No one thinks they will have an unnecessary c-section, but many c-sections are preventable. The personal beliefs and philosophy of your doctor, the policies of your hospital, and the decisions that you make before and during labor can all make a c-section necessary that could have been avoided. Right now 1 in 3 American women are giving birth surgically. If a vaginal birth is important to you, then you need to take your birth seriously.

{One} Choose a Natural Birth
Some people see a natural birth as an attempt to gain bragging rights, or a selfish mother’s desire for a specific birth experience. However, the interventions that are necessary for a medicated birth come with very serious risks, many of which increase your chances of a c-section. This is referred to as a “cascade of interventions” and poses a real danger to mothers and babies. Preparing for a natural birth will help a couple avoid many of these risks and a surgical birth.

{Two} Maybe Don’t Hire a Surgeon to Attend Your Normal Birth

“It is no longer feasible for individual physicians who have invested 12 years in training at the cost of hundreds of thousands of dollars to dedicate extended periods to observing one normal woman in labor." (Macer 1992)

Many women don’t realize that much of an obstetrician’s training is in surgery. Some MD’s went into obstetrics not because of a love for natural childbirth, but because of their love for surgery. This is of course not the case for every doctor, but it’s something to consider when deciding on your provider. Highly trained surgeons are exactly what you want in an emergency, but in a normal birth, they may see complications that aren’t there and act prematurely. Some obstetricians hold the personal philosophy that surgical births are a simpler, easier way to birth, so they might be more likely to try to "save you" from your vaginal birth. Ask lots of questions and pay attention to how encouraging your provider is when you express your desires. Their reaction does matter.

Worldwide most expecting mothers hire midwives to attend low risk pregnancies. If a midwife finds mom to need specialized care, mom transfers to an obstetrician. This model shows better outcomes for mothers and babies. A midwife is a medical professional who has received extensive training in both facilitating normal birth and recognizing possible complications. Prenatally she does everything an OB does in a typical appointment, though is often more thorough.

{Three} Skip Providers Who Ban VBACs
A VBAC ban says a lot about your provider’s philosophy and knowledge when it comes to birth, as well as the hospital’s preparedness in the case of an emergency. If your provider does not attend VBACs despite the American College of Obstetricians and Gynecologists and The National Institutes of Health‘s 2010 recommendations to do so, what other recommendations are they not following? Where else are they not providing the safest, most evidence based care?

A hospital that does not allow VBACs often gives the excuse that they can't because they do not have an obstetrician or an anesthesiologist on the floor in the case of an emergency. This may seem reasonable, but wouldn't every couple choosing a hospital birth want a labor and delivery unit that is fully prepared for a sudden emergency? In reality this risk is very low, but many couples choose hospital births to have immediate access to emergency care, it's important to know which hospitals do not provide this.

{Four} Know C-section Rates
Find out the c-section rate for both your hospital and your provider. Hospital rates are easy to get, you can simply go to cesareanrates.com. You can get your provider’s rate by simply asking them, “how often do your mothers need a c-section?” That’s a little less confrontational than “What’s your c-section rate?” If your provider is defensive or doesn’t want to answer, that’s a red flag. The World Health Organization recommends 10-15%. Locally hospital rates vary from 23% at Sutter to 33% at CHOMP.

{Five} Take a Natural Childbirth Class
A natural childbirth class will teach you the risks of a c-section and skills to avoid one.  Be aware the difference between a birth class that simply informs you of options, and a natural birth class that gives you skills to achieve your goal of a vaginal birth with a past record of helping other couples achieve their goals. A good natural birth class can cut your chances of a c-section in half. Couples who chose the curriculum I teach, Birth Boot Camp, only had a 14% c-section rate in 2013, and I can say personally none of my students delivered by cesarean last year despite a few long (40+ hr) labors. The decisions these couples made prenatally likely prevented a cesarean in labor.

{Six} Let Baby Choose His or Her Birthday
In other words… don’t get induced unless absolutely medically necessary. Many women trust that their doctor will only suggest an induction if it is medically necessary but that just isn’t true, couples must be informed. An induction DOUBLES your risk of a c-section!

{Seven} Don’t Take Pregnancy Laying Down
Getting plenty of rest in pregnancy is important, but so is staying active! It has been reported that women who are sedentary though out their pregnancy have 4X higher chance of needing a c-section. Staying active can keep you healthy and low risk. Be sure to also eat a balanced, whole foods diet with plenty of protein to remain low risk.

{Eight} Hire a Doula
Most couples don’t think they need a doula, but doulas have a real measurable impact on how your birth plays out. Having a doula present has shown to lower the c-section rate for those couples by up to 50%!

{Nine} Shut Down Negativity
Do you have a sister who loved her c-section? Is your mom telling you that you are just too thin to birth a baby normally? Women make these kinds of negative comments to expecting women all the time, not really considering how it may affect her. These comments are more about themselves than the expecting woman, they are voicing their own fears, disappointments, or insecurities. You can choose to remind them that birth is normal and you are making informed decisions to have a safe birth, or simply let them vent their feelings, knowing they are about them and not you. Try to surround yourself with women who trust birth and read positive birth stories.

{Ten} Choose a Comfortable Birth Environment
A mother who is terrified of the hospital will likely be unable to open and birth vaginally there. A woman must feel comfortable and safe for oxytocin, the hormone that causes contractions, to work properly. Feeling anxious and scared causes a surge of adrenaline which will interfere with oxytocin, slowing or stopping labor. Does mom desire a home birth but dad is anxious? Dads, do your research and help your partner birth where SHE is most comfortable, otherwise you may be setting her up for a risky surgical birth. Whether you choose a hospital, birth center, or home birth, be sure it is an environment you are extremely comfortable in.

