Article by Josh Moore
There are endless tasks to take care of in the months and weeks leading up to having your baby, and one that should be prioritized is packing your hospital bag. While there are some essentials to remember, it’s also important to know what you don’t need. Use this guide to help you pack your hospital bag and be ready for your big day. If you need extra guidance, birth and postpartum doula Liz Foster can help.
What you should bring
When it’s time to jump in the car and race off to the hospital, you’ll be far too distracted to carefully pack a bag. This is where preparation comes in: it’s a great idea to pack a bag at least two weeks before your due date so you can be ready when the time comes.
While each mother-to-be will have her own personal requirements, there are some big items that you can’t leave at home. One major must-have is a car seat: you’ll need a safe way to transport your new baby back home, and the hospital likely won’t even let you leave if you don’t have one ready to go.
A change of clothes is vital for your big day. Along with packing an outfit for the ride back home, you’ll also want comfortable clothes to wear in the hospital. Many moms opt for a special labor gown, which is a great alternative to the scratchy and unflattering gowns that hospitals typically have on hand for birthing moms. When you’re picking one out, try to find one that’s as comfortable as your favorite tee and that’s functional enough to be worn during labor.
It’s also a great idea to bring a nice top to wear in photos with the baby. It’s normal to feel pretty worn out after labor, so a flattering shirt will make you feel beautiful in photos. You can get a great top even if you’re on a budget — check online for an Old Navy promo code to get discounts when you buy.
Other important items to bring include any medications and special toiletries such as contact lens solution. Bring documents like your insurance policy information and driver’s license and a pen for ease in filling out forms. You’ll need a cell phone and charger to stay in touch with friends and family.
If you’re working with a doula, first check with her to determine what items you can leave out of your bag. For example, many doulas will bring comfort items such as massage oil, tea lights, and a portable speaker to make the birthing process more soothing. You may even want a book or magazine if you’re being induced as there may be some downtime.
What NOT to bring
Along with knowing what essentials to bring with you to the hospital, there are a few items that aren’t worth taking along. For example, the hospital will provide many items that are essential such as diapers. If you’re unsure, check with your hospital to learn what items they plan to provide for you and your new baby.
It’s not usually necessary to bring baby clothes to the hospital — they’ll likely send you home with a onesie. However, if your baby comes in the winter, you might want to pack extra blankets to keep them warm for the drive home.
Another item you might consider leaving at home is snacks. Many birthing mamas aren’t in the mood for snacks during labor. However, a couple of granola bars won’t take up too much space and could help your partner make it through the labor if you don’t have the stomach for it.
Packing for the hospital will likely make the birth feel far more real and imminent. While you may feel inclined to overpack, try not to load too many items into your hospital bag. A simple labor gown and comfortable clothes, plus a cell phone, charger, important documents, and ID cards will be sufficient. Just don’t forget the car seat.
Do you need some guidance as you prepare for the birth of your baby? Contact Liz Foster today to learn about her birth and postpartum doula services.
Avery Jane arrived at 9:45am on Friday, August 12, 2016! I was 39 weeks, 3 days and we are enjoying her so much. I rocked my VBAC with flying colors.
There I was, 39 weeks and 2 days...it feels like an eternity when you’re almost to the finish line and you’re anxiously waiting for your new life as a family of four to begin.
We went to my 39 week appointment and I was 4-5 cm, as per usual for the past couple weeks, same as with Jackson. Apparently my body works well with pregnancy even though I’m not your typically happy pregnant lady. But I love having my babies once they’re born. But the process is so taxing on me! I had sent a recipe to my mom for Labor Inducing Cookies so she invited me over the afternoon to see if they work.
Here is the recipe: https://www.loveinmotion.net/blog/labor-cookies
The instructions were to eat as many as your can stomach, take a nap and wait for labor to start! Seeing as this would be the only time in my life that I would be able to eat as many cookies as I wanted, I. ATE. 11...IN ONE SITTING! They resemble a spicy Christmas cookie and are super delicious. We will definitely be making them this holiday season!
That evening, I took some Evening Primrose oil and waited for labor to commence. Around 9:30pm, I watch a little TV before turning in but something felt different, some cramping that had increased to a more than uncomfortable state. After 30 minutes of deciding that this was real labor, I went upstairs to wake up my husband John and tell him it is time. I called the midwife, who suggested to let her know when I’d like to go to the hospital. Being the indecisive person that I am, I waited for another 15 minutes and called everyone who needed to know that we were headed to the hospital: our doula Sabira Marike, photographer Kayla Raine Armstrong, Rachael, Lois, and Mireya, our neighbor who would watch Jack for us. I threw up the cookies mid-conversation with my photographer, bless her heart. I felt better after that, almost well enough to doubt if I should’ve alerted everyone so soon. But things were already set into motion so we dropped off Jack and headed to Castle Rock Adventist Hospital (best hospital food EVER!).
