pregnancy and labor: resources and reflections [part 1]

September 25, 2023
pregnancy and labor: resources and reflections [part 1]

For those who were wondering why my previous post on women in ministry was password-protected, I initially wrote down some unfiltered thoughts to give to someone at church who had asked for my opinion, and didn’t know if I should make it public just yet.

But since then, I’ve read over it a couple of times, added some addendums and feel comfortable putting it out there, with the caveat that it was written as a response to an ongoing debate in the church, so it is definitely not the be all end all to this topic, just a personal perspective of where I have landed currently.

So here is the now-public link – feel free to dialogue with me about it if you have further thoughts!

Along the same lines of women’s topics, sharing my labor story multiple times over the past 2 months has made me want to compile a list of resources and reflections on the very unique and mysterious journey of pregnancy and labor.

My scientific brain, of course, couldn’t help looking up the studies to examine the evidence behind all the things that were recommended by my midwife/doula. So here you’re getting it all🙂 (to read the actual paper, simply click on the citation and the PDF should load – I’m all for having access to the primary sources!)

I hope this post is empowering for anyone wanting to have a natural birth but is nervous about it, and also generally informative for anyone curious about all the mystery shrouding it.

I had always insisted on getting an epidural.

In my mind, there was no way I was voluntarily putting myself through such bodily pain. Period cramps were bad enough, I had decided.

But as I started to do more research, I couldn’t seem to escape the enigma of a natural birth.

What could it feel like to feel a baby descend through your pelvis? To welcome childbirth in all of its glory, to experience it the way generations of women before me have? And the biggest question of all – could I do it?

It felt like the slow work of a cruiseship changing course, starting with me convincing Peter to hire a doula (I need all the help I can get, I told him, so epidural PLUS doula it was), and ending with me deciding to give birth at a birthing centre which necessarily meant foregoing the epidural.

A couple of key differences were what sealed the deal:

I learned that an epidural meant being hooked up to an IV and as someone who hates needles, the thought of having a needle constantly stuck in me was mildly distressing, and accidentally ripping the IV out while giving birth terrifying. Not to mention that the epidural itself meant a large needle going into my spine (and what if they inserted it wrong?)

Hospitals tend to restrict your freedom of movement (this depends hospital to hospital, of course) but from my research, being stuck on your back with your legs in stirrups wasn’t the most ideal position for baby to descend.

And the clincher – birthing centers let you eat during labor, which seemed infinitely better to me than crunching on ice chips.

I knew in the back of my mind the medical effects an epidural can potentially have on the mother and baby, but they weren’t really forefront for me when I made my decision.

They tell you to rate your decisiveness about the epidural on a scale from 1 to 10, 10 being no epidural even in the most dire of circumstances. I would say I was a 7, more tipped in favor than not, but also open to getting one if I was in the throes of pain and decided I had had enough.

How could I predict how my body would react to labor and remaining open to an epidural helped me feel better about “going natural”. The worst feeling would to be trapped in a pain I could not escape, I thought.

I’ll skip the actual labor story, although one thing I will say is that it surprised me that I didn’t feel trapped or even desire an epidural during the process (again, just my own experience, and there are plenty of good reasons why someone would want one).

And while it wasn’t easy, it was also one of the most incredibly empowering, terrifying and beautiful experiences of my life.

People say that one of the keys to having a natural birth is the preparation leading up to it, the same way you don’t just decide to run a marathon.

So if you’re curious about giving it a go, I wanted to share a list of resources I found helpful in the preparation leading up to labor, during the actual process and postpartum.

Every woman’s body is different, so disclaimer, what “worked” for me might not necessarily be the same for you, so take what you will and leave the rest.

Pregnancy and labor is an incredibly personal experience; everyone has strong opinions on what is the “best way” to go about it.

I don’t think there is one best way but rather a way that is best for your individual body, your family’s needs and even your social/economic context.

Even the scientific literature on what works is often not conclusive due to the difficulty in isolating one variable to test via a randomized controlled trial (i.e it is extremely difficult to convince a pregnant woman to only try this one thing when there are a dozen other things suggested to help, because who wouldn’t do everything they could to help their baby?).

Many of the studies are retrospective cohort studies which means you let the pregnant women do whatever they want, measure their outcomes, and then try to make associations based on what they did and what their labor/delivery outcome was.

