Umm… everything? We want you to be educated on everything regarding pregnancy, labor and birth because how else can you truly give informed consent? We don’t expect you to do it all alone though. With our training and our experience we are a great source of information that we’re only too happy to share, at length and in detail until you tell us to please, please shut up.
If I were forced under the dire threat of never being allowed to attend another birth to narrow it down for you, these are my top recommendations.
BRAIN - benefits, risks, alternatives, intuition, nothing
What bullshit “failure to progress” is
Your baby probably isn’t too big
You have all the power
(that was way harder than I thought!)
When your nurse, doctor, OBGYN, whoever (even your midwife) comes to you with a suggestion or recommendation, the BRAIN acronym is a great one to rely on. If you mix it up and make it the Brian acronym, that’s still fine as long as you don’t have a grudge against somebody with that name. It stands for benefits, risks, alternatives, intuition, and nothing. Let’s say you’re in labor, barely getting through each contraction and feeling like you’ve reached your limit. Your doctor comes in and suggests some pain relief, maybe even an epidural. That may be all they share with you, leaving you without enough information to really understand the full scope of what they’re talking about. You can take a breath and review this with yourself and your support people, then ask for more information where you need it. With the epidural example, it would go like this.
B - benefits
It would provide nearly complete pain relief and that would allow relaxation, maybe even sleep.
R - risks
It’s a needle near the spinal nerves and that’s a little scary. It can also lead to headache, sometimes long term, and it can lower your blood pressure.
A - alternatives
You could try a position change, something that might give the baby more room to turn and adjust, allowing labor to move forward easier. You could also ask for a lesser form of pain relief, depending on what the location offers.
I - intuition
What do you think? How do you feel about the suggestion of an epidural? N - nothing
What happens if you choose to do nothing? In this case, you’d keep laboring with full mobility which leaves your options for comfort measures entirely open. And remember, if you feel like you need it later you can usually still get one.
Prolonged Labor/Failure to Progress
I’m not going to sugar coat this. 99% of the time being told you’re not progressing fast enough is a load of crap based on outdated teachings and providers not keeping themselves informed. In March of 2014 there was a study published that listed ways to reduce the rate of Cesarean delivery and it states that 34% of C-sections come from “labor arrest” ( labor dystocia). It goes on to talk about how “it may be necessary to revisit the definition of labor dystocia because recent data show that contemporary labor progresses at a rate substantially slower than what has been historically taught.”
What does this mean for you? It means labor moves at its own pace regardless of what hospitals and insurance companies want, and that your provider may be using the outdated Friedman’s curve to make the call about a C-section. Remember to advocate for yourself and your baby and take the time you need in your labor.
Your Baby Isn’t Too Big
Humans have evolved in crazy ways, and an incredible part of that is how we can birth such large babies. The way our pelvis is designed to relax and open, the way the baby tucks their chin and turns during labor and the insane strength of the uterine muscles have developed over millennia from generations of successful births. It’s rare that a baby is too large to move through the pelvis in a vaginal delivery, occurring in roughly 1 out of 250 births as stated by this article by the American Pregnancy Association. Keep in mind that ultrasounds are often wrong on size and weight and there’s no way to determine how far the pelvis will open, especially in certain positions, so a vaginal delivery is still an option!
You Have ALL The Power
Quite simply, you are the one in labor and you get to make the decisions, unless you’re incapacitated and it’s a medical emergency. No one can force you into doing anything. The power is yours. While I do suggest listening to your care team and taking their knowledge under advisement, you have the final say. If you’re truly uncomfortable with something that’s suggested to you, you’re under no obligation to agree to it. This is true regardless of where you’re giving birth. Even if the plan changes and you don’t have your ideal birth it can still be an incredibly empowering experience if you’re given information and the freedom to choose, especially with a doula by your side to support you and your partner(s).