Birth Prep or Obsession?

by: Anna Barlage, LMFT

Inspired by Ashley Johnson’s blog about the things she wished she had known about postpartum anxiety, I wanted to write a bit about what I wish I had known about anxiety during my first pregnancy.

So, full disclosure, I was a therapist while I was pregnant the first time, I had a fair bit of knowledge about mental health and assessed the needs of others frequently for pay, however I did not realize the full extent of the anxiety I was experiencing, until I had something else to compare it to, my pregnancy with my son (which came with a big dose of depression, but that’s another blog post). Hindsight is 20/20, and as I started to learn more about perinatal mental health it became much clearer to me how much I was impacted by anxiety.  

I remember having trouble relaxing during the day and lying awake at night with my mind racing. I obsessed over my birth too much, reading research study after research study about interventions and how to avoid them.  I remember cleaning obsessively and organized the nursery in a way which most would find ridiculous, but it was what felt right to me at the time, the way I knew to feel “okay” with everything that felt out of control with this whole growing-a-human thing.

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I wish someone I trusted had said “Hey Anna, so I know you’re really into researching birth and all, but I think you’re good… this might be more about anxiety than birth prep.” Had I known now I would have set limits for myself on how often and how much I could read/ research/ plan, and I would have made myself see a therapist weekly while I was in my birth class to process all the shit I was learning and have someone call me out on how obsessed I was.

I wish someone had asked if I was having scary thoughts, like thoughts of something happening to myself or the baby, not because I wanted them to happen, but because I feared it so much my brain kept replaying it to try to protect me from it. Someone could have told me they had a name, intrusive thought, and that they are a common symptom of anxiety. I’d have reminded myself they weren’t my fault, and made me no more likely to hurt myself or my baby. What I needed to do was see them as a symptom, not an actual threat, and have less of a reaction to them.

I would practice self-compassion for how hard it all was, by saying things to myself like “you are doing the best you can,” and “anxiety is telling you things are not okay, what evidence do you have this is true? Answer- none.”

And I would tell the anxious me to label those intrusive thoughts when I got them (there are those stupid images again!”) sending the message to my brain they are simply thoughts, not truth or predictions, and then to focus my attention back on the moment I am in. I’d do more deep breathing, and use the 54321 technique that I teach so often now.

It’s a grounding skill, and it works wonders for anxiety.

It’s a grounding skill, and it works wonders for anxiety.

So although I can’t go back in time and help anxious Anna the way I wish I could, I find it so wonderful I can share the skills and insight I learned with others. If you’d like to talk more about your experience, or are interested to learn more about the ideas above, visit my website at www.annabarlagelmft.com for more about me, or to schedule your first session.

Birth Center - What's In The Name

A usual experience for me as a Lamaze Educator is beginning our class with introductions. We often hear from students about where they are birthing, who their chosen medical provider is, and when their estimated "guess date" is. 

Inevitably there are families that say "we are birthing at FamilyBaby Center" (psst. that's not a real place, just go with it). I find so often that pregnant people and families are confused by the smart marketing efforts of local hospitals and can sometimes be led to believe they are birthing in a Birth Center just because the name includes "Center" and "Birth".  So let's talk about WHAT makes a birth center a BIRTH CENTER and why you should care.

The definition of a Birth Center by The State of Minnesota: 

“Birth center” means a facility licensed for the primary purpose of performing low-risk deliveries that is not a hospital or licensed as part of a hospital and where births are planned to occur away from the mother’s usual residence following a low-risk pregnancy.
— https://www.revisor.mn.gov/statutes/?id=144.615

So what's the difference anyway and why should you care? 

If you're intention is to birth in a low risk setting, with waterbirth as an option, fully staffed by midwives and a care team that supports, acknowledges and believes in low-risk normal birth a hospital just isn't going to offer that. Yes, I know, there are some beautiful hospitals locally and nationally that offer a great location for low-risk birthing people with Midwives on staff. That's great! What we are getting at here is if you intend to birth at a Birth Center (free-standing, not in a hospital) then it's important to know the difference. 

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Birth Center's do not use medical induction/augmentation methods.

If you are a low-risk birthing person planning an un-medicated birth, it's important to know that when you birth at a Birth Center pitocin or other drugs/synthetic hormones will not be used to start or alter your labor.

 
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Birth Center's do NOT do continuous monitoring.

