Birth Unplugged

Between Worlds: A Birth Story, Part 3

2011-12-18T11:30:00.000-08:00

When we left me, I was kneeling on the bathroom floor brushing my teeth. I was still needing to find a comfortable position. We tried putting a stack of pillows on the floor so I could kneel leaning forward on the bed, but that didn't work for me either. Kim suggested I get on the bed and lean forward on the birth ball. That position was perfect. I used the ball to help me rock, sometimes back and forth, sometimes side to side. I started saying "peace" out loud during the pressure waves. Kim said that when I had gotten off the birth ball, the waves had suddenly gone from about 6 minutes apart to 3 minutes apart. They also let me know that Lorri was in about 25 minutes away, and Kristin was coming and bringing the assistant, Kelly, who was a nurse. I felt some strange sensations above my pubic bone--I wonder if it was the baby's head rotating or moving down. I suddenly wanted my t-shirt and pajama pants off, so I took them off, and was wearing my swimsuit top (which I had put on under my shirt after my shower that morning) and some mesh panties I found in my birth kit. Then, I sat up on the bed. It seems like a strange choice of position, but it was really comfortable at the time.

My midwife Lorri arrived. She said she would check my vitals before I got in the tub and went to get supplies. I got off the bed to go to the bathroom and then Lorri came back and took my blood pressure and temperature, and listened to the baby’s heartbeat, and all was well. I got in the tub. The tub was big and deep and I loved how I could get into all different positions in it. I took off my headphones and we played Hypnobabies out loud because I didn’t want to accidently get anything wet that wasn’t supposed to get wet. I reminded my team about the video camera, and my husband filmed me in the tub, including one pressure wave, and then went out of the bedroom and filmed the other people in the house The water in the tub was pretty hot, but I like hot water, so I didn’t really mind, until I had a few pressure waves in the tub and got really hot during them. Kim brought me a cold washcloth to put on my neck to keep me cool, but eventually I just had to get out. I think I went to the bathroom again, and then I was leaning on the side of the tub during a wave and I felt the need to yell at the peak of it. Lorri heard this, and came in. I told her I thought I was feeling pushy. She said to just try to let my body do most of the work and only push when I couldn’t help it. She asked if the water was too hot and I said yes, so she and my husband dumped in a few bowlfuls of cold water. I got back in and the temperature was much better.

Kim was filming now, and my husband knelt near the tubKristin and Kelly must have arrived around this time and came into the room and set stuff up. They were behind me and very unobtrusive. I remember turning around to make sure they were there a few times, because I guess knowing they were there was reassuring for me.

I remember reading once that in some tradition somewhere (I can't remember where), the birthing woman is thought to have to travel to the underworld to claim her baby. The beginning of pushing was definitely the most challenging part for me. Feeling that much power moving through my body was overwhelming, and I didn't quite know how to respond to it. At the peaks of the waves, when I couldn’t help pushing, I would vocalize loudly, because that seemed like the best way to release that intensity. I changed positions a lot, and loved the ease of movement in the water. I usually knelt low in the tub or was on all fours between the waves, and often during them, I had to go to a high kneel and throw my arms around my husband. He gave me Hypnobabies cues which helped me relax better. I remember apologizing for getting him wet. At one point, I was on hands and knees and lowered my face so close to the water that my bangs got wet.

Soon, I felt the baby’s head coming down and I said something like, “The baby is coming out! The baby is coming out!” It was almost like I didn't really expect the intense part to actually end, but the baby moving down meant it was definitely going to. Lorri, who was next to the tub on my left, turned to my husband and asked if he wanted to catch his baby, and he must have said he would because she started giving him instructions on how to do it. I switched from kneeling to a deep squat. With the next wave, pushing just happened. I roared, and the head became visible. I remember saying something about how excited I was that we were almost there. As the head crowned, I leaned back, letting my legs float forward in the water and my head rest against the edge of the tub, supporting myself with only my arms and head, while the rest of me floated. With the next wave, the head was out, and with the one after that, I eased the shoulders out, and out came our baby at 8:39 pm!

My husband lifted the baby out of the water, and I sat down in the tub and took my baby into my arms. He looked to see if it was a boy or girl, and exclaimed, “It’s a girl!” I was shocked because I had myslef convinced it was a boy! She gave a small cry and then got quiet and looked around.

My mom brought our two older kids in. It was neat for them to get to meet her so soon after she was born. Our son, who is 21 months, was a little more interested in the water, though, and put his hand in it (someone washed his hands), and he wanted to take his pajamas off and get in, too, but we didn't let him. The cord was short, so I was limited to holding her against me with her head on my chest, just out of the water. Lorri encouraged me to talk to the baby, so I babbled to her about all kinds of things as we waited for the placenta.

I had to push pretty hard to get the placenta out, and the membranes were trailing and full of clots. Then my husband cut the cord and Kristin helped me get out of the water and into the bed with the baby and then the baby had her first nursing. No one but me held her for over an hour after the birth. It was so peaceful and wonderful. When we weighed and measured the baby, she was 6 lbs 11 oz and 20 inches long. And perfect.

