Eating and drinking during labor

As I've mentioned previously, I'm a former Ironman triathlete, and I draw a lot of parallels between my Ironman experience and my labor experiences.

Ironman is lengthy (I completed mine in just over 13 hours; participants have up to 17 hours to finish) and physically intense. This can lead to the dreaded "bonk," which is sudden and extreme fatigue that occurs after exercise depletes the body's glycogen stores. Obviously, fatigue is not a good thing in the middle of a long race, so Ironman participants and other endurance athletes eat/drink throughout the race to replenish those glycogen stores. Not a five-course meal or anything crazy like that, just light snacks (fruit, pretzels, energy gels, etc.) and plenty of liquids (water, electrolyte drinks e.g. Gatorade, etc.)

Labor also tends to be lengthy and physically intense, so it makes sense to me that laboring women should be fed and hydrated much like Ironman participants, with light snacks and plenty of liquids.

So why do many hospitals restrict laboring women to only clear liquids or, in some cases, only ice chips?

The roots of this restriction lie in a landmark 1946 paper by an OB named Curtis Lester Mendelson, entitled "The aspiration of stomach contents into the lungs during obstetric anesthesia." I can't find the full text online, but this recent paper has what appears to be a pretty decent summary:

Nitrous oxide and ether anaesthesia administered by face mask for operative delivery was complicated by aspiration in 66 women from 44 016 maternities (0.15%) between 1932 and 1945. The only two deaths were from airway obstruction by solid, undigested food in two of five women who aspirated [vomited and then inhaled] solid material. In those who aspirated liquid, a syndrome of dyspnoea, cyanosis and tachycardia was observed. Recovery after 24–36 h was universal—in an era that predated respiratory intensive therapy by decades.

Prevention of "Mendelson's syndrome" via NPO (from the Latin nil per os, or nothing by mouth) after midnight of the day of a planned surgery became a key component of anesthesiology. After all, if you have nothing in your stomach when you're anesthetized, you have nothing to aspirate, right?

Well, not exactly: Turns out that the emptying of solids and liquids from the stomach is not as straightforward as you might think. For example, multiple studies have shown that your stomach contents are smaller if you drink clear liquids 2-4 hours prior to a procedure, versus fasting for 4 hours. As a result, the American Society of Anesthesiologists no longer recommends NPO after midnight prior to surgical procedures. Instead, they recommend fasting from solids for 6 hours prior to the procedure, but continuing intake of clear liquids up to 2 hours prior.

Even if you didn't follow those fasting guidelines, read the quote above again: In Mendelson's original study, only 0.15% of women aspirated at all, and only two out of over forty four thousand women (0.004%) died as a result of aspiration. And this was 70-odd years ago, when (as noted in the quote) respiratory intensive therapy didn't exist, not to mention numerous advances in anesthesiology that we enjoy today. Today's risk is almost certainly lower.

Finally, this should be obvious, but laboring women are not surgery patients. (With the obvious exception of scheduled c-sections, which are rightly subjected to the same restrictions as any other planned surgical procedure.) Despite all the consternation about the USA's high c-section rate, the fact remains that 2 out of 3 pregnant women will deliver their babies vaginally. And approximately 95% of those who do deliver via c-section will do so under regional anesthesia (spinal or epidural), which carries a much lower risk of aspiration than general anesthesia, like that used in Mendelson's study.

In other words, the risk of a woman going into labor planning a vaginal delivery and ending up with a c-section under general anesthesia leading to death via aspiration are miniscule. (One study theorized that it might happen in approximately 7 in 10 million births.) The risk of that same woman having a fairly lengthy delivery and needing something besides ice chips to avoid the labor version of "bonking?" Much, much, much, much higher.

So why the continued insistence on restricting food and drink? Well, old habits die hard: Even for planned surgical procedures, many hospitals still do not adhere to the updated ASA guidelines. See, for example, this study, this study, this study...

