Abby Block, CM, LM, IBCLC, LCCE

Midwife & Lactation Consultant

Partners & Doulas: What you need to know

Abby BlockComment

You've chosen your doctor or your midwife; you've decided on the hospital, the birthing center, or giving birth at home; you've decided on a natural birth or that you'll use pain medication or maybe something in between; you have a list of baby names; you have the baby gear list... so what's missing? Your doula, of course! For some couples, whether or not to hire a doula is not an easy choice. One of the main concerns I hear from couples - especially those who are planning to have a natural birth with full support of their partner - is that they wonder if a doula is really necessary. Completely valid question. Below is an article that gives you some perspective on the Doula and the Dad - although  prefer to use the term " birth partner" as there's not always a dad in every birthing couple!

Excerpt:

"But doulas aren't there only for moms-to-be. They also play a key role in helping their partners, offering them invaluable emotional and practical support during the overwhelming experience of childbirth. "I see myself as having many roles, fitting in where I am needed, lifting up and supporting the partner in order for them to support the laboring mom," says Zoe Etkin, a birth and postpartum doula and women's sexual health coach in Los Angeles. "Looking back on the birth, I hope they will both remember how connected they were, and I will just fade into the background. Although I believe my role is important, it's ultimately about the birthing couple."

Even so, it's common for dads-to-be to worry that having a doula during delivery might push them out of the main labor support role. Doulas insist that couldn't be further from the truth. "I'm there to accentuate their involvement, not to take their place," explains Gena Kirby, a doula of 10 years, childbirth educator, and host of Progressive Parenting radio. "Partners have taught me so much over the years about different ways to approach different personalities and births."

Full article here.

The Truth About Your Due Date

Abby BlockComment

Get some perspectives on your due date, or "EDD" (estimated due date), as well like to call it. Read what a midwife, a doula, an OB, a labor nurse, an acupuncturist, and a pediatrician have to say about. it And in case you didn't know already, only about 5% of women give birth on their due date. The rest of us tend to naturally go somewhere from week 37 (full term) to week 42. There are exceptions to this, of course - as always, with birth. My best advice on the "due date" situation is to consider it your due month, and when people ask you when you are due, you give them the month, not the date :)

Read the article on due dates from Well Rounded NY here.

Perineal Massage: What's it for and should you bother?

Abby BlockComment

I get asked this question quite frequently by my doula clients, and this is the best article I've found that explains the evidence on perineal massage.
 

What Is the Evidence for Perineal Massage During Pregnancy to Prevent Tearing?

December 18th, 2012 by Sharon Muza

By Rebecca Dekker, PhD, RN, APRN of Evidence Based Birth

Do you talk about perineal massage with your students, clients and patients and state that perineal massage during pregnancy will/will not reduce tearing during birth?  today, Rebecca Dekker, of Evidence Based Birth takes a look at the research on perineal massage during pregnancy and provides information on the outcomes for women who practiced this and those who didn’t.  Does the research support what you have been saying? – Sharon Muza, Community Manager

__________________

 

http://flic.kr/p/5XmJtL

Tearing during childbirth is a common occurrence among women who have a vaginal birth. In studies where the use of episiotomies was restricted, the rate of spontaneous tearing was recorded to be anywhere from 44-79% (Soong and Barnes 2005; Dahlen, Homer et al. 2007). Studies have consistently shown that women are more likely to experience tearing during a first vaginal birth and with forceps and vacuum assistance (Aasheim, Nilsen et al. 2011).

Spontaneous tears can be classified as first, second, third, or fourth degree tears. First degree tears involve only the perineal skin, while second degree tears involve both the skin and the perineal muscle. Third degree tears involve the anal sphincter, while fourth degree tears involve the anal sphincter and tissues. Third and fourth degree tears happen at 0.25% to 2.5% of spontaneous vaginal births (Byrd, Hobbiss et al. 2005; Groutz, Hasson et al. 2011).