I was amazed at how minimal the damage to my body was. I didn’t tear with my second birth either, but this was even better. My vulva wasn’t even swollen and the little bit of soreness I had went away in a few days. I think it was mostly because I did mother-directed pushing this time and because the water acts as a big warm compress.

One of the names we gave our new daughter is shared with my mother-in-law’s sister, who passed away a few days later, in my mother-in-laws arms, soon after she arrived at her bedside. I am struck with the similarities between their transitions, one into, the other out of this world. I am so blessed to have been able to give my daughter a transition into this world that was gentle and loving as well as safe. Perhaps when we come out on the other side, we will be gently lifted into peace and parental love.

End? No, the journey doesn't end here. Death is just another path, one that we all must take. The grey rain-curtain of this world rolls back, and all turns to silver glass, and then you see it . . . White shores, and beyond, a far green country under a swift sunrise. -Gandalf the White, Lord of the Rings: The Return of the King (film version)

Between Worlds: A Birth Story, Part 2

2011-12-17T17:02:00.000-08:00

Thrilled and terrified at the same time, I woke my husband up in a panic and told him I needed his help to handle these waves. I texted my midwife and she said to let her know when they had been consistent for about half an hour, and I texted my doula, Kim and told her that I was ready for her to come. The time stamp on that text is 3:35 pm.

I grabbed the Hypnobabies Birth Partner Guide and opened it to the birth prompts I went to the music on my phone and turned on Easy First Stage. I wanted to get into hypnosis as fast as I could and make this easier. I switched to the relaxation music for a while and we tried the birth prompts, but it wasn't really working for us, so my husband suggested I go back to Easy First Stage since I had found it so helpful in our last birth, and he would just do the "Relax" cue during the waves. I was sitting on the birth ball leaning forward onto our bed. I felt like the ball needed more air in it, so I asked my husband to blow it up for me. It was much more comfortable when it was fully inflated. My doula got there and she timed the waves and gave me encouraging words. My husband brought me some headphones and suggested I try using them to help me focus. At first I said no, but then I decided to try it and he was right, it did help. She and my husband were kind of tag teaming making sure the kids were okay in the other room. I stayed in "OFF" between waves, except to talk or to drink my poweraid. This helped me get deeper faster. For some of the waves, I would switch to "CENTER" and bounce gently on the ball, because it felt better. As I got deeper, I tended to stay in "OFF" and breathe deeply and use my peace cue. It didn't completely relieve the discomfort, but it helped enough that I felt calm, relaxed, and in control. This was Kim's first experience with a Hypnobabies birth. She was very impressed. I finally found my confidence, just in time.

After it had been about half an hour, someone called Kristin to let her know these things were not stopping. She said the other midwife, Lorri, was on her way, and she'd also be coming shortly. I stayed on the birth ball, except to go to the bathroom, which was just a few feet away. Whenever I got up, I would have extra pressure waves that were not as strong. Whenever Kim heard me start breathing deeply, she would write down the time, then come put her hand on my shoulder. My mom called at 5:40 pm. I told her I was in labor. She had been up very early and traveling all day and wanted to go to bed, but I kind of wanted her to come over and take care of the kids, so she said she would come. She came over and that freed up my husband and doula to both stay with me.

At some point, I noticed my legs were starting to feel stiff from sitting in the same position on the ball. I let my support team know that I wanted to change positions. We tried putting pillows on a chair so I could kneel leaning forward onto the bed, but when the next pressure wave started, that wasn't comfortable and I got up and did the slow dance position with my husband. When that one was over, I exclaimed, "Nausea!" my husband asked if I wanted a bucket and I said yes, but then I just walked to the toilet and threw up there. I heard my husband explaining to Kim that in the past, vomiting has been a sign that I was getting very close. They asked me how I felt, and I said I felt better after throwing up. My husband gave me my toothbrush with toothpaste on it and a cup of water so that I could brush my teeth and rinse my mouth out. My team decided to check with the midwives again, to make sure they'd be here soon, since it looked like I was in the transformation phase.

Between Worlds: A Birth Story, Part 1

2011-12-14T23:44:00.000-08:00

At about 5:00 am on Wednesday, December 7, I woke up to a leaking sensation. It felt like a period, or rather, it felt just like when I leaked amniotic fluid before my first birth. I got up and put on a pad and laid back down. At about 6:30, I felt a gush. Not a gush like all my fluid was coming out, but a definite gush. I texted my midwives and let them know this, and that I was not having pressure waves yet. I woke up my husband a little while later and told him that my water broke but it could still be a while before the baby came. He said that he would stay home from work. I also texted my mom, who told me she would get a flight for the next morning, thinking that if I had the baby that day, she would be there in time to take care of everything I would need postpartum. My midwife Kristin called and said she would come take my vitals and give me a Doppler so I could keep an eye on the heartbeat. She came by and she also drew some blood because she was planning to do a re-check on my iron level at my appointment on Friday. She instructed me to eat and drink well, to rinse with a hibiclens solution whenever I used the bathroom, and to take my temperature and check the hearttones every hour and just let her know when pressure waves started. She said she thought it would probably be that day.

