Push!

This post is all about pushing... what works, what doesn't, and how to have the most rewarding pushing stage for your birthing time!

Pushing, or the 2nd stage of labor, is the active process of bringing your baby through the birth canal, past the perineum, and into the world!

There are a number of ways to push, generally broken down into two categories: coached pushing and spontaneous pushing. Coached (directed) pushing (aka purple pushing) is just what it implies - you are coached when and how to push. Spontaneous pushing includes grunt pushing, singing your baby down, and breathing your baby down. Many women find themselves doing a combination of these, with whatever feels and works best for them.

There is a great article by FitPregnancy called The Push Paradox.

"“Plain and simple, coached pushing, especially with the woman on her back, can harm mothers and babies,” says Amy Romano, C.N.M., a Connecticut nurse-midwife who contributed to the Lamaze International guidelines on care during the pushing stage of labor.

Several studies on coached pushing have been conducted in the past few years. Although not all reach the same conclusions, they suggest that the practice is more likely than spontaneous pushing to tire a laboring woman and make her less satisfied with her birth experience. The excess force of directed pushing may raise the risk of vaginal lacerations and episiotomies, as well as pelvic-floor weakness, which can lead to incontinence and sexual dysfunction. Pushing on command may also contribute to fetal heart rate abnormalities, lower blood oxygen levels in babies and an increased need for such medical interventions as instrument-assisted delivery. (It can be helpful if you’ve had an epidural, however.)"

Coached pushing is the most common hospital occurrence. This entails a woman pulling her knees back, tucking her chin, taking a deep breath in, holding it, and pushing for a count of 10.

This type of pushing shortens the time of pushing to birth by about 13 minutes. Which is not much in the grand scheme when you consider that a first-time mom will push for an average of 1-2 hours. On the other hand, it does have a greater incidence of trauma and intervention.

Grunt pushing is what occurs most often when a woman is allowed to listen to her bodies cues. This entails short bouts of breath holding and bearing down. If you have never heard a woman grunt pushing, this is a beautiful example that will give you a very good idea of what grunt pushing is.

Grunt pushing is the physiological response to a baby filling the birth canal, and as a result, compressing the colon, which is directly behind the Vaginal Barrel. This compression stimulates the Ferguson Reflex, the reflex that tells the body to bear down with a bowel movement, and results in the grunty pushing that you hear and see in the example above.

Singing your baby down entails simply keeping your glottis open and making noise to release air slowly and controlled. It can be a quiet aaah or a loud open yell. Not everyone differentiates between singing or breathing your baby down, but I have found that this is the second most common occurrence when a woman is not coached in 2nd stage and has not used a formal education program such as Hypnobabies.



Breathing your baby down is something that Hypnobabies brought to the forefront of the birthing community. It was something used previously (see singing your baby down), but is 'the way' of working through 2nd stage for a Hypnobabies birthing mother and is generally more controlled and quiet than singing a baby down. Here is a beautiful example of what this looks and sounds like, a light aaahh, and truly just breathing:



She does have a bit of involuntary bearing down, but it is the best example I can find on the web.

So, what about positions?

Here is a great video on positions for second stage:


There are a great number of positions that are physiologically more beneficial than lying on your back or semi-reclining for moving baby down.

These positions include: side-lying, standing, squatting, all-fours, frog squatting, and leaning.

• Lithotomy - This position (also called supine) is the worst position for birthing. It is marked by being completely or nearly completely reclined (on your back with either your knees far apart or in stirrups. This position compresses the pelvis, making the outlet smaller, puts pressure on the vena cava (main artery supplying blood to the uterus) which can result in ineffective or stalled contractions, and works against gravity by providing an up- ward slope to push baby out of.
• Classic - What is normally seen in hospital settings during a natural birth where the hospital staff directs a woman into a position for birth, this position allows mom to pull her legs back as far as possible and see the progress of pushing in a mirror. It also allows for a support person to get behind mom to support her legs or back. It involves sitting in a 45-90 degree angle—and allows mom to completely relax between contractions.
• Squat - This position is considered the best for 2nd stage as it shortens the birth canal by 10-15% and opens the outlet of the pelvis by an average of 13%. This position is good for large babies, ‘stuck babies’, long 2nd stages, or mother’s interested in catching their own babies. Gravity is a great ally in this position.
• Standing - Standing is a very uncommon position for birthing as it requires mom’s active participation in holding herself up, though gravity assists well in this position.
• All Fours - All-Fours is a great position for posterior babies, large babies, or babies where shoulder dystocia is either present or expected. This position allows mom complete control over the strength and timing of her pushing contractions as it takes pressure off of the Ferguson Reflex.
• Side Lying - A gravity-neutral position for birthing, it is considered one of the most gentle birthing positions as mom has the ability to lift her leg as much as needed, push to comfort, and gently stretch through contractions. It takes some pressure off of the Ferguson Reflex, allowing mom more control over pushing. If 2nd stage is drawn out, or if there is a large or stuck baby, this can be a detrimental position, though.
• Variations- Sitting on a birthing stool, Frog position, asymmetrical position

To close, listening to your bodies needs, allowing your birth team to be an encouragement to you, and working with your bodies cues will ensure that you have the best, most rewarding 2nd stage as you welcome your baby into the world!

