If You Don’t Do This Your Baby Will Die

Seriously?  When it comes to maternity care the emotional tie of a baby’s health can be used unscrupulously.  Of course a mother doesn’t want to do anything that would hurt her baby, but is the emotional blackmail of responses such as these really necessary?:

“Well, if you don’t care what happens to the baby…” “If you don’t do this your baby could die.” “You can choose that if you’re going to take all of the responsibility for the risks and sign this waiver.” ~ What Are They REALLY Saying?

Natural or ‘normal’ birth advocates and educators are sometimes labeled as rebellious, extreme, etc. with the opponents claiming in the same breath to also being focused on healthy birth outcomes.  Kathy Petersen, IC member, muses more about the same team issue.

There may not be an “I” in ‘team’, but there certainly is a “me.”  The only ‘team’ that exists is the one you put together and at its center is you.  You are the “me” in team.  You are an active participant in your birth and that actually benefits your practitioner because you get to give informed consent or informed refusal.   Are practitioners so afraid of the legal system that it’s easier to just have women go along with what makes a lawsuit least likely to arise?  The truth is most consumers don’t want to have to deal with a lawsuit either.  It may appear to be easier and simpler to just go along but it isn’t.  If Big Baby Bull doesn’t help you see ‘malpractice’ intertwined with emotional tugs perhaps a mother or a baby dying from the misuse of the drug Cytotec for an induction (for the suspected big baby??) will.

Informed refusal gets dicey because a practitioner must be able to prove that their client/patient was aware of the consequences of not following a specific protocol.  Yet when it comes to maternity care, a system so fraught with the overuse of technology that many in the field admit they’ve never seen a natural birth, can practitioners really convey to a mother what will happen if they refuse technology?  We can hear that conversation now: “Well, if we just sit here and wait you will have to have this baby completely on your own!”

A practitioner’s ability to understand normal birth is greatly undermined by their own failure to appreciate the litigious environment they created themselves.  ACOG recently admitted, for example, that the guidelines for external fetal monitoring are left open to interpretation.  What they are not making clear to the consumer though is that it is the obstetricians who have failed to understand and deploy external fetal monitoring prudently but it is the mothers who are shouldering the consequences, the fear of malpractice:

“Our goal with the ACOG guidelines was to define existing terminology and narrow definitions and categories so that everyone is on the same page,” says Dr. Macones. One of the problems with FHR tracings is the variability in how they’re interpreted by different people. The ACOG guidelines highlight a case in which four obstetricians examined 50 FHR tracings; they agreed in only 22% of the cases. Two months later, these four physicians reevaluated the same 50 FHR tracings, and they changed their interpretations on nearly one out of every five tracings. ~ ACOG Refines Fetal Heart Rate Monitoring Guidelines, June 2009

Desirre Andrews, IC member and President of ICAN, shares Alexandra Orchard’s experiences spanning six years of trying to achieve a natural birth.   Again, as Alexandra and her family learned, it is not the VBAC itself that is to be feared but rather fear that the practitioner’s judgement, recommending surgical delivery in the first birth, will be called into question is what drives a practitioner’s loathe to attend a VBAC mother.

Last, the public itself is brought into the drama with irresponsible headlines such as this one from the New York Times blog, Refusing a C-Section, Losing Custody of a Baby.

Contrast Alexandra’s letter to her obstetrician (watch the video to the end!) to this scenario ripped from the headlines today over the mother who supposedly lost custody of her daughter solely because she refused a repeat cesarean.

Independent Childbirth supports the natural birth community through the use of quality and self-earned birth knowledge about natural childbirth.  Mothers are the birth experts.  We share normal birth and because we do, more mothers today recognize medical interventions are sometimes needed but they do not justify today’s rate of surgical deliveries, birth injuries and denying mothers of patient rights.  Let calmer heads prevail, that of a thinking mother (who isn’t?) choosing normal birth experienced practitioners who value a mother’s instincts.

**For more on “informed refusal” visit The Risk Management Handbook for Healthcare Professionals.  For more information on the New Jersey case visit Knitted in the Womb and VBAC Facts.

 

You Can’t Get There From Here

We hear from practitioners about women whose goal it is to avoid a cesarean and have uninterrupted contact with her baby in the first hours of her baby’s emergence into our world.  It seems that these practitioners find it completely illogical for women to desire this goal because women are often out of it, exhausted, or undergoing surgery by the time second stage arrives.  In their experience, women are begging for epidurals, asking for c-sections, are completely unprepared for “the realities” of labor.  The practitioners are completely oblivious as to their role and influence in the outcome of the birth.  They are aware, though, that the public’s awareness of the need to question the application of protocols in general is on the rise.  Chaos ensues when the practitioner no longer takes on the responsibility of learning about normal birth, remaining current on research, does not hone his/her listening skills (read: bedside manner) and does not exercise patience, a critical element for a healthy birth outcome for both mother and her baby(ies).  How can we expect them to see they are the main contributing factor to what a laboring mother’s second and third stage will be?

It doesn’t strike practitioners as odd that they’ve come to believe and accept myths or oft-repeated misinformation as fact.  Peer research concludes the use of consensus in scientific matters is not infallible.  If the Michigan AMA Resolution 710 proposed above isn’t difficult enough for expectant mothers to fight their way through, there is also the medical birth community’s attempt at blaming mothers for dismal service results including the rising cesarean rate.   It seems mothers are darned if they do (they’re identified as hostile) and darned if they don’t (they’re asking to be cut open).

For example, back in the news again is a protocol that has not changed since last highlighted three years ago, but if it did revert back to its historically safe use has the power to change our country’s maternal and newborn statistics: pitocin.

