Tuesday, November 30, 2010

Order in Our Lives, Even with a Baby

I know some people say that it is okay for your house to be messy when you have a baby. To some extent, this is true, it is important to not be so focused on having a clean house that you never play with your children, but having a really messy house can really make parenting difficult. When the house always messy, you can never relax and enjoy your kids because you are always thinking about all the cleaning you need to do. Humans need structure in their lives. Order allows us to have peace.

I recently realized that I my kids and I really needed a little more order and structure in our lives. I realized that I felt overwhelmed by my house never being clean, and I was using the computer as an escape from my responsibilities. When I did clean, I would exhaust myself trying to clean everything at once, and then I would feel "burned out" from cleaning and wouldn't maintain it, and the house would soon deteriorate into chaos again. I really wanted to develop the concept of rhythm for my kids, as taught in Waldorf education (which I have been studying after Sheridan blogged about the changes she is making in her home now that her kids are going to a Waldorf-inspired charter school), but I realized it wasn't possible with the level of chaos in our environment.

I found a wonderful system for establishing habits of cleanliness. It's Flylady's Beginner Babysteps. I am on Day 8 today, which means I have been doing it for a week, and the improvement is slow, but it is lasting change, not a temporary fix. I feel like I am finally getting some control in my life. One of the routines is you get dressed first thing in the morning, from head to toe. This encouraged me to finally go out and get my hair cut. I hadn't had my hair cut since I was pregnant with my son, who is almost 9 months old. And my kitchen is clean, which means I can actually cook dinner for my family.

I have been limiting my computer time, and as a result haven't been working on blog posts as much. I have a second post in the works about the book I read, Sisters on Journey, which I will hopefully finish eventually. If you don't hear from me, I am probably either enjoying my kids or working on creating a more peaceful environment for them.

Tuesday, November 23, 2010

A Birthy Thanksgiving

I found out that Preparing for Birth is doing a blog carnival for Thanksgiving on being grateful for our birth experiences, so I'm joining in. I have so much to be thankful for with my births, both good and bad.

In my First Pregnancy and Birth:
  • I'm grateful that I found information about natural childbirth. The paradigm shift I experienced changed me forever, and having had both a pro-epidural and low intervention attitude, I understand better where people are coming from.
  • I'm grateful that I asked questions of the OB I had been seeing and realized his policies were not good obstetric medicine so that I didn't end up giving birth with him as my provider.
  • I'm grateful that I found a wonderful midwife group who took me at 34 weeks and were very supportive and made me feel comfortable.
  • I'm grateful that I learned how harmful going to the hospital too early can be.
  • I'm grateful that I experienced pitocin induction, so I can sympathize with other women who have had it.
  • I'm grateful that I had an epidural, both because it was what I needed at the time and because it taught me to be able to tell other women that sometimes the epidural is the best choice for that particular birth.
  • I'm grateful that my epidural worked as it should, not too numb and not ineffective, and my baby was born without needing any further intervention.
  • I'm grateful that I tore so I can empathize with women recovering with perineal stitches.
  • I'm grateful that my husband was exactly what I needed him to be through the whole experience.
  • I'm grateful that my birth experience was not exactly what I wanted because it inspired me to prepare more for my second birth and was part of what inspired me to pursue a career as a birth professional.
  • I'm grateful for my beautiful, healthy little girl, who is now almost three.
For My Second Pregnancy and Birth:
  • I'm grateful that I ended up with an amazing OB, who restored my faith in the profession.
  • I'm grateful that I experienced the benefits of using Hypnobabies during my pregnancy
  • I'm grateful that I can compare pitocin induction to spontaneous labor.
  • I'm grateful that I got to labor as long as I did in the comfort of my own home.
  • I'm grateful that I learned that I had the power to make my birth much more comfortable with focus and relaxation.
  • I'm grateful that I progressed smoothly and arrived at the hospital at 8 cm, which further removed the temptation of pain relief.
  • I'm grateful that I didn't know I was GBS positive so I didn't go to the hospital earlier, and that my baby was still healthy.
  • I'm grateful that I learned how hard it can be to maintain focus with hospital distractions.
  • I'm grateful that I wasn't able to keep using my Hypnobabies during second stage so I can understand how intense natural childbirth can be.
  • I'm grateful that I did not tear and got to experience how much smoother recovery goes with an intact perineum.
  • I'm grateful that my nurse carefully read my birth plan.
  • I'm grateful that my husband exceeded my expectations as a birth partner.
  • I'm grateful that my mother-in-law did not circumcise my husband, so my husband and I easily agreed to leave our son intact.
  • I'm grateful that my experience with this birth reinforced my interest in becoming a Hypnobabies Instructor.
  • I'm grateful for my beautiful, healthy 8 month old boy, who thinks he is a toddler already.
My babies have truly brought me a cornucopia of blessings :)

Kessel- Der Erdteil Europa - Rome - Detail Füllhorn
painting by Jan van Kessel the Elder [Public domain], via Wikimedia Commons

Happy Thanksgiving, everyone!

