Tips for Having a Natural Childbirth

I already wrote up my birth story, but I wanted to have a different post where I summarized the advice I’d give someone planning a natural childbirth. (Disclaimer: I do not consider myself an expert on this subject at all, despite having read a bunch about it. But this is what I would have wanted to hear.)

  • My first, general piece of advice is that I would recommend doing a lot of preparation, whatever that looks like for you. I did quite a bit of prep, and I think I used a pretty large proportion of it.
  • Strongly consider hiring a doula. I had Will by my side for pretty much the whole process, and he was amazingly helpful, but even so I ended up calling friends who had more experience with labor, including one who was a doula, multiple times during labor. I specifically wanted the support of people who had lots of experience with natural childbirth.
  • If it’s getting really hard, or you’re not progressing much, try calling someone. I did that a few times, and found it really helpful. (To anyone reading this who knows me: call me if you want–I’d be happy to talk!)
  • Sit down with your partner and make a list of things you’ll want him to say to you during labor. Will and I did this, and it worked really well. Most of what he said to me during contractions was straight from this list. We had phrases like, “you’re already doing it,” and “your body knows what to do.”
  • Some sort of hypnosis beforehand seems like a good idea, though I don’t know how much difference it ended up making for me. It seemed like it was helpful early and not that relevant later, but I did like it. I don’t have experience with Hypnobirthing, Hypnobabies, or the Bradley method, but I would consider doing one of those classes for next time.
  • Do whatever you can to be totally relaxed, and enlist someone to point out any tension you’re holding in your body. The pain was much more okay when I was relaxed.
  • Use vocalizations that promote relaxation. I think this one is really, really important. Any time I made a tenser, higher-pitched sound, the pain was immediately much worse. Vibrating my lips in what my midwife called “horse lips” instead ended up making a huge difference for me.
  • Use visualization, especially to channel recurring unhelpful thoughts. You want to be out of your analytical mind as much as you possibly can, and visualization helps here. If you keep thinking about wanting to escape the pain, or wishing it were over, or wanting someone else to know hard it is, or whatever else, channel the underlying desire into some sort of visualization.
  • Being able to change positions, move, and labor in water if it feels right will likely make a huge difference. I had back pain during labor, and lying on my back was awful. A number of other positions worked much better, and the tub was great for taking the weight off. I found it relatively easy to listen to what my body was telling me about what positions to be in because I got immediate and strong feedback signals–some positions hurt a lot more than others.
  • It helped me to remember that labor doesn’t happen very often, and that it’s one of the pretty big human experiences, and one I wanted to have first-hand. Appreciation and gratitude and excellent mental postures to use whenever you can, and they promote physical relaxation.
  • Practice using pain relief techniques beforehand, maybe by holding an ice cube. In my birth class, we also held our arms up long enough that it hurt, and practiced a position that bends the toes in a way that is often painful (that one didn’t work as well for me). The sensations weren’t at all similar, but I think I would have had a harder time relaxing into the pain if I hadn’t practiced.
  • Remember that usually, giving birth is hard, especially the first time you do it. Let it change you, and invite the possibility of learning something from it.
  • Get a midwife or doctor you trust and can get to know pretty well, and also consider giving birth at home. I know this wouldn’t work for everyone, but I do think more people would choose homebirth if they looked into it. I may expand on my reasons for recommending homebirth in a later post, but the gist is that you’ll have a lot more control over how things go, both during and after the birth, and possibly feel much safer and more comfortable. I would definitely plan another homebirth myself, barring a medical reason not to.


Lydia’s Birth Story

Something definitely changed a bit the Sunday night before my due date, most likely the baby’s position. Maybe she dropped down a little further? Whatever it was, it made it so that whenever I lay down (on my back or either of my sides–I couldn’t try my stomach), I would feel a horrible knot of back pain in my lower back on the left side. I remember getting this same pain the previous Thursday, but at that point it hadn’t been very consistent. Sunday night, I was also getting Braxton Hicks contractions off and on, but not with a consistent pattern that I could discern.

I tried to sleep that night, and I think I did for a few hours, but then I know I called my mother at 5:30 or so in the morning. (She’s on the East Coast, so I wasn’t waking her up in the middle of the night.) I’d been searching the internet for birth stories with back labor, and, not surprisingly, there were some that sounded like what I was feeling. My mother had back labor one of the three times she gave birth, so I described what I was experiencing and asked her if it could be labor. She thought it was possible, and said to call the midwife.

