Friday, November 28, 2008

Allison's Birth: Braver than you believe, and stronger than you seem



As a doula and a Certified Professional Midwife’s apprentice I see all kinds of births and they are all special. But some of them are just extra special… Births that I know I’ll never forget.

Such was the case with Allison. Her birth happened recently, but I think I’ll remember it for the rest of my life.

When I met Allison at the midwife’s house for her first prenatal, her happy, easy-going ways immediately made me think that she would be a fun client to work with. Her bleached blonde hair, perfect tan, and French manicure made me wonder for just a second if she would find it difficult to just “let go” when labor happened. Would she be able to listen to her body, make the sounds that she needed to make, and assume the positions that she needed to when it came time to birth a baby? Would she be worrying about her makeup or simply focus inward and do what needed to be done? How would she do without any kind of pain medication at home?

She and her husband were totally confident that they could and would do this birth naturally just fine, and had no concerns. They didn't know anyone who had ever had a homebirth, but they were so excited about planning their birth. Her husband was a respiratory therapist and had worked in the medical field for years. Their midwife asked, “So why do you want to do a homebirth? After all, your insurance would even cover your birth in hospital, right?”

Rick and Allison looked at each other and smiled. “We’ve known for years that we would never have our baby in the hospital unless we had to! Rick has seen too much stuff there, and my mom is a labor and delivery nurse there and she’s always telling us stories. We would just rather stay home and have one on one care with someone who knows us as more than a patient number for their shift. We want somebody that knows US and what we want and what my health has been like….”

* * * *


When Allison was about a week overdue, I got a call: "Allison's in labor. Her water just broke, but she’s not really having any contractions right now.”

As I was driving to Allison’s house, her midwife called me to update me on the latest.

Allison had come to see her over the weekend because she wasn’t sure if she was in early labor or not with mild contractions.

”I learned some things about her pelvis that I wasn’t aware of before…” Joanne said, a hint of worry creeping into her voice. And then she said it: “I just don’t think her pelvis is big enough for any baby to fit through!”

I was a little shocked, because it had never come up as an issue at any of the prenatals with Joanne that I had been present for.

Joanne explained that she had not done any kind of vaginal exams early in pregnancy at Allison’s request. She had done Allison’s first vaginal exam when Allison and Rick had come over, wondering if she was dilating. And Allison had never seemed like the kind of person who would have a pelvic issue. She wasn’t petite and seemed to have a very average frame.


Joanne had NEVER worried about anyone else's pelvis during any of the births I had ever assisted her with. Sure, some women had to push longer and harder to get their babies out, but they usually always succeeded in birthing their babies vaginally. CPD had seemed basically non-existent in Joanne’s practice. Until today.

She thought that the inlet and mid-pelvis was adequate. With Allison, it was the outlet (nearest the perineum) that felt so tight during the vaginal exam.


We pulled up at Rick and Allison’s home and there she was - happy and walking around excitedly in early labor. Joanne did a check for dilation (2 cm.) and then said, "Can Mary check you, too? She needs some more practice."

Allison didn't mind, except that every time anyone inserted two fingers (ever so gently and slowly when she was comfortable) to check, she would totally screw up her face and clench her pillow and say, "Owwwww! My tailbone hurts SOOO bad!" That seemed kind of odd. Her midwife commented that her tailbone had been that sore the day before, too when she had done the first exam.

Then Joanne told Rick and Allison that we were going out to breakfast to give them a bit of quiet resting time to themselves in early labor. They liked that idea, and we left.



As soon as we drove away, Joanne turned to me and said, "Did you feel what I'm talking about with her pelvis?! I wanted you to feel that. That’s why I asked if you could check, too."


I exclaimed, "Did I ever! I'm thinking the exact same thing you are. HOW is a baby going to fit through THERE?!"

When I had checked Allison, it seemed as though the very outlet of her pelvis where the base of my fingers rested barely had room for more than three of my fingers. Joanne said that she estimated at the widest part, her pelvic outlet seemed to be not more than 6 cm (that's bone, plus think flesh, then try to get a space 10 cm wide and get a head through there!).

Joanne told me that Allison's horribly sore pelvis seemed to confirm to her that her pelvis was, even though tiny, doing it's best to expand for labor.


As we drove on, Joanne sighed. "I don't think she's going to get this baby out no matter how long she pushes, but if she DOES, I think she's going to break her tailbone. This is probably one of those cases of true CPD, and I feel so bad for her because the reality of a C-section hasn't even crossed her mind."

I asked her what she had told Allison about her pelvis. She told me that she had only told her half the truth when she checked her the day before, saying, "You seem to have a marginal pelvis, and I think you are going to have to work harder than most people to get a baby out. But I think you can do it."

Joanne added, "I’m really not very sure about the thinking she can do it part, but we can only wait and see what happens when she starts pushing."

We went back to the house after breakfast, and Allison was munching on a granola bar and doing hula stuff with her hips and walking and swaying constantly. It looked like she had been to a belly dance class.

She did that all day long. She never stopped moving. She constantly paced, and swayed, and swiveled her hips and sat rocking on the birth ball. A couple of times, her midwife and I begged her to rest for five minutes, knowing she had a long, exhausting journey ahead once she started pushing.

Every time she got into a new position for a contraction, if it was more uncomfortable that way, she'd say, "Ooooh! This really hurts!"

We'd look at her and say, "Well, you can try something else... You don’t have to hurt yourself more!"

But throughout her entire labor her response every single time was, "No, this feels like it's opening me up and I want to bring it on! The more intense, the better! More, baby! Ooooh! Owie! This is powerful stuff!" She put herself in the most uncomfortable positions because she thought it would help her move things along. What could we say? We were impressed with her strength and determination. We just hoped that somehow she could and would birth this baby. She would be crushed if a c-section became necessary. But we kept our thoughts to ourselves.

As labor progressed through the afternoon, she became deeply focused between contractions (instead of watching a movie, talking, eating). Allison started to do all sorts of things that had her midwife and I exchanging some strange glances.
She looked like she was doing an instructional video for the The Labor Progress Handbook! We knew that she had never read any doula or labor progress books or seen these positions anywhere, so our mouths dropped open as she proceeded to do things like the double hip squeeze (pressing in on the top of the pelvis with a contraction, widening the outlet), the lunge and then she went into doing the lunge with one foot up on a chair and a huge, low, wide, squat with every contraction for hours. She'd hang on her husband and go lower and lower and wider and wider, saying, "Owwiee! This is wooorking!"

It would have been fun to try to keep up with charting her postions - she must have done at least twenty different ones, with no guidance from us! She would do something, and then say, "Is this okay? Should I do something else?"

We kept telling her that she looked like she was doing every position for opening the pelvis that we'd ever seen in a book and it looked like her body was telling her exactly what to do.

She'd smile and say, "Well, it hurts, but I want to do it. It just feels right." She was amazingly in touch with her body and so instinctual about everything she did!

By 5 pm that night, she was almost 10 cm, but because of the tight fit of baby's head and the pelvis, the anterior part of the cervix was getting "dragged down" with the head as the baby descended. The lip of the cervix that was in front of the head and under the pubic bone was starting to swell. The baby was descending, but stretching the anterior cervix along with it. It was such a tight fit in there that her midwife wasn’t even sure how to move the cervix back above the head. Finally, around 6 pm Joanne started trying to hold it back, from being shoved down any farther. She let Allison start pushing; trying to get the head past the cervix, hoping it would soon stay behind the head. But, because it was so tight in there, Joanne had an extremely difficult time holding it back. (Her fingers would get compressed between head and pubic bone, and baby started to mold around her fingers!)


Allison pushed and pushed and pushed (mostly on a birthing stool with her husband sitting behind her, encircling her with his arms and her gripping his knees.). At 8 pm, she finally got the head past the cervix.

