Midwifery Model of Care vs Obstetrical Approach…

Reading “Heart and Hands” book ( and enjoying it!) I found some parts not just a great read, or informative textbook material, but an amazingly well put observations and advise.

On midwifery model of care vs obstetrical approach…

The essence of midwifery is staying  in the moment: humble and fully attentive, letting nature to take its course, being there to support mother in her individual journey, and being ready to deal with complications in case they will arise.

Early in training physicians learn to control themselves, their patients and outcomes through standardized procedures. They learn little of the art of care giving, being taught instead to forgo personal involvement, to mistrust their intuition, to rely only on hard evidence, to expect pathology, and to fear death. Its no wonder they seek control, and as they do there is no room for nature to take its course.

Pregnancy is not pathology and birth is not an emergency or illness. In fact research shows that more relaxed and at ease laboring woman feels, the more efficiently her body will function.

If she becomes stressed, frightened or distracted she releases hormones (catecholamines) that inhibit cervical dilation. All birthing mammals behave thus; if they are moved, threatened, denied privacy or otherwise disturbed, an arrest of progress occurs. This is why pitocin – a synthetic form of oxytocin, the hormone that causes uterine contractions – is so frequently used in hospital births. When woman finds herself in unfamiliar hospital environment, being checked again and again by strangers, undressed and exposed, put in restrictive positions, and expected to “perform” by the clock, inevitably her natural progress of labor getting disrupted. Worse yet the situation for the first time mommies, who then told that they are simply not capable of having working contractions, and interventions are the only way for them to re-establish the labor.

Unfortunately pitocin also makes contractions abnormally strong and painful, so many woman hoping for natural birth end up requesting pain relief. To make matters worse, pain medications may interfere with labor as well, so that more pitocin is needed. But if uterus pushed too hard, it will not relax enough between contractions for healthy circulation, and thus fetal distress ensues, and a cesarean section becomes necessary, at that point it is a life-saving procedure for the baby.

This is the cascade of interventions, that I have observed in my residency as a physician. That is also the primary reason why cesarean rate reaches nearly 33% in hospital births, while in a midwife practices averages only 3%.

When woman are in charge of their environment, when they have their privacy to labor undisturbed, when they feel completely at ease and supported, outcomes are always superior.

I have been at both sides of the fence, observing medical practices, while studying to get my physician’s education and learning of midwifery model of care, while having my own birth and now studying to become midwife myself. It is important to have wonderful hi-tech hubbubs of technology with great technology operators, — physicians and hospitals, — for dealing with pathologies and complications. I’ve seen technology saving lives and am grateful for it! The tragedy is when out of custom, ignorance or inavailability of other options, woman with normal pregnancies and potentially uncomplicated births end up in the system where everything is gyred towards pathology, and end up having an unnatural painful experience with possible health complications as a result of it.

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Sunny side up? Insights into back labor…

Posterior labor.

Vital information for expectant mothers and fathers 

  ( A few months ago I compiled this article for a friend of mine who just found out that her baby was posterior… I prayed a lot for her ( she had a history of long hard back labors), and she did what she could to encourage baby to turn in the optimal birth position. As a result she had her first non-back labor, and encouraged me to share this info with others. She said that many things she simply did not know, and it could have helped to prevent her hard labors before. I can not take much credit for that, as all the information compiled here was gleaned from wonderful tutoring of my midwife and instructor Lori Luyten, as well as from other sources, such as Mothering Magazine, writings of Ina May Gaskin and Robert Bradley. … )

 During the last trimester it is possible to determine the position of your baby in the womb, simply using hands.  If you in a care of midwife, she probably will check baby’s position at every visit during your last month. And will help you with council on how to reach or preserve best position of the baby for the birth. If you are in situation where hospital birth is your only option, you most likely get an ultrasound done to determine the position close to your due date. Often doctors will make decisions on possible course of action for your birth, based on that ultrasound.

Prayer can change the “worst” fetal position into the “best”, and is not limited by timings and circumstances. Prayers are powerful, and as we read testimonies of births, we see how time and again the Lord intervened and turned so many seemingly “impossible” situations into victory.

I hope that this compilation of helpful tips, knowledge, information on back labor, or posterior presentation, will serve as an aid in your birth journey. And will help you to have an important knowledge of your options, be aware of the things that you can do to prevent it, correct it, or work through it to the victory, as well as things to pray for, as you commit your pregnancy and labor to the Lord.