I didn’t want to wake Maria up, so I hung out for the next few hours, trying to get comfortable and rest. When I did get Maria on the phone, she asked some more questions, said that it sounded early, and to let her know if anything changed.

I continued to feel more Braxton Hicks contractions, but, as it happened, it was over a week before they were in a regular, progressing pattern. It was a hard week because I couldn’t lie down on my back or my side without getting quite a lot of back pain–enough that I couldn’t sleep. I mostly slept propped up, either on one of the chairs downstairs or on a pile of pillows in the bed. The morning of Monday, October 8, I went to the sensory deprivation tank in Oakland to see if I could get some rest in there, but no such luck. I had hoped that, supported by the salt water, I’d be able to lie on my back in the tank, but a few minutes after I did, the familiar pain in the lower left part of my back returned, and I knew it wasn’t going to work. (I’m looking forward to going back to the tank now that I’m not pregnant anymore!)

Alison, the woman who operates the tank, recommended that I see a chiropractor, and actually ended up referring me to one of the ones who worked in my midwife’s office. I made an appointment for the next day. I’ve never been to a chiropractor before, but at that point I was very much ready to try new things to get some relief.

I never did see the chiropractor though, because that night, around 11:30pm, my contractions got to the point where they were seven minutes apart, and gradually getting closer together. I told Will that this seemed to be the real thing, but at that point they were quite manageable, and didn’t require my full attention. By around 2:30, the contractions had gotten intense enough that during them I couldn’t concentrate on anything else, but they were manageable and we decided that Will might as well try to sleep, since we knew labor could go on for quite a while longer.

I spent the next chunk of labor, from around 2:30-4:30am in the bathroom. At first I spent the contractions breathing and bouncing on the exercise ball Will had brought home from his office, but eventually I filled up our deep bathtub and moved in there. I remembered the words of the hypnosis track I had been listening to leading up to labor: “Breathe in relaxation and out stress and tension.” I think during this time I started using the first of several visualizations, one where my body was flooded with green relaxing energy, and I was releasing tense red energy. Ina May Gaskin, the “hippie midwife,” as our home birth class instructor called her, recommended visualizing a flower opening to help the cervix dilate, but that seemed too complicated for me, so I just visualized a circle opening.

Around 4:30am, things had gotten somewhat more intense (I think…hard to really be sure at this point, but my contraction log confirms that they had sped up), and I got to the point where I decided laboring by myself was lonely and demoralizing, so I woke up Will. He has since said that he had never been so grateful to get two hours of sleep in his life. Will started timing the contractions, and we hovered close to, but not over the 4-1-1 mark (we were supposed to call the midwife when the contractions were four minutes apart, one minute long, for at least an hour).

From this point in the story on, the exact timeline blurs together, but I’ll mention some of the things that happened on Tuesday.

We called Maria, our midwife, to let her know where we were, even though it wasn’t time for her to come over. She told me that 24 hours of early labor and 12 hours of active labor (it would be active labor once I got to 4-1-1) was pretty normal. We called our friend Dee, who is quite experienced with birth herself), and she told me that the important thing to remember was that labor was really hard, but that I could totally do it. She also pointed out that even if I gave birth again, my first labor would likely be pretty different from subsequent ones, so I should try to stay present with the experience. She suggested that I spend the day alternating between trying to sleep and walking around to move things forward.

We also called our friend Sahana, who’s actually a doula, who had given us some all-important advice when we had seen her at a party a little while before. That advice had been that labor would go better if I could figure out the mind game of actually wanting it to get more intense. She said that there would be ways I could get relief that would slow down progress, and that I should beware of going down that road. When we called her during labor, she told Will that I shouldn’t have tension anywhere on my face. We’d been watching out for tension in my throat, thanks to the Ina May Gaskin books I’d read, but Will noticed that I was furrowing my brow, so I made a point of relaxing that as well. I think it was Sahana who told us that labor would probably pick back up that night, which made sense to me, since that seemed to fit the pattern I’d been having with my Braxton Hicks contractions.

One of my concerns was that I would get too tired to labor, but when I talked to my mother on the phone again, she assured me that she didn’t think that would matter. She said that labor would happen whether I had energy or not, which seemed like good advice.