{Eleven} Hospital Birthers, Labor at Home
A common reason for a c-sections is “failure to progress,” which much of the time means mom and baby were not in any real danger, labor just took longer than the doctor or hospital staff were willing to wait. Some women labor the textbook 12-14 hours, but many don’t, that’s just the average. Long, slow labors happen more often than you think, though not normally in a hospital because those moms are given medications to speed labor or c-sections. Once at the hospital there is a good chance you will be on the clock so consider not going until you are very close to birthing your baby, which you can determine with the help of a natural childbirth class and a doula.

{Twelve} Use Movement 
Movement and gravity help baby move down, and movement can be an excellent way to cope with contractions. Lying in a bed makes labor longer, more painful, and some babies just cannot come down when mom is lying. Some hospitals require women lay in beds with monitors strapped to their belly. Studies have shown that this increases the rate of cesarean without improving outcomes for babies. Choose a provider and birth place that uses intermittent monitoring.

{Thirteen} Keep People & Things Out of Your Vagina
A common intervention is cervical checks which are done by inserting two fingers into the vagina and then into the cervix.  This can be mildly uncomfortable or painful. A cervical check can push bacteria into the body, causing infection, maternal fever, and ultimately a cesarean. Cervical checks can also lead to a “failure to progress” diagnosis. Some doctors order internal fetal monitors for women which can also lead to infection in addition to restricting movement. Even in labor your body is still your body, frequent cervical checks are not necessary for a normally laboring woman.

{Fourteen} Options for Butt Down Babies
For babies who are breech (butt or feet coming first) some doctors will only do c-sections and not even inform women of the other options. Women carrying a breech baby can seek chiropractic care, acupuncture, moxibustion, find a provider who will do an external version to turn baby, or choose a provider who will attend vaginal breech births. Yes, babies can be born breech safely! In Monterey County we have several obstetricians and midwives who will suggest all the above and are happy to assist vaginal breech births. Ask your provider early on what their protocol is for breech babies, if he or she says c-sections are the only option, consider switching to a provider that will be more honest while helping you explore your options.

If despite your preparations you still need a cesarean, it's ok to feel a sense of loss. It may seem like all of your efforts were for nothing. None of us are promised an uncomplicated birth, but by being informed, choosing a supportive provider, safe birth place, and being an active participant in your birth you may be able to find comfort in knowing you and your birth team did everything necessary for a safe birth. If you are hoping to prevent or are recovering from a cesarean, I encourage you to join a local International Cesarean Awareness Network (ICAN) chapter.

Some additional resources:
The Unnecesarean
 VBACFacts.com
ImprovingBirth.org

We took our seats in church just as we do every Sunday. We’d been in a bit more of a hurry to get settled after running later than usual. This Sunday was my oldest daughter’s fifth birthday, and she’d spent most of the morning playing with her new toys and scarfing down chocolate chip pancakes. Getting dresses on and hair done had been particularly difficult, but I promised I’d help her build her new Lego set later that afternoon. As we sat down in the pew and started to sing the opening hymn, I felt a familiar tightening in my very swollen belly. Today was my due date, but I’d been having Braxton-Hicks contractions for weeks. I’d even had a few “false alarm” evenings when the contractions were particularly strong and increasingly regular. But nothing had panned out yet. I’d joked with A that she might get a baby brother for her birthday, but didn’t really think he’d come so predictably. By the time we were done with the song, the contraction was starting to subside. Twenty minutes later, the first speaker took the stand and another tightening started. And twenty minutes after that, another. Like clockwork, two or three more series of contractions happened every twenty minutes.

My second baby, my first VBAC, had been what they call a “precipitous” delivery. I’d labored for about two hours with a transition of 15-20 minutes, 15 minutes of pushing, with five pushes total. I’d ended up with a perfect, VERY alert baby girl and a third-degree tear (this kid had flown out!). With my third, I was planning on delivering in Salinas at Natividad Medical Center despite living in Monterey (30 minutes to the Southwest), because the Community Hospital in Monterey Peninsula does not allow VBACs. Period. They are 100% b-a-n-n-e-d. I figured if this little guy was as precipitous as R had been, I’d better start heading toward the hospital as soon as I suspected active labor. My contractions had only been going on for a little over an hour, and they weren’t painful yet, but they were regular, strong, and getting more intense. I told my husband we’d better head out to the hospital just in case – better to be sent home than risk having the baby on the road!

We left our two girls with some close friends who had planned on hosting them when the “big day” came. We grabbed our pre-packed bags and set out for the hospital. By the time we were halfway there, the contractions started getting intense enough to take my breath away. They still weren’t painful, just incredibly strong with a lot of pressure, and closer together. I was so glad the roads were clear and lights were green. If we’d attempted this drive during 5pm weekday rush-hour, I think I would have throttled the driver. At the sign-in desk, I had to stop talking during contractions and pace back and forth until they eased. Still no pain, but lots of pressure. Due to R’s quick delivery, the nurse completed my admission and showed us to our room. She took vitals, placed my hep-locked IV, and checked my cervix. I was dilated to 4 and 75% effaced at 0 station. Within 20 minutes my contractions had escalated from pressure to pain, and I used a birthing ball to moan my way through them. My husband let me hold on to his neck to take pressure off my belly, and I bounced slowly until the wave passed. During the next 20 minutes, the pain became impossible to “bounce” through, and I started throwing my upper body across the patient table (the one on wheels that they serve your meals on) and squatting down as close to the floor as possible. Stretching my body as long as possible was the best way for me to get through each increasingly intense crest of pain.

I’m a pretty vocal laborer, and my nurse was very intuitive. She read my cues and decided to check me again – dilated to 7, 100% effaced. The pain gave way to intense pressure and the urge to push became unbearable. I asked her to check again within five minutes, as with R I’d gone from a 3 to 10 in less than 15 minutes. Sure enough, I was fully dilated.

