much information many times leads to misinformation.

When it comes to fertility issues, there is a lot of disinformation going around. Therefore, it is no surprising what a recent survey showed: knowledge regarding ovulation, fertility, and conception issues is limited among women, and many tend to believe certain myths and misconceptions.

These are 14 fertility myths most people believe, but that science has debunked:

MYTH #1. Maternity wise, 40s is the new 30s

Our life expectancy is longer, and we tend to postpone maternity due to career or study purposes. From that aspect, the 40s can be easily regarded as the new 30s. Unfortunately, this is not true for our ovaries: by the age of 30, a healthy woman has about a 20% chance of conceiving each month, by the time she reaches 40 her odds drop to about 5%.

This is one of the most commonly believed misconceptions: unaware of the age-related fertility decline, many women start seeking help to conceive in their 40s, when they may have already missed the opportunity to become parents.

You should be aware that there is a biological clock, and it’s ticking! If for personal reasons you cannot have a child right now, you may freeze your eggs to use them in the future.

MYTH #2. Certain sex positions increase the chances of getting pregnant

You will find plenty of (mis)information on this topic! In general, it is said that the best positions for getting pregnant are the missionary position (the woman lying on her back, her partner on top) and the “doggy position” (rear vaginal penetration, with the woman on her hands and knees) because they provide the deepest penetration, allowing the man to ejaculate closer to the opening of the cervix.

In fact, there’s no scientific evidence to prove that. This belief is largely based on a single study that looked at the position of the penis in relation to these two sex positions, but it didn’t address pregnancy chances at all.

Therefore, no position seems to be better when it comes to maximizing your chances of making a baby. Sperm can be found in the cervical canal just a few seconds after ejaculation, and within 5 minutes in the tube, regardless of the coital position.

MYTH #3. Lifting your legs in the air for 20 minutes after having sex will help you get pregnant

You have probably heard this one: “lie in bed with your feet in the air after having sex to increase your chances of getting pregnant”. In fact, this is not (totally) true. You may lay in bed for 10-15 minutes after intercourse, as by this time the sperm have largely reached the cervix, and many may even be inside the tube.

In fact, a new study challenged both beliefs: women having artificial insemination were split into two groups – one that rested on their back with their knees raised for 15 minutes after the procedure and one that got up immediately. It turned out that, after several courses of treatment, 32% of the immobile group fell pregnant, compared with 40% per cent in the active group.

Therefore, there is no need to put pillows under your bottom during intercourse to get an advantageous tilt, or to perform cycling motions with your feet in the air.

MYTH #4. If we have sex every day the sperm becomes too weak, reducing our chances of getting pregnant

How often should we make love to boost our chances of pregnancy? You will find all sorts of advice on the web: every other day, 3 times a week, every single day! Which one is correct?

One thing is clear: abstinence intervals greater than 5 days impair the sperm number and quality. Nevertheless, there is not much difference whether men ejaculate every day or every other day. Most fertility specialists used to recommend intercourse every other day, as this would increase sperm quality, particularly in men with lower sperm counts (oligozoospermia). However, recent studies show exactly the opposite: oligozoospermic men had better semen quality with daily ejaculation!

Recent scientific evidence suggests that making love every day confers a slight advantage: the highest chances of pregnancy (37% per cycle) were associated with daily intercourse, although sex on alternate days had comparable pregnancy rates (33%). On the other hand, we should keep in mind that the “obligation” to have sex every day may induce unnecessary stress to the couple, resulting in lack of sexual desire, low self esteem, and ultimately reduced frequency of intercourse.

Therefore, reproductive efficiency is highest when you have sex every day or every other day. The optimal frequency, though, is best defined by each couple’s own preference.

MYTH # 5. We only have sex when I ovulate, on day 14 of my cycle

Ovulation (when the egg drops from the ovary into the tubes) occurs once a month, usually between day 11 and day 21 of the cycle (measured from the first day of your period).

Each woman ovulates on her own schedule. While it is usually said that a woman with a 28-day cycle ovulates on cycle day 14, that’s not necessarily true: a study found that fewer than 10 percent of women with regular, 28-day cycles were ovulating on day 14.

We know that sperm cells are able to survive in the reproductive tract of a woman for about 5 days, and that once the egg is released, it will die in about 12-24 hours. Therefore, the fertile period -or “fertile window”- is a 6-day interval ending on the day of ovulation.

