Got energy?  Normal birth requires sustenance.  It is among the most physical activity ANY human will ever accomplish but it is unique to the woman’s body.  The work of labor has been compared to marathon running in terms of preparation but then some say that athletic training is for endurance and extreme activity.  That’s a great analogy for preparing for birth but beyond that nothing else compares.

If we say ‘labor’ is an ‘extreme’ activity then do we mean birth is to be highly managed and a medical event?  NO!  Birth is a natural, physical event our bodies were designed to do.  Even how much energy we burn…it is possible that the stores we use are very different and that is why we don’t burn calories in such a way that we lose weight just giving birth.  The calories then are very much needed for the survival of both mother and baby. 

The human body has muscles designed for short bursts of activity and some designed for long term activity.  The energy stores in our bodies are the same, some store short term energy needs and some store the long term energy needs.  Running is an activity in which some people are naturally inclined towards sprinting and some are made for distance running.

A marathon works out just one body that many can adapt to by training.  Males and females can prepare for a marathon.

Only women can give birth because their bodies aren’t just a skeletal plan…they are a whole design.  Take a look at the elevations of the female pelvis and notice the beautiful stretchy band that allows our pelvises to shape around our babies.  If only you could see the hormones (you can smell them though!) that we have that are unique to labor and the wonder that our glands secrete even more of these hormones the higher the intensity of our birth and possibly is why women express that they must have been in denial when they tell the story of their very fast birth.  Each mother-baby pair is unique, each birth is something a little different.  It’s that something that is why the woman’s body is designed the way it is: it can birth through an astounding number of labor and birth scenarios.  Talk to someone who knows normals birth…we’ve seen face presentations, different types of breech presentations, babies that have flipped breech/vertex, babies that remained posterior throughout, babies rotating out of posterior and back (no pun intended).  Women’s bodies have adjusted wholly…physically, mentally and emotionally to birth their babies spontaneously over intact perineums.

When you read of athletes who say their birth was a struggle don’t let it turn you off to believing you can’t birth naturally if you’re not a fitness buff.  Look at the details behind the birth announcement: it still comes down to did you labor of your own design?  We release the energy we need when we need it, naturally.  We know exercise strengthens our bodies and the female body is susceptible to osteoporosis.  It’s quite possible that giving birth with both feet on the ground will also help us in our later years.  Birth is a ‘whole woman’s health’ event.  

We draw from the energy around us and need support that is not afraid of birth.  

Take care of your body in labor and it will take care of you!  So, where’s the REAL food in YOUR birth plan?

Joni Nichols in Mexico writes this of Plenitud, the birth center in Guadalajara, Mexico:

 

Our moms are required to bring a cooler with food with them.  We’ve had everything from left over stews to freshly made tuna or salmon salad. Often they will just bring the “fixings” ham, cheese, tomatoes, avocadoes, etc  and the doula assembles the sandwiches.   All bring fruits, yoghurts and yummy favorites.  Recently the couple brought a wonderful collection of chocolate; chocolate cookies, Belgian chocolate bars, Nutella etc.  The American couples seem to lean towards peanut butter sandwiches.

 

In March a mom asked for her first vaginal check mid morning.  She was at 10cm.  Said she was hungry and ambled with her husband to the hospital’s cafeteria to have breakfast.

 

I still regret not taking the photo of her empty plates stacked in front of her when we walked over to join her at the end of the meal.  For that matter it would have been fun to have photos of the plates full too!

 

She had eggs, beans, tortillas.

 

Came back to the room and got in the tub and had a baby!

 

Three years ago a couple requested tortas…nice big thick sandwiches which the mother ate while hanging over the tub edge.  Her birth ended in the operating room…not something any of us were happy about obviously but it did “test” that old saw about not eating before surgery.

 

She said she was happy she didn’t go that route hungry since she was limited to just liquids for the first 6-8 hours afterwards. 

 

Abrazos

Joni

View the trailer here and the film is expected to be featured Sunday, May 18, 2008 on 20/20.  We hope the joy of birth will be presented positively by the journalists!  Check the listings on the Birth Events page to find us hosting a screening near you!

Note:  I’ve been told this will be airing Friday, May 16, 2008.  Please check your local listings!

Now I’m hearing that song by Men At Work just after typing this title.  And I’m thinking that actually it’s probably appropriate.  Really, while I hope that birth can be that easy going for everyone I know it isn’t.  Your baby’s birth is … how many cliche’s can I come up with?

