Posterior labor.

Vital information for expectant mothers and fathers 

  ( A few months ago I compiled this article for a friend of mine who just found out that her baby was posterior… I prayed a lot for her ( she had a history of long hard back labors), and she did what she could to encourage baby to turn in the optimal birth position. As a result she had her first non-back labor, and encouraged me to share this info with others. She said that many things she simply did not know, and it could have helped to prevent her hard labors before. I can not take much credit for that, as all the information compiled here was gleaned from wonderful tutoring of my midwife and instructor Lori Luyten, as well as from other sources, such as Mothering Magazine, writings of Ina May Gaskin and Robert Bradley. … )

 During the last trimester it is possible to determine the position of your baby in the womb, simply using hands.  If you in a care of midwife, she probably will check baby’s position at every visit during your last month. And will help you with council on how to reach or preserve best position of the baby for the birth. If you are in situation where hospital birth is your only option, you most likely get an ultrasound done to determine the position close to your due date. Often doctors will make decisions on possible course of action for your birth, based on that ultrasound.

Prayer can change the “worst” fetal position into the “best”, and is not limited by timings and circumstances. Prayers are powerful, and as we read testimonies of births, we see how time and again the Lord intervened and turned so many seemingly “impossible” situations into victory.

I hope that this compilation of helpful tips, knowledge, information on back labor, or posterior presentation, will serve as an aid in your birth journey. And will help you to have an important knowledge of your options, be aware of the things that you can do to prevent it, correct it, or work through it to the victory, as well as things to pray for, as you commit your pregnancy and labor to the Lord.

                At the time of writing this article I just gave a birth to a baby, which was born “sunny-side -up” ( a nice cheery name for Posterior Presentation), and went through a battle of praying for fellow mommy who had a very difficult “back labor” which lasted 54 hours. The good news, — her healthy baby was born naturally and with my baby even though it was posterior, I was blessed with easy, smooth and natural delivery, in spite of baby’s position.

However the question is, — what if anything can be done to prevent the back labor? Since statistically most of the back labors are more painful and higher percent of these labors end in Cesarean sections , when failure to progress occurs, or when mother’s exhaustion makes it difficult or impossible to continue…

First of all, what exactly is “back labor” ?

The “occiput anterior” position (OA) is the ideal and most common position. In this position the baby’s head is easily “flexed” with his chin tucked into his chest, so that the smallest part of his head will be applied to the cervix first. The baby is most commonly “LOA” meaning his back is along your left side, and occasionally “ROA” ( back along the right). When baby is anterior, the back feels hard and smooth and rounded on one side of your tummy, the bottom will usually protrude on one side under your ribs and you will normally fill kicks on the other side under your ribs. Your belly button will normally poke out and the area around it it will feel firm.

A less favorable position is the “Occiput Posterior” or OP. This means that baby is still the head down, but facing forward towards your tummy. When the baby is posterior, your tummy may look flatter, feel squashier, and you may feel arms and legs towards the front, and kicks out in the front. The area around your belly button may appear flat or dip into a concave, saucer-like shape, especially when you lay down. If your  baby is posterior you may find that you suffer backaches during your pregnancy, but that is not always an indication of OP. You may also experience long and painful, on-again, off-again “practice contractions” as your baby tries to turn around in order to engage in the pelvis. Mothers of “posterior” babies are more likely to have long, hard labors as the baby usually has to turn all the way around to facing the back in order to be born.

Here are some additional tips that might help you to recognize possible posterior baby:

Prenatally (1):

• You feel like the baby has too many hands and feet, and the moving limbs may be easily felt and seen.
• You urinate more frequently than average for PG, due to the baby’s brow pressing against  bladder.
• You may exhibit signs of a urinary tract infection, a feeling of constant pressure at the symphysis, (above the pubic bone), and an attendant lower back ache.
• It may be difficult to hear fetal heart tones, or they may be indistinct. When it is suspected that the baby is posterior, if you roll to the side,  the heart tones will be more easily heard.

in Labor (2):

• You might experience a long period of irregular contractions with little or no dilation. Contractions may be more frequent yet of shorter duration than expected in early labor, eg: every three minutes but lasting only 30 seconds. This is due to inadequate pressing  of baby’s head against your cervix.
• Persistent backache, which even in early labor may be severe enough that the pain of contractions are secondary.