Women are more likely to have a third or fourth degree tear if they are giving birth vaginally for the first time, if a baby is in the posterior position or has a heavier birth weight, and if forceps, vacuum, or episiotomy are used (Christianson, Bovbjerg et al. 2003; Groutz, Hasson et al. 2011; Hirayama, Koyanagi et al. 2012).

What is perineal massage?

It is thought that massaging the perineum during pregnancy can increase muscle and tissue elasticity and make it easier for a mother to avoid tearing during a vaginal birth. Typically, women are taught to spend about 10 minutes per day doing perineal massage, starting at about 34-35 weeks of pregnancy. Women are taught to insert 1-2 lubricated fingers about 2 inches into the vagina and apply pressure, first downward for 2 minutes, and then sideways for 2 minutes. The massage can be done by the woman or her partner, and sweet almond oil is sometimes used for lubrication (Labrecque, Eason et al. 1999).

What is the evidence for perineal massage?

In 2006, Beckmann and Garrett combined the results from four randomized, controlled trials that enrolled 2,497 pregnant women. Three of these studies involved only women without a previous vaginal birth (mostly first-time moms). One study enrolled women with and without a previous vaginal birth. All four of the studies were of very good quality.

Beckmann and Garrett found that women who were randomly assigned to do perineal massage had a 10% decrease in the risk of tears that required stitches (aka “perineal trauma”), and a 16% decrease in the risk of episiotomy—but these findings were only true for first-time moms.

It is important for you to understand that this is a 10% reduction in relative risk, and relative risk is different than absolute risk. Let me give you an example. Say you are a first-time mom, and let’s pretend your absolute risk of perineal trauma is 50%. A 10% decrease in relative risk means that your absolute risk decreases by 5% (because .5 X .1 = .05). So for you, doing perineal massage reduces your absolute risk of perineal trauma from 50% to 45%.

*As a side note, all of the numbers I am reporting below are changes in relative risk.

Importantly, for second-time moms who had already had a vaginal birth, prenatal perineal massage did not reduce the risk of perineal trauma (any tearing requiring stitches). However, second-time moms who massaged did report a 32% decrease in the risk of ongoing perineal pain at 3 months post-partum.

Surprisingly, Beckmann and Garrett found that the more frequently women used perineal massage, the less likely they were to see any benefits. Women who massaged an average of 1.5 times per week had a 17% reduced risk of perineal trauma and a 17% reduced risk of episiotomy. Women who massaged between 1.5-3.4 times per week had an 8% reduced risk of perineal trauma.

 

http://flic.kr/p/8pLkpV

Interestingly, women who massaged > 3.5 times per week experienced NO benefits and had a longer pushing phase of labor by an average of 10 minutes. So basically the finding was: the less frequent the massage, the better off the outcomes. However, this finding was unexpected, and the researchers had a hard time explaining it. I think we should interpret this result with caution, because in the largest clinical trial on perineal massage (included in Beckmann and Garrett’s review), Labrecque et al. (1999) found that the more often women did the massage, the more likely they were to avoid any tears.

Other results: 

There were no differences between women who did prenatal perineal massage and those who did not with regard to:

  • • First degree tears
  • • Second degree tears
  • • Third or fourth degree trauma
  • • Use of forceps or vacuum during delivery
  • • Sexual satisfaction 3 months post-partum
  • • Pain with sexual intercourse 3 months post-partum
  • • Uncontrolled loss of urine or bowel movements 3 months postpartum

Wait, I’m confused. You say that there was a significant decrease in perineal trauma requiring suturing. But there was no difference in 1st, 2nd, 3rd, or 4th degree tears. How can this be?

It’s important for you to understand that perineal trauma is an “umbrella” category that means all types of trauma requiring stitches, including episiotomies. Perineal massage during pregnancy decreased the overall risk of perineal trauma (the umbrella outcome), but the effect was too weak to see any difference with each of the individual outcomes (first degree, second degree, etc.). Also, the researchers think that the overall decrease in perineal trauma may have been due to the decreased episiotomy rate in the perineal massage group.