The research tells us that intermittent monitoring of normal low risk births is actually a very safe and evidenced based option! Don't believe me, head over to Evidenced Based Birth and read about it HERE and HERE

 
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The entire staff of a Birth Center is comfortable with the usual 'un-medicated birth plan'.

Want to move around in labor? They want that too! Want to eat and drink during labor? They insist!  Want to have  delayed cord clamping, waterbirth, doula, partner catch the baby, family involved, photographer on site? Yep, yep, yep, yep, yep, yep. 

 

Birthing at a Birth Center IS safe for low-risk pregnant people!

The AABC (American Association of Birth Centers) has some very good information on this topic in their National Birth Center Study.

One of the most important findings of this study was that more than 9 out of 10 women (94%) who entered labor planning a birth center birth achieved a vaginal birth.
— Evidence Confirms Birth Centers Provide Top-Notch Care by Rebecca Dekker, PhD, RN, APRN
 
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Other than nitrous-oxide during labor, there are no epidurals or narcotics for pain management at Birth Centers.

For some people who are planning an un-medicated birth having this pain medications readily available is too tempting and they want those pain meds to be in another building completely so if they decide they want it, they have to take some effort to go get it. This isn't for everyone, but if your intention is an un-medicated birth it can be a great way to set yourself to GET that un-medicated birth you're preparing for.

When you surround yourself with people who typically practice the type of birth you're intending to have, you are setting yourself up for success and if something should go off course - you have a team of people who know what to do next. 

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Bottom line... Birth Center's aren't for everyone, but they might just be for YOU!

Special Thank You to

The Birthing Family

Willow Birth Center

Emily Isakson Photography

Local Birth Centers...

Meet Anna Barlage LMFT // Mental Health Therapist + Group Leader

1. What made you want to be a Mental Health Professional and how long have you been practicing? 

Anna Barlage LMFT

Anna Barlage LMFT

I have been working in the mental health field for about 10 years, with my first job being a overnight staff member at a long term residence for adult with serious and persistent mental illness while i was in college. I knew I wanted to be in a helping role since elementary school and even wrote that I wanted to be a psychologist in my 6th grade autobiography! My school counselor was immensely supportive during my parents divorce so I credit her for inspiring me. once it was time to choose a graduate program I was drawn to Marriage and family Therapy because of its emphasis on how to treat people with consideration for the system(s) they live in, since I know the people in my life have been immensely important to my wellbeing. 

2. Who are your favorite clients? 

This is a really hard one because I have worked in many different areas of mental health care, and have found I like parts about all of them. That being said, I would say my favorite two areas of mental health are working with those struggling with anxiety and perinatal mental health. Anxiety can be such a life altering and scary experience, so when I get to watch the transformation of seeing people get back to feeling like themselves again its pretty amazing. 

3. Is there anything else you do professionally outside of Mental Health work? 

No- but I am really good at cleaning!


4. What is the number one thing you wish for all of your clients? 

Peace.  One of my favorite quotes captures it perfectly:  Peace. It does not mean to be in a place where there is no noise, trouble or hard work. It means to be in the midst of these things and still be calm in your heart. (I just wish I knew who wrote it!)

5. If you could eat only one meal for the rest of your life what would it be? 

Brunch- eggs with some veggies and cheese, bacon, french toast, maybe some hash browns. You can cover all the food groups with a good brunch. Oh and coffee, lots of coffee!

6. If you got a whole day to yourself and you could be anywhere in the world, what would you be doing and with who? 

I have always wanted to go to New Zealand, so I would go there, to some beautiful beach with my kids and husband and just play, eat some good food and soak in their joy.

Therapy sessions available Thursday evenings 5-8pm and Saturday mornings 8-12. Mother to Mother group Saturday mornings at 10:30am. 

Meet Molly Mikacevich // Massage Therapist

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1. What made you want to be a Massage Therapist and how long have you been practicing? 

Massage Therapy and Bodywork are great ways to combine my fascination of anatomy and physiology and love of helping people.  I feel honored to be a part a client's journey towards health and wellness.  I have been practicing for almost 15 years.  

2. Who are your favorite clients? 

I feel incredibly grateful to be able to work with all types of clients.  I really enjoy working with people who are pregnant and postpartum and other care takers such as: nurses, midwives, doulas, teachers, parents,and other body workers.

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3. Is there anything else you do professionally outside of Massage work? 