The doctor arrived (he was a hospital fellow on weekend call) and I started to push with each contraction. My water had still not broken and baby’s heart rate was starting to drop between pushes. They broke my water, but it took a few attempts – had they not done it manually I’m pretty sure he would have been born in the caul! I get pretty focused during the pushing phase, so I was only vaguely aware of what they were saying, but I could see the looks on their faces. “Meconium in the fluid.” “Late decelerations.” When they asked me to give him a break on the next contraction, I knew they were concerned for his well-being, and that if I didn’t get this kid out (and quick!), I’d be getting cut again. I tried to pause on the next contraction, but there was no stopping him. I knew he’d started crowning when I felt that familiar burning sensation, and I knew I could have him out with one more good push. They’d told me to wait again, but he was having none of it. Ten seconds later I felt the last rush of relief as his body slid out into the world.

They’d warned me I wouldn’t hear him cry initially, that they wanted to suction him well before they stimulated a good, robust breath out of his lungs. I saw him only briefly before they took him to the warmer, and he looked bluish and floppy. He’d had a knot in his cord just above where they’d clamped and cut, which explained the disconcerting heart rate during delivery. I didn’t worry though – I just knew he was okay and wasn’t even remotely concerned. He would cry when he was good and ready – it was as if he was telling me this himself. After a minute of suction and stimulation, I heard his first little growl. It wasn’t a cry per se, but it was strong and reassuring. As soon as his heart rate and oxygen saturation were stable (about five minutes), they brought him to my chest and he began nursing vigorously. This kid was alert and ready for life!

Raphe was 6 pounds 15 ounces and 19.5 inches long. I think the knots may have kept him from getting much bigger, because my girls (also full term) were 7 pounds 8 ounces and 22 inches, and 7 pounds 13 ounces and 22 inches. Raphe has grown over 5 inches in four months and now weighs 15 pounds.

We’d arrived at Natividad around 2:30 in the afternoon. Raphe was born at 3:17pm, so I’d labored for even less time than with R. Had we not left when we did, had we not packed and arranged childcare previously, had we hit traffic, had we delivered in the car on the side of the road next to a lettuce field, had we, had we, had we. . .

We were truly watched over and blessed. I have no doubt Raphe is destined for great things, as I’m sure most parents feel about their children. If nothing else, with such a dramatic entrance into this world, I’m sure the next 18 years will be nothing if not entertaining.

A Natural Hospital Birth... w/ hashtags
#BirthBootCamp #naturalbirth #onlineclasses

As soon as Ray and Dana announced their pregnancy I began looking forward to their birth story.Dana is a talented writer and hilarious, and I couldn't wait for her take on birth.  I'm so honored Dana is letting my share it with you, I mention her birth in every birth series I teach.

 Ray messaged me asked for good resources. I listed a few of my favorite books, but told them they really needed a natural childbirth class if they wanted a natural birth.

There were no Birth Boot Camp instructors close to them at the time so I suggested they take Birth Boot Camp online. I was thrilled when they signed up. You can read about Dana's journey to a natural birth here. She calls me fanatical... #nottrue #oksometimes.

Washington’s story begins Friday, June 14, 2013. I had a doctor’s appointment that afternoon, but since I wanted to go into labor naturally (including not having my membranes stripped), Dr. Carnes didn’t check my cervix. My due date wasn’t until the 22nd, and as a first-timer, I was prepared to go late and battle my doctors for the right to deny induction. I had no reason to believe I would be going into labor. I hadn’t had any Braxton-Hicks contractions at all. My only “labor symptoms” were a pinky discharge that I didn’t think qualified as the bloody show and a cold, which I was informed did not mean my body was preparing to give birth. (How was I supposed to know? Last time I got a stuffy nose and sore throat, I thought it was nothing but a cold. Turns out I was pregnant!)

Ray had left that morning at about 8:15 am to work a dreaded 24-hour shift. The night before, we joked about how inconvenient it would be if I went into labor while he was on (or recovering from) an overnight. We laughed it off. I was confident I had plenty of time. But just in case, I petitioned God. I wrote in my prayer journal, “Ray works overnight tonight which is a bummer. So I pray I don’t go into labor in the next two days so Ray has enough time to rest up.” Bahahaha. I went to bed at 1 am (because I’m a night owl who never gets to stay up late anymore!), and at 4:45 am, I woke up with what felt like serious menstrual cramps.

Having never experienced Braxton Hicks contractions, I didn’t know if this was a contraction or just me not feeling well. That line right where your underwear sits across your lower abdomen ached. I lay there and focused all of my attention on What The Heck My Body Was Doing. And I realized, Ah...the pangs were coming and going! And it felt like my insides were tightening! So it must be a contraction! Cool. I thought, This is no big deal. I can do cramps. I mean, they hurt, but whatevskis. I got up and drank my glass of water and laid on my left side just like you’re supposed to when you first get contractions. If they were BH, they would go away after about an hour. Well, an hour later, they were still going strong. So I figured, I should let Ray know.

So I picked him up at 5:45 am. We both had a little breakfast snack and went back to bed. I woke for each contraction, even though these early ones were mild, until finally getting up around 10. I let Ray get a couple more hours in (remember he’d been up for nearly 24 hours). We spent the early afternoon getting last minute things done. I was mostly straightening up the apartment. Ray at some point decided to perform surgery on the vacuum cleaner because it wasn’t working right. Obviously. *insert eyeroll here* (Looking at all the evidence, I firmly believe I did not “nest” a single moment of my pregnancy. Ray did all the nesting in our family. I cleaned lightly because it was on a checklist of things to do Before Baby.)

Later that afternoon, Ray convinced me to chill out and watch my early labor distraction movies. So I showered and then labored on my “birthing ball” (AKA the yoga ball) while watching Star Trek: The Motion Picture (circa 1979). This was probably when I looked the most like all the birth videos I had watched. I was in my bathrobe with a heating pad on my lower back, head resting on my arms resting on the ball on the living room floor.  I felt very zen. The contractions weren’t fun. But I was managing fine. I tried not to call them painful (a natural birth no-no), but they were. By 2:30 pm, they moved firmly from the mild to the moderate column. My body also prepared for war, evacuating me of every last substance in my body. I continued to eat like normal, because...well, I was hungry.