Posterior presentation has increased drastically in the last 10-20 years due to change in our lifestyles. We’ve now accustomed reclining in comfortable sofas, armchairs and car seats. Since you are so big and pregnant in the last couple of months, you  probably given the best seat at the friend’s house party or family gathering, and the most comfortable reclining seat in the car on the trips out. Some woman even trying to sleep semi-upright in a recliner chair. After all, it is so difficult to find comfortable position with this big tummy!

The baby’s back is the heaviest side of his body. This means that the back will naturally gravitate towards the lowest side of the mother’s abdomen. So if your tummy is lower then your back, e.g. you are sitting on the chair leaning forward, then baby’s back will tend to swing towards your tummy – a GOOD position. If your back is lower then your tummy, e.g. you are lying on your back or leaning back in the armchair, then the baby’s back may swing towards your back and into posterior position – not so good.

You can influence the way your baby lay in your womb. Using gravity, good posture and movement you can help your baby settle into an ideal position for easier, shorter and less painful births. AVOID reclining in armchairs, sitting in the car seats where you are leaning back, or any position where your knees are higher the your pelvis.

Do what you can to avoid positions which encourage OP position. The best way to do this is to spend lots of time kneeling or sitting upright, sitting “Indian style” ( “tailor sitting”), or the hands and knees position. When you sit on the chair, make sure your knees are lower then your pelvis, and your trunk should be tilted slightly forward. Other tips for preventing a “posterior” baby are:

• If you watch TV,  sit kneeling on the floor, over a beanbag, stability ball or cusion. Or sit on a dining chair.
• Try sitting on a dining chair facing ( leaning on) the back as well
• Don’t cross your legs while sitting on the chair! This reduces the space at the front of the pelvis, and opens it up at the back. For good positioning, the baby needs to have space at the front
• Don’t put your feet up! Lying back with your feet up encourages posterior presentation
• Sleep on your side, not on your back
• Keep active, walk as much as possible.
• Practice pelvic rocks on your hands and knees every day for minimum 3 times a day for 20 minutes and/or;

• Swimming with your belly downwards said to be very good for positioning babies – not backstroke. Breaststroke in particular is thought to help with good positioning, because all those leg movements help open your pelvis and settle the baby downwards
• A birth ball ( stability or swiss ball) can encourage good positioning, both before and during labor.
• Get chiropractic care to keep your body and hips in good alignment.
• Keep your tummy warm. More babies rotate to OP during winter months. They prefer warmth so if your tummy is cold, they may turn their back away from it.

If your baby is already posterior you can try to stop him/her from descending lower. You want to try to avoid the baby engaging ( lowering down into; head dropping down into pelvic area) pelvis in this position, while you work on encouraging him to turn around. Most babies take a couple of days to turn around. During this time it is important to:

• If you can, get a chiropractor, who specializes in pregnancy, to help you with “adjusting”. It is much better to keep a good posture and do your best to prevent OP, rather then “treat it”. In my case, I had to have a chiropractor adjustment during early labor. Would I be in the hospital, I would be induced and probably rushed into C-section, for the failure to progress, when I was at 2 cm dilated after about 20 hours. But when midwife observed the pattern of my contractions, she realized that I had a problem with pelvic misalignment ( my back was not straight), and short visit to chiropractor, saved my labor. My ligaments pain was gone, labor immediately picked up and 7 hours later I was completely dialated and ready to push with well established labor. In my case the baby still decided to stay posterior, but it did not hinder the labor progress neither did  it make the labor more difficult. Some babies simply meant to be born that way.
• Avoid deep squatting.
• Use “knee to chest” position
• Sway your hips while on hands and knees
• Try crawling around on hands and knees, it is a good exercise and it helps baby positioning
• Swim belly down, but avoid kicking with breaststroke legs as this movement is said to encourage the baby to discend into pelvis. You can still swim breaststroke, but simply kick with straight legs instead of “frog’s legs”

• Sometimes a posterior position is caused by a lack of strength in your lower stomach muscles…in this case a belly support or belly binding (a large sheet or towel wrapped tightly around the belly for support) might help.
• If it’s a cord preventing baby from turning, try perhaps rotating baby the opposite direction (for example, at night try sleeping on your right side instead of left). This can help ‘unwrap’ the baby and encourage him/her to turn.