My doula and birth photographer arrived to the hospital around midnight, once we were all settled into our room. The same midwife I saw this morning for my checkup was there and on board with our birth plan and wishes, which was very comforting. We decided to strip my membranes to see if that would get things moving. Both Rachael and my mom had their phones off but I wasn’t worried. They would arrive in the morning if I didn’t have the baby by then. By about 3am, labor was fizzling out so we decided to sleep a bit, which was nice to get some rest before the main event. This photo below was a little bit of labor that night.
Shifts changed at 7:00am to new nurses and a midwife, a new one I had never met before in the practice. I was nervous because that had happened last time with Jack and everything went south very quickly, because we were not on the same page. However, my midwife Jen Holcomb was aware of what kind of birth experience we wanted and she was very accommodating. She said “Well, since you’re not having contractions anymore, we can technically send you home but since we’re here, let’s have this baby!” We decided to break my water to jump start labor again, so Jen broke my water with a long medical looking crochet hook at 7:30am. John stepped out to grab a breakfast burrito from downstairs and by the time he came back up 20 minutes later, contractions resumed but at a much higher intensity but were still felt bearable. I had been 5cm at my 39 weeks appointment the day before. When they checked me after the water breaking, I was at 6cm. Luckily the breaks between contractions were so merciful.
I took a shower, which was helpful in focusing on anything other than the intensity of contractions. The wireless fetal monitors they required for me to have on at all times (due to trying for a VBAC) was excruciatingly annoying as it lost connection every time I moved a muscle, which meant a nurse would come back into the room less than every 5 minutes when a reading wasn’t detected. It was difficult to get into a labor rhythm with constantly trying to get the stupid monitors to read my baby’s heartbeat.
Once I got out of the shower, contractions got much more intense. Shit got serious! No more laughing or talking in between contractions. These required my entire focus! John and Sabira were so supportive with the atmosphere and anticipating my needs. Music was going, my affirmation notecards taped to the bed, oil mists, colored diffuser running, birth art on the windows, dim lighting, counter-pressure, cold towels on my forehead and neck, guided meditations, and so much encouragement. I moved to a ball on the floor, leaning over the foot of the bed.
Inside, I really didn’t want to have a long labor. Labor was getting very intense, so I asked to play a special song, Fight Song by Rachel Platten. For me, this song makes me cry every single time. This birth was so important to me, a redemption for all the pain and suffering from Jack’s pregnancy and birth (to read that, go here). I wanted to prove to myself that I am more than capable of having an unmedicated vaginal birth after cesarean (VBAC). The first words of this song brought my into the present moment, seeing the contractions as waves, my baby working hard, my body moving her down. Then the song moves into proving others wrong and mustering up inner strength to complete what I set out to accomplish.
Jack’s birth was so traumatic. The doctors took away my power and everything after that, I lost my voice to stand up for myself and my son. It was a very difficult path as a single mom, fighting for my son and myself. Please listen and tell me you can’t cry!
Like a small boat on the ocean, sending big waves into motion
Like how a single word can make a heart open
I might only have one match but I can make an explosion
And all those things I didn’t say, wrecking balls inside my brain
I will scream them loud tonight, can you hear my voice this time?
This is my fight song, take back my life song
Prove I’m alright song. My power was turned off
Starting right now I’ll be strong
I’ll play my fight song and I don’t really care if nobody else believes
‘Cause I’ve still got a lot of fight left in me.
Needless to say, this song made me wail and weep with emotional grit, pain, and gumption to endure through this last leg of my birth journey. If you have ever gone through a difficult situation, believe me when I say that music can make you break any barrier or struggle. This was the moment in which I realized that the only person who could push me through the struggle of labor WAS ME. Nobody else was going to take the pain away BUT ME.
Following this song, I’m not sure how much time had passed. I merely focused strongly on birth affirmations taped to my bed:
Embrace this moment
Just let go
My body is so much stronger than my fear
Relax, lose control, lose yourself
My baby and I are working together to meet each other
I find my your inner peace and calm
Despite all my training with birthing classes, exercises, breathing, meditation, visualization, nothing prepared me for the moments in which my body took over and forced me to give into the natural urges to embrace the pain, not fight it. It’s a powerful moment to work with your body or avoid it altogether! But I was checked again still at a 6! I was distraught but knew I had to do something different. Instead of just managing contractions for what intensity they were, I realized I could actually bear down a bit with the power I’d been given by each surge to open up my cervix and guide my baby down. For some reason, I didn’t know I could do that, as if these contractions were just something my body was doing to get the baby out. “You mean I can do more than manage the pain?? Ok, I can totally do that.”