“Pit to distress” is the formal name of a protocol by which a mother is given pitocin to  either induce or speed up her labor at a rate that subsequently distresses the baby and leads to an automatic c-section.   Independent Childbirth member Jennifer Riedy explains the protocol on her blog and follows up in our post stating “First…nurses (and doulas, and OB’s…and any type of care provider) need to realize that what happens in their area of practice is not the same as what happens in another area.  Even as a doula I see vastly different practices in two hospitals that are part of the same hospital system and located only 20 minutes drive from each other.  If a particular hospital has implemented guidelines to avoid “Pit to distress” that is great.  But don’t fall into the trap of believing that it isn’t happening (in another L&D room).

Just because it isn’t *called* “Pit to distress” does not mean that isn’t what is done.  If an order is given to put a woman on a certain dose of Pitocin, then up that dose every 15 minutes up to some maximum dose, then the unwritten part of the order is “or until the baby shows signs of distress.”

…Bottom line, the package insert says to start the Pit at 0.5-1 microunit per minute, and raise at 1-2 microunit per minute increments every 30 to 60 minutes.  More aggressive protocols raising the drip rate every 15 minutes –even if it is using those same doses–also put a mother and baby at the risk of being “Pit to distress” because it takes over 30 minutes for the Pitocin to equilibate, so while baby may tolerate well the dose that was set at noon, you will not really know that until after 12:30, and if the dose was raised at 12:15 and 12:30…you may have hit the “distress point” with the 12:15 dose.”

There are other mothers who will tell you they experienced pitocin at levels that they instinctively knew were not right for their bodies because their bodies were not only in pain their bodies were also signaling signs of fight or flight response.  They begged to have the pitocin turned off, only to have practitioners refuse to document their request and outright deny it as well.   A Rockville General (hospital) doctor in Connecticut was cited by one such mom when she birthed there in 2007.  She went on to share that the practitioner believed her mother was trying to influence her decision to ask for the pitocin to be turned off and attempted to remove her mother from the birth room (labelled hostile perhaps?).  Another doctor at UConn in Connecticut has stated that he is known for having the most aggressive pitocin protocol and achieving more vaginal births that way.  But, at what cost?  Certainly we were present for one such birth where a mother experienced an adverse pitocin reaction and rather than document it as such her files were noted that she refused pitocin.  Incidentally this same doctor is infamous for telling mothers who desire a natural birth that “80% of women ask for epidurals” (could that be because of the pitocin rate you employ???).  This is not an indictment of UConn, where we have also been present for healthy natural childbirth experiences with other doctors.  It is to exemplify the need for mothers to research their practitioner options and to confirm Jennifer’s observations that two vastly different scenarios can take place in the same hospital!

Jennifer Riedy’s well researched conclusions on the use and abuse of pitocin being common are backed up by the medical community as well.  Doctors Gary Ventolini and Ran Neiger state (Contemporary OBGyn; Sept 2004): “Oxytocin is also abused when one attempts to induce labor, especially in patients with unfavorable uterine cervix, and ‘induction failure’ is diagnosed shortly thereafter, before the onset of active labor.  We feel that as long as the fetal condition is reassuring cervical ripening should precede labor induction.  Once labor induction has begun, don’t abandon it in favor of a (cesarean) delivery before the cervix has started changing only because a set length of time has elapsed.”

On the subject of routine induction at 41 weeks as another example, there are also practitioners who see the fallacy of consensus in the medical community, specifically from practitioners Leung and Lao of the Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China (Routine induction of labour at 41 weeks of gestation: “nonsensus consensus”; BJOG Volume 109, Issue 12, Dec 2002):

Sir,

We read with great interest the commentary by Menticoglou and Hall published in May 2002 and want to echo the point of increasing caesarean section rate as a result of this nonsensus consensus. Our unit has adopted the practice of routine induction of labour at 41 weeks of gestation for several years on the basis of the findings of the Cochrane Review¹, which suggested that this approach can reduce perinatal mortality. Women are admitted to the hospital at 41 weeks of gestation for cervical assessment with the Bishop’s score and induction of labour.  If the cervix is favourable, combined induction of labour with
artificial rupture of membranes and oxytocin infusion is performed on the following morning. If the cervix is unfavourable, a vaginal prostaglandin E2 3-mg tablet is used to prime the cervix. Combined induction is performed on the following morning if the cervix becomes favourable. If not, another dose of vaginal prostaglandin is given and induction is delayed for another day. In the case of labour occurring after cervical priming with vaginal prostaglandin, it is counted as induction of labour.

We have analysed the caesarean section rate for nulliparae undergoing induction of labour at 41 weeks of gestation from our hospital obstetric database. In the year 2000, 183 nulliparous women were induced under this consensus and 59 of them (32.2%) had caesarean sections. This caesarean section rate was significantly higher than that for term,
singleton, vertex presenting fetuses in nulliparous women in the same year (excluding those 183 women with induction at 41 weeks), which was 368/2271 or 16.2% ( 2 test, P < 0.0001). More alarming is that the caesarean section rate for nulliparous women undergoing induction of labour at 41 weeks of gestation increased even further to 35.0%
(63/180) in the year 2001 and 41.1% (23/56) in the current year (January to May).

We agree with the authors that it is now time to reconsider the consensus on routine induction of labour at 41 weeks of gestation, particularly in nulliparous women.

Reference
1. Crowley P. Interventions for preventing or improving the outcome
of delivery at or beyond term [Cochrane review]. The Cochrane Library,
1. Oxford: Update Software, 2002.

