As a certified nurse midwife, I take a lot of time with my women to explore the challenges they've overcome in their lives and to channel that energy if they face obstacles during pregnancies, labor and birth. I have them go back to their power. I want their mind to shift from thinking “Birth is going to be really difficult" to “This is challenging, but wow—this is incredibly empowering. I can do this!"
As providers, we need to strive to have close relationships with our patients. If that's not necessarily possible, then we must at least be intuitive and listen well. I work with women and hear what they say, paying close attention to the language they use.
Part of the challenges women face in preparing to give birth is that we separate ourselves from other birth stories we've heard, or other experiences we've taken on as our own—specifically from the women typically closest to us, like our mothers, sisters and best friends.
Here are 6 questions I often get from women about their mothers' experiences with labor and birth.
1. My mother had complications during labor. Will I have them, too?She's your mother and you love her, but you don't need to unconsciously re-create her birth story—especially if it was a difficult birth. Our minds are very powerful, and we can cleverly re-create the trauma our own mothers experienced. But your mother's birth(s) had to do with what was going on in her day-to-day life at the time—what her health was like, her relationship with her doctor, what was going on in her personal life, etc. If your mom has mentioned that she experienced complications, ask her exactly what they were and what possibly caused them. It's not enough for her to tell you, “This happened to me." You have to ask her specific questions. Let's start with one example. If your mother had preterm labor, will you? Well, what was her amniotic fluid like at the time she went into preterm labor? What was her stress level? Was she working a job that required her to be on her feet 40 hours a week? That can certainly trigger preterm labor. There are specific reasons why your mother had the complications she did, and it doesn't mean you will, too.
2. My mother had a C-section. Will I have one?So many women have asked me this question. The answer is no, not necessarily. Do you and your mother have the same body type? Is your mother 5 feet tall and your father 6 feet tall? Did your mom have a baby who weighed 10 pounds? A situation when the baby's head circumference may be too big for the diameter of the mother's pelvis size and shape is called cephalopelvic or fetopelvic disproportion. If this occurs and a baby is unable to descend through the pelvis due to a narrowing of the mid-pelvis or pelvic outlet, then a medically indicated C-section is appropriate. There are four types of pelves, but we often see a mixture of characteristics. So even if you have the same type of pelvis as your mom, the size and position of your baby will be unique for you—so you can understand how we can't let your mom's delivery outcome predict yours. Many women ask me whether their pelvis is an adequate size. Forty-one to 42% of women have a gynecoid pelvis, with diameters quite optimal for vaginal childbirth. An extremely narrow pelvis, also referred to as male or android, where the front of the pelvis is narrow (about 32.5% of white and 15.7% of nonwhite women have this type) does make it more difficult for a good-size baby to navigate through. The rare platypelloid pelvis, which occurs in less than 3% of women, is characterized by a wide front diameter and shallow depth from front to back. It makes a vaginal delivery unlikely. The good news is that labor and birth are about movement, and babies are resilient, with heads designed to mold through delivery. When the health care provider understands the mother's pelvic size and structure as well as the baby's position and size, the timing of labor and repositioning the mother in a knee-chest or left side-lying position can make all the difference in assisting the baby through. A woman needs to labor and be pushing for several hours to determine whether the baby is unable to emerge under the pubic arch. This is definitely a subject to discuss with your health care provider. It is difficult to know all the circumstances of your mother's C-section that contributed to her outcome.
3. Can I prevent any of the complications my mother experienced?Yes. Make sure you're eating well, staying hydrated and communicating openly and often with your health care provider. I also recommend seeing a chiropractor to make sure your pelvis is aligned. This gives the baby more room to move and adjust. I had a woman transfer to me late, at 33 weeks—her baby was high and she wasn't doing any exercise. I recommended she visit a chiropractor regularly. And sure enough, when the time came, she had a three-hour labor where her baby descended nicely.
4. Can my sister's birth experiences tell me anything about what mine will be like?Yes. Not necessarily physically, but psychologically. I had a client in labor who kept saying things like, “I can't believe it, I know I'm going to need a C-section." I looked at her and asked her why she was talking out of such fear. It all finally clicked and I said, “This isn't you you're talking about, is it?" And she told me it was her sister she was talking about. She was subconsciously taking on her sister's negative birth experience as her own. So I worked with her in labor to guide her through extreme birth counseling. When we talked about her relationship with her sister, I learned she didn't even like her sister's ideas about birth. So I asked what made her different from her sister. She said she was holistic, and her sister was not. I asked her to repeat after me—“I am holistic. I am not my sister." And that is what her birth mantra became. With this mantra she was able to validate that she was different from her sister, and just because her sister had Pitocin and then a C-section didn't mean that she had to have it too. She did have Pitocin to augment her contractions, which had spaced out, but I helped turn the face-up baby and then she had a beautiful vaginal birth. This could happen with any woman you're close to—your mother, mother-in-law, sister, sister-in-law, best friend, etc. That's why it's so important to have the right provider guiding you.
5. My mother/mother-in-law had big babies. Could that determine my baby's size?While there could be some genetic connection for large gestational size babies, what I really believe is that your mother or mother-in-law could have been eating lots of carbs or foods high in sugar, and she might have had undiagnosed gestational diabetes. You have to know your clients, and quite often I have to be a sneaky detective to find out what she's eating. But keep in mind: I would much rather deliver a 9-pound, 5-ounce baby than a 6-pound, 5-ounce baby. Bigger babies are often well positioned—they don't get into unusual positions that could cause complications. For example, a smaller baby can spin around during labor and cause a longer labor, and if you're in a more conservative hospital or have a more traditional health care practitioner, they may not let you wait around to progress from 4 cm to 8 cm and instead suggest a C-section. But it all comes down to understanding fetal positioning.