Wednesday, April 30, 2008

Gentle Birth is a Boon for Mom & Baby

I just took a webinar at by Sarah Buckley, MD. It was on the hormonal cocktail that happens during undisturbed birth. The hour and a half I spent listening to Dr. Buckley expound on what we, as mammals need to birth was amazing.

I'm no newbie to Dr. Buckley's work... I've read her book, "Gentle Birth, Gentle Mothering" and have read her website as well. Unfortunately I missed her at the Trust Birth Conference... there were so many great sessions to choose from! This was the first time I've been able to hear her speak, however.

This hormonal cocktail doesn't happen the way it is supposed to in a normal hospital birth. Why? Because like other mammals, we need privacy, we need to feel safe and we need to feel unobserved. What do they do in the hospital? People come in and out constantly, we're in an unfamiliar place with strange people and smells, and we are under constant observation. Having birthed under those conditions, I know what it feels like. It is amazing we can birth at all! In fact, the one time my birth went quickly in the hospital was during my last birth, when everyone left the room except my doula, who was napping. While at the time I didn't appreciate being alone, my body sure did because I went from 5 cm to pushing in a very short time.

The hormonal cocktail that we get during undisturbed labor begins with oxytocin. Oxytocin, otherwise known as the love hormone, is present during orgasm, late pregnancy, labor, the immediate postpartum (when we have the highest levels ever) and when we breastfeed. Baby not only gets some of our oxytocin during labor, but she makes her own as well. High oxytocin levels immediately following birth allow mom and baby to fall in love and imprint on each other.

Endorphins also kick in, helping us deal with labor pain and to find pleasure in our baby. Ever wonder why we're willing to do this again and again? Endorphins make us feel good.

Catecholemines (epinephrine and norepinephrine) are excreted by our adrenal glands to initiate the fight or flight response. During labor, these hormones help us find the extra energy to push our babies out, and they initiate the fetal ejection response under optimal conditions. If conditions are not right, they may delay labor. Can you say "failure to progress?" FTP is one of the most common reasons physicians either perform cesarean sections or other interventions like breaking our waters, using vacuum extractors or cutting episiotomies.

Finally, prolactin kicks in. Sarah Buckley calls this the "tender mothering" hormone. It not only stimulates milk letdown, it helps us feel tenderness and caring for our newborn.

With an undisturbed, natural birth, both mom and baby are flooded with these hormones, helping labor to flow and birth the baby. They help us to bond with our new child and vice versa.

With a labor that is disturbed by others, we only get portions of this hormonal cocktail.

With a planned cesarean without any labor at all, we get even less. How will this affect us as parents? How will this affect our children as they adapt to life outside the womb and as they grow? Will it affect their relationships with others? What about when they are adults and having children of their own?

How much have we harmed the past couple of generations who never got undisturbed birth?

Wednesday, April 23, 2008

Choosy Moms Choose Cesareans Article

Time magazine just ran an article entitled "Womb Service: Choosy Moms Choose Cesarean." The article outlines the story of a psychiatrist who chose an elective cesarean because she was afraid of laboring and then requiring a cesarean anyway. It goes on to discuss how vaginal birth can result in incontinence and pelvic damage, while cesareans can result in respiratory problems for the baby. It ends with the hope that "perhaps more women will feel less defensive about making the same choice."

Excuse me? Cesareans are major abdominal surgery. I know. I've had one. And I certainly wouldn't have chosen to have it. I did labor and end up in surgery. At least at the time I felt I had done all I could to have my baby the way nature intended. Cesareans have more risk than just possible respiratory problems for the baby. Both mother and baby have a bigger chance of dying from a cesarean than from a vaginal birth. I guess that isn't important.

And vaginal birth doesn't equal incontinence and pelvic damage. Studies have shown that women of comparable age who did not birth vaginally (or even have children at all) had the same chance of developing incontinence as those who had birthed vaginally.

If I decide I want to get my appendix removed, I should just be able to schedule the surgery whether I need it or not, if cesareans should be just another choice. It shouldn't matter that my appendix is perfectly healthy, right?

I have a fundamental problem with the argument that many obstetricians put forth that an elective cesarean is just another birth choice. At the same time, they are putting down home birth and unassisted birth as not being safe. I still have less of a chance of dying if I have my baby home alone than if I opted to go under the knife. How is this "just another choice?"

Okay, I'm even willing to compromise here. If cesareans are allowed to be just another choice, then they should concede that homebirth is also just another choice and leave it at that. If the OBs are allowed to promote the "safety" of surgical birth and point out the "dangers" of homebirth, I should be able to do the opposite. Studies have shown that homebirth is as safe or safer than birthing in the hospital. At least you won't be given pitocin and drugs that will cause the baby to go into fetal distress at home.