Simply put, you can’t get there (a normal second and third stage) from here (a medically managed first stage) without hitting a whole lot of long shots along the way.   We’ve read the book many times and the ending never changes.  Straightforwardly put, neither medical model practitioners nor mothers will ever know how different a birth experience might have been, and that has reverberations throughout a mother’s  lifetime and her baby’s lifetime.

The responsibility for knowing normal birth truly lies with mothers today as the majority of practitioners cannot get out of their own way in preventing injury to mothers and their babies.  You can, however, keep them out of your way.  Learn from the experts: other normal birth experienced support resources. The educated mother can choose her practitioner wisely and ‘get there.’

 

Men At Birth: Yes, He’s My Doula

Keith Roberts is unfazed by the attention given him as the first man to be certified as a doula by DONA.  He has has spent over 30 years in the field of holistic care, specifically focusing on pregnancy massage therapy and birth support for the last fourteen.  The prenatal massage work he does was a segue to following one mother right into labor where he found expert massage therapy was extremely beneficial to her in labor.  She was the first of fifteen more mothers he supported in labor before he determined to pursue certification as a doula.

Keith is perhaps more determined than female doulas to not replace fathers at birth.  The female support presence is invaluable because she is female and yet that bond is one that many a father may meet with trepidation: a club that he can’t be a member of by virtue of his gender.  Keith recalls an image that influences his genuine welcome of the father, an old cover of International Doula.  The cover’s image showed a mother embraced by her doula and the father is in the background.  Many a father today may not care to be present for labor but just as many men know there was a battle fought by Dr. Robert Bradley and the Hathaways to protect a father’s right to be in the labor and delivery rooms.

Those men who do want to be present for their child’s birth are already engaged in a checklist of all that they are expected to be today: he is to know everything about birth because he will be the mother’s advocate allowing her to focus on her labor; this he must accomplish while also providing physical, mental and emotional comfort.  Then after the baby is born he must strike the perfect balance between staying with mother throughout third stage and going with his baby should there be a medical reason to separate mother and baby.  As many a partner has put it, he/she must be everywhere, have eyes in the back of their heads and know how to play football, delivery room football that is.

Keith’s role is primarily for physical comfort.  It is easy for mom to choose between the two males present for her emotional and mental support….dad is her intimate partner.  “(Partners) are a reflection of mother’s state-of-mind; they tend to follow her lead and birth is just as much of an unknown to them as it is for mom.  They (dads) have as much a desire to meet birth at mother’s level of comfortability and she will want dad in front of her, to see him and be held by him.”  Further, for all of the reasons listed above, men appreciate having another male present in the primarily female energy until and unless a male obstetrician walks in for a few minutes of observation, medical speak and then exits.

When asked how he perceived the choice of a woman to invite doulas, let alone a male doula, to their births over their mothers even Keith’s keen observation of relationships is quick to surface.  In his experience few mothers want their own mothers present because they will feel a need to perform or meet parental expectations whether real or imagined.  Having their own mothers present is often an overwhelming thought no matter how comedic, true or polite the response is expressed!

Keith’s own intimate insight into birth as someone who could not experience birth for themselves but supports laboring women gives invaluable advice to partners.  These are his experienced Natural Birth Critical Factors:

• Once you are in labor you cannot stop the flow of birth care you signed up for.  Choose wisely.
• Read. Read. Read.  Take a natural childbirth class and read some more! A natural childbirth experienced and focused birth class leaves mothers and their partners with less “unkowns” and less fear of those unknowns.
• Learn about fetal positioning.  The more you know about baby presentations and how to encourage optimal ones and work with less than optimal ones the more sense prudent changing of positions in labor makes.
• Your choice of birth care practitioner directly relates to your odds of having a cesarean!
• Keep the bag of waters intact!  Artificial rupturing of membranes (AROM) or artificially breaking the bag of waters is trivialized.  EVERY practitioner knows that within a short while of breaking the bag of waters labor intensifies in a ratcheted manner (versus a natural progression) and the majority of women will subsequently ask for an epidural.
• Hire a doula for the purpose you want be it physiological support, birth knowledge, support for dad.  In all cases the doula can alleviate what stresses you most leaving you better able to meet labor’s demands with all of your own energy.
• It is very hard to buck the system therefore, go back to Critical item number one.
• Lastly, but more importantly, he reminds mothers that they have their own voice.  A doula will provide his/her opinion if asked but will never make a mother’s choice for her.  Mom must convey her choice directly to her careprovider and partners must be prepared to be be the first line of support echoing mother’s choice and minimize the number of minutes he/she might otherwise spend playing football by putting all that you’ve learned in a natural childbirth class into action.  Learn more about how your doula can best help you.

Through supporting women in labor hands on, so to speak, Keith has gained a whole new appreciation for the courage of women and for the hospital birth experience.  He concurs with Penny Simkin’s address at the DONA conference in Washington D.C. three years ago where stated the doula backlash is very real.  Keith advises new doulas to be mindful of their standards of practice and ethics.  Unless they have an established relationship with local practitioners then their voice, necessary for the support of laboring women, must be viewed as respectful of the practitioner and facility as well.  Birth is a hands on experience for the obstetricians and nurses themselves.  This is an opportunity for them to observe truly natural childbirth and learn.  If the doula is not respectful and professional in conveying her knowledge and experiences then the entire birth community suffers the backlash.

