birth


Just a quick look at the birth outcomes for Independent Childbirth educator led birth classes led by Sheridan Ripley, Gretchen Vetter, Olivia Sporinsky, Molly Remer, Aimee Crane, Joni Nichols, Ruth Trode, Dale Bernucca, Brandy Segin, Helen Loucado, Sara Wallbaum and Dorene Vaughn.

PLANNED OUT OF HOSPITAL BIRTHS  (132)

Free Standing Birth Center = 45; Planned Home Birth = 55; Planned Unassisted Birth = 4; Unplanned Unassisted Birth = 3; Transfers = 25

Combined Spontaneous, Unmedicated, Unmanaged Vaginal Births = 107

Combined Transfer Medicated, Vaginal Births = 8

Combined Transfer Medicated, Cesarean Births = 2

Combined Transfer Unmedicated then OR for Cesarean = 13

Combined Transfer Unmedicated, Vaginal Births = 2

  C/S Rate for all OOH Births:  11.36%

  Transfer Rate for all OOH Births :  19%

  C/S Rate for Transfers of OOH Births:  60%

 

PLANNED HOSPITAL BIRTHS  (101)

OB Attended = 75; Family Physician Attended = 6; CNM Attended = 19; Other = 1

Combined Spontaneous, Unmedicated, Unmanaged Vaginal Births = 57

Combined Managed, Unmedicated, Vaginal births (i.e. AROM) = 6

Combined Managed (includes pitocin/induction only) Vaginal Births = 25**

Combined Managed Resulting in Cesarean Births = 11**

Combined Spontaneous, Unmedicated, Unmanaged Resulting in C/S = 2

   C/S Rate for all Planned Hospital Births: 12.88%

   C/S Rate for all Managed Hospital Births**:  26.19%

   Percentage of Hospital Births Managed**:  41.58%

 

We did not penalize hospitals by including cesareans from homebirth transfers in their statistics.  We did however include c/s for breech in their statistics because medical training trends have forced those cesareans by no longer training medical practitioners to catch breech babies.

Amber Marlowe anticipated an easy delivery when she went into labor on January 14, 2004. But after a routine ultrasound, doctors at Wilkes-Barre General Hospital, in Pennsylvania, decided that the baby–at what looked like 13 pounds–was too big to deliver vaginally and told her that she needed to have a cesarean. The mom-to-be, however, wasn’t convinced: After all, she’d given birth to her six previous kids the natural way, including other large babies. And monitoring showed that the fetus was in no apparent distress.

After she said no to surgery, doctors spent hours trying to change her mind. When that didn’t work, the hospital went to court, seeking an order to become her unborn baby’s legal guardian. A judge ruled that the doctors could perform a “medically necessary” c-section against the mom’s will, if she returned to that hospital. Meanwhile, she and her husband checked out against the doctors’ advice and went to another hospital, where she later gave birth vaginally to a healthy 11-pound girl. “When I found out about the court order, I couldn’t believe the hospital would do something like that. It was scary and very shocking,” says Marlowe. “All this just because I didn’t want a c-section.” ~ Could You Be Forced To Have A C-Section?, Lisa Collier Cool, Baby Talk Magazine

Although the c-section rate for planned out of hospital births appears to be the same as that for planned hospital births here is the difference:  the c-section rate for planned hospital births doubles when the labors are managed (ANY intervention is used).

The possibility of a cesarean section should be discussed with every patient as part of the patient’s birth plan, with contingent consent for a cesarean section obtained early in the woman’s pregnancy. The woman must sign the consent form herself; her husband should not be asked to sign it. At the time the cesarean section becomes necessary, the woman should be asked to resign the original consent form, indicating that the conditions for needing a cesarean section have now occurred. The fact that the mother may have had some pain-relieving drugs does not render her legally incompetent to acknowledge the need for the procedure. Her husband has no authority to sign the consent to her surgery unless she has given him this right in a power of attorney. If the mother is medically unable to consent because she is psychotic or comatose, the surgery may go forward based on the consent signed as part of the birth plan. – Excerpted from LSU’s Law Center Medical and Public Health Law Site

Practitioners presenting the information for acquiring a mother’s informed consent are not always comfortable with how to explain the procedure they want to do and why they want to do said procedure.

It isn’t always easy for birth practitioners to call their colleagues’ errors to public attention and in the process perhaps admit that they themselves crave a better quality of training.  

It is necessary to call attention to and demand spontaneous, normal, unmedicated, vaginal birth over an intact perineum be the gold standard for birth care.  We do so for the greater benefit to global maternity care.  Independent Childbirth educator members are at the forefront of making a difference.  When women are educated as to all of their birth care choices including planned out of hospital birth our combined c-section rate is 12.02%. The World Health Organization declares no region in the world should have a c-section rate greater than 10% to 15%; based on the cesarean rate for managed births we know our combined cesarean rate could be improved dramatically with increased use of better birth care practices by medically trained personnel.