To boost your odds to become pregnant, have sex before and during ovulation, every day or every other day. If your cycles are irregular and you cannot figure out your fertile days, you may use an ovulation predictor kit, or otherwise visit a specialist, who can help you find your fertile window.

MYTH # 6. Smoking doesn’t affect our chances of getting pregnant. I will quit smoking as soon as I get pregnant

You are most likely aware that smoking during pregnancy is dangerous, as it can lead to miscarriage, premature birth, low-birthweight babies and -according to recent studies– congenital malformations.

But you should also know that smoking is harmful for your fertility: smoking as few as five cigarettes per day is associated with reduced fertility, both in women and men, and this seems to be true even for secondhand smoking. It has been estimated that smokers may have a 10-40% lower monthly fecundity (fertility) rate, and that up to 13% of infertility is due to smoking.

Smoking can affect ovulation, as well as the ability of the fertilized egg to implant in the uterus. The effect of tobacco is so harmful for the ovaries that menopause occurs, on average, one to four years earlier in smoking women than in nonsmoking ones.

Men are also affected by tobacco: decreases in sperm density, motility, and abnormalities in sperm morphology have been observed in men who smoke, which impact a man’s ability to fertilize an egg.

Therefore, before trying for a baby, do yourself a favor … and put out the cigarette for good!

MYTH # 7. You don’t need to worry about your age. There’s always IVF

Another common misconception! Many women believe that, if age-related infertility strikes, they can overcome their problem by getting treated with in vitro fertilization (IVF). In fact, just as natural fertility declines with age, success rates with IVF also decline as a woman gets older.

According to the USA Center for Disease Control and Prevention (CDC), women younger than 35 years old have 33% chances of having a baby after IVF; for women ages 38 to 40 the success rate drops to 17%, while those 43 to 44 years old have only 3% chances of giving birth after IVF (using their own eggs).

IVF is not a guarantee to have a baby, and does not extend a woman’s reproductive life. Despite the number of celebrities having babies in their mid-40s and beyond, they may have not necessarily used their own eggs. While every woman has the right to keep her privacy, there is a wrong perception left that fertility treatments can extend a woman’s fertility span. There is a very low probability of improving success of conceiving after age 43 by using assisted reproduction using your own eggs. Nevertheless, you may opt to use oocyte donation (eggs of a younger woman) if age-related infertility stands in the way of parenthood.

MYTH # 8. A woman can’t get pregnant if she doesn’t have an orgasm

For men, things are clear: no orgasm, no pregnancy, as ejaculation occurs during orgasm. Well, that’s not entirely true: semen can be released during intercourse prior to orgasm in the so-called pre-ejaculation fluid, or pre-come (read more here).

For women though, getting pregnant has nothing to do with an orgasm. But could female orgasm improve the chances for conception? The answer is not clear.

Researchers have wondered for years about the purpose of female orgasm, and many theories have been proposed:

Just the pleasure it provokes, so that women want to reproduce and preserve the species!
The “poleaxe” hypothesis: orgasms make women feel relaxed and sleepy so that they will lie down after sex and the sperm reach their destination more easily.
The “upsuck” theory: the contractions of the uterus “suck up” the sperm released in the vagina and help them travel through the uterus to the tubes.
Pair bonding: the hormones produced during orgasm (such as oxytocin and prolactin) contribute to warm feelings towards her partner.

Orgasms are not necessary to get pregnant, but there are plenty of good reasons to have one! Nevertheless, it is not uncommon that women trying to conceive link the desire for an orgasm with their desire to have a baby; this leads to psychological pressure and difficulty achieving orgasm, adding frustration to a process that is supposed to be pleasurable…

Try not to consider the orgasm just as goal to get pregnant. Enjoy the intimate time with your partner, without any pressure. If you have an orgasm, great. If not, that’s fine, too!

MYTH #9. We’ve already had one child, so conceiving again will be easy

Perhaps, but it’s no guarantee. Many individuals experience secondary infertility, or difficulty conceiving a second or subsequent child.

Secondary infertility may be caused by age-related factors, both for you and your partner. Sometimes, a new underlying medical condition develops. Eventually, a fertility issue that always existed gets worse; while it didn’t prevent pregnancy before, now it has become a problem. A previous pregnancy may actually be the reason you don’t get pregnant again: surgical complications or infection after childbirth may have provoked scarring, which may in turn led to infertility.