• There is also a chiropractic technique called “diaphragmatic release” and is supposed to turn posterior babies every time. In fact it can be easely done at home.

What to do if you go into labor and baby is still posterior:

Don’t get too worried…the vast majority of posterior babies rotate during labor and those who don’t are often born “sunny-side-up”. Some posteriors actually are born precipitously with no back labor, depending on how well flexed the head is, as if saying, “Surprise! It’s my little face!”  Babies come out! In fact according to statistics, the incidence of a posterior presentation occurring at the onset of labor is 15 to 30 percent, and many such babies rotate spontaneously to an anterior  position, – , – like a key turning to fit a lock.  

• First thing is to get into a knee-to-chest position and stay there for at least 45 minutes, or until baby turns. Be sure to have lots of pillows on hand so you can stay in this position comfortably for as long as is required.
• Sometimes doing stairs 2 at a time between contractions (with a spotter on each side!) will jiggle the baby’s head enough for it to turn or move the pelvic bones enough for baby to turn.
• Belly lifting is another technique for when baby won’t turn and dilation is slow. With someone supporting you from the back, lean back, arching your spine, and with both hands around your belly near the baby’s bum – pull up on it during a contraction. This realigns the vectors so that baby’s head will put more pressure on the cervix, helping it to dilate more quickly.
• A big pool filled with water will relieve a lot of the back pain and will help baby to turn, so plan a waterbirth!

It may be that your baby is going to stay “sunny side up” and will just refuse to turn; perhaps that the way he or she needs to be. …maybe that is the only way s/he can enter the pelvis, or it’s possible the placenta is in the way (for example, an anterior placenta may predispose you to a posterior baby) If you do end up having a back labor ( about 5.5 – 7 % refuse to turn and are born posterior), at least you’ll know you did all you could to make things easier for you and the baby.

Remember, however your birth turns out, even if it’s not the labor or birth you want, it WILL be the labor and birth you and your baby need. Jesus will see to it!

Many women feel some pain in their back in labor due to the descent of the baby’s head into the pelvis, causing additional pressure on the back.  However, some women experience continuous painful “back labor” due to the baby’s position throughout labor.  Some babies find it fun to hang out in what we call “sunny-side-up” or posterior position.  So, instead of lying face down, they lie face up, which puts additional pressure on mom’s back as the back of baby’s noggin rests on her back during labor.

Here are some helpful suggestions for back labor:

• Change positions frequently
• Use movement, especially sexy circular hip movements
• Hands and knees positions allow access to the back for massage and use gravity to pull baby toward mom’s belly instead of her back
• Massage and counter-pressure
• Apply heat using a rice sock or bed buddy
• Hydrotherapy – soaking in a labor tub

Another handy, yet sometimes unfamiliar, alternative for many discomforts and dystocia is the use of homeopathics.

Here’s an excerpt from a Midwifery Today article on the topic.  “Homeopathic remedies are a safe and effective means of treating a woman experiencing back labour. Homeopathic medicine along with comfort measures such as counter-pressure, hydrotherapy and positioning are very positive means of assisting the baby to move into the most desirable position for birth and result in more effective contractions with a shorter and a less painful labour for the mother. Homeopathic remedies are easy to administer and act quickly and dynamically to alleviate back pain.”

Additional suggestions for all pregnant mamas prior to labor:

• Optimal foetal positioning
• Visit a chiropractor during pregnancy for optimal allignment

Today’s primary resource for learning about childbirth is to watch Birth Day or A Baby Story on TLC. Once in a while you will see a “natural” childbirth on one of these shows, but for the most part they are made out to be emergencies with women writhing in pain, lying on their backs, and their doctors have to come in and rescue their babies. Now, the next time you see an episode where the mother is sitting in a chair, walking around, or kneeling in the tub, see if you can tell the difference in the way these labors seem to go. Although the mothers are obviously working hard, in some amount of pain, and anxious for the labor to be over with, most of the time the active mother’s babies are happier, there are less emergencies, and the delivery itself usually requires less active management on the part of the doctor. And this is no coincidence.