I changed positions to lean against John. It was a beautiful swaying dance of resting on his chest in between contractions, then hanging from his neck and burying my face into his sternum.
The intensity was so much that I felt the need to keep moving. I couldn’t stop moving. Nothing felt like it was working. At times, I wanted to escape but I knew there was a baby at the end, even though at times I literally forgot! Who forgets what pain they’re enduring to see an incredible end product of having a baby?!?
I moved to the bed and hung over the top with the head of it raised. I wanted to give up. This was definitely transition, 8-10cm, my tipping point. John and I had a safe word for an epidural: E.T. I so badly wanted to say it. I knew I was so close to meeting my baby. My carnal noises were beginning to be gutteral, primally raunchy. In the moment, it was strange but felt so good to let it out. Grunting felt like I was urging my body to get this over with. For a moment, I remember how painful Jack’s birth was, with back labor, and it reminded me to be grateful for every graceful minute (or less) I had of rest in between contractions. How did I ever do this before with back labor?!
I lost some focus, not managing my breath, not doing non-focused awareness. I was panicking so I asked for a ball. They gave me a peanut ball to straddle in bed. “Relax, Breathe, Feel the Earth, DO NOTHING EXTRA.”
Head in my hands, I worried that this whole natural route might’ve been a big mistake. “Mother Mary taped to me, doula guiding me through relaxation meditations, aromatherapy, stupid hypnobirthing, who am I kidding?! This is stupid. This fucking hurts!!!”
John could sense I had lost my cool, Sabira suggested I lay on my side with the peanut ball in between my legs. I obliged and hoped to distract myself back into confidence that this would be a good outcome. “You were made for this moment, Liz!” my green card on my bed says. “Screw you! This moment sucks!” I yell in my mind.
I flipped to the other side, trying to grasp something, hold onto something to anchor my composure. Sabira and John pounded pressure on my hips. I thought they could do my job for me and squeeze her out that way...Bummer, no good. I sat up, squatting on my knees to find what would do the trick in ending this battle. John held my hand as I regained some sense.
Note the time: 9:27am
At 9:30, the midwife came back in to check me and she said I was a 10! Thank God! Ready to go! Let’s do this! OMG is this happening??? She knew this baby was coming fast. After all, I only labored for almost 4 hours with Jack before I was whisked away to the OR for an emergency cesarean. The light was at the end of the tunnel and it didn’t look like any signs were leading to an operating room, although there still was a legit fear that history might repeat itself.
On my side again, she checked where baby was at. By this time, I heard my mom’s voice. MOM! She finally made it all the way down from Boulder Canyon where she had visited my sister and her family the night before. I thought “Why give your pregnant daughter labor cookies and leave for the mountains, you crazy woman?!?” But my mind was relieved to have my mom be there. She is good at taking care of me, such a good heart. I felt like I needed her just for this moment to give it all I had. Mom put a cool wet cloth on my forehead to cool me off. Thanks mom.
I pushed for a good 10 minutes. As Avery gradually begins to emerge, I hear, “Oh wow, she has so much hair!!” I thought, “What?! Her head is out? OMG I’m doing this! I’m really doing it!! No turning back now. I gotta give absolutely everything I have in me.” John and Sabira both held my legs as I pushed down with all my might. Jen, the midwife, asked “Do you want to feel her head?” I shook my head no. Thinking back, I would have wanted to, just to feel what was truly coming out of me.
They tell you to not squeeze your face muscles but when you have to push with every fiber of your being, you really have to push with EVERY FIBER. I tried not to so I focused my attention on relaxing my eyes, jaw and forehead. I didn’t want another popped blood vessel in my eye like last time. And I remember Ina May Gaskin (midwife goddess) saying in one of her talks that a loose jaw is an open vajayjay, so I did my best. I felt the midwife’s hands push down my perineum so as to make more room and to prevent tearing.
