A Risk Analysis' Review of Her Own Births

This is a mamas review of her own birth experiences, cesarean and two VBACs. Thanks for sharing mama C! 

To those whose c-sections were for "failure to descend" (stuck baby) who are seeking a VBAC but having doubts about your ability to push out a baby, I hope my story (and data) will encourage you.

My first OB said she'd support my first TOLAC but she didn't see why I bothered trying as I probably just have a "small/heart-shaped" pelvis and probably can't push out babies. Which is funny because she didn't even attend my first birth that ended in c/s (she had an ear infection). So how would she know anything about my pelvis? Luckily by then I had read enough to know the necessity for my c/s was probably caused by position (baby's and mine) and preparation (mine). So I fired her. Clearly not supportive. I interviewed 6 OBs and finally hired another, much more supportive, OB who delivered both of my VBAC babies.

Some data which may interest you, in order of birth (c/s, VBAC, VBAC):
Birth weight - 7 lbs 2.3 oz, 7 lbs 0.2 oz, 7 lbs 0.8 oz
Birth length - 20.5", 19.8", 20"
Head circumference - 32.5 cm, 34.5 cm, 33 cm
(So, clearly it wasn't a size issue...)

Baby's position - stubbornly OP and asynclitic, OA, OA
(Figured out first was OP due to 24 hrs back labor, slow dilation, contraction pattern, head shape post-partum, and ultimately OB had to reach in and turn her for a final pushing attempt - she then flipped back to OP prior to surgical delivery)

My position - flat on my back, seated squat, flat on my back
(Delivering my 3rd on my back was unplanned and probably only successful due to SPD during pregnancy and/or my pelvis having opened before and/or preparation (see below))

Preparation -

For my first delivery I took the hospital childbirth and child care class which taught Lamaze. I did not however practice the Lamaze on my own between classes or after the classes were complete. I assumed I had learned it, and would use it when the time came. I didn't understand that when your body is under stress the only response you can count on is one that is INGRAINED in your psyche, not one that is simply understood by your brain. So it didn't work when I went to try and remember it during my birthing time. In addition I didn't prepare well when it came to my birth team - I had my husband, who had no birth experience, and my 3 best friends, who had no birth experience. I have no local family, and we all tried real hard, but no one knew how to recognize poor baby positioning, no one could advise on how to reduce discomfort, no one had a clue about how to calm me down and get me to release and let my body do what it needed to. I saw 4 shifts of L&D nurses of varying quality, and the least helpful was unfortunately who I had at the most critical time. The OB wasn't there much at all but was very encouraging when she was (again this was not the OB I had prenatally but the on call I met when I was admitted).

For my second delivery I took Hypnobabies (HB) and I practiced between classes and practiced after the classes were over right up until delivery. I wasn't perfect, I didn't practice every day, but I did it enough because I made it through delivery using those tools. For me HB was essential in preventing panic, which is what locks me up, in response to discomfort. My husband took the class with me and became a great L&D coach, more confident in how to support me, how to help me get through it. And I hired a doula, (Cole), who supported me through both shifts of L&D nurses (yay for consistently great support no matter who's on shift!!), and also specifically used her tools to help move labor along and help move baby down, in addition to taking the time to learn all my HB cues to help me use it successfully. My second birth was a GENTLY induced VBAC - yes it can be done when medically necessary and still end with a vaginal delivery!!

My third birth I credit HB for allowing me to be in denial about being in my birthing time most of the day. I practiced HB from week 30 up until birth, most nights, just listening to my tracks and practicing finger-drop. The day I entered my birthing time I was just uncomfortable and felt crappy. So I took the opportunity to "practice" HB for some relief but never believed I was actually in my birthing time. Suddenly late that night I knew we had to go to the hospital. I gave birth 42 minutes after arriving at the hospital, using HB the whole time. Everything happened so fast that my OB didn't make it in time, but my doula (Cole) did and she and my husband again gave me exactly the support I needed. Even with birthing flat on my back I pushed her out in under 15 minutes.

My point with all of this, ladies, is that POSITION and PREPARATION are far more important than perceived body capability and baby size to achieve the birth you want. Body capability and pelvis size CANNOT be determined by an OB by any method of examination, just educated guess! Baby's size doesn't matter as much as you'd think because FAT SQUISHES! Baby's position on the other hand can be encouraged (see SpinningBabies), your own birthing position can be controlled (particularly if you have a trusting relationship built with your care provider), and your preparation is entirely in your control as well. Find a childbirth class/method that you can COMMIT to and PRACTICE, and build your birth team based on your birthing NEEDS, not necessarily the PEOPLE you simply love.

You CAN do this, and don't let anyone - including well-meaning family, friends, or care providers - tell you otherwise!!!

Two Way Street

If you read my blog much, I'm sure you have seen at least some of these stories circulating:

• Who's the Boss
• Doula's And Don'ts
• 5 Lies My LC Told Me

And so many more that I just don't have the heart to link... what two things do these tell me?

One, I cannot stress enough - it is so important to choose the right provider and birth/postpartum team. Interview, fire, hire, question, become your own advocate and conscientious consumer. It is your responsibility to choose the best option for your needs and desires.

And two, our system is broken - birth workers need to remember whom we work for. Mamas can only make the best choice with the options they have available to them - it is our responsibility to provide ethical services within our scope of practice.

'Nuff said.

End rant.

Caveat Emptor

Caveat Emptor - a principle in commerce: the buyer assumes the risk. Latin for, Let the buyer beware. A warning that notifies a buyer that the goods he or she is buying are "as is," or subject to all defects. When a sale is subject to this warning the purchaser assumes the risk that the product might be either defective or unsuitable to his or her needs. The basic premise that the buyer buys at his/her own risk and therefore should examine and test a product himself/herself for obvious defects and imperfections.

Let the buyer beware, for (s)he assumes all risk. During your childbearing years, it is so acutely important to understand this concept.

There are a set of 'rules' and expectations that every birthing place has in place. These outline how your
place of birth expects you to behave and what they expect you to consent to. Of course, you can decline any set of policies, protocols, or expectations/interventions, but at what cost? Your provider can (and many do) 'make you pay' for bucking their authority and rules.

If you want low lights, candles, a water birth, hand-held dopplers for monitoring intermittently, and a birth team that speaks in hushed tones and helps you birth in any position you want, you probably shouldn't attempt to achieve that in a florescent-lit hospital, where they have only showers, a strict policy against water birth, no dopplers on the floor, and an OB and nurse who see 'a handful' of natural births in any given year.

 Likewise, if your provider uses such terminology as "I don't normally let my patients...", "I don't do ____", or "I don't work with doulas", guess what? They are not looking out for your best interests, they are looking out for themselves and their policies to be upheld. This is saying nothing of their personality, only of their practices.

I have spoken to many women whose providers state that, in order to continue in their care, they must consent to certain tests or procedures. Again, this is not informed consent, this is coercion. Buyer beware - if they cannot respect your autonomy to make decisions for your own healthcare during pregnancy, how can you hope/believe that they will when you are in as vulnerable state as labor and birth?

Buyer beware - understand the policies and protocols of your place of birth and your provider prior to purchasing their package of goods.

Jack Sparrow on Obstetrical Training

 I love how, the longer I work in this profession, the more I see pregnancy, birth, and parenting wisdom in everything... even movies. We've done Seuss and Harry Potter... now it's time to hit up Pirates of the Caribbean.