The baby's heart rate sounded wonderful throughout pushing, so she just kept going and going and going.

We weren't "directing" her pushing, just telling her what a great job she was doing, but she voluntarily did the "purple pushing" like people are often coached to do in the hospital for four and a half hours! I've never seen anyone do that at home without being "forced" to. I guess she knew what she needed! Joanne and I watched in amazement as she pushed and pushed and pushed. Her face was red and purple and the sweat poured off her. This beautiful lady was working harder than we had ever seen anyone work! In spite of dissolving into sobs between contractions at the sheer frustration and hardness of what she was doing, she never said, “I can’t do this!” She seemed to have an iron will to get her baby through her pelvis.

And her baby’s heart rate never showed any sign of stress. Who were we to say that she couldn’t do it?

At 10:00 pm, we started to see head. And at 10:30 pm, we had a little 6 ½ pound baby boy with a very tiny, very coned head and a woman who had just become a mother, absolutely beside herself that SHE DID IT!


So much for a woman with a literal 6 cm diameter pelvic opening!

She did it anyway!

So much for a woman who seemed impossibly tiny to birth a baby!

She did it anyway!

Less then three minutes after she finished those four and half grueling hours of pushing, she caught her breath, looked at her little boy and said, "You're so worth every bit of work I just did to get you here!"


I glanced over at Joanne and saw tears glistening in her eyes. I knew that she had to be just as proud as I was of this woman who had showed us that women are braver than they believe and stronger than they seem!


Unassisted Childbirth... coming soon

I'm still working on my article on Unassisted Childbirth.

If you have any articles, links, blogs, etc that you'd like to forward my way, I'm looking for some real life examples of why women have chosen to birth this way and what motivates them to avoid using anyone who has any kind of formal childbirth training. Send them to me at: betterbirth4you {at} gmail {dot} com. Thank you!

In the mean time though, here's a birth story for you...

Tuesday, November 18, 2008

Are We Causing Our Incredibly High Preterm Rate?

The San Francisco Chronicle on the national trend towards C-section:

The Centers for Disease Control and Prevention have tracked an increase in preterm births for decades, with the percentage of births delivered before 37 weeks of gestation rising 21 percent between 1990 and 2006. That increase is the main reason the nation's infant mortality rate has stubbornly refused to decline, remaining higher than most other developed nations.

Some preterm births were linked to mothers' smoking, and others to the mothers' lacking insurance. But more than 90 percent of the increase in preterm, nonmultiple births is attributable to an increase in babies being delivered by C-section at 34 to 36 weeks gestation, according to the March of Dimes.

"It comes from a general change in obstetric practice in our society," said Dr. Alan Fleischman, medical director of the March of Dimes Foundation. "The doctors and the women are intervening in a much more aggressive style toward the end of pregnancy."

Fleischman and other medical experts say there are a number of reasons doctors and mothers are choosing C-section delivery - and not all of them stem from medical necessity, the health of the mother or infant.

Read the rest of the article here.

Sunday, November 2, 2008

Unassisted Birth... A Good Thing?

Unassisted Childbirth (sometimes called UC for short) seems to be growing by leaps and bounds in popularity. Is it a trend that we want to encourage and "sell" people on?

Did any of you watch the Discovery Health Feature about it a couple of weeks ago?

I've been thinking about commenting on the trend, but have 'til this point, decided to leave that controversial topic alone. I know that both sides of the debate have equally strong feelings... and to even venture to state my opinion on the whole matter is risky.



What shapes my opinion on the matter?
A lot of things.

~I was born unassisted, with only my dad and grandma there, in the early '80's.

~The first birth I ever witnessed was my little sister's unassisted birth.

~I'm now a hospital doula and a homebirth midwifery student.

~I'm friends with mothers who choose completely unassisted birth, non-professional (i.e. a crowd of friends and family) attended births, midwife attended home birth, midwife attended birth center births, midwife attended hospital birth, physician attended homebirth, physician attended birth center births, and physician attended hospital birth.

~I've spent more than my share of time dealing with birth-related policy issues through my work on midwifery and birth-related legislation.


Yes, I have a lot to say about unassisted birthing. Maybe I'm right, maybe I'm not.
I'll tell you what I think in a future post, as soon as I get my thoughts formatted.

In the mean time, though, why don't you tell me what YOU think about unassisted childbirth?

Check out the poll I just put up!

Tuesday, September 30, 2008

Study: Vaginal Delivery May Increase Maternal Responsiveness to Newborns

Yet another study telling us another good reason why cesarean birth should be avoided when possible.

"We found a significant difference in activity in certain cortical and subcortical areas of the brain in this group of mothers who delivered vaginally compared with those who delivered by cesarean section. Broadly speaking, the cortical brain regions are believed to be important for regulating emotions and empathy," principal investigator James Swain, MD, PhD, FRCPS, told Medscape Psychiatry.

....While the mechanism is not entirely clear, researchers believe vaginal stimulation caused by vaginal delivery results in the release of oxytocin, a neuropeptide that is a key mediator of maternal behavior in animals.

Cesarean section, said Dr. Swain, may alter the neurohormonal experience of childbirth and therefore may decrease the responsiveness of the human maternal brain in the early postpartum.

The investigators are currently looking at 3- to 4-month postpartum data to determine whether these effects of vaginal delivery on the maternal brain endure. Although the final analyses are not complete, Dr. Swain said preliminary analysis in this healthy group indicates the contrast between the 2 groups may not persist, suggesting that mothers who deliver via cesarean section may eventually "catch up" to those who deliver vaginally.


-- Medscape Medical News


Some time I'm gonna compile a list of all the reasons why one should try to avoid a c-section.

As one of my doctor friends says, "We talk about the 'hard' outcomes - the deaths, the morbidity... When do we factor in the 'soft' outcomes - like breastfeeding and bonding and emotional health and on and on?" And then as she often states so simply and yet so meaningfully, "Birth matters. It really does. We better get it right."

Friday, September 26, 2008

Patients DON'T Know Best - A Dr.s Rant on Homebirthers


I found this physician's blog post and the ensuing comments to raise a lot good topics for discussion! While I can see the frustration of an OB who sees a woman is refusing what he believes is the best medical care (whether or not s/he is right!), I certainly don't agree with him that most women choosing natural/home/vaginal/fill-in-the-blank birth are doing it for any reason other than that they believe it is the very BEST choice for them and their baby.

"Call me old fashioned, but I am not alone. I often believe that patients don't have the capabilities to make proper decisions about their clinical options. When the issue is childbirth, excuse me, patients are often nuts. Just witness the epidemic of homebirths!" - Dr. Diastolic

Check out the whole post here.

Saturday, August 23, 2008

A close up look at your cervix

I am continually amazed that many women talk about a cervix, but don't know what it is. Some think that the perineum is the cervix. They talk about their cervix dilating from 0 to 10, yet they are not sure exactly where that part is - just "somewhere down there."

I will admit, I read about the cervix all the time once I started studying midwifery as a teenager, but I really had no idea what it looked like. People described it looking "like a donut," feeling "like the end of your nose..."

I was intrigued, but really I didn't have a good idea of what a normal, non-pregnant/laboring cervix was like until I watched a PAP smear being done. The Certified Nurse Midwife who I was working with at the time was more than happy to let me see and do everything she was doing, and the woman was extremely happy to let a student examine her cervix (I'm so grateful that some people like her don't mind!).

I hope that these pictures won't gross you out.... (okay, they are no worse than this picture below, except that they are in color!)

If you don't know what your cervix looks like, check out this daily "diary" of a cervix

here



You'll see the changes with the menstrual cycle and how different a cervix looks during menstruation vs. ovulation time.


