What to Talk About?

I have been utterly swamped. In trying to find yet more ways to support the family, alas, this blog and our birth website, organic-birth.com, have been neglected. We have been through a rather rough patch. My husband has developed more health issues and we've been going through all sorts of tests for him. His dad, my wonderful father-in-law, passed away on February 2. Needless to say, it has been a bit stressful around here.

In the meantime, I have seen posts about cesarean rates by state, breastfeeding once again being attacked by Facebook and a possible resulting lawsuit, and a study showing that elementary school kids in Glasgow overwhelmingly believe that it is okay for husbands to strike wives "if the wife did something to deserve it," like have an affair (admittedly bad, but still), or was late getting dinner on the table. That is just the tip of the iceberg. Sheesh. What's a blogger to do? With so many different topics screaming to be written about, how can I fit it in my busy day?

I am working on more book reviews and an art project review for our website. I hope to have at least one posted by the end of this week. I also posted a copy of my article that was published in the Winter 2009 issue of Midwifery Today. You can read it here.

ICAN Needs Cases of Insurance Discrimination

Last Thursday, Peggy Robertson of Colorado testified before the Senate Health, Education, Labor and Pensions (HELP) Committee about being discriminated against by her insurance company. Her story can be found at the ICAN website: http://ican-online.org/users/ican-blog/blog/ican-mother-testifies-capitol-hill.

According to the ICAN press release, Mrs. Robertson was not only rejected for coverage because she had previously had a cesarean section, she was told in a letter that the only way they would give her coverage was if she consented to sterilization.

With the percentage of pregnant women who give birth via cesarean section rising to almost 33%, using a cesarean as a "pre-existing" condition is setting up a third of American women to be uninsured in the future. More and more hospitals are not offering VBAC (vaginal birth after cesarean) as a choice to women. Page Hospital in AZ was the most recent one in the news that threatened a VBAC mother with a court ordered cesarean if she did not consent, even though she had had a successful VBAC for her last birth. This mother has decided to travel hundreds of miles in order to get her VBAC. This shouldn't happen, either.

If you have stories of insurance discrimination based on previous cesarean, send them to ICAN. The Senate committee wants to investigate this issue.

Pit to Distress

Oh my. I have been reading on Facebook recently about a hospital procedure known as "Pit to Distress." What this means is that pitocin is administered to a laboring woman in a maximum dose in order to distress the baby so they can move to cesarean. While we all had our nightmare scenarios, this one appears to be real. Several nurses have blogged about it, as well as Jill at Unnecesarean.

I have spent a lot of time ruminating about this over the past week or two, and I am still flabbergasted that obstetricians get away with this kind of behavior... even occasionally. If a midwife did something so reckless, they would be hauled into court and they would never practice again. Why should obstetricians be free to cause distress to an unborn baby in order to perform surgery? What harm are they potentially causing to the baby? What about the mother, who's uterus may become hyperstimulated or even rupture? What if, due to this practice, she loses her uterus and her potential to have more children? Who holds these obstetricians responsible?

Now, I obviously realize that there are some excellent OBs out there who would never consider doing such a thing. But the fact that even one can get away with doing this repeatedly puts mothers and babies at risk. How do they not lose their license? How can they still attract patients? How can they still have privileges at the hospital? Who do we lobby to change this? ACOG posts their guidelines, but obviously the docs do what they want (look at VBAC...).

Our maternity system needs a major overhaul... thank goodness there are some nurses out there who do what they can to keep as many women from experiencing Pit to Distress as much as possible. When a woman checks into the hospital... she trusts that she is in good hands. Obviously, this is not always the case.

Cesarean Awareness & Personhood Laws

April is Cesarean Awareness Month. Because of that, I think it is the perfect time to talk about these personhood laws being promoted by Personhood USA. They currently have bills being presented in five states. These bills would give full rights to the fetus from the moment of conception. While that may not sound bad if you are pro-life, what they don't tell you is that the rights of the fetus then supersede the rights of the mother.

What this means for every pregnant woman is that a doctor or hospital can decide that you are making decisions for care that they do not agree with and can force you to have a cesarean. One woman in the video below was arrested at home while she was in labor because she wanted a VBAC. She was forcibly taken to the hospital and given a cesarean against her consent. She went on to have three successful VBACs at home later, proving the safety of VBAC and the integrity of her uterus.

Another woman was terminal. She wanted her husband to keep her alive as long as possible. The hospital decided it was against the baby's interest to do so and subjected her to a cesarean that neither she or the baby survived. Who's best interest was served here? Not the woman's... not the baby's... and not her family's.