Why would perineal massage during pregnancy reduce the rate of episiotomies, but not tears?

The researchers guess that the women who were trained in perineal massage were highly motivated to birth with an intact perineum, so maybe they were more likely to refuse an episiotomy. Fewer episiotomies would then mean fewer incidents of trauma requiring stitches.

So what can we learn from the evidence?

During pregnancy, massage of the perineum can reduce the risk of tearing requiring stitches, but this benefit is only seen in moms giving birth vaginally for the first time. It is thought that most of the decreased risk of perineal trauma was due to a decrease in the episiotomy rate. In the largest study included in this review (Labrecque et al., 1999), there was an overall episiotomy rate of 38%. In the U.S., 25% of women have an episiotomy during a vaginal birth (Declercq, Sakala et al. 2007), and rates are even lower for some providers.  It is possible that these research findings might not apply to birth settings where episiotomies are extremely rare.

Second time moms who use perineal massage will not see any decrease in their risk of tearing, but they may reduce their risk of ongoing perineal pain at 3 months postpartum.

So in summary, for first-time moms only:

Perineal massage during pregnancy

Decreased risk of episiotomy

Decreased risk of trauma requiring stitches

If women choose to use perineal massage during pregnancy, there is no consensus on the amount of massage needed to reduce the risk of tearing.

Questions for discussion: Do you recommend prenatal perineal massage to others? Have your thoughts about this intervention changed after reading this article? 

References

Aasheim, V., A. B. Nilsen, et al. (2011). “Perineal techniques during the second stage of labour for reducing perineal trauma.” Cochrane Database Syst Rev(12): CD006672.

Beckmann, M. M. and A. J. Garrett (2006). “Antenatal perineal massage for reducing perineal trauma.” Cochrane Database Syst Rev(1): CD005123.

Byrd, L. M., J. Hobbiss, et al. (2005). “Is it possible to predict or prevent third degree tears?” Colorectal Dis 7(4): 311-318.

Christianson, L. M., V. E. Bovbjerg, et al. (2003). “Risk factors for perineal injury during delivery.” Am J Obstet Gynecol 189(1): 255-260.

Dahlen, H. G., C. S. Homer, et al. (2007). “Perineal outcomes and maternal comfort related to the application of perineal warm packs in the second stage of labor: a randomized controlled trial.” Birth 34(4): 282-290.

Declercq, E. R., C. Sakala, et al. (2007). “Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences: Conducted January-February 2006 for Childbirth Connection by Harris Interactive(R) in partnership with Lamaze International.” J Perinat Educ 16(4): 9-14.

Groutz, A., J. Hasson, et al. (2011). “Third- and fourth-degree perineal tears: prevalence and risk factors in the third millennium.” Am J Obstet Gynecol 204(4): 347 e341-344.

Hirayama, F., A. Koyanagi, et al. (2012). “Prevalence and risk factors for third- and fourth-degree perineal lacerations during vaginal delivery: a multi-country study.” BJOG 119(3): 340-347.

Labrecque, M., E. Eason, et al. (1999). “Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy.” Am J Obstet Gynecol 180(3 Pt 1): 593-600.

Soong, B. and M. Barnes (2005). “Maternal position at midwife-attended birth and perineal trauma: is there an association?” Birth 32(3): 164-169.

About Rebecca Dekker

Rebecca Dekker, PhD, RN, APRN, is an Assistant Professor of Nursing at a research-intensive university and author of www.evidencebasedbirth.com. Rebecca’s vision is to promote evidence-based birth practices among consumers and clinicians worldwide. She publishes summaries of birth evidence using a Question and Answer style.

 

The Forgotten Art of Untucking The Tail

Abby BlockComment

Very interesting as it relates to birthing a human...