In Honor of International Genital integrity Awareness Week

This week marks the 17th anniversary of Genital Integrity Awareness Week. The event was established to coinicide with the anniversary on March 30th of the federal law against Female Genital Mutilation and the beginning of Child Abuse Prevention Month (which occurs each April), to bring awareness to the fact that infant circumcision is risky, painful, harmful, medically unnecessary, and unethical.

During the week, activists in favor of ending infant circumcision will be gathering at 9 a.m. each day on the west lawn of the U.S. Capitol in Washington, DC to show their support for bringing an end to infant circumcision in this country.

UPDATED! At 4 p.m. on Tuesday, March 30, the March Against Infant Circumcision will begin, with activists marching to the White House. Representatives of Intact America will be there flying an Intact America banner (see below), urging legislators to stop infant circumcision. More information is available here.

- Intact America

Additionally, there is a wonderful article written by a father on his very difficult (and painfully honest) talk with his son about sex, genital integrity, and coming of age.

Other reads:
The Winds of Change
By Definition

New YouTube Births

And a new favorite:

Out Came The Sun

Sage Birth Co-Op is excited to be a part of the MomsBloom Out Came the Sun event.

This event will be a combination of a run/walk to raise awareness in the community about PPD and how to help as well as a Family Marketplace where local businesses and organizations can give information on their efforts/businesses.

Having BTDT with a bad case of the baby blues or a mild case of PPD (its still up for debate), and having worked with women who have suffered from all levels of postpartum disorders, this is a topic that I am very intent on bringing to the attention of the general public.




There are, in layman's terms, 3 different types of 'depression' in the postpartum period. These three are the Baby Blues, Postpartum Depression, and Postpartum Psychosis (some in the medical community add a fourth - Postpartum PTSD - that can accompany Birth Trauma).

Many women experience the baby blues in the first few days after childbirth, some theorize an upwards of 75% of postpartum women experience some level of the baby blues. Some symptoms of the baby blues include:

• mood swings, including feeling sad, anxious, or overwhelmed
• crying spells
• loss of appetite
• insomnia
  

The baby blues most often peak within the first few days after birth and go away within a few days or a week. The symptoms are not severe and do not need treatment beyond community and relational support. A postpartum doula can greatly help to alleviate the symptoms of the baby blues.

The symptoms of postpartum depression last longer and are more severe. Postpartum depression can begin anytime within the first year after childbirth, although they often manifest within the first month. Postpartum Depression takes on a number of guises and symptoms and can include:

• the same symptoms of baby blues, but more severe
• disinterest in things that normally bring you joy
• thoughts of hurting yourself or the baby
• not having any interest in the baby

Postpartum depression needs to be treated by a doctor. Some treatments include: community and support groups, homeopathic or herbal remedies, or medications. Postpartum doulas can still be a great asset during this situation and help to transition a woman into motherhood in conjunction with her medical team's efforts.

Postpartum Psychosis is rare. It occurs in about 1 to 4 out of every 1,000 births. It usually begins in the first 2 weeks after childbirth. Women who have bipolar disorder or another mental health problem called schizoaffective disorder have a higher risk for postpartum psychosis. Symptoms may include:

• hallucinations
• confusion
• rapid mood swings
• trying to hurt yourself or your baby

There are some great articles on postpartum depression, including emedicine and Medicine.net, although PSI is, by far, my favorite. Offering online, as well as IRL (in real life) support, information for the professional as well as the family, and treating the woman with respect and dignity, the community is a safe haven for women experiencing PPD.

There is an online PPD screening tool, which can help you with an initial assessment, but should not take the place of professional care if you believe that you are suffering from PostPartum Depression.

I would love to see you all there, helping to encourage and support women during the postpartum period... Perhaps you will even win one of the great prizes that Earth Mama Angel Baby donated for the event.

Great Sites:
Jennifer Mudd Houghtaling PPD Foundation
Postpartum Men
Mother to Mother Postpartum Depression Network
Birth Crisis
TABS - PTSD and traumatic birth support
SOLACE - Birth Trauma support center

Emails and Interventions

Nella* emailed me the other day. The email read:

"Cole,

OK, everyone knows that you are a natural childbirth nut. But why does that mean that the rest of us should feel bad for choosing what we have chosen? Don't you think it is a little judgmental to push your way of birth on me and others who choose whatever route of birth they want.. even if it doesn't line up with your view of how it should be done?"**

Alrighty... first off, I'm not a nut, although sometimes I feel like one, sometimes I don't! Second, I never 'push'.. Unless pushing means giving options (both medical and not), information (both both risks and benefits), and sharing positive birth stories.

Another aside, I am an advocate for natural birth, and there is a good reason why. It's not just about the experience, it's so much more.

The video below is a very small excerpt from Ricki Lake's Business of Being Born.

This particular excerpt deals with the cascade of interventions that occur in the majority of American hospital births. What is the Cascade of Interventions? It is the idea that one intervention leads to other interventions, which lead to other interventions...

An intervention is anything that intervenes, intercepts, or interferes with a process or thing... an IV, a vaginal exam, Fetal Monitors, etc...



There is a great article by Childbirth Connection that talks about the best ways to avoid unnecessary interventions that I believe every woman should read and take to heart.

Interventions introduce possible risk, and increased chance of risk is something that all women should be interested in avoiding if at all possible during childbirth, as with all areas of their lives.

