Birth and Beyond Blog
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by Juliet and Lara If you are pregnant or postpartum, you may have been told by friends, family, your midwife or doctor that it is imperative to your baby’s safety that your baby only sleep in a bassinet from birth. There is cultural pressure for your infant to sleep in long stretches on their own from a very young age; there are even products made to mechanically rock, pat, shake, or shush a baby to keep them asleep for 4 hour stretches. In this blog post, we are offering an alternative perspective: that bedsharing and frequent waking is safe and supportive of healthy feeding relationships and secure attachment. It may surprise you to learn that bedsharing is an evidence-based choice that can be beneficial to both you and your baby. Bedsharing is defined as an infant sharing a sleep surface with another person. Bedsharing can also include siblings sharing a bed with one another, or parents sharing a bed with more than one child. It may be used interchangeably with “cosleeping”, which can mean sharing a surface or sharing a room or bedside bassinet with your infant. Here we will focus on bedsharing where a parent is intentionally sharing a sleep surface with an infant. Almost every parent will bring their baby into their bed at some point: per a 2023 survey of 4000 participants by the Lullaby trust, 9 out of 10 parents coslept with their infant, but less than 4 of 10 participants had been offered guidance from their care providers on how to do this safely. We’d guess that the majority of these folks did not initially plan to bedshare with their baby. Plans change, circumstances change, and at the end of the day we all just want to get as good a night's sleep. The unfortunate reality is that North American culture heavily stigmatizes bedsharing and parents get little to no evidence-based information about safe sleep. Instead, advice about sleep is based on fearmongering and preaching of an all or nothing approach. The message most new parents hear is that their baby should never sleep in their bed with them. But what is the truth? The truth is most parents are going to do it (read the survey results again!). And the truth is, it is safe, so long as it is done with care and you and your baby are healthy. Not to mention the fact that it is so cozy and nice, and often gets parents the most sleep possible! Why is Bedsharing Stigmatized? In the last 40 years, there has been a shift in understanding of safe infant sleep. The common practice of the 1960s and 1970s in North America was stomach sleeping (yes - if you can believe it, if you were born during these decades you were probably put on your tummy to sleep as a baby!). In the 1990s, researchers studying the causes of crib death or SIDS (sudden infant death syndrome) concluded that the safest sleeping arrangement is what we refer to now as “back to sleep”; placing a sleeping infant on their back. However, evidence never concluded different SIDS outcomes back sleeping in a bassinet versus a bed with a parent. Therefore, the real risk factor from these studies was not a shared sleep surface, but rather suffocation from re-inhalation, which usually occurs when babies are either placed on their stomachs, have their faces covered with a blanket, or are on a sleep surface that is too soft, causing dents in the mattress that increase re-inhalation risk. When we look at stories about infant death that occurred during bedsharing, many of the safety issues above were the reason for infant death, not bedsharing itself. For example, the Cribs for Kids ambassadors discourage cosleeping because of stories about parents who fell asleep with their child in a recliner, couch, or by accident when the bed was not intentionally set up for bedsharing. So, the real harm is not in cosleeping, but accidental or uninformed cosleeping. If we were to go further with the reasoning behind this stigma, we also need to relate the doctrine of separate surface sleep back to Western values which prioritize hyperindependence over interdependence. When you share a surface to sleep with your child, you are likely not using tactics like “crying it out”, “self soothing” or sleep training tactics. These strategies are all rooted in the idea that we need to train an infant away from their age appropriate, physiological behaviors of frequent waking and need for human contact. Capitalism puts postpartum parents on swift recovery timelines where they are rushed to return to work (in some parts of the US, postpartum parents are expected to back to work full time at 6 weeks postpartum) and expected to bounce back, leading them to need to outsource reproductive labour, and rush their babies through important developmental stages. Hustle culture prioritizes sleeping through the night before it is physiologically age appropriate and safe. Further, the neoliberal “post feminist” framework teaches us that parents shouldn’t “waste their time” moving slowly and meeting their children where they are at. Neoliberalism doesn't have the time for the major life shift of postpartum as a slow, winding road. We are used to being able to predict timelines, measure and perform, while postpartum invites us to do the opposite: meet your infant as a human, put down the clock, and look at and be with your baby. Why might bedsharing actually be a good idea? Infant sleep expert Dr. James McKenna invites his readers to consider rather than whether it is safe for babies to sleep with us, whether it is really safe for babies to sleep alone. Your baby is born expecting to be held. When a caregiver uses “crying it out”, the baby stops crying and falls asleep not because they are soothed but because they are giving up. This is an unsafe attachment practice. Of course there will be times when you as a parent do not have enough hands to respond to your