“Modern birthing science has placed a large burden on secreted hormones (like relaxin) to prepare the body for needed mobility.” Katy Bowman says. Yes, hormonal relaxin is useful in letting the body open up for the birth, but it’s not enough, unless we have strong muscles that can fully contract, but also fully release. But then, strong isolated muscles are not enough either. In order to have smooth births we need to have a whole-body endurance. A great way to develop endurance is to walk as much as you can. “The woman who wants to go about a birthing process naturally can follow the lead other “natural” processes women have been doing for millennia — walking 5–6 total miles per day, and squatting to bathroom multiple times daily” — she adds.

Read the full article here.

 

Using a Mother’s Microbes to Protect Cesarean Babies

Abby BlockComment

"The first germs to colonize a newborn delivered vaginally come almost exclusively from its mother. But the first to reach an infant born by cesarean section come mostly from the environment — particularly bacteria from inaccessible or less-scrubbed areas like lamps and walls, and skin cells from everyone else in the delivery room.

That difference, some experts believe, could influence a child’s lifelong health. Now, in the first study of its kind, researchers on Monday confirmed that a mother’s beneficial microbes can be transferred, at least partially, from her vagina to her baby after a C-section."

Read the full article from the NYT Well Blog here.

The Big Baby Card

Abby BlockComment

Below is an excerpt from When A Big Baby Isn't So Big

"The new study, called Listening to Mothers III, was based on Childbirth Connection’s nationally representative survey of some 1,960 new mothers. It found that four out of five of the mothers who were warned they might have large babies gave birth to infants who were not large, and weighed less than 8 pounds 13 ounces.

Yet these mothers were almost twice as likely to have medical interventions such as having doctors medically induce their labor or attempting to self-induce labor, presumably out of concern the baby would continue growing otherwise. They were also nearly twice as likely as other mothers to have a planned cesarean, though the increase fell just short of being statistically meaningful."

Evidence Based Care for Pregnant Women

Abby BlockComment

Ever wonder what evidence-based care is? This great free video series by Rebecca Dekker, PhD of Evidence Based Birth does an excellent job of explaining what evidence-based care is and how to get it. A must watch video series for expecting parents - even if you are not pregnant yet! In fact, the sooner parents-to-be have access to this kind of information, the better. Whether you are interested in a natural birth, home birth, hospital birth, cesarean birth, birth with a doula, or birth without a doula, midwifery care or medical care model, this video series is for you! There's also a great video on the evidence for birth plans. Very enlightening. Enjoy!

Click here to watch the Evidence Based Birth video series: Do Birth Plans Really Work?

YOUR BIRTH, YOUR CHOICE!

Abby BlockComment

Seriously! As a doula, I support my clients' personal choices. Only each woman can know what is right for her when it comes to choosing a birth location, a care provider, and what type of care she would like to receive. There are so many different ways to give birth, which is wonderful, because there are so many kinds of women!

I love this quote from this recent article that explains some of the current controversy going on in the birth world:

How and where and whether someone has a baby is, by and large, every bit as personal as the business that led to conception in the first place.

Isn't that the truth?

Read the full article here.


Avoiding the costs and risks of Cesareans

Abby BlockComment

One of the big reasons I get hired by my clients is because they want to avoid a c-section. In the U.S., our national c-section rate is about 33%, just over more than twice that of the rate recommended by the World Health Organization, which is 15%. Why are they performed so often then? Many people believe it's motivated financially, which it may be in some cases, but for most, it may be more motivated by the risk tolerance of a woman's OB. 

Read more here: http://www.latimes.com/business/la-fi-healthcare-watch-20151113-story.html?utm_content=24577747&utm_medium=social&utm_source=facebook

A Better Article for the Public About Doulas

Abby BlockComment

Recently, on my Facebook feed, there have been a bunch of articles circulating about doulas. Most of them accurately describe the general benefits and the research that proves we are a positive influence on a woman's birth experience and outcome. But then the articles often take funny twists and spiral down an odd road, describing the downsides of a doula, or scenarios which completely misrepresent the doula industry. (Most commonly the bring up doulas who don't support epidurals. I know a lot of doulas in NYC, and every single one of them, including me, supports a mother's choice to use an epidural in labor.) What if all articles about OGYNs or midwives or dentists, or geez, babysitters did the same thing and focused on a misperception that is uncommon in their industry? In any case, here's an article, for once, that doesn't seem to do that. Hurray!

