Birthing Beautiful Ideas

I think that a lot of people misunderstand what the concept of “birth trauma” is, and in misunderstanding it, they often dismiss it and/or its gravity.

I don’t think that these misunderstandings necessarily come from a place of callousness.  A lot of the time, I think the misunderstanding comes down to a matter of (incorrectly) universalizing what another woman says about her own experience–or even of forgetting that one’s own intimate, personal, and wholly unique experience of birth can be radically different from another’s intimate, personal, and wholly unique experience of birth.

When I say that people “incorrectly universalize” statements or sentiments about birth, I mean that they often say things like this:

Misunderstandings about birth trauma

• “All women who talk about their ‘birth traumas’ need to get over the fact that they ended up with a cesarean and not a vaginal birth.  Wallowing in the guilt over a birth experience is totally counterproductive, and it seems like a wasted effort to focus on feeling ‘robbed’ of an experience when you still get a baby at the end of the day!”

• “My own c-section wasn’t traumatic, and I find it highly offensive that anyone would suggest that all c-sections are inherently traumatic experiences.”

• “Here’s an example of a truly traumatic birth where the baby (and/or mom) was actually not healthy after the birth.  Any other woman who feel traumatized by her birth experience just need to focus on the fact that she has a healthy baby.”

• “‘I don’t care how traumatic a birth was, it wasn’t rape.  I had a c-section/I had a horrible vaginal birth/etc. and it certainly wasn’t rape, or even anything like rape.  All women should stop comparing their birth experiences to rape.”

Rectifying these misunderstandings takes an effort not only to point out that they are misguided but also why they are misguided (and why universalizing anyone’s experiences with or claims about birth is problematic):

Creating a better understanding about birth trauma

• Not all mothers are disappointed by their birth experience (whether vaginal or cesarean section), but this does not negate the possibility (and the reality) that some are.

• Not all mothers who are disappointed by their birth experiences would describe those experiences as traumatic, but this does not negate the possibility (and the reality) that some do.

• Not all c-sections are traumatic experiences for the mothers who have had them, but this does not negate the possibility (and the reality) that some are.

• All mothers who are disappointed by–and especially those who feel traumatized–by their birth experiences should be received with non-judgmental support. Validating a person’s feelings does not mean that one is allowing another to “wallow” in their “negativity.”

• Not all traumas involve life-or-death situations. And not all “traumatic” c-sections (or vaginal births, for that matter) are the result of life-or-death situations.

• Not all those who have experienced traumatic births would describe their experience as akin to rape. But some do.

• Not all those who describe their birth experiences as “birth rape” have had cesareans.  Some are describing vaginal births instead.

With the above points in mind, it would obviously be ludicrous (and even insulting) for someone to describe all c-sections as traumatic or as “birth rape” or even as disappointing.  This would be to engage in the same sort of “problematic universalizing” that I described above.

But it seems equally ludicrous and insulting to belittle or dismiss any mother who describes her birth(s) in this way.  And this might have something to do with the many ways in which “trauma” can manifest itself during a birth.

Sometimes, the trauma really does come down to a matter of life-or-death.  Sometimes, life (and medicine and all of the best efforts and intentions in the world) does not prevail over death.  And that is certainly not something that a person should be encouraged to “just get over.”

But other times, the trauma manifests itself when a person is “duped” into an early and unnecessary induction that leads to a c-section–a c-section that may have been prevented if (a healthy) labor had been allowed to start on its own, a c-section that may lead a woman to think that her body has failed her and her baby.

Even other times, this trauma manifests itself when (trigger warning) a woman is literally forced down onto the hospital bed so that her OB/GYN can insert an amniohook into her vagina, or when she is given a pudendal block against her will (neither of which are emergency obstetrical procedures).

And as far as I can tell, forcibly inserting instruments into a woman’s reproductive organs against her will is battery at the very least and, upon further interpretation, rape.

What’s more, the inherently sexual (which shouldn’t be confused with erotic) nature of childbirth can bring back past experiences with sexual abuse, and this in and of itself can lead to a traumatic birth experience.  (Trigger warning)  Repeated and/or rough vaginal exams, insensitive comments, having one’s arms “tethered” down during a cesarean, not being able to see the surgeons manipulating one’s reproductive organs–these can all be “triggering” and even re-traumatizing experiences for a woman.

So sometimes (if not many times) the traumas extend well beyond–far beyond, eons beyond–feeling “robbed” of an experience.

On that note, while I would agree that a healthy, living baby and a healthy, living mother are exceedingly important and should be the primary goal of any birth, these goals in no way cancel out the importance of a woman’s birth experience.  These goals in no way suggest that women cannot or should not have their own hopes and dreams for their birth experiences.  They in no way suggest that women cannot or should not regret their birth experiences, or even that they might never have the birth experience for which they hope and dream.

As I have pointed out elsewhere, we humans are complex creatures, and we can simultaneously feel overjoyed by our healthy babies and still feel devastated by the way those babies came into the world (or even by the effects their births have had on our sexual enjoyment).  Allowing this devastation to consume one’s life certainly is problematic and is probably a signal that one might want to seek out therapy and/or anti-depressants and/or a support group (such as Solace for Mothers or ICAN).  But simply feeling this devastation deeply does not seem to be indicative of a problem with one’s emotional life.

With this in mind, it is important to recognize because a woman’s birth experience is so profound and personal, and because trauma can manifest itself in so many ways during a birth, jokes about various birth experiences can be (unintentionally) insensitive.

For example, as a doula, I’ve attended two precipitous (or very fast) labors, and each woman experienced the birth radically differently: one was elated that her labor went by so quickly and without any complications, while the other was utterly traumatized by the speed of her labor, even though there were no complications for either her or her baby.  One would have laughed at a joke about “the ease of a fast labor,” and the other would have been deeply hurt by it (and actually expressed to me that she had been hurt by those jokes and didn’t know how to express herself to those presumably well-meaning people).

I’ve also had conversations with moms who have felt violated by their cesarean sections and those who were quite pleased with their c-section experience(s).  Many might bristle at and even be deeply hurt by a joke about their “tighter vaginas” or their “easy birth” while others might laugh right along with one of those jokes.

This is not to say that there is no place for humor in the healing process.  But it is to say that there are real times and places where jokes can end up hurting instead of humoring (and real times and places where even well-intentioned jokes warrant an apology).

