The Clock is Ticking ⏰

Getting ready to give birth: vaginal vs caesarean delivery, preparing my body, and practicing for labour

Hello friends,

I’m back!

First of all, apologies for the last couple of weeks of radio silence. It has been (and still is) quite hectic on my end as we’ve just gotten back to the Philippines from a trip to Germany in time to move into a new house for a few months. I say “for a few months” because the house we were actually supposed to move into has been undergoing repairs all year and still won’t be ready until the end of this year. With a baby due in a few weeks, you can imagine how much needs to get done. We’ve also just gotten internet 2 days ago as I write this, so that’s another reason I haven’t been able to sit down to do any research and writing.

I have been working on a series on breastfeeding, which is a big topic and will be rolled out over a few weeks instead of one.

For this week, just to ease us (me) back into the routine of things, I thought I’d share a few things as I prepare for labour. I’m 34 weeks pregnant, so the clock is ticking!

Me a few weeks ago, around 32 weeks pregnant

Deciding Between Vaginal Birth and Caesarean

Why I want a vaginal birth:

• I would prefer to spend as little time in the hospital as possible, and short-term in-hospital recovery for vaginal birth is often shorter than c-section if there are no complications

• I am worried about scarring or complications in recovery, since a c-section is a major surgery and I am not familiar with the hospital

• My husband will not be allowed to be with me during a caesarean birth

• Cesarean sections seem to increase risks for later pregnancies (Oster, 2021) and would make me more likely to need a repeat cesarean for future births (though I do know of some mommas who had vaginal births following c-sections)

• Vaginal birth is overall cheaper (not that this was a deciding factor, but it helps tilt the scale)

Reasons for c-section

Some people prefer to have a planned c-section for many reasons. They could have “elective” reasons, where there is no medical need for a c-section, or they could be medical reasons.

Some examples of elective reasons:

• You can schedule the date of delivery

• Some hospitals offer a tummy tuck directly after, so you don’t have to suffer the post-pregnancy belly

• Lower risk of incontinence, vaginal bleeding, and sexual dysfunction after birth

• Lower risk of baby experiencing trauma or lack of oxygen during delivery

Some examples of medical cases in which a c-section may be recommended / necessary:

• Placenta previa (when the placenta lies low in the uterus and covers all or part of the opening to the vagina)

• Developing gestational diabetes, pre-eclampsia, high-blood pressure, or a similar medical condition which would make vaginal birth risky

• Having twins or multiples

• Birth defects such as severe hydrocephalus (when fluid builds up in baby’s brain)

• Pregnant woman has HIV or genital herpes

As for me, I have discussed with my doctor the scenarios in which I would be open to a c-section. These are all medical reasons:

• Baby is in distress, and it would be a choice of life or death for her and/or me (e.g. umbilical cord is pinched or wrapped around baby’s neck, baby is not getting enough oxygen)

• Risk of infection or some other complication arising from the baby passing through the vagina

• Baby’s head is too large to fit through the birth canal, also known as cephalopelvic disproportion (CPD)

• Over-exhaustion where it’s clear that a vaginal birth would no longer be possible because labour is not progressing

Preparing the Body for Birth

1. Perineal massages

What is it?

It’s a massage which aims to stretch your perineum to get it ready for birth. The perineum is the area between your genitals and anus, and is the part that often tears during a vaginal birth. Scary, I know! Although, especially in Germany, we are often recommended several oils and teas to prevent tearing, the only methods with solid evidence showing a reduction in vaginal tearing are using a wet, warm compress to soften the perineum (or a water birth if this is an option for you) and perineal massages.

When to do it?

• Start at the beginning of week 34.

• First start with 5 mins / day and move on to 10 min / day once you get closer to your due date. It doesn’t seem like a lot, but trust me.. I struggle to even make it to 5 minutes at this point!

• If possible, do it after a warm bath. This is a good time because blood vessels in the area are already dilated, making the perineum softer and more comfortable to massage.

How to do it?

For the sake of saving time and word count, here’s a simplified guide:

• Wash your hands thoroughly and make sure your nails are clean and short to avoid infection and scratching.

• Choose an oil (natural oils, lubricants; there are also “perineal massage oils” you can purchase) and place it on your fingers and perineum.

• Prop yourself up comfortably with your legs apart. If you can’t reach your perineum at this stage, your partner may have to perform the massage instead. That’s just a sacrifice he/she’s going to have to make.

• Put two fingers or thumbs 2.5cm to 4cm just inside the back wall of your vagina. Press down towards your anus and spread the fingers apart to the sides, so it stretches downwards and outwards. It may be pretty uncomfortable the first few times, but breathe through it! Hold this for 1-2 minutes.

• Gently massage the lower curve of the vagina, massaging in a U-shape to continue stretching the perineum. Repeat this for 2-3 minutes.

2. Prenatal massages

Apart from perineal massages, I’ve been getting a lot of foot massages and antenatal massages at home. It helps to circulate blood flow, which is so important these days as my extremities have been swelling like crazy! I don’t think I’ve seen my ankles in weeks.