Read the lovely article here: Doulas, What They Do and Don't Do, by Amelia Pang. Excerpt below.

"A doula is a non-medical professional who is certified to give physical comfort and emotional support to a woman before, during, and after delivery. Doulas can provide essential information about birth, and are on call 24-hours a day.

Although studies show doulas can greatly improve birth outcomes, not many women in the United States hire doulas.

According to the Second National U.S. Survey of Women’s Childbearing Experiences taken in 2006, only 3 percent of women said they used a doula during childbirth.

This is partly because there are some misconceptions about what doulas are and what kinds of services they provide."

Exercise & Pregnancy: Surprising Benefits!

Abby BlockComment

So many benefits! More than you think. Here's one:

But now a growing body of research — mostly done on rodents — is revealing just how beneficial it is for the offspring when their mothers exercise during pregnancy. In 2014 researchers at Dartmouth College revealed that exercise during pregnancy enhances brain function in offspring, and that this boost to the brain continues into adulthood. In 2015 a team at the Washington University School of Medicine found that exercise in pregnancy lowers the risk of heart defects in offspring.

Read the full article here.

Doula Support Could Improve Health Care & Reduce Costs

Abby BlockComment

Well, this one kind of seems like a no-brainer and no big surprise, but read the story on NPR if you need more of a reason to get a doula! An excerpt is below:

" Previous research has shown lower rates of cesarean births, more satisfaction from mothers and better newborn Apgar scores — a measure of a baby's condition at birth — among mothers who use doula care. In fact, the American Congress of Obstetricians and Gynecologists says in guidelines for safe prevention of cesarean births that doula care is "probably underutilized."

This is the first study, however, to show a reduction in preterm births and a net savings for public insurance. Cesarean births — about a third of all U.S. births — cost about twice as much as vaginal births, and the 1 in 10 U.S. infants born preterm (before 37 weeks) incur medical costs 10 times greater than those of full-term infants."

Doulas for ALL

Abby BlockComment

To read the full report on insurance coverage of doula care, click here. Thank you to Choices in Childbirth and Childbirth Connection for putting this long overdue information together. Here's the intro:

"Doula support is a proven strategy to improve the quality of maternity care – leading to better health outcomes and a more satisfying experience of care.  But too many women still cannot afford doula support, despite its proven benefits.

Choices in Childbirth and Childbirth Connection, a program of the National Partnership for Women & Families, have been working together on a joint issue brief, “Overdue: Medicaid and Private Insurance Coverage of Doula Care.” The brief documents how widespread access to doula support would improve outcomes for women and babies, enhance women’s experience of care, and reduce the cost of care. Doula support is a high-value form of care that warrants widespread Medicaid and private insurance coverage and the brief identifies a variety of strategies to achieve this. These range from pregnant women and advocates making the case to individual insurance plans, to new pathways to obtain Medicaid coverage of doulas as non-licensed practitioners, to designation as a recommended preventive service by the U.S. Preventive Services Task Force, and asking Congress to act to ensure that doula care is a universally covered service under Medicaid."

http://choicesinchildbirth.org/our-work/advocacy-policy/doulacoverage/

Understanding the Risk of Hemorrhage During Childbirth

Abby BlockComment

I hesitate to put articles up like this on my blog here because if you are pregnant, the last thing you need to read is a scary stuff about giving birth. However, there's a fine line between that and being educated. Personally, I veer towards knowing more, but I know that's not everyone's cup of tea. So read on if you want to know more about this topic, but skip on if you don't!