baby’s cries immediately, nor is that the expectation. But, when the habit becomes "training" your child to not need you for soothing, healthy attachment is deprioritized and your baby is not given the signals that you are their safe place, that you always come back, and that they can depend on you. Bedsharing is a harm reduction tool, particularly against postpartum mental illness. Postpartum psychosis, depression, rage, and anxiety are all exacerbated by sleep deprivation in parents. If you are pulling all nighters trying to soothe your infant, your mental health will suffer. Bed sharing gets parents more sleep and also gives you opportunities to also receive the oxytocin rush of touching your baby. It is not just your baby who is born needing to be held, you need to hold your baby for your own wellbeing. Finally, frequent waking is a measure against SIDS and a necessity for body feeding relationships. Normal newborn body feeding habits include a full feed at least 8-12 times per day, including overnight. Every time your newborn sleeps through a feed because they are being rocked by a SNOO or patted by a mechanical toy, their stomach does not get the nutrients it needs, and the body feeding the baby does not get the signal to produce more milk. I’m sure at this point we have convinced you that bedsharing is a great idea, so, how do you do it? What are bedsharing dos and don'ts? DO:
DON’T
 Lara’s sleep setup with their mobile baby. As your baby gets older and more mobile, there are some additional things to take into consideration. Once your baby can roll back to front, the safest recommendation is to either transition to a floor bed or add a sidecar crib to your sleep setup. If your little one is to roll off the bed at some point, they will only be a short ways to the ground if you are sharing a floor bed. Consider adding a soft rug or crib mattress beside the bed for added cushion, or lining the floor with pillows. A floor bed also offers some additional longevity in terms of safety: once your baby is crawling, if they crawl off the bed it’s less of a hazard then if they were to crawl off a higher surface, and you can teach them to get off the bed feet first. Before you know it they will be able to get in and out of bed on their own!
If a floor bed is not possible, a sidecar crib can be a good alternative. It offers babies their own sleep space with three sides of railings, but still with complete access to you on the main bed. Keep in mind that if you leave your baby unattended for naps you may not wish to use this setup if your bed is raised off the ground. Some people also choose to use bumpers, bedrails, or sleep with their baby between them and a wall. Bedrails and walls can pose a risk of entrapment. To reduce this risk, you will want to pack any crevices well. With bumpers, there is a risk of baby crawling over the bumper, and once babies are pulling to stand, they could use the bedrail to pull up. Remember: you know yourself and your baby best! As babies become mobile their sleeping habits might change. When deciding how to set up your sleep space for an older, mobile baby, ask yourself:
Finally, we want to reiterate that cosleeping is a spectrum. You might cosleep with your infant every single time they are asleep for the first 2 or 3 years of their life, or you may only cosleep with them at night. You may wear them for naps during the day, or bring them into your bed during the first overnight feed. There is no such thing as too much contact and it may take many weeks or months to get into a proper sleep groove. You may feel like the only parent on the planet whose babe is waking up 3 or more times a night at 8 months old, but we assure you, you are not, and the more information out there to not only destigmatize, but celebrate this practice, the less shame and questioning we hope parents will feel around their baby’s sleep journey. Your baby’s physiological need to be held is as important as their need for milk, rest, and diaper changes. Postpartum is a winding road. It’s a slow road, it’s a special and unique opportunity in life to connect with your existence as a living creature outside of scripts of productivity and growth. So, be with your baby. Lie with them. Nap with them, wear them, hold them when they cry. Respond to their needs. You are your baby’s entire world. That is the most special gift and you deserve the most special rest with them! About Lara: Lara (they/them) is a queer parent and doula. They worked on this piece mainly from bed, while their baby slept beside them! Lara specializes in supporting queer & trans folks through the full spectrum of reproductive experience, from fertility and conception through to postpartum. You can connect with them here. About Juliet: Juliet (she/her) is a full spectrum doula living in Tkaronto (unceded Annishanabe territory). She works with families supporting birth, postpartum, abortion and loss. She’s an avid cook, cyclist, and musician. Juliet is passionate about bedsharing, babywearing, and holding parents and their little ones through transitions of all sorts You can explore her website here! Sources:
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 Choosing which doula to support you is a strange process! You will most likely meet a few doulas online during a short call and then need to consider whether you want this person as a companion during a pivotal life event. It can be difficult to know which questions to ask and even what answers to look for - and while beautiful websites and impressive CVs can be helpful, a flashy online presence doesn’t always make for a perfect match. Compatibility is the most about personality, values, and feelings of ease and safety. As a doula who interviews with clients weekly, I am happy to provide you below with a short list of red flags to look out for when looking for a doula for your birth.