Monday, November 22, 2010

Traditional Birth Secrets: The Rebozo

What is a Rebozo?

A rebozo (pronounciation) is a woven piece of fabric used by Mexican women as a shawl, a baby carrier (similar to the way I use a wrap, but the fabric is not as long), and a comfort and positioning tool for pregnancy and childbirth.

Photo by Luis Marquez
Courtesy of Special Collections, University of Houston Libraries

Rebozo Use during Childbirth

Techniques for the Rebozo in childbirth include:
  • "sifting" the mother
  • to aid in the double hip squeeze
  • rocking or dangling the mother
  • covering the mother's eyes and ears to block distractions
  • for the mother to pull on, especially during pushing
The "sifting" technique is the most well-known uses of the rebozo in birth. It is a method jiggle a woman, similar to what Ina May Gaskin calls "shaking the apples." The motion promotes relaxation of the birthing muscles, which can aid in rotation and decent of the baby. Here is a demonstration of the "sifting" technique from a doula training:

Here is the above technique being used in at the hospital during a pitocin induction:

The technique used in the above two videos are explained more in-depth at the Spinning Babies website.

In my doula training, I learned how to do a technique called a "double hip squeeze" with my hands to open the pelvis. This video explains how to use the Rebozo to make the double hip squeeze easier:

More articles and pictures:
  • The Rebozo: a transcript of a rebozo workshop given by Doña Irene Sotelo and Naolí Vinaver, published in Midwifery Today (more pictures can be seen by following the link below the photo shown)
  • "Comfort Measures for Childbirth: Let's do it with a Rebozo"--a collection of images by Patti Ramos taken at a rebozo workshop with Guadalupe Trueba, including images of the rebozo used for rocking , putting it over the eyes to block out distractions, to pull on while pushing, and other uses
  • The Many Uses of a Rebozo at Birthing Essentials--short explanations with pictures of many of the techniques
For more information on traditional baby carriers and rebozos, visit www.rebozoway.org.

Saturday, November 20, 2010

Research-backed Benefits of Hypnosis for Childbirth

As explained in this article, a meta-analysis of selected studies on hypnosis for childbirth found that women who used hypnosis were:
  • 51% less likely to use drugs for pain relief (38% of the hypnosis group used pain medications, compared to 74% in the control group)
  • 70% less likely to have their labors augmented (11% in the hypnosis group were augmented, compared to 70% in the control group)
  • 67% more likely to have a spontaneous vaginal delivery (meaning they were not induced and did not have cesareans)
The limits of this study

Despite it being a meta-analysis, the sample sizes are still quite small. As far as I can tell, the control group represents the standard population, which would include women who do not do any childbirth preparation and/or who planned to have epidurals. It would be interesting to see research comparing women using hypnosis with other methods of natural childbirth preparation, since that would provide a clearer picture of the unique benefits of hypnosis.

One reason why hypnosis is such an effective method of birth preparation: research shows women are more easily hypnotized during pregnancy.

Wednesday, November 17, 2010

Joseph B. DeLee: Obstetrics that Sucks

My first baby being suctioned with a DeLee Mucus Trap

Joseph B. DeLee, inventor of the suctioning device still commonly used in American hospitals today (though routine suctioning might actually be harmful), was an obstetrician in the early 1900s. In my Childbirth International workbook, I came across this lovely quote from him:

Obstetrics has a great pathologic dignity. Even natural deliveries damage both mothers and babies, often and much. If childbearing is destructive, it is pathogenic, and it if is pathogenic it is pathologic

If the profession would realize that parturition viewed with modern eyes is no longer a normal function, but has imposing pathologic dignity, the midwife would be impossible even of mention.-Dr. Joseph DeLee, 1915

Sometimes the words of Dr. DeLee are so extreme they sound like satire. They're not. The guy was serious. I first read about him in Tina Cassidy's book Birth, the Surprising History of How We are Born, which is a very easy-to-read tracing of the history of obstetrics and midwifery in the U.S.--The author of which, who had a standard hospital birth-turned-cesarean for her first birth, came out of the writing of the book a believer in midwifery, and had a HBAC with her second child (you can find the story if you dig around the archives of her blog). It was also in Cassidy's book that I first learned that a large percentage of women in the late 19th and early 20th century, including the population DeLee would have treated, were afflicted with rickets, a bone softening disorder caused by Vitamin D deficiency that often caused people to have severely deformed pelvises.

