Thursday, May 20, 2010

Birth and The Matrix

A few weeks ago the movie The Matrix was on TV, and my husband recorded it on our DVR. I did not see The Matrix until I could watch an edited version (because I don't watch R rated movies), but this was probably my third time seeing it, and it had been a while. Then there was a reference to The Matrix on by Dwight on The Office, and I realized that my blog title actually relates birth to this culturally significant movie.

The premise of the movie is about machines taking over the world and keeping all the humans "plugged in" to a computer program, "the matrix," so that they can use them as an energy source. The humans don't know they are in the matrix, they think it is the real world, but in reality, they are in some pod full of goo connected to a bunch of wires and tubes. When Keanu Reeve's character Neo takes the "red pill," he gets "unplugged" from the matrix and learns to see it for what it really is.

In edition to grossing us all out with the scene of a creepy mechanical bug crawling into Keanu Reeve's navel, The Matrix might actually teach us something about our birth culture. There are several parallels between this and our current birth system, which tends to benefit from keeping women uninformed and slotted neatly into their pre-arranged set up of wires and tubes--birth-by-machine, not machines that control the world, but it is about control. Most women see this as normal, as the way it is. I used to fall into that category. My own journey to natural childbirth was eye-opening in a way very similar to Neo's experience of learning the truth about the matrix in the film. And I, for one, am very glad I didn't take the blue pill.

Keep bending those spoons, ladies!

Tuesday, May 18, 2010

Natural Nutrition: Homemade Bread

Good nutrition is important for everyone, but we know it's especially important during pregnancy when your body needs extra nutrients to build a body for your child. Dr. Tom Brewer, who worked with mostly low-SES populations, found that helping women eat healthier during pregnancy significantly reduced the rates of pregnancy and birth complications among his patients. The Dr. Brewer Diet is recommended by many childbirth educators and midwives as a way to increase your odds of having a healthy baby and low risk birth.

One good building block for a healthy diet is whole grains. There are a lot of white bread products in America, though there seems to be a trend recently to return to whole grains. I used to eat a lot of white bread, white pasta, etc. I have learned, however, to love the flavors of whole grains. Some of the best premium whole grain breads, however, are quite expensive. I have found that after an initial investment in some equipment (which I recieved as gifts!) you can get get all the great nutrition at a lower price, and you can also know what everything that's in your bread is.

I got a grain mill from my parents for Christmas (I asked for one). I wanted to mill my own whole wheat flour because I heard that the kind you buy from the store lacks some of the nutrition of home-milled. I used my home-milled flour for pancakes, waffles, and chocolate chip cookies (they also have chopped rolled oats in them, so you don't taste the wheat-y flavor). I wanted to make bread but it's kind of an all-day thing that kind of takes a lot to commit to. I had been talking about how I would like a bread machine because they really simplify the process.

Well, Husband got me a bread machine for mother's day. He told me he felt like it bordered on the taboo of giving a wife cleaning supplies as a gift, but I told him I didn't care, because the bread machine was what I had wanted.

I made a one pound loaf the day I got it, using part home-milled flour and part all-purpose. It turned out pretty good, despite not having bread flour. I didn't have any powdered milk, so I looked up how to replace powered milk with fresh, and found this in response to an online Q&A:
If you are asked for dry milk for a bread recipe you can use the following substitution:

3 Tbsp dry milk = 1/2 cup+1 Tbsp fresh milk

2 1/2 Tbsp = 1/2 cup

2 Tbsp = 3/8 cup

1 1/2 Tbsp = 5 Tbsp

1 Tbsp = 3 Tbsp

1/2 Tbsp = 2 Tbsp

The milk solids add only colour and a dash of nutrients so you can either sub some of your water for milk or skip it all together without any problems. (09/28/2008)

By Wendy R.

Anatomy of a Wheat Kernel

The wheat kernel is made up of three parts: the germ, the endosperm, and the bran. The germ is the embryo of the wheat plant and contains oils and vitamin E. All commercial flours (including those called "whole wheat") have the germ removed because it is what causes flour to spoil quickly. Removing the germ extends the shelf life of the flour but changes the taste, texture, and nutritious content of the bread it makes. Commercial "whole wheat" flour is made of the endosperm and the bran. The bran is the outer protective layers of the wheat kernel. Bran is kind of like the membranes a human fetus has or the shell of an egg. Bran contains fiber and nutrients. White flour contains only the endosperm. The endosperm is the food source for the plant embryo, sort of like an egg yolk. The endosperm is mostly carbohydrate and a little protein. The protein in wheat is called gluten. I have known people who had gluten allergies, but I never really understood what exactly it meant. Gluten is also what a vegetarian meat substitute called seitan is made out of.