Red flags to look out for during your doula search: They speak poorly of providers or other doulas We all have our own relationships in this field - and of course, advocacy is an important part of our role. During our pre-birth sessions, we might discuss advocacy tools and explain certain scenarios or potential challenges that come up in different birth settings. But, unless a provider is actively harming people, there is not one providor, midwife, doctor, or doula alike that is the most perfect or the worst. A doula who is quick to talk smack may not have nuanced advocacy skills to use during your labour. They are firm on what choices you should make Although often used too routinely, birth interventions and pharmaceutical pain medication have a place in labour and birth and can help offer relief from long labours and even prevent adverse outcomes when used properly by a skilled provider. A doula who doesn’t believe in clients ever using epidurals, entering the hospital, or needing medical support may pose a red flag. This type of doula may also leave your birth if you transfer to hospital or choose an epidural, which can be times when support is especially needed. They have no backup plans or backup doulas Doulas are humans who can get sick, have family emergencies, or have two births happen at once. It’s always important that a doula contract includes information about what happens in the instance that your doula is unable to attend part or all of your birth. If there is no mention of backup, this may also be a sign that the doula doesn’t have community relationships with other doulas, which is integral to the sustainability and quality of care we provide. They don’t have a contract or have unclear, hidden fees Doula support is professional support. Any time you are hiring a doula to support you, especially for birth, it is standard to sign a mutual agreement outlining fees and services. If the price of the birth package is unclear, there are extra fees for a long labour, or unclear cancellation fees, it might be best to ask for clarification. An hourly fee for labour support is not common practice, because we don’t want you to be thinking about how expensive your doula bill is going to be while you are trying to work through a long difficult birth. If, with clarification, it is still unclear how much support will cost, this likely means that your doula will add fees along the way. That being said, our services are priced appropriately for our expertise, on call time, transportation, pre-and post sessions and virtual support. It is standard to pay between $1500-2000 for a doula in Toronto (and we are right in the middle of that range at $1750 for our birth package). They promise you a specific outcome While the evidence shows that continuous labour support decreases the use of pain medications, birth interventions, length of labour, and chances of cesareans, there is no way to know how your labour will go. And while we know trends, every time we think we know birth, it surprises us again! We will help you prepare for the birth you want but any doula who promises a painless orgasmic birth is likely to be setting you up for shame or disappointment if your birth does not go that way. We never know what the outcome will be, but we are here to support you along the way and help make the experience as smooth as possible. They don’t support you in early labour It is becoming more common for very busy doulas to require you to be 6+ centimeters dilated and already admitted to the hospital or birth centre, or already checked by your midwife in order to begin in person labour support. Sometimes early labour, especially for first time parents, can be long and difficult, and your doula can be a great tool for support during those early hours when things are still shifting into gear. We also know that obstetricians have tried and failed to measure linear timelines for cervical dilation - and that what your cervix is doing in one particular moment says nothing about how long it will be until your baby is born, or the intensity of your contractions and need for support. Doula support in early labour might also offer tools to get your labour kicked into gear and progressing. They don't share your values about the world Some birthworkers might have ideas about gender norms that don’t sit right with you. You might not want to be called “mama” or “honey” for your entire labour. Some doulas might also have very strong feelings about your parenting style, feeding style, or whether you should decline vaccines for yourself or your baby. Look out for any other political values that your doula makes clear on the internet and don’t be afraid to ask how your doula relates to anti-racism, gender affirming language or other anti-oppressive values. If you are a member of a marginalized group it will be important to have a doula who understands how different people are impacted by systems of power in the healthcare system. You will want a doula who makes you feel safe and appreciates, celebrates, and stands by who you are. The don’t engage with or mention your partner in the interview We always ask questions to your partner and make it clear that we are here to support you and your co-parent both. Sometimes partners might be afraid that the doula might replace them or push them away from the birth process. Look for a doula who engages with your partner’s hopes and fears for the birth and describes how they can support your partner through your labour. They convince you they know everything No one can ever know everything about birth and postpartum. As a doula in the business for a long while, there are still times when the answer to a question is “I don’t know”. We also know how important it is to model this practice to help take the pressure off of you to have every single answer figured out as a pregnant person and parent. We are support-people, not encyclopedias, and while we have a lot of experience and knowledge, we still have questions and we work alongside you to investigate them rather than claiming to know every single answer. We actually think that saying “I don’t know” builds trust with you and helps you build confidence. They make you feel uneasy or uncomfortable in any way Even if none of the above issues come up in an interview, if a doula makes you feel uncomfortable in any way, they are not the doula for you! You need to feel like you can be your messiest self during labour and birth. Hire the doula that makes you drop your shoulders, feel a little less tense, and seems like someone you would like to be around. I want you to feel GREAT about the doula you choose to support you through this most special moment! Hopefully these tools will help guide your search.  Tiger in a tree hold It can feel overwhelming and disregulating to have an upset baby that seems to not respond to soothing. Typically, babies can have a time of day where they may seem more fussy and unable to settle than usual.
