Actress Toni Collette, known for her roles in Little Miss Sunshine, Muriel’s Wedding, and The Sixth Sense, gave birth to her first child one year ago. In last weekend’s Parade magazine feature, she was asked how she got back in shape after giving birth.

“I do yoga and Pilates, but the body itself knows what to do,” she said. “When you’re breastfeeding, the body has its own way to shrink.”

The Labor Day holiday presents a fitting day to discuss labor — the birthing kind! Here are my answers to the Labor Day meme. You can play along with Rocks In My Dryer too, but be sure to leave a comment here with your link (or just your answers if you don’t have a blog) so I know to go read your answers!

How long were your labors?

Kid #1, 22 hours.
Kid #2, 5 hours.
Kid #3, 11 hours.

See a pattern there? Nope, me neither.

How did you know you were in labor?

Kid #1, contractions that woke me up at 3 a.m. I tried to go back to sleep but (a) I had to focus on breathing through the contractions, and (b) I was too excited!
Kid #2, water breaking.
Kid #3, water breaking.

Where did you deliver?

Kid #1, hospital.
Kid #2, hospital.
Kid #3, at home, in the birth tub.

Drugs?

Kid #1, spinal/epidural combination after 16 hours of labor. At the time I was very grateful for the relief, but with my second labor I realized that when the pain got bad enough that I wanted relief, I was getting close to delivering! For me, that’s when the really good progress is being made, and if I could just keep that in mind, I could go without pain medication. With kid #1, the epidural slowed down labor for two hours, and the nurse was about to suggest pitocin when she rolled me on my side and my water broke, speeding things along.
Kid #2, a failed epidural. I asked for the epidural, had trouble sitting still for the necessary IV (duh, because I was ready to push! No one checked me for dilation!) So five minutes after I got the epidural, the OB/GYN showed up and said, “You’re ready to have a baby!” I growled back, “I know!” Three pushes and an episiotomy later, my daughter was born, and I happened to look on the floor and see the tube for the epidural, disconnected and dripping on the floor. So I’m calling that an unmedicated birth, even though I caved and asked for the drugs
Kid #3, no drugs.

C-section?

Thankfully no. With #2 and #3, I was diagnosed with placenta previa. Fortunately, both times subsequent ultrasounds revealed that the placenta had moved away from the cervix as my uterus expanded.

Who delivered?

#1 Three teaching hospital residents I had never met. They threatened to give me an episiotomy and told me to push like I was having a bowel movement, resulting in a fourth degree tear. Luckily one of them felt so bad about that that she spent an hour stitchin’ me up!
#2 A doctor who was so embarrassed about being late to the delivery that he refused to see me for my 6-week follow-up appointment. He sent in another doctor even though I had made the appointment with him. Chicken.
#3 A midwife and her assistant, both of whom I knew and trusted.

Your turn

Play along and leave a comment!

From The Breastfeeding Answer Book:

Caused by postpartum hemorrhage so severe that the blood loss irreversibly damages the pituitary gland, Sheehan’s syndrome can cause breastfeeding failure. Other symptoms include loss of pubic and underarm hair, inability to tolerate cold, low blood pressure, and atrophy of vaginal tissue, as well as subsequent infertility.

p. 569. For more see:

~ Birthsource.com
~ “Infant Insufficient Milk Syndrome Associated with Maternal Postpartum Hemorrhage” (abstract) from the Journal of Human Lactation

On Wednesday July 16 I was 38 weeks and 1 day into the pregnancy. The midwife had just finished her pre-birth home visit at 3:15 that afternoon. At 4 p.m. I was resting in bed and reading stories to my girls. Over the next hour I had some contractions, but no more and no stronger than I’d been having over the previous several days, so I didn’t pay much attention. Until I felt a little “pffzt” in my belly and I wondered whether that could possibly be my water breaking. Read more

Nicole Marie White
7 pounds, 2 ounces
19.5 inches

Born Thursday, July 17, 2008
at 2:51 a.m.