*In our statistics there were 7 successful VBACs and 2 successful VBA2C; 2 VBACs became repeat CS for a successful VBAC rate of 81.82%.  There were 29 waterbirths.  There was one vaginal breech birth while 5 other breech presentations were automatic cesareans.  All 7 unassisted births were successful, healthy outcomes.  There were four sets of twin births, two with both vaginal but very managed labor, one scheduled c/s for breech at 31 weeks, one singleton born vaginally at term with sibling stillborn vaginally and it was known sibling had died inutero but mother chose to continue pregnancy for her other daughter’s health.  Learn more about gentle stillbirths and remembrance at Now I Lay Me Down To Sleep.

Professor Steer, BJOG editor in chief recommends …”doctors and midwives monitor how much water women drink during labor.” (Drinking Water During Labor Carries Risk)

Either the author of the above article or Professor Steer overlooked a couple of important nuances from Dr Vibeke Moen at the Sweden’s Karolinska Institute where the study he references was conducted.  He states hyponatraemia, an imbalance of electrolytes, is not uncommon following labor.  Not during labor, following labor.  That means something occurred during labor whose resultant effects are found in the immediate postpartum.

Let’s not allow the medical folks to obfuscate the hydration in labor issue.  Some real scenarios involving extreme labor:

“Scientific studies have looked at the best ways or most appropriate ways of replenishing the body with fluids under the extreme of conditions of heat and dehydration (Castellani et al, 1997, Marish et al, 2001, Kenefick et al, 2000). Castellani et al (1997) investigated athletes who were not acclimatised to temperatures of above 35oC, and submitted them to 2 bouts of exercise, which would be similar to that of a footballer in the midfield. In between they were rehydrated only once with either IV, oral ingestion or no fluid replacement after being dehydrated by 4% of body weight. It was found that there was no difference in performance between those that were rehydrated orally or by IV. They also found that oral and IV were equally effective as rehydration treatments. There was no difference between the treatments in regards to the way in which the bodies handled body temperature and fluid losses.

Marish et al (2001) found that oral hydration rather than IV rehydration resulted in athletes reporting less thirsty, feeling cooler and not as physically tired. Kenefick et al (2000), also found no added benefit of rehydrating the body using IV as opposed to oral hydration in mildly dehydrated individuals (persons had lost 4.5% of body weight as fluid loss) prior to competition. This group investigated the ability of the body to maintain body temperature and handle fluid losses. Casa et al (2000) found similar results to Castellani et al (1997), however also showed that the body and skin temperature was lower in those that orally rehydrated themselves as opposed to the use of IV.

In summary, all the studies reviewed showed no added benefit of using IV rehydration methods, as opposed to oral hydration in mildly dehydrated individuals before and during a match. There was no benefit in regards to sporting performance, body temperature and fluid control. In fact the benefits of oral hydration included persons feeling not as thirst [sic] and more comfortable in regards to feeling less exercise and heat stress (feeling tired and hot). Oral hydration if consumed in the required amounts is adequate to meet the needs of all footballers. IV rehydration should only be used under medical supervision and advice at times of severe dehydration, heat and exercise stress.” ~ Jeanette Fiedling, BSc, MHN; Oral vs. Intravenous (IV) Hydration

We admit a labor cannot be determined from the onset that it is going to last a specific amount of time, have a specific intensity, etc. is unlike a football match (American or otherwise) having set periods and a clock that winds down (or up).   Well, scratch that last comparison on the clock.  Another nuance here, dehydration is caused when the rate of fluid loss is greater than its intake of fluid.  Too much fluid intake can also cause the same symptoms of dehydration because either situation causes an imbalance of electrolytes, minerals as well as causing a change in body temperature.

As medical practitioners it is vital that they be well trained to know the clinical definition of dehydration.  As someone licensed to enact medical procedures upon our bodies it is vital to the consumer that the practitioner be attentive and act only when necessary.  It is very easy to alleviate mild dehydration, drink water.  Obstetricians are making a really huge leap here equating dehydration with hyponatraemia and it’s no surprise that they are doing so.

“One problem would seem to be that some clinicians experience difficulties in investigating the causes of hyponatraemia. It is here where the clinical biochemistry laboratory and chemical pathologist can play an important role in facilitating optimal patient care. Interestingly, Saeed and colleagues showed that rarely did patients with severe hyponatraemia have their urine osmolality or sodium checked.1 In such cases, it is difficult to see how the cause of the hyponatraemia could be clearly established. This of course is of fundamental importance, because the management of hyponatraemia should differ according to its aetiology.2–4 ”  ~ The Investigation and Management of Hyponatraemia; Journal of Clinical Pathology

Here’s another nuance from the study Professor Steer:

 “Women should not be encouraged to drink excessively during labour. Oral fluids, when permitted, should be recorded, and intravenous administration of hypotonic fluids should be avoided. When abundant drinking is unrecognised or intravenous fluid administration liberal, life-threatening hyponatraemia may develop. The possibility that hyponatraemia may influence uterine contractility merits further investigation.” (emphasis by Independent Childbirth)

Why the brouhaha over IVs in labor, really, docs?  Is it really that critical to you to win the argument over whether or not a woman consents to an IV?  Serious psychological turf issues here.  Think about it, what are the two first protocols a woman will need to make a decision about when arriving at the hospital in labor?  The vaginal exam and the IV.