 

The Home Birth Experience: Cesarean Prevention

While we don’t normally publish consecutive posts on the same topic we thought today’s post warranted release.  We are committed to increasing international awareness of the issues and controversies in birth care protocols, advances in birth policy legislation, best practices and alternative options available to mothers.  To that end I recently authored a paper for submission to the international database resource available for the summit on Respecting Childbirth.  The summit took place in France during our Mother’s Day week event, the week of May 11, 2009.  We are all pleased to announce the paper was accepted for their database and some light is being shed on the truth of the state of maternity care in the USA.  It is our desire to raise awareness internationally that although America spends a lot of money on technology it does not mean that all American technology is to be accepted on face value as being beneficial.  The link to the summit (above) will bring you to the link on the paper, Home Birth: The Gold Standard of Cesarean Prevention or you may click the title link to download the paper and distribute it in your community, to your legislators as you move forward protecting your birth options where you live.  The first link in this post will also provide you with a tri-fold brochure you may wish to distribute by email or hard copy to your state’s legislators as well.

 

The Home Birth Experience: The First Birth is HERstory

Many women choose a hospital for their first birth and talk about a home or birth center birth for the NEXT birth.  The slimmest thread firmly wound through a decades-long tapestry promoting hospital birth equates with a safe birth has effectively sewn up a veil of secrecy: home birth is not only safe, it is an inherited treasure.  A hospital birth for the normal, healthy woman (of which most of us are) denies a woman her birthright, to welcome her new family among family.  

I usually talk in my classes about how “this” is the *only* chance you’re going to get to birth *this* baby.  Sure you may go on to have other babies, but you only get *THIS* chance to birth *THIS* baby.  I also share with moms that because of this fact, the significance of this birth is infinitely greater than the significance of this birth is to your nurse, OB, midwife, etc. – Louise Delaney

So, what if our first birth is based on a myth: that hospital birth is ‘safer’?

I think there are some who choose to not deal with the reality that we tell them about, or choose not to believe that things can go so terribly awry iatrogenically because, after all, the doctors are only out to help us. When a traumatic birth does happen I think it is something of a shock for these folks. Many get angry. The survivors learn and grow from it – and these are the ones who become much more proactive the next time around, take control and do things differently “the next time.” ~ Melissa R. Bradley MethodTM Educator

OR what if our first birth is based on a friend’s outcome and not based on doing our own exploration and work for what we want?

My friend was due with her first child three months after I was due with my second. I emailed her a lot of documents from my birth classes, talked to her on the phone, bought her a few choice birth books etc. But whenever I tried to help her question some of what she told me about the midwives (medwives) that she was working with, she totally ignored me. We’ve talked about it since, and she basically told me – I knew your birth stories (two unmedicated, un-interfered with, empowering hospital births), and I figured, if you had a good hospital birth I could too. But she didn’t – I *gave* her a lot of information, which was a lot different that my own experience of taking Bradley classes and *seeking* the information I wanted/needed. For whatever reason, she had to have her own “before” birth & then learn/grow from it and have “the next time” happy, respectful, empowering birth (in a freestanding birth center, btw). ~ Christina @ Birthing Your Baby

It is a long, often solo journey a woman will take to find within herself evidence that the decision to birth at home is a good choice and that the burden to prove it is a good choice is not hers to bear.  It is the physician who holds the burden to prove his/her advice and protocol is the safe choice.  That is the crux of medical liability and is wholly relevant in the decision to choose a hospital birth.

In our society, women need to learn the hard way that fairy tales don’t happen, that no one can save you but yourself…and the people around birth should present their offerings (options) without judgement, for women to choose.  Women should be empowered and not controlled by birth professionals/facilities. ~ Randi King in Norman OK

The first birth is the pivotal birth. Every birth experience that follows builds on that one.  Our choices now are choices for the NEXT birth.  The first birth doesn’t have to be either perfect or awful and earth shattering to make us think. We don’t have to choose differently than the first birth; but it’s the first one that gives us a place to begin experiencing not just birth but ourselves as mothers, women, people. We may not all have ground shaking, earth thundering thoughts but we have them.  The experience belongs to us.  We choose what to do with it.  Choosing to do nothing different is still an influenced choice ~ made on that experience.  

Let’s say a woman has a fast hospital birth and rather than choose to just stay home next time she chooses to go early to the hospital, possibly scheduling an elective induction.  This scenario isn’t just welcomed by the state medical examining boards who have lobbied to ensure this is legal and protected under the audacity to call it an ‘option’ when in truth she has not been told home birth is a good option too!  How likely is she to find a physician today who would assure her that her fast labor is not something to fear and that perhaps she should consider a home birth?  That indeed he/she (the medical provider) may even have a home birth practitioner to refer her to?  

We do not foresee the medical world embracing the challenge to be more knowledgeable about normal birth.  The woman with the fast labors and whom the medical community embraces as having the ‘option’ of electing for a scheduled induction is more likely to end up with a cesarean even if she didn’t ‘plan on’ having one.  Then she will find herself in a battle to VBAC for her NEXT birth.  She  may not have the luxury of choosing differently for her NEXT birth.  

What will YOU do to have a first birth that leaves you with few regrets or changes for your NEXT birth?   Why not have the birth of your choosing, rooted in truth and your ability to know yourself and your baby now?