And you want himself there somehow present, and in your world ~ the real world ~ it’s him in the back yard grilling a fabulous steak that you’re gonna be happy to dine on afterwards while your midwife and other female companions, maybe even your children are there and also give you the immediate space support you need and desire.  And maybe later he may come inside and be there for that first minute…..

Breathe.  Have a reality check.  You are you and he is he.  In the entire world there is no other relationship exactly like yours.  Do the sane thing:  think it through with a grain of salt and take a look at the whole spectrum…whatever you’re thinking just make sure you’re thinking about your birth, the one that counts.

And yes, you can eat during labor and we know moms who have asked for scrambled eggs and bacon just hours before their baby reached that patiently awaited 10cm and 0+ station.  Mmmmm good!!

Danielle Elwood of ICAN of Connecticut recently began an outreach to the birth community of our fair state.  It seems that she contacted Governor Jodi Rell to request support officially acknowledging April as a Cesarean Awareness Month:

“The reason I am writing you today is about Cesarean Awareness Month which took place in April. As the founder and leader of ICAN of Connecticut, I took it upon myself to contact Governor Rell with a request to recognize April as Cesarean Awareness Month but I was met with closed doors. After being denied I called and spoke with someone on Governor Rell’s legal team who explained to me that the Governor cannot support such a controversial cause.”

Is it any wonder that our state’s Medical Examining Board enjoys the power it wields over midwives?  Gov. Rell we encourage you to learn more about the process of normal, natural childbirth and the history of misused and abused obstetrics.  We encourage you to talk to your peers in states where midwifery is welcomed as a safe option for low risk women.  Midwives reduce the unnecessary c-section rate and that shouldn’t be controversial.

Danielle also included a short list of states that recognize April as Cesarean Awareness Month:

Governor Charlie Crist (R) Florida
Governor Kathleen Sebelius (D) Kansas
Governor Mike Beebe (D) Arkansas
Governor Chet Culver (D)  Iowa
Governor Ernie Fletcher (R)  Kentucky

If you would like to contact Governor Rell you may do so at:

Governor M. Jodi Rell
Executive Office of the Governor
State Capitol
210 Capitol Avenue
Hartford  CT 06106
Toll Free: 800-406-1527
Governor.Rell@ct.gov 

You do so much to take care of yourself in pregnancy and you read about labor, try to take the most informative birth education series and choose the “right” careprovider and birth location for a healthy birth.  Most people don’t see this one coming.  We trust careproviders to first do no harm.  Harsh as it sounds, you can’t trust them all and even careproviders acknowledge some of their colleagues are doing things they would never do.

More importantly remember the best cesarean prevention is knowing your body is designed to give birth in its own time, in its own way.  If you are a first time mother it is especially important to know that birthing spontaneously and vaginally is the foundation for your next births.

“The two most power filled words - I can.”  - Anonymous

Every birth educator and doula needs to tell their clients this: Your careprovider must tell you if they plan to use Cytotec and must tell you about all of the risks involved before you consent to its use in your care.  You must remember that Cytotec also goes by “miso” or “misoprostol.”  Use all of these names in asking about this tiny little pill.

Throughout this blog you’ve read about the basis for informed consent as well as the disregard for informed consent when it comes to birth care.  You’ve also read about the dangers of Cytotec, how it’s used off label and it continues to be used in spite of the unpredictable rates of injury including death.  

While researching what progress we’ve made in raising awareness of the off label use of Cytotec I came across this lawsuit settlement from 2001 and now we are working to make others in the birth community aware of it as members of our Yahoo group spread the word:

“$2 million 

Failure To Obtain Consent For Off-Label Use Of Cytotec 
Case name withheld. 
Plaintiff’s Counsel: Joseph J. Wadland and James L. Ackerman, Wadland & Ackerman, Boston and Andover 
The plaintiffs were a 38-year-old woman and her husband who were expecting their first child. At about 41 weeks of gestation, the decision was made by her primary Ob/Gyn to induce her labor. A dose of 25 micrograms of Cytotec, a drug that the FDA has approved for the prevention of gastric ulcers, but not for the induction of labor or cervical ripening, reportedly was given vaginally. The care providers did not obtain the mother’s informed consent for the use of Cytotec that was being administered for an “off-label” indication in a high-risk situation. A series of complications arose, including the deceleration of the fetal heart rate and the baby was delivered via Caesarian section. The baby was lifeless and resuscitation efforts were unsuccessful. The mother also required a hysterectomy as a result of off-label use of Cytotec. When the claim settled on Aug. 7, 2001, it was the first reported settlement or verdict in Massachusetts involving the drug Cytotec. 
This settlement was first reported in the Nov. 5, 2001 issue.”