In the end, I think it is always worth recognizing that birth is intimate and personal and can be the most empowering or the most traumatic experience of a woman’s life–but it is her experience to judge and process and celebrate and mourn.

And I hope that all birth advocates–and all people, for that matter–can ultimately push for these goals: for healthy moms and healthy babies, for care providers who give transparent and caring and sensitive advice to the women they encounter, for care providers who treat birthing women with dignity, for care providers who practice evidence-based medicine, and for women who can find a safe space to process their births, whether these births were exhilarating or disappointing, empowering or traumatic.

*Much of what was written here was inspired by two thoughtful and provocative blog posts (and my replies to those posts), one from Her Bad Mother, the other from Adjunct Mom.  I might not agree with all of their claims, but I appreciate their thought-provoking discussions nonetheless.

If you or someone you love has experienced birth trauma (or if they are experiencing signs of post-traumatic stress disorder following a birth), a tremendous source of online support for many women is Solace for Mothers. Birth Cut also has an online space where women can safely express their “cesarean rage“.

“Why does it matter what this snarky sex-advice book says about epidurals, or how this prime time drama portrays natural childbirth, or how films tend to make birth into a super-crisis?  It’s POP CULTURE!  Women listen to their doctors and their books on pregnancy and labor when they want to make decisions about pregnancy and labor.  They don’t go to to these other books or television shows or movies for that sort of advice!  Why should you even CARE about what they say?!“

Yep.  I’ve heard that a lot.  And even though statements like these really irk me, I can sympathize with the sentiment behind it.

I mean, I don’t think I’m over-generalizing when I say that most reasonable people turn to trusted sources or experts on topic x when they are making decisions regarding x.  So when most pregnant women want to know more about pregnancy and labor, they read a book or a website or talk to a midwife or an OB/GYN or a doula or even a friend or family member who has given birth before.  They don’t always get good advice, mind you, but at least they’re generally going to the right sorts of sources.

But I also think it’s pretty foolish to dismiss the effects that popular culture has on a woman’s beliefs and decisions about pregnancy and childbirth.

In fact, I would venture to say that these effects are pretty widespread.

Of course, I’m not saying many of us literally turn to pop culture when we’re deciding whether or not to consent to an episiotomy or to request pain medication in labor or to choose one care provider over another.  That would be stupid, right?  It would be ridiculous for someone to say, “Well, my OB/GYN reminds me of that chick on Private Practice, so I think she’s the best one for me and my baby!”

But that doesn’t mean that what we see on television or read in a (non-birth-related) book or watch in a movie has no effect at all on our thoughts about pregnancy and childbirth.

Quite the contrary, in fact.

Because every a woman reads that she “won’t be able to make it without an epidural”…

…every time she sees natural childbirth portrayed as something only for hippies and freaks…

…every time she sees a movie in which birth is a crisis or a catastrophe or a comedy of errors in which the mom is a crazed, expletive-hurling woman who is seriously out of control…

…those images and words start to affect the way she thinks about birth in general, and they may even have an effect on her specific beliefs about birth.

Instead of rambling on about the general effect that pop culture can have on a woman’s beliefs about birth, however, perhaps it’s better that I give a real-life example: my own real-life example.

And it’s even a positive example!

You see, long before the thought of even trying to get pregnant was ever on my radar, I was a big Sex and the City fan.  A huge fan.  I owned the entire series on DVD, I cried into my Cosmo during the series finale, and I even went to see the first movie in the theaters a mere four days after giving birth to A.  (Judge me all you want for my messed up new-mom priorities, I know.)

I love Carrie, Miranda, Samantha, and Charlotte forever with a big, sparkly pink heart.

And one of my most-loved SATC episodes is the one where Miranda gives birth.

Before Miranda actually goes into labor, there’s this scene where she and Carrie are walking down the street, and Miranda is telling Carrie what she does and doesn’t want in the delivery room.

She wants Carrie there.

And when it’s time to push, she doesn’t want everybody getting all “cheerleader-y” on her and shouting “PUSH!  PUSH! and shit like that.”

Call me silly, but when I first saw that scene, it signaled a major change in the way I thought about how I was going to give birth some day.

I literally turned to Tim and said, “YES!  Yes!  When we have a kid some day, I do NOT want people getting cheerleader-y on ME!  Just let me do my thing.  I’ve NEVER liked that cheerleader stuff when I’m trying to concentrate on something!  [OMG, I'm so much like Miranda!  Teehee!  Pink, sparkly hearts for everyone!]”

Seriously, though, the moment was very exciting for me because all I had ever seen at that point in my life were women flat on their backs in hospital beds, pushing out a baby while everyone around them shouted “PUSH! PUSH!” and shit like that.

It was my entire paradigm for birth.

And to know that this paradigm could shift (and eventually shatter, as it did during A’s birth)?  To know that I could request otherwise?

Who knows, maybe the good ladies of Sex and the City helped to send me on the path that I’m taking this very day.

Pink, sparkly hearts and all.

*Although there are certainly silly components of Miranda’s labor–correct me if I’m wrong, but can you actually break your bag of waters by pushing it out in active labor?–I love how the writers had her walking around in labor and stating that her doctor said that natural membrane ruptures were “better” than amniotomies.  And what a tender moment when she meets Brady–not ooey-gooey sentimental, but weird, and strange, and lovely.

If you haven’t yet figured out, I tend to analyze and over-analyze a lot.  And I’m pretty damn verbose, especially when it comes to the written word.  (Case in point?  I left an 800+ word comment on a blog this past weekend.)

My tendencies toward over-analysis and verbosity seem to be part of my nature, and these tendencies have only been enhanced by my tenure as a philosophy graduate student.

But I also think it’s nice just to slow down, quiet down, and let certain things speak for themselves every once in a while.

Which is why I’m going to devote one post every week or so to “words for thought.”  Words that I find inspiring or provocative or just downright cool.  Words-without-Kristen’s-analysis-and-verbosity for y’all to ponder (and even comment on).

This week’s “words for thought” comes from Sylvia Plath’s novel, The Bell Jar (a favorite of mine).