Suddenly, Jen said “Ok, Liz. Give me two really big pushes and you’ll meet your baby, ok? You can do this.” “DEAL!!” I gave the best and biggest 2 fucking badass grunted pushes of my life. The time had come! My baby arrived! I noticed John smiling from ear to ear and crying in awe and excitement to see our new baby. The baby we made together has finally arrived! I gave out an exhaustive sigh as I looked around to see the proud faces of nurses and family smiling and congratulating me. I did it! I pushed and “loved” my baby into this world! The struggle was over. The redemptive journey of my VBAC was over in a glorious victory! Praise Jesus!! Hallelujah!!!
10 minutes of pushing, are you serious? I’m sure some of you want to throw cabbage at your screen right now. I feel you ladies!!!
I reached down to grab my baby, but Jen gently murmured, “Ok, the cord is wrapped around your baby’s neck and foot so we’ll just take that off.” John and my mom recalled later that they weren’t sure whether to be shocked, scared or neither about that statement. Jen lifted my beautiful and aware baby to my chest, while my doula lowered my gown to allow for a skin to skin embrace on the outside of this world. Oh the joy of ecstacy, to be rewarded with such a rush of pure contentment and gratitude! The nurses rubbed Avery a bit and gave her oxygen to revive some blood flow as she came out blue from the cord around her neck. I honestly don’t recall her crying, which is common amongst unmedicated “calm” births. However, I did find a documented photo of her first wails. It’s crazy the things women forget so quickly during pregnancy and birth!
I closed my eyes in relief and pure joy to feel my new baby girl in my arms. Words don’t describe the miraculous beauty of this one magical moment.
As if this moment couldn’t warrant any disturbance, the room came back into play. The pain reappeared in the version of placenta delivering. “Owwwww! How come the pain isn’t gone? Haven’t I worked hard and long enough? Is it not enough that I push a baby out, but now have to deliver a placenta too? Oh! And stitch me up please?!?” One of the nurses said, “Would you like painkillers now?” I exasperately exclaimed, “YES!!!” “Ok, hun, do you want a dosage equivalent to 2 glasses of wine or 4?” “4! Yes, 4!!!” The whole room giggled with approval. “You deserve it hunny” replied my mom. YES I DO!
They flipped Avery over to cut the cord. John and Sabira interjected, stating that we desired to delay cord clamping until the cord stopped pulsating. A nurse insisted “After a minute, there’s no benefit.” Alas, one battle I didn’t care to fight about at that moment, even though I think we could’ve fought for a bit longer and won. The cord was still blue when they clamped it. John cut it and she was brought back up to me.
The drugs kicked in quickly. Oh sweet Jesus, bless the Lord, I’m on cloud 9! As Jen stitched me up (using a huge curvy needle like a fish hook! Yikes!), I embraced this little one on my chest. My mom, John, and Sabira glance over me while my heart melted into mush. What a glorious privilege it is to experience one of God’s most intimate gifts: bringing life into the world. And we utterly embrace it with love and gratitude.
John took Avery over to the heating station to check on her as I took a few peaceful breaths. One of her first gestures to John was reaching out to his face. Whether intentional or not, this image will forever be cherished in my heart.
He brought Avery back in my arms, still naked and unwashed (Oh that baby smell!). She was so calm, squeezing my thumb, resting on her mama’s chest. They took her away once more to put tags on her, John and I. John got to hold her once more, now in a diaper and clean of a little meconium. At least, she was brought back to me to be undisturbed from the medical staff and to work on breastfeeding. Holy Champion Latcher Batman!! One of my favorite moments for sure.
As the dust settled, I regained some dignity of my exposed battle wounds and we reclined back into my bed, nestled up in a football hold of love and soon to come colostrum. Never will I forget the strength it took for me on that special day in history, August 12, 9:45am. I am so blessed to brave the challenging territory that is natural childbirth.
John, I’m so thankful for your incredible support throughout this process. It has been an honor to carry our baby into this side of heaven. I love you so much!
Would I do it again? I know now that I totally can! But I believe I’m meant to dare greatly in other extraordinary experiences in life. Since this is a rite of passage, I wish to give back to others, inform women of their choices and risks and above all, to NOT FEAR under all circumstances, especially birth! Your body is meant, born to do this. We carry the very life substance to grow, push, and nurture a baby to infancy. How crazy is that?! What a joy it is to be a vessel of creation.
Sabira, thank you from the bottom of my heart for supporting us through this incredible feat. You placed confidence in me with your knowledge and intuitive expectation of all my needs. You are an angel! I couldn’t have done this without you!
Lois, thanks for showing up right on time! Not a moment too soon right? I was YOUR VBAC baby and I was glad you were there to experience mine. Your heart shines through all of your girls and I’m proud to call you mama. Tell me again, how did you do this 3 times??? I love that you step in gracefully into your Grammy role and I can tell you are just as excited as I am to give Avery all of the girly experiences that we had as kids!