At home, in the water.

Our first nursing session lasted a blissful hour. I am happy and feeling well! More details later!

In these last few weeks of pregnancy I am busy thinking through the details of the impending birth (those for which I can plan, anyway!) As I have mentioned, I am planning on a home birth with a midwife. Should the midwife already be attending another birth, I will go to the birth center. Should I need emergency transport, I will go to the hospital within 10 minutes of my home. One detail I am still working out is where I would go in the case of non-emergency transport, in the unlikely event that I change my mind about having a non-medicated birth.

First up in my investigation of hospitals: seeing if there are any Baby-Friendly Hospitals near me. Unfortunately, while 17 of the 64 U.S. hospitals and birth centers designated as Baby-Friendly are in California, none are close enough to me to be practical.

Next I check the breastfeeding rates of local hospitals. Luckily the California WIC Association issued a California Hospital Breastfeeding Report for 2007. The report notes:

More than 86 percent of California mothers breast-feed or provide breast milk for their infants during the hospital stay. Unfortunately, only half of these babies—43 percent of all California infants—are breastfed exclusively; that is, breast milk is their only food.

Clearly it is important to choose a hospital that has both a high breastfeeding initiation (”any” breast milk) rate and a high exclusive breastfeeding rate. Oh my goodness, I just compared the two hospitals closest to me. Which would you choose, the one that has an 88.3 percent initiation rate and a pitiful 8.9 percent exclusive rate, or the 86 percent initiation rate and 49.5 percent exclusive breastfeeding rate? Or maybe it’s worth driving another 10-15 minutes for the hospital with a 90.3 initiation rate and 62 percent exclusive rate? I’m thinking that last choice is the best. It also happens to have a high level NICU and a tunnel to an excellent children’s hospital, should that be necessary.

At any rate (ha ha), please keep your fingers crossed for me for a safe and smooth home birth, with a 100% breastfeeding initiation rate and a 100% exclusive breastfeeding rate!

Hard to believe I reach 30 weeks of pregnancy tomorrow! As part of planning for the birth, I have been reading Ina May’s Guide to Childbirth (my one-sentence rave review: this is the one birth book I wish I could press into the hands of every pregnant woman I encounter). It’s got me thinking a lot about the type of birth I hope to have (at home, with as few interventions as possible), and it makes the most recent poll results all that much more interesting. Of the 150 voters, 73% said they last gave birth in a hospital setting. That left 22% who gave birth in other locations (and 5% who are currently pregnant with their first). Here is the complete breakdown:

Please take a moment to vote in the new poll!

At 27 weeks of pregnancy, with a plan for a home birth, I am starting to hear other women’s horror stories about their birth experiences (please, people, I have my own leftover trauma from a fourth degree tear and an epidural that failed (that’s how I know I can labor and deliver without pain medication if given the opportunity!)) In the last two weeks, two women have mentioned how much the International Cesarean Awareness Network (ICAN) helped them recover emotionally from a cesarean. In addition to attending La Leche League meetings, the two women attended local ICAN support group meetings. ICAN is dedicated to cesarean prevention, c-section recovery, and advocacy for the rights of birthing women. It currently has chapters in the United States, Canada, Ireland, Singapore, and the United Kingdom.

A woman’s birth experience can have a tremendous impact on breastfeeding success. For information on breastfeeding after a cesarean, see AskDrSears.com and Kellymom.com.

I am not even 20 weeks along in this pregnancy and already I am focused on the birth. After two unsatisfying hospital births, this time I am working with a midwife toward a home birth. I am curious about your thoughts on birth choices and whether or not they affect breastfeeding success rates. Do you think birth center and home births are more conducive to breastfeeding success? Do breastfeeding women tend to choose birth center or home births even if they gave birth at a hospital the first time? How successful do you think hospital lactation support is? Do the free formula giveaways sabotage breastfeeding? Leave a comment!

To see the results of the last poll, click here.