Please... let your legislators know that this type of bill harms ALL pregnant women. If this bill is being presented in your state, actively oppose it. The states currently considering these bills include Montana, North Dakota, Mississippi, South Carolina and Maryland. Using pro-life arguments to undermine and remove the rights of the mother is unjust. These women in the video all wanted to carry their babies to term. They still fell victim to the courts, who ruled that they did not have the right to choose their method of birth or even get a second opinion. They lost the right to make their own medical decisions and to bodily integrity. Please take a stand for the women who give life to these precious babies. We are not just vessels from which to harvest children. Let us make the choices on how our babies enter this world.

What No One Tells You About Birth... My Version

We picked up an issue of FitPregnancy recently. Inside was an article entitled "What No One Tells You (But You Need to Know) About Birth. I know this is a mainstream magazine, but sheesh.

Three of the tips mentioned epidurals. Five mentioned cesareans. One mentioned broken blood vessels in her face... from all the purple pushing, no doubt. One mentioned how embarrassed they were that they had a small bowel movement while pushing out the baby. Two mentioned episiotomy.

What do I see wrong with this article? Even though I freely admit I am NOT mainstream in any way, shape or form, I used to be. I admit I had a cesarean. I had two epidurals. I had an episiotomy. I learned my lesson after 4 births of hospital protocols. But I still see problems with this article.

No one mentions doulas as an alternative to an epidural. Studies show that the presence of a doula can reduce the number of epidurals AND cesarean sections because Mom gets the constant, caring support she needs.

While I don't particularly feel comfortable performing bodily functions in front of others either, the whole "eww gross" attitude that we actually have bodily functions bothers me to no end. When will we admit that people actually can smell like people instead of flowery deodorant? When will anyone admit that they pass gas at inopportune times, or that baby helped clean out your bowels on the way out? Not our favorite moments in life, it's true... but it happens frequently. In fact, baby can actually pick up important immunities by passing so close... hmmm. Maybe that's why the vagina is located down there so close to the anus and not up by our belly button?

The fact that 1 in 3 women get cesareans today (or more in some hospitals), and another 1/3 get episiotomies even though studies have shown that episiotomies cause more damage than natural tearing is utterly amazing to me. What is wrong with easing the baby out? Your body will push the baby out whether you actively help or not, and taking a break and breathing through a few pushing contractions can actually give your perineum time to stretch around baby's head. Yes, it may be uncomfortable. They don't call it the "ring of fire" for nothing! However, letting your tissues stretch little by little prevents tearing.

The whole "eww factor" that many people seem to have today really gets to me. What will they do when baby has a messy diaper? When baby throws up what looks like more milk than they've eaten in a week? What will they do when their 4 year old throws up macaroni and cheese in the middle of the night? That last one is sure to get inward groans from me and fighting my own gag reflexes, but they can't help it. They didn't do it on purpose to make your life a living hell. Life is messy. If you're going to have children, it is time to get used to it.

Maybe we need childbirth classes that really teach what will happen in labor. Will people listen and understand?

Here is my version of what you should know before going into labor.

1. It will probably hurt. Some women are lucky and don't feel labor pain... whether this is because of reframing their perception of pain, or just sheer luck... I don't know. Either way, wish I had been them! For most of us... it will involve some intense pain. But it is only for a short time out of your entire life. Drugs will cross the placental barrier and your baby will get the drug just like you. Only your baby is much smaller than you, and they are not getting the baby dose.

2. Being active can actually help you cope with pain! It's true! I've done the beached whale syndrome in labor, and I've walked, rocked on a birth ball, leaned on a wall... anything that even remotely sounded good at the time. It helped! While the contractions were still intense in active labor and transition, I knew they were accomplishing something. I told myself every contraction I went through never had to be experienced again. In the midst of transition with its overwhelming feelings, I told myself that millions of women throughout history had done this exact same thing... and so could I. I could feel the baby moving down, so as uncomfortable as I was, I knew what was happening in my labor and could deal with it.

3. Your water may break before labor, during labor, just before baby is born, or it can be broken after baby is born in rare cases. All are normal. Having someone break your waters in early labor puts you on a clock that will lead to more interference with your labor.

4. You can do this! Women are strong! Our bodies are wondrously designed to bring life into the world. This is an amazing super power that women are blessed with!

5. Purple pushing (where you continue to push hard while someone counts to 10... slowly) is not only exhausting for you, but it deprives your baby of oxygen. There are only a very few instances when you want to push this hard, and they all involve situations when your baby is in distress and needs to be born asap. In a normal labor with a healthy mom and baby, exhaling while you push, shorter pushes and pushing only when you feel the urge will let baby be born gently and you will stretch better instead of tearing. By the way, an episiotomy is like cutting a piece of fabric a few inches with the scissors. Try tearing it before making the cut. Pretty hard to do, isn't it? Now snip it and try to tear it again. It tears all the way down. Your perineum is the same way.

6. Once baby slips out, the pain is miraculously gone. Take the time to get lost in your baby's eyes... smell his or her head, still wet with birth goo. This helps your mothering hormones kick into high gear! Don't let society's "eww factor" come into play. Watch your baby... they will begin to lick and lap at your breast. This is an inborn instinct.