Kayla, thank you so much for documenting one of the most intense and rewarding moments of our lives. You were exactly what you said you’d be, like a fly on the wall. I barely even noticed you, haha! But I’m so grateful I got great photos to remember this memorable event.
To the hospital staff, you’re the bomb! From providing bomb ass food to freezing my placenta for encapsulation, you are truly the saints that make miracles happen. Thank you, Jen, for doing what you needed to do in the moments you needed to do them and you respected many of my wishes but above all, you helped deliver my baby girl!
Avery Jane, it is an honor to be your chosen mother for this wonderful journey of mother and daughterhood. You picked a really good family to be in! We are so thrilled to have you grace us with your magnificent presence. I cannot wait to show you what this life on Earth has to offer. You are a blessing to us all and by that, we also are all blessings!
38 weeks: Feeling so fat, exhausted, weak, and very pregnant, ready to get going with my new life with baby. I am 2-3 cm dilated for about 3 weeks. My sister Laura finds an old friend from Boulder who is willing to assist in being my doula for labor and the birthing process. Praise the Lord! Baby has dropped into my pelvis.
39 weeks: Baby has dropped even more into my pelvis. At Wednesday's doctor visit, I am told I am 4 cm dilated and small bloody show (she agitates my cervix). Since the 4th of July, I'm having friends and family "walk" me every day. Thanks to Rachael and Rachel for getting me out of the house and moving, outside of my daila yoga practices. Laura suggests to take Evening Primrose and mom pumps me everyday full of pregnancy and red raspberry leaf tea, also provided by Laura. I don't know what I would've done without the tips and encouragement from her, seeing as she is the only one I know that is familiar with birthing babies as of recent (she had her 2nd baby boy Dillon in February via home birth).
Friday, July 8: Al and mom decide to take me out for PIE. Rachael joins us as well at Marie Callendars. Chicken Pot Pie and community shared banana cream pie, chocolate cream pie, and chocolate satin pie...yummm. Al's bet on the birth day is July 9th and his story is that his 2 kids (now all grown up) came when pie was ingested the day/night prior... So we go back home and watch Due Date, which seemed very fitting for what would go on for the rest of the night. We finish up the movie around 8, at which time I'm starting to feel contractions and they are inTENSE now! I head upstairs to see if it's really the real deal. More bloody show. Mom is upstairs brushing her teeth and I have changed moods from happy and excited to "this sucks" and "I think this is it" mood.
The texts between Rachel and I...
R 8:15 "Double rainbow at my house!!"
M 8:27 "Contractions r more intense now. Hard to time. Last one was 5 minutes from start to next start. In my back and causing pain in my stomach."
R 8:32 "Oh buddy. Double rainbow called it..."
M 8:32 "Come over??"
R 8:33 "On my way darling."
Rachel finds me in my room laying on the floor on my hands and knees, remembering any moves to alleviate the pain. Cat/cow, pelvic tilts and rolls, tailor sitting, childs pose...Wayne calls and gives some sound advice "I'm so proud of you. You can do this!" Rachel times the next contraction and it's closer than we thought: 3-3.5 minutes apart! Rachel says "It's time to go to the hospital." As everyone is getting things together, I'm thinking "Ok this is it. MAN that hurts!!! whewwwwwwoohhhhowwwweeeeee!! This better not take too long..."
From this moment on, everything is a big blur of events but eventful nonetheless. I crawl into the back of mom's car and the seat is laid down so I can move any way need be as Rachel lays there with me, rubbing my back and calling the need to know people, Jessica my doula, my doctor, etc. Mom is letting Laura and Lee know what's happening and I get to listen to Laura's voice on the way over. "You are meant to do this. Just breathe. Just focus and breathe." She can hear me breathing deeply and experiencing increasingly intense contractions. After what felt like forever, we finally get to Parker Adventist Hospital. I distinctly remember my mom being somewhat frantic. "Are they going to let us have a wheelchair?" I look at Rachel and we're thinking the same thing...that's my mom for you and I love her for it. They wheel me in and I try to ignore the glaring faces of other patients from the Emergency entrance area. I guess it's not every day you see a woman in REAL labor, except on TV, so I wonder if it's what they really thought it would look like. It must be like seeing a car accident in person when all you've seen is what you see on the news, you know? But movies and TV are sooo diluted in how labor and delivery truly is experienced. It's nothing like you see in the movies. ANYWAY, we get up to the birth center and I'm wheeled into a regular room and apparently I'm not registered...I'm thinking to ask about the "natural birthing room" but cannot muster up a concrete sentence that doesn't involve heavy breathing, a curse word, and "I don't want to do this anymore." So I just go with it and focus on my breathing. One of the nurses asks me to undress into their stylish robes and to give a urine sample if possible. EASIER SAID THAN DONE LADY! I'm not sure why I tried to give them a sample TWICE before giving up since the attempt at squatting was beyond excruciating and in the back of my mind I'm thinking, "I thought this position was supposed to give me relief."
