Just Tell Me That You Want To: Consent, Country Music, and Physical Contact

I was listening to my favorite country radio station the other day, singing along to some lyrics I had never considered much before, when one line stuck out to me.

It was from Randy Houser's song "Goodnight Kiss." If you've heard it before, you know that the song is basically about this guy telling the woman he's (presumably) dating that he wants to blow off their plans with her friends, park his truck, and make out.

At first-listen, it's nothing particularly new or different compared to other things we hear on the radio. But the line that really startled (and pleased) me was, "Just tell me that you want to." 

Here's a man who clearly wants to go further with his partner, but he qualifies his entire suggestion with that one clincher: he'll only go through with it if she wants the same thing. He's not here to coerce her into anything she doesn't want. He's just telling her what he wants, hoping that she reciprocates! It's a surprisingly feminist approach to physical intimacy.

The thing is, I wish it didn't surprise me. I wish that similar sentiments popped up more often in popular music. But instead we hear things like Robin Thicke's famous lyric—"I know you want it" (from his song "Blurred Lines")—and we have to wonder, does she really want it?

How can this man know if his partner "wants it" unless he takes the time to ask her? Unless he gives her the chance to refuse?

Consent forms the boundary between assault and intimacy. Without clear consent from both parties involved, physical contact should not occur. That goes for not only sex itself but for other forms of physical contact, such as tickling, cuddling, kissing, hugging, and touching.

Consent should never be assumed. Even within a committed relationship (like marriage or dating), each individual should have the opportunity to reject the other person's advances without fear of retribution, guilt, or harm.

Furthermore, consent is not merely the absence of a spoken "no." When one partner is unconscious or unable to think clearly (perhaps asleep or not sober), consent cannot be obtained. Consent can also not be obtained when one partner is below the legal age of consent (which varies depending on local laws). Additionally, body language may alert one partner that the other is uncomfortable for some reason, even if the individual has not explicitly said so.

When in doubt, JUST ASK. Say things like, "Is it okay if I kiss you?" or "Can I give you a hug?" Maybe it feels silly and unromantic, but consent is always more romantic than unwanted physical contact.

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What Postpartum Moms Really Need

*WSR is grateful for this guest post by Sarah Bregel.

When I became a parent at the ripe old age of 24, I was glad to kiss a difficult pregnancy goodbye and embrace the joys of new motherhood. But while the joys were many, so were the challenges. I thought I had been adequately prepared to reach a whole new level of sleeplessness, to feed someone from my own body more than I fed myself, to answer every beck and call and do it effortlessly.

Now the word "prepared" seems laughable to use in the context of becoming a parent—literally, becoming a whole new version of yourself, shedding your old skin and giving birth to the mother in you from the moment you give birth to your child. There is no way to prepare for motherhood and I wish I'd known that. But I also wish I'd known how to ask for help.

No matter what age you become a parent, it's a lot like being thrown to the wolves. But no one really talks about it that way. Everyone talked about the baby bliss, the love I'd feel, the joy, the natural instincts. And while I certainly felt those things, I also felt depleted, overwhelmed, exhausted and utterly alone. What was worse was that those emotions made me feel like a failure because I wasn't "supposed" to be feeling them. At least no one had warned me that I would. Everyone assumed I was overjoyed, and so I played the part.

It doesn't help that our culture here in the U.S. doesn't cater to postpartum women. Typically, new mothers are expected to be back on their feet in no time. Paid maternity leave is abysmal in terms of length and pay rates when compared to other countries -- if it's offered at all. And though we have some of the highest rates of birth interventions, leading to lengthier recovery times and more emotional struggles post-birth, we still expect the glowing mother and happy baby almost immediately.

While other countries dote on postpartum women, rally around them and consider "postpartum" more like a year than our typical six weeks, we tell women to get back to themselves, back to work and back to the gym. We gaze at magazine covers of flat bellies and uphold women who breeze through postpartum and say "she got her body back in just eight weeks -- good for her!" But is it? Good? For anyone?

If this is our standard, what are we doing to the women who don't live up to it? Which, in truth, is most women. Four and a half years after becoming a mom and watching friends turn the same corner, I know this to be true. We come into motherhood expecting to bounce right back and when we don't we're confused, sad, anxious and guilt-ridden. We wonder where our bodies went, what happened to us and why is this so much harder for me than other women? Why do our babies not sleep through the night at just a few months old? And what are we doing so terribly wrong?

For some strange reason we're taught to pretend it's all gravy. We're taught to make it look easy, even if it means tuning out our newborns cries in an effort to get a good night's sleep. Even if that means we switch to bottles long before we're ready because assimilating back into the world with udders that make us feel more like cattle than women is not as pleasant as we thought. When everywhere we look, society tells us to cover up and our jobs don't support our efforts to feed our babies, why would it be? While for most new moms, the thought of handing their newborn over at six weeks is terrifying, we routinely tell women it'll be good for them. In essence, we're taught to look the part more than be it. We're taught to get out of our bathrobes and into our skinny jeans, out of the house and back into the world at lightning speed.

For many of us, it's too soon and we aren't ready.The world wants us back on our feet, but someone should really be rubbing them. We've gone through one of the biggest shifts life can bring and with unrealistic expectations and without proper support, it can be a thousand times harder than we ever saw coming.

What postpartum women really need is understanding, rather than the expectation that we should be photo-ready when the only thing we are ready for is a nap. We need people to talk about how hard this time is, instead of how happy we should be. We need time to embrace our babies, rather than the stress of what else we should be doing and how far we're falling behind. We need opportunities to talk, vent, cry and feel and know that it's okay. We need a more embracing society that doesn't mind breasts feeding babies as much as it doesn't mind them in magazines and movies. We need people to make meals, rather than expect to hold our brand new babies. We need partners who wake up in the night to give a back rub or a "you're doing great." We need friends who say "I've been there." What postpartum moms really need is a world that allows us to be mothers from all angles, even if it's not as pretty as we wanted to believe.

Postpartum is a sacred time and we need to start treating it that way. As I gear up for my second stint, I'm hoping it will be a little less tumultuous than my first. But this time, I won't be putting on my happy face at all costs. I'll be giving myself the time to heal, surrounding myself with people that understand and being real, even if it means rocking a muu-muu for three months. I'll just have to tell US Weekly to come back in the fall.

Follow Sarah Bregel on Twitter: www.twitter.com/SarahBregel

See the original post at Huffington Post.

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Pop Quiz: Women's Sexuality

True or False. Women just don't have the strong sex drives that men do.

True or False. Women have cleaner thoughts and emotions than men do.

True or False. Women can control themselves better than men can.

True or False. Women simply don't have a problem with pornography (or other sex-related addictions).

Answer key: ALL OF THE ABOVE STATEMENTS ARE FALSE.

Yet I grew up believing statements like that, and I'm sure I'm not alone. Society in general, as well as the culture of the LDS Church (not the actual teachings of the Gospel) often ignores or discredits women as sexual beings. And because we don't really address this aspect of womanhood, many people have distorted views of it.