What about if we actually teach women that labor is nothing to be afraid of? There's a unique idea. Labor is a natural function of a woman's body when it is time for a baby to be born. There, I said it. Having a baby is something we are designed to do. In fact, it seems to be a rather well-kept secret that women are actually good at having babies, too.

It sounds to me like instead of choosy moms choosing cesareans, it is uninformed moms, coerced moms and frightened moms who choose cesarean. Most women are not told all the risks of having a surgical birth. A cesarean can cause problems for future pregnancies if the placenta in a subsequent pregnancy implants over the scar. A cesarean can result in infection for mom and/or baby. Hemorrhage is common. The baby can accidentally get cut. The incision can open up during recovery. The baby can have respiratory problems. Post-surgical pain can last for several weeks, and recovery time is longer than with a vaginal birth. The list goes on and on.

All I can say is this choosy mom will choose to birth at home.

Wednesday, April 9, 2008

Bucket Babies

Okay, I can't keep quiet any longer. Every time I go to the store, I see all these poor babies stuck in those portable car seats. I call them baby buckets. Their parents lug them in and out of the store, put them in the shopping cart or lock them to the child seat of the shopping cart. How comfortable must it be to be swung back and forth awkwardly as your parent carries you in something like that? They're not ergonomically designed for the parent to carry easily, and they're heavy. The poor baby is swung one way, then the other as the parent struggles to carry it into the store.

These babies inevitably start fussing and then crying at some point in the store. Do the parents ever take them out of the plastic bucket and hold them? No! The babies I see where I shop are pretty much ignored while they're in the baby buckets. If the parent reacts to them at all, it is just to try and shush them, without really looking in their eyes or even patting them on the tummy. My heart just goes out to them... the cries I hear either sound like "feed me" cries or "hold me" cries. What is so wrong with picking your baby up?

Out of all the bucket babies I've seen when I've been shopping the past six months, one dad actually stopped and picked up the baby out of the bucket. Kudos to him! I was so happy to see one parent respond to their baby's needs.

Think about it. Babies are put in car seats. In play pens. In strollers. Products are sold to prop a bottle to feed them. Are these babies ever held? Cuddled? Consoled?

I read parents asking advice online at various parenting sites, asking why their baby won't sleep when they leave him or her to cry it out alone in a room without the comforting feel of a parent's arms about them, or hearing a familiar heartbeat. My heart just breaks. And we wonder why children grow up feeling alienated, alone and like no one cares about them.

The mainstream baby industry is doing families a gross disservice by making ever more products to put baby in that discourages picking them up and holding them.

Babies need to be held... often. Babies need to feel safe and secure. They are too young to rely on themselves for consolation. They're BABIES.

Think back to your early childhood. What do you remember? I remember two memories from my early childhood vividly... one was a birthday cake with a sugar carousel on it, and the other memory is of standing at the screen door looking out and crying because I woke up and was all alone. I felt utterly abandoned and alone. I was very small... maybe two years old, because my sister hadn't been born yet. I remember seeing my mother's black car coming into the driveway. I still have issues about being alone and feeling abandoned. It has been a big issue in several of my own births.

Now back to these baby buckets. How are these babies going to grow up? What issues are they going to have from not being held? How do we teach parents that children are not inconveniences... that they are to be loved and comforted?

Yes, we have a baby bucket car seat. It seems the only kind you can buy for infants these days. But it stays where it belongs... in the car. Babies grow so fast anyway... let me hold my baby for as long as they'll stay willingly in my arms.

Sunday, April 6, 2008

Our First Homebirth

Tonight marks the 9th anniversary of my first labor when I birthed at home. My 3rd daughter was born just before 5am on April 7, 1999 in the middle of the living room of the apartment we were living in after our housefire.

It was the most incredible experience. After gentle contractions all day long, I finally fell asleep around 9:30 pm, only to wake up at 2:30 am with strong contractions. My water broke soon after, and I kept a towel bunched between my knees as I called our midwife and a doula friend of ours. My husband awoke because of the noise I was making. He put together some quick homemade soup to cook while I labored and put on the music I had chosen. When the midwife got there, he helped her set up the tarp on the floor while I rocked back and forth on my birth ball. I thought of all the women in the entire world who labored with me that night. I drew strength from the fact that they were all feeling the same sensations as they labored to bring their babies into the world.

Soon I was pushing, and before I knew it, my husband was catching the newest member of our family. He felt her take her first breath, feeling the little airsacs in her lungs filling for the first time. My oldest daughter awoke just in time to see her little sister be born. Later, after the placenta was born and my second daughter woke up, we all sat around our newest baby and my oldest daughter cut the cord.

Our midwife made us a soft nest in the large beanbag couch we had, and tucked us all in before she left. Everyone fell asleep but me. I was so ecstatic over this birth. It had been intense, but I had birthed this child without the hospital, without medication, without beeping monitors. It was utterly amazing to be tucked in quietly with my entire family in the living room, holding my little one on my chest.

