‘Optimal Fetal Positioning‘ (OFP) is a theory developed by a midwife, Jean Sutton, and Pauline Scott, an antenatal teacher, who found that the mother’s position and movement could influence the way her baby lay in the womb in the final weeks of pregnancy. Many difficult labors result from ‘malpresentation’, where the baby’s position makes it hard for the head to move through the pelvis, so changing the way the baby lies could make birth easier for mother and child.

Here is a picture of a vertex baby. Head down and facing the mom's back, this is the easiest position for birth.

I am also including the chart below that shows the presentation view from the outlet. My son was Face First, LMT, left mentum transverse. This is considered to be a physically impossible presentation for vaginal delivery and the occurrence is extremely rare.

The ‘occiput anterior‘ position is ideal for birth – it means that the baby is lined up so as to fit through your pelvis as easily as possible. The baby is head down, facing your back, with his back on one side of the front of your tummy. In this position, the baby’s head is easily ‘flexed’, ie his chin tucked onto his chest, so that the smallest part of his head will be applied to the cervix first. The diameter of his head which has to fit through the pelvis is approximately 9.5 cm, and the circumference approximately 27.5cm. The position is usually ‘Left Occiput Anterior’ or LOA – occasionally the baby may be Right Occiput Anterior or ROA.

Gail Tully, creater of www.spinningbabies.com
is a midwife who is very knowledgable in OFP and who helped me understand my situation better, created this to help explain positioning:

SO, how to achieve optimal fetal positioning? Very simply actually. First, posture. Gail Tully and Jean Sutton say no furniture! Sit indian style in the floor, this helps open your pelvis and release your pelvic floor. Use a birth ball for better posture. “Rest Smart” Nap or sleep in positions that let your baby’s back settle in your “hammock.”

To help facilitate good positioning, pelvic tilts should be done daily and several times a day. Walking and prenatal yoga also help with positioning by moving your hips and pelvis, stretching things out and encouraging the baby to engage in an occiput anterior position. Remember though, HEAD DOWN IS NOT ENOUGH! Babies can be head down but OP (face up) or asynclitic which can cause really long hard back labors. Read here to learn more.

So you may need to figure out what position your baby is in to begin with. Belly Mapping can help with that. By feeling where the baby is, where you feel movement, where the heart beat is, the shape of moms tummy, we can figure out how the baby is positioned. It isn’t hard to do at all. Once you learn the postition, you can then focus on improving it or changing it completely. Sometimes we know before labor even starts that the baby is OP and can get the baby to rotate. There are also ways to get a breech baby to turn.

Every pregnant woman should know this information. It is so vital in ensuring that you have the best labor and delivery possible. Sometimes breech babies won’t turn and sometimes OP babies stay OP but by learning OFP techniques you are at least giving yourself a chance to make a difference.

If you are pregnant here’s a list to help with positioning:
Pelvic tilts 20 each 3x per day
Sit indian style
Do not recline
Use a birth ball
Take at least a 20 minute walk every day
Learn what position your baby is in now
Learn what to do to improve the position
Learn what to do to keep the baby in that position
Get help if you are unsure
Get help if the baby won’t move

Good luck!

EDIT: Here is some information sent to me by Ann Tumblin concerning OP babies and epidural use.

Epidural Analgesia Linked to Increased Risk of Occiput- Posterior Babies
Lieberman, E., Davidson, K., Lee-Parritz, A., & Shearer, E. (2005). Changes in fetal position during labor and their association with epidural analgesia. Obstetrics & Gynecology, 105 (5, Part 1), 974-982. [Abstract]
Summary: This prospective cohort study used periodic ultrasound examinations during labor to evaluate changes in fetal position and their relationship with epidural analgesia. The researchers sought to determine whether epidural analgesia is responsible for higher rates of fetal malposition (occiput-posterior (OP) or occiput transverse (OT)) or whether women experiencing labor with a malpositioned baby have more painful labors and are therefore more likely to request epidural pain relief. A total of 1562 nulliparous, low-risk pregnant women were enrolled in the study.