The 5 S's are a great simple tool to remember when it feels like you have exhausted options for comforting your baby. Where do the 5 S's come from? In 1981, Dr Harvey Karp began investigating the cause of colic (persistent crying in infants form 1-4 months) in Western nations. In some areas of the world like the !Kung culture of northern Namibia, babies are easily soothed in under one minute by their caregivers. The reason for this is because constant physical contact between newborns and caregivers is the norm and caregivers are able to mimic the comfort of the womb through physical contact, movements and sound. These movements and sounds are highly instinctual, and have been used by parents since parenting existed. It is the widespread Western philosophy of early parenting, with much less physical contact, separate surface sleeping, and the goal of early "independence" from caregivers that is an abnormal construct, largely related to a false sense of individualism and rush to return to work. For the first 6 months of your baby's life, they don't know that they are their own person, and they don't have any object permanence. So, when you leave the room or expect them to sleep in their own area, this can be distressing and confusing. It is my goal in my work to help bring parents closer to these instincts and unlearn the idea that a "good" baby is a baby that is independent and disconnected from their parents. We want your baby to act like a baby. A healthy baby wakes up often, needs contact to settle, and expresses their needs through crying. So, when your baby seems inconsolable, it is important to remember that your baby is a person and that they are supposed to cry! They need contact, rest, stimulation, and regulation just like we do, AND, sometimes even when they have all of those things, they may just not be calm. As they get older, you may start to recognize cues, times of day, or situations that might cause crying and work to avoid sensory situations that might make your baby overwhelmed or upset. Crying is their way of communicating that they need any type of support. Your baby will never die from crying, so when you feel overwhelmed by the sound of their cries, put your baby down and take a second to ground yourself before soothing your baby. Many parents choose to wear earplugs during times of day and night when their baby may be especially fussy to help stay grounded and calm when supporting their baby. When your baby is crying and you are feeling lost, you may choose to also follow these 5 "S" steps to help ground and regulate them: 1) Swaddle Wrap your baby tightly in a swaddle, ensuring they still have access to one or both of their hands. 2) Side stomach position Lay your baby on their side, or hold them across your forearm in a "tiger in a tree" hold 3) Swaying Babies like repetitive motion. Bounce or sway in a repetitive motion. 4) Shushing Make a repetitive "sh" sound that is as loud or louder than your baby's cries. 5) Sucking Offer some oral stimulation to your baby. If you are breastfeeding, offer the breast, even if they don't seem hungry. Breastfeeding is not only for nutritional purposes, it also offers sensory support. If you are not breastfeeding, you may choose to offer a soother or your finger to give your baby something to suck on. Choose an oral tool that aligns with your feeding goals and is approved by feeding professionals to reduce nipple confusion. These are the traditional 5 S's, but I would add to the list: Babywearing! Put your baby in a stretchy wrap, ring sling, or buckle carrier and bounce, sway, shush, and pat your baby. See if the motion and contact helps settle them down. If you are wanting to learn more about babywearing or have a consult from a local babywearing educator, check out babywearingmelody.com for local babywearing support, or The Babywearing OT for videos and tutorials about choosing a wrap and safety tips. Patting. Patting your baby's bum firmly and repeatedly mimics a heartbeat and can be very soothing for babies. Pat harder than you think! Babies often like firm, repetitive touch. And after all that? The most important thing to remember is get to know your baby! Look at your baby often, hold your baby often, and get used to parenting the baby in front of you, not Dr Google's baby. Just like in birth, your instinct is probably the right answer. You got this! Congratulations, new parent! It's time to bring your baby home! Getting home with your baby might feel exciting, overwhelming, sad, daunting, or everything all at once. So, how can we set up a plan for the first day at home, to make space for all those feelings, and set you up for success?