The difference between commercial all-purpose flour and commercial bread flour (whether white or wheat) is the gluten content. Higher amounts of gluten in the flour will give the dough more rise, and will cause the bread that is produced to be chewy. There is an ingredient you can buy called Vital Wheat Gluten which you can add to any flour to make it a high-gluten flour. I don't see anything wrong with adding gluten, since it is a natural part of the wheat, you're just changing the ratio of the wheat contents. And protein is good for you, especially during pregnancy--it is one of the most stressed parts of the Brewer Diet. I bout some at my local natural foods store and added it to a loaf I made entirely of home-milled flour. It baked up nice and big and had a great taste and texture. I looked at the ingredients on a bag of tasty oat & honey bread I had from the supermarket. Sure enough, vital wheat gluten was on the list.

Here are some pictures of my lovely bread made with added gluten:

I also want to mention I great site I found called Lots of good info on home milling, bread machines, and different bread ingreidents.

Tuesday, May 11, 2010

Understanding "Painless" Childbirth

This post is inspired by a recent conversation on my natural childbirth forum, as well as a few birth stories I have read from Hypnobabies moms who were surprised to find that their pressure waves felt "painful" to them. It also is a response to something I stumbled upon while browsing the archives of a natural childbirth blog, in which the author said she would not want to have a painless birth.

So, what is up with "painless" childbirth?

A few women are rumored to have "painless" births without special preparation. I think this is probably pretty rare, but the fact that it happens is notable. The majority of women who refer to their births ans "painless" or "pain-free" are women who used hypnosis.

I think this is something that is commonly misunderstood, and I admit I didn't understand it when I was preparing for my first birth. I read the book Hypnobirthing by Marie Mongan, and listened to the CD that came with it a few times. As I understood it, Mongan was teaching that all "pain" in childbirth was a result of the fear/tension/pain cycle, meaning birth will not be painful if you are not afraid of it. I believed that what we experience in birth is a direct result of what we expect, so I chose not to expect pain. I was really oversimplifying things, and I was in for a rude awakening.

When I started having contractions (I refer to them as "contractions" here because that is what I called them at the time--I didn't buy into the idea of changing the words then) I admitted that "they hurt," but it was very manageable. They went on for quite a long time, going away and coming back, and then I was given a very low dose of pitocin, and those contractions really hurt. I was still able to cope using movement and deep breathing for a while, but I was really miserable. I do recognize that there was a psychological element to this pain. In my mind, something external (pitocin) was inflicting pain upon me, instead of it being caused by my own uterine muscles contracting. This, as well as exhaustion and pressure to dilate due to risk of infection, made it much harder for me to cope.

I think that I, as a first timer, espoused a common misconception about painless birth: believing that your birth will be painless just because you've heard of it and believe it's possible. I didn't think I needed to do anything to have a painless birth; I thought it would just happen because birth is not "meant" to be painful (right, Dr. Dick-Read?)

My understanding of this changed when I did the Hypnobabies program for my second birth. I don't know if there is really a difference in the two programs' views or if my experiences caused me to have this new understanding. I don't know if birth is really "meant" to be painful or not, but I do know that it involves a stimulus that the majority (at least in our culture) of women's brains interpret as "pain," which is generally experienced as a negative thing. Good hypnosis for childbirth provides a system for changing your mind so that the stimulus is interpreted as not painful, so that it can be experienced more positively. For me, with my second birth, experiencing it positively involved a conscious choice on my part.

Both Hypnobirthing and Hypnobabies use a technique of renaming some of the words commonly used in childbirth. This is a strange practice and, I admit, it's a little cumbersome at times, but many women find it helpful to avoid negative associations their subconscious may have with the words. One example is avoiding use of the word "pain" and using "discomfort" instead, because it is not as negative of a word. Some could argue that "painless childbirth" is about semantics, but it's really about what you choose to believe.

I believe that most women who have unmedicated births are able to find a way to experience the stimulus of the sensations of childbirth as not a bad thing, even if they do experience them as painful. In embracing a "pain with a purpose" ideology, women are choosing to tweak their understanding of the word "pain" (which is usually a negative word to describe a sensation that occurs when the body is being harmed) to include a kind of pain that is good. This essentially means changing the negative connotation of the word "pain" to be positive in this particular circumstance, while with hypnosis, we simply change the word, eliminating the negative connotation altogether.