I support educated choices in childbearing, regardless if they are what I would do, as long as the risks and benefits are weighed carefully and completely. I have supported, proudly, beautifully empowering epidural births... but this is not the norm!

Some additional reads:
The Profit of Pain Relief
Benefits of NCB and Public Opinion

My intent is not to make you feel any way except thoughtful. I am not trying to grieve you, begrudge you, or anger you over your decision - I simply want you to know the risks and benefits so that you have no regrets, and no secondary anger, over your choices.

* name changed to protect identity
** posted applicable email content only

Children At Birth.. Revisited

How well do children do at birth?



Revisited from Children At Birth.

Tilt Head, Add Puzzled Expression

Add a heavy dollop of this... and you have befuddlement.



What's right with this video... Ok, now, what's wrong with this video?

Open Mouth, Open Cervix

So many women are afraid of being noisy in birth. You would not believe the number of women I have spoken to who are afraid of making noise, vocalizing, etc... during labor and birth.

I believe it is a biproduct of our culture. Women, a few years ago, were taught to be seen and not heard - this belief is still prevalent in some subcultures of Americana. And, more recently, women are 'supposed to be' poised, confident, and in control. Regardless if you are of the 'seen and not heard' camp or the 'poised, confident, and in control' group, there is little room for noisy birthing there.

One of the simplest 'tricks' in my bag is to simply make noise. Women who seem to be doing so well with labor, then suddenly blurt out that they can't go on, they need some help, they need an epidural - those women I immediately encourage to make some NOISE.

I am not saying that every woman needs to be a noisy birther, but there is great evidence to suggest the correlation between the vocal chords and the cervix. And, any of us who are physically active out there can attest to the stress relieving, and thus, pain relieving qualities of simply making noise.

Now, not ANY noise is good noise - it has to be a certain type of noise. It doesn't matter if it is loud or quiet, but it does matter what form it takes. Positive noise includes:

• Open glottis
• Deep breathed
• Relaxed jaw
• Resonating

Some examples of these noises are vibrating hums (when the jaw is relaxed), horse lips (per Ina May Gaskin), ooohs, aaahs, uuuuhs, naughs, and even singing.

Singing is an amazing vocal labor relaxation technique. It helps to control your breathing, encourages deep breathing, and keeps your vocal chords, jaw, and body relaxed. It also works through distraction from contractions and focus on resonation. And, just for viewing pleasure:

Childbirth In the News

For coverage of this last weeks excitement regarding VBAC information (the most talked about news this week) see here.

In other news, CNN , Time, and the Guardian reports on Amnesty Internationals report of US Maternal Mortality rates doubling, regardless of our countries 'advancements'. I wish that someone would see the benefit of having Medicaid cover home birth midwives in all 50 states. These 'underprivileged women' would get the one-on-one care that they so desperately need, there would not be as long a wait to get in to see a professional, and they would get the lower-interventive care that would better their odds of having a vaginal birth rather than surgical. GASP! Go figure, possibly fix all of the problems in one fell swoop?

A Miami Herald reporter, and mother, talks about how to avoid a cesarean in South Florida, particularly Miami, where the cesarean rates are upwards of 51%.

A woman in Georgia is charged with 2nd degree cruelty to a child after circumcising her 10 month old daughter. This is rather timely, after a recent post. I don't really have anything to say except that it pains my heart and fumes my maternal instinct.

A London newspaper stews over hospitals allowing sales reps and photographers access to newly postpartum women's rooms immediately after birth... all for commissions and referral incentives. This act is under scrutiny not only by the general public, but also the National Childbirth Trust - citing how unethical it is to 'hit someone up' through solicitations when so vulnerable, not to mention the breach of privacy.

Finally, an Australian elephant defied medical odds and, 2 days after veterinarians pronounced her calf dead in the womb, an elephant matriarch gave birth (unassisted - *snicker*) to a live calf.

Mama's Milk Cheese

Would you try it?

The First Cut is The....

Wow... I opened my inbox this morning and found a plethora of information on the results of the National Institutes of Health (NIH) Consensus Development Conference on Vaginal Birth After Cesarean: New Insights

The conclusions (per their draft statement) are shown below, although you can follow the above link and read the complete study, as well as additional information:

Given the available evidence, TOL is a reasonable option for many pregnant women with a prior low transverse uterine incision. The data reviewed in this report show that both TOL and ERCD for a pregnant woman with a prior transverse uterine incision have important risks and benefits and that these risks and benefits differ for the woman and her fetus. This poses a profound ethical dilemma for the woman as well as her caregivers, because benefit for the woman may come at the price of increased risk for the fetus and vice versa. This conundrum is worsened by the general paucity of high-level evidence about both medical and nonmedical factors, which prevents the precise quantification of risks and benefits that might help to make an informed decision about TOL versus ERCD. We are mindful of these clinical and ethical uncertainties in making the following conclusions and recommendations.

One of our major goals is to support pregnant women with a prior transverse uterine incision to make informed decisions about TOL versus ERCD. We urge clinicians and other maternity care providers to use the responses to the six questions, especially questions 3 and 4, to incorporate an evidence-based approach into the decisionmaking process. Information, including risk assessment, should be shared with the woman at a level and pace that she can understand. When both TOL and ERCD are medically equivalent options, a shared decisionmaking process should be adopted and, whenever possible, the woman’s preference should be honored.

