Will We Ever Reach Peace in the OB v. NCB war?

I'm considering removing my RSS subscription to MyOBsaidWhat?!? I used to read all the comments and sometimes comment myself, but lately I've realized that it is steeped in negativity, and I'd rather focus on the positive. Reading there, it becomes easy to assume that all doctors are unhuman douchebag stabby-hands. Of course, the "Thoughtful Thursdays" are wonderful examples of what to say to a woman, but because they are featured once a week, they come across as the rare exception in a world of horribleness. If any doctors show up and make efforts to defend their profession, they are almost always met with hostility by people who know nothing about how they practice medicine or treat their own patients.

I was recently surfing a blog called OB/Gyn Kenobi, because I thought the name was really clever, written by an anonymous obstetrician who calls herself Dr. Whoo? I haven't read a lot on her blog, but I can tell that she believes in individualized patient care and recognizes that the issue of liability in the American legal system is a huge problem for her profession. I came across one post where she expressed a lot of frustration about how the natural birth community views obstetricians, automatically assuming that they are all the same horrible stereotype. She points out that in her current practice, there is a split in philosophy between the older generation and her own younger generation.

My personal experiences corroborate her observations, as the OB I saw during my first pregnancy before switching to a midwife group, was an older doctor, and he had a "my way or the high way" attitude, complete with continuous EFM, mandatory IV infusion, NPO, and pushing on your back only. He believed that episiotomy is necessary for about a third to half of all women and that all women change their minds about wanting a natural birth when they are in labor. The OB/Gyn I saw in my second pregnancy was younger and was nothing like this--she was supportive of low-intervention birth if all was going well, and had attended many unmediated labors. She almost never did episiotomies, and actually encouraged me to write a birth plan.

It is wrong to define obstetrics by extreme negative examples. There are great OB/Gyns out there. I'd like to hope that there are a lot of them.

One of Dr. Whoo?'s most compelling points is this:

Perhaps the most disheartening thing, is that there can be no real dialogue between the two philosophies, so jaded are our particular perspectives.

I appreciate that she acknowledges that the obstetric side has a jaded perspective, too. This is evidenced by some of the comments on the post:

The fan page looks good so far. You might want to include links to things like: Mothers in Medicine, pages where people can get real information about Ob/Gyn services (other than the doctor hating, "busness of being born" websites)

Condescending, much? Here is another

go to alldoula.com I went there trying to figure out what a doula was. They are very anti-OB and also are giving very bad advice to pregnant women.

That almost makes me ashamed to call myself a doula. And this one

Do any of these doctor bashing twits realize that just a few generations ago women DIED from "natural" at-home childbirth (the only kind going, back then) on a regular basis?

I would be remiss if I didn't address the fallacy of the "women used to die and now they don't" argument. You can not compare statistics from different time periods and assume that one change in that time is the determining factor in the change in statistics. Natural birth advocates know that hosptials and interventions have benefits and save lives in certain situations. That is why women who plan to birth at home have a plan for transfer to the hospital if complications arise. The burden of reaching out the olive branch of peace is really on us because we need obstetricians. Modern homebirth, though significantly safer than homebirth in antiquity (due to sanitation and better midwifery knowledge and emergency medications that can be given in the home), can never really be safe without hospital back up. All too often, women who transfer to the hospital from a planned homebirth are met with hostility for choosing not to use the hospital and then needing it after all. The truth is she needed you all along, just in a different way than you wanted her to need you.

We need to focus on what we have in common--a desire to improve birth for everyone. We may have different opinions about how that can be done, but we will never get anywhere if we keep making this a war. Division is hurting us, and hurting mothers and babies. We cannot afford to alienate all of the the obstetricians our there who care deeply about mothers and babies and make birth their life's work! Just as there are various types of natural birth advocates, each obstetrician is an individual person. Many of these people are caring and sensitive and we push them away with our belief in an extreme stereotype. It is bigotry, and I am done with it. I am committing now to make my blog a doctor-friendly zone. I want better care for pregnant women and their babies and that is only going to come about with peace and collaboration.

check out Candy Clips by B for cute and simple hair accessories

As you may have noticed, I always like to support my friends and family in their online business ventures. My cousin's wife (who's name actually became my maiden name when she married him, just spelled differently) just started an etsy shop called Candy Clips by B. Her clips are really cute, and they are mostly in solid colors that will go with all different outfits. Most of them can be worn by any age--her photos show the same sizes of clips being worn by her and her two year old daughter. She is having a giveaway on her blog to promote her shop.