Also, women in labor (regardless of pain medications used, or not used) often vomit, which can obviously be unpleasant with a full stomach. Still, this is purely a comfort issue, not a safety issue, so it hardly seems right to tell a woman who wants to eat that she can't. Some providers recommend not eating anything that you wouldn't want to vomit back up, which is excellent advice. But that determination should ultimately be left to the patient, not the hospital. It's also worth pointing out that studies (such as this one and this one) have shown that women who eat during labor are no more likely to vomit than women who don't.

Finally, to be fair, I should also point out that those studies don't show any significant benefit to eating/drinking during labor. In fact, the first one found that women who eat tend to have longer labors -- although presumably, they're more comfortable because they're not starving! There is no significant difference in intervention rates or adverse birth outcomes. Again, I think this backs up the idea that the laboring woman is best positioned to decide whether or not she wants to eat. Blanket hospital policies should be reserved for safety issues. This isn't one.

OK, I'll step off my soapbox now. Here are my own experiences with eating/drinking during labor.

With Littles
When I went over my birth plan with Dr. K, I specifically brought up eating/drinking during labor. She said she had no problem with it, but warned me that the nurses might not be as accommodating.

The topic came up again when I got scheduled for my induction. Inductions can take a long time and I wanted to make sure that I wouldn't starve during the process. Dr. K encouraged me to eat a good dinner before coming in to start Cervidil at night. She also told me that the hospital would bring me breakfast in the morning. I chose to skip the bacon and eggs, and just eat cereal.

Once active labor got underway, my nurse informed me that I couldn't eat or drink anymore. I knew I could either sneak some snacks (I had brought some from home) or get Dr. K to tell the nurse it was OK for me to eat, but I wasn't hungry by that point anyway, so I chose not to push it. Since I was allowed clear liquids, I drank a lot of cranberry juice to keep my energy levels up. It worked out fine.

With Noob
When I asked F about eating/drinking during labor, I got a similar response to what Dr. K had said: She had no issue with it, but the nurses might. I talked it over with M at one of our prenatal visits, and she confirmed that I'd have no problems sneaking in some light snacks, but: "You probably won't be able to eat Chick-fil-A while in transition." :) This became a running joke between us, but in all seriousness, it was one of the things that made me start leaning towards homebirth. Even a great hospital is still a hospital. You simply don't have the same freedoms that you do at home. And while I was pretty certain that I wouldn't want Chick-fil-A while in transition, it made me wonder what things I might actually want that wouldn't be possible in a hospital.

In contrast, C, like most homebirth midwives, actively encourages eating during labor. I had some fruit for breakfast on the morning of Noob's birth, and then when C arrived, she had me eat a light snack (apples and peanut butter). I also drank water freely throughout. As it turns out, my labor wasn't long enough to need anything else. And anyway, it was a Sunday, so Chick-fil-A was closed :)

With Q
I ate a normal dinner the night that I went into labor. Since active labor ended up spanning a time (roughly 10 PM to 1 AM) when I don't usually eat anyway, and since it went so quickly, I didn't end up eating anything while laboring, or even immediately afterwards. I ate a normal breakfast the next morning -- my husband's homemade breakfast tacos, yum! Much better than hospital food, or Chick-fil-A!

And in case you're curious: I've had some mild nausea with all of my labors (much more with Littles than with the other two), but no vomiting.

Littles' birth story

A couple of notes about the birth stories:

1. Grab a cup of coffee and settle in. They are long.
2. They contain stuff that some people may consider TMI. Mucus plugs, bloody show, tearing "down there," etc. You have been warned.
3. They were all written within days of the respective births. That means that they are a good indication of my perspective and mindset at the time of the birth. In some cases (especially regarding Littles' birth), my perspective/mindset has changed with time.
4. Hypnobabies users: You may want to use your BOP. All birth stories contain standard terminology (no "birthing time" or "pressure waves" here...) Littles' mentions p**n a few times; Noob's and Q's do not.

Still want to read? OK. Here goes...