Things change with time. Even if you got easily pregnant on your own before, if you’re struggling to have another child talk to your doctor, who can advice you on the next steps to follow.

MYTH #10. Infertility is a woman’s issue

Typically, the causes of infertility break down like this:

Approximately one third of the couples struggle with male infertility;
In another third, the problem is female infertility;
The remaining third will either face both male and female fertility issues, or a cause will never be found (unexplained infertility).

Common causes of female infertily are: age, PCOS (polycystic ovary syndrome), tubal or pelvic issues, endometriosis, and family history.

Common causes of male infertility tend to be from prior surgery, infection, or a problem present at birth.

As part of the preliminary work-up to determine the cause and treatment of infertility, both women and men will need to undergo clinical and specialized complementary exams.

MYTH #11. Men’s age doesn’t matter

While some men can father children into their 50’s or 60’s, men’s fertility isn’t age-proof: it starts declining in their 40s, although less drastically as compared to women’s fertility.

As a man ages, the concentration of mobile, healthy sperm and semen volume overall will decrease. It is clear now that men over the age of 40 have higher chances of having children with chromosomal abnormalities, causing miscarriages in their female partners. Moreover, researchers have found a direct link between paternal age and an increased risk of autism and schizophrenia.

A man’s age does matter. While men may not have a complete drop off in fertility like women do, “advanced paternal age” is something couples should be aware of. Men’s biological clock is also ticking!

MYTH #12. If I take good care of my general health, my fertility will be in check too

Whereas a healthy body and mind may boost fertility in certain cases, most infertility situations cannot be resolved by a lifestyle or diet change, particularly those related to age.

It is a common belief that certain diet types can help you get pregnant. There is no evidence that vegetarian diets, low-fat diets, antioxidant- or vitamin-enriched diets will increase your chances of having a child.

A woman’s weight plays a role in fertility: those who are either very thin or obese may find it hard to conceive. If you are trying to get pregnant, learn more about some lifestyle tips to boost your chances of getting pregnant here.

MYTH #13. If a man can ejaculate, his fertility is fine

Many myths surround male fertility and their sexual performance. It is a common (and unfortunate) myth that if a man’s fertility is compromised, this means his sexual performance is the problem. This is not true. Problems with sperm count, shape, and movement are the primary causes of male infertility.

Another common myth is that you can tell there is a problem with the sperm just by looking at the semen. In fact, even men that have no sperm cells at all (azoospermia) usually have normal-looking semen.

For the vast majority of men with infertility, there are no visible or obvious signs that anything is wrong. Healthy erectile function and normal ejaculation are not guarantee that the sperm is in good shape.

That said, erectile dysfunction can be a possible symptom of infertility; it may due to low testosterone levels or a physical injury. Difficulty with ejaculation can also be a signal certain medical problems. But these are uncommon signs of male infertility.

If you are struggling to get pregnant, have your partner check in with his doctor. A semen analysis will help clarify whether his sperm are fit for conception.

MYTH #14. The birth control pill will affect your future fertility

All scientific evidence agrees that hormonal contraceptives do not make women sterile. Moreover, they may confer increased likelihood of pregnancy with long-term use, and in certain cases they can also preserve fertility. Read more on the contraceptive pill here.

To summarize:

Myths and misconceptions regarding fertility and conception are, unfortunately, widely disseminated. This is a serious problem, as misinformation may lead not only to unnecessary stress, but also to take wrong decisions…

Get yourself well informed! Consult your gynecologist, who can help you with any concerns you have. Your doctor can also give you some tips on lifestyle changes to optimize your fertility, prescribe some exams, and tell you when to come back if you don’t achieve pregnancy on your own.

Last, a good piece of advice: if you want to get pregnant, have lots of sex – as much as you want, whenever you want – and enjoy it! After you have had sex, do whatever you want – just don’t smoke 😉

Photo credits

Intro: pixabay.com; 1: rma-fl.com; 2: motherandbaby.co.uk; 3: romper.com; 4: pixabay.com; 5: wsaw.com; 6: babycenter.com; 7: nexter.org; 8: irishtimes.com; 9: health.clevelandclinic.org; 10: thefertilechickonline.com; 11: businessinsider.com; 12: hayatouki.com; 13: livescience.com; 14: pinterest.com

9Oct2018

VAGINAL BIRTH AFTER CESAREAN SECTION (VBAC): ALL YOU NEED TO KNOW BEFORE MAKING YOUR EDUCATED CHOICE

Posted in Health by woman2womenblog

“Once a Cesarean, always a Cesarean” has been the standard recommendation for many years. But the increasingly high cesarean section (C-section) rates around the world have led doctors to reassess the risks of a cesarean section versus delivering vaginally after having a previous C-section.