On Birth Plans

Sometimes I don't have to be original and write my own posts. Someone else has already written a great one.
This time it's Rebecca from Becca's Baby Blog.

Check out her excellent post on birth plans

here

"Just don't think about it, Honey, and you'll be okay!"

I recently attended one of my doula client's prenatal visits with her obstetrician.

She had been telling me about her obstetrician for several months. "I like her," she would say. "She seems open-minded and willing to work with me and respect my wishes... but I'm just not sure if she's just stringing me along or not...."

Over all, most of the reports about her doctor sounded pretty good. She did say a couple things about her that concerned me. For one, the doctor couldn't really remember exactly what her c-section rate was, but she assured the patient that it was "pretty low" and definitely not higher than the other obstetricians in the practice because she only does them "when necessary."

I agreed to come along to a routine prenatal visit and meet her doctor. My client wanted me to tell her what my impression of her doc was afterwards.

I was liking her doctor a lot.
She was saying lots of good things, answering questions openly and took plenty of time to discuss anything my client brought up.

And then my client again brought up c-sections. "You know, Dr. Smith," she said earnestly. "I just don't want a c-section with this baby. I'm counting on you to do everything you can to make sure that doesn't happen to me. Surgery just freaks me out and I don't want end up there... I'm trying to get myself educated so that I know about the risks and benefits of various things and can know what is most likely to make a c-section happen. Is there anything I can do to help prevent myself from becoming a c-section statistic?"

Dr. Smith smiled. "Oh, honey! Don't worry yourself about having a c-section! There's only one good way to deal with that fear of becoming a c-section statistic -- Just don't think about it!
You probably won't have one, and if you end up with a c-section, you can just know that it was necessary and you can be happy that you and your baby are healthy!"

Dr. Smith turned back to charting, but my mind was spinning.

Her best advice on avoiding a cesarean section? Just don't think about it!

I wonder how many other docs give this advice to nervous couples expecting their first baby?

Back.... after a long absence

It's been a long, long time since I've posted here. I've felt bad about it for months, especially since I've had a lot of posts rolling around in my head, and even a few in half-finished draft form.

I could give you a whole list of reasons why my living my life has seemed more important than posting to my blog... but I won't bore you.

Suffice to say, I can't promise to post really frequently, but I'll try to keep it regular and a few times a month.

Oh, and one last thing. In my last post, I talked about how Certified Professional Midwives are felons in Missouri. You probably heard back in June when it was news, but I still have to say it again.... Certified Professional Midwives are now LEGAL and free to practice midwifery in the state of Missouri!! Its been a couple of months since the Missouri Supreme Court made that ruling, but I still can hardly believe it's true. One of these days, I realize that it really IS for real!

Saturday, May 3, 2008

A Good Friday Birth!


On the morning of March 21st, 2008, I started having consistent contractions and woke up around 3:30am. Not wanting to disturb my husband (in case this was the "real deal") yet unable to go back to sleep, I took a bath.

My husband came to find me and asked what I was doing. I calmly said that I was having some good contractions and wanted to see if they were regular. I relaxed in the tub and was fairly sure that these contractions were not going to fade like the Braxton Hicks ones I had been having for weeks. Once I was done in the bath I got back in my PJ’s and asked him to help me with some chores to prepare for the hustle and bustle of the wave of helpers that were soon to come.

As the contractions grew in intensity and came closer together I decided to rest on the floor of our family room. But as soon as I got on the floor my hubby panicked: "I’m calling the midwife... you are all over the place!!!" I chuckled after the contraction was over and said, "No I’m not, the floor is comfortable." He called the midwife and she said that she was on her way. He then called my sister in laws and the doula that was coming to help support us through the labor.

I decided to take a shower and attempt to relax. When I got out of the shower it was 7:10 am. Right then the midwife entered my bedroom. She was soon joined by my sister-in-laws and the doula. We had our team in place. My sister-in-law asked what I wanted to do. I firmly stated that I wanted to go for a walk and got dressed in some comfy clothes. We got my two sons dressed and got the Power Wheel out (compliments of Santa Claus), secured their helmets and off we went.


It was me and my two sisters-in-laws, the doula and my precious sons off on a mission to get this thing going. We left daddy behind with the midwife to get everything prepared for the delivery. The air was cold and felt good as my body progressed through labor and began working harder. It was comical to see my new sister-in-law chase my sons on the power wheel since normally it’s me toting my super sized belly while ensuring that they don’t run into anything and both remain on the Power Wheel.

We had made a complete lap around the neighborhood when we decided to grab coats for my sister-in-law and the doula. As I passed by the house, my sweet midwife she asked if she could listen to the baby to see how he was tolerating the labor. She checked on his heartbeat and it was perfect so off we went for round two. The boys decide to stay behind this time and have some breakfast, so my sister-in-law, my doula and I went on to finish the mission we had started.

After several tough contractions (breathing all the way) the contractions got to the point where I had to stop and lean on my sister-in-law for support. I decided to stick closer to home by this point and we took a few smaller laps. We approached the house and I decided that it was time to go inside and check on our progress. I had a series of two contractions on the porch and my doula gently applied pressure to my lower back to ease the pain in my back (you are heaven sent, Genny). We walked into the house and proceeded up the stairs to my bedroom. We had to stop on the way for another contraction on the stairs... again my doula applied pressure to my back. My son Ethan saw what the doula was doing and asked if he could help. I replied, “sure” as I was getting off the stair that I was leaning on for support and he gently rubbed my back (sweet moment between a laboring mom and her oldest son).

I proceeded up the stairs to my bedroom... When I entered my room I was greeted by the smell of lavender and Sara McLachlan playing softly in the background. In that moment my fears were lifted and I felt a sense of peace come over me... this was the moment I had dreamt about and prepared for. This was a birth on my terms and I could see my dream unfolding around me. As I reached the foot of my bed I knelt to floor with a strong contraction. At the end of the contraction I stated that I was ready to get into the tub. I was amazed how everyone worked together to help me get my needs met. One person drew the bath as another helped me get into the wrap I wanted to wear through the delivery.

My midwife was making her final preparations. After a few more contractions in the tub, and a little screaming, I told the midwife that I was ready to know where we were at (I wanted to know how dilated I was). She checked me and stated that I was nearly complete (10 centimeters) and asked if I wanted to feel the baby’s head. I nearly shouted "no way... you are pulling my leg... you’re just being nice... how dilated am I, really?" She told me that the baby’s head was right there and asked if I wanted to feel it. I was in a state of shock when I actually felt my baby’s head and I began to sob tears of joy. I found a renewed sense of purpose and again focused on the task at hand.

A few contractions later my midwife checked the baby’s heartbeat: "whoosh, whoosh, whoosh, whoosh (Mason in utero)" My midwife stated, "130 perfect!!!"

Then a strange sound entered the room: "reear, reear, reear, reear." Once the contraction had passed I exclaimed, "that’s not my baby’s heartbeat… that’s a saw!?!?" We were having a new deck built and the project was being completed as I labored. Here was yet one more thing to serve as a reminder for myself and my family of the AMAZING experience of welcoming Mason into our home.

Throughout my pregnancy my midwife and I had discussed a plan to avoid tearing open along my previous episiotomy line. We had decided that the best course of action was to refrain from pushing and let my uterus push the baby out. I knew that this would be a hard thing for me to learn to do, but I was up for the challenge.

As the urge to push became greater and I struggled to breath through the intense contraction I heard the voice of my doula: "remember our pushing plan." This clued me in and helped me to remember what my wishes were and helped me refocus on the job at hand. (Thanks, Genny.) I could feel my uterus contracting and my body automatically pushing. I did my best to breathe through the contractions… and soon enough I heard my sister-in-law (now serving as the camera woman) exclaim, "he’s coming, he’s coming."

My midwife told me, "Slowly, slowly… we don’t want a large tear."