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Background: I had an easy, healthy, normal pregnancy, aside from testing positive for Group B strep at 36 weeks. We planned a natural birth and took Bradley method classes. Unfortunately, the baby wouldn't cooperate, and at 41 weeks, I got scheduled for an induction starting at 41 weeks 5 days (June 17). I was rather upset, as this put a major kink in my natural birth plans and there didn't seem to be any reason to rush the baby out, but I decided to make the best of it and try to make it through with as few interventions as possible.

Afternoon of 6/17/2007 - I stood up and noticed a tiny gush of fluid. I thought it was probably my imagination, or if not, most likely urine -- but that itself was odd, as I had no problems with urine leakage at all during pregnancy.

6/17 7:30 pm - We were getting ready to leave for the hospital when I noticed a more noticeable gush of fluid. Still nothing huge. I had a gut feeling that it was amniotic fluid.

8:15 pm - We arrived at the hospital and got checked in. I mentioned the fluid leakage to the nurse. She said if my water really did break, it would keep on leaking, and to let her know if that was the case. I got hooked up to the external fetal monitor, which showed I was contracting about every 5 mins, but I couldn't feel them at all.

10:30 pm - The on-call OB examined me. I was 1cm dilated, very soft cervix -- basically no change from my appointment the previous Friday 6/15, so my contractions weren't really doing anything. I had had no more fluid leakage, so she went ahead and inserted the Cervidil and kept me on the fetal monitor. Pretty soon, I started feeling more contractions. They either felt like a painless tightening of my stomach or like mild menstrual cramps. I turned down an Ambien (I didn't want the baby or me to be sedated, in case things got moving before the drug wore off) and tried to get some sleep.

6/18 12:00 am - I had just drifted off to sleep when I felt something leaking. We called the nurse, who confirmed that my water had broken. She consulted with the on-call OB and decided to leave the Cervidil in, but put in a hep lock and start IV penicillin due to my GBS status.

(In retrospect, I'm pretty sure that my water would've broken on its own on Monday or Tuesday had I not been induced. Getting induced when I did was something of a blessing, as it allowed me to labor some on Cervidil rather than going straight to Pitocin.)

6 am - The contractions had gotten strong enough that I could no longer sleep through them, so I was waking up about every 5 minutes. I tried to relax through them and hoped they were doing something.

6:30 am - Round 2 of penicillin.

7:30 am - My OB, Dr. K, came in to examine me. Good news, I had dilated to 4cm and 90% effaced on the Cervidil alone! She decided to let me labor for a bit on my own to see if we could avoid Pitocin. We called our doula E, and I took a shower and ate breakfast. I did some walking to try and get things moving -- it just felt good to be off the monitors and the IV. (I still had a hep lock for antibiotics and for Pitocin if needed.)

10 am - Yep, I needed the Pitocin :( Back on the fetal monitors and the IV. No more walking.

11 am - I posted a labor update to my blog. By this point, the contractions were strong enough that I could not type during them, but I still had a good break in between them. They quickly got so intense that I couldn't do anything but focus on them.

1:30 pm - I'd been laboring hard for 2.5 hours. My bloody show had turned from pink to bright red, and I was feeling some pressure in my bottom. So the nurse came in to check on me. I had moved to 100% effaced, but I was still 4cm dilated, just as I had been six hours earlier :( Thank goodness for Bradley classes, where we talked about the NAP (natural alignment plateau) -- my husband, E, and I all knew I could be minutes away from transition even at 4cm. Transition turned out to be a little longer in coming :), but I didn't get too discouraged. I told E, "I don't care that I'm still 4cm. I know I'm making progress. This hurts too much to NOT be making progress."

Around 2:30 pm - Dr. K came back (she'd been at the office) and asked if I'd had a shower. Of course I hadn't; I was still hooked up to the IV and fetal monitors. Bless her, she told the nurses to take me off all that and let me get in the shower. I don't know if it was the shower that helped or just being off the Pitocin, but my pain got better. It was a very welcome break for maybe 20-30 mins, giving me a bit of a second wind.