Jack Sparrow is a favorite in our home. What if he were to speak to a group of obstetricians on how to better maternal outcomes during childbearing? (I know, a far stretch, but it makes for a fun post nonetheless) hmmm....


Be Above Reproach

Make sure that all of your medical recommendations are not only justifiable, but above reproach. 

Reproach: an expression of rebuke or disapproval, the act or action of reproaching or disapproving, a cause or occasion of blame, discredit, or disgrace" - Merriam-Webster Online

Reproach of the mother and the medical establishment. Considering that cesarean because mom is moving through a second shift of staff? Don't. Considering breaking that water in the GBS+ mama just because it will get her through transition faster? Reconsider.




It's Not Every Day

Ok, I know for you it is. But for every family that you serve, this is the day for them. The day that their baby is born. This treasure is beyond measure. And, for some women, the journey to that treasure is very important.

Don't belittle their joy, their expectations, or their priorities. This doesn't make you the bigger person in the room - it makes you the bully.


Lose The 'Tude

We all know that things don't always go according to plan, and sometimes there is reason to deviate from the hopes and plans of the family.  Most families understand this and have no problem being flexible if the genuine need arises.

But, unless it is a genuine emergency, there is, oftentimes, time to exhaust other options so that families can rest assured that there were  no other options. And who knows, some of those might (often do) work. Don't laugh at that rebozo, even if you think it's silly. Don't roll your eyes if she wants to try her hypnosis tracks. And don't cop an attitude to press your case - if they hired you, they must trust you, they're only flexing their newly-found parenting muscles - muscles that should be allowed to be flexed if they are going to become confident and well-adjusted parents.


Be Flexible

By now, most people are well acclimated to the business of childbearing. Who can blame hospitals for operating like businesses, instituting policies that attempt to protect their keisters from litigation, etc.. etc...

But honestly, and I'm sorry if it burns you a little, but the parents really do call the shots in their healthcare. You could be their greatest ally. If there's no good medical reason to disagree, why not agree.


Bring It Down To Their Level

Explain. Explain the what and why and how. Even if you feel you might get some resistance, do it anyways. Really make an effort to not speak over the couple. Come down to their level and explain everything. Everything you ask? Yes, everything.

Make sure she understands what will be happening to her body, what will be put into her body. It's her body, she deserves that respect. Likewise, everyone in the room understands that you are the one with the medical degree who speaks medical jargon with ease; there's no reason to prove that point, but there is reason to talk with the couple in a language and with terms that they can understand.

 
Validation

This one kind of goes hand in hand with Lose the 'Tude. It's ok to validate a woman's feelings and frustrations. You don't need to try to make her feel better when things don't go the way she hopes. You don't need to defend yourself.

Her feelings and her perception of events are every much as valid as yours. And it can make a world of difference in her short term and long term emotional, mental, and physical health/healing.


Be Hopeful

You have no idea how your mood sets the tone for the room. It's OK to be hopeful. No one will fault you for giving a couple hope in the midst of a very uncertain time.

Until all options have been tried, or baby/mom's bodies say enough's enough, there is always time to be hopeful.


In Conclusion
What if a group of rowdy, dirty, pirates were to stand before a group of Obstetricians and offer their insight into the care of women and babies at the time of birth? I would love to see it!

A Quick History of Medication in Maternal Health Care - (and the Business of Being Born)

originally posted on 5/12/07

Taking the lead from another great blogger I read often - try to find her ;o) - and from a recent viewing of the Business of Being Born - I wanted to touch on the dark blemish of American Obstetrical practice - routine medication for birth. (BTW, it is funny that this was shown as a screening in the midst of a High Risk conference for Vanderbilt - on the heels of a recent development plan).

While watching the Business of Being Born - a WONDERFUL look at childbirth practices in the US - I was struck by one very apparent thing: doctor's know nothing about bodies and birth. They know everything about risk - and, as one OB nurse told me, their job was to take away pain and have a healthy mom - not to get the best outcome.

That mentality was prevalent back in the late 1800's - early 1900's when OB's infiltrated the childbirth field and it is prevalent now. FRIGHTENING! Why is it frightening you say? Let me expound...

Let's start with the advent of anesthesia in general. It all began on October 16, 1846, at the Massachusetts General Hospital in Boston, in a room now called the Etherdome, when William Morton administered the first successful public demonstration of ether anesthetic. This was a great breakthrough for SURGICAL needs, and the news spread around the world quickly. So quickly in fact, that within a month the first modern anesthetics had been given on both ends of Europe, and within six months in Australia and China.

One doctor who heard of the use of ether was James Simpson. Breaking out of his social class, he put himself through medical school and later became the chairman of obstetrics at the University of Edinburgh. He is best known for the forceps which he devised to counter his initial use of ether on maternal patients.

His first maternal patient was a woman whose pelvis was deformed by rickets (a common issue in that time from malnutrition) who delivered on January 17, 1847. These deliveries can be especially difficult because of the manipulation needed to get a baby out of a deformed pelvis.

There was a great concern, though, for this use of ether because of the knowledge that ether often stopped contractions. As well, most babies born from ether-administered mothers had ether-smelling breath, ether smelling placentas, and tires/lethargic/unresponsive babies. So, Dr. Simpson created forceps, to pull babies from their mother's wombs before they were 'too drugged' and to minimize the incidence of failed labors due to ineffective or stalled contractions. Then why was it continued?

To understand the merging of surgical breakthroughs and maternal downfalls, we need to look at the social climate of the time. Two major events were happening: childbirth was taken out of the home and into the hospital (where disease and infection ran rampant), and the feminist movement was on the rise.

"Early feminists campaigned for social reform of all types, for the abolition of slavery and the abolition of the use of alcohol. They were also concerned about improvements in health care, particularly for women and children. They had good reason to be concerned. Although death rates for men and women had been falling throughout the nineteenth century, risks of a woman dying in childbirth had not decreased. In New York City, for example, 15% of deaths of women between the ages of 20 and 40 were related to childbirth. Although deaths from other causes had decreased, deaths from childbirth had not. By 1900, 30% of the deaths of women in this age group were attributed to childbirth." - now remember that those deaths were NOT due to childbirth - but malnutrition causing complications in birth, deliveries being moved to hospitals where illnesses and disease ran rampant, and before the advent of antibiotics - IT HAD NOTHING TO DO WITH MIDWIFERY and THE SAFETY OF HOME BIRTH.

Suffragettes saw maternal health care as a significant area that needed improvements. The only problem is that they focused on the labor of childbirth (pain/discomfort) rather than the true source of the maternal and fetal demise of the time. Not to fault them as the information and scientific breakthroughs were not accomplished yet; in their early industrialized minds, pain equated illness and death.

(Maternal death rates dropped slightly in the US between 1880-90, when doctors rooted out the nature of childbirth fever in relation to cleansing practices in the hospitals. They started washing their hands between women's beds and the death rates dropped. Then, the numbers steadily rose again until 1940, when they dropped once again (steeply and greatly) with the introduction of antibiotics).