Repeat C-section or VBAC? The answer is not straightforward. Both options do come with some risks, and those risks vary depending on the woman and the specific pregnancy.

Here’s what you need to know about a vaginal birth after cesarean section and what you should discuss with your doctor if you want to try delivering your next baby vaginally.

1) What is a vaginal birth after cesarean delivery (VBAC)?

If you’re pregnant again and your last baby was born via cesarean section, this time you have two choices about how to give birth:

an elective repeat caesarean section (ERCS), or
a VBAC. “VBAC” stands for “vaginal birth after cesarean” and refers to giving birth through the vagina after a woman has already had a C-section. Vaginal birth also includes deliveries assisted by forceps or ventouse.

Planning for a vaginal birth after caesarean (VBAC) or choosing an ERCS have different benefits and risks (see below).

A TOLAC (trial of labor after cesarean delivery) is the attempt to have a VBAC. If it is successful, TOLAC results in a vaginal birth. If it is not successful, you will need another cesarean delivery.

2) What are my chances of giving birth vaginally after having a C-section?

As long as you are an appropriate candidate for a VBAC, there are good chances to succeed: about 60 to 80% of women who attempt a VBAC will deliver vaginally.

There are certain factors which affect the chances of success, both related to the mother and the baby (see below). Nevertheless, it’s impossible to predict with certainty who will be able to have a vaginal delivery and who will end up with a repeat c-section.

A previous vaginal delivery, particularly previous VBAC, is the single best predictor of successful VBAC and is associated with a VBAC success rate of 85–90%.

3) Am I a good candidate for a VBAC?

Planned VBAC is appropriate for the majority of women who:

are pregnant with one fetus (as opposed to twins/multiples),
their baby is positioned head down (cephalic presentation),
have a pregnancy at term (37+0 weeks or beyond),
have had one previous lower segment caesarean delivery.

4) When is VBAC contraindicated?

Planned VBAC is strongly discouraged in the following cases:

Three or more previous caesarean deliveries. See below in case you have two previous C-sections.
The uterus has ruptured during a previous labor, as this increases considerably your risk (7 times higher) of a recurrent uterine rupture with the next pregnancy.
The previous caesarean section was “classical”. In the vast majority of women, the uterus is cut horizontally, in its lower segment. This is called a low-transverse uterine incision. Rarely, a vertical incision in the upper uterus is required, this is known as a “classical” incision. Occasionally, a J- or T-shaped cut is performed. In both cases of vertical and J/T-shaped incision there is higher risk for uterine rupture. Therefore, it is very important to know which incision was performed in your previous C-section. You should note that the type of scar on your skin does not necessarily match the one on your uterus.
A previous uterine surgery, such as fibroid removal (myomectomy), as this increases the risk of uterine rupture.
There is other pregnancy complications that requires a C-section.There are certain absolute contraindications to vaginal birth that apply irrespective of the presence or absence of a scar (e.g. placenta previa)
Breech presentation (the baby comes with buttocks and/or feet first) or other abnormal presentations.
Multiple pregnancies (twins or more).

5) What factors reduce my changes of having a successful VBAC?

In general, the chances of success are lower in the following situations:

The reason for the previous c-section is likely to be problem this time around. Let’s say that a woman who already had a vaginal delivery and then had a c-section because her baby was breech (buttocks or feet first) is much more likely to have a successful VBAC than one who had a previous c-section after achieving full dilation and pushing for three hours, which may signal a narrow basin.
Labor is induced (did not start spontaneously).
You are older than 40 years old.
You are overweight.
The baby is big (over 4,000 grams estimated weight, or 8.8 pounds).
Advanced gestational age at delivery (more than 40 weeks).
Having a short time between pregnancies (less than 19 months).
You have preeclampsia (high blood pressure) at the time of delivery.

You should discuss with your practitioner about your individual chance of success and carefully weigh the benefits and the risks.

6) What are the benefits of a VBAC?