4:30 pm - Dr. K checked me again. "Floppy" 6cm dilated. OK, better than 4cm. At least I was making progress. I was still nervous that my progress might just stall at some point.
By this time, the contractions were incredibly intense. I was chanting "Open" through them and trying to visualize my cervix opening up. I was switching positions as much as I could, from sitting on the edge of the bed to sitting in a chair to sitting on E's birth ball. I was also able to stand up, but I felt very tense in that position, so I figured it was counter-productive. Lying on my back or side (which I had to do momentarily when they checked me) was absolutely miserable.

The wonderful thing about having E there through all this, besides the obvious support that she gave me, was that she was able to give my husband a break. He actually took a hard 20 minute nap during this period, and he was also able to get lunch and dinner throughout the day. Without E there, I think he would have been too exhausted by the end of the day to really support me when I needed it desperately. Doulas are worth their weight in gold!

6:00 pm - Another check. 8cm, stretch to 9cm. Still making progress. Referring to my Ironman experience, I made a crack about how I'd finished the swim and the bike, and now just had a marathon to run :)

6:30 pm - Round 3 of antibiotics.

Around this time, things got really bad. I had been able to relax through my contractions for most of the day, but now it was all I could do to hang on and stay on top of them. I couldn't even chant "Open" or hum anymore; I just tried to breath. I was incredibly tired and just wanted to get off the Pitocin, fall asleep, and continue laboring later. I actually did sleep in between quite a few contractions.

In addition to the three positions we'd been using all day, E also had me try all-fours and squatting. All-fours felt pretty good. Squatting was REALLY intense. I tried it two or three times and I just couldn't handle it.

My memories of the next few hours are a little fuzzy as far as time goes...

Contractions started to get all over the place. Some were so intense and painful that I couldn't do anything but cry out "Ow! Ow! Ow!," and I even kicked my husband once. Others were quite manageable and gave me a nice break. I also started feeling more contractions in my back. I must've hit transition somewhere in here, but it wasn't very different from what I'd been feeling all along. I did get some shakes, maybe around 7:30 or 8 pm?

Everyone kept asking me if I was feeling pressure, as this would indicate whether it was time to push. Well, I'd been feeling pressure all day, so how was I supposed to know when it was "real?"

The L&D nurse (Melissa) and Dr. K checked me a couple of times. I was fully dilated but still had an anterior lip of cervix that neither of them could push back. I was incredibly discouraged and convinced that the lip would never go away.

Finally, Dr. K said to go ahead and push as she held the lip back. This worked out fine -- the lip moved, and I was finally able to push freely!

Pushing was hard work, but an incredible relief. I was on top of the contractions again. I was DOING something! And it was fun 'cause everyone was cheering me on. I have no idea how long I pushed. My husband says 20 minutes. I think it was closer to 30-45 minutes. I pushed mostly on all fours, then switched to my left side for the last few contractions.

And then, at 9:26 pm, out came Littles! 13 days past her due date, 23 hours after labor got started, 11.5 hours after the evil Pitocin went in -- and totally worth the wait.

She came right on my belly, and not knowing any better, I thought she looked like any other newborn. It was Dr. K, Melissa, and E (who have been around a lot more newborns) who immediately said, "Wow, that is a BIG baby!" Sure enough, she weighed in at 9 lbs 7 oz. We had NO idea she was that big, as my OBs don't typically do late ultrasounds for weight estimates. I am glad they don't, because if I had suspected she was big, I might have doubted my ability to push her out. Ignorance is bliss :)

I am really glad we let her have those extra days in the womb. She has been doing so well -- very active right from the start, picked up breastfeeding right away, no jaundice issues, fantastic hearing (the hearing test lady was very excited, as she scored over a 300, which is apparently fairly uncommon) -- and I think part of the reason why is that she got those extra days for her brain to build some extra connections to help her out.