Queen Victoria used ether when she delivered Prince Leopold in 1853. From Inside Surgery:

"Queen Victoria went into labor on the morning of April 7, 1853. As her physicians readied her for the birth of Prince Leopold, John Snow positioned a handkerchief moistened with 30 drops of chloroform over her nose and mouth. The Queen had an immediate response to it. Over the next fifty three minutes he reapplied the anesthesia fifteen times, using between 15 and 20 drops each time. The birth was without complication and the child was pronounced healthy, although at the time no one knew that he was afflicted with hemophilia.When accounts of Queen Victoria's labor anesthesia reached the general public, John Snow became an instant sensation and was much in demand by the social elite of London."

The National Twilight Sleep Association was formed in order to support the use of a new maternal anethesiac development begun by a young obstetrical doctor by the name of Carl Gauss. Around 1900, Gauss combined two drugs that had been in the medical armament for a long time to treat childbirth pain. One main component was morphine, used to alleviate pain during surgery. It had, thus far, been avoided in obstetrics because of its effect on the uterus, its effect on the newborn, and its effects on bleeding and infection. The other drug was scopolamine, which causes amnesia - in the past, these had been used as poisons in high doses. Hamlet's father was killed by one of scopolamine's cousins.

Gauss mixed these two drugs and administered them in 'small doses' to his patients - the morphine provided relief from pain while the scopolamine provided the women with amnesia of their labors and what was done to them. The problems? Oh, there are many!!! Scopolamine caused women to lose their inhibitions. They would have no memory of what went on, nor did they realize what was happening, so most of them screamed during labor. They became uninhibited and psychotic. They would thrash about on the bed, causing injuries to their heads. So, their heads were wrapped with blankets or towels, turban-like. They would attempt to claw at the walls or their medical providers, so they were put in straight jackets or their wrists were strapped to the beds. Then, so that they would not fall out of bed, they were put in 'labor cribs' - and were allowed to labor, screaming, tied down, blinded and bound - often in their own urine and feces, and sometimes for days on end, until it was time to birth. The women had no memory of this, the husbands were not allowed in to see their wives, so they didn't know what was happening - and everyone was happy.

Gausses concoction was tried out first in Europe and was found to be less than satisfactory for maternal care. It would probably have died out there had it not been for an infamous article in McClure's magazine. Two female reporter's who were also staunch feminists, accompanied their friend to Germany, where she was traveling to be 'treated by Dr. Gauss'. The woman was administered Twilight Sleep and was ecstatic with it. She simply woke to a baby - with no memory of the labor or birth. The three women decided to liberate American women through Twilight Sleep.

Every woman wanted to have that type of birth. Medical research was not sought as to the safety, and feminist drive demanded quick results. So - the U.S. because predominantly a Twilight nation between the years of 1914-1945 (although my grandmother recounts her story of TS in 1956 and there are reports as late as the 1980's).

Thankfully (and sadly because of what it took) this time in American history quickly collapsed when Frances Carmody died under Twilight Sleep. Although there had been numerous women who had died under Twilight Sleep, she was the wife of a Brooklyn lawyer and happened to also be a huge rally organizer for the Twilight Sleep Campaign. Her husband and her OB assured everyone that her death had nothing to do with Twilight Sleep, but, with a key organizer gone from the game, at the very time she was using something she was promoting, the campaign began to fall apart.

Women began to have windows of remembrance, and by 1948, the baby boom got into full swing and the huge number of women having babies while under Twilight Sleep raised the issue of comfort at a cost. Women began reporting their birth trauma - both physical and emotional/mental. Moms began to speak out. And, in 1958, an article headlined "Cruelty in Maternity Wards" ran in Ladies' Home Journal. It detailed the "tortures that go on in modern delivery rooms.". The response? A flood of women sent the magazine their own horror stories. "I've seen patients with no skin on their wrists from fighting the straps," a nurse from Canada wrote.

"Just let a few husbands in the delivery rooms and let them watch what goes on there," said one reader from Detroit. "That's all it will take — they'll change it!" An Indiana mom claimed, "The whole thing is a horrible nightmare."

Women began desiring and demanding safer births - the OBs were fraught with the problem that they could not guarantee a medicated, but safe, birth. So, in the 1960's and 1970's - many women went back to natural birth. This was short lived, though, as Obstetrician's saw income diminishing... Cue the epidural.

Mothers giving birth in the late 1970s and '80s had more options than ever. They could have a medicated or unmedicated birth. They could deliver in a freestanding birthing center, a hospital, or at home (in most states). They could be attended by a midwife, an obstetrician, or both (in some states). And, through all of these options, they could have their husbands by their side.

What led up to the advent of the epidural? In 1898 German doctor August Bier injected cocaine into his assistant's spinal column. It numbed his lower body, but the next morning he awoke with horrible vomiting and headaches (cue the spinal headache). It took the next 80 years to perfect this. But, by the 1970s, lidocaine was dripped into a tube inserted by needle into a woman's spinal column. By the 1980's, it was all the rage! The hitch? The procedure numbed women to their chests, causing breathing issues and, at times, heart problems.

My question - and the question that Ricki posed in her documentary is this:

What will we find in the near future is the clinically proven downside to epidural births? We NCB advocates already know of the obvious, though seemingly unimportant to many women when compared to an easy labor, risks... But think of it...

- In the late 1880's early 1900's it was chloroform / ether - which inhibited neonatal breathing attempts, caused forceps to be necessary (which caused many horrible scarring issues with babies), maternal reproductive harm, and heart failure routinely.
- In the early to mid 1900's, it was forceps - which were necessitated from the use of 'knock 'em out medications. These scarred women's cervix's, making them incapable of dilating at all or efficiently in later pregnancies, tore ears, noses, and scalps off of babies, and created severe perineal and labial scarring in women. Forceps are still used today!
- In the mid 1920's, it was Twilight Sleep - causing maternal mental, emotional, and physical trauma, more of the same as chloroform did, AND caused a number of incidences of stillbirths.
- In the mid 1950's-60's, it was thalidomide, prescribed to pregnant women routinely - causing the widespread incidence of 'flipper babies' - children who were born with severe malformities, including phocomelia (short limbs and deformed extremities).
- In the 1970's, it was early spinal/epidurals where the needles were too large and the puncture too deep, causing a whopping 50% of women to get debilitating spinal headaches that, at the time, were not treatable.
- In the 1990's, it was Cytotec, used to induce labor (off-label and unapproved). With a HUGE risk rate, it can/did cause stillbirth, neonatal distress, uterine rupture, severe postpartum hemorrhage, and more. Cytotec is still used today!

What do all of these things have in common? NONE of these procedures are tested before they are tried out on pregnant and laboring women. We are used as guinea pigs. So, my, and Ricki's question, again, is: What will we find in the near future is the clinically proven downside to epidural births? And, at what cost?

We have a huge increase in ADHD, ADD, Autism, early and late-onset Jaundice, asthma, and allergies/intolerances... how can we know that these are not a result of our maternal health practices now? We can't. BECAUSE, we are a society driven on comfort and ease rather than health and well-being. Well-being does NOT equate to ease or comfort. And, until we demand better health care, we are doomed to repeat history on different levels - until we learn to choose better for our bodies and our babies and leave the testing to the REAL guinea pigs.

See here and here (pic) for more information on this history.

*Edited to add the great information sent to me by some readers!

Failure to Progress... part two

Failure to Progress... Such an obtuse, erroneous, and deceptive term when used in conjunction with a woman's labor.