In recent years I've had a bit of a paradigm shift when it comes to sexuality. I've had the opportunity to discuss the issue with friends, family, and Church leaders, and I've learned a lot that never really occurred to me before.

For one thing, while sex is certainly sacred and significant in God's plan for us, He never meant for us to treat it with shame or fear. We should approach the subject maturely and respectfully, but we should not tiptoe around it. Doing so enforces the false notion that sex is a sin. Rather, it's an integral part of healthy marriage relationships. Sex is a means of pleasure and of procreation. It's a way for a couple to strengthen their bond and to express love for each other. Why should we feel shame for this gift from Heavenly Father?

Also, it's totally natural—healthy, even—for young people to have a strong sex drive. That goes for men AND women. We were created this way, plain and simple. Feeling sexual urges or desires is not disgusting, wrong, or weird. In fact, nearly everyone feels them at one point or another. Yet so many women in the Church believe they are alone in this. We teach the men to avoid pornography and other harmful, sex-related media, but we rarely teach the women to avoid it. We just take it as a given that such media does not appeal to women. That women would not be tempted. And these beliefs instill themselves in the women who do indeed struggle. They think, "If no one's talking about this, I must be the only one with a problem. Something must be wrong with me."

You know what? It's a total lie. Both men and women struggle, even if we sometimes struggle in different ways. Women are human. We all have temptations and desires and we all have to learn to deal with them head-on.

Ask questions if you have questions. Don't be afraid to discuss sex with people you love and trust, as long as you do so in a spirit of respect and learning. We need to acknowledge our own sexuality and the sexuality of others if we want to develop strong, healthy relationships.

**This post was inspired by an article about female addiction to pornography which several friends shared on Facebook. Go check it out yourself!

Kelsey Allan is a senior studying English and editing.

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On Grey's Anatomy, Surgeons, and Moms

My mom and me

*Author's Note: It's a long one today! Once I started writing I realized I had some passionate feelings about the topic, and they all came out right here. I hope you will read to the end!

**Another Author's Note: For the sake of a productive discussion, I am not going to dwell on those families which require a working mother. I think most of us agree that in some cases a woman does not have much of a choice. My focus here is on those women who do have a choice.

Today I watched an episode of Grey's Anatomy, and part of the story related directly to a close friend's request for a blog post about working mothers and stay-at-home moms. I won't bore you with all the gory details of the show, but in this episode one main character struggles to balance life as a surgeon with life as a mother. Every time she gets to hold her daughter, she's called into surgery. Every time she comes out of surgery, she has to track her daughter down and find out who's watching her. Then the cycle begins again.

There's one scene, when she drops her daughter off at a friend's house (so she can go back to the hospital), and she gets this regretful look in her eyes. But the friend says sharply, "No! Don't do that! Let her see you work! Let her see you achieve!"

Throughout the show, I found myself reflecting on the virtues of both motherhood and work outside the home. Some people in the world look down on women who choose to stay at home; others criticize women who seek to establish their own careers. It seems you cannot make a choice without facing severe disapproval from at least one side.

The LDS faith teaches that motherhood is a divine calling. I definitely believe this; however, I do not believe the matter is as simple as many would have us think.

I have recently encountered a number of people who—in the name of staunchly defending family values—suggest that any woman who aspires to anything more than motherhood does not truly understand her role in God's plan. Now, I understand the viewpoint that marriage and family are the be-all and end-all pursuits of the Gospel. I agree that we should each strive to form our own families and should not devalue motherhood as a sacred work.

Yet I take issue with the condemnation of any woman who aspires to do more in life than be a mother. I have often heard the argument that there is no pursuit more honorable than motherhood and thus, we cannot possibly aspire to more than that. I see three clear problems with using this argument against women who seek careers:

1. That argument disregards the validity of a woman's longings for achievement and recognition. Yes, you may say that motherhood is a huge achievement, and I totally agree. Mothers are awesome! But how much recognition do we actually give to these women? Does motherhood always feel rewarding? Does successful parenting receive the same publicity and attention that other careers do? If we're honest, the answer is probably no. So it's understandable that many women feel inclined to seek that recognition elsewhere.
2. My desire to be a mother does not automatically negate any other passion or desire I hold in life. We all have things we love to do; I love to write and edit literature. I aim to do it professionally one day. Luckily, that's one skill that can be adapted to a freelance career without much trouble. Working from home, in between other parenting duties, will not be impossible. Other women—those who wish to practice medicine or teach history, for example—do not always have it so easy. Are we really so terrible for enjoying things and wanting to do them on a daily basis? Even if you believe a woman should only ever be a stay-at-home mom and never work outside the home, you cannot blame her for having more desires than that of motherhood.
3. An argument like that also devalues women who are trying their best to reach a final goal of marriage and motherhood, but have been unlucky in love or are unable to have children. A stay-at-home mom, while certainly admirable, ranks no higher in the mind of our Heavenly Father than a wife who just can't seem to get pregnant or a single woman working to support herself. By knocking down career-seeking women, we are also knocking down these women who want nothing more than to devote themselves to a family. To be honest, although I understand the mostly good intentions of people who say these things, I myself have felt that sting. Sure, I'm only twenty-one. But in the LDS culture, there is a lot of pressure to get married and start a family as soon as possible. I haven't had that opportunity; I'm looking into grad school instead of looking at rings. I'm nurturing a career instead of nurturing a child. And I sometimes feel lower on the hierarchy in our family-oriented faith. Not because that's how God feels, but because it's how others make me feel.

If I have the chance to become a mother someday, I will probably follow my own mother's pattern. She worked through a lot of my upbringing, but she was always home when I returned from school, and I knew I could count on that. I could see how hard she worked (at her job and at home and at her callings) and I admired her for it. I still do. I appreciate that she pursued her interests while helping to support the family; on top of that, she cooked dinner every night! For me, an arrangement like that seems like the ideal model.

However, plenty of people would disagree. I have friends whose situations differed, and it worked well for their families. Maybe a woman wants to work more hours. Maybe her husband loves to cook and she doesn't. Or maybe she wants to spend most of her time at home and as little time as possible working in an office. So be it!

Do what keeps you sane as long as you are providing your children with the attention and care they need. Be less judgmental of those in different circumstances. Focus not on others but on you and your own situation. How can you make your family a priority while also pursuing personal goals and interests? The answer will vary depending on your personality, your economic situation, and other factors. And that's okay!

Kelsey Allan is a senior studying English and editing.

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Pregnancy, Babies, and Birth: From Theory to Practice

I have been blogging about the Theory of Babies & Birth for months. But sometimes the theory is very different from the practice. So I thought it would be appropriate to wrap up the "Pregnancy, Babies, and Birth" blog series with one woman's real-life experience with birth and baby: my own.