MammamayI posted a very interesting and helpful response to my post on Choosing a Doula Worldwide. I particularly appreciated the information she provided on how women who are not able to afford a doula can find free or low-cost services. Read on for her advice on how to choose a doula:

“I’m a doula, and it’s GREAT that you’re addressing this! One of the best ways to have a mom who gets off on the right foot breastfeeding is to have that mom hire a doula. Women who have a doula in attendance at the birth of their child are statistically significantly more likely to have a successful (and longer) breastfeeding relationship. And, thank you, too, for listing more than just the DONA site for help in finding a doula in one’s area. Although DONA is perhaps the most well known certification group, they are certainly not the “best” or the “only” one. Not that they have drawbacks, per se (my partner and back-up is a DONA trained doula and I’d feel great knowing she was supporting one of my clients if I weren’t available because of some emergency), just that they’re not the only ones around.

For the most part, I’ve found that the certification process, and who is running it, doesn’t really matter to mothers looking for a doula. However, oftentimes, it DOES make a difference to the woman looking to BECOME a doula. The organizations all have a little bit of a different perspective on birth and how birth should be attended, so most women looking to become a doula will spend many HOURS carefully considering how each certifying body and its course will benefit her as a doula. It’s actually a pretty important milestone in the “life of a doula” to have chosen one’s certification course, and sometimes it’s Childbirth International, CAPPA, or ALACE.

Bellywomen dot net [http://www.bellywomen.net/] is a great resource, too, for women who have a need to be attended by a doula, and can’t afford (really, honestly can’t afford, not don’t want to fork out the money…what I do is REALLY hard work, both emotionally and physically, and if a woman CAN afford to pay me my fee, it is wonderful to be recognized for my abilities) to going rate in the area, they can look on bellywomen for a doula who is willing to work on a sliding scale or willing to fully donate their time (for really destitute clients). Many of us are willing to take a sliding scale or free birth per every so many full fee births to help women in the community who otherwise wouldn’t have the benefit of labor support. I have had many women contact me off of bellywomen, actually, simply because they want to breastfeed and having a doula gives them the best chance they have in their situation to breastfeed.

When you look for a doula, if there are several choices in your area, I highly suggest that you meet face to face with your potential doulas and talk for a while before you make a choice. This is to gauge chemistry. Having this woman in your birth space could be a significant decision for you, and if you have time to make the choice carefully, you should do so! I love my job, but I’d much rather my friend get a birth over me if the chemistry is better between a woman and her than to get the job myself and have the mother have a less than optimal experience because the chemistry just wasn’t right. And you’ll know right away with most doulas if you’re a good fit or not, so don’t worry that, after you’ve met your prospective choices, you’ll make the wrong choice. Kinda like finding the right mate…you’ll know!

The goal of a doula should really be to have birth be something that YOU DO…not something that happens to you or for you. That means that one of her major goals is education before your birth. Informed consent is a big responsibility. And to be TRULY informed when you sign any paperwork and/or make any decision, no matter how big or small, is a large part of birth being something that the mother does, rather than something that is done to her. Next, after having done her first job well, it is a doula’s responsibility to support the mother in the informed choices that she makes. I know of one doula who, if the client doesn’t take her advice, will leave the mother. This isn’t only malpractice right then, but also in that she doesn’t trust her SELF to educate her clients fully, to ENCOURAGE them to make decisions that will make their births their own. So, no matter the decision, if it was made with foreknowledge, then if it’s the right one for the mom, it’s the doula’s job to support it. This is why some women I know make very compassionate friends but would make awful doulas!…because they wouldn’t be able to support a mom no matter her choice.

Good for you, for talking about Doulas. Unfortunately, not enough women know about us and the work we do. I can’t tell you how many women I have met since I started working as a doula who say, ‘Wow! I really wish I had known about doulas when I had my baby!’”

Thanks MammamayI (cute username by the way)!

If you want to read more by MammamayI, she also had a passionate response to the Mom to Mom question on Toddler Nursing.