What I Learned After Two Births in American Hospitals, Plus 9 Tips
By: Heidi Kasa
Tags: Birth, Pain, Agency, Movement, Pain Management

What I Learned After Two Births in American Hospitals, Plus 9 Tips

In the birth world, I feel there’s a big divide between two sides: all technology/medicine/science, and what’s seen as natural/unmedicated/intuitive. It’s easy if you can put yourself into only one camp, and either have a home birth or just go to the hospital and do everything they say. But, like most binaries, a lot of people actually fall somewhere in between.

What I learned after two births in American hospitals: In any of your choices, you need to prepare for how to best help yourself. Sounds simple, right? Below are tips that might you help you.

1. EXPECTATIONS: I entered the hospital for my first birth fully trusting in the healthcare system to do everything to help me. This is an over-reliance on the system. The U.S. healthcare system is in place to provide physical medical assistance. They did do everything to help me — everything they could, which is to say, everything in their medical arsenal. Some of you may already know this (I didn’t, and I feel a lot of women especially don’t know this), but the medical assistance provided to you can vary a lot depending on the knowledge and preparation you bring in. Especially for something like birth, where you can, to some extent, prepare for the upcoming event.

So the first time around we attended all the childbirth classes provided by the hospital, and I read the books that gave information about what happened during pregnancy and various medical considerations around birth. You can see which camp I was headed toward. It seemed like the right path for me. Even if I had no other medical issues, I probably would not have chosen a home birth. Part of that is who I am, and part of that is the lack of information and ability to have home births. Which is a much bigger topic for another day.

But I had other medical issues, so I would give birth in a hospital. I would go on to have a traumatic first birth. There are many reasons for this, but for me, the core is this: I had expected the hospital to support me in every way needed for the birth. They didn’t. But they don’t have the ability or the capacity to do that. They are there for medical assistance.

2. PREPARATIONS: I had not known I needed to prepare my body, my spirit, and my mind for the birth. And arm myself with the right kind of knowledge — not only medical information about everything that can possibly go wrong with pregnancy and births. I was fully stocked with one kind of information, but I still did not have the right preparation to meet the experience fully. I was aware of some medical issues that could come up during the pushing stage (I knew what meconium was), which did help me feel more calm when they did arise. But I didn’t know the body mechanics of pushing. (Which sounds kind of basic, doesn’t it?)

Because to give birth, you need to know yourself and your body, and have confidence in your body. Don’t worry — if you don’t know those and don’t care to, then you can go to a hospital, get an epidural, and still give birth to a healthy baby. That is a choice some women make that is absolutely the best for them. For me to give birth, it turns out I needed those things. It may sound silly that I didn’t know myself and my body, and have confidence in it. It may be even sillier that I didn’t even know I needed those for the birth, or that I inadvertently looked to find those things in the hospital. I looked for compassion and support for my efforts during contractions. I got it from two out of the five nurses I encountered. The other three were damaging in unexpected ways. I thought the nurses would listen to me and respect me, not actively undermine me, outright ignore me, or push their agenda on me. (This was my first major encounter with the medical system, if you can’t tell.)

But this is not about my complaints about a particular hospital or specific nurses, because while I wish that could be fixed, ultimately, the problem lay with me. Because of my medical issues, I was going into a hospital just hoping for an unmedicated “natural” birth — because women have been doing this forever, and because it was a risk to me to get an epidural due to my medical issues. But it was just a hope, because I had not prepared myself to know what I really wanted and needed, and I hadn’t prepared my body and mind in a way where I would have the confidence I needed.

Knowing yourself and your body can be a tough ask, due to the changes in pregnancy upsetting both of those. And due to the historical treatment of the female body…again, a bigger issue for another day. And having confidence in your body going into a life-changing event that you don’t know whether it can handle it? Also tough. I’m hoping some of my lessons learned can help you.

For me, labor and delivery is the most vulnerable I had ever been up to that point. Think about it — you’re in pain, you don’t know what will happen next or how you’ll make it through it, and you have to completely rely on the people around you. But, I implore you to think about your own agency and preparation before, so that you can also rely on yourself.

I went on to have the most amazing experience at the second birth, compared to the worst experience at the first. I’m sure it was due to many factors, not least of it being a second birth where you know more of what to expect and your body has already been through it once. But I also knew what I wanted and needed, and worked to get that support for myself (including a different hospital with better care for mom and baby, having a doula, etc.). I was prepared in the sense that I knew I didn’t want to do it all alone.