The researchers found that the position of the baby (occiput anterior (OA), OP or OT) at the time of enrollment (in the early part of active labor) predicted position at birth poorly. For instance, of the women with an OP baby at birth, only 31% had a baby in the OP position at the initial ultrasound scan. Similarly, sonograms done later in labor were also poor predictors of position at birth. The data demonstrated that changes in fetal position were common during labor, with 36% of participants having an OP baby at the time of at least one scan. More than one-half of the women who gave birth to a baby in the OP position never had an OP baby at any ultrasound assessment in labor. Overall, 79.8% of babies were born in the OA position, 8.1% were OT, and 12.2% were OP at birth.

Epidural analgesia was strongly associated with delivery from the OP position: 12.9% of women with epidurals gave birth to babies in the OP position versus 3.3% of women without epidurals (relative risk 4.0, 95% CI 1.5-10.5). Transverse position was not related to epidural use. In a statistical model that controlled for various medical and obstetric factors that could affect outcomes, epidural use was still associated with a 4-fold increase in the risk of OP birth.

The data suggest that the association between epidurals and OP babies is not because women in labor with an OP baby are more likely to request an epidural. Women who received epidurals were no more likely to have OP babies at prior to or at the time that the epidural was administered. Furthermore, women with OP babies in labor or at birth reported the same degree of pain as those with OA or OT babies and were no more likely to report “back labor,” which is commonly thought to be related to the OP position. Finally, women with OP or OT babies at birth were much more likely that those with babies in the OA position to give birth by cesarean section, with 6.3% of OA babies born by c-section versus 64.7% of OP and 73.8% of OT babies (p<.001).
Significance for Normal Birth: Epidural use increases the risk of instrumental (forceps or vacuum) delivery in first-time mothers. Experts have proposed various reasons for this association, including diminished urge to push and changes in the tone of the pelvic floor muscles that inhibit proper rotation of the fetal head. Letting the epidural “wear off” has been thought to increase the likelihood of unassisted vaginal birth, however, this systematic review calls into question that common practice.
In normal birth, there are complex hormonal shifts that help labor progress and facilitate delivery. The laboring woman produces natural endorphins that help her manage the pain of labor. Her ability to move freely and assume a variety of positions while pushing work in concert with these hormonal changes. Epidural analgesia numbs the sensations of birth, and the production of natural endorphins ceases as a result of the disruption of the hormonal feedback system. When the epidural is discontinued, the woman’s pain returns but her natural endorphins may remain diminished and therefore her pain may be greater than if the epidural had not been given in the first place. Furthermore, when an epidural is administered, the woman is usually confined to bed and attached to fetal monitors and an intravenous line. The woman and provider may become accustomed to laboring in the bed attached to machines. When the epidural is discontinued the restrictions! on her movement may persist. Under these conditions, it is likely that the impact of an epidural on normal birth may outlast the epidural itself.

EDIT: Ann Tumblin also sent me this regarding OP (face up) babies. It was done by Penny Simkin who is basically the mother of all doulas. It is very informative so if you have ever had an OP baby and are nervous about it a second time, I highly recommend you taking a look at it.

This video explains how our health care system is failing babies and mothers and what we can do about it. It focuses on the issue of prematurity and high rate of infant mortality in the US and the difference in the midwifery model of care versus the obstetric model of care. Please watch and send to as many people as possible. Now would be the time to forward this to legislators as health care reform is a hot topic in the US today.

I am on the email list for My Best Birth.  The Business of Being Born did a really good job of bringing about a level of awareness of the crisis in US obstetrics and I think that it is fantastic that the follow up will be focusing on VBAC. I hope that they shed some light on VBACs for the mainstream community.

I received this email today...

A message from Ricki Lake & Abby Epstein to all members of VBAC Moms on My Best Birth!

 
As many of you know we have been working on a follow up film to The Business of Being Born, to be released this fall.