Tuesday morning, I did manage to get some 20 minute or so chunks of sleep, which was awesome, even though waking up to the pain of a contraction with no warning and less than optimal positioning wasn’t the most fun. Will got a couple of hours of sleep too.

At some point on Tuesday, not quite sure when, I really wasn’t sure I was going to be able to make it through labor. The contractions hurt more than I had expected and I was still only in early labor! I was managing to get through what I was experiencing then, but it was really hard, I hadn’t gotten a good night’s sleep in ages, and I knew the pain would only intensify. I’d read tons of birth stories, and they mostly described transition as being way worse than anything that had come before, which seemed too awful to contemplate. I don’t think I was actually, seriously considering transferring to the hospital, but I definitely wanted to express that things were hard! I told Will that I wasn’t sure I was going to be able to do it and promised myself (but did not say out loud to Will) that if, when it was all over, next time I decided I wanted an epidural from the beginning, or even a scheduled c-section, I would do it. (I had no such thoughts after birth was over. At this point I know I would definitely do a home birth again, barring medical reasons not to.)

We also called Maria for a pep talk. What she said that ended up being the most helpful was that, to help me take it contraction by contraction. She recommended that Will, who was timing them all with an iPhone app, tell me how long I was through each one and how long I had to go. It worked. And once I stopped ruminating on how much harder labor would be later and just concentrated on getting through each minute-long contraction, everything got much, much easier! The other things that helped a ton was that during each contraction I started using what my midwife referred to as “horse-lips”, where I was making a sound by vibrating my lips together. I got this idea from Ina May Gaskin’s books as well. I think vocalizing in this way worked much better at this stage because I could sustain it, whereas just trying to breathe through the contractions and remain relaxed was mostly failing.

Since Will was counting out the length of the contractions for me, I also noticed a pattern with the length of the contractions. During contractions, I had sometimes been shifting around to try to find a better position, but doing that consistently made them longer. I realized that I was moving around because I was trying to escape the pain, so instead I decided to channel that desire into a new visualization. What ended up feeling right was imaging myself in the ocean, riding a dolphin away from the pain. (Later, I changed the image to a monkey riding a dolphin, since I wanted to remind myself that it was my monkey, not my conscious mind, that knew what to do.) I had the detachable shower head on and aimed at my back, which simulated ocean spray, helping the imagery work.

Especially looking back, it’s cool to break down the specific things I would do that made me tense up in response to pain. In addition to wanting to run away from the sensation, I also had a strong inclination to signal to somehow express when the pain was particularly bad. The problem was, any sort of whimpering, saying, “ow,” high pitched noises, or talking about it would cause me to tense up. Eventually what I settled on was vibrating my lips faster and increasing the pitch only as much as it seemed like I needed to, then trying to relax into getting back to a lower pitch.

I would also periodically say the litany against fear (from Frank Herbert’s Dune books) to myself.

My the time Tuesday evening rolled around, I was effectively using rhythm, ritual, and relaxation to my advantage. Will and I were in a groove, and I was no longer having any thoughts of not being able to handle labor. I was pretty happy in the tub, and in between contractions I ate some of a banana and drank water with coconut palm sugar for the blood sugar and electrolytes.

As predicted, labor picked up again at night, and by 4:00am Tuesday night (technically Wednesday morning), we got to 4-1-1 and called Maria. She arrived within about half an hour or so and asked me to get out of the tub so she could check my progress. Much to our delight, I was already 8cm! Maria called the second midwife, a woman named Kristen who works out of the East Bay.

From there on out, I mostly wasn’t in the tub anymore. Maria told me that I’d been doing well at dilating, but that now I had different work to do. My water still hadn’t broken, so she told me to think more about bearing down. I did that for a while in the tub, and seemed to be making some progress.  I switched up my visualization one more time, and imagined that I was riding on the dolphin towards my baby, since I wanted to make my focus more goal-directed. Before too long though, tired and impatient as I was, I ended up getting on the bathroom floor and pushing where Maria directed (all the while complaining that I didn’t understand how to do what she was telling me).

Following Maria’s directions got my water to break pretty quickly. There was some meconium in there, which Maria said we could handle fine at home, but she also said that she didn’t want me actually pushing the baby out in the tub, so she could suction immediately if necessary. That sounded okay to me.

I think I was at 9cm after my water broke, but I wasn’t feeling the urge to push. I tried going up and down the stairs, squatting on the birthing stool, and a couple of different positions on the bed before settling on a sort of one-legged squat while lying on my back. Since I wasn’t in the water anymore, I was having Will push on my back so that didn’t hurt too much.