As a result of the dearth of strong scientific evidence, much of the advice does end up boiling down to each mother’s personal experience, which still has its place.

In fact, I found learning about other mom’s birth stories was one of my favorite ways of preparing for labor; perhaps this connection to other mothers is worth not tightly controlling variables to pin down exactly what works and what doesn’t.

There is also an ongoing debate within the midwifery community about whether a randomized controlled trial (RCT) is the best way to assess outcomes, given the difficulty in isolating variables in a very complex physiological process (read this perspective here).

But I tried to look up and report on the RCTs that existed for these naturopathic recommendations since they are the current gold standard of proving that an intervention works.

I couple that with my own personal experience so you get a dose of both (and then you can of course mix it in with the advice your own OB/midwife gives you).

As well, you might decide that getting an epidural is the best choice for you; even so, I think this list could still be helpful in getting your body ready for one of the biggest changes it will every go through.

For the Montreal folk, I’m hyper-linking the specific places I went to for you to check out, but I’m sure these services are easily searchable no matter what city you find yourself in.

Scroll to the end for a list of Youtube channels, books and podcasts for further reading!

Pregnancy

Note: I only cover the literature on the more naturopathic recommendations normally given by midwives. For a review of the evidence regarding the more conventional wisdom around pregnancy (e.g. alcohol, coffee, raw fish, C-sections etc.), check out Emily Oster’s book Expecting Better!

Physical preparation

(1) Raspberry leaf tea

The first piece of dietary advice I got from my doula was to start drinking raspberry leaf tea, one of the most widespread herbs used by midwives, the idea being that red raspberry leaf contains vitamins and minerals that strengthen and tone the uterus.

A small retrospective study (n = 108) (Parsons et al, 1999) found some non-significant evidence that it could potentially shorten the 1st stage of labor (p = 0.165*) and increase your chance of having a normal delivery by 10% (p = 0.22). I had also heard anecdotally that drinking the tea had helped one of my friends reduce her period cramping.

*Significance means having a p value less than 0.05; the lower, the better.

So, I started to diligently drink 1 cup of raspberry leaf tea/day (it replaced morning coffee) starting at 32 weeks, and at 37 weeks, drank 1 – 2 cups of a strong raspberry/nettle infusion (3 raspberry leaf tea bags + 1 nettle tea bag per 1L).

The scientific evidence for its effectiveness in labor, though, is spotty.

From a meta-analytic review (Bowman et al., 2021), in vitro and in vivo studies have found that raspberry leaf contains active constituents that have both relaxing and stimulatory effects on smooth muscle. A Nutrients paper (Socha et al., 2023) looked into what a potential molecular mechanism of action could be and in fact concluded that the antioxidants from raspberry leaves should actually inhibit cervical ripening due to the role inflammation plays in triggering the beginning of labor (see below for proposed mechanism).

The only double-blind randomized controlled clinical trial (n = 192) did not yield any statistically significant results between the placebo and treatment group (Simpson et al., 2001). The only differences being that the women who took the raspberry leaf tea extracts had a shorter pushing stage (9.6 minutes, p = 0.28) and a slightly higher change of having a normal vaginal birth (62.4 vs. 50.6%, p = 0.19).

I, however, had an extremely long and arduous pushing stage of 2 hours, so I don’t have much to comment on the effectiveness of the tea, except that it tasted pretty good with some oat milk and honey.

(2) 6 dates a day

Now, for the infamous 6 dates a day study (Al-Kuran et al., 2005). The results for this are actually pretty astounding.

The treatment group that ate 6 dates a day during the last 4 weeks of their pregnancy had a 74% increase in cervical dilation upon admission (3.52 cm vs. 2.02 cm, p < 0.0005).

They had a lower need for the use of oxytocin to induce labor, a higher % onset of spontaneous labor and a shorter latent phase of labor, i.e. the time it takes for your cervix to reach 4 cm (8.5 h compared to 15, p < 0.044).

Compared to the p values we had for the raspberry leaf tea studies, the significance here is super high, meaning something is really going on.