My husband spent the day cleaning up the house, buying food for after the birth, and doing last minute homebirth set up preparations. I helped a little, but didn't want to wear myself out. Pressure waves started by that evening and were about 10 minutes apart for a while. Around 10:30 pm,still thinking the baby would come that night, I decided to try lying down and listening to Hypnobabies to try to get some rest, or at least get myself into hypnosis. I ended up in and out of sleep all night because they spaced out, but didn't completely stop. I had my ipod on a playlist of Hypnobabies tracks so that it would just keep playing while I slept. I probably would not have gotten any sleep at all that night if I had not had Hypnobabies to listen to. The pressure waves were manageable when I was awake and listening, but when one would hit while I was asleep and I was woken up by it, it was extremely uncomfortable.

I got up around 5:00 and took a shower to see if that might do something, but waves were very far apart, so I ended up going back to sleep for a while. Husband was up around 7:00 am. I was kind of getting frustrated with the waves because they seemed to be far apart but strong when I was lying down, weak and close together when I was standing up, and seemed to almost completely disappear when I was sitting. I told him I was having some fears about being able to handle it because the waves seemed stronger than in my last birth (my theory is that the difference had something to do with my water not breaking until 9 cm plus last time) and I think with them being so far apart, yet so strong, I wasn't able to get deeply into hypnosis like I had with my last birth where waves started consistently 10 minutes apart and gradually got closer and closer together. I also was a little worried that it could still be a long time before active birthing started and I would be exhausted from not getting enough sleep by then. I was conflicted--I wanted birthing waves to come consistently so that I would have energy for the birth, but I also was a little afraid of the birthing waves. I asked my husband to give me a priesthood blessing for strength and comfort and to help me know what to do.

We could tell the kids needed to get out of the house (preschool group had been cancelled both days that week, so they had been home all day most of the week), so my husband took them to the store with him to get some things. It took a while to get them ready and get out of the house, and there were a few other things he needed to take care of. We ended up needing to eat lunch before they could go. Before they left, he was also on the phone with his mom. His mom's adopted sister had recently gone into a coma due to a brain infection and she was given a very small chance of survival. My mother-in-law wanted to go to Tahiti to be with her family during this difficult time, but did not have the funds. We offered to help pay for a plane ticket for her to go. My husband wanted to get out the door with the kids, so he had her talk to me to get our credit card information and she and I had a sweet conversation. There I was, with my birthing in limbo, waiting to bring a new life into this world, while she knew she was waiting for one to leave it. Perhaps my child and his or her great aunt were both delaying their transition. Maybe there is a place between our world and the world of spirits, and they were both there, together?

After I got off the phone, I decided a nap was a good idea (it was early afternoon by this point). I got in bed and listened to Hypnobabies again. I think I did the Fear Clearing track. I knew I needed that. I got some sleep. I woke up and my husband and the kids came home. I decided to try some activity to see if it might kick start things. My husband tried to take a nap himself. I mopped my kitchen floor. Then,I stood in front of the mirror in my kids' bathroom and remembered something I had learned at the Dancing For Birth&trade Training Workshop: asymmetry. Asymmetry of the pelvis can help position the baby and bring it down. The move I started doing wasn't exactly one we learned in the training, though it was sort of similar to the mighty mama (sumo) move--I alternated raising each knee up, quickly, one and then the other, over and over, and then a strong pressure wave came, and a few minutes later, another. They were strong and they weren't stopping. This was it!

Its a Girl!

2011-12-09T14:55:00.001-08:00

Baby Girl born at home in the water at 8:39 pm on 12/8/11, 39 hours after my water broke. 6 lbs 11oz, 20 inches.

Pregnancy Update: 38 weeks

2011-12-02T14:18:00.000-08:00

Yep, still pregnant! I apologize for my absence. I have been busy, and I also haven't had the laptop I usually use, and have been accessing the Internet from either my phone or the iPad, both of which are a little harder to blog from than an actual computer.

The day after Thanksgiving, my husband and I left the kids with my family who were in town at the beautiful cabin my parents rented an hour away from our house so that we could have Thanksgiving with everyone without me having to travel so late in my pregnancy, and we went to my 37 week midwife appointment. We learned that the baby, who had been head down for weeks, had suddenly flipped to transverse lie! This is a pretty unusual thing for a baby to do at this point. My midwife gave me sone suggestions to try to encourage the baby back to head down. I knew there was a small chance that the baby might not turn back before labor, and as I thought about this on the drive home, after a nice lunch at a restaurant with my husband, I felt peace about it. I knew that if I had a cesarean, yes, it would be a challenge for me, but I knew that if it happened, I felt strongly "that all these things shall give [me] experience and shall be for [my] good." (Doctrine and Covenants 122:7). I have gained valuable lessons from each of my children's births, both the good and challenging parts, which I wrote about in last year's Thanksgiving post. I expect to learn from this birth, but have no expectations about what those lessons will be.

The night after my appointment, I put ice above the baby's head and a warm pack above my pubic bone. I felt a whole lot of movement and then felt my belly. I felt a bulge under my ribs, a firm area below it, and what felt like a head in my pelvis. For the next week, I checked often, and it continued to feel the same, and kicks were on the upper right and hand movements near my left hip. My midwife confirmed it today--baby is right occiput anterior!

I am still working on completing preparations for the birth and the baby. Most of the important stuff is done. I finally got the birth tub bleached out and brought into the house. I am starting to look forward to meeting this child face to face, but I may never get to a point where I feel completely ready!

