You Got This! The 26.2 of Birth

Monday, November 2, 2020

If you are one of the few people on Earth who have completed a full marathon, let me just say: Congratulations! I know what goes into preparing your body to complete 26.2 miles, and I admire your patience, determination, and strength. I have never run a marathon and I can safely say I never will. BUT – I remember my midwife looking at me and my post-birth high and saying: “I wish I could bottle adrenaline!” Having a baby is so hard, but also crazy awesome. In many ways, very much like running a marathon.

When you _chose_ to run your first marathon you understood that it was going to be a _physical challenge. _You decided that _it was worth investing time and, probably, money _into completing the event because you were feeling excited about the _outcome. _(Let’s be real: there are only a handful of people who _love_ the race while they’re running, especially the first time). _Could your body really do it? _It’s a big ask.

As an eager marathon supporter, I do sometimes envision running the race. I can picture pinning my number on my shirt, crossing the starting line and feeling both claustrophobic and thrilled moving forward the first mile. I get emotional thinking about seeing my family cheering me on at the halfway mark and can internalize the deep sense of exhaustion and elation crashing onto the sidewalk once I’ve made it out of post-finish line walkway. But without having run it, my vision of completing a marathon is mostly a dream made up of Facebook memories of friend’s experiences and the occasional movie scene here or there. Probably something like your vision of birth. There’s a big gush of water breaking, someone sweating in a hospital bed with an adorable but petrified partner and then… there’s a baby! They’ve crossed the finish line. The truth is, neither of our visions are accurate.

Marathons are long and there is huge variability in how people experience the race. It takes folks who train between two and six hours to finish a marathon, yet, I can think of a whole lot of people who would need a day or two to walk the same distance. You can’t just wake up and decide to walk 26.2 miles straight. Sometimes your race time is within your control and sometimes it’s not. Best case is that you made it to the start line on time and healthy. No colds, food poisoning, or knee injuries crept up at the last minute. For the birthing person high blood pressure, funky fetal positioning, or a _too-_comfortable baby could all change your start time or ability to “run” at all. Hearing the bandstand playing _your song_ at the perfect moment might really speed you along, whereas missing your GU at mile 14 because your partner didn’t make it to your agreed-upon meeting spot in time, might really bum you out (sorry Matt).

Your training and race-day planning are never about guaranteeing an outcome. Completing a marathon, having a baby – _these experiences are defined by the preparation we do before hand (especially as it relates to the state of our physical body and mental resilience), the support we have around us, and a whole bunch of external factors outside of our control. _For both, we prepare to optimize the conditions that are within our control.

I don’t know if it’s because of the epidural, the level of confidence obstetricians exude, or our cultural lack of birth appreciation, but so many people get pregnant and think the baby will “come out one way or another.” While true, this severely undervalues the extent to which your prenatal care and birth experience shape your physical and mental health as well as your ability to parent after birth. Even my husband, in his injury-free-20-something-prime, trained for a few _months_ to prepare for his first marathon.

Having a spontaneous vaginal birth relies on a simple albeit awe-inspiring feedback loop of hormonal release, muscular contractions, and fetal movement. In order to ensure that this feedback loop begins and progresses well, it’s worth preparing your body. Have you checked in on your hormonal health and well-being? Played around with nutrition, sleep habits, and general stress management? Are you drinking enough water and breathing well? Muscles working for hours on end require hydration and oxygen. You know this. It helped you run. And, let’s not forget your baby. It is never appropriate to hold your breath when you have someone living in your body relying on you for oxygen. While “he-he-who” lamaze breaths have gone out of fashion (because they cause hyperventilation) breath-work for labor is as important as ever. Breathing well may sound trivial or like something to leave for the crunchy-granola type but is there anything else that simultaneously regulates our stress levels, uterine contractions, and baby’s heart rate? No. Do you know if your pelvis and pelvic floor muscles are flexible and resilient – ready to let a baby pass through? This one in particular is worth runners checking on. As a generalization, it’s safe to say that y'all have a way of holding on pretty tight down there and tension is not our friend in childbirth.

Actually, the idea that the baby will “come out one way or the other” not only undervalues the long-term implications of your labor, it allows you to miss an incredible opportunity. _Pregnancy, like preparing for a marathon, is a unique moment where you can try on lifestyle habits that may very well improve your overall health and wellbeing._

How does actually running a marathon prepare you to give birth? Where else can you practice pushing yourself through a huge feat of endurance? It is common in the birth world to break up “labor” into a few different stages. If you’re in your third trimester already, you’ve likely heard of these:

Pre-Labor is the period of time at the very end of pregnancy but before labor begins when people feel “funny” and oddly symptomatic (practice contractions, loose stools, an energy burst etc). It’s often confusing for people and there are a lot of false starts. Actual labor begins when you start having consistent uterine contractions that become longer, stronger, and closer together over time. I love thinking that pre-labor starts when you’re heading to the marathon expo. You can feel the swirl of energy around you as you grab your number, review the route, pick up your last minute supplies. You continue to garner momentum through carbo-loading, attempting a “good night's sleep” and maneuvering to your coral. At first you’re days away, then hours, then minutes. It’s all necessary and important, but at no point have you started to run.