Anyway, whatever the reason, she is just wonderful and we love her so much already :)

Childbirth preparation classes

With Littles
My hospital offered childbirth preparation classes, but in my early research, I came across references to classes focused specifically on medication-free birth. I asked Dr. S about them at a prenatal appointment at around 16 weeks. He brushed them off, saying it wasn't necessary, that all classes were pretty much the same.

In retrospect, this was the first of many red flags regarding Dr. S. (This was the same appointment where he told me, "That's fine if you don't want an epidural. I mean, 85% of my patients go into labor knowing they want an epidural, and most of the rest of them end up getting one anyway... but if you don't want one, that's fine.") But I just ignored the comment, and continued researching my class options.

I eventually settled on Bradley method classes. A couple of things appealed to me about Bradley, as compared to other childbirth methods. One is that it teaches the husband (or other birth partner) to play a key role in the birth. From the first time I brought up med-free birth, my husband was super supportive and involved, so we both really liked the idea of a class that would honor that. Also, Bradley seemed a little more "scientific." None of this woo-woo about hypnotizing yourself into a pain-free childbirth or creating a birth space to help you open, or other craziness like that.

We found a nearby instructor and started classes when I was about 23 weeks. We both found them incredibly helpful. My husband isn't the type to sit down and read a bunch of books about childbirth, but he was an enthusiastic participant in the classes. They gave him the knowledge and confidence he needed to be a great birth partner. I think that's so important. I might be the one giving birth, but it's my husband's baby, too. I want him to enjoy the childbirth experience, just as much as I do. Bradley classes helped him do that.

As for me, I am the type to sit down and read a bunch of books about childbirth :) But I still found the classes to be helpful. Probably the best part was being able to sit down with a real live woman who had been through a med-free birth experience. (Actually, two of them, plus a third birth that occurred midway through our class series.) She brought such a sense of normalcy to childbirth. This was so powerful, especially when combined with the positive way that my mother had always described my own birth. So many pregnant women get bombarded with horror stories about labor and delivery. I wasn't. In fact, I got the opposite: I was surrounded by positive stories and experiences.

I think that made a tremendous difference in my mindset going into labor.

With Noob
As much as I had enjoyed Bradley classes, I opted to make a change with Noob. One reason for this was that I felt the relaxation techniques I'd practiced in class were less than useful during labor. I'd always practiced relaxation lying on my left side, but when I got into labor, I found that lying on my left side was intensely painful. And then I felt a little lost -- like, what do I do now? It worked out OK anyway. I ended up finding other comfortable positions to labor in. And as one of my friends pointed out to me later, it's likely that all the practice did pay off in helping me stay relaxed throughout labor, even if I didn't do it in the same position I'd practiced. Still, with Noob, I wanted to find a method that gave me more flexibility in how I labored.

For this reason, I started looking at Hypnobabies -- one of those methods that I had dismissed as too "woo-woo" with Littles. The basic premise of Hypnobabies is that you can experience labor as being pain-free through self-hypnosis. I know... woo-woo :) But one of the things I really liked about it, compared to Bradley, was that it gives you a variety of self-hypnosis scripts to listen to in preparation for labor, as well as during labor itself. It also teaches "eyes open hypnosis," where you're able to move around and labor in different positions, while remaining under hypnosis. This appealed to me more than Bradley's left-side relaxation.

In addition, actually going through birth had changed my entire mindset on it. With Littles, I expected labor to be most painful experience of my life, because everyone told me it would be. It wasn't. As I've mentioned previously, I found labor to be more like my Ironman triathlon experience: It was intense, and challenging (both physically and mentally) -- but not "painful" in the same way that, say, getting whacked in the head with a lacrosse stick is painful. (Yep, I've had that happen, too, on more than one occasion...)

This put me somewhat at odds with Bradley, which teaches pain management techniques: Why would I need pain management for something that's not painful? Interestingly, this is right in line with Hypnobabies' philosophy. Really, Hypnobabies and Bradley are more alike than they are different, but there is one subtle distinction between the two: Instead of teaching pain management, Hypnobabies teaches that childbirth is pain-free. That sounds crazy to a lot of people, but it made perfect sense to me.