While I was pregnant, I spent countless hours reading books and articles about pregnancy, birth, and the transition to parenthood. Not to mention spending hours writing posts for this blog series! So I thought I had a pretty dang good idea of what giving birth would be like, what things I wanted and didn't want, and exactly how I thought it was going to go. I had a 3-page birth plan with all my preferences listed concisely: I imagined a medication-free birth where I weathered my contractions like a fierce warrior, a quick pushing period, a smooth delivery where they placed my perfectly healthy baby on my chest, and a rapturously happy bonding period where my husband and I stared down at the beautiful little life we brought into the world. I imagined myself resting for a couple of days when I got home, then jumping enthusiastically back into my role as homemaker, wife, and mother.

Things didn't go as planned.

Even though I had spent months preaching on this blog about how unpredictable the birthing process was, I never thought it would be that way for me. I naively believed that I would be the exception; my labor and delivery were going to go exactly as I wanted. It would be beautiful and natural, painful but quick, and I would be a perfect new parent. Everything was going to come naturally to me, my mothering instincts would kick in right away, and I would know just what to do and what was best for my baby. I had done all the research, so I was totally prepared, right?

Not quite . . .

It was a long and difficult labor and there was a constant threat of danger to my baby. I had to have Pitocin to kickstart my labor and eventually was in so much pain that I was ready for an epidural. When the time came, I was able to push efficiently, but my baby got stuck. So exhausted, I opted for an assisted delivery to avoid a C-section. The forceps did some damage to both me and my baby. When my baby was finally delivered 24 hours and 25 minutes after my water broke, he wasn't crying like he should, so they whisked him away to the NICU. My husband and I weren't able to hold him until almost 9 hours later when he was stable enough to come to stay in our room.

My postpartum recovery was incredibly difficult and painful, both physically and emotionally. I couldn't sit or walk without debilitating pain, which made it hard to even hold my son for long. I spent weeks laying in bed or laying on the couch praying for God to take away the pain. Simple tasks were too much for me to accomplish, so my husband had to take over everything around the house. I couldn't leave the house, I couldn't have visitors, and I started to get cabin-fever. I felt like it would never end.

About 5 days postpartum, I started to develop postpartum depression. I felt numb. I lost my appetite completely. I felt indifferent to my baby. I had inexplicable crying spells. I had an overwhelming urge to run away. I had never felt so inadequate in my entire life. In my worst moments, I was absolutely convinced that I would never be happy again. It made it almost impossible for me to care for my baby. After my husband returned to work, I had to reach out for help from my parents, which they graciously gave. I felt envy and disappointment as I watched others caring for my newborn instead of me. But mostly, I felt horribly, horribly guilty.  

I have to say, there is no guilt quite like Mommy Guilt. There are all these things that we are supposed to do as mothers that we may or may not be able to do.  When I wasn't able to do all of the things that I knew I "should" have been doing as a mother, I felt like a complete failure. I remember thinking how my baby deserved a mother that could give him all of the things that I couldn't. I was convinced that he deserved better than me.

It took many weeks for me to heal physically and emotionally, in fact, I'm still healing.  If it hadn't been for my amazingly supportive husband and the Atonement of our Savior Jesus Christ, I don't know how I would have gotten through the entire process. But things got better little by little. I started feeling a little less pain and less depression with each passing day. I bonded with my baby. I learned what his cues meant and developed my parenting skills. I held my husband a lot tighter. I prayed more sincerely than I ever prayed before. I began to accept that all my preconceived notions about parenthood were less important than giving myself room to be imperfect. I started to see that being a good mommy DOES NOT mean being a perfect mommy.

As I got back to myself, I wanted nothing more than to share my experience with other women. I didn't (and don't) want pity for what I went through, but I did (and do) want to share these things because I know there are other women out there who have had similar experiences. And I know there are women who will have similar experiences in the future. It is incredibly lonely to feel like you are the only woman in the world who doesn't have a perfect "A Baby Story" delivery and recovery. Even though my husband was beyond incredible, he just couldn't understand all of the things I went through. It wasn't until I spoke to other women, like my own mother and my mommy-friends, that I began to feel peace and relief about what I was going through. Ladies, you are not alone! I firmly believe that sharing our struggles with each other can only serve to strengthen one another. We need each other. So, please, if you are struggling similarly, reach out for help!

We live in a culture where there is so much expected of us as mothers but we just can't meet all those expectations. Perfection is impossible. And that opens the door to a lot of feelings of inadequacy and guilt. But I have good news, Sisters. Our Heavenly Father doesn't require perfection from us. He knows our circumstances and He knows our hearts. The expectation of perfection comes from ourselves and sometimes from other women in our lives. Do I think my Heavenly Father blames me for not doing "enough" in those first few difficult weeks? Absolutely not. He knows that I did the best I could with what I had been given. And that was enough.  

I was enough.

For all of the women out there doubting your abilities, feeling guilty and inadequate, pushing yourself to run faster than you are able, YOU ARE ENOUGH. Don't let the Adversary convince you otherwise. Self-doubt steals so much away from you. Work as hard as you can on learning self-acceptance and self-love, all the while remembering that you have a loving and forgiving Heavenly Father cheering you on, not One who is chastising you from on-high for being imperfect. And if you need someone to talk to, someone to encourage you and lift you up, come visit us here at Women's Services. We have a lot of practice at being imperfect! Heck, I'm getting better at it every day.

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Pregnancy, Babies, and Birth: Adapting to Parenthood

Bringing Home Baby

You've gone through the intense process of bringing your sweet little miracle into the world! But . . now what?!  "You mean, we have to take our baby home now? By ourselves . . . without a call button and Labor and Delivery nurses to help us and answer our questions? What are we supposed to do now? How are we supposed to know what our baby needs? What's the difference between a hungry cry, a hurt cry, and a tired cry? I don't know if we can do this..."

For a lot of couples, there's a small panic moment when leaving the hospital and striking out on their own in the realm of parenting for the first time. If this happens to you, don't feel bad! You are embarking on a huge new adventure that doesn't come with a road map or an instruction manual. For the first time, you are in charge of a tiny, helpless little being that is completely dependent on you for all of its needs and wants. That can be an overwhelming prospect, to say the least. Add that to recovering and healing from birth and shifting hormones for mommy, it can seem downright impossible! But remember, the best thing you can do is to take things a little at a time. Don't let yourself start worrying about baby's first day of kindergarten; instead, just focus on meeting one need at a time, one hour at a time, one day at a time.

Baby's Basic Needs

For the most part, your hospital staff will do the best they can to prepare you to go home and tend to the basic needs of your baby. They will probably teach you the best way to give baths, how often you need to give baths, how to change diapers, how to properly care for the umbilical cord until it falls off, how to care for your son's penis if you choose to circumsize, tips on breastfeeding and bottle-feeding, how to swaddle and hold baby, and lots of other stuff. My suggestion is to write down questions that you have about newborn care throughout your pregnancy and then bring that list with you to the hospital. When baby comes, you'll probably have lots more questions to add to the list. Don't be afraid to ask anything and everything; there is no such thing as a dumb question. If you don't know the answer, ask! Also, you are likely to get overwhelmed by the amount of information that you are given, so write it down or have your partner write it down as you go along. You definitely won't be able to remember everything, so don't stress yourself trying to memorize the long list of things they tell you to do and not to do.