One thing that I wish more parents were aware of is that the placenta keeps your baby fully nourished for the first 24 hours of their life! This is a wonderful way to reframe feeding and sleeping windows in the first 24 hours as less of a survival need for your baby, and more of a way to get acquainted with them on the outside. This, of course, depends on how their blood sugars are, and if your midwife or doctor has recommended a particular feeding regiment (with reason to back it up) it is important to follow that. It is indicated that babies that are born bigger or smaller than a certain range be be monitored for blood sugar in the first 36 hours of their life. This is a protocol that you can choose to consent to, or make an informed refusal, but you may choose to ask more questions about recommendations for feeding in the first few days if this is the case. With that in mind, some questions you might want to keep in mind for the first day are:
Because your baby's stomach is full the first 24 hours and they are tired from labour, you may choose to also have one longer stretch of sleep with your baby. Ask your midwife or doctor about the length of this sleep. What I have witnessed care providers say is that a 4-6 stretch one time in the first 24 hours is a good amount of rest for your baby. Otherwise, you can expect them to begin rooting in that 8x in 24 hours that we strive for during the newborn phase, or even more often if they are interested in cluster feeding, which is a normal behaviour for newborns learning to feed. If your midwife or doctor has not recommended a particular feeding regiment, the best course of action is to feed on demand. You may choose to write down when your baby eats, but put the clock down and get to know your baby's cues. Your baby will also still be passing bowel movements with a thick heavy form of stool called meconium. This substance is different than human stool, as it comes from nutrients in the placenta, rather than colostrum. You can expect to be looking out for the number of poos and pees, and may choose to write this down in case your midwife or doctor asks. You may choose to also take note of your baby's "poop transition"; where their poop changes from meconium to look more like human stool (more green, yellow, or brown). You should also expect some hormonal changes in yourself as a birthing parent. This might include the need to cry, feel snappy with your partner, or exhausted. You may feel heaviness in your breasts as your milk matures, which might cause irritation or pain. It may be helpful to have a conversation with your partner before birth to develop some tools to use as your body begins this postpartum hormonal transformation. How can your whole family tend to this shift and care for one another? What does your partner need to know or hear to show up for you well? The most important thing to remember is that while your baby needs monitoring to make sure they are fed and safe, they are a human being. The biggest thing they need is love and attachment, which you can simply give them by holding them, doing lots of skin to skin, and giving them a chance to explore what it feels like to be on the outside! Take a deep breath, and take it all in! You've got this! Home births are very special events that require special preparation.
Whether you have been planning a home brith for many months, or have recently decided on one, it is important to build your birth space with sensitivity and care. When you choose to birth in your home, you are choosing to give yourself agency to create a sanctuary for yourself, and decide from scratch how you wish to be comforted by your environment during labour and birth. I often suggest to clients no matter their birth place to consider taking an afternoon of visioning for their birth. This might include drawing, journalling, collaging, or making a pinterest board. What does the birth space look like? Smell like? Feel like? Sound like? Who is present? From there, you can start making a list of how the space will be set up and start building your sanctuary. The first consideration in creating your sanctuary may be which room in the house you want to deliver in. Where do you feel most safe and comfortable in your home? Your bed? The bath? The living room? How can these parts of the home be enhanced to create a calm and positive environment? This may also include the consideration of whether you plan to give birth in water or on land. If you are planning a water birth but don't have a large bathtub, it may be the best course of action to rent a birth pool or tub from a local group (such as doulas on bikes: https://doulasonbikes.com/birth-pool-rental/ ) Even if you plan to birth on land (ie not have a water birth), you may want to think about how water might help you during your labour. Do you have a bathtub in your house? How can you help make the bath feel special and comforting? In the space you see the bulk of your labour happening you might choose to print photos, affirmation cards, or create a vision board for your labour, make a playlist, light candles, or purchase a special light to make the room feel different and special. You may also want to consider what time of year it is when envisioning how to decorate for the birth. I once heard of a client due around Christmas who added to her birth vision board that she wanted to labour and birth next to her Christmas tree! If it is springtime, you may way fresh flowers, an open window, and running water sounds. If it is fall or winter, you might want to focus on warmth and festivity. From there, there are items you will need to have on hand to prepare for the delivery. They are as follows: For the birthing parent:
For the baby:
For the birth partner
For the birth space:
Other
Setting up for home birth is such an exciting process. Have fun with it and get creative! Oh, and don't forget to hire your doula! As the fall looms, I thought it would be a good idea to dedicate a post to preparing for a doula interview!