In this passage, Esther (The Bell Jar’s narrator) sneaks into a hospital maternity unit with her boyfriend, Buddy, a medical student.  And I think what she has to say is brilliant and insightful and all-the-more haunting given the fact that The Bell Jar was published after Plath herself had given birth to her two children:

I was so struck by the sight of the table where they were lifting the woman I didn’t say a word.  It looked like some awful torture table, with these metal stirrups sticking up in mid-air at one end and all sorts of instruments with wires and tubes I couldn’t make out properly at the other…

…The woman’s stomach stuck up so high I couldn’t see her face or the upper part of her body at all.  She seemed to have nothing but an enormous spider-fat stomach and two little ugly spindly legs propped in the high stirrups, and all the time the baby was being born she never stopped  making this unhuman whooing noise.

Later Buddy told me the woman was on a drug that would make her forget she’d had any pain and that when she swore and groaned she really didn’t know what she was doing because she was in a kind of twilight sleep.

I thought it sounded just like the sort of drug a man would invent.

From the news that 27% of first-time, low-risk moms in the state of Ohio had cesarean sections in 2008 to the World Health Organization’s findings that elective cesareans are riskier than vaginal birth for both mothers and babies, cesarean sections have been a fairly frequent topic of discussion in the news over the past few days.

While I’m glad that word about the risks of unnecessary c-sections (and of high c-section rates in general) is getting out, I more than a little dismayed by the fact that most of these articles (and the health professionals interviewed in them) engage in some serious (though perhaps unintentional) mother-blaming when it comes to explaining the reasons for the climbing c-section rates throughout the world.

In fact, reading these articles might make it seem as if the c-section rate can be blamed on the ”facts” that we birthing women are all too fat and too old, carry too many babies, are too scared of labor, and are too stuck on the idea of picking our babies’ birth dates.

Don’t believe me?  Just read this report from the Newark Advocate:

Dr. Elizabeth Koffler, an obstetrician at [Licking Memorial Hospital], said the increase in the national rate, which is at 32 percent, has to deal with more women having twins or triplets and maternal obesity.

Women who request a C-section tend to have a fear of labor and also a fear of future complications, Koffler said.

I’ve said it before, and I’ll say it again, but that 27% c-section rate reported by the Ohio Department of Health DOES NOT INCLUDE BREECH BIRTHS, MULTIPLE BIRTHS, REPEAT CESAREANS, OR PRE-TERM BIRTHS. 

So all of those twins and triplets births cannot be blamed for the state’s inordinately high c-section rate.

What’s more, while it may be true that women who request cesarean sections harbor certain fears about complications from a vaginal delivery, maternal-request cesareans (which should not be conflated with elective cesareans in general) only account for an exceedingly small proportion of all c-sections performed in the United States. 

So maternal-request cesareans cannot be blamed for the state’s (or the nation’s) inordinately high c-section rate.

Adding fuel to the mother-blaming fire, a recent MSNBC article on the WHO’s findings on the risks elective cesareans reports that:

In the U.S., where C-sections are at an all-time high of 31 percent, the surgery is often performed on older expectant mothers, during multiple births or simply because patients request it or doctors fear malpractice lawsuits. A government panel warned against elective C-sections in 2006.

Oh, so birthing women are also too old and too sue-happy?  Got it.  Now I know why the nation has such an inordinately (and unhealthily) high c-section rate.

Perhaps you think that my reaction to these articles is more fittingly an overreaction.  Do I really think that the people interviewed for these articles come right out and say that women themselves are to blame for the c-section rate in this country?

What’s more, it shouldn’t go without saying that the article from the Newark Advocate (along with a similarly-themed article in the Mansfield News Journal) does make some worthwhile points about the importance of necessary c-sections, including those performed for “fetal hemorrhaging” or breech birth (with a birth attendant unskilled in breech birth, I might add).  So shouldn’t we be thankful for these necessary c-sections?

And my answers to these questions would be: No, the interviewees don’t directly blame mothers, and yes, we should be extremely thankful for these necessary c-sections.

But.

BUT.

If medical professionals continue to omit and/or neglect to mention the ways in which certain obstetrical practices may also be responsible for the cesarean epidemic in this and other countries, then they are inadvertently (or perhaps blatantly) placing the blame for the c-section rate squarely on the shoulders of birthing women.

And this is simply not the case.

What about failed inductions?

And forced repeat cesareans?

Inordinate standards for adequate labor progression?

The care provider who has a dinner or a golf game or a meeting to attend (which, I hope beyond hope, is just as rare as those maternal-request cesareans that have been blamed for the rising cesarean rate in the past)?

These (and other) problems are also significant contributors to the climbing cesarean rate.

But instead of playing the blame game, I think that it would be far more productive to carefully and critically examine those issues that contribute to unnecessary c-sections and to remedy those issues where possible.

Instead of blaming the rising c-section rate on obese mothers, let’s try examining (and fixing) the ways in which the modern maternity system mistreats obese mothers.

Instead of blaming the c-section rate on high-risk births, let’s look at the birth practices of Miami Valley Hospital in Dayton, OH, which not only specializes in high-risk births but also has the lowest c-section rate in for first-time, low-risk moms in the state of Ohio and has hospital representatives who know that “some hospitals are too quick to do C-sections” and that “there is a lower rate of admission to the neonatology critical care unit due to low rates of respiratory problems … and [that babies are] more likely to successfully breast-feed” after a vaginal birth.

Instead of blaming the 31.8% c-section rate in the US on maternal-request cesareans, let’s look at the ways in which many women are forced to undergo repeat cesareans when they would prefer to attempt a vaginal birth after cesarean.

Instead of insinuating that many women are too old, too big, too small, and too scared to birth their babies vaginally, let’s make sure that our labor inductions are not performed too early and too frequently, thereby leading to a slew of failed inductions and cesarean sections.

Let’s not blame the mothers.  Let’s just fix the system.

Every single one of them.

Whether they’re asking difficult questions or making difficult decisions or planning for their birth or coping beautifully with contractions or showing unimaginable strength in an unexpected birth situation, they continue to astound and inspire me.

And one of my current clients recently did something that makes me so proud that I feel the need to share it here.

J* (my client) is expecting her first child in late spring.  She is very well-informed about childbirth and has chosen to give birth at an in-hospital birth center that offers (and routinely does) water births.  Although she has already toured the birth center, she and her husband made the decision to tour the hospital’s Labor and Delivery Unit as well so that she could get a better sense of what to expect there just in case unforeseen circumstances prevent her from birthing at the birth center.

This is what she wrote to me about her experience during the hospital tour:

So we went on our tour of [the hospital's Labor & Delivery Unit] last night.  We had been to the Birthing Center [tour]which focuses solely on the birthing center but I wanted to check out the rest in case the Birthing Center ends up not being an option for us. 