When you bring baby home, some women find it comforting and incredibly helpful to have a female relative or close friend come stay with them for a few days or weeks while they adjust to parenting. A loving, experienced "been there, done that" mom friend or family member can be a great comfort and wonderful source of information. Even if you don't have someone who can come stay with you or you prefer to try things on your own, feel free to call your mom, your sister, your neighbor, your Relief Society President, your best friend, or any other mom you trust for advice!  Additionally, make sure you choose a pediatrician for your baby so you have someone to call if you have any questions about your baby's health. Again, it is completely normal to feel overwhelmed and to have a lot of questions as you learn how to read your baby's signals and develop a routine that works for your new little family.

The Transition to Parenthood

The early stage of adjusting to parenthood is often the most difficult. This stages usually last around 4 months or more and is characterized by feelings of losing control, anxiety, uncertainty, feeling overwhelmed, and feeling physically and mentally exhausted. The next stage of parenthood has you focusing on rebuilding your day-to-day routine and your personal and familial identity. You begin to make more conscious decisions instead of "just trying to survive" and feeling a greater sense of control. This stage can last a couple of weeks to a few months.  The final stage of adjusting to parenthood is when you begin to feel adjusted to the change.  You will feel like you are back to normal and feel like yourself again. You have fully integrated the new roles and responsibilities that come with having a baby into your daily life.

Another huge transition when you become a parent is the cognitive transition, which includes learning to conceptualize yourself as a parent. I find myself constantly thinking, "I'm going to be a mommy . . ." and that thought blows my mind. I don't think it will actually sink in until I have that little infant in my arms. Seeing yourself as a parent means learning to constantly sacrifice your wants and needs to meet the needs of your child. You can't just spontaneously run to the grocery store while your husband is at work without taking the time to get baby ready, work around naps and feedings, etc. What would have been a 10–15 minute errand before you were a parent is now a 30-45 minute (or more!) errand. You must learn to sacrifice a certain amount of your independence in order to be a good parent. Both you and your spouse will go through the process of seeing yourselves, and each other, in a very different light.

If you want more information about the transition to parenthood, I found this amazing website by Dr. Stephanie, who has a Ph.D. in Sociology and emphasizes in studying parenthood and motherhood. Check out her website HERE.

The Marital Relationship

When it's just you and your husband, there is only one other person in the equation that is the focus of your attention; they get 100% of your attention at home. When baby #1 enters the picture, that goes from 100% down to 50%, at the least, so your spouse is losing a huge chunk of your time and attention for the first time. With each additional child, the attention gets split more ways, but never as drastically percentage-wise as with that first child. Going from a 2-person family to a 3-person family is going to require quite a shift in your marriage. Both Mom and Dad may find that they feel like they are being ignored by their spouse; for example, Dad comes home from an 8 hour shift and Mom is excited to see Dad, but Dad heads straight for baby. Moments like these can leave each spouse feeling a little sensitive and hurt.

The key to surviving this transition in your marriage is the same key to any successful marriage: positive communication!  If you haven't already been practicing how to communicate in healthy, effective ways, start now. It will serve you so well after you become parents. Some basic tips on positive communication are as follows:

• For the Speaker
• Use "I" Statements: This means saying something like, "I feel [emotion] when you do [action]," instead of, "You make me so [emotion]." This way, you are taking ownership of your own emotional experience rather than trying to blame it on your partner. Blame language will almost always create defensiveness in the Listener, which sets a conversation up for failure.
• Avoid name-calling: There's nothing that sabotages a conversation quite like belittling your partner by calling them a name. If you feel the urge to say, "You're such a jerk! Why would you say something like that to me?!," try to express what you are feeling in a different way. How about, "It really hurt my feelings when you said that to me. I feel pretty angry that you would make that comment."
• The Soft Approach: If you want to talk about a topic that you know is sensitive, use what we call the "soft approach." Approach your partner kindly and lovingly, use "I" statements, and willingly take responsibility for your part in the issue. This will help your partner remain non-defensive and listen to what you have to say. The alternative to this is running into a conversation already riled up and leaving your partner feeling like they've just been hit by a freight train. A soft start-up is like the old saying, "You catch more flies with honey than vinegar." Remember, you love this person, so approach them with respect and care.
• Avoid "Always" and "Never": Let's get this straight—no one "always's" or "never's."  It's tempting to say things like, "You always do [this]," or "You never do [that]."  The truth is usually somewhere in the middle; they may do something more or less than you like, but they don't "always" or "never" do it. Using these little words has the same effect as name-calling and blaming, it creates defensiveness in the Listener and makes it more difficult for them to listen to and validate your experience and/or concern.
• For the Listener
• Give the Speaker your full attention: Nothing is more frustrating than trying to talk to your partner when they are glued to their cell phone, watching TV, or playing on the computer.  If your partner approaches you and wants to have a serious conversation, put everything else aside that you can or suggest a time that would work better to talk if you can't give them your full attention in that moment.  Remember though, your relationship with your spouse is the most important thing in your life, so if you can set what you are doing aside for a moment, do it. It's especially hurtful if they approach you and are brushed aside because you want to finish this one TV show or this part of your game. Unless you have a pressing reason to continue doing what you are doing (a due date for work or school, or a fussy baby to attend to), give them your attention.
• Really listen, don't half-listen while you think up your own argument: This is super common in all relationships. The next time you are in a conversation with one of more other people, pay close attention to how long of a gap there is between one person finishing a thought and the next person starting up on their own thought. Most often, the next person begins to speak before the first person's last sentence is finished. We are so eager to share our own thoughts, feelings, and experiences that we often spend more time thinking up what we are going to say back and we miss a lot of what they other person is saying to us. When I begin teaching couples how to communicate, we take turns being the Speaker and the Listener. The Listener doesn't get to argue their side at all; their only job is to LISTEN. Successful communication hinges on each person's ability to be an attentive, responsive listener.
• Ask questions to clarify meaning: One of the biggest reasons that people struggle with communication is they misunderstand what the other person is trying to say or they make assumptions about what they are really trying to communicate. If you find yourself thinking the Speaker is trying to communicate one thing, ask, "So, what you're saying is _______?" and give them a chance to clarify if that is or isn't what they mean.
• Validation, Validation, Validation!!!: As a marriage therapist, the biggest complaint I get when teaching couples how to communicate effectively is, "My partner just doesn't understand/care what I say." There is only one way to avoid this very common pitfall: VALIDATION. If your partner says, "I feel sad when you snap at me," instead of getting defensive or explaining why you snapped, simply say, "I can see how that would make you upset. I would feel that way too if you snapped at me."  The BIG key here is to validate your partner's feelings and experience even if you don't agree with it or understand it. Validation=/=Agreeing! Even if you don't feel like you snapped at him/her, they feel like you did. You can say, "It wasn't my intention to come across like I snapped at you. I can see how that would be hurtful and I'm sorry that your feelings are hurt." I can't emphasize the importance of this skill enough: VALIDATE, VALIDATE, VALIDATE!!!