3. WHAT FEELS RIGHT TO YOU? Because of my risk factor with the epidural and other medical issues, getting an epidural was not going to be a comforting, relaxing experience for me. Even with a release of some pain, my mind was freaking out, worried about my risks. I had gone into the birth thinking I was either going to be: randomly “good” at tolerating pain — in other words, lucky — or randomly “bad” at tolerating pain, therefore needing the epidural to get through the birth. I didn’t know there are more choices than that. And here is the main point that I didn’t know before my first birth and that I wish I’d known: You can move your body in ways that work to both mitigate the pain, but also give more information to your body and baby to speed up labor.

If I had known this was a third choice, then I would have been motivated to learn and practice these movements, because I am an active person who has a high body awareness. I was really dumb about this, but I was not aware that with an epidural, you become incapacitated. An epidural confines you to a bed, and turns an active process of you giving birth into nurses shoving their fingers in you, telling you when to push. I felt like an object, not a person. Mentally, I hated this experience and feeling. And I had already known this isn’t what I would have wanted to, but I felt I didn’t have another choice.

For my second birth, I found a hospital that offered nitrous instead of only epidurals. I didn’t end up using it, but I was so happy that I had a different option to fall back on that matched more of who I am. For some women, an epidural is the good match. It does not feel passive, and instead is a way they can relax through the experience (I hear). You decide whether you prefer active or passive, and then you can be okay with your decision.

After my first birth, I thought I just needed a better nurse who is actually good at coaching people when to push. What I needed, instead, was more accurate information about using the right muscles for pushing. Neri Choma, a fabulous doula, has a video for expectant couples, in which the last section details the position and how the pushing stage actually works in the body, so you can work with it instead of against the body: https://birthcoachmethod.com/products/practicing-active-birth-visual-guide/

A bonus of the rest of the video is that you can use the movements taught for labor in your last few months to help with pregnancy discomforts. Yes, the video has got some male partners who look really bored. Don’t let their boredom deter you from doing what you need to do. Practicing those movements gets you used to moving in your pregnant body, which helps in pregnancy and birth.

It matters most to do and be what feels right to you. So really get to know yourself when thinking about some common birth scenarios. If it feels right to get pain intervention, do. If it doesn’t in the slightest, then figure out why.

4. MOVEMENT. It’s not only important for an active birth instead of an epidural one, it’s important for being aware of how your pregnant body moves in space. Movement provides information to your body and to your baby. And whatever that looks like for you depends on you. If you like to walk, great. Brisk walking for 25 minutes a few days a week is good for pregnancy. Movement is also important in terms of discomforts in pregnancy. The pregnant body does not like to be in one position for a long time. Try new movements. Get up often, try new chairs, don’t be afraid to shift position while sleeping.

When we’re told medically why something is happening, sometimes we can feel that means there’s nothing we can do about it. But it’s actually just telling us why something is happening — it’s up to us to meet what is happening. If all you know is why it’s happening, instead of possible ways to meet it, then you are in a passive, victim-type state, and you’ll feel upset about it or trapped by it. For example, you might get leg cramps in the night during pregnancy. You can either wait to feel lucky or unlucky, and curse them when you get them. Or you can try relaxing your leg (the cramp goes away faster) if they do happen. If you tense up, the cramp lasts longer. Or you can try eating some calcium before bed (almonds or milk). You can change position. Try something new. Try a gentle stretch, or sitting in a different chair. It can be simple, but moving very often can help with several pregnancy ailments.

Although I know that moving in labor and birth helped me, I don’t think that’s the best route for everyone. I do believe, however, that even if you move during pregnancy and not during birth, it will help you.

5. PAIN. You can’t change whether you’ll have pain or how much — you can only change your response to it. Your relationship to pain. What experiences in your life before have been painful to your body? What do you remember of those pain experiences and how you met them? We think of pain in the Western world as a problem. Something to avoid, erase, solve. We sometimes forget that pain can be information. I know other cultures understand this better than Americans, but it’s something we can learn. Because labor is different pain — it is transformational pain. It is pain that indicates — the worse it gets — the closer you are to the transformation. So that means it’s a good sign when the pain gets worse. And a big difference: I said “mitigate pain.” Expect the movements to take the edge off the pain, not get rid of all pain. If you go into labor wishing to get rid of all pain, then by all means, try the medical pain interventions. (Though I had fentanyl and then an epidural in my first birth, and neither gets rid of all the pain.) Just know that they might come at costs to you that you didn’t think about and may not be okay with. Or, you might be just fine with some side effects. I want you to be in a situation where you feel supported to make the choice that’s right for you — not cornered to take the pain medication only because you feel alone and unsupported and feel it’s your only choice.