C-section is a major abdominal surgery, and as such is associated with certain increased risks as opposed to a vaginal birth. Therefore, a successful VBAC entails:

Shorter recovery period
Less post-partum pain.
Lower risk of infection.
Less blood loss, reduced need for a blood transfusion.
Less chances of needing an emergency hysterectomy (uterine removal).
Lower likelihood of damaging other organs (bladder and bowel).
Lower risk of developing a blood clot (thrombosis) in the legs (deep vein thrombosis) or lungs (pulmonary embolism).
Reduced risk of pelvic adhesions (internal scar tissue that forms between the organs, which may be responsible for chronic pain, infertility or intestinal obstruction).
Decreased chances of breathing problems for your baby. About 4-5% of babies born by planned C-section have breathing problems, compared with 2-3% following VBAC; the risk is slightly higher if you have a planned caesarean section earlier than 39 weeks. In fact, breathing problems are quite common after caesarean delivery, but usually do not last long.
Many women would like to have the experience of vaginal birth, and when successful, VBAC allows this to happen.

If you plan to have more children, VBAC may help you avoid certain health problems linked to multiple cesarean deliveries. In fact, C-section complications, such as haemorrhage, emergency hysterectomy, bowel or bladder injury, adhesion formations are all higher with the increased number of cesarean deliveries. Moreover, every C-section you have raises your risk in future pregnancies of placenta complications, such as placenta previa (the placenta lyes low and covers the cervix) and placenta accreta (the placenta implants too deeply and doesn’t separate properly at delivery). Both conditions can result in life-threatening bleeding and a hysterectomy. If you know that you want more children, this may figure into your decision.

7) What are the risks of a VBAC?

One of the most feared complications of a VBAC is the possibility of uterine rupture, that is, the scar of the uterus tears or separates. Even if you’re a good candidate for a VBAC, there is a 0.7% risk (that is, 7 out of 1000 woman undergoing a VBAC) that your uterus will rupture at the site of your C-section incision. If this happens, it may result in severe blood loss for you, eventually life-threatening, and possibly oxygen deprivation for your baby, which may result in brain damage (in 8 out of 10,000 cases) or even death (in 2-3 out of 10,000 cases). While this risk is very small overall, it is higher as compared to a scheduled C-section.
Regardless of uterine rupture, VBAC carries in increased risk of long-term neurological damage or even death. Again, the risk is very small, but is higher in women who undergo an unsuccessful VBAC than in women who have a successful vaginal delivery or a scheduled C-section.
If you end up being unable to deliver vaginally, you could endure hours of labor only to have an unplanned C-section. This may be very frustrating for certain women, as their expectations for a vaginal birth are not fulfilled.
You may need an assisted vaginal birth using ventouse or forceps, which may lead to increased risk of having a tear involving the muscle that controls the anus or rectum (third or fourth degree tear).
You may need to have an emergency C-section during labour. This happens in 25% of women. An emergency cesarean carries more risks than a planned C-section. The most common reasons for an emergency caesarean section are if your labour slows or if there is a concern for the wellbeing of your baby.

You should note that while a successful VBAC is less risky than a scheduled repeat C-section, an unsuccessful VBAC requiring a C-section after the onset of labor carries more risk than a scheduled C-section. And the risk of complications is even higher if you end up needing an emergency cesarean.

8) Can I have a VBAC if I have two prior C-sections?

According to the American (ACOG) and British (RCOG) guidelines, women who have had two prior lower segment caesarean deliveries may be offered VBAC after careful counselling. Nonetheless, they should be aware that the risk of uterine rupture is increased up to 5 times (0,9 to 3,7%).

VBAC after 2 previous C-sections is highly controversial, and may not be acceptable for certain physicians or institutions.