Consenting to both, declining both or consenting to one and not the other, each scenario is the beginning of a scoreboard.  If she is allowed to ‘get her way’ from the start, all the other items an individual practitioner will decide are important may face a “no” from mom, too.  The latex gloves are off.  

“At one time, a myth became prevalent that drinking lots of water each day was a healthy habit.” ~ Professor Philip Steer

I had no idea that the belief in drinking lots of water each day is healthy is actually a myth.  How much is “lots?”  There are ounces, liters, but lots?  Okay, but when you have an IV in place Professor Steer, how can you tell if you really are thirsty?  You go on to cloud the issue for your colleagues,

“However, recent research shows clearly that in general, one can trust one’s natural body messages, and that we only need to drink more when we feel thirsty.”

According to you, are we laboring women capable of taking care of ourselves by laboring naturally and spontaneously so as to recognize thirst all by ourselves or aren’t we?

A word of wisdom for birth practitioners, the same one for mothers: don’t say no to everything.  Say no only when you mean no.  That way when it’s really important the “no” will truly stand for something and capture our attention.

One thing we loved about the documentary Orgasmic Birth, is how it complements Business of Being Born’s consumerism awareness and vice versa because the woman herself was the focus.  Her power.  Her ability to birth.  No focus on who is catching the baby.  AND…the births take place in America in the mother’s own time and her space.  A Disney film attempted to show waterbirth with dolphins and took place in scenery meant to be exotic and far away, but took a toll on both the dolphins and the women and families birthing in the name of cinematography in the process instead.  Disney, we don’t need to sell birth in an infomercial, but birth is of global interest.

Practitioners are selling fear of birth.  The truth is birth is simple and we do more harm just by using words to put a fear of the unknown in place rather than the empowerment of experiencing the new.  Birth is not an unknown UNLESS you throw interventions into the mix.  Then you’re on a whole ‘nother flowchart.

I think we, natural childbirth educators and advocates, are accused of “selling” natural childbirth by careproviders annoyed that they’ve lost another customer. 

When birth is allowed to just happen it is not only an experience of wonderment for all in its presence it is also an experience in appreciation for a woman to be “a” woman, one not one of many.  For a baby to be the individual human welcomed, not one of many.

I loved “Kerstin’s Birth Story” which is the birth story of our own Olivia Sporinsky now living in Texas with her husband and family on his military base.  Olivia tells us of her birth experience in Germany where the careproviders believed something definite about American women.  Still, they were open to allowing Olivia to birth her way even though it differed from what they believed to be true about American women and how they birthed.

I recalled Henci Goer during the NIH conference on elective cesarean.  The panel was quick to say “more research is needed”, the typical wishy-washy answer so as not raise the ire of an industry that has a heavy interest in the public perception of cesareans.  However, Henci, in her usual to the point manner, asked, “What are careproviders telling women about labor, birth?”  Her viewpoint being if we only look at “elective” cesarean as a “whatever you’d like” versus talking to women about labor as a healthy and safe process; VBAC labor as one where we support natural labor as the healthiest route even more so; talking to women about how normal it is to have trepidation about natural birth and recommend resources for them to learn more about the birth process, well then, of course you breed more fear of birth.  Careproviders themselves are actually talking themselves into being afraid of the laboring woman as pure risk.

Here’s to you Olivia and Kerstin.  May the international birth community and women around the world know that technology is good to have but do not attach technology as a necessity for American women, for any woman.  America’s maternity care has misplaced faith in technology and other countries need not follow.  There are American women who are not afraid of birth and every day these women are a hands-on lesson for society and practitioners every day.  Humble and wiser is the practitioner who gives the mother her due for a most satisfying labor only she can do.

In January 2005 I found out that I was expecting my 3rd child.  Being stationed in Germany with my husband I was excited about giving birth outside of the US.  I was assigned a German OB and also sought out a midwife.  Home birth was finally an option with my insurance.  The funny thing was that the insurance insisted that I continue to see the OB even though I was seeing a midwife.  I eventually stopped seeing the OB because it was a waste of my time to go to 2 appointments for the exact same thing. 
 
In my 8th month the midwife informed me that due to some legal technicalities she could not attend my birth on the Army base.  It is considered US soil, and there was some question about whether she could lose her license if she attended a birth there.  I would have been the first home birth on the base.  I then returned to the OB who sent me to register at my choice of hospitals.  I chose St Hildegardis-Krankenhaus I would be attended by midwives at the hospital and an OB would only be called in if there were a problem.
 
