#1- Pick the right health care provider
Since I was the first of my friends to get pregnant my process for choosing an OB with my first baby was very sophisticated. I opened the phone book and dialed the first doctor I saw. Not surprisingly, it wasn't the greatest process for picking someone to be there during such an important life event. I figured all doctors were the same and hadn't really heard of a midwife. When I gave him my birth plan at my 35 week visit he basically crossed things off of it and said the rest I could only have if everything went perfectly. Since it went quickly and smoothly I did end up with most of what I envisioned, but not because we saw eye-to-eye. As he entered the room where I was pushing unmedicated and making some moaning noises as most women do he said, "Calm down, you've been pregnant for 270 days so you can wait a minute while I get my gloves on." What? Not exactly a supportive attitude!
Fast forward 13 years and I'm choosing a provider for my 9th baby. I now know much more about how I want to be treated during pregnancy and birth, so I picked someone who had similar views on the subject instead of trying to change or convince someone. For me, this was a midwife who spent about an hour at prenatal appointments, was easily available for questions, suggested additional testing when there were red flags about my health, but also treated me as an individual instead of doing every birth in the same way. I felt free to say, "I know you normally do that, but I don't want to do that." It was then no accident that I felt surrounded by support during my labor and afterwards, which made the whole experience much more pleasant. Maybe your ideal is to have every test and procedure available. Then go get a provider who wants to do that! It's never a good idea to be fighting with your doctor or midwife during or after labor.
#2- Ignore early labor
A very frustrating thing for a full-term pregnant woman is trying to decide when labor has really started and when to let your birth team know. With my first baby I carried to 41 weeks, which is quite common for first babies. I had told everyone I was due February 3rd, and had circled the day on my calendar. Intellectually, I knew all babies didn't come on their due dates, but the daily calls from family wondering if I was "feeling anything" got really annoying. Every Braxton-Hicks contraction had me wondering if this was "it", then left me disappointed when it wasn't. On February 11th at 3:00 am I woke up with some mild contractions and proceeded to get so excited I got up and walked around the apartment through them. It was actual labor, but he didn't end up being born until 10 pm that night. It made for one tired Mama because of my lack of sleep the night before!
This time around I've learned not to give people and actual due date as a rule. When asked when I'm due I usually answered "September". No pressure if I carried past my due date or people getting mad when they made plans and baby came earlier. I also have learned to ignore any early labor contractions. "Real" labor contractions will get longer, stronger, and closer together as time goes on, but even then could occasionally stop only to pick back up days later. This time, when fairly strong contractions woke me up I stayed in bed relaxing through them. Even though I couldn't sleep much I at least rested as much as possible. It gave me plenty of energy reserves to push out a baby the next evening.
#3- Push physiologically
My first birth went along just fine, but the pushing phase ended up being very scary and disconcerting for me. Nurses pulled my legs back and started yelling, "One! Two! Three!..." counting all the way to ten. There was lots of "Keep pushing!" and "Push harder!" This technique is called Directed Pushing, or "purple pushing" since mom's face turns purple when holding her breath for a count of ten. Knowing what I know now I've realized that it was just the way they handle every woman pushing, mostly because many of them have epidurals and can't push very effectively. At the time, it made me think something was wrong because of all the yelling and I found myself fighting my body. They told me to rest when I still felt like pushing and told me to hold my breath when I really needed more oxygen. In fact, this type of pushing often leads to a decrease in the baby's heart rate because of a lack of oxygen. I only pushed for about 10 minutes, which is really fast for a first-time mother. Even so, the next day I had broken blood vessels in my face and shoulders, two tears requiring stitches, as well as hemorrhoids from the Directed Pushing flat on my back.
With this birth I was encouraged to push just as I felt like pushing. My midwife did not feel it necessary to make sure I was fully dilated before the pushing phase. Rather, we had talked earlier about not pushing until the urge was strong from the very beginning of the contraction. I panted and blew through a few contractions to make sure I was fully dilated, and then made a conscious decision to try pushing to see how it felt. The only suggestion from my midwife was that I could turn on my side and put my foot on her shoulder, which I sort of followed. I pushed my daughter out in one push, without any tearing and without any yelling. It was wonderful to feel in control of the whole process instead of being told what to do. There are times when a baby is not tolerating pushing very well and Directed Pushing is really helpful for getting them out quickly. In general, though, physiologic pushing is better for mothers and babies.
You don't have to have nine babies in order to have the birth you want. Education and listening yourself about what you really find important from your birth are the keys. No matter what happens, you'll never regret making informed decisions!