 “Women who walk, sit, kneel or otherwise avoid lying in bed during early labor can shorten the first stage of labor by about an hour,” according to a new Cochrane evidence review. Women who labored out of bed during the early stages were also 17 percent less likely to seek pain relief through epidural analgesia, the review found. Women who have a baby in the posterior position (what frequently causes “back labor”) have nearly a 90% chance of turning their babies in labor if they remain upright and moving during much of their labor. Shortened labor, less pain, and better positioning of babies are just a few of the benefits of remaining active during labor. Here are some others: increased comfort to the mother, as well as distraction and an enhanced sense of control. It can also help to relieve the sense of being overwhelmed. Other benefits include reduced likelihood of tearing (if in an upright position while pushing), less fetal distress, and a reduced incidence of low maternal blood pressure (this can happen if mom is lying on her back or even semi-sitting).

Why does being active keep things normal? Pelvic bones are not inflexible. They are actually made of a few bones held together by flexible cartilage. When the mother remains upright and active, her bones are constantly moving and adjusting. This means that her baby, who needs to move it’s head quite a bit to rotate down and through the pelvis, is getting help from his/her mother to be able to mold and flex his head and neck to be born. Being active not only makes this process easier, but faster. With direct pressure from the baby’s head on the mother’s cervix, she will also dilate and soften her cervix easier than if she were only lying down or sitting in bed. 

As for the pain, it is not usually completely removed by being upright, but a woman’s pain threshold can be increased this way, and pain from certain positions (like being on her back) can be removed. Lying on one’s back in labor really is the most painful position for a couple different reasons. One, when her uterus contracts it tilts forward, so if she is lying on her back her uterus has to tilt up and forward and the harder it has to work to remain efficient, the more pain it causes the woman. Second, lying or sitting ontop of a surface prevents the mother’s pelvic bones from moving, and constricts the space within the pelvis, both actions make it more difficult for the baby to mold and descend through the pelvis (often this situation mimics a case of “baby too big for pelvis” when really the mother just needs to get out of bed). This of course is not only difficult for the baby, but more painful for the mother.

Although most women will need some encouragement from a knowledgeable person (such as a doula) during labor on choosing helpful positions, they also tend to adopt positions or movements that will help them without being told how to do them. For instance, hands and knees is a very common position that laboring women will try without suggestion, simply because it feels right. And the positions that “feel right” are probably the best ones for them to use. In this case, pain directs women to choose positions that not only feel better but are also beneficial for the progress of labor and the health of her baby. If good progress is not being made, changing positions, or trying different movements, every 20 or 30 minutes may help to get things moving again. I very strongly recommend that if you can’t buy any other books about childbirth, that you pick up these three books: Ina May’s Guide to Childbirth by Ina May Gaskin, The Labor Progress Handbook by Penny Simpkin, and The Birth Partnerby Penny Simpkin. Ina May’s Guide will give you some great ideas on creating an environment that encourages freedom of movement and great progress in labor, and the other two have wonderful drawings of positions that you can try during normal labor and during any complications that might arise. Here is a website with a few good examples of positions you can try in labor.

So happens if you choose not to get out of bed, or if you are restricted to bed by your risk level, complications, or pain medications? It is more difficult to get the benefits of movement when you are restricted to bed, so it is helpful if you can stay out of bed as much as possible. Frequent trips to go pee in the bathroom are a help if you are given no other excuse to get up. Sometimes it is better for you or the baby if you do stay in bed, although realistically this doesn’t happen very often. If your doctor or midwife asks that you stay in bed, first ask why they are saying this. Then, ask how strict this rule is, since there might be leeway. For example, if you are supposed to get frequent heart rate monitoring, you may still be able to get off the monitor and out of bed for 20 minutes every hour. If you must stay in bed, like if you have a high-dose epidural, ask the nurse to help you switch positions every half hour or so to encourage good progress. You can sit up, lie on each side, try the exaggerated side position, hands and knees, and others. The Penny Simpkin books I mentioned above all have very good drawings describing these positions and how they can help you to dilate more quickly, or to help move the baby if he/she is not positioned well.