We are concerned about the barriers that women face in accessing clinicians and facilities that are able and willing to offer TOL. Given the level of evidence for the requirement for “immediately available” surgical and anesthesia personnel in current guidelines, we recommend that the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists reassess this requirement relative to other obstetrical complications of comparable risk, risk stratification, and in light of limited physician and nursing resources. Healthcare organizations, physicians, and other clinicians should consider making public their TOL policy and VBAC rates, as well as their plans for responding to obstetric emergencies. We recommend that hospitals, maternity care providers, healthcare and professional liability insurers, consumers, and policymakers collaborate on the development of integrated services that could mitigate or even eliminate current barriers to TOL.

We are concerned that medico-legal considerations add to, as well as exacerbate, these barriers. Policymakers, providers, and other stakeholders must collaborate in the development and implementation of appropriate strategies to mitigate the chilling effect of the medico-legal environment on access to care.

High-quality research is needed in many areas. We have identified areas that need attention in response to question 6. Research in these areas should be prioritized and appropriately funded, especially to characterize more precisely the short-term and long-term maternal, fetal, and neonatal outcomes of TOL and ERCD.

The LA Times reports on these findings as well in Panel urges more choice in birth after C-section.

A National Institutes of Health panel says vaginal birth after caesarean is reasonably safe and should be more widely available. Many hospitals ban the practice as a matter of policy or liability. Vaginal birth after caesarean, or VBAC, is reasonably safe and should be more widely available, a National Institutes of Health advisory panel concluded Wednesday.

Such deliveries once accounted for 25% of U.S. births among women with a previous caesarean delivery, but have now fallen to less than 9%. Many women would like to attempt a vaginal delivery, however, and the panel's consensus statement is expected to increase their access to the option.

Daniel DeNoon reports in NIH Panel: End Bans on Vaginal Birth After C-Section:

But women who might want to give labor a try very often don't get a chance. That's because of so-called "VBAC bans" -- hospital policies that forbid a vaginal birth after a cesarean (VBAC) unless fully equipped and staffed surgical and anesthesia services are readily available. These policies align with current guidelines set by gynecology and anesthesia professional societies.

Not all hospitals are able to comply with this standard, so many women who have had a C-section have no choice in the matter. In fact, 30% of hospitals stopped offering women this choice after the professional-society guidelines went into effect.

Denise Grady of the New York Times wrote on this subject in her article Panel Urges New Look At Cesarean Guidelines:

A panel of medical experts on Wednesday recommended steps to reverse a trend that has dismayed many pregnant women: the increasing difficulty of finding doctors and hospitals that will let a woman try to give birth normally if she has had a Caesarean section in the past.

The new recommendations came at a conference held in Bethesda, Md., by the National Institutes of Health to examine why the rate of vaginal birth after Caesarean, or VBAC (pronounced VEE-back), has plummeted, to less than 10 percent from 28.3 percent in 1996. The repeat operations are feeding the nation’s overall Caesarean rate of 31.8 percent, which has been rising steadily for the last 11 years.

Lauran Neergaard, AP Medical Writer, covers that Women Need A Chance to Avoid Repeat C-Sections

Too many pregnant women who want to avoid a repeat cesarean delivery are being denied the chance, concludes a government panel that urged doctors to rethink litigation-spurred policies that have swung the pendulum back toward the days of "once a C-section, always a C-section."

Fifteen years ago, nearly 3 in 10 women who had a first C-section were able to deliver their next baby vaginally, a trend called VBAC for "vaginal birth after cesarean."

Now that rate has dropped to 1 in 10, in part because a third of hospitals and half of physicians ban women from attempting VBAC, a panel of specialists convened by the National Institutes of Health said Wednesday.

But VBAC remains a safe alternative for the right candidates, and when those women try labor, between 60 percent and 80 percent of the time they do give birth vaginally, the NIH panel concluded. It urged that doctors offer mothers-to-be an unbiased look at the pros and cons, so they can decide for themselves.

Lolita Carico writes, at Mama Gloss, in her article Why Are C-Sections on the Rise,

Cesarean sections are the #1 most performed surgeries in the United States, with 1 in 3 pregnant women giving birth via c-section. That figure is up significantly since 1996, when the rate was 1 in 5.... The debate rages on, but a new report being released today by the NIH (National Institute of Health), has determined that VBAC’s are just as safe as normal births. The findings could lead to a decline in c-sections.

MSNBC shares on Women Need the Chance To Avoid Second Cesarean:

Visit msnbc.com for breaking news, world news, and news about the economy

I have high hopes that this exposure will change (over time) the unethical ban of VBACs in hospitals across this nation (and two in my own area) and create an uproar by consumers over insurance companies dropping women seeking VBAC or even women who have had prior cesareans and find themselves pregnant again - and force change.

As the results of this conference snowball across the birth community news, blogs, Facebooks, and Tweets, I anticipate and joyfully expect more women to seek out alternatives, vocally so, and hospitals/practices to be urged to make changes to accommodate these options.

Additional Blogs of Note:

The Feminist Breeder (along with more coverage of the conference) concludes in Once a Cesarean, Rarely a Choice :

Time will only tell if the more positive points made by NIH consensus will have an impact on access in this country. From a birth activist’s point of view, the statements made by many of the conference speakers were a huge leap in the right direction. However, our cesarean and VBAC rates will not be reversed overnight, and in the interim, scores of women are left without a choice but to either fight the system for their VBAC, or submit to a surgical birth. To these women and their families, this is really no choice at all.