 

Anyways, we were in the labor and delivery room and one of the husbands asked if “all the horror stories about epidurals are true?”  The nurse said that the epidural is safe but like any intervention there are risks associated with them.  And that was all she said.  So I asked her if they had any information available about the risks associated with epidural use and she said “well the Anesthesiologist would go over it that day.”  SO I replied, “Well the thing is I don’t think I will be able to make an informed decision while in the middle of labor about the benefits and risks of this procedure so it would be nice if there were a way for people to find out the risks associated before hand.”  I was mainly asking for the benefit of the other couples because I know how to find the information and will do the research in advance….I was hoping that helping them find the resources and encouraging them to read up before hand would help them make an informed decision.  Although the other couples may have thought I was a bit nuts – I was asking about intermittent monitoring, freedom of movement during labor, ability to eat and drink at will, and need for IV’s.   The nurse knew i wanted to do [the in-hospital birth center] so she kept saying “well at [the Birth Center] things are different” and I said “I realize this but if I don’t end up in [the Birth Center] I want to know what my options are here.”

 

1. She set a great example by following up on the one father’s particular question which asked about the potential risks and benefits of routine hospital interventions.  In other words, she did not allow an overly general answer about the risks of a major intervention to suffice.  And while some of the parents on the tour may have dismissed her as “one of those natural childbirth freaks,” I would bet that there was at least one parent (and perhaps more) who may have been inspired to ask similar questions or to research their birth options in more detail.
2. She shed light on the issue of informed consent.  As she rightly pointed out, in order to give truly informed consent, one must be apprised of the potential benefits and risks of any suggested or recommended procedure.  And as J also pointed out, active labor is not the best time to weigh the pros and cons of any particular birth intervention.  Thus, her questions were in no way intended to convey the idea that epidurals are “bad.”  Instead, they were intended to convey the idea that not giving women and their partners accurate and thorough information about epidurals is “bad.”
3. In that same vein, J illuminated the fact that it is very difficult to give truly informed consent when one is in the midst of active labor, especially when one is at the point of really wanting an epidural.  (For what it’s worth, even though I had an unmedicated birth, there were a couple of times during my labor where if I hadn’t a) prepared for a natural childbirth, b) had access to some non-pharmeceutical comfort measures to help cope with contractions, and c) known the risks of epidurals ahead of time, I would have likely shouted, “YEAH, YEAH, I DON’T CARE IF THAT EPIDURAL TURNS MY EYEBALLS INTO WALNUTS, JUST GIVE ME THE DRUGS!”)  In other words, in order to best honor the concept of informed consent, one should strive to educate others (and oneself) about the pros and cons of birth interventions before and not during labor.

In one of the early chapters in Birthing From Within, the authors suggest that pregnant women should interview the “wise mothers” in their lives in order to gain a better understanding of the birth experience–to get a peek at other women’s insights into birth, to see how they have coped with the physical and emotional intensity of birthing.  The authors provide a list of questions that women can ask other mothers in their lives, questions asking what helped them most during the birth, what their spiritual experience of birth was, what they would do differently, what they would do the same, what they wish they had known beforehand.

Although I would not go so far as to consider myself a “wise mother” (and all that the term connotes), I do think that my birth experiences imparted some wisdom to me.  Or at least they made me wiser.  And, maybe on some level, the ways in which I was made wiser are worth sharing.

In the context of M’s birth–my first birth, which was an unplanned, pre-labor cesarean section–I answered the Birthing from Within questions as follows:

What helped you most when you gave birth?

Sheer willpower and the uncanny ability to remain cool, calm, and collected on the outside when there’s a storm raging on the inside.

I had planned (oh, those dear, sweet plans) on a spontaneous, drug-free, hypnobirthing-assisted labor.  I had planned on laboring with my husband, my mother, and my mother-in-law by my side.  And by the time I was nearing the end of my pregnancy, I was even excitedly anticipating those first few contractions.

But when a non-stress test revealed variable decelerations into the 60-70 beats-per-minute range, and when an ultrasound also confirmed these decelerations, and when the decelerations not only continued but also worsened during an oxytocin challenge test, my doctor determined that M would probably not tolerate labor well once it started.  So it was decided that M would arrive via cesarean section.

I had four hours from the start of my prenatal appointment to the first incision to get used to the idea that all of my plans for M’s birth were evaporating into the sterility of what was to become my–and his–birth experience.  And the shift in plans wasn’t made any less dramatic by the fact that M’s c-section was, by most stretches of the imagination, a necessary one.

So, as Ani DiFranco once sang, I learned like the trees how to bend, how to sway.

Flexibility.  It’s a mighty good tool to take to the birth of one’s child.

Surprisingly, my doctor even provided one of the most helpful aids in my emotional recovery from the cesarean.

For although he was patronizing and misleading and haughty with me as he tried to talk me into unnecessary repeat cesarean in the 36th week of my second pregnancy, I can still say that I appreciate him for “slowing down” my first son’s birth so that my husband could take pictures as my son was born. 

The doctor moved away the surgical instruments and the surgical team’s hands so that Tim could snap a quick shot of M’s head just as it emerged from my belly.  Just his head, just my belly, nothing else. 

Perhaps a grotesque photograph for some.

But for me, it was and is my one tangible link to M’s birth.  I was numb and paralyzed and scared and sick and anxious when he was born, and I could literally do nothing to actively bring him into the world.  I could not even see him being born.  So to have that photograph–to have that document of the moment of his birth–helped and still helps me to feel a deeper connection to his birth.

And finally: breastfeeding.  Breastfeeding is what helped me the most.  Hands down.

Admittedly, breastfeeding was a struggle in the recovery room.  The spinal medication had worn off.  I was groggy and tired.  My baby had been rooting for my breast while we were still in the operating room, and he didn’t even get to my arms until he was over one hour old.  He was so distraught, and I was in so much pain, that we had trouble getting that first latch.

But we persevered.  (And we persevered for weeks, through cracked nipples and colic and all.)  I told him that if I couldn’t give him the perfect birth, I would give him this.

It was what I could actively, happily, and empoweringly do for him.

And it helped me to become a more active, happy, and empowered mother. 

What was your spiritual experience of giving birth? 

It was a humbling experience.

