When I tell pregnant friends I delivered all three of my babies without pain meds, most of them look at me as if I'm crazy: Why would anyone in her right mind pass up an epidural? Um, large needle to the spine? No thanks!
Turns out, ditching the drugs has advantages I didn't even know about. Women who get an epidural (as the majority giving birth vaginally in the U.S. do) have a greater incidence of risky interventions to get Baby out, such as vacuum extraction and delivery by forceps, or even a c-section, according to a recent study in National Vital Statistics Reports. An epidural can also mean short-lived but unsavory side effects for Mom, including low blood pressure, headache, and fever. Not exactly the warm and fuzzy feelings you want in those first moments with your newborn!
Recovery, too, can be smoother for those who go au natural. "These moms are up faster, feel better, and often experience less tearing and swelling," says Ryan Dickerson, M.D., an obstetrician in Baton Rouge. (Women who skip the meds instinctively push, rather than exerting when they are told, which mean less pushing -- and less tearing, Dr. Dickerson explains. Other reasons they stay more intact: They generally don't need equipment to get Baby out and they get vaginal exams to see how far labor has progressed.) And whether they end up with an epidural or not, patients who intend to forgo the drugs often make a more concerted effort during their pregnancy to eat right, exercise, and learn relaxation exercises that keep them feeling more in control during labor, Dr. Dickerson says.
Want to give it a go? Tap into these strategies from experts and moms who made it through without meds. Even if you do opt for the epidural (hey, we're not judging!), you can stay calmer and more comfortable till the anesthesiologist arrives.
They have more in common than huffing and puffing: Like long distance running, childbirth calls for energy and stamina. "You increase your chances for success [of natural birth] by being very physically fit," Dr. Dickerson says. You'll want to consider the 10 months of pregnancy your training period, and start preparing for labor early on by working out regularly, he says. Dr. Dickerson's prescription: 30 minutes of movement, seven days a week. Hit the elliptical machine or stationary bike and aim to get your heart rate up to 150 beats per minute and keep it there; lace up your sneaks and walk whenever you can. (However, if you were not physically fit before becoming pregnant, check with your doctor to come up with a safe cardio plan for you.) Flexibility, especially in your hips, will help you when it comes time to push, so stretching sessions are important too. Shoot for 30 minutes of prenatal yoga (either a video or a class) one or two days a week. Cautionary word to the wise: Your body produces relaxin in pregnancy, which makes you naturally flexible, so be careful not to overstretch or work yourself too hard.
Kate Clow, a mom of three in Chatham, New Jersey, credits her pregnancy workout routine for getting her through her third labor: "When I was at 10 centimeters and my midwife told me to push, I was like, This is it?!" says Clow. "It was night and day from the labors I had had with my two daughters." Her regimen: 45 minutes of jogging three days a week (she switched to walking at 20 weeks), plus strength-training once a week, which included push-ups and squats.
Exercise will also prevent you from gaining too much, which correlated with delivering a bigger baby. The larger the baby, the harder she'll be to get out, emphasizes Dr. Dickerson. Of course, following a healthy diet is also key. Pass the veggies, please!
It's designed to grow a baby for nine months and welcome her into the world. "The pelvis and vaginal tissues were built for delivery, the brain releases endorphins that help with pain, and the fetus has a soft spot on her head so it can mold to fit out of the birth canal," says Dr. Dickerson. What's more, "complications are the exception -- not the rule." So each time you look at your beach ball of a belly in the shower and start to panic over how that baby is going to squeeze out of there, repeat this mantra: Birth is a natural function. My body knows how to do it, just like it knows how to breathe. You were born to breed!
From my second trimester on, each night before falling asleep, I tensed and released various muscle groups while chanting a mantra that went like this: I am relaxing my forehead, I am releasing my forehead, I am relaxing my forehead. I am relaxing my nose, I am releasing my nose, I am relaxing my nose. I focused on each part of my body from head to toe, imagining melting each one into my mattress like a scoop of ice cream on a hot sidewalk. This exercise, called Progressive Relaxation, teaches you to isolate muscle groups, so you're aware of them during labor and can make sure they are limp and lax, says Julietta Appleton, certified childbirth educator, hypnotherapist, and labor doula in Bedford Corners, New York. "During labor you want all of your voluntary muscles -- like your jaw, shoulders, and back -- to let go so your blood supply is focused on your hard-working uterus." Practice releasing your muscles 15 minutes per day, says Appleton. They'll be more mellow when it's go-time.
One of the secrets to a natural childbirth is being able to relax in response to pain -- a tall order, we know. When you're afraid or in the throes of agonizing contractions, your body's reaction is to stiffen, which tends to exacerbate discomfort, explains Heidi Rinehart, M.D., an obstetrician in Keene, New Hampshire. Fear increases tension, which ups the agony. "When you're tense, some muscles are tightening and trying to hold the baby in, while the muscles in your uterus are tightening to try to push the baby out," says Dr. Rinehart. "The muscles are fighting with each other, which makes it hurt more."