If you are in an online group that shares birth information share this one.  Please.

Then continue to read our posts on understanding informed consent and the stories of Cytotec’s unpredictability. 

Own your birth.  Demand full disclosure of all care practices.  Spread the truth about birth: You can.

The only thing I was aware of for my first birth was that I didn’t want Misoprostol, per my reading. So, when I went in at 42 weeks and a few days for my induction (19, naive, unprepared) I told the doctor (not my normal one) that my doc and I had agreed to no misoprostol. He ‘reassured’ me that they hardly used that any more. In hindsight, I see he didn’t really give me a straight answer, so he also didn’t ‘really’ lie to me.

He administered the pill and left, saying my doctor was ‘on’ in 2 hours. When my doctor came in to see how I was doing and read my chart, he jumped through the ceiling, ANGRY.

He didn’t tell me what was up at that time.

Labor went seamlessly.

Birth went quite well.

AFTER birth, I had quite a hemorrhage immediately afterward. Then, 4 nights after birth, I passed a few huge clots. Early EARLY a.m. leading into the 5th day, I woke from a sound sleep to what I ‘thought’ was my babe crying (she slept in a bassinet a few feet from my bed). I got out of bed and walked the two steps to her bassinet only to see she was still sound asleep. What I DID notice is that, in those two steps, blood began pouring from my body. I was having a late-postpartum hemorrhage (pph) and the only person who could help me slept like a rock and was 1 room away.

WARNING, THE REST IS QUITE DETAILED AND NOT FOR THE SQUEAMISH:

I hobbled quickly to the bathroom and sat on the toilet. When I heard the bleeding was not slowing, but increasing, I tried getting ‘low’ to get my blood pressure balanced and reduce gravity’s assistance with my bleeding. Crawling to the tub, I began yelling for my mom (who I was living with at the time). Once I pulled myself into the tub and laid down, I began beating on the wall that separated her bedroom from the bathroom. It felt like an eternity… it was probably a few minutes, but she finally came into the bathroom and found her tile and walls, bathroom and tub, painted in my crimson blood. Hand prints dotted the walls and counter tops while a steady line trailed from my room to the bathroom.

She didn’t wait for an explanation but called the hospital, told them she would not be waiting for an ambulance, but to prep the police because she would NOT stop for their lights. She bundled me up in the car on a towel and told me to hold my baby. Her reasoning, she later said, is she thought I was going to die and reckoned that holding my child would help me hold onto this world a little longer.

Off we sped.

I passed out a few times on the way.

Once we got there, they could not find a pulse because it was so weak, nor could they get bp. They had a horrible time getting an IV line in too.

They were asking me questions but I couldn’t hear them. All I saw was their lips move and this rushing water sound. I was answering them as best I could - later my mom would tell me I was yelling and swearing like a sailor - something I never do. They took me away, yelling over their shoulders that she could sign while I was IN surgery.

That’s the last I remember. Next thing I know, I wake up a few hours later in recovery - catheterized, I.V.ed, my then-boyfriend was there, and my stomach felt empty….

I had had placental retention - which caused massive hemorrhage and clots. I was somewhat ‘toxic’ as well and spent some time on antibiotics. My doc said that if I would not have woken up, I would have bled to death in my sleep. A few minutes longer, and I would not have survived my trip to the hospital.

While there in the hospital, he told me he considered it the fault of the misoprostol, aka CYTOTEC. He never used it, because my case made 2 life-threatening Cytotec inductions on his watch. The first, he administered the Cytotec and the mom almost died on his table. The second, me, he had specific orders for no Cytotec and the other doctor blatantly disregarded it and misled me.

My file says ‘iatrogenic complications due to the administration of Misoprostol for postdatism’ regarding my early pph. For my near-death hemorrhage, it states ‘late pph due to placental retention and subsequent septicemia’.

It affected my milk production. I dried up like the Mojave and had no idea (at that time) that I could reestablish milk production. So, at 5 days postpartum, my daughter went fully onto formula. I was devastated.

The saddest and most outrageous thing is that my file clearly ‘cuts out’ the TRUE cause for my placental retention and thus, my pph… the two are so clearly ‘divided’ that an untrained eye would never put the two and two together - thus, another example of the ills of Cytotec goes unreported.

My recovery took over 1 year. I had soreness and battled infection for 3 months postpartum. It took me another 4 months to be ‘ok’ having anything inserted into me (tampons, etc…) because of anxiety, and anemia was my ever present ‘friend’ while trying to regain my blood count and get my iron levels up. I have low bp anyways, so losing that much blood was no small stress on my body.