With one last contraction Mason joined us. It was 11:10am. He was welcomed into a room full of people that had worked together to make his entry into the world peaceful and full of love. I was in awe of him from the moment I saw him. He is BEAUTIFUL and has been a blessing from the moment he entered our home. Mason… I love you!!!


In the months proceeding his birth I had many doubts concerning my ability to deliver at home and when all was said and done, all I had to do was focus on the time that I had spent bonding with this little person growing in my womb and think of the sweet reward that was waiting for me at the end of the pain. It was through my own inner strength and through the love and support of a carefully selected team that I was able to make this dream a reality. To all of you that were a part of this journey I thank you for believing in me and providing me with the encouragement and support necessary to lay claim to my own personal victory!!! I will never forget this day…it certainly was a Good Friday!!!


- Linda D.
O’ Fallon, Missouri


Thank you, Linda, for sharing your birth story and photos. Your birth was beautiful, and I hope that it inspires other women that they, too can have a beautiful, peaceful birth like yours.

The saddest thing about Linda's birth is the fact that Linda's midwife could face up to seven years in prison for having attended her birth. Currently under Missouri law, midwives are committing a Class C felony every time that they attend a birth, which carries a penalty of up to seven years in prison.

We have spent several decades trying to change our law but year after year, the power and money of organized medicine has won in the State Legislature as groups like the Missouri State Medical Association have defeated the midwives bills every time.

Last year, one sentence was passed in a larger health insurance reform bill that would have made Certified Professional Midwives (CPMs) legal in the state of Missouri. However, organized physicians groups took the new provision of midwife law to court, alleging that it was unconstitutional and should not have been included in the larger bill. The physicians groups (with aid from the AMA and ACOG) have spent hundreds of thousands of dollars over the past year, trying to maintain Missouri's felony status for Certified Professional Midwives.

The physician's groups won a lower court ruling in August of 2007, saying that the Certified Professional Midwife provision was unconstitutional and unrelated to the health insurance bill that it was contained in. Consumer groups like Friends of Missouri Midwives
(www.friendsofMOmidwives.org) as well as individual pregnant couples appealed the ruling to the Missouri Supreme Court, where it was heard in early March 2008. We are waiting to hear the ruling of the Missouri Supreme Court, which will probably be issued by June of this year.

Linda's midwife was committing a felony under Missouri law
as she assisted with her home birth.
(Only her midwife's hands are pictured above to protect her identity.)

The groups and individuals in defense of midwives have also accumulated huge legal bills, as they have had to hire top lawyers to match the ones hired by the well funded Missouri State Medical Association, et al. So far, they have raised about one hundred thousand dollars for the court cost through bakes sales, fund raisers, and generous donations from all across the U.S. However, giving has recently stalled out and there is still about $40,000 more needed to finish paying off the court costs.

Would you consider contributing to this worthy cause? $5, $10, $50, or $200... Whatever you can give will go a long way towards paying off this debt to "Free the Midwives" of Missouri, so that more women can have a birth experience like Linda!

You can donate online or find information for donating by check at:

www.freethemidwives.org

Thank you!

Mary



Thursday, May 1, 2008

They Know So Much That Ain't So


The trouble with people is not that they don't know,
but that they know so much that ain't so.
Josh Billings

Monday, April 14, 2008

Dear "Sarah": There IS Hope for a Better Birth!

Sarah,

When I read your email, my heart went out to you. I know of so many women who dread to think of having another baby... because of the trauma of labor and birth. Some of my friends, even though they've wanted another baby, have told me that they've cried to see the little pink line appear on their pregnancy test, as reality hit them and they knew that once again they would be subject to a overwhelmingly painful labor in a few short months.

I can't promise that this birth will be different for you, even if you do everything suggested. Some women have relatively easy births. And some women have agonizing births. I've learned over the years, it's not all about whether the woman is a wimp or not or whether she thinks positive thoughts, or whether she just hasn't yet discovered the pain coping technique that "works for her."

You are absolutely right. Some of the most painful and overwhelming labors are those that happen so fast. Women talk about 12 or 20 hours of painful labor, and then say, "What?! You got away with 2 hours of labor?!" In reality, what most of them don't realize is that many times a 2 hour labor is just like compressing the 12 or 20 hours that they experienced into a fraction of the time. So, yes, it is often even more overwhelming, relentless, and excruciatingly painful. There is not magic solution to slow your labor down and let it hit you with the normal intensity that most women experience, but there are certainly some things that you can do to make it a better memory.

Some women try everything and still, they have miserable labors and/or births.

For many women,
Getting prepared is good, but it doesn't fix everything.

Being well-supported is good, but it doesn't fix everything.

Being in the right environment is good, but it doesn't fix everything.


Neither does trusting your care team,

or being in water

or being upright

or being in bed

or planning to "just ask for pain meds"

or listening to music

or being at home

or being in the hospital

or eating handfuls of Vitamin C tablets

or overdosing on Calcium and Magnesium in labor

or eating more beans during pregnancy

or the hundred other things that friends, magazines,
websites and other helpful people will recommend!


Sometimes you do everything right (I'm not implying that all of the above are "right" or a good idea) and STILL your birth is a miserable experience.


But I can offer you hope. Rarely does a women come to birth well prepared, well supported, choosing the right environment and the right care provider for her situation and still hate the way it turned out.


A friend of mine who I'll call Susan has had 8 children. They've all been hospital births, mostly with epidurals. One was a forceps delivery that damaged her son's spinal column for life. One of the middle kids was a c-section for an emergency that arose in labor. She has polyhydramnios (too much amniotic fluid in pregnancy) and she has borderline gestational diabetes. Sometimes her doctors control her diabetes with insulin, sometimes she controls it with diet. She's been induced for part of her labors. Other times she's labored naturally for about 24 hours before making little progress and succumbing to an epidural.


Susan has talked about how horrible birth is for as long as I can remember. As a teenager, my mental picture of birth was partly painted by the things Susan would tell me about her births. I shuddered to think that birth had to be that hard and that for her, the only saving grace was an epidural.


When she became pregnant with her eighth and last child, I had recently taken some doula training, and offered to be at her birth. With very little experience and only a stack of books to loan her, she began unloading on me the full horrors of her past birth experiences. She explained how she never goes into a normal contraction pattern once she gets past about 5 centimeters dilation. She said, "The doctors always come in and look at my fetal monitor strip and say, 'Wow. You don't do contractions like most women. You just have one long contraction till you start to push.' "

She explained how her contractions all melt into one, and she only gets a short break of a minute or less every half hour or so. "So, you see why I can't do it without the epidural," she explained. I totally understood. If I had one long contraction for 48 hours, I'd be begging to get signed up for the epidural as well! I felt very powerless to change what her body does to her. After all, this had happened seven times now, right?


But I encouraged her to work towards what she wished her birth experience could be, even if it wasn't likely to happen that way. She began reading books on Natural Childbirth and for the first time in her life she was saying, "Oh, I wish my labors were normal so I could do them without the epidural...." She really did want a natural birth, but she felt that would be absolutely impossible in her situation. Nevertheless, she prayed desperately that somehow this baby would be born differently. My dear friend had endured 30-40 hours of torture with other earlier births before getting the epidural, and saw no point in doing that to herself again with this one. I didn't disagree with her decision, just tried to be supportive.


The day came when she wondered if she was in labor. We headed to the hospital to see. Contractions were regular, but not very painful or strong. Things were most likely just putsing around. The doctor gloved up and reached for the cervix, when his eyebrows shot up.

"Oh, my!" he exclaimed. "Have you been doing this labor for awhile?"

"Well," she said, "Kind of all day, but I pretty much ignored it and went on with my work because I had a lot going on."

"Well, you're going to be happy. You're a stretchy 7 centimeters!"