Let's take the term one word at a time.

Failure - omission of occurrence or performance; a failing to perform a duty or expected action; a state of inability to perform a normal function; a fracturing or giving way under stress; lack of success; a falling short : deficiency : deterioration, decay; one that has failed - Merriam-Webster Dictionary

to - used as a function word to indicate the result of an action or a process - Merriam-Webster Dictionary

Progress - to move forward : proceed; to develop to a higher, better, or more advanced stage; gradual betterment - Merriam-Webster Dictionary

So, failure to progress means 'an inability to, lacking of, falling short of, or otherwise deterioration of'... 'a forward movement, a higher better or more advanced stage; a gradual betterment'.

Hmmm....

With all due respect (and some amount of lack thereof), I would have to deem that the American Congress of Obstetrics and Gynecologists have failed to progress.


The ACOG's failure to progress has resulted in their recent very courageous admission that only 1/3 of their clinical guidelines are evidence-based practices. This means that the majority of obstetrical practices and recommendations for pregnant and birthing women is based on opinion and inconsistency.

I say courageous because it takes a lot of ovaries to admit:

Our findings highlight the difficulties in developing high-quality clinical guidelines. Although guidelines do not equate with standard of care and cannot replace clinical judgment, the College's recommendations clearly strongly influence the practice of obstetrics and gynecology ... clinicians must remain mindful of the limitations of guidelines. There is an urgent need to continue to conduct high-quality research in obstetrics and gynecology and to provide the funding to undertake such research.

Here is a short list of some of the practices that are based on limited or inconsistent evidence or are purely based on consensus and opinion (i.e. not evidence based practices):

• Routine IVs/Heplocks
• Continuous Fetal Monitoring
• Erythromycin for all newborns
• Routine cervical exams before labor
• Routine cervical exams throughout labor
• Routine administration of pitocin (augmentation or postpartum)
• Coached pushing
• Time constraints on labor
• Time constraints on pushing
• VBAC bans
• Routine Induction after 42 weeks
• Accepting 40 weeks as 'due' or 'term'
• Late-term ultrasound for gestational accuracy and fetal weight
• Elective cesarean
• Elective induction
• Non Per Oris
• AROM
• Calling homebirth risky
• Newborn circumcision
• Automatic Cesarean for breech presentation
• Induction for (full term (37-42 weeks), big baby, low or high amniotic fluid, etc... etc...)
• Lithotomy position for 2nd stage
• Cervical ripening by Cytotec /Misoprostol
• Restrictive or Required Weight Gain
• Premature Clamping and Cutting of the Umbilical Cord

This is not to poo-poo on the ACOG; this is a reminder to women that, again, you are responsible for your healthcare.

"Many women... carry fear of being responsible for their own healthcare and the healths of their unborn children, so they relinquish that responsibility to doctors and hospitals, blindly trusting that those doctors have their best interests in mind. They fail to take into account, or choose to ignore, that the vast majority of obstetrical practices are not founded on infallibility, on evidence-based practices, or are without the personal ambitions, impatience, bias', and sometimes even greed of the individual hospital or care provider." - Fear

Be sure to hire a midwife or doctor who you trust to give you honest information regarding those options and recommendations which are rooted in evidence/science, those that have limited or inconsistent evidence, and those practices which are purely their opinion.

Further Reading:
Talk It Out
Tricky Research
If We Can't Make it Illegal
Profit of Pain Relief
Birth Partners
Quick History of Medication
GBS
US Childbearing Healthcare Crisis
The First Cut is The...
VBAmC
The length of uncomplicated human gestation
Perinatal Pitocin as an early ADHD biomarker

Our Own Worst Enemy

Lesley over at MotherWit wrote a post last year on Doulas Behaving Badly. This post returns to mind often, as I am seeing an increasing number of doctors and practices in my area refusing to ‘allow’ patients to have a doula attend them during their birthing time.

I love her post, it resounds so true, and is a great jumping off point for my own thoughts on the subject.

“... my purpose and my goal is to ensure women get the best possible care within the system they choose. This is not by control, but by support.” Lesley Everest

When I speak with women during labor and birth, it is never with bias or coercion, This is an important one – all doulas start their businesses with passion; a passion for things to happen the ‘right way’ or the ‘best way’… but, through experience and personal growth, we should all come to the realization that, as our name implies, our job is not to give every woman the ‘right’ or ‘best’ way to birth in our own eyes..

Our job is, as doulas, to give every woman ‘her right and best way to birth’ to the best of our abilities.

Much of this is accomplished prenatally.

We have all have encountered the women who want a doula to ‘save’ them from the experience of a hospital birth, and yet, they are choosing a hospital birth. My role, every doula’s role, is not to save a woman from the situation that she places herself in, instead it is to educate her prenatally on how to be an empowered and educated consumer within the system that they choose.

If a woman chooses a doctor whom I think it paternalistic and controlling, I will be sure to point out the inconsistencies in what she says she wants and the type of care giver she is choosing. If she persists with that caregiver, though, she has chosen that caregiver.

My job is to support her choices.

I cringe so hard when I read reports and hear stories like the ones in Doula Makes Four. In this article, a doula ends up walking out on a family who, prenatally, wanted a natural birth but, because of her particular labor situation, chose to have an epidural. In another example, a LC encourages a mom to take her preemies off of formula and only IV nourishment until mom was able to nurse.

I know doulas who have:

• Grabbed doctor’s hands to stop them
• Walked out on families who deviate from their birth plans
• Coarsely and rudely ‘call doctor’s out’ in front of their patients
• Turned off pitocin
• Yelled at nurses or spoken down to them

Again, my job is to support the woman’s choices, not make them for her.

Don’t get me wrong, I work my butt off to keep her on track with her prenatal choices and desires, but I, like any wise woman in the childbirth field, will tell you: labor and birth is organic, unscriptable, unknown.

It is best supported knowing what you want, doing all you can prenatally to ensure that the goal is feasibly accessible, and then working hard to achieve it.

That means, while in the birthing room, my job is to make communication between her caregiver and herself fluid and open. It is not my job to grapple with the medical staff, inhibit their care of our mutual client, or make choices for the couple I am working with.

If the mother has given me expressed desires, though, I will be sure to remind her of those throughout the birth journey so that she can make her own choices while traversing her own organic experience.

I do not give medical advice; I supply women with many options and recommend that she talk with her provider about which would be appropriate, through analysis of the risks and benefits, for her particular case.

I do not unhook a woman from IVs, encourage her to check herself out of the hospital AMA, or take women off of EFM. Though, I will remind a woman of how long she has been on them, ask the nurse if mom can get off the monitors, and be truthful with a mother about the ability to refuse any treatment at any time.

Doulas who create an atmosphere of tension, a power struggle, with the care providers whom the woman has chosen are stepping outside their role as a doula.

Doulas who tamper with medical equipment without notifying the medical staff or otherwise inhibit their care of the client are stepping outside their role as a doula.

Doulas who openly argue with nurses and care providers, contradicting them or openly and hostilely confronting them are doing their clients a disservice, not supporting the client’s choices, and stepping outside their role as a doula.

And the long term consequences of these actions are becoming evident: doulas are getting banned from doctors clients, offices clients, and even whole hospitals.