I know my cesarean was really indicated. short short cord, knotted, every time he would begin to descend his heart rate dropped a bit lower. Breech was the only way he wasn’t pulling on it (the surgeon explained this to me in minute detail since he knew my background) which explains why he stayed breech on and off for the last few weeks. I really wanted him to turn head down, and he complied (which fits his personality so far too! so cool… anyway… back to the story). But by complying with my need/desire for a head-down birth, he put himself in a position that pulled on the cord/knot. I saw the knot – I’d call it a double knot… one on top of another… He never did crash, and I never did establish a labor pattern. I just KNEW something was up. So I called in and had the surgery. That was a leap, for sure… to lay myself up on that table without a KNOWN reason. I just knew. Knew it all along really…So yeah. I trust the process more… I had a cesarean with my first baby – 15 years ago – and now again with my 5th – 3 VBACS in between. Seems I’ve come full circle in alot of ways. I trust moms more too – when someone says to me, “something doesn’t feel right” I will NEVER brush that off even for a second. Not even in my head. I don’t think I did it before, but for sure I won’t do it now.   But yeah… it wasn’t a failure, just… I still ***wish*** for my homebirth. Maybe someday.  ~ Kelly

The first birth is ‘herstory’.  It is a myth that women who seek a home birth are willfully putting themselves at risk. Women are fully capable of considering their options and choosing how to care for themselves.  It is not rational to say home birth is never safe; saying so is the product of hysteria.  Protecting choice, not limiting choice, is good, no, GREAT health care.  Tell a friend, tell your state government, tell the White House, the NEXT birth is now.

 

 

Teach Your Children Well

A survey on a popular parenting website recently asked the question, “Do you think older siblings should be present at birth?” As one might imagine, the ensuing comments reflected a wide spectrum of attitudes toward childbirth. Some mothers wrote that they would like to, or even had already, shared the beautiful experience of their baby’s birth with his or her older siblings. Others wrote vehemently that the labor room was no place for a child. Here are just a few of the comments that struck me:

On the pro-sibling side —

1. My six year old daughter is very excited to attend the birth of our third baby. (We also have a 3 year old son.) She was the one who expressed interest in attending the birth. I am having the baby at a Birth Center. In this home-like setting she will be able to participate as much or as little as she likes. We have discussed the birth process at length and have even watched some videos so that she will know what to expect. I think it will be a great way for her to bond with the baby and a way to remind her that she is an important part of our family. Plus, she is a female and may have children of her own one day. How many of us have had the opportunity to attend a birth before we have our own children? I think this will help her see that having a baby is a natural thing and give her confidence when it is her turn.

2. My 2.5 year old daughter watched my 2nd daughter’s birth (it was a c-section) from start to finish from a viewing room, on the side of the operating room. 
It was SO GREAT having her there (with Grandma) because it took my focus and stress away and I just loved seeing the excitement in my little girl’s eyes, as she watched her little sister come into the world. 
And on the anti-sibling side: —

 1. Would you let your kids watch the “making” of the baby, too??? They have NO business being in the room while the mother is giving birth! Outside waiting with a grandparent is fine, but certainly not in the same room!

2. There is no question in my family that being there wouldn’t work for my kids. My girls, 3 & 5 are very protective of Mommy. They would be completely traumatized by the birth. If they were older, I would consider it, but at their ages and with their personalities, we will leave that process to a movie in health class.

3. To expectant parents, birth is a natural and beautiful thing. To a child, it is confusing and icky and scary. I know there are a lot of people here that think their child was ok with it, but trust me, they don’t see it the same as an adult does. There are just some things you don’t show off to a child-no matter what age. My opinion: leave the children out of the delivery room and in the hands of a caregiver until the baby and mommy are more “presentable”.

And my personal favorite:

4. I think small children need to have mostly positive associations with the birth of the new sibling. They have the rest of their life to learn about real life and how their sibling really got there.

A common thread that one might expect runs through all these comments, namely, the parents who view childbirth as normal, healthy, and empowering invite their older children to witness the event, while the parents who see it as scary, traumatic, and shameful (or “icky”) do not. It’s no surprise, therefore, that the pro-sibling numbers seem to be much higher among home-birthers, since regarding childbirth as natural and healthy is a prerequisite of sorts for choosing to birth at home.

As I read through page upon page of the survey respondents explanations for their positions, an even more important distinction became apparent.  The pro-sibling (dare I even call them “pro-birth”?) parents seem to recognize that they have the power to influence their children’s attitudes toward childbirth and family. Not only do they know birth is healthy, they are also raising their children to see it that way. As Kathy blogged about recently,our culture faces an epidemic of fear about birth. What better way to combat that fear in the next generation than to help them understand the inherent well-ness of birth while they are still young?

Of course, the anti-sibling parents exercise that same influence over their children’s worldview, whether or not they recognize it. As many readers commented, children are sensitive creatures. Children whose parents regard birth as scary will likely grow up scared of birth themselves, regardless of whether they witness one first-hand.  The last comment, while short, says it all: To the writer, the process of birthing the baby leads to “negative associations” (which the writer, interestingly, equates to “real life” in the next sentence).

Until relatively recently in history, birth took place not in the hospital with doctors and nurses, but in the home with a midwife and female family members. By the time a woman gave birth to her first child, she had likely had the opportunity to witness several babies enter the world. Ask a pregnant woman today whether she has ever witnessed a birth in real life, and her answer will likely be “no.” Our culture has televised births (a disproportionate number of which end in cesarean), movie births (in which the deliveries are either comical or end in tragedy), and books about pregnancy and birth. Yet our direct exposure to normal birth is almost nil.

I can’t help but think that the children, especially the daughters, of the pro-sibling / pro-birth parents will have better birth experiences in adulthood than the children of the anti-sibling group. Imagine a generation of young women who were raised to recognize birth as sacred, healthy, and empowering – women whose earliest family memories include experiencing the beauty and nature of childbirth.  If more girls grew up with this perspective, I believe maternity care could change dramatically in a generation.