On September 8th I drove a friend home, about 20 minutes from my home.  On the way back I had a strong contraction.  I thought to myself, “if I have many more like this before I get home I won’t be able to drive”.  I returned home, climbed the 3 flights to my apartment and sat down on the couch.  A couple minutes later I had another contraction that made me jump off of the couch.  I said to my husband that that was the 2nd strong contraction like that I had had.  It was now about 9:45 in the evening.  He asked if we should call the neighbor to come take our other 2 for the night and I said no, it will probably be a while yet.  The first 2 contractions were about 20 minutes apart and the next few were strong, not painful and about 10 minutes apart.  I spent my time sitting on the toilet, the most comfortable position for me, but also a good position since it opened the pelvis.  I prayed that this labor, which felt so different from my 2 previous, would go quickly.  God granted my prayer request.  Around 10:20 or so I said he needed to call the neighbors and let them know he would be bringing the kids over.  When he asked for the number, and wanted me to call, I couldn’t form a complete thought.  I pointed him to the list of emergency numbers to call.  After he carried our second child over, I realized I could not wait for him to come back upstairs to get me.  I gathered my bag, his wallet and the keys and was waiting in the parking lot for him.  He looked at me as if I’d lost my mind, but I knew we needed to leave then.  The normally 26 minute drive took 45 minutes that night, and the car ride through the country to the “big city” was painful.  Every bump in the road hurt. 
 
We arrived at the hospital, around 11:20, and he dropped me at the door and then went to park the car.  I rang the bell for the night watchman (not all German hospitals have “emergency” rooms, we went to a private hospital that handled scheduled procedures and birth), told him in my very broken German that I was in labor.  As he went to get a wheelchair I waved him off and said I couldn’t sit anymore.  We made our way slowly upstairs, pausing every 2 minutes or so for a contraction.  When we arrived in the labor area, I rang the bell and told the midwife I was American.  She returned with an English speaking midwife who watched me through one contraction and said we needed to be in the birth room.  The next words she said shocked me.  She said, “we should call the anesthesiologist, yes?”  I responded with “No, please don’t”  She then said, “you are American, yes?”.  I said that I was but I really preferred to do this without any drugs.  It wasn’t until later that I realized the full implication of what she had asked me.  She asked if they could check to see how far I was dilated, and I agreed, again, curiosity getting the better of me.  I think I was 6 or 7.  I requested that they break my waters, my other 2 had come so quickly after the release.  She grudgingly agreed and did it the German way–no amniohook, just pinched the bag during a contraction and popped it–never again will I request that!  They wanted to get a good read on the baby, so I allowed them to hook up the EFM.  The room (at the hospital) was wonderful.  I had all the tools at my fingertips that I needed.  The midwives then left me to labor quietly, peacefully.  I spent most of my time swaying, doing the belly dance, and chanting “baby out, baby out”.  My husband wonderful as he is, is not a great labor companion.  He kept saying that he wished he could get the baby out.  I didn’t want him to do anything, I just needed to say it.  Suddenly there was a flurry of activity in the room and I realized that they were pulling out the internal monitor.  I couldn’t verbalize that I knew where the baby was, that all was ok with her/him.  There was no way that I was letting them screw that electrode into my baby’s head.  I knew it meant that my 4 hour recovery stay would turn into 24.  All I could say was that I would have 1 more contraction and push.  I climbed on the bed on all fours, had one contraction, rolled over and in a half-sitting position pushed before the midwife knew what was happening.  My husband was frantically ringing for the other midwife to come in.  She ran in just as my baby’s head was born.  They all stood there and stared at me.  After a short time, 2 minutes, she that I needed to push again to birth the body.  I’m not sure if she was concerned that the shoulders were stuck, or what, but when I felt the urge, I birthed the body.  They allowed me to reach down and pick up the baby, who was a girl.  She was born at 12:28 am.  They nestled us skin to skin and covered us with warm blankets.  Then came the next crazy (in my opinion) question:  “did you remember to bring your own formula?”  I pointed at my breasts and said “I have 2 of these and they work great!”  The lights were turned up a bit when they took baby Kerstin across the room to weigh her and do her exams.  They dressed her and brought her back where she happily nursed away.  They continued to bring us warm blankets until about 5:30 when they took me to my room, holding the baby in my bed.  I then had the option to take her to the nursery while I showered.  I shared a room with 2 other women, neither of whom had her baby in the room and both were sleeping.  I showered, got my baby, and ate breakfast.  While I waited for  my husband to come pick us up, I noticed that there were several nurses who kept pausing at our door.  I started listening to their conversations (oh, the joy of understanding a foreign language) and realized they were all talking about me–the American who didn’t have drugs and was breastfeeding.  I also insisted on leaving that morning, 9 hours after her birth, we left for home.  The Germans typically stay for a week until the birth certificate is ready, they leave rested, and prepared to care for a baby. 
 
I finally understood understood why the midwives were so surprised that I refused the drugs.  Most of the American spouses who deliver there demand drugs, the German women don’t.  I started asking all the Germans I knew, they all had home births, or non-medicated hospital births.  It also made me so sad that American women are seen as weak, not able to handle labor.  The Germans don’t see it as painful, just a necessary process to have a baby.  So what if it hurts a little?  They accomplished it.  I’ve often said if I were to have another baby I would hop a flight across the Atlantic if I could not have a home birth. 

Our thanks to Laura Shanley for catching Birth Love re-open on the web!

For many women, both birth advocates and just your every day mothers (not!), Birth Love was the top, up-to-date birth support site.  It has returned and we recommend you visit Birth Love for great info and great birth choices support.   