From this moment on, it seemed as thought the nurses were against me. Jessica is not there yet so I work on leaning over the bed to stretch out my back. The moment I find some glimpse of relief from a contration, a nurse tells me I have to get in the bed. "Are you kidding me right now? I want to birth a baby and whatever position that will help, I'm going to do." I comply because I don't know what's going on. IV, fetal monitor, and who knows what else is established on my body and I'm examined at 8cm. What??? Then I remember Jessica finally arriving. She became my focal point from then on, which helped immensely. Even through hospital bed bars, she was able to intercede for me and be my advocate for any unnecessary intervention by the hospital.
Since I was not pre-registered, during contractions, they continuously explained paperwork and had me sign stuff when one would be over. You could've had me sign my life away, I was so focused on each and every contraction. As they became more and more intense, being reminded of low moans kept me at bay. All my inhibitions flew out the door as people kept prodding at me for information.
The ongoing frustration I had was as I found a comfortable position to alleviate any pain, specifically back pain, the nurses would come back in, saying the fetal monitor cannot read the baby's stats. The birthing ball, the birthing bar, squatting, hands and knees, they all helped until nurses forced me to lie back on my back, the worst position that increased the contractions. On TOP of this, the OB/GYN that tended me throughout my pregnancy was not on call and the least desirable doctor from the practice was on call. Yet another let down, but I didn't care. I was going to get this baby out naturally! 9cm....and I'm on an oxygen tank.
I kept hearing that people were amazed that I wanted a natural birth, that I was doing incredible, and later I come to find out that the reason why I was having so much back labor was because little Jackson was faced posterior, spine to spine. Anytime it was too intense, "back baCK BACK!!" was what I said. I recall that I kept looking at the clock on the other side of the room, hoping that time would fly faster and that I would see my baby soon. My mom read me some Bible verses and I overheard some calming music and hypnobirthing tracks that distracted my mind from the ever increasing contractions.
As the contractions became even more than I had ever imagined, my voice would want to go higher, saying "I can't do this. I don't wanna do this anymore" to Jessica. "Lower your voice, oooooooooo. Jackson is coming so soon. You're there. You're almost there." Almost 10cm.....
Around 11:30pm, there was continued failure in getting a continuous reading on the fetal monitor around my swollen belly. All of a sudden, I see 3 times as many people in my room, along with an unknown male doctor talking to my doctor. "She wants to birth this baby naturally." "Well my room is prepped when you're ready. She's not going to make it." This gave me more motivation to take this experience to completion...the arrogance of this doctor was just too much. I'm ready to push. It's go time!
I was surprised that at this point, the pain wasn't as intense as during transition (8-10cm). It felt like I was a ticking time bomb so whatever I wanted to do naturally, I had to do it fast before the nurses would make me sit back on my back so everyone helped me try to push on my hands and knees...it wasn't enough. Squatting...still not enough. My doctor said "we still can't get a good reading so we'll have to get a node on his head to get a good reading of his heart rate." "Oooookkkkaaayyyy..." Returning to my back once again, I feel like I'm pushing a camel out of the eye of a needle. It feels like progression but it wasn't enough for the doctors. "We're going to try to use a vacuum. I know you want to do this naturally, but your baby is in distress. Can we try with a vacuum?" *Nodding and crying at the same time* "This is not what I wanted...this wasn't in my birth plan!!!" my mind racing with thoughts and fears: "It'll be okay...he'll be okay. This is for the best." I get a nerve block to get the vacuum in and set on the top of Jackson's head. I can imagine what he was thinking: "wtf? Keep me in here! It's warm and cozy..." I push even harder but am having a hard time feeling contractions anymore, which was frustrating. Everything was happening so fast and I was losing so much focus with all the people in there. What is the need for all of these frickin people??? Didn't I ask in my birth plan for this not to happen? Of course my modesty is out the window but still, sphincter law is in full effect: Who in their right mind can seriously go #1 or #2 in front of THAT many people? At that point, I knew this wasn't going to happen if things didn't change. Nonetheless, I keep pushing whenever possible, even at the sight of my doctor talking to the male doctor, which angered me that if I were to push him out at that point, she would've been distracted and my baby would fall on the floor. They gave me one last push, "for good measure" is what I'm thinking the rude doctor is saying. "Nope, let's get you going." I immediately burst into tears, looking at Rachel with the largest fear in my eyes. "What's going to happen? I'm scared!!!" She looks back at my with her hands on her face, mirroring my thoughts and emotions. Everything will be okay. I hear a distant quiet voice in the back of my head. For I know the plans I have for you.