Now we looked shocked. She the most shocked as she stammered, "I've never experienced 7 centimeters without an epidural! Never! I've never been able to handle it by the time I get to 5 centimeters. Usually by then I'm climbing the walls with pain, and there is no break between contractions! And usually by the time I get to 5, I've been in labor for at least 24 hours!"


An hour later, Susan was sitting on the birth ball, still smiling and talking between contractions.


An hour later, after the doctor broke her water, she was declared completely dilated and ready to push with her next contraction. Things were getting intense at that point as she was in transition and crying, "I can't do this. It hurts so bad!"


Then for ten whole minutes, her husband, the doctor, the nurse, and I just stood and waited for a contraction that didn't happen. Susan kept looking around the room and saying, "This is so weird. It's surreal. Is something wrong? Why am I not contracting anymore?"


The doctor wisely smiled. "Oh," he said, "Sometimes this happens. It's usually just your body giving you a little break for what's ahead..."


Soon the contractions resumed and she set to work pushing, which she had never experienced without an epidural. Even though she could feel what she was doing, and was being more effective that her usual pushing, she hated the feeling. Fifteen minutes of pushing, a few screams, yelps, blowing and breathing, a few more,"I can't do it's" and "Yes, you can! You're moving your baby down" later, she had a chubby pink baby girl in her hands.


Sobbing, and panting she looked over at me and said, "I don't know how that happened like that! I can't believe I just had a baby like that! I wanted a natural birth. I never thought I'd get one, but I did! God is so good!"


Years later, she still talks about her birth to almost every woman she meets, telling them that birth isn't always bad, and there is always hope that you can have a "good" birth, no matter how many miserable experiences you've had.


She's asked me over and over again what it was that I did for her to miraculously change her birth experience. I have told her over and over that I honestly didn't do anything except answer her questions, breathe with her, get her extra pillows, and show her husband where counter-pressure felt good on her back during labor. I didn't do anything special, but her body obviously did a totally new labor pattern that she had never experienced with her seven previous babies.


I don't know what happened or why that birth was different. All I know is that her last birth radically changed her life. Instead of feeling helpless and at the mercy of a "dysfunctional body," she's never forgot how empowered she felt to push out her own baby and to see her body work perfectly fine.


I wish for you the same miracle.



In the meantime, though, I suggest that you do everything you can to prepare for the birth you've always wished to have.

I recommend an experienced doula as #1 on your list.

When you are experiencing overwhelming contractions, it makes all the difference in the world to have someone there to walk through each one with you, and keep you centered, helping you to stay on top of the pain. Of course, husbands are great and it sounds like your husband does a great job helping you through labor, but they can also be so emotionally pulled into your pain that they can't focus on your need in the same calm, reassuring way that a motherly doula can. It is optimal to have one person there to focus on whatever you want physically (back pressure, massage, cool washcloth for your forehead, etc) and one person there who is going to stay right at your face constantly during every contraction, watching your every facial expression, and listening to everything you do so that they can totally focus on where you are at "in your head" and walk you through the contraction one at a time. Find a doula who is experienced and has attended at least a few dozen births in that role. Someone who you feel comfortable with and can trust. Many doulas are certified through ALACE (http://alace.org/) or DONA (http://dona.org/), but other very good and qualified doulas have attended hundreds of hospital births, but have never been certified. Interview them thoroughly. Who do you like? Who seems to understand how you feel about birth and what you wish could be different? Who do you feel completely comfortable with?

My #2 recommendation would be to evaluate whether your birthing location and caregiver are appropriate and best for your situation.

You may have always went to the hospital and used an obstetrician for your births, but perhaps your situation would be more appropriately handled at home with an experienced, well-trained midwife. That is a decision that you will have to make, based on lots of research and reading. Of course, you may be a person with certain risk factors that makes a hospital birth a necessity. If so, or if you just aren't comfortable with a homebirth, then make sure that you have the best doctor (or hospital based CNM) and hospital for your particular situation. Is your doctor committed to helping you have the best birth possible? Is s/he sensitive to your wishes and needs during labor and birth? Do they adhere rigidly to protocols and procedures that are typical, but not evidence-based? Will your doctor allow you to labor in whatever position/use whatever comfort techniques are helpful to you?
Many people think of homebirth as more "risky" than typical hospital birth. It can be when not done right or not properly attended. But when properly attended, it can actually be safer for healthy, low-risk women. I encourage you to do your research carefully. All of the quality homebirth studies show that planned homebirth (when attended by a well-trained midwife) is equal or safer in outcomes for mothers and babies, with far less interventions like c-sections and forceps/vacuum delivery. Of course, there are things that can occur at home that would be better handled in the hospital, because they have the technology/machines to deal with that particular situation. But, on the other hand, there are many situations that occur in the hospital (think: under staffing, more medical errors, infection rates) that would be more safely handled at home. The risk factors for home and hospital birth are different. But that does not mean that there are more risks at home for healthy low risk women attended by experienced, knowledgeable midwives. If, after much research, you decide that homebirth is for you, do some more research and talk with your midwife about the possibility of water birth. Obviously, it's not for everyone and benefits and risks should be carefully considered. But, for many women who have really intense, painful births, having a water birth makes all the difference in the world to them. Waterbirth International (Barbara Harper, author of Gentle Birth Choices) offers lots of resources in this area.

There are many, many ideas out there for reducing the pain of labor. Some of them have been suggested in the comments section of the previous post. Many of them have not been mentioned on this blog. As I find time, I will post more ideas for you.

Regardless of who you decide to have deliver your baby, and where you decide to give birth, I hope that you will think it through carefully and research your options. Birth is never something to be taken lightly. On one hand, it carries with it a life and death responsibility, and on the other hand, it can be the most joyous, beautiful day of your life!

Plan for your birth to be better this time, know that it can be, and then take steps towards making that happen!

And whatever happens, I applaud you for your bravery to experience natural, unmedicated childbirth to give your baby the best start possible. You are among the bravest 10% of American women who experience labor with no pain medication!






Saturday, April 5, 2008

Sarah's Births - "Will I always Scream and Find the Pain Unbearable?"

Since the last post, I have received a number of emails from women asking all sorts of questions... telling sad birth stories, asking if things could have been different for them.

I decided that rather than try to respond to each person individually, I would try to respond to some of these emails on my blog as I have been given permission.

So, here is the first email I will respond to.
First, though, while I am composing a reply, I thought I'd put it out there for the rest of you to comment on. Please do suggest anything that you think might be helpful for this mother. I look forward to hearing your ideas and even just your stories, validating what she has experienced. It is the worst feeling to feel like you are the only person in the world with a particular problem or experience.
I know from my years of experience as a doula that "Sarah" is not alone and there are many women who are like her.
If you would like to reply to her off-list, feel free to email me at: betterbirth4you {at} gmail {dot} com and I will gladly forward your messages to her as well.

Thank you!



Hi Mary,
I am wondering if there is a way I could have a less painful birth experience. I am pretty certain that we are pregnant right now with our fourth baby. Our three previous births have all been with midwives (but not at home)who never encouraged "purple pushing", but my births are horribly painful toward the end.

I have a very high tolerance for pain, but I still end up screaming every time. Our first birth was by far the worst. It was so traumatic for me that I literally cried for almost a year any time I actually thought about what I had been through. Just remembering the pain brought back tears. I screamed with every contraction for five or six hours before our little girl was born.

Then I had trouble with bleeding afterward, as I have with every one of our births. My uterus does not want to contract back into shape after the baby is out, so I lie there in a happy state of shock, bleeding away. It is always scary to everyone but me. I turn pale, and hardly feel a thing. I am totally happy to have a little baby in my arms and to be out of pain, but everyone else sees the blood and my paling face and gets worried. That's after the birth...

