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.

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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!

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

The ICAN offer below is a genuine offer and has been posted through VBACtivism, an organized yahoo support group.  It is our understanding that you should contact the group below if you are seeking help protecting your access to VBAC health care because you have been denied the right to VBAC.  You will be asked to provide information pertinent to your situation and a determination will be made as to whether or not you have a case.  Please, if you’re thinking about contacting the email below, do it!  Just the fact that you are thinking about it is enough to warrant following through.  You and your baby deserve to exercise your rights to choose your health care for yourself.  Write a letter to your careprovider first but don’t wait for a response that may never come, learn more now!

I’m a lawyer with the Northwest Women’s Law Center in Seattle.  I’m investigating possible legal responses to bans on vaginal birth after cesarean at hospitals in the northwest states – Alaska, Idaho, Montana,Washington and Oregon.  If you are currently pregnant and want to have a VBAC, but are facing a hospital policy that would require you to have a c-section regardless of whether you want it and whether it is medically necessary, and are willing to consider working with a lawyer on this, we’d like to talk with you.  Please email us at vbacbanhelp@ican-online.org.  Our services will be provided free of charge.  

 

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

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

 

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

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

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

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

$2 million 

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

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

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

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

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

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

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

Labor went seamlessly.

Birth went quite well.

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

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

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

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

Off we sped.

I passed out a few times on the way.

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

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

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

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

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

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

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

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

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

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

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