Finally, it is important to really make an effort to stay connected to and close to your partner. Spend some uninterrupted time together each day to talk or just be with each other. When baby goes to bed, it's a great time for Mom and Dad to talk, cuddle, kiss, engage in a shared activity that you both enjoy, do the dishes together, whatever. Make each other a priority! If you can, continue to go on dates (even if the date is a picnic in the middle of your living room floor). Communicate with each other using the tips listed above. Reach out to each other for help and support, especially to get your emotional needs met. Remember, you are still a husband/wife, not just a Mommy/Daddy, even if it feels like your new parenting role takes up your whole life!

Disclaimer: The "Pregnancy, Babies, and Birth" blog series is meant as a source of general information only. Its intended use is to encourage women to further consider and discuss reproductive and birthing decisions themselves, with their partners, and with their medical care providers. Information included in this series is not intended to be professional medical advice or a substitution for a relationship with a licensed physician or practitioner. Any serious questions or concerns about reproductive, prenatal, and/or perinatal health should be directed to your primary care physician or other licensed specialist. Women's Services and Resources does not promote any particular brand, medical provider, birthing location, or any other specific birthing decisions. We strongly encourage women to become as educated about their choices as possible so they are empowered to make educated decisions for themselves and their babies.

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Pregnancy, Babies, and Birth: Breastfeeding Basics

Breastfeeding is a potentially sensitive and extensive topic to try to cover in one post, so I have just included the very, very basic information available. Please, seek out and read other resources on breastfeeding as well as reading this simplified post. Additionally, I highly recommend taking a breastfeeding class. I was able to attend one at UVRMC that was taught by a certified lactation consultant and I learned a ton even though I had already done a lot of research on the topic. I feel much better prepared to make educated decisions about breastfeeding now that I have that foundation.

Breastfeeding, Formula-feeding, or Both?

Deciding whether to breastfeed, bottle-feed, or some combination of both is another important personal decision to make before having your baby. Just like any other aspect of pregnancy or parenthood, we advocate that women educate themselves as much as possible on the topic, then make the decision that they feel is the best for themselves, their baby, and their family. Both breastfeeding and formula-feeding offer unique advantages and disadvantages. Some mothers prefer to breastfeed exclusively without introducing a bottle, some mothers prefer to pump and then bottle-feed with breast milk, some mothers prefer to breastfeed and supplement with formula, and some mothers prefer to exclusively bottle-feed using formula. As long as your baby is getting adequate nutrition, all these choices are great! However, there are some unique benefits to breastfeeding that stand out enough that they necessitate extra discussion.

Benefits of Breastfeeding

The American Academy of Pediatrics recommends that babies be exclusively breastfed for the first six months of life due to the immediate and long-term benefits for the baby. Exclusively breastfeeding means that you offer no other form of food/drink to your baby other than breast milk (no water, no formula, no foods). Even if you are not able to breastfeed from the breast for the first six months (for example, if you have to go back to work or school, or if your baby rejects the breast at any point during those first six months), you can still express breast milk by using a pump and feed it to your baby using a bottle. If you want to feed using both the breast and the bottle, most lactation consultants recommend that you exclusively feed from the breast for at least the first four weeks to avoid nipple confusion; then slowly introduce the bottle (using a slow-flow nipple).

Did you know that your breast milk is perfectly tailored to suit the individual needs of your baby? Breast milk contains all the vitamins and nutrients that your baby needs in those first vital months of life. Additionally, it passes on substances that help supplement their delicate, developing immune systems and helps them fight bacteria and disease. Research has shown that breastfed babies are typically less susceptible to certain diseases (including some cancers) later in life. In addition to the numerous benefits that breastfeeding has for your baby, it also has lots of benefits for you too, mommy! Breastfeeding has shown to reduce stress, reduce occurrence of postpartum depression, facilitate bonding between mommy and baby, reduce the risk of breast and ovarian cancer, and help mom return to a healthy weight quicker after delivery. I could probably do a whole post on the benefits of breastfeeding, but for more information on this topic, visit the La Leche League website.

How to Get Started

Is breastfeeding a natural process? Yes. But, it is also a learning process. It's something that you and your baby will have to learn together in order to be successful. Learning as much about breastfeeding as you can before your baby is born is a great way to prepare yourself for this transition. I highly recommend taking a breastfeeding class from your local hospital or independent lactation consultant before you give birth. Once you have delivered your baby, the best time to try to breastfeed is within the first hour after birth when baby is most alert. If your baby is healthy, you may even attempt to begin breastfeeding right in the recovery room. If you want to breastfeed as soon as you can after birth, make sure to tell your doctor and nursing team so they can help and encourage you.

The key to successful breastfeeding is to get the right latch. There are certain ways that you can position your baby, regardless of the kind of hold you use, that will facilitate a better latch than others. Make sure you bring your baby in to latch when their mouth is wide open (it may look like they are yawning), not when they are just opening up slightly. You want them to get as much of the breast as possible; if they just have the nipple in their mouth, you are going to end up with sore, bleeding, and cracked nipples. Again, getting just the right latch is key! This brings me to a hugely important point: Talk to a lactation consultant while you are in the hospital. Most hospitals these days will have a certified lactation consultant on staff that will visit each mom and baby during their recovery time. If you want/need help before they come to you, go ahead and ask that they visit you sooner. Also, most nurses will be able to assist in breastfeeding support while you are learning. Let your lactation consultant offer tips and observe your methods so she can help you avoid common mistakes and set you up for successful breastfeeding.

Seek Help Early if you Struggle

Some women feel ashamed if they are having a hard time with breastfeeding. They may feel like they should already know how to do it without help or they may feel embarrassed about having someone help them because it requires a relative stranger to see an exposed breast. If you feel like the first, don't be ashamed that you aren't magically endowed with amazing nursing skills. You are just learning something new, so it is okay to have a learning curve and ask for advice. If you feel like the second, it's understandable to feel a sense of unease, but remember that you are dealing with a trained professional that is there to help you, not to make you feel uncomfortable or exposed. One of the biggest issues that lactation consultants see is women who are coming to them when they are at the end of their rope. What they really hope to see is a mother coming for help at the first sign of difficulty. If you are experiencing pain, if your breasts are becoming inflamed or engorged, if you see signs of a blocked duct, if you worry that your baby isn't getting enough to eat, then call or visit a lactation consultant for help right away rather than waiting until you want to give up.

What if I Can't Breastfeed?

For several unknown reasons, there are some women that cannot physiologically breastfeed. Sometimes their milk doesn't come in or it doesn't come in with a strong enough supply to adequately meet baby's needs. If this happens to you, first, visit with a lactation consultant to see if there is anything you can do to pinpoint and alleviate the problem. If you find yourself still unable to breastfeed, you have to be easy on yourself.  Don't think that you are a bad mother or an incomplete woman if you struggle! You still love your baby and will provide the best you can for your baby in terms of meeting his/her needs. Seek out support from other moms that have experienced similar issues. Talk openly with a trusted friend or family member about your feelings or seek out a professional counselor to help you through the transition. It's perfectly normal and understandable to feel disappointed, sad, angry, confused, helpless, whatever it is that you are feeling. Do the best you can, and if it doesn't work out for you, your baby will still be healthy and happy with the proper nutrition from other sources. Get help and support, then give yourself permission to let it go and move forward.