Pregnancy Update: 36 weeks!

2011-11-15T10:45:00.000-08:00

I really have been in denial about this baby coming! Two nights ago, I had some serious feeling pre-birth pressure waves (Hypnobabies lingo for false labor), and I think that made me finally start to accept that this is really going to happen!

I have had two midwife appointments since I posted my last pregnancy update. At my 32 week appointment, I learned that the results of my glucose screen were excellent. I also learned that there had been a mistake with the tube the blood was drawn in for the CBC I had drawn at the same time. I decided to re-draw it because I really wanted to know what my iron level was. The midwife and I discussed the supplements I was taking, and she told me the vitamin D I was taking (2,000 IU) was probably not high enough. A recent study found that routine supplementation with 4,000 IU in pregnant women (ten times the current recommended daily intake) resulted in no harm and better outcomes. Considering that my level was very low in my prenatal blood work (and that was in the spring time), I need to be taking a much higher dose, so I have upped it to 10,000 IU a day.

A couple days later, my midwife let me know the results of my CBC--my iron was low. Not dangerously anemic low, but low enough for me to feel tired. I started taking Floradix, and feel so much better. I realized that the amount of sleep I was needing to function (about 9-10 hours in a 24 hour period) was not normal, and I have so much more energy now. I am keeping my house clean while busy with preschool and Hypnobabies and feel like I'm staying on top of things pretty well! I took it in my last pregnancy when my iron came back a little low at the same time and I thought it increased my energy level then, too. Why didn't I start taking Floradix earlier? Probably partly because Floradix is really expensive...

My 35 week appointment was a nice, long one. We talked about everything we need to do to set up for the birth. I asked about placenta encapsulation, and how I am interested in it but I'm not sure because there doesn't seem to be much definitive evidence out there. She said that everything she had seen about it is very positive. I have a friend who does encapsulation, so I might just have her do mine. The midwife said that they will make sure to take care of the placenta if I decide I want to have it encapsulated.

Somehow we got on the subject of cord clamping and I said that both of my prior two babies had their cords clamped earlier than I wanted. She said that they prefer to wait a long time, because even after all the blood has gone to the baby, there are stem cells that transfer from the placenta to the baby. I said that with my prior babies, they were taken away to be given oxygen, deep suctioning, etc. The midwife explained that it is possible to do those things in the mother's arms. She explained that at a recent neonatal resuscitation class she attended, she demonstrated, using the neonatal resuscitation doll, that the way that people instinctively hold newborns actually keeps their airways open.

The fee for my midwives is paid and the birth kit is ordered! My midwife will be giving me the birth pool next week, and I also ordered a liner to go in it along with my birth kit. I have a student doula who will be coming to the birth to help out with whatever we need--filming the birth, helping with the kids (who I plan to have present, as long as they want to be there and are not bothering me), helping with Hypnobabies tools, etc. I really want to capture this birth on film, which is something I didn't do with my others. I am really happy to give this opportunity to this student doula--I know I appreciate those who agreed to be my first few doula births! She is working on a nursing degree and hopes to eventually do a Masters in Midwifery at Bastyr, so I think seeing my birth will be great for her!

Preschool Co-op Lessons: Pumpkins

2011-10-29T13:00:00.000-07:00

I taught for my daughter's preschool again. We lost one of the families in the co-op because they moved across town. We found a new family to join, but at the time I taught, we only had 4 kids in the class.

We did two days of pumpkin lessons. I checked out every book I could find on pumpkins from our public library. The children's favorite was Pumpkin Day by Nancy Elizabeth Wallace, a fiction book about a family of bunnies going to a pumkin patch. The other titles we read were The Pumkin Book by Gail Gibbons (non-fiction, hand illustrations), Pumkins by Ken Robbins (non-fiction, photo illustraited), and Pumpkin Jack by Will Hubbell (fiction). Songs we sang were Five Little Pumpkins and a Halloween version of Ring Around The Rosy, called Ring Around the Pumpkin.

Pumpkin Day talks a lot about cooking with pumpkin, and includes some recipes. The day we read that one, we made pumpkin muffins. I used this recipe from all recipies, but left out the raisins and walnuts and substituted some ginger and allspice for the cloves, because I couldn't find the ground cloves I know I have somewhere, and I thought it would be good with a variety of spices. I took all the ingredients to my kitchen table, along with a big bowl, and had the children all help dump flour, sugar, etc into the bowl. I had them all smell all of the spices as we were putting them in. They got to help crack the eggs (messy!) and stir the batter. They had a lot of fun with it. They came out perfect...