I'll give a quick example to better explain this distinction. In labor, there is a period called "transition," which is when your body switches from dilating your cervix to pushing your baby out. Most childbirth classes, Bradley included, talk about this being the most painful part of labor. So when I was laboring with Littles, I kept waiting for it to get really painful and difficult. I was hoping to feel that, because it would be an indication that I was almost done. As it turns out, transition didn't feel much different from the rest of labor for me -- but in my head, I was trying to make it feel worse than it actually did. Pretty counterintuitive.

Hypnobabies is different. For starters, it shies away from using childbirth-related words with negative connotations, so "transition" is called "transformation." And it teaches that transformation is pain-free, just like the rest of your "birthing time" (aka labor).

With Noob, I remember very clearly when I entered transformation. The house was full of people by that point, but somehow, I ended up alone in my bedroom. My husband came up behind me just as a contraction (or "birthing wave," in Hypnobabies terminology) hit, so I leaned back into him and swayed a bit while he supported me. The contraction ended and I opened my eyes and noted the time. As I did, the contraction started right back up again, so I leaned back into my husband and we swayed again. When it ended and I opened my eyes again, I saw that the second contraction had been a full 2 minutes. Long, back-to-back contractions like that are a hallmark of transformation, and I knew it. But they weren't "painful" in the normal sense of the word. This is hard to explain. I felt many things. I felt the power of my body, I felt my baby moving into position to come out, I felt the love of my husband supporting me -- but I didn't feel pain.

I can't say for sure why the two experiences were so different. Certainly, it could have been because I was expecting transition to be painful with Littles, and I was expecting transformation to be pain-free with Noob. But it also could have been that I was more relaxed in the comfortable surroundings of my own home, as compared to the hospital. It could have been that I was experiencing spontaneous birthing waves, rather than Pitocin-induced contractions. It could have been that Noob's labor was just easier.

But after that experience, I knew I'd use Hypnobabies for any future births.

With Q
I'm 25 weeks right now, and I've been doing my Hypnobabies scripts for the past two weeks now. With Noob and with Q, I've chosen to do the Hypnobabies home study course. This was another thing that appealed to me about Hypnobabies: We can study it on our own, rather than having to go somewhere to take classes. This is really convenient, especially since now we'd have to find child care if we wanted to take live classes!

Of course, by doing the home study course, I lose the benefit of having access to a live instructor, which I found so valuable during my Bradley classes. I'm OK with this now that I have my own childbirth experiences to draw on, but I think it would have been less than ideal for my first pregnancy. (There are live Hypnobabies classes available as well.)

Also, with Noob, I found that my husband was less involved in childbirth preparation than he had been with Littles. Hypnobabies does have a lot of information for the birth partner, but as I said before, my husband is not the type to sit down and read a bunch of stuff on childbirth. He did read a bit of the home study material, and he remembered a lot of the basics from our Bradley classes anyway, so it worked out fine and he was still a wonderful support to me during labor. But I'd love to get him a little more involved this time around.

So, is Hypnobabies better than Bradley?
No, I don't think it's necessarily "better." Just different.

When it comes to childbirth classes, whether a mom is planning to forego the epidural or not, I think it's incredibly important that she and her birth partner take childbirth preparation classes that are not affiliated with a hospital. The reason for taking non-hospital-affiliated classes is that they'll help you explore all your options, not just the ones that are available at your hospital. For example, childbirth preparation classes at a hospital without birthing tubs are unlikely to spend a lot of time talking about all the benefits of waterbirth. A non-hospital-affiliated class will likely discuss waterbirth, allow you to figure out whether or not that's something you're interested in doing, and possibly help you make the decision to change hospitals if having that option is important enough to you.