Read the article: Understanding the Risk of Hemorrhage During Childbirth

Eating during labor? YES, it's very important!!

Abby BlockComment

Newsflash, everyone: Eating during labor is safe, and might even be beneficial! (Insert some sarcasm and eye rolling.) Can you imagine running a marathon and not being able to have anything except water and ice chips? For women in labor, who are embarking on one of the most physically (and emotionally) intense experiences, eating and drinking to hunger and thirst is essential. Read more here.

Things you can stop worrying about in pregnancy!

Abby BlockComment

Great article here! You have enough to worry about it as is, so check out this article to help you let go of some of those things that may have been weighing on your pregnant mind . . .

PREGNANT? 11 THINGS YOU CAN STOP WORRYING ABOUR RIGHT NOW, by Dr. Aviva Romm
October 23, 2015, published on Mind Body Green

As a family doctor specializing in obstetrics, a midwife for 25 years, and the mama of four grown kids, I know firsthand what women go through during the precious nine months of pregnancy. And if there’s one universal emotion I’ve seen, it’s worry. 

Worry is a normal response to the uncertainties of pregnancy, as well as to caring deeply about our babies. And there are a lot of legit things to be concerned about, like the health effects of the chemicals in our cosmetics and the antibiotics in our foods. 

The truth is, most babies are born healthy and perfect. And when there is a problem, it’s just not your fault.

But here's the thing: While we should definitely pay attention to the risks we can avoid — and make the most educated choices we can — worry itself doesn't usually help. In fact, it tends to make us lose sleep and feel overwhelmed, and can even affect stress hormones in ways that affect pregnancy and labor. 

So, to encourage you to step away from the stress, here's a list of 11 things you definitely don't have to worry about during your pregnancy: 

1. Harming your baby.

I find that the most common fear is that we’re going to do something that harms our baby. The truth is that most congenital problems are a result of genetics or an environmental exposure that we didn’t even know about or had no control over. 

If you’re reading this, my guess is you’re already a health-conscious adult and aren’t regularly engaged in activities that can harm baby, like drinking excessively or using cocaine. 

The truth is, most babies are born healthy and perfect. And when there is a problem, it’s just not your fault. Period. 

2. Eating for two.

The idea that we have to "eat for two" in pregnancy is a flat-out myth — and one that has encouraged women to both suspend good dietary habits and worry about whether they're getting enough. 

The truth is that during the first and second trimesters, you don’t need any more calories than usual. And by the third trimester you only need 300more calories a day (double that if you’re pregnant with twins). That's the equivalent of just a glass of milk and half a sandwich. 

So if you're eating an overall healthy diet, let go of the worry that you’re not eating enough for baby. 

3. Having sex during pregnancy. 

Having sex while you're pregnant doesn't usually cause miscarriage or preterm labor. The only precaution? Making sure your sexual partner doesn't have any diseases that could be passed on to the baby. 

But if you're having symptoms of miscarriage, preterm labor, or have what's called placenta previa, that’s a different story — follow the “nothing goes in the vagina” rule until your midwife or doctor clears you. 

4. Eating foods that could give your baby allergies.

A lot of food-conscious mamas avoid dairy, gluten, nuts, and soy during pregnancy, worrying about how it will affect their baby. But while nutrition is super-important, restricting foods during pregnancy has not been found to prevent allergies. In fact, it may even increase risk

So unless you have to restrict certain foods for your own health, liberating your diet can actually be beneficial to your baby. Keep it healthy, but don’t restrict. 

5. Sleeping on your back.

You’ve probably heard that you shouldn’t sleep on your back during pregnancy because it can cut off oxygen to your baby — and that might be leading to a lot of uncomfortable nights on your side. 

But until you’re six months pregnant, this isn't something to be concerned about. After six months, the weight of the baby and your uterus can cause pressure on a large vein called the inferior vena cava, restricting blood flow to you and baby. 