Around 8 pm, Ray left to get groceries. (Obviously.) While he was out, I made myself a bath, then we went to bed. At 10, contractions were undeniably strong. At midnight, I wrote that they were “starting to wear on me. Trying to stay strong.” (Code for: “This freaking hurts. But I know it’s going to get worse.”)

I could no longer lay down and sleep. I started out in bed, standing for each contraction while Ray slept. (I was trying so hard to be tough. I didn’t want him to help me until I really needed help. And it’s a good thing too…)

At 1:45 am, I took bath/shower. But regular home bathtubs are not equipped to handle a giant pregnant woman with contractions. I wanted to relax. I would lay back during off minutes and, when the next one hit, heave myself over onto my hands and knees, leaving only part of my giant belly in the water and the rest of me exposed to the cold air. It was awkward and ultimately not all that relaxing. So I eventually gave up on the tub altogether.

Then began the circus of sleeping arrangements. I couldn’t lay on the bed anymore. So I slept on the floor in the baby room and labored on my hands and knees. But that didn’t last long. I decided I needed Ray’s help. Poor guy. I slept upright in chair with my head resting on my arms resting on 2-3 pillows resting on our kitchen bar counter while Ray slept on the floor by the piano. I’d jump up and lean on the chair for each contraction with Ray squeezing my hips through them. We did this for HOURS. Not the best rest by any stretch.

Around 7 am, we decided to…help labor along in the most natural way we knew how… Ahem. Gotta say, during labor, it’s not nearly as fun as not during labor. For me, this was for birthing purposes only. (And I’m glad for my husband’s sake we did because the following six weeks were a doozy.) Afterward, I labored straddling toilet, attempting to sleep propping my arms on the tank. I chose Sleeping At Last to be my labor soundtrack. It was a great choice.


Around 10 am, contractions were coming hard enough and close enough that I wanted my doula there with me. Danielle arrived around 11 am and did counter-pressure with me for a little over an hour until we all decided it was finally time to go to the hospital.

Riding the car with contractions wasn’t as bad as I was expecting, but still wasn’t fun. I’m glad our hospital is only 15-20 minutes away. We shuffled through the parking lot. I walked around the lobby, squatting for contractions which hadn’t felt good earlier but was a requirement for these intense ones. Before we went upstairs, I decided to use the bathroom. Danielle asked if I wanted her to come with me. I balked. I’ve always been pretty shy when it comes to my body. I never stripped naked in the locker room even when my fellow volleyball players did. My roommate in college never got a really good look at EVERYTHING I’ve got going on. I’ve peed in front of like 2 people and my husband isn’t one of them. I reallyreally wanted to tell her, “No, I can pee by myself.” But then a contraction hit. Ow. So I decided, okay, this is the moment my modesty goes. I’m in labor. She’s gonna see a lot more of my parts than me sitting on the pot. So I let her join me. It was weird trying to pee and it felt like I didn’t really have to go as bad as I thought. By this time, I really felt like I had to poop (TMI?). I kept trying, but nothing was happening. She helped me through the contractions (I was already getting kinda vocal).

When I left the bathroom, I remembered it was Sunday now. Father’s Day! This might be my last chance to call my dad. He didn’t answer so I left a message that basically went, “Hi dad. I just wanted to call and say Happy Father’s Day. And as a gift I’m giving you a grandson. I’m at the hospital and IhavetogobecauseI’mhavingacontractionsBYE!”

We moved slowly toward L&D, but I couldn’t walk through these contractions. I stopped and squatted for each one. I even labored in the courtyard outside L&D, hoping to make as much progress as possible before surrendering myself to the hospital.

At 1 pm, I checked in. This was the worst part. To be admitted, you must be contracting for 1 minute, 4 minutes apart, and 4 cm dilated. I was SURE I hit all of those qualifications but there’s only one I couldn’t check for myself. (What? I don’t know where my cervix is. I’ve looked. It all looks like...you know what? Let’s not get metaphorical about my lady business.) I got into triage and ditched my pants. They belted me. I had to wear the horrendous contraction monitor for 20 minutes so they could confirm active labor… and I wasn’t allowed to move with it on. I agreed to this when they put it on me. But when those first contractions hit, I thought, there’s no way. I need to move. I’m in crazy intense pain. And I’m just supposed to lie there and take it? It gets worse.

The nurse came in. She seemed professional…and unimpressed with me. She had me scoot down and spread ‘em so she could check me. I had never felt pain like that in my life. I don’t know what it is they do exactly when they reach in to “check” you, but it hurts like a swear swear swear. I screamed and tried to back away from her intrusive prying unkind hands. She retracted and with a smack of her latex gloves announced, “You’re closed.”

“What?!” I said, traumatized and no longer even resembling a person holding it together.
“You’re 80% effaced and closed.”
“What do you mean ‘closed?’ How many centimeters is that?”
“Zero.”
“Zero?” I couldn’t stop the tears them. How was this possible? I mean, I’d heard plenty of stories about people who come to the hospital too early. But I waited 33 hours. I waited until I was sure it was the real thing. And I wasn’t dilated AT ALL? My prayers started sounding pathetic at this point. I was begging God to help me because I couldn’t imagine doing this for 12 or 16 or 24 more hours.

A doctor came in. He was young and also looked unimpressed by me. I’d been making a lot of noise. So yeah. He said he was going to check me now too. Which terrified me because I already knew I didn’t want him to do it. Why go through all that pain just to hear the same thing? What could have changed in 5 minutes? I scooted and spread for him (Joy.), and he reached for the stars. My scream was a visceral thing. I said, “YOU HAVE TO STOP NOW!” And tried to back away again. He unreached and said stiffly, “Yeah, you’re only 2 cm dilated, 50% effaced.”I was crying a lot now. I felt every kind of violated. I know they were just doing their jobs (and I learned later it hurt so badly because I was still posterior), but I held it against them personally for also making me feel like crap. I hated both of them unequivocally and that hasn’t change. I still don’t know why I went from 80% to 50%. But going 0 to 2 wasn’t really an improvement because they still wouldn’t admit me. It was all terrible.