The first thing that I always advise clients of is to interview multiple doulas. This gives you a chance to get acquainted with the different styles of practices and offerings, since the umbrella of "doula" is so wide. On a practical level, some doulas offer additional supports like TENS rental, meal preparation, placenta art, or placenta encapsulation, that might be important to you to have included in your contract. On an emotional level, interviewing multiple doulas allows you to notice how you feel interacting with each doula. Picture yourself during an incredibly vulnerable moment in your life. Do you want this person close to you? Do you feel safe and nurtured by this person's energy? Comparing how each doula makes you feel about your upcoming birth and postpartum is important information into how they might make you feel in the moment. Other things to notice: - Was the doula on time for the interview? Maybe this is old fashioned of me, but I truly and deeply care about respecting people's time! - Did the doula interrupt you? - Did the doula try to talk you out of certain wishes or plans for your birth or postpartum? There is a fine balance between advising with expertise and assigning one's own agenda onto someone else's experience. Do you feel like this doula has a preconceived notion of what a beautiful/respectful/empowering experience is, or do they make space for you to share what feels important? - Is the doula guaranteeing an outcome that is not guarantee-able? I.e. promising you will have a home birth, unmedicated delivery, or promising you won't have a c-section? To me, the traditional questions (and questions I hear a lot) focusing on experience (number of births attended) and emergency response can be misguided. What this signifies to me as a practitioner is that this client is looking for reassurance of safety and needs to process some fear about the birth experience. Being able to be a calm, grounded presence for a family in a moment of chaos, disappointment, or fear does not come from experience. Alternative questions to ask that might get at the heart of the matter might be this:
Additionally, you might want to ask a doula about their values! How do they relate to birth and postpartum in the broader political context? Birth does not exist in a vacuum and purchasing a doula is not a transaction outside of power structures and capitalism. How does this person represent themselves to their community? Do they use gendered language about birthing people's bodies? Have they spoken out against the perinatal health crisis in Palestine? Do they use the term "natural labour" rather than unmedicated, or non-epidural? These are all things that would matter to me much more as a client than number of births attended, or ability to catch your baby in the car if you have a precipitous birth (if you are a first time parent - you probably won't). So, from my perspective, it is most important to steer the conversation back to how a doula makes you FEEL. If you leave the interview feeling like this is someone you want to continue talking to, that makes you feel excited for this transition; if they asked you questions getting to the heart of the matter and really cared about the answers, and wore their values on their sleeve this might be the doula for you, even if they've only been to 10 births! If you leave the conversation feeling uneasy, overwhelmed, coerced into changing your mind about your plans, unprepared, interrupted, or dismissed, or just "meh", it might be time to keep looking, even if they've been to 400 births! The doula right for you is out there --- you might just need to ask the right questions.  Image: The VBAC link The hospital system has a term for describing a lack of change in cervical dilation. They label this pause in labour as "failure to progress". Yes! Sometimes labour stalls or full on stops, but this language is laden with value and implies that the pause is progression is somehow a failure on the birthing person's part to "do" labour. This is simply not true. Nothing about a stall in labour has anything to do with success or failure. The progression of cervical change and contraction pattern is indicated by so much, including: - Whether your body started labour naturally, or your labour was induced. - The position of your baby's head on the cervix. A baby that is "sunny side up" may result in a longer labour with more stalls. Read further to hear about positions to try to get baby to rotate! - Your hormone levels, cortisol levels and sense of comfort and ease. Labour uses the right side of the brain, and when people are far into labour, they often appear to be in a sort of trance, where the left side of the brain shuts down. Their speech may slow, and they may not be able to answer practical questions. When birthing people are stressed out, being poked and prodded at, and being interrupted out of "labourland", the flow of the right side of the brain is interrupted and labour can stall and stop. (Source: Birthing from Within). - How long you have been labouring and you and your baby's exhaustion levels. Babies have a point in labour where they struggle to tolerate contractions. At this point you may choose to transition to a surgical birth, if your baby's heart rate is showing signs of distress. Also, are YOU distressed? Do you feel like you're just done? Birth is a balance and if you truly feel like you are ready to switch gears, there is no shame in doing so. - Your provider's schedule and the demand on the labour and delivery unit. If there is high demand on the unit, there may be more pressure for providers to "keep things moving". This is a good reason to consider an out of hospital birth or midwifery care if your pregnancy is low risk, because there is no one waiting to take the room you are in. - The "rest and be thankful phase". Right before your baby is born, your contractions may slow or stop altogether. This is a natural mechanism from your body to give you enough energy to push! So, what to do? The first option is just wait and see! Depending on whether you are still at home or are in your birthing setting, the cervix may change rapidly just by waiting and taking the pressure off. It's important to remember that there is no rush, and you get to call the shots of whether to shift to chemical augmentation or a surgical birth. If you have an epidural, you can go to sleep for a few hours and get into a comfortable position with the pelvis open (using a peanut ball if you wish). There are lots of ways to increase oxytocin that don't include medical intervention. Some examples are: - Sex and intimacy - Nipple stimulation (bring your breast pump to the hospital) - Dancing and playing joyful music - MILES circuit (www.milescircuit.com) - Touch from a loved one or doula - Change in environment - Use of water for comfort (bath or shower).