What would you do to cope with pain if you had no medicine? That’s what my amazing doula asked me, and it is really good to think about for birth especially.

6. MENTAL WORK OF LABOR. I also did not know that the three main stages of labor ask for different things from us as birthing women. I talked about the physical actions necessary for an effective pushing stage already from Neri Choma’s video, but she also talks about the differences in the stages of labor and how we can meet each of those. I cannot recommend her video enough. It’ll be the best money you’ve spent if you watch it and practice on your own.

The other work of birth, outside of the physical, is surrender. I would say this is probably the main work of labor. It’s most important to accept and relax into your body. Let it happen. This is where knowing yourself and doing what feels right to you is important. If an epidural would help you relax and surrender, then do it. You know yourself. For some women, they are more afraid of the pain than anything else in birth. For others, putting themselves in a passive position confined to a bed will not help you relax. So then don’t get an epidural. If massage and a doula helps you relax and surrender and accept the process and your changing body, then do that.

As a friend of mine said, what she learned after her first birth was: “Take care of yourself, because no one else will.” It sounds harsh, but it’s true because no one else will be giving birth for you. No one else will save you from pregnancy. Decide what support helps you best and seek it out. And I would add that this isn’t some great life changing mystery — it’s usually an extension of who and what you already are, and paying attention to that. If you usually like to read or watch certain shows, just be mindful of sticking to reading and watching shows that you find comforting, funny, or supportive in some way. I learned I was more sensitive during pregnancy to watching violence, so then I didn’t. Trust yourself and your instincts.

Most births sound dramatic without context. So it’s easy to read or hear about a dramatic birth story and just feel like, “Gee, I wish that doesn’t happen to me.” And I can’t tell you what will happen to you. But I can tell you it might help to go into it thinking, instead, “How will I meet this birth, no matter what happens to me? What can I bring from my strengths, and what weaknesses do I know I have, so that I can navigate whatever comes up?”

Women often live without much context of other women all the time in this society. We are isolated from each other, and there are outside pressures on us from the male-dominated cultures and the expansion of technology. So when women talk about their birth stories, honestly, there are a whole host of other factors that can go into what happened.

My weaknesses turned out to be that I don’t like to be passive, I don’t like people invading my body without even asking or telling me (and it was not an emergency situation), and I don’t like people assuming I won’t be good at something before I’ve even started the work. That erodes confidence. And I knew all this about myself before my first birth — I had just not realized those things would be part of the birth, and that at birth, I would be the most vulnerable I’d yet been, so those things could be more damaging.

When I think about the work of birth as surrendering to the process of the body, then I think very differently about how to support and “measure” that. During my first labor, I lay in bed, trying to cope with the pain of contractions with music and heat pads. And that did help, but I also thought I was doing well, and then they’d check my cervix and tell me the number had changed only a little. Then, immediately, hearing a number that I thought had been higher, I judged myself. I must not be doing well. Maybe I couldn’t handle the pain. And I was all alone.

So, for me, having actions to do in labor helped me concentrate more on doing the actions, instead of on whether or not I could handle or conquer the pain. Each contraction is not a test of your limitations (but I had been judging it as that) — they are your body accepting labor and getting closer to ending labor. The contractions can get you to where you are going.

For someone else, pain medication can help with relaxation and surrender.

7. BEING VS. DOING MINDSET. Also when I think about the work of birth as surrendering to the process of the body, I think of the being vs. doing mindset. This was clarified for me by the book “Mindful Birthing,” by Nancy Bardacke (https://www.thriftbooks.com/w/mindful-birthing-training-the-mind-body-and-heart-for-childbirth-and-beyond_nancy-bardacke/431843/item/6814819/?gclid=EAIaIQobChMI0_L554nI8gIVE1VgCh3NgQEIEAQYASABEgJ_qvD_BwE#idiq=6814819&edition=6918712). I had felt it before during my monthly periods, but hadn’t heard anyone articulate it. In the doing mindset, there’s a desire to measure and judge, which can feel counterproductive during labor and delivery, because it can make you feel certain progress and efforts are not enough. The being mindset lets acceptance in. Acceptance, surrendering — those sound similar, eh? And the doing mindset, in our current day and age, feels like our state of being. Always productive. So it can be something you have to cultivate, but I know I feel it about once a month, a desire to go away from the world and all the counting and watching and doing. It’s much more discussed in the book, so I highly recommend that too.