Since your tea is likely to get a little cool after spending time zoomng around Birth Love, why not warm it up and return to read some Positive Birth Stories next?

In a recent discussion we have had on our independent childbirth educators email list, the topic turned to one of the basic differences between supporting a woman through labor, and medicating a woman through labor; between listening to a woman’s complaints, and “fixing” a woman’s complaints; between most home births and far too many hospital births.

One woman told of an experience in supporting a woman through her labor.  The mother turned to her doula and husband once and said, “This sucks!” The doula answered, “Yes, I know it hurts, but you can do it.”  The mother responded, “Yes, I know I can do it. I just wanted to let you know it sucks!”

How many nurses, husbands, or other birth-support people would have heard the woman say that, and offered her medication to “fix her problem”? She wasn’t needing anything fixed — she just wanted to communicate. Isn’t there a whole industry in attempting to help men and women communicate, especially in marriage and other personal relationships? Why should we think that doctors (who are typically trained in the all-male tradition of med school for generations) and the medical establishment will know how to communicate in the all-female world of birthing mothers?  Men tend to want to know the answer. Doctors are also trained in how to fix problems, medically. Mothers want to talk about it first.

So many women just want to be listened to. These basic differences will not just disappear because women are in labor. Some people — both men and women, although men tend to fall into this much more easily than do women — just want to know the answer and use it to fix problems, even if the “fix” is something unwanted by the person who is dealing with the situation.

When a woman’s birth-support team moves too quickly from listening and encouraging – and the other basic tenets of female relationships and female support – they may undermine a woman’s innate courage and strength.  This can happen regardless of the sex of those who surround her in birth.

What if, instead of telling her “you can do this,” the doula had responded, “would you like an epidural?”  The mother may have heard, “You’re not strong enough to handle labor without drugs, so just go ahead and get an epidural before it gets any worse.”  For my part, I’m very vulnerable to suggestion during labor.  A question like that — as innocent as it sounds — may have been enough to make me say “okay.”  Because, after all, if the people who are watching me labor think I need an epidural, then maybe I do!

Fortunately, nothing like that happened during either of my labors.  Instead, the midwives asked open-ended questions, like, “What do you want to do?”  Every time they asked a question or made a suggestion (like getting into or out of the labor tub) I obeyed it as much as if it were a command; questioning it no more than if they had asked me if I wanted some cake, or if I should breathe.

Sometimes, women just want acknowledgement of what they’re going through, rather than changing what they’re going through.  At times labor hurts, it’s intense, you just can’t get comfortable and there is no way in hell you would call what you’re doing relaxation.  It can suck.  It’s time to honor that too.  Don’t fix us.  We’re not broken.

It’s that time of year where many of us look out the window, see snow and wildlife footprints (even the city has its “wild” life).  Some of us can stir the embers and place another split log on.  Others have the banging and clinking of radiator pipes to give us familiarity.  Still others watch the heating bill and wrap up in a blanket and a hot cup of tea.

What we all have is a winter project such as a book we’ve been meaning to read, are reading or wish for one.  The AAMI Reading Rooms on Yahoo are once again ready for a new year of books and their suggestions are wonderful.  The Childbirth Reading Room features “A Wise Birth: Bringing Together the Best of Natural Childbirth and Modern Medicine” by Penny Armstrong and Sheryl Feldman and is open to everyone!  The Unassisted Childbirth Reading Room features “Magical Beginnings: A Holistic Guide to Pregnancy by Deepak Chopra, also invites everyone!  The Midwifery Reading Room, intended for midwives and birth professionals, features Giving Birth: A Journey Into the World of Midwives and Mothers.

One book we’ve heard much about and some of our group members have LOVED is Lady’s Hands, Lion’s Heart, A Midwife’s Saga by Carol Leonard available from Bad Beaver Farm.  Let us know if you’ve read it!

I have chai, a crochet hook and a huge bowl of yarns next to my pile of books to read.  There are only so many hours in a day!

As a group whose every day bears witness to the entry into this world of many a newborn we enjoy hearing women’s descriptions of all things birth.  We tend to cringe hearing harsh language surrounding birth.  An irritable uterus?  What is that, a belly with angry eyes???

I remember Laura describing her daughter’s entry into the world as one where her cord was “creatively wrapped.”  What a difference it makes to view each birth with wonder, not as a risk.  I believe it is in the documentary by Patchwork Films called “Born In The USA” where Dr. Joanne Armstrong admits hospitals have low tolerance for viewing laboring women as anything but risk.

We spent a good portion of last year bringing awareness to the misleading presentations on technology in birth.  We will continue to do so as new “turf battles” with ACOG arise, but it’s time now to see the beauty of labor and birth as it really exists.  I know many believe “orgasmic birth an old midwive’s tale” or simply too extreme a description for what is otherwise only a reverential experience.  I have to smile to myself and just state the obvious: birth is personal and some take their personal view as the only view and are taken aback when their view isn’t just like someone else’s is.  Perhaps that’s why Ms. Moore fails to mention that Orgasmic Birth also contains the story of a mother who labored and labored and labored.  It wasn’t orgasmic in the sexual sense.  It was sexual as in liberating.  Had this woman labored in a hospital she would have been sectioned.  The only real point of discussion is that whether or not any of us feels she should have been sectioned is a matter of personal choice.  And that’s what we here at Independent Childbirth see as the reason why globally maternal care is so faulty: it does not have choice at the foundation.