I think some people, when they hear "painless," assume that means not feeling anything--that the "hypno-anesthesia" would be like an epidural and make them numb. It doesn't work this way. Hypno-anesthesia is very strong endorphins. It's like when you cut yourself or you twist your ankle and at first it hurts a lot, but then it doesn't hurt as much, that's endorphins. They soothe and dull pain, but they don't take away sensation. With a pain-free unmedicated birth with hypnosis, you would still feel your baby being born, it just wouldn't feel like pain to you.

Sometimes the talk of feeling "only pressure and tightening" in Hypnobabies leads women to expect that birthing waves will feel just like Braxton-Hicks waves. This is not true either. Braxtion-Hicks are just tightening sensations, for me, birthing waves (and also the pre-birth waves that can occur irregularly for weeks before the actual birth) have an extra level of intensity--what I now call a "downward pressure" which signaled to me that my uterus was now working to begin moving my baby down instead of just flexing itself for the exercise.

One of the changes in the new 6th edition of Hypnobabies is the re-recording and re-naming of a track that used to be called "Painless Childbirth" to "Easy, Comfortable Childbirth." Hypnobabies appears to be moving away from using the word "painless," which, considering all of the misconceptions about it, I think is a good move. I feel like "comfortable" is a more accurate description of how Hypnobabies helped me. Whatever sensations I felt (some of which I may have called "painful" under other circumstances), I knew they were normal and was able to not be afraid of them, which allowed me to feel calm and confident and not out-of-control or panicky (except during the cervical lip and the pushing, but I have theories about that). I wouldn't say I was "in pain," because for me, being "in pain" never involves that degree of serenity and self-composure.

I know there are some women for whom surviving the pain of childbirth provides a sense of accomplishment. It makes them feel like they are "hardcore." I, on the other hand, am not "hardcore," nor do I want to be. I can get a sense of accomplishment from seeing that I did something most people experience as very painful, and it was mostly comfortable to me, and I did it with my mind!

Wednesday, May 5, 2010

In honor of International Day of the Midwife

In addition to being the day Mexico celebrates their independence, May 5 is also International Day of the Midwife. In honor of the day, I'd like to share the link to the story of Puah and Shiphrah (from the book of Exodus) on Heatherlady's Women in the Scriptures blog. I love how the midwives in the story couldn't go against their divine responsibility to protect mothers and babies, even if it meant going against Pharaoh's orders.

I credit the nurse-midwife I had for my daughter's birth with helping me avoid an unnecesarian.

Does anyone have any good midwife stories to share?

Tuesday, May 4, 2010

A New Way to Assess Labor Progress Externally!

I don't like vaginal exams. I was pretty proud of myself that for the recent birth of my son, the first vaginal exam my OB performed was at 8 cm. I did check myself twice before that, but checking yourself is different because you can stop poking before you hurt yourself.

Someone on my natural childbirth forum posted this link:

It goes over what a vaginal exam measures and what it does (and doesn't) tell us about the progress of labor. It also goes over the risks, including rupture of membranes and infection. Okay, okay, tell us something we don't know, right?

Here's the good part: The credit is given to midwife Anne Frye for a method for measuring labor progress externally by comparing the location of the fundus (top of the uterus) at the height of a contraction to the zyphoid process (the cartilage at the tip of the sternum/breastbone):

Your birth attendant can determine how many fingerbreadths of space are between the fundus and xiphoid process at the height of a contraction.

# 5 fb = no dilation
# 4 fb = 2 cm
# 3 fb = 4 cm
# 2 fb = 6 cm
# 1 fb = 8 cm
# 0 fm = complete

To some this does not make sense: that the space between your xiphoid and your fundus shortens - becomes narrower - dilation advances since your baby engages more and more as the contractions push him inside the birth canal. Remember, the upper segment of your uterus thickens as labor advances. Your uterus also rises more as contractions intensify. This is also the reason why this must be done at the height of a contraction. Midwives have reported this to be very accurate...and a bonus no fingers where they do not belong!

At first it didn't make sense to me that the fundus gets closer to the zyphod process. I thought, shouldn't the uterus move down as the baby does? But then I got it: as the uterus thins and opens at the bottom, it thickens at the top--that's physics. This method is actually measuring dilation from the TOP of the uterus instead of the bottom. AMAZING!

If this method really works (and midwives say it does), then it could lead to the end of vaginal exams in labor! No more uncomfortable, intrusive exams that increase the risk of infection, and no more getting into uncomfortable positions to be be "checked," and no more ending up stuck in those positions to push.