I am also trained as a Birth and Postpartum Doula and take on a limited number of those types of clients.

4. If you could eat only one meal for the rest of your life what would it be? 

 I am a sugar addict, so if nutrition wasn't a concern, I would eat candy for the rest of my life. 

5. If you got a whole day to yourself and you could be anywhere in the world, what would you be doing and with who? 

 I would be on the beach in Costa Rica or Madeline Island with my family.

Massage Hours: Tuesdays/Wednesdays 10-7pm (if needs arise outside these hours please contact us)

birthEDucated - When the plan is "No"

It's a familiar conversation that comes up when my students are developing their birth plans.  I point to their dream birth choices that they have laid out in front of them and ask them how their current birth place and provider practices are different than the dream items they have selected. 

When the conversation begins to ebb and flow into "well, my provider doesn't do waterbirth, but..." or "my provider said they want to induce me at 39 weeks", or "my provider says that their practice monitors continuously and I can't eat and drink in labor", I gently ask more questions. 

Any good Childbirth Educator will tell you, that we don't care how you birth. I'm not being flippant or rude when I say this. What I mean is, I have already birthED my babies. My babies came into this world the way that they did because of who I am as a unique individual. I'm not interested in helping you have MY births. They aren't what is right for you. I am, however, VERY INTERESTED, in helping you align your values with your provider so that you can have the birth that matches YOU best. 

My good friend Amber Bastian always used to say, "Don't go to a Chinese restaurant if you're really looking for Italian food".  They are likely to be able to whip up some delicious noodles and sauce, but it's not going to be the Spaghetti and Meatballs you're after.  So what the hell does that have to do with birth?

When you line out your dream birth and then select a provider that doesn't customarily practice those elements on a routine basis. You are inevitably making a plan to say "NO" in labor. This isn't a workable plan for a multitude of reasons - but let's take a closer look with a good ol' TOP 5!

Top 5 reasons that the plan of saying "NO" in labor, is not the best approach. 

1.  YOUR THINKING BRAIN IS NOT USEFUL IN LABOR

Yea yea, I know somebody is gonna get up in my grill about this one, but hey hear me out. When you spend time in the part of your brain that is necessary to make decisions, arguments, and remember logical reasoning you are actually inhibiting yourself from progressing normally in labor with your natural hormones. Don't believe me? Check out Dr. Sarah Buckley's work on The Hormonal Physiology of Childbearing. 

2. YOU ARE SUPER VULNERABLE IN LABOR

I can't tell you how many times I have seen a strong, powerful, take no shit mama in labor become a sweet obedient soul. We are all trying to do the right thing, PLUS you're going through some massive sensations in your body. If someone with a strong enough confident voice instructs you to do something, even the strongest of humans can be willing to do things they wouldn't normally do given the circumstances. 

3. PUTTING YOUR PARTNER IN THE ROLE OF WARDEN DOES NO ONE ANY GOOD

Your dear partner, who has taken the classes with you, watched the documentaries, loves you dearly, is also NOW in the new and uncharted space of welcoming their child into the world. Now let's heap the role of "pay attention and fight" on to them when something comes up that is not in your Birth Preferences Letter. It's just not realistic that they will be able to know what is medically necessary at the time of birth and what simply is just a style preference of your particular care provider. 

4. TRUSTING YOUR PROVIDER IS ACTUALLY REALLY IMPORTANT

If you are able to align your values with your care provider BEFORE birth you don't have to feel any of this yucky stuff in the first place! Just imagine with me... a birth where you feel excited to call your birth place/provider and tell them you're in labor. These places and people exist, and you're gonna work to go find them NOW (prenatally) instead of not trusting your provider in labor. If your labor takes on the twists and turns you can't predict at this point, you can at least feel a sense of full trust that they have your ultimate goals and values in mind. 

5. YOU DON'T GET A DO-OVER

You've got this one chance at this birth to get it right and by "right" I don't mean some magical unicorn fairy dust birth necessarily (unless that's your jam, then by all means twinkle twinkle I'll be the first to grab the fairy dust). Don't wait til your 'next' birth to go to that Birth Center or try out that Midwife. Do it now and set yourself up for the birth you dream of. I trust you'll be able to roll with the twists and turns of what labor and birth gives you - you're smart and pretty kick-ass. 

Meredith Westin Photography http://www.meredithwestin.com/

Meredith Westin Photography http://www.meredithwestin.com/