Elective Cesareans as Commentary on a Failed Birth Model

A recent article out of Australia, Fear of natural birth driving one in three mothers to cesarean, addresses the issue of maternal request cesareans. I feel that this article misrepresents the issue by placing so much of the burden of rising cesarean rates on maternal request. The author doesn't site a source for the "research" that supposedly supports this, but research can be misleading in what they categorize as "elective cesareans." Sometimes such cesareans are actually "doctor unofficially recommended" cesareans and not "maternal request." Also, elective repeat cesareans are different from elective primary cesareans because of the factor of having a uterine scar. However, there are women out there, while I don't know how few or how many, who do actually request their first cesarean.

While I have strong opinions about what constitutes safe childbirth, I respect the rights of all women to make their own choices about their births. It appears that in reaction to the strong natural childbirth presence on the internet (where many women get support that they do not get from their doctors, families, or local girlfriends), there are now websites with the purpose of promoting elective cesareans as a viable birth choice.

Many birth advocates (perhaps myself not exempt) are guilty of using fear of cesareans as a springboard. I realize that most of the stuff out there is attempting to dissolve some of the fear that surrounds c-sections, and I don't really have a problem with that. I would prefer for women for whom the benefits of having a c-section clearly outweigh the risks to be able to go into their cesarean birth without fear. As I have said before, I am all for lessening fear in all types of birth. However, what good does it do to attempt to make vaginal birth sound scary in order to make c-sections sound less scary?

The September 2009 opinion piece at Pregnancy Zone, The Benefits of A Cesarean Section Delivery, which one of my friends at an online community recently shared, is one such attempt. The article was bombarded by comments from women who disagreed with the point of view of the author and criticized her approach of using generalized claims without evidence to support them. I think the two sides of this argument are starting out with different basic assumptions that prevent them from effectively communicating with each other.

The author of the article is assuming that the alternative to a cesarean section is the typical medical model hospital birth. On the other hand, most of her opponents are likely working from very different construct of "vaginal birth" (such lack of understanding is quite common in internet mommy wars). I'm not going to argue about whether the claims made in the piece are true, but rather to look at her characterization of vaginal birth and what that says about our maternity care model and birth culture.

In the "No Labor Pain" section she brings up three kinds of pain associated with vaginal birth: contractions, perineal stitches, and hemorrhoids. When discussing contractions, she assumes that all women see birth as a necessary evil to get over with in order to get a baby. She compares being in labor to recovering from surgery. She assumes that "most" women receive episiotomies (and don't have a choice in the matter) and seems to feel that stitches in the abdomen are preferable to stitches in the perineum. Even without episiotomy, there are a lot of women who assume tearing is inevitable. The author also assumes that hemorrhoids are common in vaginal birth. So, in this author's view, a woman who has a vaginal birth not only has "labor pain" but also a painful, messy recovery involving a sensitive area.

The "Dignity and Privacy" section assumes that all women giving birth are dehumanized and violated, mentioning the presence of a multitude of medical strangers doing vaginal exams and being in a "less than flattering position for any number of hours." At best, this birth sounds like pseudo-surgery, and at worst like sexual assault and torture. No wonder women want to be disconnected from this.

What does the fact that there are women who view vaginal hospital birth as less desirable than cesarean surgery say about how our system treats vaginal birth? Has our system really made birth so clinical, unknown, and scary that major abdominal surgery sounds preferable to a normal human process?