Now, I won’t place all of the blame on doulas…

Sometimes women choose to have a close female friend attend them at their birthing time – acting as their doula. This is a great option if you have a wholly supportive and educated female friend.

If you are one of those women and your friend does attend you during your birth though, please don't refer to her as your doula, call her your friend. I have been privy to a few occasions where a friend calls herself a doula, acts outside the standard of practice of a doula, and, as a result, taints the name of doulas to that particular doctor or practice.

The result could mean doulas being banned from that particular practice or hospital.

Bottom line, all of you Doulas behaving badly: cut it out. We have worked hard, as professionals, to create a standard of practice. If you want, consider it working within enemy lines, but the truth of the matter is this: in most situations we are all on the same team. We all want what we see is best for the women we serve.

Just as a mother hires her provider to provide her a service of childbearing care, so is she hiring you to provide her a service of educating and empowering her… not robbing her of that empowering opportunity by taking that power into your own hands.

You work for her… as a woman’s servant.

“You may justify yourselves all you want by making snide remarks about brown nose diplomacy. I would rather wipe off the occasional stain than have my spotless snout shut out entirely and responsible for leaving vulnerable women unbuffered in that system”... “Instead of healing this birth culture through your angry, righteous approach, you are going to get doulas, the very ones who hold the power to heal it, barred from hospitals entirely.” - Lesley Everest

Talk It Out

Many women researching natural birth will hear about the ills of medical providers, their responsibilities and shortcomings towards their patients… but what about YOUR responsibility as a consumer?

A positive consumer understands that, when it comes to healthcare, they are an active participant, having an ethical and personal responsibility to make sure that the medical care provider that they hire will work hard for their choices and beliefs. You heard right, you hire your care provider.

Would you allow a landscaper to make all of the decisions regarding your lawn or would you research what you want your lawn to look like, be like, and produce like? Would you turn your lawn over to that landscaper and, when (s)he let you know their plans, mutely nod even if you didn’t like what was being planned, or would you tell them your expectations and desires, plans and hopes? Likewise, although your lawn might not turn out exactly like you had planned with your landscaper, if you trust them fully, you can trust that it will come as close as your soil and your property allows for.

Consider this: your doctor or midwife has a responsibility to give you factual information, practice unbiased and evidence-based medicine, and to treat you as a whole woman, not simply a patient. They have a responsibility to let you know their policies, procedures, and standards of care – what they expect from you as a patient.

But, as a patient, it is your responsibility to be open and honest with your care provider. Withholding your feelings, beliefs, desires, and fears breed distrust on both sides of the proverbial fence. It is vital that, as a patient, you be able to speak up about your choices regarding your health care, even if you and your care provider do not see eye to eye on some issues.

The relationship that you have with your care provider is not their sole responsibility - it is a two way street. If you are fully open and honest with them and don't feel it is reciprocated, perhaps they are not the caregiver that you want to trust to handle your body and baby during the most vulnerable event of labor and birth.

If you feel they have ulterior motives beyond your health and wellbeing and that of your unborn baby, if they are not fully supportive of your choices (whether or not they agree with your choices), or if you simply do not make a good team (yes, you two are a team), perhaps it is best to look for another care giver. It is never to late to make the change.

For additional information, please take a look at the links below:

• What Type of Care Giver Fits Your Beliefs
• 10 Questions to Ask Before You Have a Baby
• Switching Care Providers in Pregnancy

first posted in 2008

BirthsMART (tm) - via Mama Is..

I love Mama Is... I mean, how could you not? I fell into her video this morning and simply had to share. Enjoy and comment away if you would like.

In Defense of Doctors

I wanted to talk just a bit about obstetricians. In their defense, they are only working within their training and nature. Most don't go out of their way to be bull headed, opportunistic, business-minded, opinionated, god-complexed individuals. They are simply doing what they were taught to do: stand in the way of birth.

The typical course of study for a med student hoping to become an obstetrician includes, roughly:

• Undergraduate degree (BA or BS, 4 years)
• Medical school (4 years)
• OB/GYN residency (4 years)

Very early on in their career choice to become an OB-GYN, for a very short amount of time, the medical student learns anatomy, biology, and physiology of normal, natural pregnancy, labor, and birth. The rest of their career is a stringent desensitization to normal and natural and an indoctrination of the risk, diagnosis and preventative medicine, variable obstetrical and gynecological conditions, procedures (including operative), business ethics, and professional ethics.

In other words, whereas a midwife spends her whole career focusing on the normal and natural, and thus are experts in normal, natural childbirth. Obstetricians are experts in risk and conditions of pregnancy and birth.

Because midwives are experts in normal pregnancy and birth, they will see deviations from normal and natural pregnancy and labor/birth early on, be able to assess these variations, and take immediate and early precautionary measures to ensure your safety...

Because obstetricians are experts in risk and conditions associated with pregnancy and birth, they will be seeing the process as 'guilty until proven innocent', watching expectantly for these conditions to crop up, managing and attempting to control the event so that they can, in their trained minds, control the outcome.

Unfortunately, studies have found that the more we 'do' to pregnancy and birth, the more active management we try to assume over nature, the more unnatural and risky the event becomes. In other words, the very thing that doctors set out to avoid becomes reality - iatrogenic complications.

This training is amazingly beneficial for when true emergencies arise, when we truly medically need these services, when natural acts up. But, when nature takes it's normally uneventful course, obstetrics can really mess things up.

The very word 'obstetrics' comes from the Latin root obstāre, which means to stand in opposite/opposition to, obstacle. Medicine.net states that the clinical definition of obstetrics is: The art and science of managing pregnancy, labor and the puerperium (the time after delivery).

Doubly unfortunate is that, because of their training, most doctors loose sight of what is truly going on here: the miracle of life through the conduit of the feminine form. Oftentimes, they forget that the majority of pregnancy and birth IS normal and natural

Likewise, often they forget the autonomy, as well as the humanity, of the individual giving birth. For 12ish years they have been staring at diagrams of parts of the female anatomy, illustrations and models of the reproductive organs of the woman, not the person of the woman.


Not all doctors are ready to cut, or probe, or induce; I have been blessed to meet and work with many obstetricians who are midwives in wolves clothing, and you can find them every once and while in the blogsphere.

Not all doctors are ready to cut, or probe, or induce, or whatever... but the majority are. And, I cannot blame them, it is what their training has prepared them to do - to stand in the way of.. I cannot blame them, and neither can you. They are simply doing what they were taught to do: stand in the way of birth. And, if you don't want them to, then why did you hire an Obstetrician?

On the other hand, you have no one else to blame except yourself if you choose this model of care for your health care and should not feign surprise at the outcome of your experience.

This is just one more reason to be sure that you trust and are happy with your choice of care provider. If you aren't, then find another who you can trust and who does reflect your believes and ideals.

Tricky Research

The AJOG printed a 'study' that, in their minds, validates the ACOG's continued stance against home birth as a safe option for healthy, low-risk women. Their conclusions were that less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.

Before we swallow this hook, line, and sinker, though, lets break it down, shall we?

Tralee Pearce of The Globe wrote a response article to this 'study' on Thursday entitled U.S. Analysis on Home Birth Risks Seen As Deeply Flawed.

Patricia Janssen, an associate professor at the University of British Columbia’s school of population and public health, says that conclusion is “sensationalist” and based on data that are in some cases decades old, on very small samples and in some cases incomplete.