They wheel me into the OR, without Jessica, my mom, or Rachel, and I begin to panic. "Just put me out of my misery. Just put me out. I'm pissed at you guys." A nurse says "We need to move you to this table beside you. Now it's a narrow table so don't move too much." *Are you serious??* Ohhh, this is my worst nightmare...Oh God Oh God, what did I deserve to have this much go wrong?? They're forcing my legs straight and my arms to the side, crucifixion style...Just relax. "You're going to be ok, sweetie" says a male voice giving me gas. As I'm laying there, mourning my birth plan, I'm praying to God for deliverance from this pain and fear. Finally I fall asleep.....
When I woke up, my brain was foggy, uncertain as to what just happened. They finally bring in little Jackson, happily alert and more beautiful than I could have ever imagined. As I attempt to nurse him for the first time, all I can think about is how empowering this birthing experience was despite my birth plan flying away from my control. Lesson learned: God is in control. Jackson and I laying skin to skin, I felt an immense love for this new little being so much so that I could have laid there forever, staring at his tiny naked body, so peaceful, such a gift. My mom and Rachel come in to greet me and are so proud of me for laboring naturally all the way up to the end. A nurse comes in to take Jackson for his bath and they bring me back into my room to rest. Wayne and Rachel are there to stay the night with Jackson and I. I am so exhausted but feel an energy within me that anticipates my first night with Jackson. A few hours later, they bring him in, swaddled and sleeping peacefully. When all becomes silent, I start to nurse baby Jackson and hold him close, adoring each and every part of his body. 10 fingers 10 toes, lean long legs, and the softest skin, fresh from the womb. Throughout the night, he had his moments of little cries, melting my vulnerable heart as he opens his eyes for the first time. The brightest blue eyes that could pierce the coldest soul. We spent the next 6 hours of the night into the morning telling each other our stories: his journey from my body to my arms and my walk with enduring pain and immeasruable emotional intensity that is my rite of passage to motherhood.
The roadmap of labor
I have created a visual guide to labor progress using the metaphor of a road map. It shows key labor landmarks and appropriate activities and measures for comfort as labor progresses (see Figure 1 above).
Parents can use it during labor as a reminder of where they are in the process and what to do. Teachers can use it as a tool for organized discussion of normal labor progress and as a backdrop for discussing laboring women’s emotional reactions, and how partners or doulas may assist. Health professionals can use it to help parents identify where they are in labor, adjust their expectations and try appropriate comfort measures.
Normal labor pathway
The roadmap portrays three pathways. The main brick road represents unmedicated labor and shows helpful actions, positions, and comforting techniques to use as labor progresses. The twists and turns in the brick road indicate that any normal labor does not progress in a straight line; the large turns between 3-6 centimeters and 8-10 centimeters indicate large emotional adjustments for the laboring woman, and present an opportunity to discuss emotional support and comfort measures for the partner or doula to use. After 10 centimeters, the woman’s renewed energy and confidence are represented by the second wind sign. Along with discussion of emotional support and comfort measures, the teacher can offer perspective and practical advice for partners and doulas, to use both when the woman is coping well and when she feels challenged or distressed.
The roadmap provides a clear and effective way to teach about normal labor. It keeps the discussion focused purely on the physiological and psychological processes, without inserting discussions of pros and cons of interventions, complications, or usual policies and hospital practices that alter labor.
Once parents have a solid understanding of normal labor, the teacher can explain usual care practices and possible options for monitoring maternal and fetal well being during labor. She can also discuss labor variations or complications and treatments with medical (including pain medications), surgical or technological procedures. With this approach, parents are better equipped to discuss risks, benefits and alternatives, because they can distinguish situations and conditions that are more likely to benefit from the intervention from those in which the intervention is optional, unnecessary, or harmful.
