"Pit Her til Distress..."

Pit til distress... A scenario that happens all too often in the hospital.
The thought in the back of everyone's mind seems to be, "Well, we can always turn the Pitocin down, and if that doesn't work, we can always do an emergency c-section."


Here, the labor and delivery nurse tells it from behind the scenes:
Pit to Distress: A Disturbing Reality

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The Classic Old-School Doc Re-Appears

I am at one of the local hospitals pretty frequently, supporting doula clients in labor - often enough that I now have some favorite nurses and some of the L&D staff people remember me. That's usually a good thing.

I've also done exactly one birth each with quite a few different doctors. Fortunately, some I never see again. Other times, I wish we could trade back for the doc that attended the last birth.



As a side note, I have only ONCE in the last 4 years of attending hospital births, ended up at a birth where the attending physician was actually the laboring woman's own doctor. I used to kind of hope/assume that my client's doctor who had signed off on their birth plan and all would be there. I've stopped planning on that. It's always somebody else. Usually, somebody from that practice, but I find that doctors came come from the North and South Pole and still be in the same practice together! So, we're always in for a surprise when the doctor walks in the door (unless I've worked with him/her before... in that case, I may have an idea about what's coming!).

Not long ago, "Belinda" was due and planning a natural birth in the hospital. She had 2 little ones already, so part of our doula visits prenatally focused on who would take care of the kids and arranging transportation and all kinds of practical details. Besides her husband was in Iraq for most of the pregnancy, and arrived back just a few days before she went into labor.

As for the birth plan, her doctor had said that she was fine with everything on it.
She said that she doesn't do an episiotomy "unless it's necessary."
She said that she avoids C-sections whenever possible.
That she encourages natural birth for any of her patients who want to try it.
That she would allow her patient to move and walk and do whatever she wanted to during labor.
That she would allow her to shower during labor (since a birthing tub wasn't available).
The only thing the doc wasn't very agreeable with was delayed cord clamping. But my client decided to give on that one if she had to.

Then labor happened.

The couple had just been moved from triage into their room. Labor was progressing quickly. The nurse checked Belinda's cervix and cheerily announced, "You're a good, stretchy 7 centimeters! I better tell the doctor to come right in!" With that, she chucked her glove in the trash and hurried out. Belinda was concentrating hard on the next contraction. It looked like all she could do to keep from screwing up her face and crying out in pain.

Meanwhile, the nursing student was having trouble getting the I.V. inserted. So the phlebotomy tech came in to help. Eventually, the I.V. was in and running after the fifth try. Belinda grimaced as she gripped my hand and said, "This is the last stick, right?"

And then Mr. Old School Doctor walked in. He looked like a classic, right out of a book about an eccentric old man... And it began.

"How are you, Ms. Smith?" he asked, touching her shoulder briefly.

"I'm, uh, ok." She sighed, exhausted. "What do you need to do right now?"

"Well, we need to assess how quickly you're progressing. So, I'm going to check your cervix, and we can break your water..."

"No, I - uh, don't want my water broken. Not right now, anyway."

"Oh." he stopped and shrugged. "Well, then that's fine for now." He turned back to adjusting his glove.

Belinda spoke up quickly before the next contraction. "Then can I get up and walk around after you check me?"

"No, oh NO! No, dear. You're going to stay right in that bed. Catastrophic things can happen if you get up and move around in labor."

Belinda looked a bit shocked, but another contraction hit, and she sank back against her pillow and closed her eyes. A couple of minutes later, as she opened her eyes, and looked back at the doctor, she brought it up again. "But I've been planning to walk and be up in labor all along. My doctor said it would be just fine. We talked about it a lot. She said as long as the baby was fine, I could get into whatever position feels good while I'm having contractions."

I chimed in to try to help her. "Maybe," I appealed to the doctor, "She could stand by the side of the bed and lean over it, but not walk around...?"

He looked at me as though I was suggesting that we bring a real, live tiger into the room to help things along. I backed off and he repeated, "No, no, no.... "
Then turning to Belinda again, "Honey, I don't let people do that. The best place for you and your baby is right in that bed."

He sounded patronizing, kind of grandfatherly, and yet... I wasn't sure what to do next. The nurse had a sympathetic look on her face, but she was nodding with the doctor. I knew she knew there was no good reason for this. I had just done a birth with her several weeks earlier and that doctor had let the woman move anywhere she wanted during labor.

Belinda's husband looked uncomfortable. Clearly, he didn't like the conflict. "Uh, honey, maybe..." he trailed off as Belinda rode another contraction out.