When I chose the recipe, I didn't look closely enough to realize that the yeild is 3 dozen muffins! I only have one muffin pan, so we had muffins our oven for much of the day! They made the house smell amazing, though! There were plenty to share some with friends and they all got eaten! After having our muffins for our snack, we decorated some mini pumpkins. The kids drew on them with markers and I helped them glue googly eyes on them. There were 4 orange pumpkins and 4 white ones. Only the youngest child chose a white one. The one with the eyes on the top of the pumpkin is the same child as the one who glued leaves on the trunk of her tree in the tree's and plants craft (she thinks outside of the box). The one in the back that has a mouth is my daughter's :)

On the second day, we made paper plate pumpkins. I adapted this craft by using pre-cut construction paper for the facial features instead of cutting them out of the paper plate itself and gluing crepe paper on the back (it sounded like it would be too much work for me to do in the middle of the craft). Our color of the week was black and our shape for the week was a diamond, so the black diamond eyes seemed appropriate. I didn't get a picture of all of them, but this is my daughters (she is one of the oldest in the class, so she had better paint coverage and more face-like arrangement than some of the others)

Yay for pumpkins! Have a great Halloween, everyone!

Raise Your Hand if You Have Prenatal Depression

2011-10-24T13:00:00.000-07:00

I do. Or I think I did, anyway. I think it is gone now. And now I think I can finally talk about it.

Prenatal depression (also known as antenatal or antepartum depression) is the term for depression that occurs during pregnancy. According to ACOG, it occurs in 14-23% of pregnancies. That is common! Shockingly common, considering how little it is talked about. I think we need to be talking about it! I think a lot of women do what I used to do, and ignore anything we come across about prenatal depression, because we think it could never happen to us. Until it does.

Symptoms of prenatal depression include:

A sense that nothing feels enjoyable or fun anymore
Feeling blue, sad, or "empty" for most of the day, every day
It's harder to concentrate
Extreme irritability or agitation or excessive crying
Trouble sleeping or sleeping all the time
Extreme or never-ending fatigue
A desire to eat all the time or not wanting to eat at all
Inappropriate guilt or feelings of worthlessness or hopelessness

(source: babycenter.com)

Guilt was a big part of it for me, as were appetite issues and fatigue, and lack of motivation. I experienced more "irritability" than "excessive crying," though at one point I was crying about once a week. I think that because I felt angry and overwhelmed and not always sad is part of why I wasn't sure I had it at first. It was when I read Sheridan's experience of her postpartum depression that I recognized that feeling irritable could be a symptom of depression. I felt like I wasn't myself, like I wasn't enjoying day-to-day life or motherhood, and a whole lot of guilt because of that.

Prenatal depression wreaked havoc on my marriage. My husband didn't understand why I was so unlike myself, and he took it personally as a rejection. When he feels rejected, he withdraws, which was the last thing I needed at the time. Thankfully, our marriage made it through, and is stronger for it.

If you think you might have prenatal depression, what can you do about it? Here are a few ideas:

Talk to someone. Someone who understands. I will talk to you if you need me! If you can't get what you need with peer support, seek therapy with a qualified provider. And if your depression causes thoughts of hurting yourself or others, get professional help immediately.
Take a vitamin D supplement. Vitamin D deficiency can cause depression, and the majority of the American population is deficient because of how little time we spend in the sun without sunscreen. My midwives routinely check Vitamin D levels as part of prenatal bloodwork, and mine was 28 (optimal levels are 50-80).
Take an Omega oils supplement. These fats are good for your developing baby and research suggests they can improve mood.
Eat healthy. I know how hard this is to do when you aren't feeling motivated, but obviously your body needs nutrients to feel well and grow a person at the same time.
Light or Moderate exercise. Find something you can do to get moving that you don't hate--walking with my kids in the stroller and dancing with my prenatal dance DVD have helped me when I've done them.
Establish routines. This happened because we started the preschool co-op. It helps tremendously to have a rhythm to the day and the week. I also feel a lot better when I am accomplishing things and when I am in an uplifting (read: organized) environment, but it is hard to clean when you a depressed. Having Hypnobabies classes in my home each week has given me a reason I have to keep my house clean. If cleaning routines are new to you, I recommend FlyLady.
If you are spiritual, pray or seek other spiritual help.
Recognize that it will get better. Feeling this way is a temporary thing. It is not your life from now on. You are not a bad mother and prenatal depression is not your fault.

Support Resources:

Postpartum Support International also offers support for prenatal depression. Visit their Support Groups & Area Coordinators page to get connected with help in your area.
Prenatal and Postnatal Depression Support Group on Facebook
Prenatal Depression and Anxiety Support at CafeMom

You are not alone: other women's expereinces:

Antepartum depression - Birth Faith
Depression in Pregnancy? - Choose Your Birth
I Battled Prenatal Depression...For the Whole Nine Months, article at Mail Online
So why doesn't anyone ever tell you about PREpartum depression? - Home/work
The Pregnancy Taboo by Jody Santos
Antepartum Depression: Stopping the Tears - The Deliberate Mom

Comparison of Midwifery Education in Different Developed Countries

2011-10-18T13:00:00.000-07:00

A couple of months ago, Amber at Midwife{ology} wrote a post, Educational Standards of American Midwives: A Comparison, which compared the direct-entry midwifery education program she left to the nurse-midwifery education program she is currently pursing. She points out what she sees as a huge discrepancy in the training of these two different types of midwives, and concludes that CPM training is inadequate to prepare a midwife to be a competent birth attendant. Stephanie at Nurturing Hearts Birth Services (who I highly respect as a midwife and appreciate for the wonderful midwife's perspective on Hypnobabies she wrote) responded in her post CNM vs CPM by saying that she feels that the training of CNMs and CPMs are different because they have a different scope of practice: CPMs attend only out-of-hosptial births with low risk women who are not being medically induced or receiving drugs, while CNMs are trained to work with medical interventions in a hospital environment and do pretty much everything an OB can do except vacuum/forceps assisted births and cesareans. Training for CPMs is different because what they need to know is different. Good points on all sides.