If birth is just a clinical baby extraction, it does make sense that women would prefer to do it through their bellies instead of their vaginas. But this doesn't make sense to women who see labor as a rite of passage, a challenge to rise to, or even a joyful experience that doesn't have to be painful. Natural birth advocates know that with the right kind of care, vaginal birth with an intact perineum or with very minimal tearing is very possible and that vaginal birth doesn't have to permanently damage the vagina. For women who understand humanized birth, it is sad to realize that women think vaginal birth has to be demeaning and rape-like. With sensitive, respectful care, when women choose their own labor positions and choose when they have vaginal exams (or not to have them at all), vaginal birth can be dignified, private, and even empowering.

Perhaps the question physicians should be asking themselves is not, Should we perform cesareans at a womans's request? but, What have we done to vaginal birth to cause women to request cesareans?

Great Minds Think Alike

A fellow Childbirth International student, Jessica, who is also a photographer, pointed out to me that about a month ago, without knowing about my blog, she posted the images from a birth she photographed under the title Birth. Unplugged. In Jessica's words...

Christa's birth is unlike any other hospital birth I've seen. She was not hooked up to a single machine, there were no wire or cords or tubes attached to her, she wore her own robe (the hospital gown was behind an armchair - lol - I'm assuming it slipped off the back of the chair), she snacked on crackers and sipped Gatorade, Norah Jones was playing on the iTunes, and I'm honestly surprised she gave birth on the bed :) Christa didn't spend much time on the bed until right when the baby was born.

The images are stunning and it's really special to see such a home-like birth in a hospital setting captured in photos. Jessica and I thought it was interesting that we both came up with the same phrase to describe low-intervention birth.

Hands-off Neonatal Care

My previous posts, A Natural Third Stage? and Physiological Third Stage, without the "as long as" have discussed how some common procedures right after birth can be disruptive and sometimes even harmful, both for the mother and the baby.

Suctioning of newborns is very common in U.S. hospitals. MidwifeThinking has an excellent post on meconium that also details the risks of routine suctioning. I actually did not know that routine suctioning was not done in other developed countries, so I found it enlightening to hear the perspective of a UK-trained midwife practicing in Australia on this.

I have discussed the theory that immediate skin-to-skin after birth may reduce the risk of postpartum hemorrhage. It also influences the initiation of breastfeeding. This video (which I saw for the first time when Bonnie shared it on her blog, Birth-Joy) demonstrates the results of a study that found that not only was a baby's ability to self-initiate breastfeeding affected by pain medication used in labor, but also by whether or not the mother and baby were separated following the birth.



Given the benefits of skin-to-skin contact, I feel that hospitals really should work to make initial skin-to-skin between mother and baby possible. Here is an excerpt from what I hope will be a great tool for improving hospitals in this reguard. (Thanks to Rixa, who posted this after seeing a presentation on it at the Lamaze/ICEA MegaConference)

Pregnancy and Infant Loss Remembrance Day

If you would like to honor the day, here is the information for the Wave of Light:


Please visit www.october15th.com to learn more about Pregnancy and Infant Loss Remembrance Day.

For all who have lost babies, born or unborn, my heart goes out to you and my thoughts are with you today. No one may know why your child could not be with you longer. All life is fragile, but it seems it is often even more so when it is brand new. As someone who has chosen to pursue a career in birth, I know this is something I have to live with, but I am still learning how.

Discovering and Celebrating Female Fertility

One commenter on my Progesterone post mentioned that she loved how Toni Weschler's book taught her that there is so much more to the female cycle than just menstruation. I also loved this about the book. I explained to my husband that I agreed with Weschler's assessment of our society's current ways of teaching women about our bodies. I know I looked at menstruation with fear and shame as a young girl. In fact, when I told my mother about my first menstural period, she congratulated me and told me it was wonderful. I thought that was awkward. It didn't feel wonderful to me because I was never taught what was so wonderful about it. I plan to have it be different for my daughter.

When one of my peers asked about it in the class about puberty at school, we were told that the non-blood secretions from the vagina were "bacterial discharge"--sounds nasty. How I wish we could have been taught by someone who knew the truth--that the white/clear stuff is actually a fluid produced by the cervix in response to normal hormonal changes during the cycle. Of course, going into specifics about how observing it for pregnancy achievement or birth control would not be appropriate for this age group, but now seeing the ignorance of those who were supposed to be teaching us about our bodies, I can't help but feel a bit betrayed.