In many cases, she says, women included in the studies may not have planned to give birth at home. They may not have been attended by a properly trained midwife. And much of the data used were retrospectively, gathered using birth records, which may not include enough information...

... Michael Klein, emeritus professor of family practice and pediatrics at the University of British Columbia, says the analysis and its conclusion has to do with the climate in the United States around midwifery. It is less accepted by the medical profession there than it is in Canada, he said.

“We’re dealing with a politically motivated study,” said Dr. Klein, who was a co-author with Dr. Janssen on the B.C. study.

NHS writes their own follow-up on this study in Safety of Home Births Questioned:

Applying sensitivity analyses that excluded poorer quality studies had little effect on the findings. However, when the researchers excluded studies of home births attended by people other than certified midwives, there was no significant difference between the newborn mortality rates associated with the two locations of birth...

... There are other key points to consider when interpreting this research:

• Although home birth was associated with greater neonatal death (within 28 days), neonatal death is still very rare, and the absolute size of the risk is low (0.2% among planned home births and 0.09% among planned hospital births). The researchers calculated that only 0.3% of neonatal deaths could be attributable to birth occurring in the home rather than the hospital.
• It is also important to note that there was no increased risk of neonatal death with home birth compared to hospital birth once the analyses excluded those studies of home births attended by people other than certified midwives, i.e. when the home birth was assisted by a certified midwife there was no increase in mortality compared to a hospital birth.

Carolyn Ryan of the CBC reports that

The authors found that when babies were born at home there were fewer medical interventions like epidurals and episiotomies, and women in home deliveries tended to have fewer tears or lacerations, fewer cases of postpartum hemorrhage and fewer infections.

The team also came to the conclusion that there was a tripling of neonatal deaths for home births once babies with congenital abnormalities were left out. The tripling of fatalities represents a very small number — from four in 10,000 to 15 in 10,000, acknowledged Dr. Jay Iams, the journal's associate editor.

But Iams said the findings provide an appropriate caution to women that giving birth in a hospital can be safer.

"The study results are consistent with what common sense would tell you," Iams said.

But Dr. Michael Klein, an emeritus professor of family practice and pediatrics at the University of British Columbia, said the U.S. conclusions are "crap" that don't consider the facts.

"It's a politically motivated study that was motivated by the American College of Obstetrics and Gynecology who is unalterably opposed to home birth, and they probably were quite happy to publish this article because it fits with their political position," Klein said.

UBC epidemiologist Patricia Janssen, who collaborated with Klein, said the American study mixes their work with research dating back to the 1970s, and surveys with as few as five recorded births.

"The data and the methods taints the quality of the study," Janssen said, noting the review includes studies where the qualifications of the caregiver were not known.

In conclusion, their methodology of information gleaning doesn't support a well documented, well researched study that warrants any type of support. It doesn't lend any validity to the hospital birth debate, either.

It's not clear who attended all of the women, under what situations they were birthing at home, if it was planned or not, what types (health, age, 'riskiness', etc..) of women were birthing these babies, what training their attendees had, and what life saving equipment their attendees (if any) were carrying.

Other, more appropriate studies of planned home births with trained attendees in other countries have so far shown that there are improved outcomes for mothers and no significant increase in risk for baby.

Chalk it up to just one more case of the ACOG up to their dirty little tricks again.

** updated to add CIMS response and Science and Sensibility's response.

Boardwalks and Home Births

I met you on the boardwalk, a beautifully bronzed burst of sunshine adorned with sparkles, bright yellow, and black flowers that flowed around your barely rounded belly. Your tangled mass of thick, wavy, auburn hair reached down toward your elbows and your smile was as brilliant white as the sun-bleached wicker chairs dotting the deck.

A square jaw jutted forward as you pressed your face toward the wind as you laughed gently at something that was said between your lover and you. Your partner lovingly wrapped his hands around you from behind, caressing your abdomen, before dashing off into the crowd.

I edged closer.

"My, are you ever beautiful! I love a pregnant woman, so full of life!"

You blushed darker bronze and murmured a thanks while outlining the contours of your baby with your palms.

I introduced myself and told you my calling. Instantly, your eyes began to sparkle and dance like the sunlight on the nearby cresting waves, "Oooh! I wanted to have a home birth so badly!" you exclaimed.

"What's holding you back?"

"My partner/I thought it was too risky", "I will definitely look into it further for future pregnancies, but, with my first and because I don't know what to expect, I think the hospital is a better choice", "It seems a little too hippy for me", "My partner is not comfortable with it", "my doctor is just fine and its only one day, right?".

You named your reasons, and I listened quietly, offering only a gentle nod of encouragement to continue. When you had exhausted all of your worries, you looked at me anxiously, apologetically. Your partner appeared as if a mirage and wrapped his sheltering arms around you, moving you away from me and further down the boardwalk.

I grasped your hand in goodbye, pressing my card, and this blog address, into your palm. "I wish you all the luck in the world. You are an amazingly beautiful, strong woman who is doing a good work to bring this beautiful life into the world!"

And you were gone.

I hope you have found your way here. Because I had so much I wanted to tell you!

A midwife and a doctor view birth so much differently! There is a wonderful source of information on what to ask your care provider to find out if they are truly Mother-Friendly, and I invite you to read it here.


Additionally, here is a pretty concise outline of the differences between a midwife and a medical model of care.

Midwives Model of Care	Medical Model of Care
Definition:	Definition:
• Birth is a social event, a normal part of a woman's life. • Birth is the work of the woman and her family. • The woman is a person experiencing a life-transforming event.	• Childbirth is a potentially pathological process. • Birth is the work of doctors, nurses, midwives and other experts. • The woman is a patient.
Definition:	Definition:
• Home or other familiar surroundings. • Informal system of care.	• Hospital, unfamiliar territory to the woman • Bueaucratic, hierarchical system of care
Definition:	Definition:
• See birth as a holistic process • Shared decision-making between caregivers and birthing woman • No class distinction between birthing women and caregivers • Equal relationship • Information shared with an attitude of personal caring. • Longer, more in-depth prenatal visits • Often strong emotional support • Familiar language and imagery used • Awareness of spiritual significance of birth • Believes in integrity of birth, uses technology if appropriate and proven	• Trained to focus on the medical aspects of birth • "Professional" care that is authoritarian • Often a class distinction between obstetrician and patients • Dominant-subordinate relationship • Information about health, disease and degree of risk not shared with the patient adequately. • Brief, depersonalized care • Little emotional support • Use of medical language • Spiritual aspects of birth are ignored or treated as embarrassing • Values technology, often without proof that it improves birth outcome

No matter how natural of a birth you have in a hospital setting, it will never even come close to a home birth. Home births are different on so many different levels than simple surroundings.

"My partner/I thought it was too risky"
There have been many studies throughout the years that have found that home birth is as safe, if not safer, for healthy, low-risk women, as hospital birth. Most recently, a Canadian study has shown these same findings, once again. Home birth midwives will, very often, carry oxygen, and all carry homeopathics as well as are trained in lifesaving CPR and first-aid.

Home birth midwives are experts in normal, natural childbirth. Because they are experts in normal pregnancy and birth, they will see deviations from normal and natural pregnancy and labor/birth early on, be able to assess these variations, and take immediate and early precautionary measures to ensure your safety... this is part of the reason why home birth is so safe.