However, if you find that you’ve rolled over onto your back during the night, don’t worry! It’s very unlikely that this would cause harm to baby. 

6. Stress during pregnancy.

You might have heard that a mom being stressed during pregnancy can affect the baby’s long-term mental health. The irony is that this very information is what gets pregnant mamas all stressed out! 

The truth is that you’d have to be under a lot of stress (we’re talking war zones or violent homes) for stress to have a serious impact on your baby’s health. 

The normal stresses most of us experience daily — money worries, relationship tensions, and job anxieties — are not going to cause your baby to have three heads or lifelong depression. As a species, we’ve given birth to healthy offspring under much worse threats. 

You can’t force a homebirth, vaginal birth, unmedicated birth, or a perfect story. And worrying about it is not going to get you there.

7. Being a vegan or vegetarian. 

No, you don’t have to eat meat and dairy — you can be vegan or vegetarian and have a perfectly healthy pregnancy. In fact, I was vegetarian for three of my four pregnancies. 

Just make sure your diet includes plenty of vegetarian protein sources(legumes, beans, nuts, and seeds), calcium (organic tofu, almonds, tahini, and green leafy veggies), and iron (legumes, green veggies, red beans, dried apricots, and raisins). And if you're vegan, make sure to take a B-12 supplement. 

Work with your midwife or an integrative nutritionist who is pregnancy-savvy to make sure you’re meeting your prenatal nutritional needs. 

8. Normal pregnancy symptoms.

Pregnancy brings with it some quirky symptoms, including nausea, increased urination, round ligament pain, breast tenderness, changes in your sense of smell and taste, sleep disturbances, mood changes, and many more. Knowing what’s normal — and what’s not — can make a huge difference in letting go of unnecessary worries. 

There aren’t too many symptoms to worry about, so make sure to talk with your midwife or doctor about those. You can also learn about natural solutions for common symptoms in my book, The Natural Pregnancy Book

9. What labor will be like.

Labor can't be controlled. All you can do is set a destination on your GPS, prepare well for the journey, and then move gracefully through any obstacles on the way. 

You can’t force a homebirth, vaginal birth, unmedicated birth, or a perfect story. And worrying about it is not going to get you there. 

The best thing you can do is prepare for labor. Take childbirth classes and read books that are supporting of the kind of birth you hope to have. (I recommend Spiritual Midwifery and Birthing From Within to start.) You can also take a hypnobirthing class to give you mind-body skills that can help.

If something comes up that requires you to reroute your plans — for example, a medical reason to have a cesarean — it’s totally appropriate to grieve. But be gentle with yourself and just make sure you’re in good hands. It’s all good. 

10. Dying.

OK, truth be told, the most common fear that women experience is probably fear of death — our own, our baby’s, or our partner's. 

Fear of our own death stems from the intense uncertainty of the process of birth, compounded by the historical risks, magnified by movies in which birth is depicted as dangerous and even life-threatening. That can make birth feel really terrifying. 

The reality is that there is an infinitesimally low for healthy women in the U.S. There's also a very low infant mortality rate

Remind yourself that it’s normal to have such thoughts. And then have an affirmation or meditation you can use to transform the fear. Talk your worries out loud with your midwife or other women, or write them down in a journal. If you're severely plagued by worry or anxiety, it's important to talk to a prenatal mental health professional. 

11. What other people think.

The hard fact is that women can be really judgmental with one another around pregnancy and parenthood choices. 

I’ve had many wonderful women tell me they were kicked out of natural mom online groups because they had an epidural or needed a C-section. My response? What other people think is not your worry. 

How you do your pregnancy, birth, and parenting is your business alone. If you’re worrying about what other people think, please, stop right now — because it will keep you from making the choices that are best for you and your baby. 

And when you make the choices that are right for you, your family and friends will get on board, and you’ll find the right mommy groups for yourself too!

 

http://www.mindbodygreen.com/0-22112/pregnant-11-things-you-can-stop-worrying-about-right-now.html