Planned and spontaneous rituals
The normal labor road suggests measures to use for distraction, comfort, and progress. Distraction is desirable for as long as it helps. The Relax, Breathe, Focus sign reminds parents to use this pre-planned ritual for dealing with intensifying contractions when distraction is no longer possible. Parents need to rehearse these rituals in childbirth class (i.e. slow breathing, tension release, and constructive mental focus) and use them in early labor. They set the stage for the spontaneous rituals that emerge later in labor (as women enter active labor), when they realize they cannot control the contractions or continue their planned ritual, and give up their attempts to do so, though sometimes after a stressful struggle. Spontaneous rituals replace the planned ones. They are not planned in advance – they are almost instinctual – and almost always involve rhythmic activity through the contractions – breathing, moaning, swaying, stroking, rocking, or even letting rhythmic thoughts or phrases repeat like a mantra.
The three Rs
The spontaneous rituals usually involve the three Rs: relaxation (at least between contractions), rhythm, which is the most important, and ritual, the repetition of the same rhythmic activity for many contractions. In order to give herself over to spontaneous instinctual behavior, the woman needs to feel emotionally safe, uninhibited, accepted unconditionally by partner and staff, and to be mobile in order to find comfort.
The motto ‘Rhythm is everything’ means that if a woman has rhythm during contractions, she is coping, even though she may vocalize and find it difficult. The rhythmic ritual keeps her from feeling totally overwhelmed. The goal is to keep her rhythm during contractions in the first stage. Once in second stage, however, rhythm is no longer the key. The woman becomes alert and her spirits are lifted. An involuntary urge to push usually takes over and guides her behavior.
The role of the partner in labor
The partner helps throughout labor, comforting the mother with food and drink, distraction, massage and pressure, assistance with positioning, and constant companionship. Sometimes, a doula also accompanies them, providing continuing guidance, perspective, encouragement, and expertise with hands-on comfort measures, positions, and other techniques gained from her training and experience.
The role of an effective birth partner includes being in the woman’s rhythm – focusing on her and matching the rhythm of her vocalizations, breathing or movements – by swaying, stroking, moving hand or head, murmuring softly in her same rhythm. Then, if she has difficulty keeping her rhythm, and tenses, cries out or struggles – as frequently occurs in active labor or transition – her partner helps her get her rhythm back, by asking her to focus her eyes on their face or hand and follow their rhythmic movements. This is the take-charge routine, and is only used if the woman has lost her rhythm, is fearful, or feels she cannot go on. Partners who know about this are less likely to feel helpless, useless or frightened. Simple directions, given firmly, confidently, and kindly (‘look at me,’ or ‘look at my hand’), rhythmic hand or head movements, and ‘rhythm talk’ with each breath (murmuring, ‘Keep your rhythm, stay with me, that’s the way…‘) are immensely effective in helping the woman carry on through demanding contractions.
During the second stage, rhythm is no longer important; now the partner encourages her bearing-down efforts and release of her pelvic floor, and also assists her with positions.
The motto “Rhythm is everything” means that if a woman has rhythm during contractions, she is coping, even though she may vocalize and find it difficult.
The detour for back pain
A second pathway, a rocky, rough road, represents the more difficult ‘back labor’, which may be more painful, longer, or more complicated than the normal labor pathway. Fetal malposition is one possible cause. The measures shown for back labor are twofold: reduce the back pain and alter the effects of gravity and pelvic shape to encourage the fetus’s movement into and through the pelvis. It helps a woman endure a prolonged or painful back labor if she and her partner use appropriate comfort measures, and if they know that dilation may be delayed while the baby’s head molds or rotates to fit through, or that changing gravity and pelvic shape may give the extra room that the baby needs to move into an optimal position.
The epidural highway
This third pathway represents a dramatically different road – smooth, angular, man- made, more comfortable – but it comes with extensive precautions and numerous procedures, monitors, and medications, which are necessary to keep the epidural safe. The woman adopts a passive role while the staff manage labor progress, and monitors the mother’s and fetus’s well being closely. The excellent pain relief and chance to sleep are the usual rewards. Discussion of how to work with an epidural in order to optimize the outcome is beyond the scope of the paper, but the basic principle is: treat the woman with an epidural as much as possible like a woman who does not have one! This essentially means,‘Keep her cool. Keep her moving. Keep her involved in the work of pushing her baby out. And don’t assume that if she has no pain, she has no distress! Do not leave her alone.’
The roadmap of labor provides a useful framework for teachers to explain the psychological and physiological processes of labor, and a variety of activities for comfort and labor progress for women and their partners to use. By focusing on the normal unaltered process, parents learn to separate the norm from the numerous interventions that alter the process, sometimes for the better, sometimes for the worse. The intention is to give them confidence that they can handle normal labor and to participate meaningfully in decision-making when interventions are suggested.