I am definitely going to be telling my birth attendant about this whenever I have my next baby!

Sunday, May 2, 2010

Birth Attendant as Lifeguard

Clarification: I use the term "birth attendant" here to describe a maternity care provider such as a physician or midwife, not a doula. I don't often use this term, but I must have subconsciously chosen to use it while writing this post because it is most appropriate for the role I was trying to describe, the midwifery model's idea of a caregiver who "attends births" rather than "delivers babies."

Since writing my last post about lessons from the freebirth movement, I have been thinking more about the roles of birth attendants. A guest post at The Gift of Giving Life (one of my favorite blogs) written by Heatherlady called On Cows and Chickens, got me thinking even more.

I believe that women are created to be able to birth their babies. I have read a lot about how hormones control birth and how negative emotions affect hormones and thus interfere with birth. I think that when a birth attendant interferes with the delicately balanced natural process of birth, they risk doing more harm than good. And interfering can probably happen easier than we sometimes realize.

People who believe strongly in the natural process of birth, including unassisted birthers, often compare birth to other normal activities that have some small level of risk associated with them, such as driving a car, playing a sport, etc. They argue that we don't need immediate access to medical technology while doing these things, so we shouldn't need it for birth.

My husband hates analogies because people sometimes use things that are not similar enough to make a good comparison, and I often agree (for example, unmedicated childbirth is not like getting teeth drilled and has nothing to do with hitting yourself with a hammer). However, occasionally, I find a good anaolgy. One such analogy, which I originally got from the Hypnobabies program, compares the birth attendant to a lifeguard.

Although birthing is instinctual and swimming is a learned behavior for humans, there are still a lot of similarities between the two. Swimming is an everyday activity, and the risk of drowning is quite low. The website for the International Life Saving Foundation(ILS) cites a drowning rate of 1.2 million people per year. Worldwide, swimming is statistically safer than childbirth, as the World Health Organization statistics from 2005 give a stillbirth rate of about 3.3 million, and a neonatal death rate (during the first 28 days of life) of over 4 million (WHO World Health Report). Worldwide maternal mortality for 2005 was 536,000 (WHO maternal mortality)

Most people who know how to swim feel confident and comfortable doing so freely without immediate access to medical technology. We are cautious with our young children, for whom the risk of death is greater ( the ILS website states that children make up more than 50% of drowning victims). But with the proper precautions (such as careful supervision and use of flotation devices), swimming can be safe and enjoyable for young children as well.

Despite the relative safety of swimming, we have people trained to attempt to make it safer. According to the ILS website:
The terms “lifesaver” and “lifeguard” are used around the world to describe individuals with special training who are stationed to prevent accidents and to respond to life-threatening emergencies in the aquatic environment.
My older brother used to work summers as a lifeguard at one of the community pools in the area we lived. His job involved watching swimmers to make sure they were safe and reminding them the rules that would could protect them from danger (things like no running, no diving in the shallow end, and making sure the area below the diving board is clear before diving). He had special training and certifications for the job, and was paid for it. Life guarding is often over-dramatized in movies and television, where they are always jumping in to save people and doing CPR. My brother never had to rescue anyone, he mostly sat on his tower all day and worked on his tan, but he could have saved someone if he needed to.

The ILS website estimates that those trained in their lifesaving skills make over 1 million rescues a year. Considering the drowning rate of 1.2 million per year, that means they cause a significant reduction. Parents who take their children to a pool with a lifeguard might feel some assurance knowing that there is an extra layer of safety there--an extra pair of eyes watching for danger, someone who is trained in rescue swimming and has current CPR certification.

I like to think of a good birth attendant as being like a lifeguard. They are specially trained professionals who have the skills to save lives when things go wrong. Occasionally, they may remind a birthing mom to breathe deeply or help her relax, but mostly they should sit and watch for signs of problems. "Watching" could possibly include a variety of things (checking hearttones, recognizing pathological labors, checking for tears, monitoring blood loss, ect.), but it should not include routine unnecessary medical intervention (e.g. elective induction, IV drips, pitocin augmentation, artificial rupture of membranes, etc), telling the mother how to birth her baby, or making decisions for her. In the event that there are complications, birth attendants can save lives (by helping get shoulders unstuck, giving pitocin for bleeding, resuscitating an oxygen-deprived newborn, ect.) much like a lifeguard, but if lifeguards were to jump in and pull people out of the water who didn't need saving, they would likely interfere with people learning to swim on their own and ruin people's swimming experiences.