A meta-analysis conducted in 2020 of 8 studies confirmed that dates improve one’s Bishop score (a score you are given that measures how ready your body is to go into labor)

Apparently, dates contain prostaglandins that work on oxytocin receptors that ripen the cervix and stimulate uterine contractions.

Before pregnancy, I thought I liked dates but it turns out trying to maintain a 6/day consumption was pretty challenging.

My favorite ways to use dates were: sticky date pudding, as granola add-ins, in smoothies, banana-date muffins, date-cardamom scones and date energy balls.

Nearing the end, I was pretty sick of date-filled baked goods (Peter even brought a Ziploc full of date energy balls to my labor; I didn’t touch a single one) but this data makes me believe they must have had some sort of effect on my cervix.

Looks like you’re doing that date thing again, Peter remarks, when I tell him about the data.

(3) Walking & birthing ball exercises

My normal commute to work/school involves trucking up the Peel hill from the Lachine canal to McGill, a 30 – 45 min walk one way.

Needless to say, this became increasingly difficult to do the bigger I got, but walking is in fact one of the best things you can do during pregnancy/early labor.

The other type of main exercise I did was birthing ball exercises; the birthing ball being literally the best $10 I have ever spent the entire pregnancy.

I sat on the ball whenever I was doing computer work, doing pelvic tilts and hip rolls while I listened in on meetings.

Not only did it help my back pain from carrying the baby, the bouncing helps to get baby into the right position, plus post-birth, the ball was one of the things that was a surefire at calming Noah.

The minute our first birthing ball started to deflate, Peter and I immediately went out to Winners that day to buy a replacement. Case in point, I am currently writing while sitting on our 2nd ball with Noah fast asleep in a carrier.

Moral of the story: buy a birthing ball.

Some data on walking and birthing ball exercises:

  • Shojaei et al., 2021
    • The walking group of moms (40 min 4 times a week, starting 34 weeks) had a higher Bishops score (6.14 vs. 3.49, p < 0.001) than the control group
    • 41% of them had normal vaginal deliveries compared to 22% of the control group (p < 0.001)
  • Jha et al., 2023
    • Use of a birthing ball during the active phase of labor resulted in a lower labor pain score (8.36 on 0-10 pain scale compared to 9.4, p = 0.001)
    • The “birthing ball” moms had a higher rate of cervical dilation, a shorter overall length of labor and a greater rate of vaginal delivery (86.7 vs. 53.3%, p = 0.03)

A great Youtube tutorial on the types of birthing ball exercises one can do to prepare for labor:

(4) Spinning babies & cat/cow

Another one of the recommendations from my midwife and doula was to hold myself in various positions for a minute at a time to help the baby get into the right position.

These positions included the forward leaning inversion, where you put your knees on the couch and then carefully lean your very top-heavy body down to the ground, as well as the side-lying release, where you lie on your side with one leg over the other.

Bonus if your partner helps you lightly jiggle your thighs (or fascia, as my midwife would say) while in this position (bless Peter’s heart :P)

Demonstration here:

These positions are recommended by a popular method called “Spinning Babies”, created by midwife Gail Tully, which purports to help you get your baby into the right position before labor.

The method is controversial, lacking evidence as a Cochrane Review would gently point out, to which Gail would retort back that her years of experience proving the method should suffice.

Anyway, I would try to do the inversion whenever I remembered (there was a slight spike in frequency when we thought the baby might be breech), but the position that helped me the most was probably cat/cow.

It’s an exercise taken from yoga that involves tucking your pelvis in (cow), then arching your back (cat), while on your hands and knees.

I did the cat/cow religiously every night before going to bed (and on the back of chair during a Sunday sermon when the pain was too intense and I couldn’t sit still), mostly because it was the only thing that would ease my back pain.

Mental preparation

Apart from the physical preparation for labor, mental preparation is the other crucial piece to the puzzle.

To this end, I found that hiring a doula and learning about labor to be the two most helpful things in my preparation.

(1) Hiring a doula

If you are anything like my husband, you might be asking, “What is a doula?” And as he later learned to explain , a doula is like a village elder (in his own words), who has the accumulated wisdom to both emotionally and physically support you during labor.

The evidence for doulas is in fact pretty strong – a meta-analysis of 16 different studies showed that the presence of a doula can decrease your chance of C-section (by 8%), epidural/pain medication (by 9%) and increase the likelihood of breastfeeding (by 7%).

