The Business of Being Born Message Board

Q:I’m 25-weeks pregnant and am getting concerned about my midwife’s views on delivery. Let me first explain that I was initially ecstatic when I found out that my health insurance had any midwives that were considered in-network. I had two options to pick from: a team of midwives at a hospital or a midwife with her own private practice. I chose the private practice. (There was no guarantee with the team of midwives of who would be at the actual delivery.)

My midwife has been very caring, on-time with appointments, and listens to and answer my questions patiently. My issue is that the only significant difference in her perspective on delivery from the current, standard, western views is that she tries to avoid to c-sections at all costs. I thought this was going to be enough to create the right environment for my birthing experience until we discussed the actual delivery yesterday; she explained that I’d be using a vasalva manuever and she would be coaching me through each push.

I’m a prenatal yoga instructor and 100% believe in listening to my body; it’s NEVER been wrong yet.
I’m also have spent many months focusing on my connection to and the strength of my pelvic-floor muscles and I’m a good belly breather and have a strong connection to my transverse-abdominal muscles. I’d like to wait for my own body to tell me when to push and not to hold my breath in a vasalver maneuver while doing it.

I don’t have the money to switch to a midwife that isn’t in-network. Do you think a doula would be helpful to keep my birthing plan in place? I’d love to do an at-home birth, but don’t know if the cost is less if I the prenatal care given is only from my third trimester on (rather than being cared for the entire pregnancy).

Any suggestions would be helpful.

Marina

A: Marina, I see that you have a couple of questions. First of all, let me explain what a vasalva manuever is. Merriam-Webster defines the Valsalva maneuver as “the process of making a forceful attempt at expiration while holding the nostrils closed and keeping the mouth shut for the purpose of testing the patency of the Eustachian tubes or of adjusting middle ear pressure.” This can effectively increase pressure in the chest that is used to help “push” the baby out. Basically, it is holding your breath to build up pressure in your diaphragm.

Certainly it takes a lot of effort to push a baby into the world. But, hypnobirthers and other proponents of gently birthing techniques are foregoing this type of pushing and teaching moms to “breathe” their baby out. As a midwife, I think that can be very difficult for a first time mom to get her baby born this way, but mostly I would recommend and intention of gentle pushing, but giving it your all when you need to. I usually see moms work up a sweat in their pushing efforts. Birthing is hard work!

A doula would certainly be helpful in coaching you how to push your baby out. It also sounds like having her as an advocate would be helpful too. This is YOUR BIRTH. You can do whatever you want. Don’t let anyone steer you into pushing in a way that you would rather not. You can find positions and styles of pushing that will work.

Switching to a homebirth may not be any cheaper at this point. Usually midwives charge a flat fee for whenever you come into care. Next time though, a home birth might be exactly right!!

Good luck with your birth,
Maria Iorillo, LM, CPM