If your midwife were to see something that did not match normal and natural, she would be able to attempt to get you back to normal and natural before it became an emergency and, if she couldn't, she would be able to transfer you to appropriate care. Home births have come a long way from ripping up bedsheets and boiling water.

"I will definitely look into it further for future pregnancies, but, with my first and because I don't know what to expect, I think the hospital is a better choice"
This particular reason is like a punch to the midsection. There is a large body of women who choose home birth for their second birth because they had a horrible experience with their hospital birth. If you are considering a home birth, your first birth is a great birth to start with - you cannot go back and redo your first birth, and that first birth can impact your options, emotional health and wellbeing, and even fertility of future pregnancies/births.

Some women, by the end of their labor, believe that their doctor/hospital has saved them from a bad outcome, when, in actuality, the hospital or doctor (procedure that they performed) caused the risks that they ended up needing to save you from. But, the perception that is given is that a woman is so thankful that they were in the hospital and are glad that they didn't have a home birth because they 'needed' this or that intervention.

Other women end up with unnecessary cesareans and find it hard to find a homebirth midwife or hospital based doctor who will take her on for a vaginal birth with subsequent pregnancies and births. I am sure you have heard the saying 'there is no time like the present'.

Bottom line, THIS pregnancy and birth is the best one to pursue a home birth for.

"It seems a little too hippy for me"
The wonderful thing about midwifery going mainstream in the last 20 years is that you have all types of midwives now practicing. There are more traditional midwives, as well as more modern midwives. This allows for families to find the right type of midwife to fit their families needs.

I know midwives who wear hemp, bohemian skirts, have dread locks, drink herbal teas, eat a vegan diet, and choose a more natural lifestyle.

I also know midwives who wear high heels, highlight their hair, like cabernet sauvignon and sushi, and have a more urban feel.

And most of the midwives I know fall somewhere in-between. The stereotypical 70's midwife is not the only option anymore, but the continuity of care, the midwifery model, will remain constant no matter whom you choose.

"My partner is not comfortable with it"
Not all partners are men, and not all partners fit this stereotype, but the majority of male partners are not comfortable with home birth at first. They usually don't research and read as much and tend to follow the paternal medical suit more readily.

That said, if you can simply get your partner to go to an initial interview/consultation with a home birth midwife and present it as an opportunity for your partner to ask whatever questions they might have of the midwife, this can, oftentimes, dispel fear, uncertainty, and incorrect stereotypes and assumptions that they might have about home birth and midwives. Oftentimes, just one consultation is all it takes to get a partner to start seriously considering a home birth.

Here and here are two different examples of the types of interview questions you might ask at an initial consult.

And finally, when it comes down to it, although it is always best to have both of you in agreement over your birth options, it is your birth and body, ultimately, it should be your comfort level and decision on where and with whom to birth.

"My doctor is just fine and its only one day, right?"
I know lots of good doctors, I know some 'just fine' docs, and many bad doctors. Not bad at what they do, but bad at taking care of a woman and babies needs and holistic health.

There are doctors who have great bedside personalities, but who are not good doctors. There are doctors who make you feel 'taken care of', but don't shoot straight with you about your options... or disguise your options as necessities so that you don't have true options. And there are doctors who, when you are at your most vulnerable (labor and birth) will 'not allow you' so many things previously promised. It is necessary to more than LIKE your doctor... you must trust him/her with your holistic health and life, and that of your unborn baby. If you don't, you really truly should look for another care provider.

And let's not forget that the average first time labor is around 16 hours. This is average. Some women labor for a few days, some for a few minutes. Beyond the actual laboring time, your birth experience will last with you for much, MUCH longer.. in fact, your whole life. So, if you think it is 'just one day', think again.

My heartfelt desire is for you to remember this moment, which will stick with you for the rest of your life, with joy, trust, love, and fondness. Please make sure that you can trust your care provider for that.

As Dr. Biter said in a recent interview,

They don't even know the difference between natural birth and a vaginal birth. They think that, just because a baby is born out of a vagina that that is a natural birth.

But a natural birth is an unmedicated birth, a birth that is honored, where women and their partners are respected, and where that little buddy comes into this world in a solemn sacred moment. That's what a natural birth is!

There are additional great resources out there that will help you to work through other scenarios that you might encounter to help you make the best choice for you and, hopefully, feel secure in choosing a home birth for your first, beautiful, birthing time.

And finally, just for you, Sunshine Mama, some inspiration!

Immediate Breathing At Birth

Jenna, this one is for you.

I was recently at a birth where baby didn't pink up and start yollering right away. Now, someone who has been at a great number of births can start to tell when it is normal flaccidity that will ebb with a little attention and patience and when baby needs a little help starting up.

But, one of the main concerns I have is how this is managed at the hospital...

This babe was quite shell shocked from a rather severe case of shoulder dystocia and a little tired from the hard work he and mama had done. He was born with no tone, bad color, and no breathing. He was one of those babies that needed a little help. Doc gave him 40 seconds to become responsive and, with vigorous rubbing, sole thumping, and mama and daddy calling him earth bound, pronounced him 'needing more work' and clamped and cut the cord, whisked him away to a nearby table, and continued what they were already doing previously on mama's tummy.

Only now, his oxygen line was gone.

In this study, it is shown, in part, how the presence of oxygen, as well as decreased blood flow in the umbilical cord, help to stimulate a babies first breathe. The downside is, if you are worried about baby showing stimulated response, independent breathing, and coming 'earth side', WHY THE HECK WOULD YOU CUT OFF THEIR ONLY SOURCE OF OXYGEN in hopes that they will start respiration? It is exasperating an already possibly problematic situation.

They rubbed him down... coulda continued to do that while he was still attached. They thumped his heels... coulda continued doing that while he was still attached. They ran the oxygen under his nose... coulda done that while he was still attached.

As it was, he took his first breath, independently, about a minute and 45 seconds after he was born... 45 seconds after he was deprived of his oxygen source. seconds from being intubated. They were literally prepping the line to intubate him when he took his first shaky breath. He began crying lustily and everyone cheered, me included... but they could have avoided that emergently necessary first breath by leaving him attached. The placenta detached 30 minutes later.

I have seen homebirths where baby was born equally shell shocked and the midwife was equally diligent at getting babies first breath initiated... while leaving the cord intact. The difference is that one babe will have to be 'bagged' when the placenta detaches or umbilical cord stops pulsing (generally within 2-5 minutes) vs. baby having to be bagged within 1-2 minutes postpartum. Giving baby that extra cushion can be the difference between an 'emergency' and the emergent first breath.

Most homebirth midwives carry oxygen, the same as hospitals, but usually let nature, and baby, determine when they need to intervene, not before, which reduces risk by default.

.. sigh, I was planning on posting the birthstory of Tres this evening, but this is what you got instead. I have it written down on pen and paper (I know, what is that) and promise to get it up by week ending. I know Mama M and Daddy M are getting anxious to see it, and the pictures - BREATHTAKING (no pun intended).

Childbirth in the News

There have been some wonderful articles on recent studies that are very encouraging that I wanted to pass on to the women in my life (both IRL and blogsphere) that are expecting babies soon.