Birth is.  Period.  That’s the true beautiful secret of birth.  Each birth is unique as well as being unique to the mother at that moment in time.  When she first birthed she was not the same woman that she is giving birth the following year or years later.  She is not the same woman giving birth two, three, four births later.  None of those babies are the same as the ones before.

When women fail to honor the different choices we each make we tear each other down.  Why else are the mommy wars the fodder of many a journalistic piece?  It makes for entertainment: judging each other for the decision to breastfeed even when it means dealing with people who cannot see breasts as anything other than sexual; judging each other for a mom who wants to both be a mother and have a successful career.

We need more appreciation for the turtle women.  Yes, turtle women.  There are turtle women specific to the birth world but I think turtle women abound in all aspects of our life.  They are the women who support, not criticize, our choices.  It does not mean they agree with every choice we make.  It does mean that they are wise enough to recognize the value of stirring every woman to think about her choices, why she made them and most importantly be confident in her own wisdom to adjust or make different choices because she has learned something new.

“Orgasmic Birth” is scheduled to be reviewed in a segment by ABC’s 20/20 tonight at long last.  Unfortunately it may be viewed as a part of a theme called “extreme mothering.”  Today’s journalism just isn’t journalism unless it’s sensationalist.  Sigh.

No matter.  Turtle women all the way down … enjoy!

So, I just attended a very traumatic twin birth.  After watching the WHO film on vaginal breech delivery I was completely horrified at the lack of skill shown by these doctors.  The whole ‘hands off the breech’ was not present at all, nor was anything else for that matter. 

Here’s the short version as I am very tired.  Mom was a primip pushed beautifully…  She allowed her epidural to wear off to the point where she felt the pain of contractions enough to really push effectively.  She began pushing at 12:15a and baby A was born head first one hour later without incident.  Doctor did a completely unnecessary episiotomy without consent or even informing mom she was going to do it.  Nothing was said at all.  Baby B was transverse and that is when things got ugly.  The docs said they were okay with delivering him breech, but were very aggressive about getting him to turn.   The doctors hand was completely inside the uterus trying to grab an appendage.  The baby’s water wasn’t even broken, what did she think she was going to get a hold of!!!!  She finally broke moms water after 6 minutes of this manual attempt to turn the baby.  After the water broke, the doc grabbed the baby’s feet and pulled him through the vagina.  She continued to pull and pull on the baby and turn and pull on the baby, while the other doc pushed on the fundus and mom gasped she couldn’t breath.  Horrid!  Then, they both started pulling on the baby to get his head out.  They heard a pop when they broke this poor little 4 lbs 8 oz baby’s arm. His humeris.  I just can’t believe it!  They turned him nearly 360* using his body, pulling on his legs.  It was the most disgusting lack of skill I have ever witnessed.  It took two minutes, he was born barely 20 minutes after his sibling.  The rationalizations the docs gave were of course ‘well a broken arm is better than brain damage’ …  I am heartbroken. ~ B 

We were discussing a different subject just before B shared her doula birth story when an observation was made: many babies stop fussing when the person holding them stands up.  Perhaps, Ruth Trode mused, as a baby fusses or the environment is less than optimal for the person holding the baby that negative energy builds.  In that sitting position this energy finds pockets to “sit” in (think standing water).  When the adult stands up the energy is dredged and flows out into the air instead.

Have you ever noticed that a baby who sees its mother upset also becomes upset?  How is that?  A baby supposedly isn’t born feeling (else why would practitioners use invasive tools such as internal fetal monitors, IUPCs and pitocin?) so how would they have learned this facial expression means “sad” or which one means “happy?”  

Instantly I thought of babies during labor and how they show signs of stress first from interventions on mothers.  We know babies experience their mothers’ emotions.  They obviously experience energy …. why do I think this? Because they are not physically seeing the situation their mother is experiencing. They are in the womb.  It’s the ENERGY that they are feeling.  They are on a totally different plane than we are.  Then they are born and susceptible to losing the acuity of their intuitiveness and will instead learn how to compartmentalize instead.

This brought to mind how contrast colors grab newborns attentions, but blending colors don’t hold their attention as well. To me, I see that their world is so fluid in color, texture, sound and energy–there are ebbs and flows. It is only when we start defining the difference from black to white, here to there, me to you that we start down the path of seeing the world and the things in it as separate. Oh to be a baby again and see nothing as being separate.  ~Ruth, Musing on a cold, snowy day

It seemed to me that it is only we humans who have “evolved” (cynical) to see anything as seperate.  Witness this mother gorilla mourning the death of her baby .  Elephants also have a capacity many of us humans do not.  They also have a reverence for the life of their own.  They are who I think of when I hear the phrase “singing the bones.”