Sadly, in this particular survey, only 27% of respondents voted to allow siblings to witness the new baby’s birth. (To be clear, there was no “maybe” option — a full 73% of those taking the survey voted “NO” to children’s presence at birth.) For those of us hoping to see dramatic changes to maternity care in the next generation or two, these numbers are discouraging.

I am convinced that those of us with positive birth experiences, those of us who recognize birth as healthy and empowering, have not just an opportunity but in fact a responsibility to share that wisdom with the next generation of mothers.  I am not advocating inviting your neighbor’s children into the labor room. Yet I do advocate healthy dialogue about your healthy, positive birth stories. You don’t need to bare all the finest, most personal details. But consider sharing your views on birth, particularly your attitude toward your own birth experiences, with the young women (or even the young men) in your life. It may be just the “normal” perspective they need.

 

Celebrate Women’s Real Birth Wisdom!

The more a midwife speaks to a mother and spends quality time with her, the more likely a mother is to open up and reveal more of her daily routines and habits that can affect her pregnancy and birth.  For example, the midwife will ask a mother the most basic yet critical questions like what is she eating and follow up with nutritional counseling, a topic in which the midwife owns expertise. She’ll ask her what is occurring in her life today, yesterday, expecting for tomorrow. A mother’s every day peace and stress contributes to her body’s sense of well-being and reaching the point where mother and her body believe it is time now to give birth safely and securely.

The psychology of labor is addressed during the med school L&D rotation by incorporating finding other resources for emotional and mental support.  Subsequently we have a number of practitioners in all fields lacking in bedside manner today, but in birth this aspect has an impact intangible to the practitioner but very real to the mother and her family.  The average obstetrical course of education includes fewer than three credit hours in understanding nutrition.  The focus on prenatal nutrition is only a small portion of the syllabus (do your homework choosing a careprovider!).  The home birth midwife also follows the mother into the immediate postpartum and continues home visits to see how mother and baby function as a unit.

It is the midwife who is better versed in delivering babies in various but normal birth situations.  A breech baby can be birthed safer in the hands of a midwife than a hospital attendant.  She has not let her skills fall behind because medico-legal liability has dictated a breech birth to be enough of a risk as to deem a cesarean to be the required course of action; therefore, she continues to hone both her observational and palpating skills.

The American College of Obstetricians and Gynecologists (ACOG), America’s leading organization promoting the benefits of clinical obstetrics in the sterile rooms of trained physicians, has found itself in a dilemma.  The technology and protocols ACOG promotes are the very ones that directly influence our birth statistics negatively.  The birth technology ACOG promotes to prevent or lower risks in birth for both mothers and their babies has not been proven to be beneficial, yet it is used profusely.  Birth in America rarely includes the intimacy of the act that culminated in procreation.  Images of an infant gently caught into its own mother’s arms are so rare that they cause the general public to question the safety of such an event. Debate for and against the licensing of midwifery – and the definition of midwifery itself – is gaining momentum, because statistics for hands off care of normal, natural childbirth are far better than those of managed birth.

In fact, Rebecca Watson of the New Mexico Department of Health has stated, “I sometimes wonder why [we bother compiling statistics on midwives], since their statistics are so much better than everyone else’s.”

While home birth is stereotyped as dangerous because of the lack of medical supervision, it is the lack of that technology and medicine that actually makes birth at home safer than birth in a hospital under today’s protocols.

Studies have shown that once a technology is introduced and mandated, it is difficult to remove it from care practice despite being proven unsafe or unnecessary.  For instance, although the rates involving an episiotomy (cutting the perineum to create a larger opening for the baby to pass through) have dropped drastically since 1980, it is still a common practice.  Ironically, episiotomy rates today are justified as integral to the higher use of vacuum-assisted deliveries or unfounded fears that a baby is stuck because it is a large baby or presenting in a less than optimal position, (posteriors, for example, where a baby faces away from the mother’s back during labor).

America is one of the few nations where birth is managed more with technology than with the hands and eyes of the care provider, but other countries will soon catch up. In a country that boasts technology superior to other developed nations and is not known for undernourishing its citizens, our mothers and babies are faring no better at birth than underdeveloped nations such as Croatia. No improvements have been made in the maternal mortality rate in America since 1982, and  America’s infant mortality rate in the past two decades also has not improved. Our birth technology has increased and the number of routine prenatal screening tests have multiplied since the early 1960s, but our maternal and fetal outcomes have gone progressively backward.

“Despite a significant improvement in the U.S. maternal mortality ratio since the early 1900s, it still represents a substantial and frustrating burden, particularly given the fact that – essentially – no progress has been made in most U.S. states since 1982. Additionally, the U.S. Centers for Disease Control and Prevention has stated that most cases are probably preventable.” states C.T. Lang in a 2008 obstetrics and gynecology report.  Further, the Centers for Disease Control (CDC) reported in 1983 that the maternal mortality rate in the U.S. was 8.0 for every 100,000 live births (Monthly Vital Statistics Report).  In 1993, the rate was 12.0/100,000 live births (CDC).

Among the causal deaths that could be prevented were those that involve both underlying health issues such as poor nutrition and high blood pressure (World Health Organization) as well as those that are physician-caused including infection and hemorrhage.  Bacterium can be introduced first by the mother arriving in an environment where diseases are being treated as well as from infiltrating the natural barriers we have against infection through vaginal exams and, of course, surgical delivery. In addition, there are higher incidences of hemorrhage from forced delivery of the placenta as when a care provider intentionally pulls on an umbilical cord to tear the placenta away from the uterine wall of the mother’s womb. In all instances, normal birth evidence training of the professional birth attendant is critical.