For some great suggestions and links about celebrating your daughters becoming women, see The Menarche at Bellies and Babies.

I also wanted to share a few links for some great online resources about fertility charting:

The Beautiful Cervix Project offers some cool pictures to supplement study of Fertility Awareness. It started with a woman using FAM for birth control sharing the photos she took of her cervix each day of her cycle, documenting the changes in it along with the other fertility signs she charted. The site has now expanded to include many different types of cervix pictures.

And here are a few sites that currently offer free charting software:

• Taking Charge of Your Fertility
• Pregnancy.org's BBT charting tool
• Fertility Friend

Progesterone: the pro-gestation hormone

I just finished reading Taking Charge of Your Fertility by Toni Weschler. I had been wanting to read it for a while, and it is on the Childbirth International reading list, of which I have to read 3 books for my doula training. Although I had already learned the basics of fertility charting from the internet (and charted a little while trying to conceive my first), this book opened up a whole world of understanding for me about the female body, as well as a better understanding of my own (somewhat strange) gynecological history.

Progesterone's Role in the Menstrual Cycle

This chart shows the changes in hormone levels throughout the female cycle.

(image originally uploaded to Wikimedia by Shazz)

Part A depicts the follicle maturing, releasing the egg at ovulation, and acting as the corpus luteum after ovulation. Part B shows the changes in hormone levels throughout the cycle:

1. Follicle Stimulating Hormone
2. Estrogen
3. Luteinizing Hormone
4. Progesterone

Here is a somewhat simplified explanation: Follicle stimulating hormone (1) causes follicles on the ovary to mature. These follicle release estrogen (2) and when the estrogen reaches a certain level, a surge of luteinizing hormone (3), which is the hormone ovulation predictor kits measure, occurs which triggers ovulation and one of the follicles releases an egg. That follicle then becomes the corpus luteum, which secretes progesterone (4). All of these hormones are amazing, but progesterone is the star of this post.

Progesterone has a warming effect on the body, which is why there is a shift in basal body temperature after ovulation. Progesterone sustains the lining of the uterus for the second half of the menstrual cycle, until the corpus luteum disintegrates, resulting in a drop in progesterone, which triggers menstruation. In late 2006 and early 2007, after I went off the birth control pill, before my daughter was conceived, I was anovulatory. My gynecologist prescribed an oral form of progesterone, which I was to take for a few days and then the drop in progesterone would trigger a bleed, which it did.

If the corpus luteum is not producing enough progesterone, the uterine lining would be unable to support implantation of a fertilized egg, often characterized by either spotting in this phase or menstruation starting too soon. In the fall of 2008, when I was breastfeeding my daughter, I was having issues with constant spotting. I took an herb called Vitex, which is said to increase the progesterone secreted by the corpus luteum. The spotting stopped, and I began to have menstrual cycles, so whatever the Vitex did to my hormonal balance, it worked.

Progesterone's Role In Pregnancy

If the egg is fertilized and implants, it secretes HCG, which is the hormone that changes the color of the second line on the pregnancy test. HCG tells the corpus luteum not to disintegrate and it continues to secrete progesterone, keeping the contents of the uterus in, until the placenta is fully formed and takes over the secretion of this hormone. The warming effect of progesterone continues in pregnancy, so the woman's core temperature remains at the slightly elevated post-ovulation level.

Initiation of labor is a complex process, and what exactly starts it is not known. A signal from the fetal lungs is proven to be one factor. Progesterone withdrawal, like that which causes menstruation, is a well-known theory, and probably also plays a role. Progesterone is said to inhibit oxytocin. That would explain why most women do not experience pre-term labor from activities that increase oxytocin levels, such as sex or breastfeeding. Oxytocin is free to cause contractions after the progesterone level has dropped.

While I was looking for links for my resource list on indications for induction, I found a Cochrane Review on the use of progesterone supplementation to prevent pre-term birth in at-risk women. The review found the progesterone made a significant difference in the women who carried their babies to term. Perhaps the placenta not producing enough progesterone is one cause of pre-term labor, just like not enough progesterone in early pregnancy is one cause of miscarriage. Just as it did during the luteal phase, progesterone keeps the contents of the uterus in.