I think that maybe comparing different midwife certifications in the U.S. is the wrong comparison, and we should be comparing American midwife training to midwife training in the rest of the developed world.

The United States: In the U.S., the types of midwives practicing fall into three basic categories:

Certified Nurse Midwives (CNMs): Those seeking this path must train as a Registered Nurse first and obtain a Bachelors of Science in Nursing (BSN) or the equivalent (usually through a "bridge" program), and then complete a midwifery program. CNM clinical training focuses mostly on hospital birth, and most CNMs attend hospital births, though some work in birth centers or have homebirth practices.
Credentialed Non-nurse Midwives: This path to midwifery is for those who do not have and are not seeking a nursing degree. These include those with the Certified Professional Midwife (CPM) credential obtained through the North American Registry of Midwives (NARM), the Certified Midwife (CM, which is only recognized in 3 states) credential from the American College of Nurse Midwives (ACNM), and various credentials bestowed by state licensing, such as Licensed Midwives (LM), Licensed Direct-Entry Midwives (LDM), or Registered Direct Entry Midwives. Different states have different requirements for their licenses. A midwife can obtain both her state license and a CPM (in some states a CPM is required to get a license, some states have requirements above what the CPM credential gives). There are multiple training paths for a CPM, including MEAC-accredited midwifery schools and apprenticeship options. All must pass the NARM exam. For more information, see the NARM website. These midwives practice almost exclusively out of the hospital and very rarely get training in hospital birth.
"Traditional" or Non-credentialed midwives: Licensure for non-nurse midwives is available in about half of the U.S. states. In the others, there are midwives who practice without licenses. Some do go through the training process with NARM, but they are still not legally allowed to practice. Some midwives in states that offer licenses choose to remain unlicensed, and do so illegally, except in Oregon and Utah, where it is currently legal to practice midwifery without a license. Training for these individuals varies widely.

United Kingdom: In the UK, there is one type of midwife training, done through a university. Training in nursing is not required, but those who have it have a head start in the program, so there must be overlap between basic nursing and early midwifery training. Midwives in the UK are qualified to attend births in all settings, home, hospital, and birth center. From the Nursing and Midwifery Counsel:

Education and training
In the UK midwifery education and training programmes are only run at NMC-approved educational institutions. Courses usually take a minimum of three years, unless you are already registered with the NMC as a level 1 (adult) nurse, in which case the training can be reduced to 18 months.

Midwifery training takes place at a university, with at least half of the programme based in clinical practice with direct contact with women, their babies and families. This can include the home, community and hospitals, and in other maternity services such as midwife-led units and birth centres.

Canada: Midwifery training in Canada is done through university education that prepares midwives to be able to attend both home and hospital births. From the Canadian Midwifery Registers Consortium

Midwifery education in Canada is offered at a university baccalaureate level. Education programs are “direct entry” (i.e. there is no nursing or other credential required for entry).

One example: The University of British Columbia Midwifery Education Program

The Midwifery Education Program at UBC is a four-year, direct entry, full time undergraduate program leading to a Bachelor of Midwifery degree. The curriculum combines broad-based knowledge and understanding in the humanities and the social and bio-medical sciences. . . .The first two years of study are located on the UBC campus and in the area of the Lower Mainland. The final two years, including the summer between years 3 and 4, consist of clinical courses. . . .Students are prepared for practice in both high tech and low resource settings (home, hospital, rural, international).

Australia: From the Australian College of Midwives - New South Wales

To become a midwife you need to complete either a Bachelor of Midwifery degree (direct entry) or a postgraduate program if you are already a registered nurse.

For an example of an undergraduate midwifery program in Australia, see Bachelor of Midwifery from the University of Technology, Sydney. This program takes 3 years of full time study to complete.

New Zealand: New Zealand also has a 3-year direct-entry program, where registered nurses can get advanced placement. From the New Zealand College of Midwives:

Each midwifery school offers an extended three year bachelor degree programme meaning that each year has a minimum of 45 programmed weeks rather than the more usual 36 programmed weeks. All students whether full time or part time must complete the programme within four years of commencement. This is the framework for all routes to midwifery registration. Each programme has a Recognition of Prior Learning Policy that enables those with appropriate previous qualifications and experience to receive credits or partial exemptions for aspects of the programme. Midwifery students who hold a previous nursing registration or those with other degrees or other relevant experience are likely to gain credit under these policies and complete a shorter programme. Registered nurses will usually complete at least two years of the full programme.

New Zealand midwifery training also includes mandatory hospital-based clinical experience:

Students work in a variety of settings over three years including family planning clinic, independent midwifery practices, neonatal intensive care units, maternity hospitals, laboratories, homebirth, and community. All students have a dedicated ‘block’ in base hospitals to achieve the experience necessary for competency in recognising deviations from the normal and working collaboratively with obstetricians in the provision of secondary care.