As we “listened” to B’s doula birth story what we felt in our hearts was more than the heartache of knowing this birth didn’t have to be this way.  Giving birth in anything less than humane care will tear us down as a society.  I seriously question who or which of us is the one that is “evolved.”

What deep wounds ever closed without a scar? ~ George Gordon, Lord Byron, Child Harold’s Pilgrimage

We continued to feel the reason for our being.  It’s not about restricting women’s choices or judging their choices.  It’s about whether or not THEY made the choice.  It’s not about what babies can tolerate.  It’s about why do they need to tolerate what practitioners impose on them?  

So begins a new year of sharing our message, how we give birth matters.  Not giving birth vaginally does not make a mother less of a woman.  Hearing us say this may surprise many who would claim we are inflexible wanting natural birth for all.  The practitioners who want to claim that we do not want to allow medications or believe cesareans are evil would rather you just turned away from us less you begin seeing those generalized statements for what they are: fear mongering of the worst kind; meant to stifle freedom.  When it permeates the laboring woman’s environment creating “atmosfear” that energy does make its way to the baby inside.

Thinking on our discussion of how babies sense and absorb the energies of their immediate and intimate space the twin birth story came rolling in causing great shock to us hearing the story and emphasized our entire past 24-hour discussion:  how we birth and how we are born matters.

Peace on earth can begin at birth.

For more on the newborn birth experience visit Birth Psychology and Newborn Breath.

“Home Birth Experience 1: Decision and Expectation” is a midwifery clinic teacher’s summary of her interviews with eight women who planned ahome birth in the recent decade.  Author Alison Andrews proposes that the birth experience leaves a very strong imprint on the woman’s mind, while the medicalization of birth has reduced the birth experience to terms relating to a consumer decision, i.e. “satisfaction” or “attitudes on intervention.”  It is the desire to experience birth as an organic experience leaving its memory on the mother’s whole self that is a strong basis for choosing home birth over medicalized birth.

Women will share their birth experience with great detail and acuity in the days immediately following the birth, be it a positive or a negative experience.  The quality of that experience is beginning to be recognized as having a lifetime impact in other areas of the mother’s life, including her marital relationship with whoever was her partner at the birth.  As birth moved into hospitals through historical industrial developments technology served to also separate mothers mentally and emotionally from the xperience, fewer and fewer natural birth experiences existed tobalance the case for home birth as a safe and healthy experience.

Birth “narratives” in fact, are an essential and typical skill for the midwife to have.  The medical profession would relay a birth only in terms of patient notes, regardless of whether the birth was organic birth or some interventions were introduced.  This is a detriment to improving maternal health care because a mother’s birth story is a valuable data source recording live testimony to maternal health care protocols enacted upon them.  Based upon this theorem, Ms. Andrews interviewed eight women from her home region of South Wales with backgrounds ranging from affluent to indigent, from rural to desolate.  Of these women, seven had previously birthed in a hospital and therefore provided that experience in relation to their choice to birth at home.

The results concluded n two themes, each with secondary threads for further discussion.  The two main topics that women related the strongest emotion to was the decision to have a home birth and the expectations they held for their home birth experience.  the reasons behind their decision to birth at home ranged from pragmatic – fewer worries about child care for the siblings of the new baby – to addressing the need for intimacy via familiarity of surroundings.  These mothers also considered the risks of home birth, and in some cases the risk carried less weight in their decision-making process.  One woman sought only to ensure her midwife had basic emergency care items, while another retorted that things go wrong in hospitals too.  All women undertook some form of birth education and preparation but the preparation was more about the physical location itself than about their own body’s preparation for the birth.  This is interesting to note in direct contrast to the often reported indicator for hospital birth being about women desiring to be near pain relief or help if their body cannot manage the labor.  In other words, labor is in the eye of the beholder and that’s another post in itself!  To continue, the women’s expectations themselves were not of as great a note as the importance of recognizing that women held expectations for their births both in terms of the birth itself and the care they would receive.

This last consideration, it was observed, led to both discussion about holding dialogue with their friends and families regarding their decision.  It also led to strife with hospital care providers, who viewed the decision to birth at home as a personal indictment of both their profession and their personal reputation, rather than an honest examination into the quality of care – which is the basis for many of these mothers’ decision to birth at home.  It is this sole perspective from proponents for hospital birth that casts light on the goal of the medical profession: to lobby strongly to keep births in hospitals, although there is little evidence that home birth is not safe for lowl-risk, otherwise healthy women.  If this trend continues, concludes Ms. Andrews,

… childbirth … (will no longer be) part of life in the community for most women and will remain so as long as birth remains centralized in the hospital setting.

She quotes the Welsh Assembly government paper, “Delivering the Future in Wales,”  which concludes the option of a home birth with a skilled midwife must be a protected option.  Further, Britain itself is pleding to strive fora goal of a ten percent (10%) home birth rate based on utilizing home birth as a safe option in maternal health care birth choices.  this humble goal is indicative of the  deft persuasion and patience that will be required to advance the view of home birth is a complementary option to medical obstetrics.

Are you listening ACOG?  Complementary.  Working together.  Is it really your goal to improve mother and infant birth outcomes in the spirit of care and concern for humanity?