The change of plans, the awesome flexibility required of me, and the tenacity I needed just to feed my child in those first weeks of physical recovery all humbled me in a powerful way.  It was not the spiritual journey that I had envisioned whenever I imagined M’s birth when I was pregnant, and it took time for me to accept the spiritual journey that had actually occurred.

What’s more, combined with some traumatic events following M’s birth, the circumstances of his arrival into the world contributed to months and months of spiritual bankruptcy (otherwise known as post-partum depression).  I am lucky to have come out of that darkness–to have emerged “on the other side” with my spirit intact.  And stronger.

But M’s birth also set me on the path toward one of the most spiritually powerful experiences of my life–my second son’s birth.  And if it weren’t for what M’s birth taught me–if it weren’t for those dark, cavernous places I had to confront within my soul–I’m not sure that I could have experienced the triumph of A’s birth with the level of depth that I did.  In some strange way, I am eternally grateful for M’s birth for that.

If you could do it over again, what would you do the same?

I would still offer my breast to my baby as soon as he was placed in my arms, and I would still fight just as hard as I did to develop and maintain a good breastfeeding relationship.

And, of course, I would want him to be just as healthy as he was (with 9/9 Apgars) from the moment he emerged from my body.

Is there anything you would do differently?

I would insist upon holding my baby in the operating room.  Skin-to-skin contact.  Earlier breastfeeding.  Just something so that it would not have felt as if they were placing a complete stranger in my arms when I first “met” him in the recovery room.

I would also have hired a doula.  Especially so that she could have stayed with me as my incisions were being repaired in the operating room.  At this point, Tim had gone with M to the nursery, so I was then separated from everyone I loved most in the world.  And there’s nothing like being in an operating room while having your uterus sutured and hearing the OR team make small talk and being separated from the one person with whom you have been as intimate as is humanly possible for the past nine months to make you feel like one of the loneliest people in the world.

I also would have been a better (and snarkier) advocate for myself.  To the pregnant nurse in the operating room who exclaimed to the rest of the surgical team, ”Gosh, I hope that I don’t have to have a c-section,” I would have said, “HELLO.  I am not a slab of meat on the operating table.  I am awake.  I am alive.  And when I woke up this morning, I was also hoping that I didn’t have to have a c-section!” 

Instead, I remained silent.  Afraid to talk, because I was afraid that I would start crying.  And that’s because I was all alone, save for the OR team.

What do you wish you had known beforehand?

I wish I had known that I could have asked to bring M closer to me in the operating room, especially as Tim was holding him.  I wish I had known that I might have been able to offer M the breast sooner after his birth.  That I could have nuzzled him closer, and maybe even had Tim bring him closer to me for some (even minimal) skin-to-skin contact.

In that same respect, I wish I had known that preparing for birth should not involve simply preparing for a vaginal delivery.  I wish I had known that I could make some personal requests for a cesarean section.  That I should have discussed my doctor’s c-section protocol with him and his partners well before M’s birth.

I wish I had known to attend my local ICAN meetings soon after M was born.

But I also wish I had known just how much M’s birth would transform me.  I wish I could go back to myself, as I lay on the table, and whisper in my ear, “This will make you stronger.  And you are already amazingly strong.”

In fact, I think that any woman who brings a child into the world should know this beforehand. 

Whether she has a vaginal birth or a c-section, a drug-free birth or an epidural-assisted birth, a spontaneous labor or an induced birth, a hospital birth or a homebirth, a birth after months of carrying a baby in her womb or a homecoming after months of carrying love for an adopted baby, she is amazingly strong.

I will be neither the first nor the last person to draw comparisons between birth and marathons.

And I will certainly not be the first nor last blogger to address this analogy.

Rixa Freeze at Stand and Deliver, for instance, offers a beautiful and inspiring metaphorical story documenting the physical, mental, and emotional preparation that the story’s character “Ann” undertakes before running a marathon.  It’s the sort of a preparation that leaves her proclaiming, ”I can do it. I am strong. I am ready” as she stretches before the race. 

Just the sorts of affirmations that any birthing woman should be able to say to herself before welcoming her child into the world.

And then the blogger at Raising My Boychick gives a compelling account of both the misogynistic implications of comparing birth to athletics and the potentially empowering implications this comparison could have if the needs and autonomy of birthing women were respected just as much as the needs and autonomy of certain athletes.

Just the sort of respect that birthing women deserve.

But despite the fact that both bloggers (and many others) have pursued the birth/marathon analogy with remarkable depth, critique, and insight, I would like to add my perspective–a doula’s perspective–to the multitude of analyses and musings on this issue.

Because after witnessing my husband complete his first marathon last week, and after watching hundreds of other people sometimes triumphantly, other times agonizingly, and always inspirationally cross the finish line, my “doula’s attention” was drawn immediately to birth–and not necessarily toward how the physical, mental, and emotional work of a marathon is comparable to labor (although I’m sure in many ways it is) but instead toward what good labor support can offer to birthing women.

In the hours after the race, Tim told me how at all the major mile markers–the half-marathon mark, the 18 mile mark, the 26 mile mark (before the last .2 miles) and so on–there were volunteers whose primary job was to cheer on the runners.  And this was even in addition to the loved ones and general public who were there to see their friends and family run.

They’d remind the runners of how far they’d already come.  They’d remind the runners of how far (or how little) they had to go.  They’d share feelings of pride and excitement and awe with, for the most part, complete strangers running past them.  People they neither knew nor would likely see again.

Of course, I’m sure some runners may have “tuned” out the cheers, either with iPods or with their own internalized focus and awareness–that is, the internal tools they used to accomplish their goal.  (Must like hypnobirthing, I might add!)

But I’m also pretty sure their encouragement carried some runners right through those last strenuous miles.

Tim experienced this particularly in those last few tenths of a mile, where the volunteers were strategically placed to exclaim, “The finish line is just right past that hill up there!  Just run over that hill, and you’ll be there!  You can do it!  We’re so proud of you!  Just keep going!”

It’s what I’ve said to a woman in the throes of transition.  Or at least it’s remarkably close to what I’ve said.  (Without the shouting, of course!)

The pride and awe and encouragement is what doulas and other labor support people all over the world offer to women as they give birth.

And as my eyes welled with tears–as I felt the deepest awe and respect not only for my husband and the runners there that day but also for every woman who has welcomed a child into the world, no matter how she has done it–I said:

“Every woman deserves that sort of support during labor.  I want every birthing woman to experience the sort of encouragement and awe and celebration that you and the other runners received today.”