7. If breastfeeding hurts, baby is not latched on correctly! Baby needs to open wide and take in as much of the areola as possible. Their tongue needs to be under the nipple and over their bottom gum line. Don't let them clamp down ON the nipple. The nipple should be taken deep into their mouth along the roof of their mouth.

8. Sleep when baby sleeps! Don't take that precious time and clean the house or update your blog. Get as much rest during your babymoon as possible to get you and your baby off to a good start.

I have a zillion more tips... so more later. :) In the meantime, visit our site, http://organic-birth.com for more tips and advice.

Spreading the Word

I've been thinking a lot about homebirth. With all the new movies out featuring homebirth like "Business of Being Born," "Orgasmic Birth," and "Pregnant in America," it is becoming front page news.

Instead of just a human interest story about a baby born "too quickly to get to the hospital... luckily they were both checked out by the doctor and are both fine," homebirth is being discussed, dismissed, considered and legally fought for.

This is good.

What else can we do to spread the word? More women need to learn that we are strong. We don't need to be saved from birth. We can birth our own babies.

We certainly don't need to add to the amount of cesarean sections. They can be life-saving, it's true... but does anyone really think that 1/3 of American women CAN'T have a baby without it being cut out of her? Really?

There is so much education to do. I don't really care where a woman chooses to birth. If she wants to be at home, fine. If she wants to be at the hospital, fine. But she should stand a good chance to have a natural birth in the hospital... not just a 2/3 chance.

What about educating the public about eating? Could it be that eating real food instead of the processed stuff we buy in boxes and in drive thrus can be contributing to women being overweight and diabetic? These are two major reasons for cesareans and why we are told "You must birth in the hospital!"

There is so much to do. Please share your ideas by posting comments. I want us to make a difference. I want my children's generation to feel confident in their body's ability to grow and birth their babies.

We need to start spreading the word.

At Least You Have a Healthy Baby

"At least you have a healthy baby..." How many times have you heard this? While in the case of an emergency, we would all do whatever was needed to protect our babies, why should this be the standard of care? Why should we expect to undergo interventions that cause our babies stress, violating exams and have to be a spectacle to whoever wants to peek into the hospital room? Why should 1/3 of us expect to be cut open to deliver out babies?

REACHE (Regional Association of Childbirth Educators) of Washington State is presenting a conference called "At Least You Have A Healthy Baby: Exploring the Forces Behind the Cesarean Epidemic" on April 18, 2009. For more information, check out their website at http://www.reache.info.

Gentle Birth is a Boon for Mom & Baby

I just took a webinar at consciouswoman.com 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?

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.

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!

Birth

Birth. I think about it a lot. Not only processing my own memories and what I felt went well and what didn't, but about birth in general.

For my first birth, I did everything I was supposed to do. I read books. I went to a childbirth class that was not hospital-based. I had a CNM. I had a cesarean with an epidural. Not by choice... I had every intention of not having drugs of any kind. But my inexperience, my willingness to think that my CNM knew best and my own beached whale mentality put me in that OR as surely as if I had scheduled it.

By the time I had my last birth in 2007, I was doing my own blood pressure checks, I didn't bother with weight checks and only did urine tests close to my due date. My midwife dropped by and we listened to the baby and we talked to the baby. It was fun. I finally figured out how to hear with a fetoscope... I'd been trying since my 5th baby. When I went into labor, my midwife came over and camped out with the kids. She gave me quiet suggestions occasionally, and my baby was born into my arms with hardly anyone's input at all. The biggest effort was to get up off the floor and move to the sofa.

My own journey to trust birth has encompassed a long road from that initial cesarean. I thought I trusted birth then, but really, I didn't know what it meant. I don't expect to convince every woman to birth like me. I think every woman should follow the path that makes her the most comfortable... but at the same time, I have a hard time hearing about pregnant women continuing to check into the hospital only to leave via the OR. What kind of start is that for them as mothers and for their babies' introduction to life outside the uterus?

Mothers today have more choices than they used to in most states. Where they don't have as many choices, many moms are taking things into their own hands. I think a huge movement away from the managed care system is beginning. Unassisted birth is happening frequently enough that it is becoming big news. More women are hiring midwives and staying home. So much so, that ACOG had to rush to issue a statement against the safety of homebirth after "The Business of Being Born" was released. I've seen the movie. It was difficult for me to watch, because although I knew the statistics, it was difficult to see them in print and said out loud. I think this film will get a lot of women thinking about their options.

There has been a lot of criticism about having the director's birth included, since it was a cesarean. I thought it was good to include it... not because it "balanced" the film, as I've heard, but because it showed her laboring at home, realizing that she needed more assistance, and had plenty of time to get to the hospital for the extra help.

That's my take anyway. Birth is a large part of my life. I hope that never changes. Birth is the beginning. The start of a new person. Full of potential.