If you can stay (somewhat!) relaxed in the face of strong contractions, you'll have less resistance to opening up for the baby to come out. One trick? Try an exercise called The Grip. "It simulates contractions and allows you to up your pain threshold," says Appleton. Lie down on your side with a pillow between your knees, and if you're in your third trimester, with one supporting your belly too; have your partner apply steady pressure to the muscle between your neck and shoulder for one minute. Focus on relaxing that muscle beneath your partner's gasp. Wait for the pressure to grow very strong before tapering off. The idea is to get used to relaxing your muscles rather than tensing them in response to pain. You are simulating pain so you can learn how to control your response to it. You can also try the space between your thumb and index finger, or an even more sensitive area, such as the Achilles tendon at the back of your ankle. At first the pain should be distracting and at worst very uncomfortable. Ronni Aronow, of Port Washington, New York, swears by this technique: "My husband and I practiced The Grip several times a week in the last month of pregnancy, and it helped me deliver my second and third babies naturally!" she says. Bonus: It can also prep you for any stressful situation, including a cranky baby.
Contrary to what you see in most movie birthing scenes, you don't have to be lying in a hospital bed to have a baby. In fact, many women are more inclined to squat during labor. "I was dead-set against it during my first delivery because it seemed so primitive," says one mom, who asked that we not use her name because she was embarrassed. "But after an hour and a half of pushing, my husband made me squat and the baby was born within 10 minutes. It works!" Squatting opens the pelvis and helps the baby get into the ideal birthing position (head down, face toward back, chin tucked in), explains Henry Dorn, M.D., an obstetrician in High Point, North Carolina. It's most effective if you've been practicing your squats throughout your pregnancy and building those muscles in your legs. (Yes, that exercise thing again.) It's safe to practice squatting throughout pregnancy as there's no evidence it can induce labor. "If your doctor tells you the baby is not in an optimal place in the last trimester," says Dr. Dorn, "try kneeling, sitting cross-legged, or perching on an exercise ball for as much of the day as possible." Or, open a door, hold onto the doorknobs on either side, and drop into a squat for one or two minutes with your knees wide apart. Pull yourself back up using the doorknobs. Deahdra-Lynn Atencio of Gilbert, Arizona, practiced something called Three-Stomp Squat, "where you take three large, high-knee, sumo-wrestler-style steps, and then squat," says the mom of four. "The steps have to be high and powerful. I'd squat on and off as I walked around the house."
When you arrive at the hospital, keep moving to stay comfortable. (If you're strapped to a monitor, you're bound to bed; ask ahead of time if your hospital allows intermittent fetal monitoring, which gives you the freedom to get up, or if they have telemetry, remote monitoring that allows a woman to walk the halls while monitored.) "Walk and stretch, sit on a birthing ball, and hop in and out of the birthing tub if it's available," says Dana Gossett, M.D., an ob-gyn at Northwestern Memorial Hospital in Chicago. And use a combo of gravity and hip movement to help the baby come down, advises Dr. Rinehart, who delivered two of her own three children naturally: "When you take the cork out of a wine bottle, you don't take it straight out, you jiggle it back and forth to get it to ease through," says Dr. Rinehart. "Movement of the hips, belly dancing, hula dancing, squatting, rocking, pelvic tilts and such help manuever the baby down and through to find the easiest path out of the mother," she says. Get shakin'!
The Transition phase, when the uterus is dilating from 7 to 10 centimeters and then it's time to push, is when most moms-to-be want to call it quits. Make sure your partner knows you'll need a good pep talk at this stage, says Dr. Dickerson. "When women hit that wall and ask for medication, I lean in close and whisper. 'This is absolutely normal, your body is doing what it's supposed to do, it's almost over.'" And how to deal with the notorious "ring of fire" at push time when you've opted out of their epidural? "I couldn't remember much of it after the nurse had me hold on to the bed sheet like I was water skiing," says Kristen Stults, of Anaheim, California, mom to Alexander, 5 months. "After that, he was out and I couldn't have been any happier!"
When is it time to utter those words? If you can't focus during contractions or relax between them, doctors agree it's probably a good idea to ask for pain meds, which at this point may help move things along. Your pelvic muscles can go into spasm mode if you aren't able to catch a breath between contractions, and then it's difficult for the baby to descend. An epidural, by relieving your pain, can let the pelvis do its job. Have an open mind: "If you reach the point where a natural labor is just not happening, you have to accept what's good for your child," Dr. Gossett. "The goal is a healthy baby."
How do doulas and daddies make a natural birth more bearable? Coaches share their secrets.
"I always pack a night light. Women birth best when given privacy, and low light goes a long way toward making her feel that. Within seconds of turning off the neon hospital lights and plugging in a small bulb, I can create a spa-like feeling for Mom." Amy Alexander, a doula in Baton Rouge, Louisiana
"I constantly suggested different positions in the early stages of my wife's labor. It kept her distracted from the pain and focused on an activity. Each time we moved, I told her we were getting closer to our baby's arrival." Chris Hadley, a dad Barrington, Rhode Island
"Don't ever let your wife think she's alone in this. Remind her you love her, and that this won't last forever. And remember, you're never quite sure what you can do until you have to do it!" Grant DiCianni, a dad in of Temecula, California
"I told her when each of her contractions was at 30 seconds. Most of her contractions didn't last longer than a minute, so 30 seconds was the peak, which is as difficult as that one would get." Mark Atencio, a dad in Gilbert, Arizona
Originally published in the May 2012 issue of American Baby magazine.
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