Science & Sensibility writes, in Do Women Really Need To Know The Uterine Rupture Rate To Make Informed Choices About VBAC:

The NIH press release about the VBAC Consensus Meeting includes only a single instance of the phrase “uterine rupture.” Having spent 2 1/2 days watching the streaming webcast of the event, my strong sense is that this was by design. During the expert testimony, we heard over and over again that uterine rupture is the most feared outcome of a VBAC. We heard in gripping detail what happens when a uterine scar ruptures in labor, and even saw photographs of the devastation. We heard about deaths and hysterectomies and hypoxic injury to newborns that occurred with uterine ruptures. But after all of that, we heard a rather consistent message that uterine rupture itself is not the issue.

Courtroom Mama ruminates, over at The Unnecesarean, NIH VBAC Consensus Development Conference: Gift Horse or Trojan Horse?

There are a lot of wonderful things to say about the recent NIH VBAC Consensus Development Conference. Hopefully it will expand access to VBAC by urging ACOG to reconsider the “immediately available” standard, and end the practice of banning VBAC rather than working to lessen the risks through physiological management of labor and other techniques. I’m happy to see that they are finally acknowledging that there is no way to reduce infant mortality to zero, and that the risks inherent in VBAC are no different from the risks of catastrophic outcome in any other delivery, making singling out of VBAC nonsensical. I applaud the panel for that.

But, as a law geek and a birth geek, I have to look a gift horse in the ass here.

When the draft statement first came out, I was a little bit troubled by the part that is now the end of page 14 and top of page 15.

Along these same lines, the 1999 ACOG guideline urged, “After thorough counseling that weighs the individual benefits and risks of VBAC, the ultimate decision to attempt this procedure or undergo a repeat caesarean delivery should be made by the woman and her physician.” Presentations at the conference suggested that this important recommended practice is not uniformly followed, but there are no strong data documenting the extent of this problem.

In my opinion, this portion of the recommendation didn’t strongly address some of the concerns raised in the prior two days about what happens to women who aren’t ideal VBAC candidates and who nevertheless don’t want to have surgery. Surely I wasn’t the only one worried…

Stand and Deliver posted a great review on her blog, along with much more linkie love on the whole event.

Doula-la talks about what Shrimp and the NIH Panel have in common.

Karen The Pittsburgh Doula covers a small blip and privies us to her 'shell shockedness' of the whole communication-sphere of the US going abuzz with the news.

Academic OB/Gyn writes about a possible solution through Micro Tort-Reform. Very good read.

VBAC in the News is covered by Your Best Birth.

Momotics talks about what wasn't covered at the conference.

And, to close, Refuse to Be A Womb Pod writes I know what you did last summer

I did something last summer.
Actually, I did it for the second time.
Most professionals think what I did is dangerous.
I was told I shouldn’t do it. Many institutions have banned it.
I meet women very often who have never even heard of what it is I did.
Sometimes women say they wish they could do what I did
but they aren’t allowed.
Or brave enough.
Or wide enough or thick enough.
Or, it’s just not convenient
enough.
Sometimes the very law itself doesn’t allow women to do what I did....

Go to her blog to read the rest.

Embrace Life

This is the best public health commercial I have ever EVER seen. I didn't expect to, but I choked up. It gets the point across, and oh so beautifully too!

Baby Wearer? GASP!

I am sure you have heard about the recall on Infantino Slings because of reported infant deaths.

If you haven't, be prepared and FULLY educated regarding this recall. I have already received a great many phone calls and emails about the bane of baby wearing and other 'dangerous' attachment parenting practices. The thing is, the media reports are (whether intentionally or not) minimizing the fact that these are a specific brand of sling, not all slings.

There is a great blog post from Undercover Mama that I encourage you to read:

Brace yourselves, babywearing parents.

If we thought we got inquiring looks for slinging our babies before, I'm sure we're in for a firestorm of more than just curious glances now that the Consumer Product Safety Commission is preparing to issue a warning to parents about infants having suffocated in popular slings sold at our local Target. And it might not be such a bad thing.

I want the conversations to begin flowing when I'm wearing my babes mostly because my heart weeps for the parents who lost their little ones while trying to wear their babies close to them. It's terribly heartbreaking that these moms and dads wanted to love and protect their babes by wearing them, and just the opposite happened when their precious little ones suffocated while being worn.

So this warning is important. Yes, it's so very vital, not only because slings that are being marketing are responsible for death but also because this warning will further thrust babywearing into the spotlight. And though I'm praying that the warning will clearly explain and define why the types of slings that have caused these terribly tragic deaths are dangerous, I, for one, am not willing to leave any of the babywearing education to a government safety commission. - The Real Deal on Safety

I'm sure many people either didn't hear about the danger of using your babies car seat as either a baby carrier or a bed.

I am worried that, rather than learn SAFE baby wearing, women will revert to detachment parenting again, leaving their children in car seats for extended periods of time beyond the car rides for safeties sake.

Beauty

Today is International Women's Day 2010. I wanted to take this moment to thank all the beautiful and strong women in my life: mentors, my mother, grandmother, and greatgrandmother, my friends, and so many more.