In fact, taking non-hospital-affiliated childbirth prep classes is the single biggest recommendation I make to expectant parents. There are tons of other things to consider, such as choosing a supportive OB or midwife, learning about all the options available to you during birth (eating and drinking in labor, different positions for laboring, relaxation techniques, waterbirth, episiotomies vs. tearing naturall, etc.), ensuring the birth partner knows as much about childbirth as the mom herself, considering whether a doula might be beneficial (I'll do another post on doulas in the future), etc... but a good childbirth prep class will cover all of that. Hence why it's the single biggest recommendation I make :)

As for Hypnobabies vs. Bradley and other "methods," I don't think the particular method is very important. Obviously, I've chosen Hypnobabies for myself, but I know it's not for everyone. Heck, it wasn't even the right method for me, during my first pregnancy! I always encourage women to choose a childbirth prep class that feels comfortable to them. Which may or may not be what feels comfortable to me.

My birth mindset

If it hasn't come through already in my posts to date, I'm really passionate about birth. I think it's just the coolest experience ever! That said, I'm not planning on becoming the next Michelle Duggar, so my personal birth experiences will be limited. But I love talking birth with other women who are passionate about it -- or, even better, with women who are interested but maybe not so passionate, and helping them understand that birth doesn't have to be what they see on "A Baby Story" or "16 and Pregnant."

Obviously, I started this blog to talk about homebirth specifically, which I particularly love discussing because it's so different from the "Baby Story" view of birth and because so few people have any direct experience with it. But I also have a lot of thoughts on birth in general. Since you've wandered onto this blog, I assume you have some sort of interest in birth :) So forgive me if I jump up on my soapbox every now and then, and talk about stuff that isn't specific to homebirth -- or even related to homebirth at all.

Starting... now :)

One of the places I love to hang out is The Bump's Natural Birth board, because it's full of women who are passionate about birth! A few weeks ago, a woman asked about the "mindset" going in to a planned natural birth. How do you truly commit to avoiding an epidural -- because from what I've seen, most women who go in saying "I'll try to avoid an epidural but I'll see what happens" end up getting one -- without feeling like a failure if you end up really needing one?

A lot of people liked my response, so here it is, slightly modified to make some pieces more clear.

About a year before I got pregnant with Littles, I did an Ironman triathlon. It's probably the experience in my life most analogous to labor, in a variety of ways. The morning of the race, my dad told me something along these lines: "You've done the hard part. All the training and preparation. Today is the easy part. All you have to do today is get out of the way, and let your body do what you've trained it to do."

That was precisely my mindset going into labor. I lined everything up... I did the classes, I did the exercises, I talked over my preferences with my doctor, I hired a doula. I did all that because I needed to know going in that I had done everything possible to achieve the birth I wanted. I didn't want to look back and think, "If only I had sprung for a doula..." That preparation meant that on the day of the birth, all that was left to do was get out of the way and let my body do what I had trained it to do.

As for changing my mind, well, I didn't line up at the Ironman start line thinking, "I'll try to finish, but we'll see." After nine long, hard months of training, there was no doubt in my mind that I was going to finish. But -- this is hard to explain -- ultimately, finishing wasn't the important thing. It was the journey to get there. On the bike, I watched a guy 10 feet in front of me fail to make a left turn and go crashing over a ledge. He probably didn't finish, but he also didn't "fail." Just getting to that start line took more guts, more hard work, than most people are willing to give. He might not have gotten a finisher's medal around his neck at the end, but he still got the really important things. The improved fitness level. The discipline it takes to train for an event like that. The knowledge that his body was capable of doing way more than he ever thought possible. Those things come from the journey, not from the race at the end.

Again, this was my mindset going into labor. There was no doubt in my mind that I would do it. But if the unexpected happened, I'd know that ultimately, avoiding an epidural wasn't the important thing. It was the journey -- preparing, learning about birth, learning about my options, and setting myself up to make the safest, most informed decisions for myself and my baby. In some labors, the safest, most informed decision is an epidural, or a c-section, and that's not a "failure." In fact, it's anything but.

So. That's my mindset.