With a quick googling his name, I found that Jill at the Unnecessarian has already posted a whole series on the writings of Joseph B. DeLee:
Dr. DeLee was a very influential figure of his time, and his ideas were very shaping of the course maternity care in this country. The influence of DeLee resulted a wiping out of nearly all of the traditional body of knowledge about birth (luckily, a few "grand midwives" survived, mostly in the South, allowing one unbroken link to the midwifery past), and replaced it with an ideology that was not founded in science, but the belief that birth was a problem, and technology was the solution.
Obstetricians, as members of society, tend to blind faith in technology and the mantra: technology = progress = modern. The other side of the coin is the lack of faith in nature, best expressed by a Canadian obstetrician: 'Nature is a bad obstetrician.' So the idea is to conquer nature and results in the widespread application of attempts to improve on nature before scientific evaluation. This has led to a series of failed attempts in the twentieth century to improve on biological and social evolution. Doctors replaced midwives for low risk births, then science proved midwives safer. Hospital replaced home for low risk birth, then science proved home as safe with far less unnecessary intervention. Hospital staff replaced family as birth support, then science proved birth safer if family present. Lithotomy replaced vertical birth positions, then science proved vertical positions safer. Newborn examinations away from mothers in the first 20 minutes replaced leaving babies with mothers, then science proved the necessity for maternal attachment during this time. Man-made milk replaced woman-made milk, then science proved breast milk superior. The central nursery replaced the mother, then science proved rooming-in superior. The incubator replaced the mother's body for care of low-weight newborns, then science proved the kangaroo method better in many cases.
-Marsden Wagner, MD, MSPH, Fish Can't See Water: The Need to Humanize Birth in Australia
...Routine pitocin and cord traction replaced physiological delivery of the placenta, then science found a natural third stage superior for low risk women.

Science has helped American maternity care come a long way from DeLee's time, but the fact remains that the roots of our obstetric system are in the ideas of people who had a lot of things about birth wrong, at least when applied to a population of women with normally developed pelvises. I also believe he was wrong about midwives. Obstetrics (speaking of the profession generally and not of specific members) will continue to be at odds with those who support the midwifery model as long as it continues to dismiss the value of childbirth knowledge gathered by those who learn by being with woman.

Saturday, November 13, 2010

How you can win a Baby Bond--the nursing cover that covers you and not your baby

I wrote before about how I usually don't cover my babies' heads while nursing them in public. I usually wear a nursing tank under my shirt and nurse from the bottom of the shirt, and then everything is covered, as you can see in this photo. However, this doesn't work with button up shirts, dresses, and some wrap-style tops. The Baby Bond is a sash-style cover perfect for remaining covered while nursing from the top of your shirt, and you don't have to cover up the baby's head!

Sheridan at EnjoyBirth is giving away a sample Baby Bond Flex that she reviewed. Click here to learn how you can win!

Tuesday, November 9, 2010

Results Are In: Austrailan Study Supports Physiological Third Stage!

Back in June, I wrote about a theory paper by Australian researchers that I read that discussed the limits of current research literature that does not compare medically managed bith with truly "psychophysiological" birth, meaning unmedicated birth without routine interventions, in a comfortable setting with supportive care. This means that you can't compare the third stages of an actively managed hospital birth with a hospital birth where oxytonics and cord traction are not used, but other hospital factors are included--such as early cord clamping/separation of mother and baby, distractions, stressful atmosphere, IV fluids, unnatural positioning, etc, and claim that "expectant management doesn't work." The article proposed research that could be done comparing what they called "midwifery guardianship" with "active management."

I just learned today (thanks to Birth Sense) that the Australian researches who wrote the theory paper have completed a study on third stage management. The abstract is available here, and the results are very interesting! The study found that for low risk women, active management in a hospital was actually associated with a significantly higher rate of postpartum hemorrhage (11.5%) than the rate they found for midwife-led "holistic physiological care" in a freestanding birth center (1.7%). Considering that previous studies had found the risk or hemorrhage using other definitions of "expectant management" to be higher, these findings are important for determining what factors are necessary for a safe, natural third stage.