                At the time of writing this article I just gave a birth to a baby, which was born “sunny-side -up” ( a nice cheery name for Posterior Presentation), and went through a battle of praying for fellow mommy who had a very difficult “back labor” which lasted 54 hours. The good news, — her healthy baby was born naturally and with my baby even though it was posterior, I was blessed with easy, smooth and natural delivery, in spite of baby’s position.

However the question is, — what if anything can be done to prevent the back labor? Since statistically most of the back labors are more painful and higher percent of these labors end in Cesarean sections , when failure to progress occurs, or when mother’s exhaustion makes it difficult or impossible to continue…

First of all, what exactly is “back labor” ?

The “occiput anterior” position (OA) is the ideal and most common position. In this position the baby’s head is easily “flexed” with his chin tucked into his chest, so that the smallest part of his head will be applied to the cervix first. The baby is most commonly “LOA” meaning his back is along your left side, and occasionally “ROA” ( back along the right). When baby is anterior, the back feels hard and smooth and rounded on one side of your tummy, the bottom will usually protrude on one side under your ribs and you will normally fill kicks on the other side under your ribs. Your belly button will normally poke out and the area around it it will feel firm.

A less favorable position is the “Occiput Posterior” or OP. This means that baby is still the head down, but facing forward towards your tummy. When the baby is posterior, your tummy may look flatter, feel squashier, and you may feel arms and legs towards the front, and kicks out in the front. The area around your belly button may appear flat or dip into a concave, saucer-like shape, especially when you lay down. If your  baby is posterior you may find that you suffer backaches during your pregnancy, but that is not always an indication of OP. You may also experience long and painful, on-again, off-again “practice contractions” as your baby tries to turn around in order to engage in the pelvis. Mothers of “posterior” babies are more likely to have long, hard labors as the baby usually has to turn all the way around to facing the back in order to be born.

Here are some additional tips that might help you to recognize possible posterior baby:

Prenatally (1):

• You feel like the baby has too many hands and feet, and the moving limbs may be easily felt and seen.
• You urinate more frequently than average for PG, due to the baby’s brow pressing against  bladder.
• You may exhibit signs of a urinary tract infection, a feeling of constant pressure at the symphysis, (above the pubic bone), and an attendant lower back ache.
• It may be difficult to hear fetal heart tones, or they may be indistinct. When it is suspected that the baby is posterior, if you roll to the side,  the heart tones will be more easily heard.

in Labor (2):

• You might experience a long period of irregular contractions with little or no dilation. Contractions may be more frequent yet of shorter duration than expected in early labor, eg: every three minutes but lasting only 30 seconds. This is due to inadequate pressing  of baby’s head against your cervix.
• Persistent backache, which even in early labor may be severe enough that the pain of contractions are secondary.

 

 

Posterior presentation has increased drastically in the last 10-20 years due to change in our lifestyles. We’ve now accustomed reclining in comfortable sofas, armchairs and car seats. Since you are so big and pregnant in the last couple of months, you  probably given the best seat at the friend’s house party or family gathering, and the most comfortable reclining seat in the car on the trips out. Some woman even trying to sleep semi-upright in a recliner chair. After all, it is so difficult to find comfortable position with this big tummy!

The baby’s back is the heaviest side of his body. This means that the back will naturally gravitate towards the lowest side of the mother’s abdomen. So if your tummy is lower then your back, e.g. you are sitting on the chair leaning forward, then baby’s back will tend to swing towards your tummy – a GOOD position. If your back is lower then your tummy, e.g. you are lying on your back or leaning back in the armchair, then the baby’s back may swing towards your back and into posterior position – not so good.

You can influence the way your baby lay in your womb. Using gravity, good posture and movement you can help your baby settle into an ideal position for easier, shorter and less painful births. AVOID reclining in armchairs, sitting in the car seats where you are leaning back, or any position where your knees are higher the your pelvis.