For more information on Cytotec, you can go to the Tatia Oden French Memorial Foundation website. Tatia Oden French was induced with Cytotec when she went past her due date. Both she and her baby died.

Women need to demand FULL and INFORMED consent/refusal. I was deliberately mislead and it almost cost me my life. It has cost many other women and their babies a higher price than I paid.

Imagine yourself in labor, and suddenly a very painful memory intrudes your mind and consumes your thoughts. Imagine how distracted you would become. Your contractions could slow down and stop. The physical intensity of labor might be overcome with the emotional pain of your past.

But it doesn’t have to happen this way. You can prepare yourself during pregnancy by reading When Survivors Give Birth by Penny Simkin and Phyllis Klaus and Survivor Moms by Mickey Sperlich and Julia Seng.

If you have been abused or even just suspect that abuse may have occurred, you are highly encouraged to discuss it with your entire birth team. This includes your doctor or midwife, birth partner, doula and childbirth educator.

Remember, all of your care providers have a responsibility to protect your privacy and rights. If they believe it to be in your best interest, they may also go out of their way to help you obtain appropriate services. Open communication is important and will certainly make a difference in your over-all pregnancy and birth experience.

If you are able to share specific details, those caring for you will be able to make better judgments and be more sensitive to your needs. There are some things that might trigger your memories of abuse. Some are obvious things such as being in bed during labor or breastfeeding after the birth. But other triggers, unique to your situation, might not be so easy to identify. This is where communication between you and your caregivers can prove extremely beneficial.

Having vaginal exams are common during labor and at the end of pregnancy. But having them might put you in an extremely vulnerable position. If you let your medical team know about your history of abuse, they will be exceptionally sensitive to your particular situation and comfort level. You have the right to opt out of this particular intervention, and your choice should be respected.

Fortunately, there are many resources available today that help shed light and understanding on the problem of sexual abuse. Care providers typically maintain a list of resources that include local therapists or counselors that specialize in abuse. They may also have books, recommend websites, and provide educational materials.

get help

There are several options you can pursue in order to promote health and wellbeing. What may work for one mother, may not be the best method for another. Sometimes, you may need to experiment with several techniques before discovering which is the most helpful. A care provider should always be consulted prior to trying any form of therapy

• counseling
• talk therapy
• Hypnosis
• Emotional Freedom Technique (EFT)
• Reiki
• Massage
• Art
• Meditation
• Naturopathy
• Homeopathy

This is the first in a multi-part series on pregnancy, birth and sexual abuse. This article is written for the pregnant woman with a history of abuse. Future articles will be written for those who work with pregnant women and will address ways to help a woman during pregnancy and birth.

About the author: Lasi Leavy has 15 years of working with at risk adolescents. She is an ALACE Birth Doula and Hypnobabies Childbirth Hypnosis Instructor.

Have you ever considered looking at your patient? Seriously, there’s a real person, a laboring woman behind each strip on your computer screen.

While walking the hospital halls recently with a client of mine who was in active labor, I caught snippets of the conversation between the charge nurse and my client’s certified nurse midwife.I knew exactly who they were talking about. They were looking at the computer screen containing my client’s EFM strips. The nurse said, I can see that the baby is doing fine, but I need to know what is happening during this time. When is she having contractions? Is she even having contractions? How do I know that she’s in a good labor pattern?

Dear Miss Labor Nurse, Please turn your head away from the computer screen and actually look at this person who is in your care for the night. If you look at her and listen to her, you’ll see that she is in labor and experiencing strong contractions. A cervical check not too long ago showed 6 centimeters dilated. Upon admittance at the hospital, she spent 30 minutes on both the uterine monitor and the external electronic fetal monitor. Perfect strips.

The midwife explained to the nurse that she was sitting with her patient and that she was having good strong contractions and that the baby was handling those contractions fine. The nurse just didn’t get it. She wanted to see proof on her computer screen and on the paper printouts.

She wanted a record of the contractions. A continual record of the contractions.

Only minutes earlier, we had all been in the room, my client sitting on a birth ball leaning over the bed. Her husband was doing counter pressure on her lower back during contractions while the midwife sat beside her, holding the doppler up to her contracting baby belly both during contractions and in between them for some “continuous fetal monitoring.”

Beautiful heart tones. Strong. Reactive. Variable. No decels.

The midwife didn’t bother putting the contraction monitor on my client because she knew it bothered her and everything was going ok, so there was no reason to. The LDR nurse walked in the room and wondered if the monitor were working, only to discover it had not been placed on her patient.