I was unable to find websites about midwifery in countries where English is not the first language, but according to reports from midwifery students on the studentmidwife.net forums, midwives in the Netherlands must complete a 4-year direct-entry program which qualifies them to attend both home and hospital births (and to allow women to choose to change her birth location up until the last minute without having to change providers), and midwifery school in Denmark takes 3 1/2 years to complete and midwives can do home or hospital births. Though it was a little difficult to decipher exactly what the French student midwife was saying with the language barrier, it appears that midwifery school in France is 4 years and may be part of medical school.

Okay, so, which one of these things is not like the others? All of these other developed countries train midwives to be qualified to attend births in both hospital and out-of-hospital environments and all of them require a university degree to practice midwifery. A class of midwives that deals exclusively with out-of-hospital births is unique to the United States. This raises some questions to me:

Would requiring midwives who practice out-of-hospital to receive hospital clinical experience (where they are much more likely to encounter rare complications), make them more qualified to handle rare emergencies when they occur in out-of-hospital births?
Would it benefit consumers for direct-entry midwives to be qualified to attend both home and hospital births and be able to obtain hospital privileges and attend the same types of hospital births certified nurse midwives currently do? Would this allow for better continuity of care when circumstances require a change in planned birth location?
Would standardized training and education for midwives similar to what other countries do give midwives who attend out-of-hospital births more respect in the medical community, allowing for better cooperation with obstetricians, nurses, and other hospital providers?
Would requiring more education for midwives, as some fear, "turn them into obstetricians"? Would training have less emphasis on skills needed to support normal birth with too much focus on pathology?

What do you think about how the training and scope of practice of midwives in the U.S. compares to the rest of the developed world?

Preschool Co-op Lessons: Trees and Plants

2011-10-13T12:30:00.000-07:00

On Thursday of my first week teaching preschool, our theme was trees and plants. I only had three in my class that day because one was out of town and one was sick. After doing puzzles and block and the calendar/weather/letter/color/shape routine, we sang our songs, In the Leafy Treetops (an LDS Primary Song), and Trees (to the tune of The Farmer in the Dell, which I found online). Then we read several books about threes, The Giving Tree by Shel Siverstein, Up, Down and Around by Katherine Ayres, and A Tree is A Plant by Clyde Robert Bulla. (I think only having three kids in the class probably allowed them to pay attention to reading books longer!)

Then, for a "sensory activity" we went outside, and my husband had these packets of sunflower seeds and little containers left over from something they did at his work, so each child got to fill a container with soil (which I had bought), put some seeds in it, and put more soil on top. Then we watered the seeds and the kids got to take them home. I put my daughter's in the windowsill above our kitchen sink, and five days later, the seeds sprouted!

Then, since we were already outside, we went on a short walk and looked at my neighbor's garden and talked about all of the vegetable plants she has growing there. By this time, it was already almost time for snack, but I let the kids play for a few minutes while I got it ready.

For our craft, I had prepared large pieces of paper each with a drawing of a tree (I just drew them myself) and I had some cut up some pieces of green tissue paper to be "leaves." The kids used glue sticks to glue the "leaves" on the trees. Most of the trees ended up being a bit sparse, and one child took creative license with the placement of the leaves (she put them on the trunk). I think they are very lovely trees!

We always close each day of preschool with the same set of songs:

Ring around the rosey
Pockets full of posies
Ashes, ashes, we all fall down!

Cows are in the meadow
Eating buttercups
Thunder, lightning, we all stand up!

Teddy bear, teddy bear
Turn Around
Teddy bear, teddy bear
Touch the ground
Teddy bear, teddy bear
Give a jump a try
Teddy bear, teddy bear
Wave bye-bye

Thank you for being our friends today
Come back again and we'll sing and we'll play!

Preschool Co-op Lessons: The Farm

2011-10-08T14:30:00.000-07:00

I recently taught for my daughter's co-op preschool for the fist time. We have five kids in the class, and we rotate it to each mom's home each week, so when it was my turn, I taught two lessons. Here is the structure of the day:

9:00-9:15 Structured Play
9:15-9:35 Circle Time
9:35-10:05 Sensory Activity and Free Play
10:05-10:20 Snack
10:20-10:40 Art Time
10:40-11:00 Outdoor/Indoor Play
11:00-11:15 Clean up and close

For both days, I did puzzles and blocks for the structured play. Circle time consists of a welcome song, which includes each of the children's names in the song, followed by updating the calendar and weather chart, and there is a song we sing for the weather, too. Then we go over the letter, color, and shape for the week. Our week we had the letter C, the color yellow, and triangle. We have a color book in the preschool box (which travels to each home, along with the calendar and weather chart) with pictures of things that are all one color on each page, so the kids get to point to one thing that the like on the yellow page that is yellow, and there is also a shape puzzle book where all of the pictures on a page are magnetic puzzle pieces that are the same shape, so the kids get to take a piece, say what thing they have that is a triangle, and then put it back. All of this is basically the same in every circle time, no matter whose house school is at for the day..