Contrary to popular belief, there is no magic button on your body that will accidentally induce pregnancy, but a prenatal massage should be light and relaxing. Since we can’t lie on our stomachs, you can do them sitting down or lying to one side. It’s best to check with your massage provider to check if they are trained or informed about prenatal massage.

It helps:

• reduce stress hormones

• relax and loosen your muscles

• increase blood flow

• keep your lymphatic system working at peak efficiency

and relieve:

• insomnia

• joint pain

• neck and back pain

• leg cramping

• sciatica

• swelling in your hands and feet (as long as that swelling isn't a result of preeclampsia)

• carpal tunnel pain

• headaches

• sinus congestion

There is some evidence about acupuncture also being great to prepare for labour, but I haven’t included it in this issue.

3. Exercise and staying active

Bed rest has been proven to be more harmful than helpful for pregnancy.

If your doctor prescribes bed rest, try to understand why and whether there is significant evidence to prove that it helps. A majority of the time, women are prescribed bed rest to prevent preterm birth, but there is no evidence that this works.

“Plus, there are actually medical risks to bed rest—bone loss, muscle atrophy, weight loss and, in some studies, decreased infant birth weight. There is some evidence to suggest that bed rest increases the risk of blood clots (to avoid this, women on bed rest sometimes wear compression socks).” (Emily Oster, Slate 2013)

Instead, it helps to stay active and healthy throughout your pregnancy. Here’s what I try to do:

• Daily walks

• Kegel exercises 1-3 times per day (so important for your pelvic floor!)

• Prenatal yoga 3-5 times per week (or daily, if you’ve been practising regularly)

• Pregnancy-safe low intensity strength training 3 times per week

• Pregnancy-safe cardio 2-3 times per week (brisk walking, inclined walking, swimming)

Practicing for Labour

I will be trying to have a relaxed, vaginal birth using techniques I’ve learned from hypnobirthing (Miller, 2019). As my husband and I prepare for the big day, we practice the following to hopefully help us keep calm and trust my body during labour and birth:

1. Breathing techniques

There are different breathing techniques out there, but these two are specifically those from Hypnobirthing. You can also check out Lamaze and Hypnobabies techniques and resources, for example.

UP BREATHING

Use this technique in the first part of active labour.

(WATCH: How to Nail Up Breathing || Hypnobirthing Breathing Techniques)

• Close your eyes and inhale slowly and deeply, through your nose, for a count of approximately four beats

• Exhale slowly and lightly through your mouth, for a count of approximately eight beats

• Practice doing this 4 times because contractions (or as they’re called in hypnobirthing, “surges”) should last for around 4 of these breaths

DOWN BREATHING

Use this technique in the pushing part of active labour.

(WATCH: Why you don't need to push when giving birth || Down Breathing || Hypnobirthing Breathing Techniques)

• ‘Self directed pushing’ - encouraging a woman or birthing person to be in tune with their own body and to respond to it’s cues

• No counting, just take a deep inhale and exhale your body downwards

• Breathe out as if you’re blowing out a candle, and feel your muscles push down

As you breathe down you will feel your baby’s head move down the vagina and as the feeling passes, the head will bob back up, slowly kneading the walls of the vagina, allowing gentle stretching of the tissues and a slow gentle birth for your baby. This is also better for your perineum, as instead of pushing hard and stretching it out, you’re slowly kneading the perineum.

2. Positive affirmations

The language and mindset we have is so important to how our minds and bodies respond to situations, so I’ve printed out positive affirmations that will encourage and keep me focused on a natural, beautiful birth.

Some examples are:

• I love and respect my pregnant body

• My body is built for this

• With each moment, I’m getting closer to meeting my baby for the first time

If you’re in need of inspiration, Siobhan Miller’s book, Hypnobirthing: Practical ways to make your birth better includes several examples you can print out and repeat to yourself. I am also happy to share a PDF of affirmations, so just write to me or leave a comment if you’d like a copy of this.

3. Meditations

The Headspace app has a great series of meditations for birth, and there are several other resources online. It helps to redirect your thoughts and focus on your breathing.

I’ve created a Spotify playlist that mixes guided meditations for birth with sound baths (e.g. tibetan singing bowls), calming music, and chants to help sink into relaxation during labour and birth. I also have printable PDFs which your partner can read to you as you labour. Write me or leave a comment for a copy.

4. Light-touch massages

A light massage releases endorphins into our bloodstream, which can help us relax and ease our perceptions of pain. These massages can be helpful during labour.

One technique of light-touch massage:

1. For the birther: Kneel over a birthing ball or sitting sideways on a chair with your back facing your partner.

2. For the partner:

   1. (V shapes) Then ever so lightly with the very tips of your fingers gently form a series of V shapes from the base of her spine up her neck, ears and down her arms. Repeat three times.

   2. (S Shapes) Then form a series of S shapes from the base of her spine up again to her neck, ears and down her arms. Repeat three times.

During labour itself, it will also help for your partner to push your back as a counter-pressure to your uterine surges (contractions) in this same position.

---

I would love to hear from my birthing readers about how you are mentally and physically preparing / prepared for your births. The more positive birth stories I hear, the less anxious it makes me, which will hopefully help keep me relaxed for mine. I feel like sharing these types of experiences are so important to help women understand what could happen and to remind us of the amazing things we are capable of.