I would also like to take this opportunity to encourage all of the beautiful pregnant women that I have had the honor of meeting, knowing, and working with.

There are so many different concepts of what true beauty is.

For me, beauty is fertility, life, love, trust, fullness, and expectancy - beauty is the pregnant form.

Here are some other interpretations of beauty in the pregnant form:

LeeAnn Alexander

Gunther von Hagens
Wallegree
Sekti Artanegara
Ron Mueck
Ron Mueck
Rein Nomm

Nooshin Zarnani
Kazuya Akimoto
JoJoInnees
Imogen Cunningham 1959
Gustav Klimt

Geo Geller

Christophe VorletAnith Kapoor
Alexia Lounds
Al Farrow

Thank you, every woman who has ever inspired, challenged, taught, humbled, elated, surprised, or loved me!

Babies!

I am so excited to see this!

Interactive Birthing

There are some wonderfully fun, informational, interactive programs on the internet nowadays. A few years ago, Contraction Master arrived on the internet, and shortly thereafter, Virtual Labor found it's way online. Just recently, even more choices are cropping up, and I can't say that I am disappointed!

Deliver My Baby - an interactive provider decider. :) "When you become pregnant, you are faced with many decisions. Who will provide health care for you and your baby, and who will deliver your baby? Here is a short quiz to help you narrow down the type of health care provider that best fits your needs. It will also give you a list of key questions to ask when interviewing potential care providers."

Inside Homebirth - an interactive birth settings comparison! Mousing over the different birth settings, you can see the risks and benefits of, explanations of, and tools of each birth setting.

Interventions and Your Body - this is a fun tool that allows you to move between hospital and home birth interventions and how they might affect you, your baby, and your birth.

Have fun clicking, comparing, and making the best choices for your desires/needs.

Mother of Many

Ok, so I am totally stealing this from Dou-la-la, but I am completely intrigued! I am with you, if you can find how to get it state-side, perhaps a few of us can go in on the cost and then 'share' it by mail?

The Winds of Change?

Without meaning to, it seems that a great many of us in the blog world have written posts on circumcision and education regarding the act in the last month. For that reason, here is a small list of blogs who recently posted on this subject:

• Shinemama - In God's Image. Circumcision, Darwin, and the Nature of Humans
• IntactAmerica - Alan Cumming Joins Forces
• Doula Ambitions - Parenting Choices

If you have posted about this in the past, I would encourage you to link your blog post in the comments

Interview with Barbara Herrera

A few weeks ago I decided to ask Barbara Herrera, one of the midwives that I follow on the blogsphere, to be a guest on my blog. She is better known in the online community as the Navelgazing Midwife. She is an LM (CA) and CPM in San Diego, CA and continues to write thought provoking, controversial, and timeless articles on women's healthcare, history, and advocacy.

I invite you to pull up a chair and enjoy learning just a little more about the Navelgazing Midwife.


What led you to midwifery?

I wasn't led; I was dragged into it. Growing up, I never liked kids. They were messy, noisy and stank; I didn't want anything to do with babies. But, starting when I was 18, friends began asking me to help them when they were having their babies. After I'd been to a few, I thought I should learn a thing or two. It wasn't until after I had my second baby, at home, that I was bitten by the birth bug. Once I got going, there was no stopping me!

What does midwifery mean to you?

I serve women. Midwifery is serving women. The mission gets all jumbled up with the law, insurance, odd educations, inept midwives, overbearing doctors, interminable technology and minimal societal support. Those of us who keep moving forward despite the obstacles *really* want to be midwives. It isn't an easy "occupation" (calling?).

What is your hope for all women you attend?

There's an underlying belief that midwives empower women, that we have the key to helping them find their inner strengths, giving them the power to transform their lives. In reality, women empower themselves. Simply by choosing to birth at home, to hire a midwife, to remove themselves from The System... all of these actions are her empowering gifts. She gives them to herself. My hope for women is they discover and, if possible, embrace aspects of themselves they never knew existed before. Tapping into these previously unknown strengths buoys us along as mothers, as parents. It is not uncommon for women to remember their laborious journey and be able to take another deep breath and say, "Okay, I did that, I can do this."

I notice that you help women in the hospital setting too. What are your feelings on hospital vs. home birth?

People do like to say "home versus hospital" as if it is a contest, one that will be won by whoever has the best/most natural/least interventive/most (or least) painful/etc. birth experience.

There is a birth place for everyone. For most women in our culture, that place is a hospital. The latest statistics seem to show out-of-hospital births are increasing, but they are still a fraction of those hospital birthing mamas. I support women wherever they choose to birth. I really enjoy working with hospital birthing women. It's totally different than my homebirth clients, but the joy is identical.

What types of situations would lead you to transfer a woman to the hospital?

I use the term "transfer" if we go to the hospital in a car. A "transport" is going by ambulance. There are far fewer reasons to transport than to transfer since those are absolute emergencies. A postpartum hemorrhage, a baby that needs more than basic resuscitation and a baby's heart tones (while the baby is still in the uterus) that do not resolve are the most common reasons for a transport. A transfer is slower, less urgent and can be because progress in labor has stopped, because mom wants pain medication or if her blood pressure begins climbing. I also have no experience delivering breech babies, so would transport for a surprise breech (and I have).

Do you stay with women during transfers/transports and, if so, what is the vibe you get from the medical institution during these transfers?