So I put my pants back on and began the long shuffle back to the car with a spirit I can only describe as utterly hopeless. The contractions had gotten worse from the inactivity. The pain was excruciating. The squats were harder to get down into and especially to get back up out of. We made it to the lobby and I had to pee again. Danielle came with me again and as I peed I noticed it seemed...different. When I thought I had stopped peeing there was still something leaking. We waited and the trickle continued. I was almost certain I wasn’t peeing (but things get crazy during labor. Maybe I was losing sensation down there!). But maybe that bro had broken my water with his nether reach. She left me alone in the bathroom to find me a pad because obviously I didn’t bring any because obviously I’m a moron. I feel bad for the mother and daughter who came in while I was alone and moaning and groaning. The mom explained I was having a baby. But I’m sure the little girl is scarred for life.

Danielle returned with a pad and helped me begin my journey back upstairs. Along the way though, my legs started shaking. I felt exhausted and I wasn’t even admitted yet. How could I keep doing this? I could no longer labor in squats. I got on my hands and knees every time and walking became all but impossible. I finally made it to L&D again, this time just to check if my water broke. We asked not to have my cervix checked. I wouldn’t do it. I just wanted to know if my water has broken. If so, they’d admit me regardless of my dilation. If not, I’d request some Ambien to help me get some rest and go home.

The doctor (who I’m convinced hated me) begrudgingly agreed. The nurse (who I’m ALSO convinced hated me) got out the speculum. She said, “Okay, I know this is uncomfortable. But I need you to lie as still as possible. No flailing and moving around.” As in, not like last time. I agreed and gripped Ray’s hand and forced myself to relax even though contractions were coming and I was laying down with a monitor belt around my waist and them putting things in my hooha when something else wanted to come out felt like death. But it didn’t hurt as bad as being checked. They swabbed me and quickly confirmed my water was leaking and I can be admitted. Yay. Because regardless of how many centimeters I was, I was SURE I was in labor. I thought, My baby is coming soon. He better be, or he’ll be born in serious trouble.

I changed into a gown. And a new nurse, who would be my nurse, came to give me my IV. This was something we fought for a while. I abhor needles and have terrible veins and always wind up getting stuck over and over. Or they search for a vein for so long that the anticipation makes me want to hyperventilate and vomit. But ultimately we agreed, because 1) it’s their policy and we really couldn’t NOT agree, 2) they agreed to just give me a saline lock without fluids, and 3) I wound up positive with GBS and had to have antibiotics anyway. Joy.

Shannon was my nurse’s name. She was blonde, pretty, happy, nice. But she stuck me twice in my left arm and didn’t get a vein. She told me she only tries twice then she gets someone else. And she rarely misses a second time. But I was the lucky winner that day. (#hatinglife) A different nurse came in to stick me and got it the first time. But I’d have a bruise on my left arm for two or three weeks from where Shannon tried.

The doctor came back and said they had to wait until I’m further dilated before they could give me an epidural. I told him with as much confidence as I could muster through my drying tears that I planned to do this naturally. To his credit, he didn’t laugh, roll his eyes, or do anything that confirmed he thought I couldn’t hack it. I was already doubting myself, but he just said, okay then. I asked if my doctor had been informed that I was there. He said she’s off duty/doesn’t work on the weekends so she wouldn’t be delivering me. I almost had a conniption.

“She told me you would call her when I was admitted, and she would come in. She assured me she would deliver me.” He said he’d see what he can do. I have no idea why this conversation even happened. I want to call the doctor a moron. Of course she has regular office hours, but she is my maternity doctor. She’s not an OB, but she is responsible for my obstetric care. So...get her the frick on the phone.

Now my plan was always to walk myself to my room because letting them sit you in a wheelchair projects an image of needing to be saved, so the medical staff tries to intervene/interfere more. Walking projects strength and capability. I made it one step out the door and a contraction hit. I dropped to the floor like I’d been shot, got on my hands and knees and yelled through the pain. I didn’t feel strong. My legs felt like they couldn’t hold me anymore—even on hands and knees. The nurse said, “You can’t do this here. We’ve got to get you to your room.” And she and Ray tried to get me up. But I couldn’t move. I wanted to be able to walk myself there so bad, but when they rolled up a wheelchair and plopped me in it and whisked me down the hall, I didn’t protest and I was secretly very, very grateful.These contractions felt like Satan and all his demons trying to break out of hell via my body. Which is to say—OW. They wheeled me straight to the bathroom and suddenly my doula had returned to me. I have no idea how that happened. Maybe Ray went to get her as I was flying down the hallway. Either way, I was glad to see her. I still felt like I had to poop (TMI?), but clearly I was not in transition or even near ready to push. In retrospect I believe this sensation was because Wash’s head was already SOOOOO LOW in my pelvis that he was putting pressure on my rear. (Result of hours and hours of counter-pressure?) I was not able to poop for all my trying. In the bathroom I had my first of many hysterical breakdowns. I labored on the toilet for a while, then tried to walk back to the bed. I didn’t make it out the door. The next contraction had me back on the floor. I remember looking up at Ray on one side and Danielle on the other yelling, “I don’t think this is right. I can’t do this anymore. I’m too tired. My legs are dead. I can’t even stand.” I looked at Ray, crying, panicking, and said, “Please, please let me get an epidural. I know it’s not what we wanted. But I’m too tired to keep doing this. I feel like I am breaking in half.” He said I was doing fine. Everything was okay. I could do this. At the time, I felt like he didn’t understand. This couldn’t be normal! He didn’t believe how my strength was really GONE. He thought I could get up and walk to the bed and push out a baby, but I was sure the only thing I could do was lay on the floor and die. #melodrama

I was so scared. I begged him to pray over me. I wanted to feel calm. I wanted to feel reassured that God was with me. That I wasn’t alone, because for all my support from Ray and Danielle, I felt the weight and the burden and the pain in my body on my own. I can’t imagine going through that WITHOUT support people. But they are emotional and moral support. They are there to get me out of my head and believe in myself and my body. But my God is the God of my body. He made me this way. He made women for birth and motherhood without the interventions of medicine and medical professionals. And I wanted to talk to him and remind him that I was down here doing what he made me to do and could he please for the love of Himself help me?! Ray didn’t want to encourage my panicking. He reaffirmed that I could do this. This is normal. I was doing great. And he helped me get back out to the bed.