Perhaps lowered progesterone levels when spontaneous labor is imminent is the reason that natural and low-tech induction methods such as membrane stripping (which triggers prostoglandins), breast pumps (which trigger oxytocin), and intercourse (which, if done correctly, does both), only start labor "when the body is ready." You can also see how trying to use artificial oxytocin to induce women whose progesterone level is still high could be tricky.

The body's process of starting labor and the role of different factors in it is something I'm quite curious about and hope more research is done on in the future. I'd be very interested to know what causes contractions to change from Braxton Hick's to ones that feel more intense, and why some women experience these more intense contractions on and off for days or weeks before entering active labor.

The more I learn, the more amazed I am by the human female body!

I babywear

My son likes to snuggle in my homemade cotton jersey no-sew wrap (instructions here). It makes it easier for him to block out distractions and fall asleep, and then I can put the edge of the cloth over his head so it stays secure while he sleeps.

I practiced babywearing a little with my daughter, especially when she got heavier--I would put her in a pouch sling on my hip. Then I had two hands and my arm wouldn't get tired. I also had one of those commercial carriers with the buckles and straps, but it was a low-end one and not very comfortable (it didn't distribute the weight very well to the hips or across the shoulders).

I am glad I decided to do the wrap for my son. I started using it when he was very small (I am wearing him in my blogger profile pic, you can barely see his tiny head--my how he has grown in not yet seven months). A wrap is such a simple way to carry a baby--you just need a long piece of cloth and someone (even if that someone is on youtube) to show you how to tie it.

I am not an avid babywearer or a babywearing expert. I don't babywear everyday. I don't scorn the use of bouncers, jumper-roos, swings, or even strollers. I own all of these things and find them useful sometimes. I use babywearing where it can benefit me, and find it benefits my babies, too.

Babywearing makes having two kids a lot easier, especially when we go out. It is a lot safer to wear my son and put my daughter in the seat of the shopping cart than it is to put my son in the seat of the shopping cart and my daughter in the basket (which is also impractical because I could never trust that little scavenger from opening all the food). It is also nice to wear my son and either push my daughter in a stroller or have my hands free to hold her hands instead of trying to juggle her, the baby, and the diaper bag. And it's great for those times when I really need to cook dinner or clean the kitchen and my baby is tired or fussy and wanting to be held.

When I do babywear, I do so proudly. I welcome all the compliments and questions I get about my wrap, and smile when strangers point it out to their partners and tell them they "want one like that." When other moms who babywear see me with my son in the wrap, I know they recognize me as one of their own. Many babywearers, especially those who use simple, traditional carriers like the wrap, are also part of the natural childbirth movement. I believe that the reason that babywearing and empowered childbirth are linked is because they are both parts of women's wisdom that have traditionally been passed from generation to generation, were lost in the industrial revolution, and now being rediscovered.

When I babywear, I know my baby is safe and happy close to the womb that was his home just a year ago. When I babywear, I treasure it, because I know before long my baby will grow up and never be a baby again, and what better way to savor his babyhood while I still can?

Babywearing has gotten some bad press from the CPSC recently, and baby carriers are being targeted as an "unsafe" product, which they are not. This post was written as part of a campaign to promote baby carriers as the natural, safe, useful tool they are. Please visit the linky at Adventures in Babywearing, and add your own post on why you love/need babywearing and the safety of wearing your baby (and you'll be entered to win a free sling!), and visit the Baby Carrier Industry Alliance page on Facebook, where you can also add links.

Beanies With Love

A friend of mine is starting a business selling homemade crocheted beanies for kids. She is having a giveaway to help get her off the ground. Cold weather is just around the corner for us, so it's the perfect time to start buying some warm things for little ones! Visit Beanies With Love to enter the contest and see her samples! She takes requests for colors. My son would be adorable in a blue one to match his gorgeous blue eyes, and for my daughter, I'm thinking either lavender, pink, or fuchsia!