Absolutely! Any midwife who leaves her client is unethical as far as I'm concerned. If she cannot stay because of legalities, then she needs to have a doula go with mom. Sending a mom into the hospital without support is cruel.

In all the years of transferring and transporting women, I have had really good relationships with the nurses and doctors -except for one doctor/hospital. I acknowledge that the hospital staff will be wary of me, probably won't know me and will probably distrust my charting. I meet them where they are. I answer each question as it comes to me, even if it is the same one 10 times. I know that the fewer the waves, the better the care for my client. I would do anything to help her; I can take anything the hospital dishes out. As long as they are kind to my client, I don't care how they are to me.

Do you "take on" "high risk" women? If so, which do you take on and which don't and how do you treat their 'risks'?

Ah, but risk is in the eye of the beholder, isn't it? To some midwives, a woman with Gestational Diabetes is too high a risk for her to take on, whereas another midwife (me) has no problem with the diabetic, but won't take a mom pregnant with twins. Our skill sets are different, we all excel in different areas. Knowing our skills and our limitations is vital as a midwife.

Our law is pages long outlining who we are legally permitted to accept as clients. With informed consent, a midwife with specialized skills is able to accept someone who falls into the (legally) "high risk" category. For me, the main complications that I am not able to attend to, merely because of lack of skill/education, are breeches and twins. I can refer a client to another midwife who does do them at home, someone with more skill and education than I have in those particular situations.

If women have specific questions... post-dates, large babies, prolonged rupture of membranes, high blood pressure... these sorts of things are worked out on a case-by-case basis. Little of midwifery is absolute.

What is your view on childbirth itself?

That's an interesting question to ask a midwife. I work with clients to allow birth to unfold as it is supposed to, as it is meant to, to not try and write a script that will, 100% of the time, not be followed. As a midwife and care provider, I believe I am required to do the same... to allow birth to unfold in front of me without my manipulating the experience for the woman/baby/family. I am hired as a consultant with years of experience, a woman who has specific skills to keep mom and baby safe if things step out of the realm of normal. I use my skills when they are called for and sit back quietly when things are moving along perfectly fine without my help.

Childbirth is magical, base, gritty, loud, fills the senses to the brim and is shared by millions and millions of women around the world -and a connection with mothers from all of time. Birth is as we make it - and what it makes us.

What is your view on the state of women's health care in the U.S.?

Oh, don't make me cry! I've worked with migrant and inner city teens and have listened as women share their stories of medical neglect, of not having insurance so putting aside even very serious illnesses, of women who don't know how to maneuver through the maze of free-care offerings. It's just all so sad. Women who have one type of insurance who are strapped into a birth location or a birth provider they want nothing to do with and women who fall in the inbetween... no insurance, but make too much for any assistance. Oh, my. It's just all so sad.

What would you like to see changed at a national level and how do you see this being accomplished?

Well, of course I'd love to see Licensed Midwives be a part of the healthcare team around the US... nationally recognized... not parcelled out into state legislatures. I'd love to be able to take Medicaid/MediCal. I'd love to have hospital privileges.

It's going to take an enormous shift in the medical model in order to accommodate the specific niche an LM/CPM can offer. Increasing the number of midwifery organizations in our country, lobbying and educating the public as well as those in control (docs, hospital administrators, insurance companies) all move us incrementally forward. While I can see this lovely, idyllic world in my head, I don't quite know how to traverse to it with my feet. But, I keep trying.

Who am I?

Over the years, I've added dabs of skills, interests and hobbies to my basic skeleton of woman. I'm a mom of four kids (first born in the hospital, second at home, third in the car, and the fourth is a life-long step-child), all grown and all the dearest friends a mom could ask for. My spouse Sarah and I met in 1986 (when my youngest was 2 days old and she was 7 months pregnant) and are still so in love. We've gotten legally married each time we were able to, this last time seeming to still be legal (as of today). I'm vocally pro-choice, tend to write controversial posts and articles and apparently enjoy rocking people's boats.

I love writing, have been published a number of times and have been doing amateur photography for 20+ years, but sold my first photo to "Mothering Magazine" last year. I love teaching and spend a great deal of time teaching student midwives and apprentices (as well as birth junkies) via my blog and in Facebook. The Internet has transformed every aspect of my life.

To end where I started... I serve women. That's what I do and who I am. I serve women.

Thank you Barb for your time!

You can find Barbara both at her blog here, as well as her professional website here.

By Definition...

Mutilation: Mutilation or maiming is an act or physical injury that degrades the appearance or function of any living body, usually without causing death.

I have encountered many people who state that they are vehemently against female circumcision but that they are ok with male circumcision. When we broach the subject of it being mutilation, they are aghast that I would use such a horrible term to describe their choice to circumcise their son. Some even point out that they have had it done to their child and their child is fine (or, if it is a guy I am talking to, he is quick to point out that he is completely fine, so what's the big deal?). This post is going to offend some, but let's open this can of worms, shall we?

Of FGM and MGM



Female circumcision - an issue that, we in the childbirth field, should be more active in. I was recently asked if I had ever attended a woman who had been circumcised. My answer was no, but the question posed a strong culture shock. In the U.S., female genital mutilation is not as common as in other countries, not by a long shot. But, many women and their husbands have been relocating to the US, the world is getting smaller, and I may very well find myself assisting one such woman sometime in my career.