Before the baby is born, this is what it is like. My early contractions are usually tolerable until I get to about four centimeters. I wince and ache, but I can pace and breathe through them. Then at that point, my body usually kicks in high gear and I dilate the rest of the way very quickly. Once my body decides to get serious I can go from four to ten centimeters in half an hour. This period is so intensely painful that I choose to start pushing as soon as I am fully dilated because I can't stand the pain. The pain is especially intense in my lower back, so I usually birth in a hands and knees position while my husband pushes HARD on my lower back with his fist/knuckles, which helps a little, and which I really appreciate. I push the baby out as fast as I can because I am screaming and exhausted and I can't stand the thought of slowing down and allowing the pain to linger a moment longer than it has to.

I always wondered if I was wierd. I know that nurses don't seem to be used to the screaming. I never hear screaming when I know the woman down the hall is giving birth, too. It's a little embarassing for me. I am definitely not a dramatic type of person who would choose to put on a show like this. And I am definitely not just screaming because I think it's therapeutic or something. It just really is THAT bad. I can't stop it or help it.

When I have spoken about this, other women tend to doubt that it could have been this way for me. It seems like outright screaming is unusual. I never knew that it was until I started reading other people's birth stories. No screaming. I have even heard people say that they experienced almost no pain at the very end, that all their pain came during dilation, whereas my pain just kept going until the baby was born.

My births are done without pain medication. They never give me pitocin until after the baby is born, to deal with the bleeding problem.

Am I doing something wrong? Is there a way I could do this differently? Have you ever worked with someone like me? Do you have any thoughts on this?
Any ideas or words of wisdom you could share with me would be greatly appreciated! Thanks for taking the time to read this.

Sincerely,

"Sarah"

Friday, March 14, 2008

Ten Centimeters. Push!

Last week I found myself in one of my favorite positions -- Leaning over a hospital bed, rubbing the back of a laboring mother.

Over all, the labor wasn't bad.

I went in with a positive attitude, hopeful of seeing a good birth. I liked the obstetrician - she was an extremely nice woman with a great personality, and seemed to genuinely be enjoying her job. She was very supportive of the mother's desire to have no epidural if possible. Although medical reasons made the obstetrician decide that induction of labor was appropriate, she respected the mother's wishes to keep the Pitocin drip at a minimum and not turn it up once she started contractions.

The mother had given birth in the same hospital twice previously and was well prepared for labor. Her husband was supportive and as helpful as possible.

As labor progressed and the Pitocin induced contractions became more and more unbearable and on top of each other, the nurses were awesome. They provided one-on-one care, basically having someone in the room with us constantly. They, along with the father and I, encouraged the mother to try all sorts of positions - standing, hands and knees, sitting on the birth ball, rocking, etc.

I was even more impressed when the nurses got into whatever positions they had to to continue to monitor the baby's heart rate. It seemed that whenever the mother was in an upright position, the electronic fetal monitor (EFM) just wasn't tracing the heartbeat very well. So, the nurse had to stand there for several hours continuously holding the doppler in place to maintain a tracing. There was absolutely no "I'm really busy. You'll just have to lay in bed so we can get a decent tracing" or any, "I'm sorry this isn't working. We're going to have to put in a fetal scalp electrode." (The obstetrician wanted constant monitoring because of an increased risk of fetal distress with the Pitocin induction.) Care was all focused around what the mother wanted and needed and what made her most comfortable.

I was also impressed with the information that they provided the parents with before taking any action. The mother got vaginal exams when she wanted them, not every two hours or according to any set protocol. The father and mother both didn't want her water broken early in labor. The hospital staff respected their decision and didn't do it till near the end, when the mother requested it.

As I massaged the mother's shoulders and gave the father suggestions for new ways he could support her and asked the nurses to better explain the progress to the couple, I found myself thinking, "This birth isn't bad. It's about as good as hospital birth gets."

Of course, the Pitocin made things miserable for the mother, and more than once she just burst into tears and cried, "I just can't do this anymore!" But every time she got to that point, we managed to re-focus her on dealing with this contraction and just getting through right now. Her obstetrician poked her head into the room at just such a moment, and very quietly, almost reverently watched her experiencing an intense contraction. "Wow," she whispered. "You just never see women willing to do this any more. I'm so impressed."

Ten centimeters came as the sun came up. The shift would be changing soon, but these nurses were excited that they would get to see the fruit of this labor before they left. The doctor was summoned. Mother got back into bed and was positioned in a semi-sitting position. The bed was broke down, and her legs were spread apart while the overhead lights were turned onto the site of action. The doctor gowned and gloved. Two nurses held one leg (since the stirrups were uncomfortable) and I held the other. Sterile drapes were placed everywhere, leaving only the vaginal opening exposed. The father, nervous and excited at the same time, held her hand, and reassured his exhausted, tearful wife that she was almost done. She was so tired, and kept saying, "I don't think I have the energy to push. I can't."

We all assured her over and over that she could and would get her baby out. The doctor leaned in close to her face and looked her in the eyes, "Just listen to me and do what I tell you. Just follow my instructions closely and you'll be just fine."

The mother nodded through her tears, and the father whispered, "Honey, you can do it. Just listen to the doctor."

"Okay, on the next contraction...." The doctor began to explain the process of letting the contraction build, then taking a deep breath and holding it while pushing as hard as possible while the nurses count to ten.

I sighed to myself. Purple pushing. Why do all doctors think that this is the only way to get a baby out? I knew they'd do this. Why do I even hope that this time will be different?

("Purple pushing" is the above described technique, termed such by many doulas and midwives because the mother has so little time to breathe and exerts herself so intensely that she often starts to turn purple and even burst the blood vessels in her eyes. It has been employed at nearly every hospital birth I've ever attended. It barrels a baby a baby out faster than any other method of pushing. A first time mother who might take an hour to push a baby out when allowed to do it at her own pace, will usually push a baby out in less the 20 minutes with this incredibly intense way of pushing. I personally think that purple pushing can be necessary and effective if a baby is in fetal distress and there is a good reason to get the baby out as quickly as possible. If there is not medically indicated reason, I think it just traumatizes the mother's body [tissues don't have much time to stretch and she's more likely to tear, etc.] more than necessary, not to mention that she thinks of pushing as one of the hardest, most exhausting things she's ever done.)

So, the pushing began. "Take a deep breath. Hold it! PUSH!! One.... two..... three..... four.... no, no, don't take a breath yet! Keep pushing down and out as hard as you can!... five.... six... that's a girl!... seven.... eight... nine... TEN! Good push! Now, quick, quick, another deep breath, and down and out! One.... two.... three.... "

(Mother falls back exhausted. "I can't! I have to catch my breath! I can't breathe! Just let me catch my breath!")

"No, honey. Not till this contraction is done." (Pulling her forward) "Take a deep breath right now, and hold it. Hold it while I count to ten... (more insistently) ONE! TWO! THREE! FOUR...."

Ten minutes have passed. We're seeing a baby's head. The doctor comments on all the hair. Mother is gasping for air between pushes and saying she needs to slow down. The Pitocin drip is still going, and the contractions are coming right on top of another.

"No, not till your baby's here. Keep going!"
The nurses get in her face to help her stay with the pushing a little longer. I want to tell her she can take a 10 second break, but that is obviously not the opinion of the doctor.

I tell myself that this is ridiculous, but determine to keep my mouth shut. I'm the doula, not the obstetrician. The doc keeps taking sideways glances at the monitor. The baby's heart rate shows no sign of compromise. It's plugging away with nice short and long term variability around 140, even during contractions with head compression. Wow! The doctor smiles, "Your baby is doing great! Let's hurry up and get him out!"