In fact, the evidence is so well-known that it is famously quoted,

“If a doula were a drug, it would be unethical not to use it.”

– John H. Kennell, M.D.

It is not surprising to me that the most “effective” intervention for labor is social/emotional, rather than physical.

And is further proof to me that labor (and perhaps more of medicine than we think) cannot be boiled down to a bunch of numbers, but is rather a complex yet beautiful mess of the body, mind and spirit.

We landed upon Barbara as our doula after a couple of interviews; her calm and matronly demeanour was reassuring to both Peter and I.

“What do you want this birth to be like?” she asked in a baby-soothing register during our first prenatal session with her.

In subsequent sessions, she taught Peter how to use counterpressure to ease my pain, a move that proved to be absolutely essential during the labor, and answered any random question I had from that week of researching the Internet.

A few days after the birth, she showed up at our door with a mason jar full of homemade Ayurvedic turmeric milk tea to help increase lactation.

“Mama, you are doing amazing,” she told me, looking me in the eyes with a look only a new, sleep-deprived mother would fully understand.

(2) Learning about labor

It was Barbara who also spurred on me learning about labor, which included both reading books/blogs about the various stages and what to expect, as well as hearing other mom’s tell their birth stories either on podcast episodes or watching it live on Youtube (see below for my favs!)

I think learning about what to expect at which stage was helpful mental preparation, although there is no way to imagine what the pain is like until you’re actually in it, and at that point, you’re not thinking about how the pain feels but how to get through it (more on that in the next post).

The biggest way that my research down the rabbit-hole of labor helped me, however, was in replacing my fear with wonder – amazed at how the human body knows what to do at each stage.

One of the first birth stories I watched, I had tears uncontrollably streaming down my face the minute the baby was pulled out of the water and put on the mother’s chest.

Here was the stranger I had no connection to, and there I was with this baby inside of me, and I remember putting my hand on my belly, saying, “We’re going to do this, you and me, baby.”

(3) Pelvic floor physiotherapy

At week 37, my midwife suggested I try pelvic floor physiotherapy at a clinic in Pointe Claire called Energie Active Physio.

During the session, she taught me how to do perineal massage and ways to push without tearing (push on the exhale while releasing your muscles).

Apparently I was doing it perfectly during the physiotherapy session, but honestly during actual birth, you’re pushing any which way to get the baby out that it doesn’t really matter how much “practice pushing” and perineal massage you did.

So, did it help? I’m not sure it did anything for me, but it would perhaps be more useful if you struggle with tight pelvic floor muscles and/or if you did more than one session.

(4) Christian hypnobirthing

The last thing on this list is Hypnobirthing. So, one thing you should know is that there are all these methods out there that purport to help you reduce and manage your pain during labor and birth (Lamaze, Bradley method).

One of the most popular methods is hypnobirthing, with crazy testimonials of women not even feeling any pain during labor (!) I first had it recommended to me by my PhD supervisor, who sent me her full collection of hypnobirthing mp3s to listen to.

These mp3s were mainly guided meditations filled with affirmations and visualizations to help you relax your body and guide your thoughts. Nothing out of this world, but definitely soothing to listen to.

It was a bit “woo-woo” at parts though, especially the phrase, “I open myself up to the power of suggestion,” which I found myself instinctively reacting to by doing the exact opposite.

So, I looked up Christian hypnobirthing and paid $4.99 for 1 month of access to their audio tracks. They were mostly similar – a soothing voice getting you to breathe and relax your body – but included Bible verses that were spoken over me.

To get the full benefits of hypnobirthing, you’re supposed to listen to the tracks every day and during the actual labor, both of which I didn’t do.

My personal opinion is that having a regular prayer life was much more effective for me than any hypnobirthing track at getting me to a place of calm in the midst of intense physical pain – again, more on that in the next post.

OK that brings us to the end of the 1st part of the series – I’m breaking it up as I’m realizing all this research is a bit too much cover all in one post. For further reading and journeying down this rabbit hole, see my list of resources below.

Part 2 will be on what actually helped during the labor itself and Part 3 will be some theological reflections I had on the whole process, so subscribe to the email updates if you’d like to be notified when those parts come out!

Resources:

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