We are deep into the editing now and are hoping some of you might help us out by sharing 

your personal birth footage and photos. Specifically, we are looking for:

In Part One and Part Two of this segment, I discussed why I believe in the six care practices and the first three of the care practices which include: labor begins on its own , freedom of movement throughout labor and continuous labor support. The six care practices that support normal birth are based on research and evidence based maternity care. This is the healthiest and safest way to have a baby in most cases. In a normal healthy pregnancy most women can and should deliver their babies vaginally and with few interventions. All this medicalization of labor and delivery is not only not necessary, it’s also causes problems.

The fourth care practice is no routine interventions.

No Routine Intervention

Routine interventions are anything that is done or not allowed at hospital that isn’t medically necessary. Evidence based maternity care through research has shown that these interventions are not only not necessary but can cause more harm than good when used routinely. Here is a list of the most common routine interventions.

Restriction on eating and drinking: Back in the day when women were knocked out with general anesthesia food and drink were not allowed in case the woman vomited and inhaled it. Rarely is general ever used any more but it’s still the policy at most hospitals. Women need food and drink to keep their bodies fueled and hydrated for the hard work of labor.

Use of IV fluids: Because of the restriction on drink, the IV fluids are given to keep the mom from getting dehydrated.  IV fluids are just not properly balanced in a way that gives the mom the energy she needs to labor. The intervention spiral tends to begin with the IV and it’s easy access to the vein and it also keeps you tethered and restricts movement.  The IV line does provide quick access to the vein in case of an emergency. One compromise is a heparin lock. It’s the little catheter that put in the vein and shut off without the IV line actually being connected.

Continuous electronic fetal monitoring:  In a normal low risk labor continuous EFM isn’t recommended. Intermittent monitoring, or 20 minutes out of every hour is just as beneficial. With intermittent monitoring the mom is allowed the freedom of movement. Continuous EFM increases the number of inventions without improving outcomes.

Speeding up labor: Artificial rupture of membranes and augmentation of labor:  Speeding up labor sounds pretty tempting but when the water is artifically ruptured (AROM) it increases the pain of the labor and removes the baby’s cusion to move around and get into a better position. Infection risks are increased and most hospitals have a time limit on how long the water can be broken before intervening.  Augmenting labor with pitocin can make labor go faster but it also interupts the normal flow of hormones and makes labor much more painful while increasing the risk of fetal distress.

Epidurals: Epidurals do take the pain away (most times) but can also cause a cascade of other interventions and problems. They increase the risk of an OP baby (sunny side up) because the pelvis is over relaxed and baby finds it harder to rotate and turn without the gravity because mom is stuck in bed. The risk of c section increases and the drugs do reach the baby potentially causing breastfeeding problems. Please see my post To Epidural or Not to Epidural for more details on the risks of epidurals.  There are many other ways to cope with labor. Preparing physically and mentally for labor, continuous labor support and avoiding routine interventions all help make labor an easier process.

Episiotomy: Routine episiotomy can be more harmful than tearing. Tears typically aren’t as bad as the cut would be and they heal faster. Episiotomy frequently causes more tearing and more pain. Avoiding epidurals and upright pushing positions reduce the risk of or need for episiotomy.

Medical need for interventions are occasionally necessary. Routine intervention should be avoided. Learning about the routine interventions and when they may become necessary and writing a birth plan can help reduce the chance of having routine interventions forced on a laboring woman. I think it is also very important for the partner to understand these procedures so that they can assist the mother as much as possible. Research is on the side of the mother when it comes to these routine interventions and discussing the written birth plan before the birth will help the labor go more smoothly.  Hiring a doula can also help keep routine interventions from being carried out as she can remind the mom of what the risks and benefits of the interventions are and of what her wants are.

I am doing a series on the Lamaze Six Care Practices that Support Normal Birth. Here are Part 1, Part 2 and Part 3. In Part 4 I will be discussing the 5th Care Practice, which is Spontaneous Pushing in Upright or Gravity-Neutral Positions. In the mean time, below is a link to a very informative article and video on vertical pushing.