Do what you can to avoid positions which encourage OP position. The best way to do this is to spend lots of time kneeling or sitting upright, sitting “Indian style” ( “tailor sitting”), or the hands and knees position. When you sit on the chair, make sure your knees are lower then your pelvis, and your trunk should be tilted slightly forward. Other tips for preventing a “posterior” baby are:

• If you watch TV,  sit kneeling on the floor, over a beanbag, stability ball or cusion. Or sit on a dining chair.
• Try sitting on a dining chair facing ( leaning on) the back as well
• Don’t cross your legs while sitting on the chair! This reduces the space at the front of the pelvis, and opens it up at the back. For good positioning, the baby needs to have space at the front
• Don’t put your feet up! Lying back with your feet up encourages posterior presentation
• Sleep on your side, not on your back
• Keep active, walk as much as possible.
• Practice pelvic rocks on your hands and knees every day for minimum 3 times a day for 20 minutes and/or;

 

• Swimming with your belly downwards said to be very good for positioning babies – not backstroke. Breaststroke in particular is thought to help with good positioning, because all those leg movements help open your pelvis and settle the baby downwards
• A birth ball ( stability or swiss ball) can encourage good positioning, both before and during labor.
• Get chiropractic care to keep your body and hips in good alignment.
• Keep your tummy warm. More babies rotate to OP during winter months. They prefer warmth so if your tummy is cold, they may turn their back away from it.

If your baby is already posterior you can try to stop him/her from descending lower. You want to try to avoid the baby engaging ( lowering down into; head dropping down into pelvic area) pelvis in this position, while you work on encouraging him to turn around. Most babies take a couple of days to turn around. During this time it is important to:

• If you can, get a chiropractor, who specializes in pregnancy, to help you with “adjusting”. It is much better to keep a good posture and do your best to prevent OP, rather then “treat it”. In my case, I had to have a chiropractor adjustment during early labor. Would I be in the hospital, I would be induced and probably rushed into C-section, for the failure to progress, when I was at 2 cm dilated after about 20 hours. But when midwife observed the pattern of my contractions, she realized that I had a problem with pelvic misalignment ( my back was not straight), and short visit to chiropractor, saved my labor. My ligaments pain was gone, labor immediately picked up and 7 hours later I was completely dialated and ready to push with well established labor. In my case the baby still decided to stay posterior, but it did not hinder the labor progress neither did  it make the labor more difficult. Some babies simply meant to be born that way.
• Avoid deep squatting.
• Use “knee to chest” position
• Sway your hips while on hands and knees
• Try crawling around on hands and knees, it is a good exercise and it helps baby positioning
• Swim belly down, but avoid kicking with breaststroke legs as this movement is said to encourage the baby to discend into pelvis. You can still swim breaststroke, but simply kick with straight legs instead of “frog’s legs”

• Sometimes a posterior position is caused by a lack of strength in your lower stomach muscles…in this case a belly support or belly binding (a large sheet or towel wrapped tightly around the belly for support) might help.
• If it’s a cord preventing baby from turning, try perhaps rotating baby the opposite direction (for example, at night try sleeping on your right side instead of left). This can help ‘unwrap’ the baby and encourage him/her to turn.

• There is also a chiropractic technique called “diaphragmatic release” and is supposed to turn posterior babies every time. In fact it can be easely done at home.

What to do if you go into labor and baby is still posterior:

Don’t get too worried…the vast majority of posterior babies rotate during labor and those who don’t are often born “sunny-side-up”. Some posteriors actually are born precipitously with no back labor, depending on how well flexed the head is, as if saying, “Surprise! It’s my little face!”  Babies come out! In fact according to statistics, the incidence of a posterior presentation occurring at the onset of labor is 15 to 30 percent, and many such babies rotate spontaneously to an anterior  position, – , – like a key turning to fit a lock.  

• First thing is to get into a knee-to-chest position and stay there for at least 45 minutes, or until baby turns. Be sure to have lots of pillows on hand so you can stay in this position comfortably for as long as is required.
• Sometimes doing stairs 2 at a time between contractions (with a spotter on each side!) will jiggle the baby’s head enough for it to turn or move the pelvic bones enough for baby to turn.
• Belly lifting is another technique for when baby won’t turn and dilation is slow. With someone supporting you from the back, lean back, arching your spine, and with both hands around your belly near the baby’s bum – pull up on it during a contraction. This realigns the vectors so that baby’s head will put more pressure on the cervix, helping it to dilate more quickly.
• A big pool filled with water will relieve a lot of the back pain and will help baby to turn, so plan a waterbirth!

It may be that your baby is going to stay “sunny side up” and will just refuse to turn; perhaps that the way he or she needs to be. …maybe that is the only way s/he can enter the pelvis, or it’s possible the placenta is in the way (for example, an anterior placenta may predispose you to a posterior baby) If you do end up having a back labor ( about 5.5 – 7 % refuse to turn and are born posterior), at least you’ll know you did all you could to make things easier for you and the baby.