What you can do to ensure freedom of movement in labor:

1. Exercise during pregnancy to build your stamina for labor. Brisk walking and the breast stroke while swimming are two of the best and safest exercises you can use.

2. During early labor, REST as much as you can, drink water to quench your thirst, and eat carbohydrate and calcium rich foods.

3. During active labor, take a sip of water after EVERY contractions, and try to eat nourishing food to keep up your body’s energy. Sometimes labor slows down just because a woman isn’t hydrated, she’s too tired, or she hasn’t eaten all day. If you are well nourished with food and drink and labor still slows down, consider taking a rest before going for a walk. Don’t be afraid to give your body a break during labor. If you and your baby are tolerating labor well, there is no reason to rush the birth.

4. Talk to your doctor or midwife about staying upright and active during labor. Ask them in what situations you would have to stay in bed, and ideas of how you can stay active even if complications arise (eg. rocking in rocking chair, sitting on a birth ball, or sway-dancing with a partner next to the bed so you can stay on the fetal monitor).

5. Read books and visit websites (preferably with a person who will attend your birth) to get ideas of positions you can try. If you can, bring one of these books (like the ones I mentioned above) to your birth place so that if you forget them you can look up some fresh ideas.

6. Hire a doula. She can remind and help you to keep up your energy, to encourage you and reassure you that what you are experiencing is normal and that you are doing a good job, and physically support you in different positions so that you don’t get tired too quickly.

7. Don’t worry about trying to find the “right” position. Just do what comes naturally, do what feels good, and chances are you will be doing just what you should be doing. Stay out of bed unless you are tired and need a rest. Even when you are in bed you could still adopt a hands and knees position, or get on your knees and rest on the back of the bed (when the head of it is raised). There are so many options, so pick your favorites, use one of them for a while, then try another one.

Here is a University of Toronto study that shows what happens when the hospital bed is no longer the “focal point of labor”.

This weekend I supported a VBAC mother through both in-home visits leading up to her due date and during labor.  Her previous c/s was for failure to progess when in fact she had a persistent posterior presenting baby boy and her labor was augmented with pitocin (a drug dripped intravenously in the hopes the drug will speed up labor) after just 12 hours of laboring naturally on her own and following her own instincts to labor on her hands and knees.  This labor began spontaneously with her water breaking.  She proceeded to labor on her own until Dad called to say mom would like to have me there now.  Mother labored with me providing answers to her questions about what she was experiencing and Dad providing her with answers to how well she was doing, how beautiful she is.  We arrived at the hospital with Mom fully dilated and initially beautiful fetal heart tones.  Expectations were that she would begin pushing when she felt like it.  This was just after midnight.  She was never on her back but rather tried pushing by hanging over the back of the hospital bed, side lying and ultimately squatting.  The parents listened to the request from the supervising OB for an internal fetal monitor due to a slow heart rate and a need for consistent fetal heart tone documentation.  Changing positions to squatting provided a happier baby and supportive evidence for mother’s informed decision to try positional changes before continuing discussions on the baby’s well-being.  Upon baby’s birth the OB supervising for the midwife who now supposedly had a birth to see to proceeded to immediately clamp only to have parents tell him to remove the clamp.  There was much pressure to change mom’s mind about a natural delivery of the placenta.  There was a commentary from the doctor that perineal tearing always accompanies natural childbirth.  FACT:  Natural childbirth proponents do not claim no woman will ever tear.  Rather, normal birth experience shows women are less likely to tear in such a way as to need a repair or are not likely to tear at all when they are encouraged to push only to the point of comfort, push only if they feel they need to be proactive in pushing, and when pushing in any position that feels best to them.