When my next contraction came, I hit the floor again. My legs were shaking, giving way to muscle failure. Suddenly I felt hot all over. All I had on was the robe, but it instantly became much too much.

I yelled, “Get this thing off me!” And yanked at it. Ray and Danielle helped too, Danielle going so far as to pry one of the more difficult snaps with her teeth. They got me up onto the bed where I continued to labor on my hand and knees while spewing aggressive barbs at Shannon The Nurse because she forced me to wear the baby HR monitor, the band of which wrapped directly over my lower abdomen where my contractions were attempting to rip me in half.

At one point I tried to use the squat bar, but I hated that so I went back to hands and knees. Apparently I was very calm between contractions. Quiet, zen. I honestly don’t remember this much. The doctor kept wanting to check my cervix to see if I had progressed, but I said no. I didn’t need more pain. Give me time to dilate without sticking your germy hands all inside me please and thank you.

With each contraction I thought I would pass out. The pain would be too much and I’d just go unconscious. Thinking of the ocean, reciting poetry or Psalms, all of that was gone. I would cry and say over and over, “I can't do this any more. I don’t think I can do this anymore. Please please please.” I was a basket case. I’m so embarrassed by this.

At some point a couple hours later my doctor, Dr. Carnes, came—hallelujah. I was so relieved to see her. It’s not that I particularly love her. I just know her. She is a family medicine doctor, young, introverted, and sometimes...she seemed like she didn’t have a freaking clue about hospital policies or practices involving birth. But she’s assured me several times that she has delivered lots of babies. I kept her because she agreed to work with me toward a natural birth and was open to laboring AND delivering in any position, which sadly I didn’t get to prove.

I finally let Carnes check my progress even though I was terrified to hear another depressingly low number. She announced I was 7 cm! I had gained 5 cm in 2 or 2.5 hours. Just one away from transition. And I’d been feeling like I was in transition since I was admitted. I couldn’t imagine it getting worse. But I was ready to move on. I was ready to get that freaking baby out of my freaking body. “Seven centimeters,” I said, in awe. “I’m doing this. I can’t believe it. I’m doing this!”

Danielle says this was her favorite part. She and Shannon apparently looked at each other and got a little teary watching me realize that I could do this and was in fact already doing it. I had this incredible moment where I thought, I’m actually going to be able to give birth naturally. I’m getting close to the end. And then my baby will be here. And I’ll have “done” birth. I’ll have succeeded. That was a heady awesome feeling.

Soon I began shaking uncontrollably. My stomach roiled, and I said, “I think I have to throw up.” Shannon immediately placed a bucket under my face. And hurl I did and did a lot. But this was the LEAST scary moment for me. My contractions didn’t change in a way that I noticed (not yet), but feeling the shakes and throwing up, I knew what was happening to me. This was normal. This happens. It meant I got to push soon.

So I was surprised to hear an hour had passed since I was checked but I was still at 7 cm. I swung from confident in what my body was doing to extreme frustration that my body hadn’t progressed. Maybe my attitude affected my perception of these next contractions, maybe I was exhausted and fed up from consistently severe contractions, or maybe this was real transition and the contractions became severe-er—but I started to lose it. I went deeeeeep into the psycho place. I did exactly what Donna Ryan said you shouldn’t do if you want to keep yourself under control. But it was involuntary. I tried to back away from my body. I pushed with my arms as though I could physically distance myself from my waist. Ray tried to help me. Told me I was panicking. Reminded me that I could do this. But I was freaking out. I wanted this to end. And I was willing to do almost anything to get there. Shannon stepped in and asked me then what my baby’s name was. “Washington.” She told me to say it again. So I did. Over and over and over. Washington. Washington. Washington. It became my new mantra. Just his name on my lips was encouragement to me.

Six pm finally rolled around, and with it the news, that I had at last, at last reached 10 cm. (For those keeping track, I went from 2 cm at 2pm to 10 at 6!) Doc said I didn’t have to push yet if I didn’t feel the urge. But I said, “I want to push.” I didn’t have the urge, per se. *rolls eyes* But I had decided that it was time. Mentally, I thought if I’m at 10, then there’s nothing stopping me from speeding this thing up. She said she’d let me push once to see if that brought the baby lower in station. My very first push, I moved the baby from a 0 station to +2. Everyone was impressed, and Dr. Carnes said I could keep pushing if I wanted since I made so much progress. Sadly, I could never push as well as I did that very first time.

Indeed, a lot of metaphors were thrown at me in an attempt to help me push the right way. I did it right probably one in five times. Not breathing for 10 seconds in a row, I discovered, was not possible. It led me to screaming out the last few seconds which was a waste of my voice and strength and got me in trouble with everyone every time. I wanted to yell though. I wanted to scream myself hoarse with frustration and anger. Why the heck was I doing this? Let them cut the kid out of me for all I care. I just wanted it to be over. (#heckamelodrama) Anyway, going for a 7-second push was better. But my contractions no longer seemed long enough to make progress. And pushing without the momentum of a contraction cost me strength I didn’t have and didn’t progress me at all. It was aggravating to make it all the way to the pushing stage and to feel again like I couldn’t do this anymore.

Laying slightly reclined, I had to get creative with the position of my legs. Stirrups were never offered. No, instead I stuck my giant horse legs up in a proud exultant V on the squat bar. I imagine when I’m on my death bed, if I decide to pinpoint the least dignified moment of my existence, this will be it. Naked as the day is long. Screaming my head off, spewing mild to moderate profanities. Legs, like steeples, pointed toward heaven. And all of my private bits very publicly exposed to God and everybody.