Great article and video on vertical pushing HERE.

Most women in hospitals do end up pushing on their backs. The military hospital here always wants the mom on her back and does not encourage any other position, in my experience. I have seen nurses lean the back of the bed back so that  mom is closer to flat on her back saying ‘let’s help baby out.’ The hospital here does have a squat bar but last time my client wanted it the nurse said she had to go find it and never did. After the birth she told my client that ‘oops, it was in the bathroom the whole time.’ You may have to insist on not pushing on your back. You may have to demand that the nurse find the bar but it should be your voice that the staff hears. A doula can help you by asking and reminding but ultimately the mom needs to be heard when she is in an ‘on your back’ environment.

As I said in Part One of this article, there are six care practices that support normal birth. Lamaze International says “The six care practices below are supported by research studies that examine the benefits and risks of maternity care practices. Therefore, they represent “evidence-based care,” which is the gold standard for maternity care worldwide. Evidence-based care means “using the best research about the effects of specific procedures, drugs, tests, and treatments, to help guide decision-making.”

Unfortunately, in the U.S., the trend is not towards normal birth and adhering to the six care practices that support normal birth. Maternity care in the U.S. has a “prominent position, large expenditures and troubling performance” according to the Milbank report Evidence-Based Maternity Care: What It Is and What It Can Achieve released in October of 2008. This report discusses the issues with the U.S. maternity systems, the overuse of routine interventions and the harm they cause and closing the gap between them and the normal birth practices for healthier moms and babies. I will talk about this report in depth in another post as it has some great information that every pregnant woman should know.

Care Practice #1: Labor Begins on its Own

This seems so obvious but women are being induced more and more and for more and more reasons that really are not means for induction. In my Truth About Pitocin post, I discussed the difference between medical inductions and elective inductions. The medical reasons for induction are:

* your water has broken and labor has not begun.
* your pregnancy is postterm (more than 42 weeks).
* you have high blood pressure caused by your pregnancy.
* you have health problems such as diabetes that could affect your baby.
* you have an infection in the uterus.
* your baby is growing too slowly.

Suspected big baby is not reason for induction and ACOG doesn’t recommend it either but it is commonly a reason for induction. Also common to that is the birth of an 8lb baby after the induction failed and a cesarean had to be performed when if given time, the mother would have spontaneously began labor on her own when both she and the baby were ready.

Also important to note is that a pregnancy is not considered post term until AFTER 42 weeks. Only after 42 weeks should the pregnancy be induced if all else is normal.

Labor induction is not without risk. Research has shown there is a significant increase in

* vacuum or forceps-assisted vaginal birth;
* cesarean surgery;
* problems during labor such as fever, fetal heart rate changes, and shoulder dystocia
* babies born with low birth weight;
* admission to the NICU;
* jaundice (yellow skin caused by the breaking down of red blood cells) that required treatment; and
* increased length of hospital stay.

In addition, the chance of cesarean is nearly doubled when induced and there is a higher risk of prematurity as due dates are only estimates. There are also psychological effects as it makes us think that there is something wrong with us for not going into labor on our on. I have had clients ask me if I thought a friend was capable of going into labor or if someone's water can break on it’s on. These are pretty valid questions, especially for a first time mom who has seen most of her friends get induced for one reason or another and every one of them had artificial rupture of membranes (water broken for them). The thing is, our bodies will not stay pregnant forever. We are meant to birth the babies that we grow. We are just forgetting that in this day in age where most women are given pitocin and think that they just HAD to have it or they couldn’t have birthed their baby. It’s really sad that we have come to this. We do not HAVE to have pitocin to give birth.