Really.

We deserve it.

You deserve it.

Whether it’s from a partner or a midwife or a nurse or a friend or family member or, yes, a doula, all birthing woman deserve the encouragement and awe and excitement and celebration that I witnessed at that marathon.

Oftentimes when I see anything birth-related covered by the national news, I end up feeling very underwhelmed (to say the least).  One-sided coverage (mostly from ACOG’s perspective), exaggerated risks and benefits of various procedures or processes, and even a blatant lack of research on a given topic all seem to pervade the segments on pregnancy and birth that I’ve seen in recent years.

But the past week has been a relatively good week for transparent and seemingly fair (though, admittedly, not always cheery) coverage of a few birth-related issues.  And in my opinion, each of the following news pieces is worth checking out–not just for the decent news coverage but also for the helpful information.

From CNN

Senior medical correspondent and “Empowered Patient” columnist Elizabeth Cohen examines the relative risks and benefits of VBAC and cesarean section within the context of two current news stories: 1) the fact that some insurance companies have denied women health care coverage after considering their previous c-sections to be “preexisting conditions” and 2)  the story of Joy Szabo, a mother in Arizona who must travel 300 miles to the nearest “VBAC-supportive” hospital just to have her second VBAC (and who was threatened with a court-ordered cesarean by her local hospital if she attempted to have a VBAC there). 

All in all, I am impressed with Cohen’s discussion.  Could she have done a better job of reporting the risk of uterine rupture?  Sure.  (For what it’s wort, the rate of uterine rupture during a VBAC is less than 1% for most women: .4% if labor begins on its own, .9-1.1% if labor is augmented or induced with pitocin, creating a rate of approximately .7% for all VBAC attempts, induced or not.)

But Cohen does a superb job of addressing issues that are often overlooked in the coverage of cesarean sections and VBAC.  For one, she is careful to place the risk of uterine rupture alongside the risks of cesarean section.  This simple exercise in good reporting helps to dispel the illusion that VBACs are a “risky” option when compared with “easy” and “risk-free” cesareans.

In addition, Cohen points out that patient-chosen, non-necessary elective cesareans make up a very small percentage of the cesarean sections performed in the United States.  This is especially noteworthy in light of the fact that some medical professionals (though certainly not all) have often pointed to “too posh to push” cesareans as one of the primary reasons for the nation’s rising cesarean rate.  But their “mother-blaming” (in addition to being inherently misogynistic) simply doesn’t pan out when one considers the relative infrequency with which patient-chosen, non-necessary elective cesareans occur.

You can watch the following video to see more about what Cohen has to say about VBAC, c-section, the related issues:

From MSNBC

The very title of this article left me smiling: “Hospitals to crack down on induced labors.”

An even better title, however, would have been “Hospitals to crack down on UNNECESSARY and EARLY induced labors.”  Because as the article reports (and as studies have demonstrated), these inductions–especially those performed before 39 weeks–can lead not only to iatrogenic (or doctor-caused) prematurity but also increase a baby’s risk of NICU admission and increase first-time mothers’ risk of cesarean section.

So don’t worry–if you and/or your baby’s health requires an induction, hospital regulators and administrators are not going to deny you an induction.  But they may restrict your care provider’s ability to schedule convenience inductions–and that’s all with your and your baby’s health in mind.

From the BBC

And finally, this week the BBC news published an overview of maternal mortality across the world.  In their examination of the United States, they found that:

The US spends more money on mothers’ health than any other nation in the world, yet women in America are more likely to die during childbirth than they are in most other developed countries, according to the OECD and WHO.

The article points to the lack of health insurance and coverage, poverty, the staggering c-section rate, and obesity as potential contributing factors to this sad and disheartening state of affairs.  What’s more, it sheds brief light on the fact that African-American women are “three to four times more likely to die during childbirth than white American women,” even when one compares the outcomes of wealthy black women to wealthy white women.  (Notably, many people have speculated that the stress of racism has a significant effect on the disparity of maternal outcomes between black and white women in the United States.)

But what this article also illuminates is the fact that we must demand better maternity care for women in the United States (and in all countries, for that matter).  We need better prenatal care (which should include not offhand castigations about “gaining so much weight” but respectful and helpful nutritional counseling from the first trimester and beyond).  We need better labor and delivery care (with more emphasis on evidence-based maternity care and not on unnecessarily intervention-heavy birth).  We need health care coverage for all pregnant women (period).

At least that’s what the BBC article illuminated for me!

(For more on issues of maternal mortality in the United States, please see Ina May Gaskin’s Safe Motherhood Quilt Project.)

“At the end of the day, it doesn’t matter how the baby came out.  All that matters is that you have a healthy baby.”

It’s that dreaded “healthy baby line.”  The one I’ve written about before.  The one that others have addressed with admirable sensitivity and eloquence.

And I’ve been thinking about that line in a relatively new light lately.

My general position on the “healthy baby line” hasn’t changed.  I still think these sorts of statements are hurtful and demeaning and insensitive to women’s experiences.  To be fair, I also don’t think that people generally intend for these statements to be taken as such.

But in addition to the aforementioned response that I’ve given to the “healthy baby line”–a response that focuses on the emotional aspects of birth and new motherhood–I’d also like to add this point: Healthy babies do matter.  And that’s why I (and others) care so much about how they come out.

This is because unnecessary birth interventions that interfere with how babies “come out” can pose additional risks to moms and their babies.

This is not to say major birth interventions such as induction of labor or cesarean section are so risky that they should never be used.  To the contrary, when these interventions are necessary and/or medically indicated–for example, when a woman has a cesarean section for placenta previa, or when a woman’s labor is induced because of preeclampsia–they are wonderful and even life-saving uses of the medical technology that is currently available.

But when these interventions are used in the absence of necessity or medical indication, some parents may decide–and have the right to decide–that the possible benefits of these interventions might outweigh their risks.

Notably, some of these risks are relatively small.  Some of them may even be risks that moms and/or their partners examine and pore over and say to themselves, “You know, I think that the convenience of having an elective induction still outweighs the risks that it presents, and I am willing to take on those extra risks.”

And in these sorts of cases, they’ve made an informed decision.  And informed decisions–informed consent–are something that I not only respect but also champion as a fundamental right for all medical patients.