For more information about breastfeeding, visit http://www.babycenter.com/breastfeeding-basics

Disclaimer: The Pregnancy, Babies, and Birth blog series is meant as a source of general information only. Its intended use is to encourage women to further consider and discuss reproductive and birthing decisions themselves, with their partners, and with their medical care providers. Information included in this series is not intended to be professional medical advice or a substitution for a relationship with a licensed physician or practitioner. Any serious questions or concerns about reproductive, prenatal, and/or perinatal health should be directed to your primary care physician or other licensed specialist. Women's Services and Resources does not promote any particular brand, medical provider, birthing location, or any other specific birthing decisions. We strongly encourage women to become as educated about their choices as possible so they are empowered to make educated decisions for themselves and their babies.

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Pregnancy, Babies, and Birth: The Stages of Labor

There is a common misconception that being in labor = having contractions. True labor, however, is when you are progressing towards giving birth; meaning that your cervix is changing (either effacing or dilating progressively). Pregnant women can start having "practice" contractions, also known as Braxton Hicks contractions, as early as the second trimester, but this doesn't necessarily mean they are in labor. Labor itself is divided into three separate stages:

• First Stage: This is the stage of labor that we most commonly associate with "being in labor." This stage starts when contractions cause progressive changes to the cervix and ends when you are completely dilated and effaced. The first stage is often divided into 3 phases: early labor, active labor, and transition. Early labor is when your cervix gradually begins to dilate (widen) and efface (thin out); usually between 0–4 centimeters (cm) dilated. Active labor is when contractions come on stronger and closer together; usually between 4–7 cm dilated. Transition, which is the most difficult and painful part of labor, is when you have the most intense contractions and your body moves from 7–10 cm dilated (10 cm is fully dilated). You may notice an increase in mucusy discharge from your vagina that may be tinged with a small amount of blood. This is completely normal and is known as "bloody show." This is your body shedding your mucus plug, the literal plug of your cervix that developed to help keep foreign particles out of your uterus while your baby grew. Additionally, your water may break at this point, either in a gush or a slow trickle. If your water breaks, call your care provider immediately and ask when he/she wants you to go to the hospital. Most providers will want to have you come in right away after your water breaks.

• Early labor can sometimes be difficult to distinguish from the Braxton Hicks contractions that you may have been having for several weeks now. You will be able to tell the difference between false labor and true labor by monitoring your contractions. True labor contractions will become longer, stronger, and closer together and they will not go away with a change in position or change in activity. False labor contractions are irregular and sporadic and will oftentimes diminish or go away completely if you change your activity (If you are laying down, get up and walk around. If you are walking around, lay down on your side). As you approach the end of your pregnancy, talk to your doctor about recognizing signs of true labor and when he/she wants you to head to the hospital. If you've had a healthy pregnancy, expect to go through early labor at home. Most providers will have you rest comfortably at home until your contractions get to a specific frequency and duration (usually between 3-5 minutes from the start of one contraction to the start of another and usually lasting about 30-60 seconds for each contraction). It's important not to wear yourself out during early labor because you'll need all the strength and endurance you can get for the later stages of labor. Avoid strenuous activity and even try to sleep in between contractions if you can. Also, stay hydrated and empty your bladder often because a full bladder may impair the ability of your uterus to contract as much as it needs to.

• Active labor is when things really get rolling!  If you haven't already gotten to the hospital, get there as soon as you can.  At this point, most women who are going to have a medicated birth will be in enough pain that they will ask for an epidural or other medications.  Baby may start descending into the birth canal now, but may not get all the way down into the position he/she needs to be in for the pushing stage until after transition.

• Transition is the most intense part of labor for most women, but also the shortest phase of the first stage. At this point, your contractions may be occurring very frequently and lasting a long time (sometimes only 30 seconds apart and contractions lasting up to 90 seconds). You may begin to shake, shiver, or feel nauseated and vomit at this point as well. If you are trying for an all natural birth, you may begin to lose faith in your ability to manage the pain. Reach out to your support person for extra coaching and support and focus on getting through one contraction at a time. If you change your mind or find that the pain is too intense, consider your backup plan (medications that you may be comfortable with). Having a medicated birth does not make you any less of a woman or your birth experience any less important! Do what is right for you, whether that be pushing through transition med-free or choosing pain relief through medication. Additionally, you may begin to feel some rectal pressure as your baby gets lower in the birth canal. Some moms report the beginnings of the urge to push, but it is important to avoid pushing until your nurses/doctor gives you the okay. The cervix needs to be completely dilated and effaced and baby needs to be in the right position in the birth canal before any pushing is beneficial. Pushing before your body is ready will only wear you out and sap you of whatever energy you have left.

• Second Stage: From the point that your cervix is completely dilated and effaced to the point where you actually give birth to your baby is the second stage of labor. This is often referred to as "the pushing stage" because this is when women get to become a more active participant in the labor process as they push their baby through the birth canal. Your contractions may slow down at this point, offering you a chance to get some much needed rest. If your baby has not descended all the way into position yet, you may have a while before you are ready to push. If baby has descended, you may feel pressure in you bottom and an urge to push. Make sure to communicate this to your nurses. You can choose to have your nurse coach you on when to push or wait until you feel the spontaneous urge to push. With the combined effort of your contracting uterus and your abdominal muscles, your baby will slowly make his/her way down the birth canal. For first time mothers, baby's descent through the birth canal is usual gradual, lasting about 1 hour. It can feel like a slow, "two-steps forward and one step back" process. But, eventually, your sweet little boy or girl will enter the world!

• Third Stage: The third stage of labor typically occurs about 5–15 minutes after the birth of your baby when the doctor delivers the placenta. After the baby is delivered, the body receives a signal to detach the placenta from the uterine wall and through a series of contractions, the placenta is delivered in much the same manner as the baby. Don't worry, this isn't like giving birth to another child! Most of the time, mom is so elated and wrapped up in her new little miracle that she barely notices this part of labor. The doctor may ask her to give one or two pushes to help deliver the placenta, but it is nowhere near as painful as the rest of labor. After the placenta is delivered, your uterus will clamp down to stop up the blood vessels where the placenta was previously attached in order to prevent you from bleeding too much. Your doctor or nurses will make sure your uterus continues to do this by checking and even massaging your uterus (by pressing down on your belly). If you tore your perineum or had an episiotomy, your doctor will deliver a local anesthetic to the area and then stitch up the tear or cut. 

Every birth and every woman are different, so it's difficult to say exactly how long each stage of labor will last.  For most first time moms, it typically takes between 10–20 hours to go through all 3 stages of labor (some moms go quicker and others are in labor for much longer). Similarly, each mom will spend different amounts of time in each stage of labor, but each stage should be progressively shorter than the last (first being the longest and third being the shortest). Remember that birth can be a very unpredictable process, so be flexible in your expectations and be open to suggestions from your care team. The most important result, regardless of the methods, is a healthy mom and healthy baby.