The contraction ends. Mom falls back on her pillow and sobs and gasps for air. "Just... just let me rest for a minute..." I'm happy to see that the contraction is over and baby is wonderful. Surely they will let her rest till the next contraction hits. The father looks slightly concerned, torn between wanting to help his wife get what she says she needs, and wanting to follow the doctor's orders for the safety of the baby.

But, no, rest is not an option. The doctor wants to get this kid OUT! "You're almost crowning! You can't stop pushing now till your baby's head is out," she says firmly. The mother wearily sits forward, clutches her thighs again and pushes.

"No, harder, longer. Take a deep breath. Hold it while we count...." And again.... and again.

Finally a head emerges.

I breathe a sigh of relief. Finally the mother will get to inhale once without holding her breath for the count to ten.

I wait for the doctor to feel for cord around the neck. Instead she graps the baby's head firmly, locking her fingers under it's jaw line on both sides, braces her feet against the base of the hospital bed, and leans back, pulling for all she's worth. "PUSH!" she shouts at the dazed mother.

I watch with horror. The baby hasn't even rotated! How does she expect to pull the little guy out without allowing his shoulders to properly spiral through the pelvis?

The baby doesn't pop loose. Her eyes register panic. I see "lawsuit!" flashing through her mind. She yanks a little harder on the head. Still no baby. "Stuck baby!" the doctor half whispers severely to the nurses. The father has realized that the doctor is frightened and something is dead wrong. Tears squeeze out of his eyes.

"Supra-pubic pressure!" the doctor shouts in the direction of the nurse at her right shoulder. There are four nurses and a respiratory therapist standing by. Three of the nurses dive for the mother's stomach. (Supra-pubic pressure is usually applied with the palm of the hand, pressing down hard on the top of the pubic bone, trying to help the baby's shoulder "pop" out from underneath. It's a maneuver used for shoulder dystocia.)

One nurse lays the bed back flat with one swift maneuver. The other three pile onto the mother, leaning all of their weight into her stomach. She screams. "PUSH!" everyone yells together. "HARDER! HARDER! You've got to get this kid out!" The mother again grips her thighs, now having her knees almost to her ears and pushes with every ounce of strength she has left.
The doctor leans back and with all of her 200 pounds, pulls on the baby as if her life depended on it.

The baby pops out. It's been less then 15 seconds since the head emerged. The doctor quickly grabs a hold of the pink, squirming body of a crying baby and suctions and cuts the cord while uttering a sigh of relief. All that scare and an APGAR of 10. The nurses straighten up, slightly shaky. The parents can't stop crying and shaking. Their little boy is here, but his arrival was the worst minute of their life.

I stand there, still holding the mother's trembling leg and rubbing it and thinking...
About how this birth happened. About how it could have happened differently, if only some common sense had been used and everybody hadn't been in such a rush.

I replay every move over and over. It wasn't a shoulder dystocia. It was a little 6 lb. baby, being pushed out by a woman with a more than ample pelvis. If the baby would have been given another 30 seconds to rotate and line up the rest of his body, he would have slid out with the next push.

I shake my head, feeling sorry for the obstetrician who created her own emergency and is still shaking about the "close call" she had.

I feel most sorry for the mother and father who just went through some of the scariest moments of their life as they welcomed their baby.

The obstetrician tugs on the still pulsing cord, pulling out the placenta and throws it into a basin for pathology to inspect. She asks the nurse to turn the Pitocin up (to keep the mother from bleeding), and then inspects for tearing.

Seeing none, she looks pleased. It's been almost 5 minutes since the baby was born. He is wailing in his little warmer next to the bed. The mother is too exhausted to want to hold him right now, so the nurses are playing with him. The doctor pats her patient on the leg and says, "You look great! You'll be a little sore. Just use ice packs for a couple days. Congratulations! You have a beautiful baby!" She breezes out the door, to deliver the next patient.

I like her. She's a nice, caring woman. She's sweet and friendly. The nurses were great.

But now I know why I don't want a hospital birth. Sometimes I forget.
I'll remember this one for awhile.

Monday, February 25, 2008

Daylight Section

After receiving the email from our mutual friend about her new grand baby's delivery, my friend wrote the following poem, which she has given me permission to share with you...

Daylight section

Your baby is here!

What an awesome blessing!

Congratulations!

Congratulations!

You hear

7 lbs, 3 oz baby girl

Healthy, full head of hair

Your baby is here!

You should be so happy!

Broken water

Ticking time-clock

Fetal monitor, pitocin drop

Doesn’t matter now, be happy!

Rejoice, rejoice, your baby is here!

Happy, healthy, full head of hair.

Tied down, trussed up, starved and drugged

Lied to, terrified, heart tones dropped?

But your baby is here, you should be happy,

Congratulations!

They did their best for you

Congratulations.

Your baby is here.

Prepped for surgery, shaved and scrubbed

Catheters, monitors, gaping wound

Daylight section

Beautiful baby extracted

A good outcome, no distress after all

Congratulations.

…and condolences.

This poem is dedicated to Sofia, Noelle and all the others
who have been cut from their mother’s womb for no good reason

Be Happy! It's a 7lb, 3oz. Baby Girl!

I received this email from a new baby's grandma about week ago. It's the story of millions of American women who don't know whether they should grieve over their surgical birth, or just move on and "be happy" that they have a healthy baby.
After all, what more could they ask for? Their doctor all but promised them a healthy baby.
S/he didn't promise how that baby would arrive, except that it would be in the safest way possible, the best that 21rst century medicine can deliver.


"Noelle" was surgically delivered before noon today
7 lb 3oz.
They say she has a full head of long dark hair and that she is pink and alert when awake, nursing at least every 3 hours.
They sent a picture of her to my cell phone. The picture of Noelle is now my cell wallpaper.

The interventions and subsequent "fetal distress" were horrific. I cried all day long from anxiety over what they did to "Sarah" [daughter in law] and my granddaughter. They tied her, they trussed her, they starved her, they drugged her, they exhausted her and they terrified her.
After that torture, "fetal distress" was inevitable. (Eeek! fetal heart tones dropped to 127!!)
.... It was all conveniently resolved with major abdominal surgery.

In spite of the interventions, Noelle was vigorous upon extraction. Oops, no cord wraps or fetal depression after all, hmmm.... But they got the kid conveniently "delivered" during daylight hours and within the 24 hour deadline from spontaneous rupture of membranes (SROM). Another "good outcome" for their stats.

A good outcome on paper. But was it good for mother and baby?
Did the treatment they received increase their chances of safety, of life, of successful breastfeeding,
of bonding, of happy mothering?

They had a one in three chance of C-section just by choosing hospital birth in the United States.
But 1 to 3 is 100% if you happen to be the ones sectioned.
It's not like my daughter-in-law was only 33% sectioned.

I am grateful that Noelle seems to have weathered the storms of intervention fairly well. But who knows the long term effects? Mommy, on the other hand, is now not only a new mother, but a post operative patient.

There is a place for emergency C-sections. But in this case, the emergency was created by the very system my loved ones blindly trusted to provide "safety".
I was painfully aware of the peril they were entering with their choice of care and helpless to avert the impending tragedy.
I did what I could to provide accurate information and techniques for dealing with a system that is more about avoiding medical liability than supporting the normal process of birth. (And I had prayed that they would "luck out" and end up being blissfully ignorant of the dangers they had avoided.)

I am so angry at the successful "sale" of "services" with which my loved ones got a total "bait and switch".
The reality of grandmotherhood has not really set in. I SO want to be happy.
And I am grateful for the precious child.
But I am heartbroken by the inhumane way she and her mother were treated at such a crucial time in their lives.
Thankfully, Sarah planned to breastfeed which seems to be going fine.

It's tomorrow now. Maybe I have cried myself out and I can get some sleep now.