Then she snapped her head around and said very calmly but firmly, "I want to be upright. I've read that it can help with labor. Can't I do something that will aid gravity to make the baby come down and out easier?"

"Ah... " he rubbed the white stubble on his chin. "We have ways to get babies out if you're worried about that. Have you ever heard of the McRoberts position?"

Another contraction hit, but he kept talking. Belinda stared, glazed over at Dr. Old School as he rattled on about the McRoberts position while she breathed and nodded and winced. I pressed on her back and wondered to myself what would come next.
He repeated, "Do you know what the McRoberts position is?"

Belinda gripped her husband's hand a little tighter. "No," she gulped, catching her breath.

"The McRoberts position opens up your pelvis as wide as possible for your baby to come through. Its when we lay you on your back and pull your knees back to your ears. So, let's do that. Okay? When it's time to push, we'll lay you on your back and your pelvis will open wider so this baby won't get stuck."

Belinda nodded and was swallowed up by the next contraction. Afterward, she tried one more time, "But can I get up now? Can I stand by the bed or something? These contractions are KILLING me! They are hurting so bad in my back here in bed."

The old doctor straightened up and adjusted his glasses. "No, dear, did you already forget what I just explained? We need you IN BED till you have this baby, okay? Terrible, terrible things can happen to babies sometimes when you get up. You wouldn't even want to know what. But they are catastrophic. Sometimes babies die. I'm just trying to keep your baby safe. And didn't you understand, the best position for this baby to come out in is when you lay back? Do you understand?"

Belinda meekly nodded her head and then looked away as she felt another contraction coming.

And so went the labor... the whole thing. I tried asking the doctor lots of questions about the how's and why's of what he was decreeing, but nothing made a difference. Every time he didn't want something done a certain way, he'd say in his most grandfatherly voice: "Catastrophic things can happen if you do ____ . Do you understand, honey?"

Belinda pushed her baby out in the McRoberts position, which the doctor insisted upon.
And really, everything went fine. Nothing catastrophic or even close to it happened. She didn't have a tear or skid mark or anything.

It wasn't that terrible of a birth. But, Belinda was frustrated at her helplessness to have any say in simple matters of labor. Frankly, I was, too. I thought the whole "not getting out of bed" thing was ridiculous.

I was honestly a little surprised to find a doctor around still practicing so "old school"... He suctioned really vigorously on the perineum for over a minute before he let the shoulders deliver... and the amniotic fluid was completely clear. And then he spent a full two minutes holding a pink, kicking, screaming baby upside down, wiping it's face again and again and again before he handed him off to his mother. I don't know what he was thinking.
I guess it was just protocol.

That's the kind of hospital births I see a lot. They're usually kind of okay, but some of the stuff you put up with is just... dumb and frustrating at times, and for some mothers, infuriating!

People like Belinda will probably have a homebirth the next time. But the hospital might get to keep her as a patient if all their doctors would just be a little more open minded to a very few things that can make a big difference in a mother's experience.

As for the catastrophic things that were likely to happen, I'm still a little confused. Beyond the possibility of a cord prolapse (which can happen at any time, in about any position), what did he think was going to happen if the mother stood beside her bed?!

Oh well. I just hope that I never run into him again at a birth. And should I ever need to have a baby of my own born at that hospital, I hope Dr. Old School won't be the one walking into my room.

But, then, again, it really wouldn't be the end of the world. If I really, really needed hospital care for me or my baby, I would put up with most of it. And I'd try to be grateful. But it would be hard to be impressed. I'm just sayin'...

The Trouble With Repeat Cesareans (Time Magazine)

Time Magazine is starting to get it... the mainstream media is publishing articles that are telling the truth about what has gone wrong in our modern maternity care system.


"Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them. More than 9 out of 10 births following a C-section are now surgical deliveries, proving that 'once a cesarean, always a cesarean'--an axiom thought to be outmoded in the 1990s--is alive and kicking..."

Read the full article here at Time.

Waiting Till 40 Weeks of Pregnancy... So Much Better

The Wall Street Journal published an excellent article back in December, stating the benefits of carrying a pregnancy to term and the risks of inductions that are "just a few weeks early."

"Conventional wisdom has long held that inducing labor or having a Caesarean section a bit early posed little risk, since after 34 weeks gestation, all the baby has to do was grow.

But new research shows that those last weeks of pregnancy are more important than once thought for brain, lung and liver development. And there may be lasting consequences for babies born at 34 to 36 weeks, now called 'late preterm.' "

Check out the rest of the article here at the Wall Street Journal

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...

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.

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!

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."