But before a parent can make an informed decision about unnecessary induction and/or cesarean section, they should know the following:

According to Childbirth Connection’s systematic review of the comparative risks of cesarean section and vaginal birth, cesarean section poses the following extra risks* to both mothers and babies:

• Physical problems in mothers: Compared with vaginal birth, cesarean section increases a woman’s risk for a number of physical problems. These range from less common but potentially life-threatening problems, including hemorrhage (severe bleeding), blood clots, and bowel obstruction, to much more common concerns such as longer-lasting and more severe pain and infection. Even after recovery from surgery, scarring and adhesion tissue increase risk for ongoing pelvic pain and for twisted bowel.
• Hospitalization of mothers: If a woman has a cesarean, she is more likely to stay in the hospital longer and is at greater risk of being re-hospitalized.
• Emotional well-being of mothers: A woman who has a cesarean section may be at greater risk for poorer overall mental health and some emotional problems. She is also more likely to rate her birth experience poorer than a woman who has had a vaginal birth.
• Early contact with, feelings toward babies: A woman who has a cesarean usually has less early contact with her baby and is more likely to have initial negative feelings about her baby.
• Breastfeeding: Recovery from surgery poses challenges for getting breastfeeding under way, and a baby who was born by cesarean is less likely to be breastfed and get the benefits of breastfeeding.
• Health of babies: Babies born by cesarean are more likely to:
  • be cut during the surgery (usually minor)
  • have breathing difficulties around the time of birth
  • experience asthma in childhood and in adulthood.
• Future reproductive problems for mothers: A cesarean section in this pregnancy puts a woman at risk for future reproductive problems in comparison with a woman who has a vaginal birth. These problems may involve serious complications and medical emergencies. The likelihood of experiencing some of these conditions goes up sharply as the number of previous cesareans increases. These problems include:
  • ectopic pregnancy: pregnancies that develop outside her uterus or within the scar
  • reduced fertility, due to either less ability to become pregnant again or less desire to do so
  • placenta previa: the placenta attaches near or over the opening to her cervix
  • placenta accreta: the placenta grows through the lining of the uterus and into or through the muscle of the uterus
  • placental abruption: the placenta detaches from the uterus before the baby is born
  • rupture of the uterus: the uterine scar gives way during pregnancy or labor.
• Concerns about babies in future pregnancies: A cesarean section in this pregnancy can affect the babies of future pregnancies. Studies have found that they are more likely to:
  • be born too early (preterm)
  • weigh less than they should (low birthweight)
  • have a physical abnormality or injury to their brain or spinal cord
  • die before or shortly after the birth

And in addition to the general risks of induced labor (such as an increased risk of NICU admission, forceps and vacuum-assisted delivery, and abnormal fetal heart rate), the use of synthetic oxytocin (or pitocin) itself carries a number of risks of which parents should be aware.  As reported in the RxList Drug Guide, pitocin can lead to the following adverse reactions in a mother:

Anaphylactic reaction
Postpartum hemorrhage
Cardiac arrhythmia
Fatal afibrinogenemia
Hypertensive episodes
Nausea
Vomiting
Premature ventricular contractions
Pelvic hematoma
Subarachnoid hemorrhage
Hypertensive episodes
Rupture of the uterus

Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus.

And according the same RxList Drug Guide, the pitocin can lead to the following adverse reactions in the fetus or neonate:

Bradycardia
Premature ventricular contractions and other arrhythmias
Permanent CNS or brain damage
Fetal death
Neonatal seizures have been reported with the use of Pitocin (all due to induced uterine motility)

and:

Low Apgar scores at five minutes
Neonatal jaundice
Neonatal retinal hemorrhage (all due to use of synthetic oxytocin in the mother)

It should go without saying that none of these lists are meant to frighten anyone about labor induction or cesarean section.  To reiterate, these invertentions can be wonderful, life-saving uses of medical technology.  What’s more, there are ways to make the experience of these interventions more mother-, baby-, and family-friendly.

Nonetheless, the risks that these interventions pose to mother and baby demonstrate just why it does matter how a baby “comes out.”

And that’s because how a baby comes out can have a significant affect on how healthy that baby is.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

*Worth noting is that the Childbirth Connection’s systematic review of cesarean section and vaginal birth did find the following increased risks of vaginal birth (as compared with c-section): an increased incidence of perineal pain and incontinence for mothers, and increased risk (though still low risk) of nerve injury in babies.

Lamaze International’s research blog, Science and Sensibility, has announced a call for submissions for its second Healthy Birth Blog Carnival.  Whereas their first blog carnival showcased bloggers and other guest posters writing about letting labor begin on its own, this second carnival will feature posts on walking, moving, and changing positions during labor.

According to the Lamaze Healthy Birth Practice paper on this subject, research shows that:

…when compared with policies restricting movement, policies that encourage women to walk, move around, or change position in labor may result in the following outcomes:

• less severe pain,
• less need for pain medications such as epidurals and narcotics,
• shorter labors,
• less continuous monitoring, and
• fewer cesarean surgeries (Lawrence et al., 2009; Simkin & Bolding, 2004; Simkin & O’Hara, 2002).

In fact, no woman who participated in any of the research studies said that she was more comfortable on her back than in other positions (Simkin & Bolding, 2004). No study has ever shown that walking in labor is harmful in healthy women with normal labors (Storton, 2007).

So it is easy to see why walking, moving, and changing positions is a healthy birth practice!

For this post, I’d like to document and describe the ways that I walked, moved, and changed positions throughout my labor.  And this is because I think that it is important for women to have access to images of real women who are really laboring and who are really able to walk and move and change positions throughout their child’s birth.

Worth noting is that for most of my labor, I just followed my body’s signals and natural instincts when changing positions.  Sometimes, I also changed positions based on what my doula suggested. 

And for the entire time, I found my labor to be an intensely powerful, empowering, and healthy experience.

A few “stats” about my labor before I begin:

• Even though this was my second child, I was a “first-time laborer” since my first child was born via a pre-labor cesarean section.
• My labor began with my membranes rupturing.
• My contractions began approximately 1 1/2 hours after my membranes ruptured.
• My entire labor lasted a little over 14 hours (or 15 hours if one were to count the irregular, painless contractions I was having in the hour before my water broke).
• I labored at home for approximately 8 1/2 hours before leaving for the hospital.
• My cervix was 1-2 cm dilated and nearly 100% effaced by the time I was checked at the hospital.
• Three hours later, my cervix was dilated 4 cm.
• Just over one hour later, I was fully dilated.
• I actively pushed for about 35 minutes before delivering my healthy 8 lb. 3 oz. baby.
• And I moved and grooved all throughout my labor.