Birth works. Especially when we don't muck about with it. I had my proof in my arms.

Friday, April 4, 2008

Giving Birth

The terminology of birth gets to me sometimes. Women are not "delivered," we give birth. It sounds like we need to be saved from this most womanly of experiences. It really is disempowering and sad to hear our power removed from this most powerful of times. Giving birth is my passion, my life. If I am not the one doing it, I want to help others find this same elation, this same boundless sense of being.

My baby grows from a tiny seed deep within my body to an individual who is all their own. My baby signals when she is ready to leave that snug warm nest, and together we strive to bring baby forth.

My uterus tightens snugly around my baby, gently nudging her toward the world. My baby responds, pushing against the fundus with her feet, propelling herself closer to her first breath. Labor is a dance between mother and baby... an intimate ballet where mother moves to help baby do the pirouette through her pelvis and into the world.

To carry and bring forth life is a gift. To feel the butterfly flutters of a growing child within is pure happiness. To labor and birth a child is an expression of love.

Tuesday, April 1, 2008

Cesarean Awareness Month

April is Cesarean Awareness Month. In these days of rising cesareans, it is necessary to bring this information out in the open, to let people know that not every birth should be a surgical event.

How prevalent are cesareans? The CDC reports that the average rate in the US is over 30% of births are by cesarean. Some hospitals have rates of 50%... 60%... 80%. Are they saying that women cannot give birth? However did the species get as far as we've come?

When I had my first child, the rate was about 25%. That meant that 1 out of 4 women would birth by cesarean. We had 8 couples in our childbirth class, and yes, two of us had cesareans. I was one of them. While it was probably unnecessary, at least I could have a VBAC in those days without fighting for it. VBAC was a popular choice in the early 1990s. Now, women are not so lucky.

My mother had three children and no cesareans. Two girls and a boy. Both my sister and I have had cesareans for one of our births, and so has my sister-in-law. That makes 3 for 3. The reasons? My sister-in-law was past her due date with a large baby. My sister had a breech baby that did not turn after they attempted an external version. And my CNM was too tired and needed a nap, so they first gave me a cervical block, then after they effectively knocked out my endorphins with that, they talked us into an epidural, so we could not try different positions to get my daughter into an optimal position. All she need was to tuck her head, but I could do nothing to assist her since I was numb from my ribs down.

I do take some responsibility for receiving those drugs. While I had planned not to have them, I let them wear down my resolve. "You're too loud, you'll hurt your throat," they told me as I made deep moans with my contractions. "Your midwife needs a bit of a rest... and you look so tired. You could do with a rest yourself. Let us give you this epidural and you'll be able to take a nap." I had been in labor for only 6 hours at that point.

While I admit that I was a poster child for beached whale syndrome while in labor with my first, I think that with more support from the staff in being active I would have been fine. In fact, I was fine lying in bed dealing with the contractions. They hurt a lot, but I was sure I could handle it until they insisted that we do the cervical block. Once that wore off, I was doomed. This was my first baby, and the first time I had experienced any type of severe pain. All the books I had read and all that they talked about in my childbirth class went right out of my head.

I did try to put them off... but eventually we were worn down... after pushing ineffectively, I was wheeled to the operating room, where I swear no one was with me for quite awhile. I had made it to ten centimeters and had been doing purple pushes for 2 hours before they took me in for surgery. Seems they couldn't find an anesthesiologist, so I was left alone on the operating table, arms strapped out to each side and legs tied together. The epidural had worn off, and I had to push. If there was anyone in there with me, they were not within my field of vision and they certainly did nothing to either reassure me or help me deal with the strong pushing sensations I had to give in to.

When people finally came in, the anesthesiologist re-did my epidural. I asked the OB to please keep me informed on what was happening. They didn't... they talked about some vacation one of them was going to take. I tried to watch in the reflection on the overhead light... but it was too blurry. The only way I knew for sure that my daughter had been born was I heard her cry. They took her to the nursery and my husband followed. While they repaired the incision, it seemed an eternity went by before they finally brought her back in so I could see her. Every one else in the family met my daughter before I did. When my husband was able to bring her in, she was all swaddled in a tight blanket with a hat on her head. I couldn't hold her or touch her because my hands were still strapped down. The repair took forever!

At long last, they took me to recovery and I was able to hold my daughter at long last. I was finally able to unwrap her blankets and look at her, and was able to feed her. I was ready to have another baby right away, so I could get it right. I did not want another cesarean ever again, and now I can say that I have had 7 VBACs, four of which have been at home, and five of which have had no pain medications of any kind.

Let's do our part and spread the word. We don't all need to be cut open to have our babies. If it has happened to us, we don't need repeats of this surgery just because we're pregnant. We can give birth without a surgeon!

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