After lots of trying to push and not getting it quite right, the actual pushing felt extremely satisfying. I won’t say it wasn’t painful, but compared to the contractions, it was totally different, I could tell I was making progress, and I knew it would all be over soon and I’d get to meet my baby! To an outside observer, I’m sure the pushing would have seemed like the worst part, since I started screaming at the top of my lungs, but from the inside it was mostly just primal and intense, not aversive. But at that point I’d let go of all my inhibitions, quite unusual for me, and the screaming seemed to help. Something Will liked a lot was that in between all the crazy pushing and screaming, Maria told me I could reach down and feel my baby’s head, and that completely shifted me into a different state. I just reached down and said, “Oh, cool!”

The pushing went on for about an hour, and then, all of a sudden, at 8:53 Wednesday morning after about 30 hours of labor, she was out! Will caught her, and Maria suctioned her a little, but she cried right away. Her one and five minute Apgars were 7 and 9, and she was much bigger than we thought she would be! Maria had guessed maybe 6.5 pounds, but she was 8, and 21 inches long! I’m grateful to have given birth at home for a bunch of reasons, but one of the biggest things was that I trusted that everything would go the way I wanted it to right after the birth. We waited for the cord to stop pulsing before cutting it, and then Will held Lydia while I squatted to deliver the placenta, which came out quickly and easily. I did have about 750mL of blood loss, which is high, but not high enough that we had to do anything about it. After I was done with the placenta, we put Lydia on my chest to feed right away. I was intrigued by the idea of the breast crawl, and had planned to let Lydia find her way to the breast on her own as much as possible, but I ended up directing her a fair amount. It felt like the right thing to do when I saw her pushing herself in completely the wrong direction. She did get latched on, and she fed for a bit, which felt good.

Here we are, shortly after she was born:

Big as she was, I did unfortunately have a bunch of tearing, and Maria was busy stitching me up while I had Lydia on my chest. The stitching took a while, maybe half an hour, and I find it funny that after 30 hours of painful labor, I objected as much as I would have any other time when I could feel the stitching poking through the lidocaine. So much for the perceptual contrast principle

After the newborn exam (everything went smoothly) and help getting me set up with what I needed after the birth, the midwives left me and Will to get to know Lydia!

It’s been hard to get writing done in the midst of baby care, but look forward to more updates soon, including collected tips for having a natural childbirth (now here) and my reflections on the early days of parenting.

How to Prove to Yourself Once and for All that Pain is Not Suffering

Pain is not suffering. Don’t believe me? Good, you don’t have to…yet. But if you not only read what I say in this post, but try the strategies I recommend and allow yourself to notice what’s going on inside, you’ll get it.

Now, the reason I’m talking about this at all is that people talk about pain as though it’s suffering. “Pleasure is good, and pain is bad.” “The goal of life is to seek pleasure and avoid pain.” I say, that’s nonsense.

Pain is a part of life, and pain is especially a part of growth, so learning to do it without suffering is an obvious win.

Examples of Popular Pain

At the same as people go around saying that pain is bad, almost everyone I know can name some pain that they enjoy. The classic examples are spicy food, deep massage, and exercise. I’ll add sad books and movies to the list so that it includes examples of emotional pain.

Have you ever enjoyed the burn of spicy food, the feeling of pain as a knot in your back unravels, or the gentle ache of your muscles after a good workout? Have you ever cried in a movie while reading a particularly heart-wrenching scene in a book and considered the experience positive? If so, you’ve experienced pain that wasn’t suffering.

And if you’ve experienced pain that wasn’t suffering, then when you experience pain that does induce suffering, you should realize that there’s something different going on with that pain.

The Function of Pain

Pain is an attention signal. More accurately: think of pain as an attentional signal and you’ll suffer a lot less. Some part of you has some data that it wants to share, and it’s not going to shut up until it communicates it. Your model of the world is wrong, and the pain isn’t just trying to inform you, it is actively informing you right now. If you try to resist it and pretend you can’t hear what it’s telling you, you will suffer.

Maybe your pain is telling you that the hot stove is hurting your hand (true). Maybe it’s telling you that cold weather could be dangerous (maybe true, likely not true). Maybe it’s telling you that your dog is dead and you can’t play with him anymore or that you can’t always believe your own promises.