Remember, however your birth turns out, even if it’s not the labor or birth you want, it WILL be the labor and birth you and your baby need. 🙂 Jesus will see to it!

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Does it hurt? Pain in Labor..

About the pain in labor

(Resources from Ina May Gaskin. Lori Luyten, Mothering Magazine, Peggy O’Mara, “Natural Childbirth the Bradley Way” and Jennifer VanderLaan)

 

It is safe to say that number one worry for most pregnant woman is pain during labor. If you the first time mom, it does not matter how much preparations you have done, books read or birth classes taken, you still probably secretly asking yourself “Will I be able to handle it?”. Worse yet if you one of the folks who heard mainly “difficult” birth stories, you probably feverishly searching for the best methods to “really make sure” that that pain will be brought to the minimum.

It is totally understandable that you might be afraid of the unknown, but your experience of pain in labor may be more within your control then you realize. Here are some points which may help you to elivievate some of your fears and to better understand your options for managing pain, and getting the best possible outcome!

** There is a myth, that pain is pain and you UNDOUBTEDLY WILL HAVE IT PRETTY BAD, THIS IS JUST HOW THE BIRTH IS. The truth is – the amount of pain you feel during the labor is affected by your perceptions of pain in general and your beliefs about pregnancy and birth in particular. A supportive environment during pregnancy can help you to change these perceptions so that you feel more ready for a natural birth, which is, by definition, is drug –free. One of the most startling truths about the pain of labor is its relation to the mother’s confidence in her ability to cope. In general, the more confident you are you will be able to cope, the less pain you will feel. Another important factor is the people you have with you at labor, because your ability to cope with the pain of labor will be influenced by the interactions you have with those attending you (midwife, doctor, nurse). This paints a far different picture of what you will need to get through labor than the old “high pain tolerance” theory. In fact, you can be a wimp about pain and still cope well with labor pain.

But what is labor pain anyway? Its nature is so couched in mystery and overdramatized by the media, that you probably have a hard time imagining that you will have to go through something like that. In fact however, it is much comparable to stretching, tensing sensation or period cramps, or wave-like sensation that slowly gets stronger and then gradually let go. It is the result of the dilation of the lower, narrow portion of the uterus, called cervix, which needs to open to roughly 10 cm diameter in order to allow the baby to pass through. In labor the job of cervix is to stretch from an opening the size of the tip of your nose to an opening the size of a circle drawn on the palm of your hand. No wonder you will feel singing and stretching sensation as this is happening.

The dilation ( or opening) of the cervix happens gradually and rhythmically. During the natural labor, the contractions that stretch the cervix last for only 45 to 90 seconds, and peak at intensity at about 30 seconds. There are breaks between contractions during which there is no pain at all. The reason you can have confidence in your ability to handle these contractions is exactly due to their very rhythmic predictable nature. You have to handle only one at a time, and each time the period of rest follows it! You can count on that!

(The reason we specified “contractions in natural labor” above is because in case you use medications in order to start, strengthen or regulate contractions, it will cause you body to have contractions unpredictable in their strength, nature, intensity and rhythm, or not have any at all for a while, which will call for additional medication, etc. Such contractions triggered by medications, can turn to be titanic contractions (very powerful unnatural ones) which can result in baby having a distress; they can be very difficult to manage and often will start the “cascade” of interventions, necessitating pain medications to manage your pain, other medications to regulate the contractions that “got out of hand”, etc., more on that in the article on labor induction)

It might be interesting to know, that pain in labor is not like the pain from an injury – persistent constant pain that requires relief after a while. Tooth pain for instance, is throbbing and relentless. You have to get to the dentist, even if you really hate going there, you just have to do something. Unlike tooth pain, pain in labor is manageable, — it can be influenced by specific techniques, and it lets up. It is also not aching but stretching. A toothache hurts, labor stretches and somewhat stings.