One year ago I supported a VBAC mother through both a natural childbirth series of classes and as her labor support.  Her labor began spontaneously at 41 weeks.  She called to let me know she was in labor so that I could make arrangements for my family’s care.  Around 3pm that afternoon Dad called to say she would like me there now.  I arrived to her moaning through contractions yet speaking to me in between.  She let me know how she was feeling, what she was feeling, what she’d been doing to cope and how being on her hands and knees felt so good right now.  Her biggest concern?  That she would dirty the brand new slate flooring!  Around 8:00 p.m. she decided she was ready to go to the hospital.  We left a clean home and we arrived at the hospital with her bearing down.  The midwife on call wanted mom on her back for an exam.  Mom went to her side, midwife propped one of mom’s leg’s up, saw the baby’s head and decided there was a dystocia.  Dad stated mom did not want an episiotomy, midwife said she’d let mom have one more push.  After the next push contraction the midwife cut an episiotomy and proceeded to ‘guide’ the little baby girl (just under 8 pounds) out.  We were all subjected to a lecture on how mother’s previous C/S was due to ‘failure to progress’ and she probably had pelvic issues.  FACT:  This mom’s ‘failure to progress’ was in actuality a posterior presenting baby whose birth had been augmented with pitocin and the back-up OB for this subsequent VBAC birth was on his/her way in to the hospital.

Two years ago I provided labor support for a VBAC mother whose labor began very slowly at 40 weeks.  Her first birth was a scheduled cesarean without labor for twins with Baby A presenting breech.   At the 12 hour mark with mother wanting nothing more than to just hang out at home Dad became fearful…both family and friends were calling to tell him he was crazy not getting her to the hospital right now.  We arrrived at the hospital shortly thereafter and mother proceeded to labor at the hospital for 48+ hours.  Again, the labor was never intense.  She did not experience the classic, intense transition.  More than once cesarean was brought up, not by the doctor.  Rather a second cesarean was ’offered’ by her husband and sister who was now also present for the labor.  The doctor did however bring up time.  Mom went through two doctors’ shifts and two other women’s deliveries by c/s for failure to progress.  Mom’s sister’s c/s had also been for failure to progress as she had ‘made it’ to second stage (with an epidural) and after almost two hours of pushing had made no progress.  Fortunately for mom, Dr. Carolyn Zelop of the Boston study on VBACs (and co-author of the most recent ACOG VBAC practice guidelines) was on and in the hospital (she is not affiliated with the primary careprovider) for this labor.  Dr. Zelop smiled at mom and stated the best care for VBAC is to allow for the labor to progress gently and naturally.  Were it not for two women secure in their knowledge of the birth process this mom would have been coaxed into a second cesarean.  FACT:  This mother was experiencing labor for the first time.  She labored spontaneously, naturally and consistently slowly as is typical of most first labors.  The coping mother did wasn’t easy to see because the physical aspect was not the main influence.  In other words, mother’s mind was not reflecting on pain, but rather that it was truly laboring, something she didn’t ‘know’ her body would do and did not believe her body was doing until the final release of her son into her arms.abor is physiological and nowhere is the power of the mother’s frame of mind stronger and a greater aspect to appreciate than that of the VBAC mother.  Patience and respect for the mother’s sense of security in her body are crucial to the positive VBAC experience.

Women reading this post are likely to be aware for the first time of two pieces of birth consumerisms: posterior labor knowledge is scarce among the medical birth trained practitioners and that natural, spontaneous labor is a good thing for VBACs and are likely to lead to healthy outcomes.  Families and friends reading this post are mulling over their fears over some aspects of the births and probably empathizing with the father and sister in the second birth.  Practitioners are thinking one thing and one thing only:  these mothers labored without any hands on medical observation or protocols which equates with ‘not under their control’ and therefore, must be stopped.

Have these births had an impact on VBAC care?  Yessss, in a way.  The midwifery group mentioned in the first and second births continues to support their client’s informed choice but their back-up OB group is now pushing (no pun intended) to have VBAC birth plans submitted for their review/scrutiny and approval/counterfire.  The practice mentioned in the third birth no longer takes VBAC mothers. 