9) What to expect during a VBAC

VBAC should take place in a hospital or maternity that can manage situations that threaten the life of the woman or her fetus, and should NOT be attempted at home.
You should meet all the criteria, and have none of the contraindications for VBAC above-mentioned.
Factors that may reduce or increase the likelihood of success will be thoroughly discussed, and are different for each woman and each pregnancy.
Best candidates for VBAC are those women whose labor starts spontaneously, as induced labor (started with drugs or other methods) reduces the chances of a successful vaginal delivery and carries 3 times higher risk of complications.
You will be advised to present yourself at the hospital at the earliest sign of labour for careful assessment.
Your baby’s heartbeat will be monitored continuously during labour; this is to ensure your baby’s wellbeing, since changes in the heartbeat pattern can be an early sign of problems with your previous caesarean scar.
An intravenous (IV) line is indispensable in order to promptly manage any eventual complication.
You’ll have to refrain from eating anything during labor in case you require an emergency c-section later.
You can choose various options for pain relief, including an epidural.
The following signs may be indicators of uterine rupture, and warrant an emergency C-section:
- Persistent fetal bradycardia (the baby’s heart rate drops; this is the commonest sign of uterine rupture).
- Vaginal bleeding.
- Uterine scar tenderness.
- Pain between contractions.
- Cessation of contractions.
- Pain “breaking through” the epidural analgesia, or excessive epidural requirements.
- Palpation of fetal parts outside the uterus.
- Haematuria (blood in the urine).

It is important that you understand that uterine scar rupture may be silent, and that even an emergency C-section may not prevent serious complications, both for you and your baby.

In conclusion:

Successful VBAC has the fewest complications.
The greatest risk of adverse outcomes associated with VBAC occurs when a VBAC results in an emergency caesarean section.
It is often impossible to predict who will be able to have a successful VBAC and who require a repeat C-section.
Spontaneous (not induced) VBAC has a 1:150 risk of uterine rupture.
Uterine rupture is a rare but potentially life-threatening condition, both for the mother and her baby.
Even an immediate emergency C-section may not prevent serious complications, both for the mother and her baby.
The absolute risk of severe fetal problems and death associated with VBAC are very low, but higher than for planned C-section.
Babies born via planned C-section have increased risk of neonatal respiratory problems, which are usually short-lived.
Planned C-section is associated with an increased risk of placenta praevia/accreta complicating any future pregnancies; other complications such as pelvic adhesions are higher as the number of C-sections increases.

VBACs are controversial, and it may be challenging to decide whether is the best choice for you. Find a practitioner willing to support VBAC, discuss with him/her your options. Give yourself plenty of time to inform yourself and consider carefully the pros and cons of each option.

References

The American College of Obstetricians and Gynecologists (ACOG) – Vaginal Birth After Cesarean Delivery FAQ 070, December 2017 (For patients)
ACOG Practice Bulletin Number 184 – Vaginal Birth After Cesarean Delivery, November 2017
Royal College of Obstetricians & Gynaecologists (RCOG) – Birth options after previous caesarean section – July 2016 (For patients)
Royal College of Obstetricians & Gynaecologists (RCOG) – Birth After Previous Caesarean Birth – Green-top Guideline No. 45, October 2015
National Health System (NHS) UK – Clinical Guideline for: The Management of Vaginal Birth After Caesarean (VBAC). July 2016

Photo credits

1.Parents.com; 2.EvolutionaryParenting.com; 3.goldengateobgyn.org; 4.Healthymummy.com; 5.YouTube.com; 6.Scarymummy.com; 7.geoscripts.meredith.services

21Jul2015

MY NATURAL HOSPITAL BIRTH STORY

Posted in Health, Inspire me, Pregnancy by woman2womenblog

Wonderful. Empowering. Overwhelming. It is difficult to find a word to describe the experience of a vaginal birth. As a mother -who went through this experience- and obstetrician, even after having delivered thousands of babies, I can’t help but admire every single time the beauty of a vaginal birth, it always feels to me like a perfectly designed choreography…

But the fact that something is natural doesn’t mean that is devoid of risks or complications. Thus, a hospital natural birth allows a woman to deliver with minimum intervention, while assuring peace of mind in case something goes wrong. And believe me, sometimes things DO go wrong, and then we may have just a few minutes to save the mother or the baby…

True, hospitals can sometimes interfere with the process of a natural birth: measures such as fetal monitoring or the IV line are usually non-negotiable requirements for a hospital birth, but they can be invaluable, even life-saving in case an emergency ensues.

A natural, unmedicated hospital birth IS possible, it’s just a matter of having a motivated mom and a supportive team…

Here, KM shares her experience of a natural birth at a hospital and provides some tips to overcome the obstacles that may present in the process…

My Natural Hospital Birth: Overcoming obstacles to get to the birth I had

“I gave birth without pain relief and I consider my fifteen hours of labour as some of my best. My husband turned ace birth partner – a nice surprise, and a lucky one considering we opted not to hire a midwife or doula. We swayed to Don Carlos’s Rivers of Babylon and Simon and Garfunkel’s I am a Rock, among other soothing tunes in our Labour Chill Mix; moo-ed like cows; and got tennis balls rolling on my back. The first ten hours at home and en route to the hospital felt like a date: laughter, teamwork, watermelon juice (it was August, we live in Greece)… and some manageable pain thrown in to rally against together.