Friday, February 15, 2008

On Surgeons and Normal Birth

"In [European] countries, obstetricians serve as specialists. They are essential members of the maternity care team, but they play a role only in the 10 to 15 percent of cases where there are serious complications. Most women have babies without ever setting eyes on a doctor.

In the United States, the numbers are reversed. Obstetricians "attend" 90% of births and have a great deal of control, essentially a monopoly, over the maternity care system. Obstetricians are taught to view birth in a medical framework rather than to understand it as a natural process. In a medical model, pregnancy and birth are an illness that requires diagnoses and treatment. It is an obstetrician's job to figure out what is wrong (diagnoses) and do something about it (treatment) - even though, with childbirth, the right thing in most cases is to do nothing.

To put it another way, having an obstetrical surgeon manage a normal birth is like having a pediatric surgeon babysit a normal two-year-old. Both will find medical solutions to normal situations -- drugs to stimulate normal labor and narcotics for a fussy toddler. Its a paradigm that doesn't work."

Marsden Wagner, M.D., M.S.

Born In the USA,
How a Broken Maternity Care System Must Be Fixed
to Put Women and Children First,
University of California Press, 2006


Sunday, February 10, 2008

ACOG's lastest grenade tossed at homebirth

It should come as no surprise... homebirth advocates are stirring the water and challenging groups like ACOG to justify their stances on homebirth and midwives with evidence. No new studies in the works, just another statement of their opposition to homebirth...


ACOG NEWS RELEASE

For Release:
February 6, 2008

Contact:
ACOG Office of Communications
(202) 484-3321
communications@acog.org

ACOG Statement on Home Births

Washington, DC -- The American College of Obstetricians and Gynecologists
(ACOG) reiterates its long-standing opposition to home births. While
childbirth is a normal physiologic process that most women experience
without problems, monitoring of both the woman and the fetus during labor
and delivery in a hospital or accredited birthing center is essential
because complications can arise with little or no warning even among women
with low-risk pregnancies.

ACOG acknowledges a woman's right to make informed decisions regarding her> delivery and to have a choice in choosing her health care provider, but
ACOG does not support programs that advocate for, or individuals who provide,
home births. Nor does ACOG support the provision of care by midwives who are
not certified by the American College of Nurse-Midwives (ACNM) or the
American Midwifery Certification Board (AMCB).

Childbirth decisions should not be dictated or influenced by what's
fashionable, trendy, or the latest cause célèbre. Despite the rosy picture
painted by home birth advocates, a seemingly normal labor and delivery can
quickly become life-threatening for both the mother and baby. Attempting a
vaginal birth after cesarean (VBAC) at home is especially dangerous
because if the uterus ruptures during labor, both the mother and baby face an
emergency situation with potentially catastrophic consequences, including
death. Unless a woman is in a hospital, an accredited freestanding
birthing center, or a birthing center within a hospital complex, with physicians
ready to intervene quickly if necessary, she puts herself and her baby's
health and life at unnecessary risk.

Advocates cite the high US cesarean rate as one justification for
promoting home births. The cesarean delivery rate has concerned ACOG for the past
several decades and ACOG remains committed to reducing it, but there is no
scientific way to recommend an 'ideal' national cesarean rate as a target
goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean
Delivery to assist physicians and institutions in assessing and reducing,
if necessary, their cesarean delivery rates. Multiple factors are responsible
for the current cesarean rate, but emerging contributors include maternal
choice and the rising tide of high-risk pregnancies due to maternal age,
overweight, obesity and diabetes.


The availability of an obstetrician-gynecologist to provide expertise and
intervention in an emergency during labor and/or delivery may be
life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG
believes that the safest setting for labor, delivery, and the immediate
postpartum period is in the hospital, or a birthing center within a
hospital complex, that meets the standards jointly outlined by the American Academy
of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that
meets the standards of the Accreditation Association for Ambulatory Health
Care, The Joint Commission, or the American Association of Birth Centers.

It should be emphasized that studies comparing the safety and outcome of
births in hospitals with those occurring in other settings in the US are
limited and have not been scientifically rigorous. Moreover, lay or other
midwives attending to home births are unable to perform live-saving
emergency cesarean deliveries and other surgical and medical procedures
that would best safeguard the mother and child.


ACOG encourages all pregnant women to get prenatal care and to make a
birth plan. The main goal should be a healthy and safe outcome for both mother
and baby. Choosing to deliver a baby at home, however, is to place the process
of giving birth over the goal of having a healthy baby. For women who
choose a midwife to help deliver their baby, it is critical that they choose only
ACNM-certified or AMCB-certified midwives that collaborate with a
physician to deliver their baby in a hospital, hospital-based birthing center, or
properly accredited freestanding birth center.

The American College of Obstetricians and Gynecologists is the national
medical organization representing over 52,000 members who provide health
care for women

Response to ACOG's recent statement on Home birth

PushNews from The Big Push for Midwives Campaign

CONTACT: Steff Hedenkamp, (816) 506-4630, RedQuill{at}kc.rr.com

FOR IMMEDIATE RELEASE: Thursday, February 7, 2008

ACOG: Out of Touch with Needs of Childbearing Families

Trade Union claims out-of-hospital birth is “trendy;”

tries to play the “bad mother” card


(February 7, 2008) — The American College of Obstetricians and Gynecologists (ACOG), a trade union representing the financial and professional interests of obstetricians, has issued the latest in a series of statements condemning families who choose home birth and calling on policy makers to deny them access to Certified Professional Midwives. CPMs are trained as experts in out-of-hospital delivery and as specialists in risk assessment and preventative care.

“It will certainly come as news to the Amish and other groups in this country who have long chosen home birth that they’re simply being ‘trendy’ or ‘fashionable,’” said Katie Prown, PhD, Campaign Manager of The Big Push for Midwives 2008. “The fact is, families deliver their babies at home for a variety of very valid reasons, either because they’re exercising their religious freedom, following their cultural traditions or because of financial need. These families deserve access to safe, quality and affordable maternity care, just like everyone else.”

Besides referring to home birth as a fashionable “trend” and a “cause célèbre” that families choose out of ignorance, ACOG’s latest statement adds insult to injury by claiming that women delivering outside of the hospital are bad mothers who value the childbirth “experience” over the safety of their babies.


Hundreds of Missouri home birth families in support of midwives fill a Senate Hearing room in 2005


“ACOG has it backwards,” said Steff Hedenkamp, Communications Coordinator of The Big Push and the mother of two children born at home. “I delivered my babies with a trained, skilled professional midwife because I wanted the safest out-of-hospital care possible. If every state were to follow ACOG’s recommendations and outlaw CPMs, families who choose home birth will be left with no care providers at all. I think we can all agree that this is an irresponsible policy that puts mothers and babies at risk.”

The Big Push for Midwives calls on ACOG to abandon these outdated policies and work with CPMs to reduce the cesarean rate and to take meaningful steps towards reducing racial and ethnic disparities in birth outcomes in all regions of the United States. CPMs play a critical role in both cesarean prevention and in the reduction of low-birth weight and pre-term births, the two most preventable causes of neonatal mortality.

Moreover, their training as specialists in out-of-hospital maternity care qualifies CPMs as essential first-responders during disasters in which hospitals become inaccessible or unsafe for laboring mothers. In addition, CPMs work to ensure that all babies born outside of the hospital undergo state-mandated newborn screenings and are provided with legal and secure birth certificates.

Currently, Certified Nurse-Midwives, who work predominantly in hospital settings, are licensed and regulated in all 50 states, while Certified Professional Midwives, who work in out-of-hospital settings, are licensed and regulated in 24 states, with legislation pending in an additional 20 states.

The Big Push for Midwives http://www.TheBigPushforMidwives.org is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico , and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.

Media inquiries should be directed to Steff Hedenkamp (816) 506-4630, RedQuill{at}kc.rr.com.