After trying positional changes and oxytocin boosting activities, you may choose to talk to your provider about augmenting your labour in some way. Your provider may agree to rupture the amniotic sac, which can pick up contractions depending on baby's position. You may also choose to use synthetic oxytocin to augment labour. This is a medication that is given through an IV that simulates the hormones your body uses to make long and strong contractions that result in cervical change. You may also choose to get an epidural which can sometimes help the pelvic floor relax and the cervix to open. The reality is, nature's design is not perfect! And neither is the hospital's. It is always your choice whether to continue labouring and wait and see with position changes, or shift to a surgical birth. There is no wrong or right answer and any choice you make is the right choice for you. But, make the choice for you, not your provider. And no, you are not a failure. Your body is doing amazing things and you are giving birth to your baby no matter how and when they come! The reality of our healthcare landscape often means that new parents begin their postpartum period with birth experiences that need deep processing and that include a wide range of feelings that aren't only the joy of meeting your baby. Arguably, birthing in our current medical system most of the time gives way to disappointment, anger, and frustration, and resentment of others who had a better experience. Even if there was no emergency, it's likely that you will leave your birth with a need for some amount of processing.
Birth trauma exists on a continuum, from care providers' comments that dismiss your confidence in your inherent ability to birth, to having a baby separated at birth to go to the NICU, a "stalled" labour, instrumental delivery, disruption of the golden hour, unwanted touch of your body, or the sometimes deep disappointment that comes with an emergency or unplanned cesarean birth. The most important thing to remember coming out of an experience that didn't go how you wanted is that it was not your fault. You are one individual birthing in a landscape of obstetric violence. Your body and your baby's body are responding to the environment around them. And, even if that is a beautiful, patient and nurturing birth environment that supports progression, sometimes the body or the baby has a different plan. Birth going to plan has mostly to do with luck. Yes, there is a lot of preparation involved. But, doing the mental and physical preparation for delivery is one part within a landscape of a system that is used to your birth looking and going a particular, hegemonic, controlled, and disempowering way. After a difficult delivery, you may feel alienated from your partner, your baby, and your doctor. You may feel alienated from yourself and your body, violated, or ashamed. You might feel worse if others are making comments about how happy you should feel now that your baby is here. Please know that you don't need to be over the moon or rush to bond with your baby. There is plenty of time to bond with your baby. The most important thing after a hard birth is to tend to your needs. So, what might those needs be? Space and quiet for you and your baby to rest at the hospital immediately after birth and hands off from nurses and providers. Low or no interruptions on the postpartum unit. No visitors to your house, or only visitors who will understand and support that you may not feel the happiness and satisfaction that you thought you would with your new baby. Help from a mental health practitioner who understands the specific intricacies of birth trauma. Support groups for new parents who had similar difficult birth experiences (see perinatal resource list) Nutritious meals of your favourite warm food. An artistic outlet. You may choose to draw a picture of how the birth experience felt, what moments felt the most difficult and violating, and rip the paper up when you are finished. You may choose to dance or listen to loud music to let the energy of anger and disappointment move through and out of your body. Connect with nature. Take your baby for a walk, or go with a partner or a trusted friend to a park or near water. Notice what your body feels like as it is in that moment with the changes of postpartum. You might choose to say something out loud to yourself or give yourself a self-hug. File a complaint with the hospital or care provider. Let the hospital know that you were disappointed and upset with the care you received and exactly why. The more people who speak up about these violations, the more change will occur to disrupt obstetric violence. What do children do when they feel angry and disappointed? They scream, yell, cry, and stomp. I strongly believe that adults should do this more! Use sound and force to release the energy of the disappointment of anger through and out of your body. Have a pretend or real conversation with yourself, your provider, or your baby. Imagine what you or your baby needed to hear in the moments that felt the hardest. There is nothing wrong with my body. My body is important. My body withstood a lot. My baby withstood a lot. My instincts were violated and it wasn't fair. Other people have beautiful birth experiences and I didn't get that and it isn't fair. Say these things out loud to yourself and perhaps try a self-hug while you are saying them. Rest in bed for as long as you need. Cover yourself in warm blankets or a heating pad. Have a stay-cation with your baby for as many days as you need until you feel like you are ready to face the world again. Accept help from partners, friends, and family members or a doula who understands your feelings and isn't going to push any other feelings onto you. Let the housework, cooking, and cleaning be a village effort while you pick up the pieces. There is no need to bounce back from any type of birth, especially a difficult one. Taking the time to be with yourself and accept all the feelings that come with birth and postpartum is incredibly important on the road to healing. You will need anger, sadness, and rage to navigate parenthood just as much as you will need joy and tranquility. It is my hopes that the more we talk about birth trauma, the more we can open ourselves to these feelings as welcome visitors, and see what they can teach us about building a future of empowering births for generations to come. The "due date" has come (or not) and you are beginning to feel changes in your body that might indicate that your baby is preparing to meet you!