Source: www.babycenter.com

Disclaimer: The "Pregnancy, Babies, and Birth" blog series is meant as a source of general information only. Its intended use is to encourage women to further consider and discuss reproductive and birthing decisions themselves, with their partners, and with their medical care providers. Information included in this series is not intended to be professional medical advice or a substitution for a relationship with a licensed physician or practitioner. Any serious questions or concerns about reproductive, prenatal, and/or perinatal health should be directed to your primary care physician or other licensed specialist. Women's Services and Resources does not promote any particular brand, medical provider, birthing location, or any other specific birthing decisions. We strongly encourage women to become as educated about their choices as possible so they are empowered to make educated decisions for themselves and their babies.

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Pregnancy, Babies, and Birth: Pain Management Methods During Birth

Making the Decision

Deciding on how to handle the pain of labor is an important personal decision. Nothing gets women more passionate about labor than talking about their beliefs concerning pain management techniques. However, keep in mind that the choice should be yours to make, in conjunction with your partner and with guidance from your care providers. Throughout your pregnancy, you will undoubtedly get unsolicited advice from a lot of sources regarding whether or not to use pain medication during labor. Take what they have to say with a grain of salt because your experience will differ from their experience(s).

Labor is such a diverse experience for each and every woman that you can never really go into it with a solid idea about what labor will be like for you. Some women go in expecting to use medication and end up making it through labor without it, while others go in not wanting medication but end up changing their minds during labor. The best thing you can do to prepare in advance is to gather as much information about pain management techniques beforehand and make an educated decision about what you would and would not like to try. Feel free to incorporate these preferences into your birth plan if you are creating one. Also, share your preferences with your primary care provider (doctor, OB/GYN, or midwife), your partner or birth coach, and your care team at the hospital (labor and delivery nurses, specifically).

Keep in mind that labor can be an unpredictable process, so if you go in with an open mind and flexible expectations, you can avoid some unwelcome surprises. If complications arise, like the need for an emergency C-section, you may not have a choice in terms of medications used. This doesn't always mean that you will be forced to make decisions that you did not want. So, be as true to your own preferences as the situation allows, but trust those you have chosen to provide your care if they offer alternative suggestions. Feel free to ask as many questions as you want, whenever you want, if you are being encouraged to make a decision that you wanted to avoid, then make your decision. If you are in a vulnerable state or in no state to talk at all, encourage your partner or birth coach to ask questions for you (prep them for this beforehand so they know how to be a good advocate for you).

Non-medicated Labor

There are a variety of different methods that are currently in use in terms of dealing with pain during labor without the use of medication such as Lamaze, the Bradley Method, and Hypnobirthing. Click on these links or see our previous post on Childbirth Classes in order to learn more about these specific methods. The main focus during an unmedicated labor is to listen to your body and provide it with what it needs. You can choose to follow the guidelines of a certain method during labor, or you can use a combination of any of the following techniques to facilitate pain management during an unmedicated birth. Additionally, should you choose a medicated birth, you can still employ any of these methods to keep yourself calm and focused during labor.

• Deep breathing exercises: Most childbirth classes that you take will offer at least basic training in breathing techniques. Yes, we've all been breathing long before we have the opportunity to take a class on it, but a class will teach specific techniques that increase your awareness and focus your attention on your breathing. Breathing techniques include taking a deep, cleansing breath before an after each contraction and patterned breathing that is rhythmic and comforting (such as the stereotypical hee-hee-hoo breathing).  
• Massage/Counter-pressure: Ever heard of back labor? If not, you might be in for a surprise if your back hurts just as much as your front during labor. One of the best ways to manage back labor is to have your partner or birth coach massage your back or apply counter-pressure. Massage and touch can be a great way to manage pain, especially if delivered from your partner since it can provide both physical relief and emotional connection during labor. Have your partner massage whatever part of your body that feels good, whether it be your back, your arms, or your feet. Some women, however, find that they don't want to be touched at all during certain points in labor, and that's perfectly okay.  Be flexible and communicate with your partner (in the kindest way that your contractions will allow, haha).
• Warm or cold compresses: If you get overheated during labor, ask for a cold compress to put on your forehead. Likewise, you can have your partner or birth coach apply cold or warm compresses to your lower back to manage back labor. Just see whether cold or hot feels better at the time, or alternate between the two if you like.

• Movement/Changing positions: Some women find that getting up to walk, moving around on a birthing ball, or simply changing positions can offer some measure of relief. For the most part, hospitals have women in a semi-reclined position to give birth, but if other positions (squatting or on all fours, for example) feel better to you, go ahead and shift. If you choose to get up and walk around, you may find it helpful to stop and lean against something or someone during the hardest part of your contractions.
• Visualization: You can picture yourself in a calming place, imagine yourself as a female warrior, or visualize yourself holding your baby. Whatever you choose to do, visualization can often help to distract you from the pain or hold out through each individual contraction by focusing on a specific goal or image.
• Self-hypnosis: This method often involves getting some sort of training from a professional before you employ it. It is often used to create a deep sense of relaxation to manage pain, fear, or anxiety during labor.

• Aromatherapy: Some women like to use essential oils or something similar to help them relax and create a soothing environment. You can even combine aromatherapy with massage and have your partner or birth coach rub essential oils onto different parts of your body. Feel free to bring these kinds of things from home, but remember, no candles (no open flames!). If you are wondering what is okay and not okay to bring from home, call your hospital and double check with them.
• Listening to music: Just like with aromatherapy, listening to music can help foster a calming environment. Whether you choose to play it as ambient background noise in the room or you pop in/on your headphones, music can help you focus your attention elsewhere. Feel free to create a playlist of your favorite calming music (or rockin' music, if you prefer) in preparation for birth.
• Distraction: Most women will try this method during labor, whether they are aware of it or not. This doesn't require any special technique or anything like that. It can be as simple as joking with your husband or chatting with your L&D nurses. You can also play cards, watch TV/movies, update your blog, surf the internet, take a walk, or any other number of things. This method may be more effective during earlier stages of labor and more difficult to employ as contractions intensify, so be sure to have other methods in mind to manage pain.

• Taking a bath or shower: The impact of the water during a shower or the warmth of a bath can have very calming effects on a laboring woman, so much so that this method is often referred to as the "midwife's epidural." Jacuzzi tubs are a popular pain reliever because it offers some of the weightlessness and warmth of a tub in combination with the massage of the jets. You can take a warm bath or shower at any point during labor; some women even choose to give birth in a birthing tub.
• Having a focal point: This is simply choosing something in your environment to focus on during contractions. It can be a picture, a flower, a spot on the wall, or your partner's eyes. With this method, you focus your energy outside yourself and onto something else. This can be especially comforting if you are feeling panicked or anxious; you can lock eyes with your spouse or birth coach and throw your focus there. However, some women prefer to have an internal focus and close their eyes during contractions. Find whatever works best for you and go with it!