What I found least pleasant about my birth experience wasn’t the pain. It was the hospital admittance process keeping my husband and me apart and waiting. The hospitals I know prioritise hospital practicalities and legal self-protection over emotional wellbeing. Routine procedures like the IV are designed to allow quick and easy access to medical intervention, not for soothing pregnant women to “open up and let the baby out”. We didn’t expect the hospital setting to encourage natural birth, so we worked with my obstetrician ahead of time to overcome the obstacles we could predict.

Having read Birthing from Within and Ina May’s Guide to Childbirth (one of these suggests moo-ing like a cow to relax and open the cervix), attended birthing classes at Eutokia and Babycenter’s online birthing course, we were convinced that the less unnecessary medical intervention the better for both mom and baby. Avoiding unnecessary intervention seems like common sense, but as my obstetrician reminded us: common sense is not so common. We prepared for birth in the country with the highest rate (at 70%) of caesarean births in the world, a Human Rights in Childbirth case study.

Here is what was at stake at the hospital and how we managed each concern:

A. My rights over my body – My obstetrician kept me informed of my choices throughout. Her track record in vaginal births, willingness to explain our options, welcoming attitude to our attempts to be informed all set the stage for mutual respect. When she suggested interventions, we agreed. I had a membrane sweep a day before my due date and had my waters broken when I was about 8cm dilated.

B. My responsibility towards my baby – Protecting my birth experience felt like a first success at parenting. The memory still provides a deep well of confidence that we draw from in the endurance sport of parenting.

C. Recovery time – I was able to walk to the toilet by myself after the birth, and to walk to the nurse’s desk to ask for my baby back.

D. Breastfeeding success – I chose to room in with my baby and I enforced this choice by asking for my baby back. Even though we were “rooming-in”, our baby spent a lot of time out of our sight. My obstetrician informed the hospital staff that I was interested in exclusive breastfeeding and asked that they not to offer formula or water. Leaving the hospital after 24 hours ensured that any accidental feeds during the baby’s long absences from rooming in didn’t sabotage my breastfeeding goals.

E. The opportunity to bond with baby – My obstetrician did her best to remove unnecessary separations between us and our new baby. She arranged some alone time for the three of us before the hospital’s priorities took over again after the birth. She also signed off on our “early” release at 24 hours.

Eight tips to having a natural birth in hospital:

Learn about what you can expect. We had read about the “I don’t think I can do this” moment getting through the last couple of centimetres. Knowing about this ahead of time kept us calm and later we laughed in recognition of the predictability of it. Just because childbirth (and breastfeeding, for that matter) is natural, it doesn’t mean that it comes easily or without need for knowledge.
Be vigilant about what you want and get your birthing team on the same page. My husband and I wrote our birth wishes down (see below) and talked them over with each other, our obstetrician and the hospital staff until we reached a version that was more realistic. The process of writing this one pager was invaluable – it helped us become more informed and helped us mentally prepare for what success could look like.
Arrive at the hospital late. On our obstetrician’s advice, we didn’t leave our home until after my contractions were about three minutes apart, ten hours into labour. I credit my obstetrician with sharing this advice, but I imagine that the advice she is able to give varies based on how informed a couple is.
Make yourself at home in the hospital. We dimmed the lights, brought music and admittedly a small suitcase full of other personal touches we didn’t end up using. It turned out that I was focused inward much of the time in the later stages of labour at the hospital and my husband and music were all I needed to feel relaxed. I still claim that having the little suitcase of other supplies was comforting.
Have at least one champion who will be vocal about what you want. There came a time when I was in another zone and talking was difficult. I was lucky to have both my husband and obstetrician fend off well-meaning nurses offering an epidural too late into my labour, when it was tempting but would have been counter productive. I later roomed with a mom who was given such a late epidural, essentially sabotaging her natural birth efforts after having done most of the hard work.
Rooming in – ask for your baby back! In my experience “rooming in” babies seem to spend a surprising amount of time in some auditorium that parents aren’t allowed even to look into. They are not returned after their individual checks are done but when they are all done, unless you ask.
Ask for the advice you need to care for your baby yourself – how to change a nappy, how to hold the baby to wash away poop, how to help baby latch onto nipple, how to breastfeed lying down. Many of these are much easier to learn with guided practice rather than through books. I noticed that hospital staff are used to parents who are content to let them handle the baby, but who miss out on learning while in the hospital.
Get out as soon as possible, unless you find the hospital setting a rest from home (my obstetrician suggested I keep an open mind about this since the hospital can be a nice break when there are other children waiting at home). I gave birth at the only Greek hospital at the time that allowed exit after 24 hours, assuming all is well. We fought for our exit and the two couples we roomed with decided to do the same. We were much more relaxed at home and I could stop demanding for my baby back.