Care Practice #2: Freedom of Movement During Labor

This one is pretty simple but too often women are told to get in the bed and stay there. Usually this happens because they are on some medication (pitocin, cytotec, anesthesia) that requires continual fetal monitoring and IV lines. All of this is counterproductive to what the body and the baby are trying to do. The uterus works better when a woman moves around. It’s a muscle and movement increases circulation. The pelvis not stationary. It moves and flexes and bends and as it does the baby is able to moved and wiggle down into it with the help of gravity. Being on the back in bed prohibits this movement and closes the pelvis up making a smaller exit for the baby to move in to.

The research has shown that movement causes:

shorter labors,
more efficient contractions
greater comfort
less need for pain medicine in labor

Even if there is a medical reason to have continual electronic fetal monitoring, there is enough slack in the line to get out of bed and sit in a chair or a birth ball or to sway with your partner.

Care Practice #3: Continuous Labor Support

I am a doula, I think every woman should have a doula. It’s not because I am trying to justify the profession or the cost or to promote myself, but I really believe that no woman should have to birth without someone who is trained to support a laboring woman. There is a big difference between a doula and a loving partner, a doula and a best friend who has had five kids and a doula and the grandma. While a doula does form a relationship with her clients, she doesn’t have that intimate relationship these other people do and can help the laboring woman without the emotions that are often involved with these family members. Doulas are also trained professionals who study birth and labor and ways to make labor easier and more comfortable with different positions and massage and other techniques that even someone who has had a few kids of their own may not know. Doctors, midwives and nurses often times have several patients at once and cannot stay with the laboring woman.

The research has shown that the presence of one-on-one support such as that of a doula a less likely to have:

have a cesarean section;
give birth with vacuum or forceps;
have regional analgesia (e.g., an epidural)
have any analgesia (pain medication)
report negative feelings about their childbirth experience

Doulas can also help incorporate the partner into the labor experience. Often times partners are very inexperienced in childbirth and they are nervous and worried and are scared of labor pains. They are often scared and unsure of how to help their partner even though they very much want to. I have found that they are relieved to have the help of a doula, especially once labor kicks in to high gear and they do feel more of a part of the labor process when they are shown ways to help the mother. It gives them a greater sense of importance and usefulness that they very much appreciate. I love working with the partners as much as the moms because they are so willing and grateful by the end. Even the strongest, most loving and supportive dads benefit from having a doula around.

There are three more care practices supporting normal birth. I will discuss them in Part Three.

Many of you know that I will be training to become a Lamaze certified childbirth educator and as part of that training I am hosting a Passion for Birth (PfB) seminar in Seoul in October. PfB is a program accredited by Lamaze that focuses on how to ’stomp out boring childbirth classes.’

I chose PfB and Lamaze for many reasons.I chose PfB because I liked the way the material is being presented. Stomping out boring childbirth classes, that’s GREAT! How many of you have been to a hospital childbirth class that was a full day of listening to someone tell you about when to show up to get your epidural, what the hospitals policies are and how everyone is required to have this or that done to them once they are admitted? How much did you learn about birth? About natural birth? Normal birth? Did you leave more nervous the when you got there? Were you worried about your birth plan being respected? The idea that PfB has of teaching CBE’s (childbirth educators) how to teach evidence based care and to be fun and interactive at the same time really inspired me. The other reason for chosing PfB is Ann Tumblin. My husband ran across her when I was pregnant with my son. We were searching for doulas in Korea and her name came up as she has been here to train Korean doula instructors for DONA. She was really nice to my husband and he remembered her (and she remembered him) over a year later when I decided to train as a doula myself and looked her up. I was trying to find other doulas in Korea to learn from. She was just amazing with her advice and with how willing she was to talk to me about being a doula and a childbirth educator. When I found out she was coming to Korea again in October, I just HAD to see if we could have a PfB seminar while she was here. I can’t wait!