This is what it looked like.

Here I am in early labor, kneeling over the armrest of the couch.  Obviously, the contractions weren’t terribly intense at this point since I could still talk on the phone.  (I do believe, however, that I ended up throwing the phone onto the end table about ten seconds into my next contraction!)  Nonetheless, even though the contractions weren’t very intense, I still found that this position helped to relieve the discomfort that they caused.

What else does kneeling help to do?

It can help to relieve backache, it can encourage the rotation of the baby, it can help a mom to move and/or rock through her contractions, and it also provides a mom’s labor support team with access to her lower back for counter pressure.  One can also kneel over a birth ball or over the back of a raised hospital bed.

Here I am laboring on my side.  I was still in the early phase of my labor, so I wanted to relax as much as possible before the really hard work began.  I used one of my hypnobirthing deepening exercises to help me do just that.

How does side-lying help a mom during labor?

It helps to promote rest and relaxation in early labor, it can help to improve fetal oxygenation (especially when a mom is on her left side), it can help to slow down a precipitous second stage, and it can help to encourage fetal rotation.  It is also a good “alternative position” (instead of lying flat on one’s back) for a mom using epidural analgesia.

Here I am standing to stop for a contraction after walking around the house for a while.

Standing and/or walking throughout labor gives a woman the advantage of gravity to help the baby descend, it encourages the rotation and descent of the baby, it can help to bring on more productive contractions, and it also helps the baby to be well-aligned with the mother’s pelvis.  What’s more, it is yet another position that gives a mom’s labor support team access to her back for counter pressure and/or other touch-based comfort measures, if she desires them.

One of the other great standing movements is to slow dance with one’s partner, doula, or other labor support person.  (I slow-danced with my husband, Tim, right after this picture was taken!)  Besides providing emotional closeness(especially if one is dancing with one’s partner), dancing can offer a mother all of the benefits of walking or standing while allowing her to take some of her weight off of her feet.

Remember how I mentioned the “really hard work” that was on my horizon?

It had definitely begun by the time this picture was taken.

And laboring on my hands and knees felt like the most comfortable and most natural position for me to be in at this point.

Being on one’s hands and knees during labor can help to relieve backache (which I was definitely experiencing here), can encourage the rotation of the baby, and can also allow access for back massage and/or counterpressure.  Doing pelvic rocking while on one’s hands and knees is also an especially good exercise for encouraging the rotation of a baby in the occiput posterior position.

Here I am standing and leaning against the stairs.

As with most upright positions, this position gives moms the advantage of gravity, it can encourage more productive contractions, it can help with fetal rotation, and it can be more restful than standing alone (and putting all of one’s weight on one’s feet).

Since the stairs are pictured here, I should mention that I also made quite a few trips up these stairs during my labor.  Climbing stairs can also enhance rotation of the baby and pelvic mobility, and it may help to “speed” up one’s labor even more than walking does.

Worth noting is that most of those trips up the stairs were taking me to our bathroom, where I spent a good deal of time laboring on the toilet.  (For obvious reasons, I have no photos of this!)  Laboring on the toilet gives a mom the assistance of gravity while still allowing her to “rest,” and it may help her to relax her perineum.  (It is usually not recommended for moms who have trouble with hemorrhoids, however.)

Here I am sitting and swaying on my birth ball.  This proved to be tremendously helpful during the time that I labored at home.

In addition to offering a mom the advantage of gravity, swaying on a birth ball can help to enhance pelvic mobility.  It is also much more comfortable than merely sitting on a chair!

As you can see here, using this particular position with the birth ball also allowed me to gain the advantages of leaning, to receive some emotional support from Tim, and to get the back-relieving benefits of counterpressure from my amazing doula, Chris.  So this was really the “mother” of all laboring positions!  (Sometimes I can’t help myself when it comes to silly birth-puns…)

Here I am at the hospital, lying on my side just as I did at home during early labor.

I was strapped to the wires and transducers needed for the electronic fetal monitor (and didn’t have access to the telemetry unit yet), so my range of mobility was significantly limited.  And even though I needed to rest and “re-group” after a night of laboring and after discovering that I was “only” 1-2 centimeters dilated, the very fact that my range of motion was limited seemed to make coping with my contractions more difficult.

In fact, the time that I spent in the hospital bed, strapped to the monitors, was the only time that I ever considered asking for pain medication during my entire 14-hour labor.

But then I got in the water.

Oh, the water!  Take a moment to review the look on my face in the above picture and then the look on my face as in the picture to the right.  These pictures were taken within about three hours of each other.  And in the one to the right, I am a little less than two hours away from holding my baby in my arms.

Hydrotherapy during labor (which also includes laboring in the shower) can be very relaxing and can help to reduce the intensity of the pain of contractions.  Notably, women are generally advised to avoid getting into a tub or jacuzzi until they are at least 4 cm dilated since getting in the tub “too early” can contribute to irregular and/or less frequent contractions.

In addition, although these items are not visible in the above photograph, moms laboring in the water should also have access to a cold drink (my choice was Gatorade) and cool washcloths so as to help regulate their body temperature.

(Although a bigger tub–or an actual birthing tub–would have been preferable to the hospital’s small bathtub, I was still able to float in between contractions and to move my body during contractions.  In other words, I was still able to move and change positions while in the tub!)

I began pushing while lying on my side.  Although I did not find this to be the most comfortable and advantageous pushing position for me, pushing on one’s side does have some specific benefits.  In particular, this position encourages good fetal oxygenation, it is helpful for moms with elevated blood pressure or who are using epidural analgesia, and it allows the mother to rest in between contractions.

I eventually moved to my hands and knees while pushing and then rested in a sitting position in between contractions.

As one of the many optimal birthing positions, pushing on hands and knees can help to improve fetal heart tones, it can assist with fetal rotation (especially for a baby in the occiput posterior position), it is an excellent position for a woman expecting a large baby, and it can help a mom to avoid a laceration or an episiotomy.

And it was certainly a position that helped this first-time-pusher to deliver her 8 lb. 3 oz. baby after only 35 minutes of active pushing!