When you resist pain and try to ignore it or push it away, it will get louder and grow bigger. It will overwhelm you and create a feeling of urgency.

How to Look into your Pain: Six Ways

First, you need to pick some pain that you’re feeling. It can be physical or emotional: either will work. If your knee hurts, you can use that. If you’re judging yourself or worrying about something, use that. If you aren’t experiencing any pain at all right now, get some ice water and put your hand in it. (This is completely safe for at least ten minutes–scientists use the hand in cold water test to measure pain tolerance.)

Now, try these techniques:

  1. Observe the pain with curiosity. Be greedy for its data. Pretend that you are an alien who has been studying humans intensely for the past 50 years. You want to know everything about them. Today is your lucky day–you have been granted 10 minutes to experience the reality of a human. You are so excited about what you’re going to learn!Ask yourself these questions:
    • Is the intensity constant, or does it fluctuate over time?
    • Where exactly do you feel it in your body?
    • What is its character? (achey, sharp, dull, etc.)
    • Does the experience of the pain seem to be correlated with anything else that is happening?
  2. Lean into the sensation, and even try to intensify it. Often, when we experience pain, we try to minimize the sensation. This time, do the opposite. Try to feel the pain as much as you possibly can. Invite it to get bigger, stronger, and louder. Nick Tarleton has reminded me of the power of concrete metaphors and has suggested taking a cold shower so that you can literally lean in while you try to feel the sensation as much as possible. You’ll know when doing this one is working when feeling the pain is making you feel more alive.
  3. Observe your related mental processes.
    • What are you picturing when you feel this pain? (If that doesn’t work, try asking what the pain would look like if it did look like something.)
    • If the pain sounded like something, what would it sound like?
    • What related thoughts are running through your head?
    • What tone of voice are you using to talk to yourself about the pain?
    • What is the pain trying to tell you? Why is that important?
  4. Observe your sense of self and expand your awareness. This is probably my most abstract recommendation, but it does work. How does the pain interact with your sense of identity? When I feel pain, it starts to feel as though the content of my pain is who I am. It never is. I think one of the key factors here is that my spatial awareness gets distorted. Imagine your awareness expanding outwards and becoming in line with the proportions of reality. Don’t try to make your awareness of the painful sensation any bigger, expand your awareness of everything else.
  5. Engage in dialogue with yourself about opening to the pain. practice IFS, which means I spend a lot of time engaging in inner dialogue. If you’re trying to look into your pain but it isn’t working, it’s almost certainly because you’re afraid to do it. Direct these questions to the part of you that doesn’t want you to feel the pain:
    • What are you afraid would happen if I were to feel the pain?
    • Do you trust me?
    • What are you afraid would happen if you were to trust me?
    • Are you afraid that I won’t be able to handle the pain?
    • What are you trying to protect me from?

    Listen to the answers you get and respond appropriately. Tell yourself that you can handle the pain. Tell yourself you’re trying an experiment, and that you can always go back to resisting later if you decide you don’t like the results.

  6. Go meta. My favorite :-). If you’re totally stuck and haven’t opened to the pain, do you now feel pain about not being able to open to the pain? When I set out to accomplish something and don’t succeed, I feel pain. I bet you do too. Maybe you even feel anger at me for suggesting such crappy techniques that didn’t work? Great! Open to that. Try all the steps above on that pain. Or try to open to the part of you that is resisting the pain. Try all the tools on the resistance itself. If you don’t get a shift by doing this, please leave a comment or email me and let me know. I’ll be surprised!

How I learned to look into pain

I mostly have Michael Vassar to thank for learning the right mental posture. Not so surprising, if you know me. Michael has had a huge influence on my thinking in a bunch of ways.

But oddly enough, looking into the pain was something I learned from Michael mostly before I really knew him. Based on a Less Wrong comment of his, I made some Anki cards for myself about how the right thing to do with pain was to look directly into it. And at first I wasn’t quite sure what that meant, but I kept trusting that he must have meant something, and that it was probably good advice. When I found myself in either physical or emotional pain, I would remember to try looking into it. I got the hang of it more and more over time. If you’re interested in turning your pain into something that isn’t suffering, my hope is that this list will help you learn to do it faster than I did.

Further Reading: Suffering as attentional allocation conflict and Overcoming suffering: Emotional Acceptance from Less Wrong