When I look back on my first birth, the moments that led to us transferring to the hospital for a perfectly healthy birth, stand out pretty clearly. At the time it felt blurry, intense, and out of control. I was left feeling confused and angry. How birth unfolds is largely uncontrollable, but the way we prepare for birth and how we build ourselves up for this huge rite-of-passage is up to us. I wish I’d gone into my first birth feeling like, “I’ve got this! I’m a powerhouse and I have all the skills and intuition I need inside of me to birth this baby.” Instead I entered with our culture’s usual trepidation, fear, and sense that I would need a lot of help from the outside (even with lots of “natural birth” training). My preparation largely, was making sure I would be surrounded by all the people and things I thought I would need.
As you’ll see below, the “help” from the outside was distracting and caused a lot of unnecessary intervention, making my birth experience more challenging. I was left with the bitter taste of victimization, that is so common in our medicalized birth system, that boots the birthing person out of the center of the experience and hones in on the baby and the medical stuff, as if the one giving birth is not important. (Watch: The Machine that goes PING!)
I’m writing about these mistakes because I’ve learned so much from them and so have my birth clients. Let’s spread the love of birth and learn to trust this amazing process that nearly always works on its own, when we don’t get in the way and mess with it. Let’s practice the skills of relaxing our bodies and minds and following the dance between mother and baby.
Sometimes when I’m teaching classes to prepare for birth I share the idea that birth can be highly psychedelic, where we transcend our body and mind, and entering the stars or some strangely magical place. When I suspect my clients have experimented with psychedelics I offer this idea: What if someone gave you mushrooms or acid and said, “Take this and it will be the most horrible painful experience of your life.” What do you think would happen? You’d probably have a bad trip, because we can somewhat control our own reality. It’s the same with birth. Most of us go into this experience with the “common knowledge” that it will be the most painful, disgusting, dangerous, shitty thing we’ll ever do in our lives and that it is our burden or punishment for having a vagina in the first place. Or we think the opposite and put all this pressure on ourselves to have the most beautiful blissful perfect experience.
It doesn’t need to be this way! Think of the hormones that are released as the sensations of labor get intense: oxytocin, endorphins, serotonin. These are the body’s drugs that produce a sense of love, elation, and ecstasy and they’re produced at their highest peak levels at the moment of birth! These hormones balance the pain, work, and raw primal messiness of birth. The pain and bliss come together. We have the opportunity to be transformed; to walk through the fire and emerge anew as a stronger more powerful version of ourselves.
If you’d like support learning relaxation and empowerment practices for birth and motherhood, check out these offerings: Meditation For Birth and Mom Village
Let’s dive in to these juicy mistakes and see what gems we can dig up:
1) Not Interviewing Midwives
I live in a small city where 4 years ago there were 4 licensed midwives (now there are only 3!). I knew I wanted to birth at home so I should have met all of the midwives and interviewed them. It’s so important to do our due diligence and make sure that the people we invite into the birth space are people we love, feel safe with, and can relax with naked. Birth is similar to sex and for it to be any good we need to be able to relax deeply, feel safe, and have a sense of privacy.
2) Getting Out of Bed with Early Contractions
When contractions started I was so excited! As a doula I should have known to do whatever I could to keep resting: drink a glass of wine, take a bath, watch a movie, make love with my husband (or masturbate!)... I should’ve ignored labor until it really took over. As it was I got out of bed, pet my dog in the dark, and timed my contractions all night, setting myself up to be really tired once labor got real.
3) Timing Contractions in Early Labor
I did this out of curiosity and perhaps to feel like I had a sense of control. Timing contractions, especially early on, is distracting and keeps us in our heads. Labor progresses best when we can relax deeply (think orgasm!) and let the parasympathetic nervous system (rest and digest) do the work. Every time we focus on numbers or answer questions, we turn the thinking mind back on and come out of the deep state where labor is attempting to bring us, also known as “labor land.”
Most medical professionals will say to call or come in when contractions are about 4 minutes apart, so we start timing them and getting all excited. Timing contractions is usually unnecessary because we can tell when we need help and that is when to call. The work is learning to trust ourselves and the sensations of the body before we are in labor. It’s fairly obvious when contractions start to be closer together and become powerful for a long time. Don’t go looking for labor, it will find you.