Beyond that, as a shadowy part of US history that we are not often made aware of, as recent as the 1950s, partial or total removal of the clitoris was prescribed in western Europe and the U.S. in response to hysteria, epilepsy, mental disorders, masturbation, nymphomania, melancholia and lesbianism.



Beyond even that, as an advocate of women's birth and sexual health options, I (we) should be more active in defending and supporting these women. Thus, this somewhat non-birth related post.

This is an educational, but disturbing video that I would be remiss not to share. It involves both childbirth as well as female circumcision (no mutilation shown occuring).



If you can stomach it, there is a great powerpoint presentation (can open as PDF as well) here that outlines the different types of female circumcision and the impact it has on women's health as well as the demographics and issues surrounding the practice.

Mona Eltahawy writes, in the Huffington Post article "Smashing the Silence", about her intimate knowledge of FGM in her families history and how her family has, thankfully, overcome it.

The reasons given for circumcising women are for religious obedience as well as aesthetic appeal. Thankfully, Uganda just recently outlawed female circumcision as they don't believe that either reason is justification of such a painful and non-consenting surgery. It is really interesting to read the debate/comments below this article.

The reasons I am showing these are, one, as stated before, we as women's health advocates should make our voices heard and stand up for the health, safety, and rights of these women, and two, because, as we work with newborns on a regular basis, we should be educating families to the similar reasons and risks that U.S. couples continue to circumcise their sons.

Type 1 circumcision of females is the only one that is the same as male circumcision. In both instances, it involves removing part or all of the prepuce (hood). In males, it removes it from the glans (head of the penis), whereas in females, it removes it from the clitoris. In both cases, these anatomical parts are created to be mucous membranes that are protected, kept moist, and sensitive, by these fleshy tissues (prepuce or foreskins).

In both cases, it results in less sensitivity (sometimes no sensitivity) because these tissues are no longer protected by these natural hoods and thus, dry out and become less sensitive. Some people will say "well my husband/partner has no problems with sensitivity" or "well my son is circumcised and has no problems". Fact: he has less sensitivity than he would have if he were uncircumcised - just as you would.

In both cases, there is risk of infection, hemorrhage, botched surgeries, and are done without the consent of the individual. In both cases, it is done for religious (Islamic, Christian, Jewish, etc..) reasons or aesthetic appeal (so the child will look like their same-sex parent and the others in their culture).

"In female circumcision, the goal is to ensure chastity by eliminating the girls' sex drive by removing the sensuous nerve endings in her external genitalia." ... "The loss of sensuous nerve endings and motion to the penis penile mobility is quite similar to this form of female circumcision. In some cultures one of the labia majora (outer labia) is also removed, the other outer labia is stretched over the wound, sewn, and holes punched through the now hidden female external genitalia for the passage of urine and menses. This is called infibulation.

Some girls have bled to death, died of infections or other complications. Some of our boys have bled to death, died of infections, gastric rupture or other complications. Damage is created in both cases.

Female circumcision is a custom. Circumcision of our baby boys is a custom. The American Academy of Pediatrics policy on circumcision concluded by saying "however, that it is legitimate for parents to take into account cultural, religious and ethnic traditions..." I disagree. In countries where girls are circumcised because of those reasons we shudder at the thought and consider the practice barbaric, so why is it okay to take those into consideration here." - Female Circumcision. Male Circumcision. Is There a Difference?, Compleat Mother

So, with all that said, do you agree that both male and female circumcision is genital mutilation? Should routine circumcision be stopped?

ADVOCACY AND ACTIVISM AGAINST FGM:
IRIN
UNICEF
MYWOKenya
NPWJ

BEFORE MAKING THE CHOICE TO CIRCUMCISE YOUR SON:
There is a great resource for parents that delves into the History of Circumcision as well as national trends, medical data, scientific scrutiny, and humanity rights.

Additionally, I have blogged about this issue in What About Afterward, and encourage you to read that post (video has been fixed), as well as Circumcision Organization, Circumstitions (although this is a rather strongly worded/biased site - be warned), and Claims Explained

Additional MGM education sites:
NOHARMM
CIRP
NOCIRC

Birth of Silas Jeffery

BEAUTIFUL!!!

I love this woman's photography, and she has so many beautiful videos on youtube. Enjoy, then check out her channel!

Hospital to Home - Childbirth at Home on the Rise

"The fact that it's primarily women who had kids before and had birth in hospitals before, certainly suggests it's a reaction to their prior birth," said Eugene Declercq, a professor of community health sciences at the Boston University School of Public Health, and a author of the study. "It certainly suggests it's an experience they don't want to repeat."

ABC reports on a recent study published by the CDC showing that there is a small, but steady, increase in the number of American women opting for a homebirth over a hospital birth.



I was reading through the report and loved how thorough it was in showing the demographics, geographics, and selective characteristics of this study and where the most change is occuring. I am happy, as an advocate of women's choice in place of birth, it is good to see the 'concrete' evidence of what we, in the childbirth industry, have been seeing - women are learning of their options and are becoming proactive about their healthcare -making the choices best suited to them and their situations.

If you are a woman who had a hospital birth (regardless of mode of delivery) and have then opted for a homebirth in subsequent births, I would love to hear your comparison birth stories and reasons for these choices. If you want, email them to me (check my profile).