One discusses the issue of nuchal cords during labor and birth. A nuchal cord is, by definition, when the umbilical cord wraps around tte baby's neck while in the womb.

The article states:

A new study backs up previous research showing that nuchal cord is not the
threat it's percieved to be.

The second article I would like to bring to your attention is entitled Eating During Labor Has No Ill Effects. According to the study cited in this article

Allowing a pregnant woman to eat during labor does not seem to have any impact
on the outcome of the infant or mother, and doesn't increase the risk of
vomiting, according to a new study.

This is exciting that they have documented what many of us already know! Combine that with the decrease in labor length (albiet small) in the group allowed to eat during labor, and our knowledge of the human body and it's need for fuel during strenuous activity, eating when hungry during labor and birth is a good thing.

This borderline hypoglycemic is so happy to see this archaic practice is getting the bad attention it deserves! Hopefully this means women no longer *have* to sneak their nourishment when opting for hospital births.

I am happy to say that I have also contacted local hospitals recently to see if they have updated their NPO ("non per oris" or nothing by mouth) policy and 3 out of 4 immediately said yes.

Finally, this article talks about the increase risk of cesarean section from inducing labor prematurely.

Again, this is not new news, but definitely exciting to see it get some good media coverage. My favorite part of the article is the last sentence (emphasis mine)

"Glantz advises that pregnant women and their doctors may be better off waiting
for spontaneous labor. "Try to reserve interventions for situations
where risk outweighs benefit". (and I assume he means risks of not intervening)

Now to see that in practice.... :-)

Friendly Emails from Midwives and Codes of Ethics

Hi Nicole,

My name is ****, I am a CNM at ******. We are an independent Midwifery Clinic and deliver at ******. Dr. Judd has backed this clinic for years. And everything you're reading is true, he uses tons of Forceps and I was shocked as well and don't always agree with it, but what I can tell you he is very safe. I've never seen forceps used where a Dr. can actually keep the perineum intact while doing it. The nice thing is, He lets us be more natural with our patients and only helps us when we absolutely need him. I agree it is shocking to see the sign in his office, he just prefers these patients see a Midwife. What people need to know is that he is safe, and he has the lowest C-section rate I have ever seen in an MD. If you need his percentage I can get you that. I think it is important that people know he is safe. Of course, I prefer Midwives and I imagine you do too. Spread the word for Midwifery. If you have any more questions, let me know.

I received this nice email in response to my previous post (shared by permission). I am looking forward to seeing the percentages from my newly acquired midwife-friend and enjoy that we can have this dialogue.

On another note, I have been active in a BirthWorkers workshop that is held monthly. We are instructed by a CPM as childbirth professionals who either ARE or WILL BE pursuing midwifery in the near future. The last meetings were on Code of Ethics... The next series of meetings will be on anatomy and physiology. As we were working on Codes of Ethics, I did a little research and pulled up both MANA and ACOGs CoEs...

It is interesting if you read them as a comparison.

MANA
ACOG

Happy reading!

Careers in Maternal-Child Health

Childbirth Professionals - Please visit here to help with an online survey for others seeking professions in the childbirth field.

The Profit of Pain Relief

Well, let's get straight to the point: hospitals make a lot of money from epidurals. This article gives particular insight into this hostile fight over finances... now don't miss it:

“According to him, much of the information that women receive is incomplete or inaccurate, and that the lucrative “natural childbirth industry.... Natural childbirth has become a multimillion-dollar industry. The fear of epidurals is promoted by those who discourage their use - and who have a vested interest in doing so."

Ok - so, we have a vested financial interest in a woman not getting pain medication? Yes, you are right, my vested interest is to support a safer, more effective labor and birth for mom and baby while preserving her physical body and autonomy as much as possible, but we are not making a living off of this, NCB is not a lucrative industry by a long shot... What Mr. Grant fails to tell you is that we don't have thousands of dollars to loose per birth, as he does, if a woman refuses pain medication. No wonder he wrote his completely inaccurate book, Enjoy your labor: A new approach to pain relief for childbirth

How many of you can remember a nurse coming in every hour to ask you, “Are you ready for your epidural now?”. Sometimes, it is even more of a demand, "Well, we know what you want, but sometimes it is about what we need to do and how it is going to happen." (yes, I have heard that one personally). Ever wonder why the push so much? In America, an epidural costs anywhere from $800 to $2500, depending on the hospital and community. The United States spends more money on birth ($50,000,000,000/year) than any other nation in the world... and that is without getting better results.

The average medicated hospital birth costs $7,500 - $12,500 and that can mean double for cesareans. It is not conspiratory to see that this provides nice profits for obstetricians, anesthesiologists, and the drug companies that market to these hospitals. Did you know that many pharmaceutical companies offer incentives and bonuses for the 'top sellers' in any given hospital or practice? In fact, my OB told me that one such rep offered a new plasma TV to the OB with the most medicated births in the first month of the new year from the hospital I was planning on birthing at. As I have said time and time again, the majority of hospital policies are based on financial goals and protection from litigation.

Ok, back to that wonderful article:

"It is barbaric that pain should still be viewed as an integral, even desirable, element of childbirth."

(Let me reiterate, his book is full of misinformation, and this article is no different. I am only hitting on a few of the lies therein) . Contrary to his claim, medical studies have shown that pain in labor and birth is beneficial to the process and allows for a safer and healthier outcome. I know I have cited it before, but check out Dr. Buckley's wonderful article on this phenomena.

If you want pro-epidural substantiation of this fact, see this video. The poor CNM talks out of both sides of her mouth saying that epidurals are safe for labor and birth and alludes to them not slowing down/stopping labor, or raising the incidence of cesareans and yet, the flash-board says, first, "Myth: Epidurals are unsafe and I should wait as long as possible to get one.".. and then is followed up with "Fact: pain causes body to release stress hormones that cause muscles to contract not relax"...

Well DUH! that is the whole point, thank you for proving it for me. Epidurals cause your uterus to RELAX because your body does not feel the discomfort associated with it and does not, as a result, contract the uterus as efficiently - causing an increase in the use of pitocin, instrumental delivery, and cesarean.. all of which are profitable to some degree or another. I know what she was trying to say, that tension can inhibit progression of labor, but she fails to acknowledge the uterus is just one. big. muscle. A relaxed uterus does not contract, which does not dilate, which does not birth.

One woman hit the nail on the head when she said "Epidurals are for tolerating hospitals, labor is the easy part". With hospitals 'requiring' that a woman dilates 1cm every 2 hours or she will be given pitocin, which, in turn, makes contractions less tolerable, requiring women sit or lie on the bed for continuous fetal monitoring, making contractions less tolerable and dilation slower, requiring women to have multiple vaginal exams, which mentally discourages women and causes tension (both of which discourages dilation)... it is no wonder that they are making the nice profit that they are.

Now things begin to line up... why women are being refused VBACs because of hospital policy or individual practice, why a nurse refuses to adhere to one request out of many on her birth plan: that medication not be routinely offered, why the AMA refuses to acknowledge that home birth is as safe as hospital birth for low-risk women and why they are attempting to outlaw home birth all together, and why hospitals across the board are pushing for the 'safety' of medication in birth... profit.

But, you shouldn't take my word for it. After all, we NCB advocates are in such a lucrative industry, and have selfish vested interest for you birthing our way....