They offered me a mirror several times. I thought the only thing worse than exposing everyone to all my private parts is to see for myself exactly what they are seeing. But soon, the next worst thing was about to happen. Leg cramps.

The act of pushing requires you to pull your knees up to your chest and curl forward like a sit up and squeeze your whole body, including your legs. I can’t explain how impossible that seemed at the time. The only issue I really had with pushing was how exhausted my legs were. Each time I felt defeated by them. And when the leg cramps—which I had been staving off for hours—finally set in, I thought I would go mad. My toes curled and my calves twisted wretchedly, leaving me panicked (again) because how could I focus on having a baby when my legs were trying to break themselves?!

Apparently this was quite an ordeal. Danielle insists a good chunk of time was devoted to me trying to work out the cramps in my legs. I would sit up pathetically, impeded by my still sadly gigantic and baby-full belly, and reach for my legs, which were too far away, and squeeze them in imitation of how I wanted to massage my calves. I put Ray on one leg and Danielle on the other, but I couldn’t show them where the cramp was. And they didn’t know how to rub them. All the doctors and nurses didn’t offer to help, and I felt like they thought I was crazy. The consensus was that my priorities were out of order. I was having a baby and needed to ignore my spasming legs to push him out. Ha! Easier said than done. That is like saying I’m going to squirt salt water and lemon juice in your eyes while you shoot a bow and arrow. And the consequences of not hitting the center target is major abdominal surgery.


At 7 o’clock, the nurses change shifts. Shannon told me she’d stay. She’d stuck with me this long and she needed to see this baby. I was grateful. Her replacement was already there, a black lady named Pam with good best-friend-in-a-sitcom qualities, if you know what I mean. She is not the only extra body in the room. Roll call: me, Ray, Danielle, Shannon, Pam, Dr. Carnes, her attending, douchey doctor from earlier, and a male pediatric nurse waiting for Wash. Every time I pushed they would ALL yell to keep going, push harder, almost there almost there ALMOST THERE. But I couldn’t sustain it. I would let go, and they would fizzle like popped balloons. Each time, Dr. Carnes would press inside, I’m assuming this was a perineal massage and she was trying to protect all my bits from tearing. But it hurt like a mother and started to piss me off. So I may have exasperatedly said, “What the heck are you doing down there? I don’t like it.” And she stopped. Shannon found a warm compress and THAT felt heavenly.

Then things got kinda crazy. The monitor around my waist couldn’t track baby’s HR anymore because he was too far down, and since I’d been pushing for so long and his heart rate naturally dipped with each contraction, they thought it was important to keep monitoring him. They wanted to attach one to his head. This was one of the things we didn’t really want to do. Ray and Shannon conferred over me about whether this was something that could be avoided and decided it wasn’t. He agreed to it, and I trusted him to make that decision because I was starting to become delirious.

Suddenly Pam was there helping me push. She gave me the best direction for pushing. And with her on my left by my face and Ray next to her and Danielle on my right, the chorus of encouragement was overwhelming.


After a long while of useless pushing, I decided to see what all the fuss was about. I accepted the mirror and watched myself push. When I saw that my baby’s head went out out out OUT when I was pushing and then aaaaaaaall the way back in when I let go, my head literally tilted to the side. Huh. That’s ridiculous. I thought all this time he was inching his way forward. But it’s more like a suction than a train. On the next push, his head stayed halfway out. Danielle was excited, “He’s not going back in!”

I grunted. “I’m holding him.” She also loves to tell that line. She makes me sound like a feisty pirate saying, “Aye, matey!” Which I guess is pretty cool. In any event, I had decided he was not going back inside. He was only going out. Whether this was a good decision or not, I don’t know. At the time, it was the only thing that made sense. With the mirror, I became much more motivated. I remembered I was the only one who could get that baby out. I had to focus, try not to think about my legs and push. The next several minutes are a blur to me. Literally. I took off my glasses (I wish I’d been wearing my contacts. Maybe I would’ve really seen Wash born. :/). I was in a state of absolute delirium. I pushed. I cried. I was all over the place. Mostly I had no clue what was going on. I was just going through the motions. I remember the ring of fire as my baby boy crowned and I watched that happen. I was freaked out by how much blood I could see and didn’t know if that was because I was tearing or if it was normal.

Then finally his head was out! But suddenly his heart rate dropped. In my memory, the room became a hurricane of motion. They told me I HAD to push. He had to be born RIGHT NOW. I dug deep. I thought if I didn’t get myself together something horrible would happen. Without my glasses and in the craze, I was sure I saw my doctor reach her entire hands inside me and pull my baby out. But she didn’t. I was sure she had to cut me wide open to get him out. But she didn’t. I pushed one final incredible time and he was out. Because the professionals in the room were freaked out by his dropped heart rate, they forced Ray to cut the cord immediately and ran Wash over to the side to check him out. But within seconds, he started crying. And Ray said, “He’s okay. Hear him? He’s fine.” And I could hear him, and I was so so happy. I kept saying, “It’s over. It’s finally over.” Since Wash didn’t immediately start breastfeeding, I let them give me Pitocin to stop the bleeding. Shannon congratulated me and told me he was beautiful and she was glad she stayed. A few moments later, they placed Wash in my arms, and I was immediately overwhelmed by him. His beautiful face. His tiny hands. His adorable curls. His wrinkly skin. My button nose. He began breastfeeding right then. His skin on my skin. He was all mine. And I was all his. In that moment, I was fundamentally altered. I thought I was a whole person. And in a way, I was. But with my son in my arms, I discovered this whole other side of myself that has been dormant and waiting to be revealed. And that missing piece is fierce and passionate and tender and impenetrable. It’s the mommy piece. I’m not sure I ever knew who I was before. I’ve spent years trying to figure it out. But I know I was made for this. For pregnancy. For birth. For motherhood.

I’m a mom. And I love it.