My client didn’t want it on. She asked what information it would provide. The LDR nurse said they could monitor her contractions. The LDR nurse said so you are refusing? My client asked her if she needed it. The LDR nurse said that they were watching the baby’s heart rate but they didn’t know when or if she was having contractions.

Then I said, your midwife is sitting right here next to you and SHE is monitoring the baby’s heart rate plus SHE knows exactly when you are having contractions because she is right here with you and she is watching your baby during the contractions and so far your baby is doing fine.

With that, my client said that she refused the uterine monitor. A new nurse stormed in a couple minutes later; the charge nurse who I spoke of earlier in this account. The nurse demanded, “Where is she?”

I said, you mean A? (the midwife).

“No the patient.” The nurse hadn’t even bothered to find out her name.

I said, “P is in the bathroom.” The nurse did a quick 180 and stormed out.

This was the first time I’ve doula’d at this hospital, and perhaps my last. There are other doulas who absolutely refuse to go there. I loved my client; I had been to her previous births at a different hospital and I didn’t even consider not going to the birth just because of the place of birth.

Labor nurses: every once in awhile you’re going to get a woman coming into your labor hall who doesn’t need continuous monitoring because she’s not using pitocin. She’s not having an epidural. When a woman doesn’t get those drugs, the rules can be different. It’s fine for a midwife to watch a woman in labor, using her eyes and ears and hands to help her patient. Labor progresses. Birth happens. Mommies and babies thrive without machines and paper printouts.

Watch the movie to the end. If you know the answer e-mail it to us at thepowerofbirth@independentchildbirth.com for a chance to win a free pair of BabyLegs (ship to USA only, sorry!)

Hi Dr. Amy ~I’m curious as to what really is going on that has you so afraid of allowing women to have the birth of their choice. No matter what I, as a safe birth advocate and you as a safe birth advocate ~ yes, we both want birth to be safe ~ believe is actually the safest, the fact is that in America we were meant to have our rights to do what we choose to do with our bodies, ourselves, protected.

Pregnancy is simply one piece of healthcare and care involves nothing less than what is given to all others in all other health care fields regardless of gravity of the situation. I want to know why you feel a need to TELL women not to birth at home. I don’t TELL women not to birth in hospitals. I do what they ask of me: share what I know, point them to resources and let them choose for themselves.

Women who have been my birth clients have chosen from among hospital with OBs, hospital with MW/OB, free standing birth center with MW, homebirth with CPMs and Traditional Birth Attendants, homebirth with CNMs and unassisted childbirth. They made their own choices and collectively they represent a c/s rate right around 10% (the WHO guideline recommendations) and of the almost 90% vaginal birth rate a little over 80% of those were without drugs ~ pain medication ~ and only a few with augmentation.

The reasons for cesareans were breech and less than textbook labor patterns. I don’t believe everyone is either at your end of the “birth is not safe” spectrum or at my end of the “birth is safe” spectrum” rather I believe the greater majority is somewhere in the middle. Certainly statistics show that less than 10% of births take place at home. I wonder that such a small group with healthy birth outcomes would take up so much of your time.

I wish that you devoted the same amount of energy to asking careproviders to give all the facts about every procedure and protecting the right to make our own health care decisions. What exactly is it about homebirth that is so dangerous? I know I can pinpoint the abuse of oxytocin, the abuse of medical privileges in prescribing drugs off label and the untold risks of cesareans, such as putting your future children’s lives at risk, for specifics about medicalized birth that is dangerous.

I’m not alone in that aspect. There are doctors out there who agree these practices bear scrutiny and are unethical. They question America’s maternity health care system in whole. I really am very interested to know exactly what aspects of homebirth are dangerous in your opinion and why you feel a need to use fear to quell an individual’s right to explore and educate themselves, invade a person’s home, privacy, body and right to choose for themselves. I notice that most of what is posted between you and others on the internet is lost in rants.

I don’t need the stats. I can find stats myself and I fully understand anyone can interpret stats however they’d like. I’m interested in hearing what YOU KNOW about birth, your experience with birth.

As a matter of interest, in my case it wasn’t homebirth advocates who advised me to VBAC spontaneously, without medications and especially with my premature son.  My skilled homebirth midwives advised me to birth in a hospital with the underlying medical conditions I had.  It wasn’t the homebirth advocates that encouraged me to VBAC telling me I could do it and I would be fine.   It was two different obstetricians in two different hospitals.  It was obstetricians who weren’t just trained in VBAC and complications of birth, they were SKILLED.