The VBAC mother continues to confound the medical birth world.  She is in the precarious predicament of representing evidence of and liability for the obstetrician’s or his/her colleague’s previous actions.

More birth consumer’isms’ – VBAC mothers require mental and emotional support on a greater level than the physical coping with labor.  Medically trained birth practitioners offer little by way of mental and emotional support for laboring women as that is not in their scope of care admittedly.   A medically trained birth practitioner as the primary careprovider is NOT the best choice for VBAC labors.   It is difficult for a mother to find a VBAC pracitioner at all let alone one who has the vision to see that the midwifery model of care can provide the support VBAC mothers need and can fill the void in hospital-focused birth advocate’s call for improving maternity health care.

I am a big fan of unassisted births. Hey, I had my own! Many birth professionals look down on women who choose to go unassisted, believing them to be taking birth ‘too far’ or being selfish. I personally believe that every woman should be able to birth how she feels she needs to. I find it very sad that even those surrounded by birth, women who say that they trust birth,  are so quick to call unassisted birth irresponsible.

All of the women I have come across who have gone unassisted know their stuff. I know I read a million books about birth before I had Oliver. Most of these women are not going blindly into birth. It is a tough road to travel; you must defend your choice to everyone who finds out about your “plan”.

As a doula, I am proud to say that I support any woman who wants an unassisted birth. Surprisingly, when I began researching doula work, I discovered that most doulas will not attend an unassisted birth. Most fear that if something goes wrong, that they will be prosecuted.

So, as I was saying, I love free births! I was extremely excited when I was asked to attend one in September.

I got the call early on September 25. She was in early labor, but definitely progressing. Once I got there mid-morning, I was really pumped! She was doing great, and her partner was there by her side. I was happy to be able to provide relief for him, so he could rest and take care of a few things. She was having back labor, and I was lucky to have brought along my new little massage ball.

It really helped, and through the rest of her labor, both her partner and I took turns massaging her lower back.

Although really tired from lack of sleep, she did so fantastic. She changed positions when she needed to, and was really amazing. I felt so lucky to be able to be apart of something so great

During transition, she thought she had more time to go, so she wanted to get in the tub. Before the water even rose high enough, the baby was crowning! She stood in the tub, and with the support of her partner, gave birth to their beautiful daughter.

I felt a bit useless at the time, so I did what I knew I could: take some pictures! She was kind enough to give me permission to post this:

Amelia was born at 3:15 in the afternoon, just a little under 4 hours after I arrived! It was a beautiful birth. Brought me back to that excitement and awe of having my own birth. I am usually not a gushy person, but I definitely had tears in my eyes when she was born.

Often, when a couple is considering hiring a doula, the baby’s dad thinks, “Well, if we have a doula, what will my role (as father) be?” In fact, when meeting with the couple, if the dad doesn’t ask this question himself, I bring it up directly. It’s a real fear dads have, it’s honest. Well, the answer is simple. The dad’s role is incredibly vital in the birth process, it is, after all, his baby that is being born, not mine! I have seen, in births and childbirth preparation classes, however, some fathers who feel very uncomfortable in the “labor support” or “coach” role. They are sometimes not prepared to see their wife/partner coping her way through the intensities of labor, and feel a bit helpless in knowing how to best support her. A doula allows dad to support his wife/partner through his pure love, loving her like nobody else involved in her labor can. He is her lover, and it was the power of their love that conceived the baby, and it is that same power that helps birth the baby! During labor, there are times when the woman is most comforted by her guy’s smell, his heat, hands, breath, feel of his stubble, whatever. If dad is allowed to just do that, to love her and hold her and tell her he loves her, that is job enough. That way, he does not have to be the labor expert – knowing which positions are most soothing for back labor, and how often it is necessary to change positions, and have all the hot packs and cold cloths ready, etc. Then his entire focus can be on loving and supporting her, wholly. So, when a couple hires me as their doula, I am supporting both of them: offering continuous emotional guidance and physical support for both the mom and dad. And 100% of my dads, while having had mixed emotions about hiring a doula before the birth, expressed their sincere thanks and happiness that I was around to support them, too.