In the hospital, the nurses and doctors are in a doing mindset. They measure your cervix mostly to see how far along you are, although that can actually change drastically even in half an hour. So it’s not an accurate assessment in terms of telling you how long your labor will be. However, when you are exhausted and in pain, emotionally, that number can feel like a barrier or a savior. Something to think about before going into the hospital — it doesn’t necessarily yield important info, unless there’s a medical concern instead of just tracking your “progress,” and it can work against your confidence.

8. PERCEPTIONS. Your perception of the pain and flow of the contractions matters. So it’s good to think about that before birth, too. I can tell you that my first birth felt like the pain never stopped. So when people talk about how the contraction comes, and then it lasts for a certain time, and then it recedes — I was like, what the hell? But I know now that it had to to do with my lack of mental preparation. I had been expecting the pain to be gone completely, with no reverberations. Just completely nothing. So I was, again, disappointed and judging myself for not having that experience. But remember, I was also in a doing mindset. I was waiting for each contraction to come so I could conquer it, and then this whole thing could be over. And this whole conquering thing — isn’t that the opposite of surrendering?

In Nancy’s book and in Neri’s video, they both talk of the need to let go in between contractions. Neri says to fully relax physically, and she coaches you into how to do that. Nancy writes about the kind of mental rest. And Neri says it best: “Don’t wait for the next contraction. Don’t worry, it’ll come to you.” So let it come, but let it go in the meantime. And when she said that, it really clicked for me that I had experienced far more pain in my first labor because I did not take this important rest between the work of the contractions. I had been anticipating the next one, dreading it, and therefore, feeling like I was in pain all of the time. The mental pain compounds the physical.

Which is a good lesson for more than birth, of course. Exercising, dealing with your children — these all have moments of exertion and moments of rest. And you’ve got to learn to breathe and rest, or it will compound the hard work. What it means to me outside of birth is that whatever pain/problem you are having, don’t only keep thinking about that in the inbetween times when you aren’t experiencing the full capacity of the problem (pain, children’s tantrums). If you do, then you will have this perception that the problem is bigger and more long-lasting than it is.

9. SUPPORT. In my second birth, I had an amazing doula and I could not recommend her more highly. There are so many options in terms of doulas for different ranges of pay, and student doulas who sometimes attend births for free to gain experience. Even a woman in your life whom you know respects your agency can do wonders for not feeling alone with your contractions. I believe a doula is indispensable to supporting you when you are so vulnerable. The other people in the room are supporting you in other ways (partner — emotional, etc., medical team — medically). But the doula is supporting your physical and mental efforts during the birth. Then you are not alone in dealing with your contractions. I believe a doula helps, no matter how the labor goes.

Do I wish nurses and medical teams would better understand women’s agency and have respect for women? Yes. But we do live in the patriarchal society we live in, and these ideas carry into all aspects of life. And I know the nurse who was negative about my ability to cope with labor without pain medication is just numb and overworked. I do wish she wouldn’t do the work of undercutting women that some men do, but I also know I should’ve been prepared to find that anywhere — even in the most vulnerable state of labor in the hospital where I thought I’d be supported.

TO SUM UP

— Get to know yourself again, even in the tumultuous process of pregnancy. Then you will be able to prepare the way YOU need to.

— No matter what kind of birth you desire or ultimately receive, learning proper body mechanics for pushing can help.

— Seek out the small but important things that matter, and people who know these things. For example, some doctors don’t know that lying on your side during the pushing stage can prevent the baby’s head from getting stuck. They are mainly trained in medicated childbirth, and don’t use some of those “natural” tactics that can prevent medical interventions.

— Think about how you might learn to relax, surrender, and accept the process of birth, including pain and discomforts. How will you meet whatever happens, and perhaps change your relationship to it?

— Take care of yourself, because no one else will. You are the one who carries the pregnancy and gives birth. Take your first step into the role of mama, and protect your boundaries, whatever they may be.

I hope we can all learn how to better support women’s agency. And, oddly enough, that starts with you getting to know yourself, especially when thinking about the birth process.