These changes might include: - Pre-labour contractions (previously referred to as "Braxton-Hicks" contractions) - Low back pain and pelvic pressure (although this may not be new in late pregnancy!) - Release of the mucus plug - Hind waters leaking (a slow leak of amniotic fluid) - Fore waters breaking (a big gush of amniotic fluid) - Early labour contractions: contractions that follow a clear pattern but are less than one minute long and mild to moderate in intensity. Especially for first time parents, the instinct when these signs begin is to gather your belongings and rush to the hospital, or call the midwife immediately to settle in for an out-of-hospital birth. But, birth may still be days or weeks away! The biggest piece of advice I give to clients at this stage in labour is to REST. Rest as much as possible until you cannot ignore the contractions, and then keep resting more. Imagine not sleeping for 2 or 3 days and running a marathon. Many many parents (and I used to struggle with this too as a new doula) get overly excited during early labour, go to the hospital sooner than needed, and exhaust all energy and tools before the really intense part of labour sets in. Then when things get ramp up towards transition and pushing, there is no energy store to draw from. Exhaustion is usually the first step in the cascade of interventions that lead to an unwanted surgical birth. Additionally, seeking clinical care earlier than needed often leads to unnecessary augmentation or so-called failure to progress. So, here are a few ways to spend your time in early labour: - Sleep or rest between contractions. You may even be able to sleep through contractions in very early labour. - If it is daytime, go for a long low impact walk in nature, taking in the sensory experience of a slow walk. - Date night or time with friends and older children and pets. - Immerse yourself in water. Take a long bath or shower. - Listen to a birth-focused meditation, practice intention setting, or pray. Get into the zone of the mountain of birth you are about to climb. Breathe deeply and notice how it feels to surrender to your body's timeline. Talk to your baby! Tell them you are excited to meet them soon and that you will take care of them as they embark on this journey of labour with you. One of my favourite birth meditations is linked here. - Do a short, low stakes project that is easy to abandon, like a puzzle, knitting, or low-stakes household task. - Low impact movement, like lunges, cat-cows, and hip-openers. - Put your phone away! Don't record the space between contractions until they become regular and unavoidable. You may note the time that contractions began, but expect things to stay mild for a long time, especially if you this is your first pregnancy. And did I mention REST?! Have other favourite rituals for early labour? Leave a comment!  Whether planned or due to unexpected complications arising during birth, needing a c-section can invite different type of needs from a vaginal delivery. One of the most common fears with a c-section is that the birth isn't "real" or doesn't hold the same type of gravity that giving birth vaginally does. This is simply not true. Having a baby via cesarean is still giving birth. Both types of entrance for baby can be beautiful and meaningful for you, your baby, and your family.
It is important going in to your experience, whether it is medicalized or non medicalized (or sits outside of that binary) to know that ALL birth is inherently meaningful and sacred. Whether a through surgery, at the hospital, or at home it is possible to tap into that spiritual significance while adapting to the circumstances. No matter how baby comes to meet us, we can tap into the magic of birth when we find pathways to do so. This post will include a few practical ideas for highlighting the spiritual transition of birth in surgical settings. First of all, if you are planning a c-section it will be easy to incorporate spiritual or religious significance into your plan. This may mean playing a certain piece of music in the OR while baby is emerging (yes, this is allowed in many hospitals), or having your support person read a poem while baby comes. In the OR, you can also request delayed cord clamping and skin to skin once baby has arrived, the same as if a vaginal birth occurred. Skin to skin can and should happen in the OR! This may look like your support person placing baby against your chest while the tissue is being repaired postpartum. You may ask for the placenta to be saved for your observation or keepsake. Once you reach the recovery area after surgery, you can continue skin to skin and baby may begin to root to try a first feed if you are planning to breast/chest feed. Another wonderful idea that one of my clients with a planned cesarean had was to have her friends and family all light a candle in their respective homes during the time of her scheduled surgery. This is one of the beautiful things about a planned c-section - your community and loved ones will know when it is happening and be able to send you well wishes or say a prayer or thought for you on the day. While recovering from a cesarean can bring its own pains and challenges, there are many resources to support in recovery and it is okay and a good thing to ask for support. One of my favourite resources that I often draw from is nurturingthemother.ca. Janelle provides many resources that support expectations and needs around cesarean birth, and has a recovery guide available on her website. The most important takeaway is that giving birth via c-section is still giving birth. It will still release the hormones that move through the body to promote bonding between birthing person and baby and support lactation. There are so many ways that c-sections can be made meaningful through ritual, music, poetry, and bonding and it is more than possible to leave your c-section feeling satisfied with your birth experience! |