Monday, November 8, 2010

Birth and Death: "to mourn with those that mourn"

Today, Navelgazing Midwife wrote a beautiful post comparing the transition phase of childbirth to the transition of death. It related so much to so many other things I've been thinking about, studying, and experiencing, and inspired me to finally get those thoughts down in writing.

I have been reading my second book for the Childbirth International book review assignment (the first one inspired me to write posts on progesterone and celebrating fertility). My local library had a book that was on the list called, Sisters on a Journey: Portraits of American Midwives by Penfield Chester. Chester interviewed 27 midwives for the book, and each chapter tells one of their stories, each in that midwife's own words. I am really enjoying reading all the different perspectives. I find it inspiring, for any future midwifery aspirations I may have, but also for doula work, as it has taught me that doula-ing is actually a very large part of midwifery.

One of the common themes in the interviews is dealing with the responsibility of life-or-death situations and the possibility of death being so close. Honestly, this is something that terrifies me about the idea of becoming a midwife. I don't want the pressure to have to make such important decisions and have to act quickly and skillfully in a crisis. This book has taught me that my feelings are normal and has helped me learn how midwives may deal with that responsibility. I also learned that birth and death have a lot in common. Here is one example that stood out to me, from the interview with renowned midwife, Ina May Gaskin.
In our community, although we had never read anything about this, it was the midwives that naturally gravitated toward being with families who were dealing with death. Everyone noticed that death felt much like birth, that there was the same sort of energy--a very heightened awareness. Things and people looked dear to you; you had the sense of life being precious, of the need to be good to each other, of the need to be thankful for life, of the need to be attentive to what you had to say, of the need to mix sadness and laughter, to tell stories, to come together and be very human with each other. Not to think about money, not to think about what would anybody think.

My own baby was the first one in our community that died. I was in the first few months of my midwifery practice, exhausted and anemic, and he was born very premature and lived for twelve hours. I knew that he couldn't have been saved a the time, so we didn't go to the hospital. We did what we could, but I knew from losing him, I learned a lot. I think if it had happened to somebody else I wouldn't be a midwife now. But because I had the support of the community, I learned about grieving. I also knew that in some what that happened to teach me something important as a midwife and so I tell that story. I've learned about healing, and I learned about how you treat somebody when they've lost a baby.

(Chester, Sisters on A Journey, 1997, pg. 132-133)
That's all I am going to quote here, but Ina May also explained more about how midwives are like "gatekeepers" of birth and death, and also told the story of her daughter's death at a young age.

I recently saw the film The Curious Case of Benjamin Button, and though I found the film very long and the ending, sad, I learned the lesson I think it was trying to teach--growing up and getting old are really the same, just in opposite order, and life is really more of a circle than a line. Based on this perspective, birth and death are basically the same.

October 15th
was Pregnancy and Infant Loss Remembrance Day. As I lit my candle that evening, I thought of my friend who lost her baby in her second trimester recently. I was very affected by the loss, since we had discussed her preparations for the birth and I had offered to serve as her doula. I found I needed to cry alone about it, and I don't think I would have anticipated that happening.

Last week I learned that my high school U.S. History A.P. teacher, now retired, was killed in a car accident while traveling in Greece. She was my favorite teacher, an entertaining storyteller whose love of history really shined in her teaching. She was an inspiration, the kind of educator I aspire to be. Any time such a vibrant person leaves this world, it kind of brings you face-to-face with your own mortality.

Through all of these experiences and learning, the following passage from the Book of Mormon has been on my mind:
...and now, as ye are desirous to come into the fold of God, and to be called his people, and are willing to bear one another’s burdens, that they may be light;

Yea, and are willing to mourn with those that mourn; yea, and comfort those that stand in need of comfort, and to stand as witnesses of God at all times and in all things, and in all places...(Mosiah 18: 8-9)
These verses represent the covenant one makes when joining our faith. Interestingly, the last part of it is quoted in the document I wrote about in my Guest Post at the Gift of Giving Life. It is the part before that which I have been thinking about, especially "to mourn with those that mourn." If we have charity and love others as God loves them, we will have the desire to support others through their journeys in life. This includes things like crying with someone who is in the middle of grief. I have been thinking that maybe working with pregnant and birthing women, in the fragile time of newly developing life, who will sometimes not keep that life as long as we all would want them to, will be my personal way to fulfill my promise "to mourn with those that mourn."