Remember the time you had a very sore tight muscle and needed to get a good massage to relax it in order to stop the aching in your back or shoulders? One of the ways you can describe the feeling during the contraction is as if a very tight muscle is smoothed out by a strong pressure of someone’s fingers. When you get the massage to relax tight muscle, there is a distinct stinging sensation, depending on the degree of pressure. You sometimes squirm from this stinging, but you can handle it. You know it will be over quickly and you breathe with it. It’s the same during labor; the pain is manageable because it does not suddenly begin as a gripping pain at full intensity. It generally starts like a light tightening, stretching that slowly builds, in strength and intensity. The contractions come in waves. That’s why they also called “birth waves” or “birth rushes”

Although this is a general description of how contraction feels, no two woman experience it in exactly  the same way.

(Note :if you had a baby and did have “unmanageable pain”  you most likely was working against your body and was not working with it)

It is interesting to know that even the perception of pain in labor is so uniquely subjective. In one study, a group of pregnant American woman were compared with the same group of woman from Netherlands. Each woman was given the same information beforehand about the risks of pain medications during labor. Only about 33 percent of Dutch woman asked for some kind of pain medication during labor ( we are talking here about woman who were not specifically prepared or trained to have a natural birth, but were having a routine hospital birth). While among the American group of woman, — 83 percent asked for pain medication. In further interviews American woman noted that they were generally anticipating painful birth and the need for drugs, whereas Dutch woman anticipated less pain, and thus les likelihood of the need for drugs.

This study is just a little example of how our expectations affect our experience of labor. This principal was noted in the writing of legendary midwife Ina May Gaskin, when she mentioned that one of the most important preparations for the birth is exposure to positive birth stories, contact with other woman and their families, who had natural positive un-medicated births, and positive trusting attitude in the Lords care and the ability of your body.

 

While the most important factor in considerably reducing the pain is relaxation ( see the article on Relaxation during labor and birth), the most important factor in reducing your perception of pain is to reduce your experience of stress. One important way is to have the companionship of another woman during labor. A number of well-designed studies show that continuous labor support is one of the most effective ways to reduce pain in labor. One study is worth mentioning, because it was done specifically in a hospital setting among woman who were not specifically trained or prepared for natural birth. It reported a 30 percent reduction in request for pain medication among woman who used a coach or a doula for labor support. Clearly you will be less likely to want drugs if you don’t feel alone, and  someone familiar with the process of labor is there to support you.

Woman who take childbirth education also tend to request less pain medication. There is a lot to support the notion that when you know what to expect, you are able to better handle it. There is a lot to be said for the fear of the unknown. Usually when person does not know what to expect, she tenses, and uses all her strength to be “alert” and on top of it, ready to refute every possible challenge. That releases adrenalin, and starts the hormonal response which makes it difficult to relax, “fear-tension-pain” cycle is triggered, and it only gets worse as the labor progresses.

Practicing meditation and relaxation is another excellent way to learn to let go and flow with the moment, and can tremendously help you to take labor contractions one at a time. Some woman report, that focused relaxation ( not “patterned breathing”!)  helped them not just significantly reduce, but even eliminate pain altogether, all they felt were stretching wave-like sensations that were coming and going. It does take concentration and practice beforehand, but it is definitely worth it ( Check out the Relaxation article)

During labor, there are many things you can do to sooth the discomfort of the dilation of cervix.

** Shower or bath in early labor, or a birthing pool as labor progresses, can make a world of difference.

** Asking you coach/partner  to give you a light rhythmical massage may help you to relax and focus.

**  Massaging the inner thighs, buttocks, or lover back can help to relieve pressure during labor.

** Midwifery”, called “shaking”, when your partner slowly and rhythmically starts to shake your buttocks and thighs, slowly increasing the rhythm. Gaskin and her midwives were able to use this technique to help loosen tense muscles and start the relaxing for some women who tensed up in the beginning of labor and were experiencing pain as a result of that..

**  Scent is another effective natural labor soother. Some essential oils are relaxing and reduce sensation of pain by increasing the production of endorphins, the body’s natural pain relievers. For example jasmine essential oil is reported to strengthen the contractions while helping them to be less painful. Other helpful essential oils are lavender, chamomile, sweet geranium, rosewood, lemon balm, mandarin and cedar wood. Remember, womans senses are very acute during birth, so do not put too much of any of these scents in the air. Also make sure that you can switch and chose between a few, you can not be 100% sure which scent will make you feel the most relaxed during labor, your perceptions and preferences change so much in order to accommodate your body to carry the perfect birth for you… Try a few of these oils shortly before birth and chose a few that might appeal to you…

Talking about endorphins…

These are natural body hormones which act as very effective pain relievers. One of the best ways to ensure their production is to go into your labor with positive emotions. In a few observational studies, midwives reported that woman that went into their labor with positive emotions and feelings of excitement, showed significantly lesser levels of pain and discomfort later in labor and their labors were shorter on the average. It is explained with release of endorphins shortly after the labor starts.