So with the PfB portion of the childbirth educator training in place, I really had to spend some time learning about Lamaze International, since that’s who my certifying agency would be and whose care practices I would be teaching. I was one of those people who heard ‘lamaze’ and thought of the old school hoo-hoo, hee-hee breathing that I saw laboring women do in the movies. I was apprehensive because I took the Bradley Method when I was pregnant and while I loved the classes, the amount of childbirth education I received and the relaxation techniques, I had gathered that Lamaze was considered second rate to the Bradley Method. Just to set all this straight now so there is no confusion, I really do love and respect the Bradley Method and even considered becoming Bradley certified but I didn’t go with it because it is more of a method. I wanted flexibility so that I can teach normal birth but not necessarily methodically. I wanted a birth philosophy that was in line with my own way of thinking. All that said, I remember my classes making me think that Lamaze was in fact some kind of patterned breathing technique. It was but in the 80’s they changed from a method to a philosophy and that philosophy spoke to me when I started digging in.

I have a very strong idea about what kind of childbirth educator I want to be, about how I want to teach and the way I want my classes to be. For instance, I want to keep my classes to ten couples or less. I would like for them to be in someone's home, mine or one of the students. I want to develop relationships with the students and answer their questions honestly and factually with evidence based answers. I want to instill trust of the birth process and of a woman’s ability to birth into my students. I want them to leave my classes with the knowledge and the confidence to have whatever kind of normal birth they want be it hospital, home or even unassisted. I want them to know that they have choices and a voice in the birth of their child. I believe that with PfB and Lamaze that I can accomplish these things and I am looking forward to my seminar very much. I just hope we have enough participation!

The title of this post is “The Six Care Practices that Support Normal Birth”. These are the care practices that Lamaze teaches. They are:

1. Labor begins on its own

2. Freedom of movement throughout labor

3. Continuous labor support

4. No routine interventions

5. Spontaneous pushing in upright or gravity-neutral positions

6. No separation of mother and baby after birth with unlimited opportunities for breastfeeding

I labeled this post Part One because I knew it would get long. In Part Two, I will discuss the six care practices. Stay Tuned!

Please follow THIS link.

A doula (doo-la) is a Greek word that means ‘woman who serves.’ A doula is a professionally trained woman who provides information, physical and emotional support before, during and immediately following birth. Women have attended birthing women for centuries in all cultures. Ancient hieroglyphics show women birthing with other women supporting them. It is only in modern times that we have begun to stray from this support with the medicalization of birth. The need for one on one support in labor is so crucial to the birthing woman’s perception of the birth experience and ability cope with birth. Women supported by a doula frequently report a significant decrease in the length of labor, the perception of pain and the need for anesthesia or analgesia as well as fewer cesarean sections.

I am a doula, I think every woman should have a doula. It’s not because I am trying to justify the profession or the cost or to promote myself, but I really believe that no woman should have to birth without someone who is trained to support a laboring woman. There is a big difference between a doula and a loving partner, a doula and a best friend who has had five kids and a doula and the grandma. While a doula does form a relationship with her clients, she doesn’t have that intimate relationship these other people do and can help the laboring woman without the emotions that are often involved with these family members. Doulas are also trained professionals who study birth and labor and ways to make labor easier and more comfortable with different positions and massage and other techniques that even someone who has had a few kids of their own may not know. Doctors, midwives and nurses often times have several patients at once and cannot stay with the laboring woman.

The research has shown that the presence of one-on-one support such as that of a doula a less likely to have:

have a cesarean section;
give birth with vacuum or forceps;
have regional analgesia (e.g., an epidural)
have any analgesia (pain medication)
report negative feelings about their childbirth experience

With a doula you can have up to*

• 50% reduction in the cesarean rate
• 25% shorter labor
• 60% reduction in epidural requests
• 40% reduction in Pitocin use
• 30% reduction in analgesia use
• 40% reduction in forceps delivery

Doulas can also help incorporate the partner into the labor experience. Often times partners are very inexperienced in childbirth and they are nervous and worried and are scared of labor pains. They are often scared and unsure of how to help their partner even though they very much want to. I have found that they are relieved to have the help of a doula, especially once labor kicks in to high gear and they do feel more of a part of the labor process when they are shown ways to help the mother. It gives them a greater sense of importance and usefulness that they very much appreciate. I love working with the partners as much as the moms because they are so willing and grateful by the end. Even the strongest, most loving and supportive dads benefit from having a doula around.