For more on the home birth decision making thought processes at large look into the Nursing and Midwifery Council report of May 5, 2005.

Works Cited:  Andrews, Alison, “Home Birth Experience 1: Decision and Expecation”; August 2004, Brtish Journal of Midwifery, Volume 12, No 8

ACOG State Legislative Update Year In Review (August 2007)” begins by noting “troubling trends” in state legislation and sets the tone for the bias of this opinion from the American College of Obstetricians and Gynecologists (ACOG).  There are four trends ACOG finds troubling: right to home birth bills are on the rise, more midwives not recognized by medical associations are being licensed by states, midwives appear to have a public advantage and finally that ACOG considers itself on the defensive today.

The facts ACOG provides are clear and succinct in their first two cases, but are opinion laden in the latter.  More home birth bills are being introduced and those that have been in debate for years now are finally passing.  For example, Virginia recently passed legislation protecting women’s rights to birth at home and in 2007 Missouri granted midwives licensure.  It is also true that states are granting Certified Practicing Midwife (CPM) licensure, hands-on training including non-medical skills.  This is not the same training model as the medical path for midwifery recognized by ACOG and the American College of Nurse Midwives.  ACOG does not debate the safety of home birth but rather goes into examining why midwifery and home birth are gaining groundswell support.

 ACOG tells us that midwives have learned how to “work” the legislative system and are now using the same tactics ACOG has used themselves: lobbying and propaganda.  Midwives have been so successful that they have garnered endorsement from the American Legislative Exchange Council (ALEC) for a model to license Certified Practicing Midwives.  ALEC’s endorsement is powerful because it is conservative in nature and therefore, an endorsement renders the CPM licensure model credibility.  ACOG’s illogical stand is, without medical training, midwives are an unsafe choice.

However, ACOG pointedly leaves out the basis for recognizing midwifery: it is not the practice of medicine.  This is critical to understanding the process by which midwifery is recognized and can be protected as a viable option for birth care.  Connecticut is undergoing the struggle to create a definitive line on the issue of whether or not midwifery is practicing medicine.  Almost ten years ago midwife Donna Vedam found herself on trial for practicing medicine.  The courts determined she was, in fact, practicing midwifery and midwifery is not medicine.  Then in 2006 the state’s Medical Examining Board (MEB) found another case to try, midwives who made the right decision, transferring a mother whose birth was not an emergency but should have the medical care her evolving situation might call for available.  The educated decision these midwives, Joan Mershon and Mary Ellen Albini, made in transferring the mother is argued by the MEB as practicing medicine.  There is an irony as midwives finding themselves hounded for providing midwifery care are also persecuted for transferring the mother into appropriate medical care.  The outcome of the birth was a fine healthy baby and mother.  Both mother and father refuse to testify against the midwives.

 ACOG states that midwives have the public advantage of winning support through the use of the buzz words “safety” and “choice.”  Their case – that this advantage is an unfair one – is not fact based.  They argue that home birth is safe in the Netherlands only because everyone lives near a hospital.  There is no evidence in that statement at all.  It only implies that home birth is safe only when it takes place near a hospital.  Their statement is not a case and it is clear they cannot even make the effort to understand what home birth care is.  It is evident that they fear what they do not understand, what is different.  

Further, ACOG also argues that comparisons of home birth and hospital birth cannot be compared because the studies are not scientifically rigorous.  This also ignores the basis for home birth care: birth occurs naturally and organic without active management.  Therefore as each mother-baby pair is unique, they cannot be controlled.

ACOG’s final cited troubling trends is, interestingly, presented last.  It should have been first as it clearly state’s the article’s bias: ACOG is on the defensive.  ACOG is clearly feeling not only outmaneuvered, but also recognizing that they placed themselves in this position.  For example, it is ACOG who made it difficult for hospitals to provide care for women who want birth vaginally after having had a surgical delivery (cesarean) also known as a VBAC (Wagner).  Yet, their position in this paper is that women are seeking out alternatives, home birth with midwives, since their care providers cannot provide VBAC as a birth care option.

ACOG closes the article stating that their position is that legislative support for midwives is not won on merit but rather a sympathetic public and press.  Additionally, ACOG says, it finds itself in a situation where showing up in large numbers when they can give testimony makes them appear to be engaging in a “turf battle” rather than a credible alliance.  This is the plea that they make to find or create alliances with other organizations.  Make no mistake, this is not a light objective to note as some pediatric and newborn service providers have jumped onto ACOG’s wagon.  

This written public statement is clearly an opinion piece reporting facts that are driving ACOG to explore options for defeating midwifery and home birth as a legally protected option for women.  It fails to cite any merits for this position and in fact the “uninformed public” they lament could also be the informed reader’s lament for the uninformed public may not understand that denying American women access to home birth is a clear violation of every American citizen’s right to privacy and right to choose what care or actions are taken upon their bodies.

What did 2008 bring us at Independent Childbirth?  Many, many, natural, spontaneous unmedicated labor and birth over an intact perineum taking places in homes, birth centers and a few hospitals under the expert care and guidance of independent midwives and enlightened midwifery/ob practices.

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