Injuries and deaths related to the physician’s care range from the off-label use of medicine such as Cytotec (also known as Misoprostol) for the inducing of labor as well as the sanctified use of surgical delivery, which gives us embolism, one of the leading causes of maternal mortality and a risk directly associated with cesareans.  Cesarean rates for delivery rose by 46 percent from 1995 to 2006.

Women around the world, the time to look again at the image of women birthing with women versus a medical obstetrical group in normal birth is now. WE can improve global maternal and newborn birth outcomes and experiences. WE know birth. WE know women’s hopes and fears.  A new generation of birth wisdom and experiences is here!

Wishing you a truly happy Mother’s Day secure in the knowledge of your body’s innate wisdom!

Learn more about the wisdom of utilizing your best resource: an Independent Childbirth member led birth education class like Dorene Vaughn’s All Natural Baby!

Visit our comments section (this post) to find some of the most awesome birth wisdom posts our readers have found on the web and to add the ones you’ve found!

 

The Independent Birth Center

There are many variations on the only thesis available to opponents of home birth: What do the statistics say? Despite the enticement of a warm, peaceful and private birth that a home birth offers, the perceived importance of missing technology lingers like impending doom. In America, less than 1% of births takes place in homes. It is difficult for the other 99% of Americans to make the transition from technology as the benchmark for establishing worldwide leadership to the reality that the human body is designed to give birth and it has evolved to make many variations in labor and birth look so easy.

The Stockholm Birth Center Study followed one birth center’s outcomes over a ten-year period culminating in 2000 and comparing the outcomes to the associated hospital’s birth outcomes. The one strong observation in this study is the truism that many women will choose a birth center because of the perceived safety in having a hospital nearby. However, it is a mistake to conclude the birth center is free of institutional intervention. The study’s results are negated because of the influence of the obstetrical backup. Every woman who chose the birth center for her birth location was still subjected to the institutional care package. This is the most influential determinant in whether or not a woman is “risked out” of laboring and ultimately delivering in the birth center.

A birth center so closely associated with a hospital is not autonomous and must operate under strict supervision by institutional birth practitioners. The authors themselves state they did not study the effect of individual labor and delivery protocols, but rather the care documented in each case as a “package.” In addition, they have correctly remarked standards of maternity care do not exist, but they have again missed the mark on the importance of this statement. This is critical to interpreting the outcomes, because one solitary intervention can turn out to be the predictor of a birth outcome. For example, every care provider practices according to their comfort level; although every care provider will monitor a baby’s heart tones in labor, how the monitoring is done varies by care provider. Continuous electronic fetal monitoring (EFM) can range in definition from ten minutes hooked up to a monitor every hour on the hour to a handheld doppler check through a contraction every few hours to a telemetry unit (a girdlelike band outfitted to wirelessly transmit fetal monitoring data) that allows the mother walk more freely.

The ability to walk freely even under continuous monitoring allows the mother greater mobility for finding a position that increases her ability to cope with her contractions. Setting aside the U.S. Preventative Service’s Task Force’s findings and stance that continuous fetal monitoring provides no benefit at all – and the data showing that continuous EFM results in more cesareans – it can be argued that fetal monitoring that limits a mother’s mobility is therefore more likely to result in more intervention as the mother shows signs of distress and therefore the baby does as well.

The authors of the Stockholm Birth Center study argue that many other studies have reached conclusions similar to theirs. In the same publication we are offered a Cochrane Systematic Review of Home-Like versus Conventional Institutional Settings for Birth. Here the reviewers concluded births in home-like settings compared to purely hospital settings “provided only modest benefits including reduced medical interventions and increased maternal satisfaction.”

A hasty read of this data by institutional birth practitioners correctly supports their ingrained training that routine intervention is acceptable and “safe.” However, the paper actually clearly demonstrates that all births taking place in a hospital are going to meet up with interventions at some point during labor, and it is the overuse of technology that needs to be analyzed. Indeed that message is there somewhat cryptically as the authors instead hinder the possibility of improving on the scope of research by advising “caregivers and clients should be vigilant for signs of complications.” It is difficult for any woman who has given birth or who respects her body to hear such little value placed on the differences the studies do reveal, such as the “modest benefits” of “reduced medical interventions” and “increased maternal satisfaction.” Surely even one avoided episiotomy would be appreciated by the woman whose perineum would have been cut and would find several women healing from receiving an unnecessary episiotomy envious.

In 1998, a study of infant mortality in planned home births was conducted in Australia. Author Hilda Bastion reviewed these outcomes as neither hospital nor home births have defined what constitutes standard care. She reviewed both midwives and medical practitioners, registered and unregistered, minimal experience and heavy case load. Also included in the study were births that would be deemed risky by virtue of poor health in the mothers or other underlying health conditions. This is crucial to understanding the bias of many hospital birth proponents: It is not the intent of home birth advocates to claim home birth is best for everyone, but rather a viable option for low-risk and otherwise healthy women. The author goes so far as to note it is a disturbing trend that midwives may be encouraging and willing to take high-risk births because of the high number of low birth-weight infants counted in the statistics. In fact, it is quite possible that a woman who cannot afford good nutrition may also not be able to afford hospital birth care, and perhaps a midwife is her better choice than no care at all.