With every birth I attend, I believe more and more that no woman should birth without a doula and that every woman has the ability and probably should birth without drugs. I have not had a client get an epidural yet but I would completely support a woman if she chose to.

The average range of doula fees are between $300-$1200 depending on what area of the country they work in. Considering that this is for one of the biggest and more important experiences in a woman’s life, it is a very wise investment. Most doulas will offer payment plans if necessary and if the fee will cause a hardship to the family they will often times discount their fee or work out a trade with the client. Doulas who are working on their certification often times work at reduced rates as well. I believe every woman who wants a doula should have a doula and will work for expense reimbursement only if necessary. If you truly want a doula, shop around, interview, compare fees and find someone who fits best with your expectations.

For more information on doulas  please see my blog www.doulamomma.wordpress.com

*Information was obtained from Mothering the Mother: How a Doula Can Help You Have a Shorter Easier and Healthier Birth, Klaus, Kennell, and Klaus (1993)

This month’s focus is on preparing for labor and delivery. As a doula, I always discuss ways to prepare for the big day in the prenatal appointments with my clients. I think that the best way to approach it is to break it down by trimesters.

First Trimester

Read these books:

• Pregnancy, Childbirth, and the Newborn: The Complete Guide by Penny Simkin, Janet Whalley, and Ann Keppler (Paperback - Jul 31, 2001)
• The Thinking Woman's Guide to a Better Birth by Henci Goer and Rhonda Wheeler (Paperback - Oct 1, 1999)
• Ina May's Guide to Childbirth (Mar 4, 2003) by Ina May Gaskin
• Gentle Birth Choices: A Guide to Making Informed Decisions about Birthing Centers, Birth Attendants, Water Birth, Home Birth, and Hospital Birth by Barbara Harper, Suzanne Arms, and Robbie Davis-Floyd (Paperback - Jun 1, 1994)

Learn about the Brewer Diet

Continue exercising if you already do and start exercising if you don’t. Walking and prenatal yoga do amazing things for the pregnant body.

Second Trimester

Hire a doula

Explore childbirth classes and relaxation methods such the Bradley Method, Hypnobirthing, Hynobabies, and Lamaze. Pick one and enroll.

Continue the Brewer Diet and exercising

Start researching where you want to give birth and make a decision. Interview midwives and OBs. Check cesarean rates for the OBs and the potential hospitals. Do hospital tours. If planning a homebirth be sure to look into getting a birth pool.

Learn about the risks of pain medication in birth. Learn about the risks of routine interventions.

Start learning Optimal Fetal Positioning techniques and exercise suggestions.

Third Trimester

Use birth ball when sitting and do pelvic tilts three times a day/twenty times each to help strengthen and loosen you pelvis

Discuss your fears and concerns about your birth with your doula and midwife. Any mental hang ups can affect labor so it’s best to clear your head before it happens.

Learn to trust birth! Let go of your fears and trust your body. Trust that you will know what to do.

Finalize your birth plan. I think that by putting it in writing you are solidifying in your mind what you truly do want. Make sure that your partner understands every aspect of your plan so that he or she can help advocate for you if need be.

Read Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation by Pam England and Rob Horowitz (Paperback - Jul 1, 1998)

The Final Few Weeks

Relax and enjoy the time with your partner. Soul search and take care of yourself. Birth is not something that can be planned but with a little planning we can birth the way we want to and on our own terms whether it’s a hospital birth, home birth or even an unassisted birth. The key in all of these situations is to be informed and to know your options because sometimes things don’t go the way we want them to. If you understand what is happening and  have a solid support team that you trust then you can have the best birth possible for you and your baby regardless of the circumstances.

Good luck!

Thanks Ivana and Empowered Mommies for inviting me to blog. I look forward to discussing pregnancy, birth, cesarean, VBAC, babies and more. Stay tuned!