The husband adds:

Preparation was key to having an excellent birth experience. To support my wife, it was important to be involved, not just by being present for the labour but at an early stage. Reading the books Katerina mentions, Birthing from Within and Ina May’s Guide to Childbirth, were critical to understanding exactly what was going on – and what to expect — at all of the stages of labour, and how panic can cause the process to go into reverse. Doing my homework beforehand allowed me to remain calm and focused. Being involved also created a sense of shared endeavour with Katerina, an important bond necessary for fostering the feelings of trust and safety between us during the labour.

One more thing: if you’re a birth partner, and you have any feelings of self-consciousness about not behaving “seriously” during the labour, get over them. The books were full of useful tips about what to do in specific situations to help Katerina overcome fears and relieve tensions that commonly crop up. If she was going to open up her whole body to let a human out, mooing like a cow was a small ask for me.

BIRTH WISHES

KM & MB

Due date: Sunday, 11 August 2013

Baby details: Our first, a girl, we intend to name her CLLB

Obstetrician: Dr. Liliana Colombero

We are open to any intervention that Dr. Colombero judges is necessary for the safety of mom and baby. We ask that, outside of an emergency, we are informed before any procedures and be allowed to ask questions about the pros and cons. We are aware that things can change suddenly. Below is our best case scenario, as we imagine it today, 9 August 2013. Thank you for taking the time to read our birth wishes.

HOSPITAL ADMISSION & PROCEDURES

Once I’m admitted, I’d like to:

Prep

Opt out of being shaved, assuming I’ve shaved myself already.
Opt out of the enema, assuming my system has emptied out ahead of time on its own.
Have a heparin lock instead of routine IV, assuming I’m not going for an epidural or c-section.

Environment

Listen to music and limit outside noise.
Dim the lights when visibility isn’t important.
Drink water, or other clear fluids.

LABORING AND BIRTH

As long as the baby and I are doing fine, I’d like to:

Avoid a cesarean.
Avoid being induced with pitocin.
Try a membrane sweep before induction by pitocin.
Progress in labor without time limits.
Not be offered an epidural, unless I request it.

When it’s time to push, I’d like to:

Try different positions.
Try perineal massage or compress.
Push instinctively when I have the urge.
Get guidance about how to push during crowning to reduce the chances of perineal tearing.
Avoid an episiotomy, unless Dr. Colombero feels that tearing will be very extensive.

After birth, I’d like to:

Have the baby placed on my stomach immediately for skin-to-skin contact.
Hold off on the cutting of the umbilical cord until it stops throbbing.
Try to nurse immediately.
Wait for the placenta to be delivered in its own time, as much as possible.
Hold off on procedures (labelling, shots, tests) for an hour to allow for nursing and bonding.
Stay together during recovery with my husband and baby as long as possible.

IF CESAREAN IS REQUIRED

I would like to be conscious and have skin-to-skin contact with the baby as soon as possible.
Please use double-layer sutures to raise my chances of a VBAC in future.
I would like to stay together with my baby during recovery, and to breastfeed as soon as possible.

POSTPARTUM

While recovering, I’d like to:

Choose 24-hour rooming-in with our baby.
Have procedures on our baby done in our presence, as much as possible.
Breastfeed exclusively.
Speak to a lactation consultant as soon as possible.
Avoid baby formula, sugar water, or a pacifier being offered to my baby without my consent.
Go home as soon as possible, if all is well.”

Do you have any experience to share with us? You may help other women! Send us your story to woman2womenblog@gmail.com

Woman 2 women

Share. Inspire. Empower.

Tag Archives: maternity