So while you would want to be calm and rest at the onset of the labor, reserving your strength for later, when the real work begins, and not letting your initial excitement to keep you up at that point. Make sure that you preserve and cherish that feeling of joy and excitement, that Jesus gives each woman at the point of realization ”this is it”, it may be your best painkiller after all!

** One of the most important ways to relieve discomfort during labor is to change positions.

Get off your back. Birthing upright can make labor shorter and less painful. Alternate among sitting, standing, squatting. Do you know that squatting can widen pelvic outlet by 25-30%? During early labor, — walk around, walk stairs to help your contractions to pick up in intensity. Get up on your hands and knees during contractions later on in labor, when you want to take any pressure off your pelvic muscles…

**   A number of acupressure points can also afford significant pain relief.  From what I heared, in China, acupuncture techniques is used instead of epidural anesthesia in 98 % of births.

**  Homeopathic remedy arnica, indicated for sore muscles, can be used effectively during labor as well. Herb catnip helps to calm and relax the body; chamomile tea helps to relieve tension, which largely causes the pain.

 

**   Nutritional supplements such a s calcium, vitamin E, essential fatty acids. And magnesium can ease labor discomfort.

Pain in labor is intensified by fear and tension.

Tension can be result of bad expectations or fear of unknown. And you can become very fearful and nervous when you are disturbed during the childbirth. The muscle contract involuntary during contractions and we can not help them to do that, but what we can do is not to disturb the process. When you feel disturbed during labor you produce adrenaline, which slows production of the hormones of labor: You body assuming that you are in trouble, prepares to stop labor. If your body produces adrenaline at the same time that you uterus is trying to contract, it will cause the muscles to oppose its contractions, and so you will feel more pain.

If, on the other hand you are undisturbed during birth, your body will release a cocktail of chemicals that will alleviate pain, give you amazing ecstatic rush after childbirth, make your baby irresistible to you, and help your breast milk to let down. This cocktail is one of the many benefits of drug-free birth

Drugs in labor unequivocally disturb labor process. The mix of local anesthetics used for epidural blocks can cause varying degrees of maternal, fetal, and neonatal toxicity, according to Physician’s Desk Reference. Adverse effects of pain-relief methods during labor has hardly been studied at all, but we do know that while placenta reduces the effects on the baby of drugs that were given to the mommy, about 70 percent of any medication given the mother does reach the baby. When narcotics are given to the mother the amount is calculated based on the mothers weight and other factors, if a large portion of these medications reaching the baby (the amount of the drugs in relation to baby’s weight), the overdose of it can have a very serious effect on the newborn.

Narcotic analgesics such as Demedrol, Nubain, Stadol slow baby’s heart rate and affect his respiratory system while he is still in the womb, and if given close to birth can affect his breathing after birth. Babies of mothers who received such narcotics show general slanginess, low Apgar scores at birth and sometimes have trouble in the early days. Remnants of the narcotics stay in baby’s bloodstream for weeks

I know it is not easy to brace yourself for the possible pain. But with support, help and relaxation, you can take one contraction at a time. The good news is that God designed it so that you get times of relief between the contractions, and each contraction only lasts a little over a minute. There will be a short period of time in every labor, when you feel like you just cannot do it. But that is usually the sign that you are in the period of your labor called Transition and at that point you are almost at the finish line, — those are the last final stretches of the cervix, just before you will be ready to push your baby right through it. Once your pushing contractions will start, usually they will again space out, and you will be able to even rest and catch a moments of sleep in between them.

Remember, this birth is something you can handle, there are so many wonderful promises on your side, and testimonies of those who went through this experience before you. Don’t let others underestimate you, and don’t underestimate yourself. You cant expect yourself to know everything, especially if this pregnancy is your first. Find another mother who have experienced drug-free birth and ask her to be your guide. Allow yourself to be supported and nurtured through your pregnancy. Model your pregnancy after the pregnancies of those who have had successful natural births. Find a practitioner who has lots of experience with drug free birth, who will support you and believes in you. Trust the Lord and believe in yourself. Your baby does.

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