Washington Ray Moore was born on Father’s Day, Sunday, June 16, 2013 at 7:39 pm. He was 7 lb 10 oz, 20 inches long. I labored a total of 40 hours (34 hours early labor 4.5 hours active labor, 1.5 hours pushing). And I did it all naturally. I’m so proud…of both of us.

You can read Ray's thoughts on our birth story in my friend Cori's article "Birth Matters to Dads."

And on what doulas do.

Sometimes (lots and lots and lots of times) I hear couples say "I don't think we need a doula." If you've said this to me, this post is not about you specifically. This happens a lot. Imagine I am a dentist writing about that one time I found a cavity. That's how often I hear "I don't need a doula."

Let's explore some reasons couples don't think they need a doula, and why they still do.

"I don't need a doula, I'm taking a birth class."
I am so glad you are taking a birth class! It is essential that you and your partner prepare for your natural birth with nutrition, education, and relaxation. When you leave my class you will have everything you need to have an amazing birth... including my recommendation to hire a doula. Yep. That's part of it! Can you have a positive natural birth without a doula? Sure, but a doula can make the whole experience easier and more enjoyable. Ten hours into labor your excitement may have faded, the details of your birth class may become fuzzy, and you and your partner may feel lost. Your doula's knowledge will not become fuzzy and she, as an expert in natural birth, will help guide and comfort you. Your class is your map, your doula is your compass. You need both.

And if you think you can skip the class and hire the doula, read this.

"My husband will be my doula."
Your husband shouldn't be your doula anymore than he should be your midwife or obstetrician. Your husband should be your husband. He should love and comfort you the way he knows how and with the tools he learned in class. But there are skills he will not have. Do you have any idea what this doula is doing? Does your husband?

Maybe you are thinking "I don't want a woman I've only met a few times doing that." You may be thinking that now, but when she does that and all of a sudden your contractions are 100% more manageable not only will you be ok with her doing it but you will be begging "do that thing do that thing dothatthing!" at the start of a contraction. Actually... that probably won't happen, because she will just do it before you even have to ask because she knows exactly what a woman starting a contraction looks like since she does this all. the. time.

Your husband doesn't know how to do that thing. He doesn't know how to do a lot of birth things because he doesn't work with laboring women. This is a doula's job, she helps laboring moms (and dads!) feel better physically and emotionally. How are you going to say no to that?

Notice in the picture that the doula is working on physically comforting mom while dad is loving and encouraging her. Mom and dad are still deeply connected, the doula supports that connection and does not interfere with it. Without this doula mom may be so uncomfortable that she and her partner would not be able to enjoy these tender moments. And if dad was the one using the rebozo (that's the fabric the doula is doing that thing with), then who would be in mom's ear loving her?

"We are having a home birth, my midwife will be my doula."
Your midwife probably won't be your doula. A midwife is there to intervene if a complication arises and to monitor you and baby. Your midwife is a wonderfully skilled lifeguard. Her job is not to provide emotional and physical comfort for a woman laboring normally*, it's to help you birth your baby safely. A home birth couple will still have to labor and still deserves the support of a doula.

*Some midwives work in teams and one midwife, maybe an assistant midwife acts as a doula. Ask. Just because you have two midwives doesn't mean one will be your doula. 

"It would be weird to have someone other than my husband at the birth."
Historically women have always comforted women in labor. It is actually weird to not have a woman knowledgeable in natural birth present to comfort mom and provide guidance. Up until birth moved to the hospital and support women were left in the halls, women were comforted by women... and it worked! You know what doesn't work? Leaving mom and dad in a sterile hospital room alone with no support. Tired and discouraged in a foreign environment, those couples often watch their natural birth slip through their fingers.

A doula will be someone that you will get to know over the last months of your pregnancy. She will not be a stranger, she will be a friend. In contrast, there may be 2-3 nurses and 1-2 doctors that you have never met at your birth... and guess how many of them are going to rub your back? Probably none of them because they have their jobs. Of the many people that will be in the room, make sure one of them is a doula.

"Baby is low, I'll probably have a really fast labor, we won't need a doula."
In class we talk about 5 hour labors and 25 hour labors and I know a lot of couples think they'll get the 5 hour labor. Well... maybe... but realistically you will fall somewhere in between. I want to see my couples filled with confidence and excitement, but not to the point that they under prepare. In my last class three couples labored for more than 40 hours! Guess how many of them thought they would labor for 40 hours? Dads are you ready to support moms for 40 hours? Have you ever done anything for 40 hours? A doula has, she will help you.

"We can't afford a doula."
I compare a birth to a wedding day often. How much time and money did you invest in that one day? When it comes to the birth of a child there seems to be a disconnect between the importance of the event and a willingness to invest financially in it. Couples decide to forego the home birth they desire because the insurance will not cover it, or choose an unsupportive hospital because they will have to pay less out of pocket. Well... how much more important is the birth of your child than your wedding day? I don't know your finances, but if it meant having the natural birth that I desire and a better Birth Day for mom, dad, and baby, then I would start selling things to make that happen.

My first birth cost over $30,000... double what my natural hospital birth cost. Yes we had insurance, but we still had to pay a percentage. A doula could have saved us a lot of money, and we could have had a better birth!

Some doulas charge using a sliding scale and give military discounts. Some insurance plans cover doulas. This friend had to choose between taking a vacation that year and a doula. She chose a doula and had her first natural birth after 3 medicated ones. You have options, get creative... if this is your first natural birth you really can't afford to not have a doula.

Will a doula ensure you will have a perfect birth. No. Can you still have an amazing birth without one, absolutely. You still deserve a doula. You may only give birth a few times in your life, these are special days that you will remember forever. I know many couples who have realized that they should have hired a doula, my husband and I are one of them. If you are still hesitant, do a little more research, you don't have to commit to anything. Check out yelp reviews of local doulas, browse your birth network listings, ask your care provider or childbirth educator for referrals. Interview a few doulas or attend a Meet the Doula event, you might be surprised how quickly you click with one.