In general, birth care is divided into either purely institutional care or modified institutional care. No research exists on pure, spontaneous vaginal birth over an intact perineum without induction agents, drugs, surgery and instruments. What is available is mounds of research on what a mother or baby can “tolerate” in labor and what interventions have achieved an acceptable degree of risk. The acceptable degree of risk is not defined by an independent counsel but often influenced by the strongest or loudest lobbying effort, as witnessed by the American College of Obstetricians and Gynecologists’ (ACOG) August 2007 statement on the advance of midwifery options for consumers. ACOG’s bottom line is midwifery options must be controlled and home birth as an option must be eliminated. The average consumer misses the bias and conflict of interest: A rise in home births means a decrease in income for a field already plagued by the reality that there is no money to be made in natural childbirth.

In addition to a lack of studies of organic birth as defined above, there are no long-term, randomized longitudinal studies to confirm or deny the correlation of many interventions. For example, the impact of a mother’s drug use in labor on emotional bonding, breast-feeding, postpartum depression, later drug abuse (baby as a young adult), etc. In the 1970s, Doris Haire, the President of the American Foundation for Maternal and Child Health, said, “No drug has been proven safe and effective for use during pregnancy or childbirth.” Considering that 25% of drugs introduced in the market today are recalled or pulled off the market in 1 to 5 years, this statement has never been more true. Until such time that midwifery care can be studied with a critical but appreciative eye, we will find only the weakest of studies boxed in by outdated beliefs that American women cannot afford to birth outside of a medical institution. In fact, it is our country that cannot afford to NOT offer free standing birth centers as a birth care option for American women.

Works Cited
Bastian, Hilda, “Perinatal Death Associated with Planned Home Birth in Australia Population Based Study”: BMJ 1998; 317: 384-8

Hodnett, E.D and S. Downe and N. Edwards and D. Walsh, “Selected Cochrane Systematic Reviews: Home-like versus Conventional Institutional Settings for Birth”; BIRTH Issue 32:2; June 2005

Waldenstrom, Ulla and Charlotta Grunewald, “The Safety of Birth Centers Responses to a
Critique of the Stockholm Birth Center Study”; BIRTH Issue 32:2; June 2005

 

Stay tuned ……

Stay tuned for our upcoming International Birth Wisdom week!  

FLEX (Spain) currently airs this ad campaign for their mattresses.  A lovely homebirth on a FLEX mattress because where you sleep, your home, is the most important place in the world.  The place that welcomes a new life into this world is a special place and the memory lingers there!

Our thanks to Birth Activist for one of many birth community members to find this ad!

 

Overcoming Fear of Childbirth

One thing that has been on my mind lately, is the fear of childbirth (technical name, tocophobia).

Sometimes women are afraid of childbirth prior to having any children, and this is not really surprising — after all, the average woman will have seen few actual births, but only those portrayed in movies and on soap operas. Of course, those are all not just dramatized (fake) but are typically dramatic — water breaks and the woman has to get in the hospital this instant or the world will come to an end!! Or she’s stuck in the backside of nowhere in labor with just her husband (yes, I still remember when Jennifer had Abby on Days of Our Lives, and Jack was the only other person in the cabin, with serious snow outside), and everybody is panicking. Or labor is portrayed as the worst and most awful thing that it is possible to endure, until the magic epidural comes and makes everything all right. The other thing that is now available on TV, that I didn’t have as a child, are shows like “A Baby Story” which do portray actual births, but I notice that an inordinantly high number of those end in a C-section, or are otherwise highly interventive; and I’m not surprised that this leads to a fear of birth prior to the woman’s actually giving birth the first time. And this doesn’t even begin to touch on all the labor and birth horror stories that mothers for some reason feel so imperative to scare first-time pregnant women with.

Other women, however, have given birth before, and this experience has made them scared to have any more. Some women may choose never to have any more children at all (this happened to a friend of mine; her daughter is now about 8-9 years old). Or they may choose a C-section because they can accept pain from surgery and the attendant post-op pain (which may be manageable by narcotics), but they fear the lengthy but intermittent pain from labor. But there are other options.

After her first very painful birth, this woman was terrified to give birth again, but she chose to overcome her fears by using hypnosis to relax during labor. If you watch the video on that link, you’ll notice that they show a few clips from an online video of a woman using hypnosis during labor. That woman in the video was Independent Childbirth Educator Sheridan from EnjoyBirth blog whose painless childbirth using hypnosis (Hypnobabies) was what this Georgia mom saw that gave her the courage to try to give birth again. [I’ll clarify that although the news story referred to hypnosis during birth as “HypnoBirth,” that is a name for a particular type of childbirth hypnosis, and Hypnobabies is another, and it was this type that Sheridan used during birth, and what she teaches.]

The fear of childbirth is very real. And it’s understandable, considering all the negative images surrounding birth that we are bombarded by almost from our own births — and considering that most of us were born in less-than-ideal circumstances ourselves (my mom was under general anesthesia and given an episiotomy, and I assume I was dragged out of her womb by my head), perhaps it might be not too big of a stretch to say that we are surrounded with negative birth images from the time of our birth. But all too often, doctors are just willing to tell women who are afraid of childbirth, “Oh, don’t worry about a thing — if you don’t want to give birth, we can give you a C-section.” While I can accept that women should have the right to choose to give birth as they wish, I wish that doctors (and others) would give a little extra time to ask a woman why she’s afraid, and see if they can work through her fears, rather than just cutting her open unnecessarily. If her fear is irrational yet she holds onto it, fine, give her a C-section; but if she has a rational but misguided fear (for example, I heard recently of women who want a C-section because of a fear of their “vaginas exploding”), then get to the root of the fear! Instead of treating her like a little child who is afraid of getting her dress mussed by going outside, treat her like the rational woman she is, and give her true information to combat the

F-alse

E-ducation

A-ppearing

R-eal.