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.
June 4, 2009
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May 27, 2009
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.
February 5, 2009
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.
January 30, 2009
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.
January 21, 2009
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?
January 4, 2009
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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!