4) Calling Parents in Early Labor
The following morning I called my mom and then was surrounded by a lot of excitement, energy, and more people to time contractions! This early labor time is special and I wish that I’d kept it to myself, spent time with my husband, and rested more. I called in the support party too early and it was distracting and probably slowed down labor. With my second birth I protected this time so I could go inward and be by myself, like a cat (or any mammal!).
5) Too Many Vaginal Exams!
I didn’t know how distracting and sometimes violating vaginal exams can feel until I experienced a labor and birth without any. When I worked at a birth center as a midwifery student we did lots of vaginal exams as a way of learning. In practice what I’ve learned is that they’re usually unnecessary and asking a laboring mom to lie on her back to be “checked” gets in the way of her following the messages of her body and the delicate dance of labor. I hated lying on my back with contractions and not being able to follow my body’s intuition. It also adds to the power dynamics of the mother feeling lower and less in control than her medical professional.
The number of centimeters the cervix is dilated is not a magic 8-ball predictor for when the baby will be born. It could take 24 hours to go from 6 cm to fully dilated and it could take 2 hours to go from 3 cm to pushing. We are not machines! There are situations where a vaginal exam can be helpful, but routine exams can be harmful by getting in the way of the natural progression of labor and adding to laboring people not trusting their own bodies.
10cm is considered full dilation and my second baby’s head was 14cm. If I had a vaginal exam and was told to start pushing because I was fully dilated at 10cm, they would have been wrong! It probably would have caused fetal distress (accelerated heart tones) because my baby was not ready to be squeezed out.
6) Calling Midwives Too Early
This is a big one! If you’re trying to have a home birth or hoping to have a “natural birth” elsewhere, take your time! Studies show that the longer you have midwives in your home, the more likely it is that you’ll transfer to the hospital. The longer you’re at the hospital, the more likely you’ll receive drugs and other interventions. Moral of the story: practice trusting yourself before birth and find great providers who trust you to do the birth and you both trust the process of birth. If the midwives had left when my labor slowed or if we’d asked everyone to leave, I’m confident that we could have rested and then had the baby at home. With so many people around, high energy, chatting, and lots of distractions I couldn’t focus, relax, and find the calm and quiet I needed to allow my body to open more than ever before.
7) Birth Tub Too Hot and in Living Room
The water was too hot so I couldn’t relax and rest. Most birth tubs are easy to heat up right at the end, during the pushing phase so the water is warm enough for the baby. This is super important but before the pushing phase, mama is working very hard and likely sweating and having trouble thermoregulating. She doesn’t need to be getting dehydrated in a hot bath. Secondly, having the birth tub in a place that feels private is so important for labor to progress! We are mammals and mammals like privacy to give birth.
8) Excitement and Pressure Around Dilation
When my cervix was 6cm dilated my midwife told me I could get in the tub (there’s not much data backing this as a rule to follow). My mom was so excited and thought the baby would be born soon so she woke my dad up at 2am to bake the birthday cake. All of a sudden the house was full of energy, excitement, and some pressure for me to just get the dang baby out! This probably slowed labor down and guess when the baby was born? The next night just after 12am.
9) Holding Anterior Lip Back and Pushing
I’ve learned so much about “anterior lips” since this first birth. The main thing is that they’re usually not a problem and only a sign that the cervix is not fully dilated. In the midwifery model of care, there’s not much to do about this other than wait and rest. As long as there are no problems there’s no reason to speed up labor. My midwife offered to hold back my cervix while I pushed. This has been shown to cause fetal distress. This was the moment her assistant got scared and decided we needed to transfer to the hospital. I believe they caused the problem by asking me to push before I was ready. This is so common! Listen to your body and when people offer to “help” before there is a problem think twice. In my second birth I asked my new midwife to please not fuck with me at all. She obliged kindly and the birth was amazing because I had the time and space to totally listen to and follow my own body without outside distractions. When we don’t do vaginal exams, we don’t find “anterior lips” and babies are still born perfectly.