Medicated

There are several classes of medication that can be employed during the labor process, namely regional anesthesia, systemic medication, and general anesthesia. Following are brief descriptions of each class of medication, their general uses, names of common drugs or techniques in each class, and the differences between the three classes. Both advantages and disadvantages/risks are discussed for each class.

• Regional Anesthesia: These kinds of medication are used to numb or relieve pain in only a specific part of the body, which is why they are administered into the lower back during labor to target that area of the body. They cannot be administered by nurses, like other forms of medicated pain management may, but instead must be given by an anesthesiologist. The most commonly used regional analgesics are epidurals, spinal blocks, and the combined epidural and spinal block. 

1. Epidurals: A woman either lies on her side or sits up in a hunched position to expose the lower part of her back. The area is cleaned and then a small needle is used to numb the area where the epidural will be administered. A larger needle is then used to inject the medication into the epidural space (the fluid that surrounds your spine) and then a small tube—called a catheter—is inserted and left in the woman's back in order to allow for adjustments in the amount of medication or continued administration of the epidural throughout the labor process. Epidurals allow you to get pain relief in the lower part of your body without affecting your conscious state and can be given at any point during active labor (usually around 4 to 5 centimeters dilated--sooner than that, there may be a concern of slowing the labor process). Very little of the medication will reach your baby because it isn't introduced into your bloodstream. Some of the disadvantages of getting an epidural are being confined to your bed for the remainder of labor (you will get catheterized in that case to allow for emptying your bladder), being monitored more closely and frequently (both mom and baby), possibility of weakening the "bear down" response during the pushing stage which may extend how long it takes to push the baby out, risk of reducing your blood pressure and subsequently baby's heart rate, increased risk of itchiness and nausea, and small possibility of a bad headache that may last for several days. 
2. Spinal Blocks: A spinal block is similar to an epidural, but differs in two main ways.  Instead of being delivered into the epidural space, the medication is delivered directly into the spinal fluid. Secondly, a spinal block is given in a one-time administration, usually right before the pushing stage, instead of being continuously administered through a catheter. A spinal block will usually last about 2- 2 1/2 hours, which is why it is usually give near the end of labor. The benefit of a spinal block over an epidural is that the pain relief is more fast-acting, but it won't last as long as the relief you may get from an epidural. Like with an epidural, only a small amount of the medication will reach your baby. You may benefit from a spinal if your labor is progressing really rapidly or if you ask for pain relief at a very late stage of labor. The disadvantages and risks of a spinal block are similar to an epidural.
3. Combined: A relatively newer approach is the combined epidural/spinal which offers the fast-acting relief of the spinal with the longevity of the epidural. It is administered in much the same way as the epidural except that 2 needles are used instead of one (they put the smaller spinal needle inside the larger epidural needle so you only have to be stuck once). The spinal needle is then used to inject medication into your spinal fluid, then it is removed and the catheter is put in place so medication can be administered as needed. During earlier stages of labor, this is often referred to as a "walking epidural" because it tends to lead to less lower body weakness so you can continue to walk around for the first few hours, should you desire to do so. The disadvantages and risks are the same as those listed above.

• Systemic Medications: Systemic medications, such as narcotics (specifically morphine, Demerol, Fentanyl, Stadol, and Nubain for labor), are medications that are used to alter your perception of pain. Unlike regional anesthesia, which are used to specifically target the uterus and pelvic area, systemic medications are delivered directly into your bloodstream via an IV or into a muscle and will affect your entire body. These medications will dull or numb your pain, but they will not eliminate it altogether since a low dose is required to minimize the effects on your baby. They may make you feel sleepy, but unlike general anesthesia, it will not render you completely unconscious.  In some cases, you may be given the option of patient-controlled pain relief where a small pump is hooked up to your IV and by pushing a button, you can increase the amount of medication that is being delivered to you; there are limits programmed into the pump so you don't have to worry about self-delivering too much medication. Systemic medications are a less invasive form of medication and don't require the services of an anesthesiologist. Additionally, women who use systemic medication instead of an epidural or spinal block are less likely to need pitocin or delivery assisted by forceps or a vacuum. The disadvantages of systemic medication are as follows: must be given in smaller doses so it may not offer as much pain relief as regional anesthesia, will cross the placenta and can affect the baby, unpleasant side effects such as nausea or dizziness, can slow labor if given too soon, can affect baby's heart rate, may make mom and baby less alert after birth so it can interfere with breastfeeding, and in rare cases it can affect mom's breathing and baby's breathing after birth.

• General Anesthesia: The most rarely used form of medication during labor is general anesthesia. This kind of medication is employed specifically to promote loss of both sensation and consciousness. The reason that it is used so rarely during labor is because the mother's participation during the process is key during most kinds of deliveries and the risks of general anesthesia usually far outweigh the benefits. The only time a general anesthetic would be used would be in the case of a Cesarean section, never in the case of a vaginal birth (doctors cannot facilitate a vaginal birth while the mother is unconscious). Some of the rare cases where this method is used are emergency C-section where very rapid loss of sensation is necessary, when an epidural or spinal block cannot be placed, and when a women cannot tolerate a regional anesthetic. When general anesthesia is used, the woman is given a muscle relaxant through an IV, which relaxes her and renders her semiconscious. She then inhales nitrous oxide which facilitates total loss of sensation and consciousness. A tube is inserted into the mother's trachea to maintain an open airway for breathing and to avoid inhaling vomited material should the mother throw up while unconscious. Research has shown that maternal and fetal death rates using this method are at least double those of regional anesthesia, therefore, the use of general anesthesia during birth has all but been eliminated in the U.S.

Questions to Ask Your Health Care Team Regarding Medications

• What's involved in the method?  How will the medication be delivered into my system?
• How will it affect me?
• How will it affect my baby?
• What are the possible side effects?
• How quickly will it work?
• How long will the pain relief last?
• When is this method available to me during the labor process (at any time, after I have progressed to a certain point, only near the end of labor, etc.)?
• What happens if it doesn't work in the way it was intended or not at all?
• Will I be able to remember everything?
• Will I be able to breastfeed my baby right after birth with this medication in my system?

Sources: www.babycenter.com, www.mayoclinic.com, www.americanpregnancy.org. www.anesthesiologyinfo.com

Disclaimer: The "Pregnancy, Babies, and Birth" blog series is meant as a source of general information only. Its intended use is to encourage women to further consider and discuss reproductive and birthing decisions themselves, with their partners, and with their medical care providers. Information included in this series is not intended to be professional medical advice or a substitution for a relationship with a licensed physician or practitioner. Any serious questions or concerns about reproductive, prenatal, and/or perinatal health should be directed to your primary care physician or other licensed specialist. Women's Services and Resources does not promote any particular brand, medical provider, birthing location, or any other specific birthing decisions. We strongly encourage women to become as educated about their choices as possible so they are empowered to make educated decisions for themselves and their babies.

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