Stage One is the period of labor when contractions begin to cause cervical dilation. It’s really happening! You’ve crossed the start line. In birth, we break up Stage One into three phases.

Early Labor is about mile 1-13. Things start out mild, but slowly increase in intensity. Mile 4 is going to feel thrilling, while_ _Mile 11 might start feeling hard. As a born and raised NYC Marathon supporter I know that 4th Ave (miles 3-8) is the place to be! You’re feeling good, the support is good, it’s a general party. By Mile 11 you may start feeling fatigued, or intimidated, trying to understand how this could get harder. You try and remember that 11 miles is not nothing. Progress is progress and our job is to keep moving. For many, early labor is long and more tedious than difficult. Early labor often gets people because it’s difficult to imagine the step after step after step continuity. Remember our visions of running a marathon or having a baby are made up of highly edited and dramatic moments. Things taking _time,_ without other complications, is not a cause of concern.

Active Labor is mile 15-20. Much shorter than early labor, but now you’re really working. Oh, did you notice that we skipped miles 13-15? That’s a straight up in between period and can be self assigned to early or active depending on how you want to tell your story. We have a very loose rule in the birth world that folks are in active labor, and should start heading to the hospital, when their contractions hit a 4-1-1 pattern. This means contractions begin every four minutes, last one minute, and have been happening for at least one hour. My question in class is, _if your contractions are about 55 seconds long, come every four minutes for 30 minutes but then two contractions comes come every three minutes followed by a few that come every six minutes, _are you in early labor or active labor? First and foremost the answer is that it doesn’t matter. Like, at not all. Completing this task is not about watching the clock or dissecting your data. The other answer though, is that you’re somewhere in between. For my NYC people, think of this as Long Island City (mile 13-15). W_here are you, really_?

You become a little more internal in active labor. A little more focused. A little more reliant on support. You may benefit from a cry. But, a well timed honey stick, very enthusiastic side line, or amazing poster can make a huge difference. This is your race to run, but if you let them, the sidelines may lift your spirits and carry you on.

Earlier, I mentioned the positive feedback loop of childbirth. It’s worth understanding it a bit more specifically: the hormone oxytocin which is induced by feeling relaxed, safe, and loving causes uterine contractions. Uterine contractions do two things. They push a baby down and pull the cervix up and out of the way. When a baby is pressed down, the pressure causes a release of a hormone-like substance called prostaglandins. Prostaglandins soften the cervical tissue which allow the contractions to cause dilation. A soft cervix can open, a hard cervix cannot. Once your cervix is very dilated, contractions get a bit _longer, stronger, and closer together_ to maintain the force needed to reach full dilation.

Transition is mile 20-21. In NYC it happens in the Bronx. Miles 20-21. You hit a wall. After all of pregnancy and pre-labor. You’ve trained and made it to the start on time. After early labor and active labor. We’re talking 20 miles. After all of that, there’s more. And then, there’s more after that. There is always crying in transition. A desire to give up. Some may say they have decided to keep the baby in, while others declare it’s time to cut the baby out. Anything but keep going. _I can’t, _you’ll say. But. You can. Much more so with an amazing team of people by your side to let you break down and then build you back up. We won’t say “you’re almost there,” because we know better, but we will tell you that _you’re doing great. We’re right here with you. You are so incredibly strong. _And then it’s done. You move through it. By most accounts transition is the steepest section of the birth challenge, but it is also the shortest. Your efforts are rewarded with heaping amounts of adrenaline that make you continue. You’ve made it to Stage Two. 

Of course, it would be nice to be done already. But, you decided to run this marathon and you’re not one to give up. Again, barring injury or unexpected circumstance. You somehow move your body from mile 21 to 25. Likely by following the direction of the crowd to _just keep going. _You may have someone hop on the course and run a mile or two by your side. Pushing out a baby is no small task. And unlike a marathon, with a fixed destination, delivering a baby can feel like an ever moving target. For some this milage is confusing and upsetting. For others knowing there is a light at the end of the tunnel brings a second wind! At some point after mile 25 you can feel the finish line before you can see it. The sense of relief rushes over you, nearly, but not actually, canceling out the burning sensations and extreme fatigue. And then, just like that, you cross the finish line. Yeah, baby! Savor this moment for it does not come again.

To officially mark the labor and delivery experience complete, we wait for your body to birth the placenta. This is Stage Three. When all you want to do is celebrate, you still have to find your way out of the marathon machine. There’s much more walking than you were expecting and no one talks about it. Honestly, why would they? It pales in comparison to anything else. I love to think that after you run a marathon, best case is that you get a medal and a mediocre bagel. After birth, you get your baby! And, if you’re lucky you can have a bagel too.

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