10) Directed Pushing
Both my midwives at home and the obstetrician at the hospital practiced directed pushing. This is so common and problematic. Directed pushing usually looks like this: you’re told to take a deep breath, hold it, and push down as hard as you can “like pooping.” This is not how we should be pooping! Also if we are directed to birth like we’re pooping, we’re not using the right muscles! This causes hemorrhoids, tearing, and a plethora of other problems. We need to get in touch with our pelvic floor muscles and learn to use the musculature of the vagina. VAGINA, VAGINA, VAGINA! We’re told it’s like pooping partly because no one wants to talk about VAGINAS! But you know what? BABIES ARE BORN FROM VAGINAS! We can change the name to “the birth canal” for this one event, but we all know the truth.
When we wait for the very real “urge to push,” the body ejects the baby on its own. It’s very helpful if the birthing person has good body awareness, the ability to completely relax, while waiting for the body’s urge to push and ONLY bears down during this time. There’s no breath holding or eyes popping out and bursting blood vessels. This really happens! We’re told to push in a way that is so aggressive that we burst blood vessels in our eyes and blow out our pelvic floors, specifically our butt-holes (more on this later!). This practice is old and began as a way to speed up labor but we have plenty of data showing that it only speeds up labor a tiny bit. Not enough to make blowing out a butt-hole worth it. Are you with me?! Labor takes time on purpose. We need to practice patience. If there’s a medical need to speed up labor- OK. But if the need is to free up a room in the hospital for the next patient, please take your time! Rushing nature can be dangerous.
11) Lying on My Back
Fuck this! I hate this position so much and it’s still very common. Here’s what we know: lying on our backs is the worst position to give birth in. PERIOD. Think about it. Would you ever poop lying on your back? Me neither! And you know what? Babies are way bigger than poop. Also they have bones. When we lie down, our sacrums are trapped pointing up, so the baby has to be born being pushed upwards over the tail bone (which can’t move in this position), completely fighting against gravity rather than using it.
Why do so many women birth on their backs? Because it’s more convenient for the doctor! Great birth positions include standing with support, squatting, hands and knees (all fours), lying on your side... This is another reason to avoid pain medications as much as possible because then you give up your power to feel the sensations of the body and follow the best position to get into for you and your baby. Being on our backs makes us more vulnerable to interventions. It adds to the power differential where it can feel like we are the passive ones “being delivered” by doctors.
12) Too Many Kegels!
Once we were at the hospital our OB really made me laugh by saying, “You have a 6-pack vagina!” Here’s what I learned: I was too strong. I was much better at contracting than relaxing and this is so common. We’re taught that our vaginas need to be tight and strong but we also need to be able to fully relax. To prepare for birth don’t do too many kegels. You might explore contracting the vaginal muscles and relaxing them completely. Most of the work of labor and birth is actually about softening and opening the pelvis. We must learn to relax the body and quiet the mind so that we are able to show up for whatever comes our way in birth and as parents.
Birth is a lot of work and it’s a practice of regulating the nervous system and telling the mind over and over again that we are safe. The body will relax when it feels safe and it will contract and attempt to hold in the baby when we feel stressed (distracted, excited, afraid). This is a very smart mechanism in case we need to run from a lion before it’s safe to have the baby. Most of the time in modern births we are stressed because a stranger walks into the room or the lights are too bright or the hospital doesn’t smell like home. It takes a lot of practice to prepare our minds and bodies to have the ability to relax completely wherever we give birth.
One big take-away from this first birth was that for the next one I knew that I could do it. I ended up feeling like I’d experienced a home birth and a hospital birth in one, since I’d labored over 24 hours at home (with breaks) and then birthed in hospital. For my second birth I felt confident that I could have a beautiful empowering home birth because I’d managed to have a healthy vaginal birth in the hospital despite being surrounded by strangers, bright lights, and beeping machines. Even though most women in our country birth in the hospital, it’s a tough setting to fully relax the body and convince the mind that you’re safe enough to open and release a baby.
We are long over due to change the birth culture in this country! The US is the second most expensive country to give birth in (averaging $13,000-$14,000 without complications!) and has the highest infant and maternal mortality rates of any developed country! What the fuck people?! This is controversial but I’m just going to end this piece with a hypothesis, OK? If insurance companies would cover all low-risk pregnant people to birth at home or in birth centers and to cover both midwifery care as well as doula support, these rates would plummet. We would likely have happier healthier moms, babies, and families. Can I prove it? Let’s try!
Feel free to leave a comment below! Ask any questions or share a story. Let’s grow this community and support each other.