On Tuesday, our theme was The Farm. We sang some songs about farms: Old MacDonald Had A Farm (the children really enjoyed getting to choose what animal sound we were going to sing) and The Farmer in the Dell (I had one child be the farmer and let her choose who would be the wife, and she chose who would be the child, and so on, and as they were chosen, they got to stand up). Then we read the book Click, Clack, Moo: Cows That Type by Doreen Cronin, which is about a farm, but it is a bit of a higher level and their attention wasn't staying focused on it. I had some other farm-related books picked out, but I decided to skip them. We sang another song "This is the way we..." with farm chores for the actions, while I got out my laptop. I used this website to play real recordings of animal sounds and had the children listen and try to identify which animal it was. I think they got all of them except for the turkey.

For our craft on Tuesday, I printed pictures of a pig on pink cardstock and mixed some shaving cream with a little brown paint in a cup for each of the kids. I explained about how pigs need mud to protect their skin, and let them use their hands to smear the shaving cream "mud" on their pigs. It was really fun! They took a long time to dry, but I thought they looked kind of neat after they dried.

It was actually really cool for my daughter that we had just learned about farms in pre-school because we ended up going to a farm, Smallwood's Harvest Farm Park near Leavenworth, WA, as a family that weekend. She fed the animals, rode the cow train, and did other fun farm-related activities.

Pregnancy Update: 29 weeks!

2011-09-30T14:50:00.000-07:00

I haven't been keeping you posted on my pregnancy! This pregnancy is going by SO fast! It has been a bit tough for me, emotionally. I have been a bit overwhelmed about the idea of three children so close together (my oldest will turn 4 about 2 months after this baby will be born) and have just felt out-of-balance and at times, overwhelmed. I am feeling better lately, though.

I had a midwife appointment today. I am 29 weeks, 5 days. We did a blood draw for my glucose screening and a CBC, mostly to see how my iron levels are doing. The midwife I saw today said she prefers to do the version of the test that uses a meal, rather than the glucoa drink, so that's what we did. I considered choosing not to do the test at all because I have easily passed the screen with my other two pregnancies, I am not overweight, never gain excessive weight in pregnancy (I'm only up about 17 lbs from my pre-pregnancy weight so far), my babies have been average-sized (7 lbs 3 oz and 7 lbs 10 oz), etc. But I decided, considering the risks of GD and the fact that I was diagnosed with PCOS in 2007 before we conceived our first, it was better to just do it, and I wanted my iron checked anyway.

My fundal height was 28 cm (It was 20 cm at my 19 w 5 d appointment and 26 cm at my 24 w 5 d appointment). The baby is positioned oblique right now (I had pretty much determined that by where I've been feeling kicks), and that probably has something to do with the slightly lower fundal height measurement. Heart-tones were in the 130s. I have gained one pound per week since my last appointment, so weight gain is going fine. No sugar or protein in my urine. (I love that I get a copy of all of the numbers so I can refer to them later!) .

My midwife recommended a great website, The World's Healthiest Foods. They have a page with a list of nutrients where you can click on each nutrient and it will take you to a list of the foods that are highest in that nutrient. Pretty cool.

Went to the health foods store after my appointment and picked up a liquid whole food vitamin, some probiotic capsules (been having issues with vaginal yeast), almonds (to eat when I have heartburn), and some nettle and red raspberry leaves for my herbal pregnancy tea that I have just started drinking daily.

The fact that this baby is going to be born hardly feels real. I better start adjusting to the idea, because I don't have much time. I am teaching my first Hypnobabies class starting next Tuesday, and am planning on doing all of the homework along with my first student to prepare for my own birth--maybe that will help it feel real for me!

I haven't been taking belly pictures, maybe sometime soon when my husband is home, I'll get him to take one and I can post it!

Can Hypnosis Increase Your Chances of Having an Uncomplicated Birth?

2011-09-24T13:00:00.000-07:00

The Hypnobabies (Official) facebook page recently shared a research study published in April 2004 in the American Journal of Clinical Hypnosis. I think the findings of the study were very interesting, so I am summarizing them for you here.

The researcher performed psychological evaluations on 540 women and randomized them to two groups: one group received prenatal hypnosis to prepare for birth and the other recieved supportive pyschotherapy. It compared these two groups to each other, and also to a third group of women who had no contact with the research. The study used cesareans, pitocin use (for induction and augmentation), diagnosis of fetal distress, low apgar scores, and postpartum hemorrhage as measures of whether a birth was "complicated" or "uncomplicated." The results between the no-contact group and the psychotherapy group were similar, with rate of epidural use being the only significant difference between the two. I think the following findings of the study are significant:

The hypnosis group had a statistically significantly lower rate of complicated births than the other two groups.
Women whose psychological assessments showed psychological factors such as high levels of fear, poor maternal self-identity, negative beliefs about birth, depression, high anxiety, and high levels of stress were more likely to experience complicated births.
When compared with the supportive psychotherapy group, prenatal hypnosis was shown to decrease the negative effects of these psychological factors on rates of complications.

The findings of this research appear to support the theory that psychological factors (sometimes called the "mind-body connection") play a role in childbirth. It appears that the way that hypnosis works to change subconscious beliefs can contribute to less psychology-related complications in birth.

In Hypnobabies, we use hypnosis to help women decrease anxiety and stress, change negative beliefs about birth, and identify and reduce fear. I believe this contributes to the great outcomes Hypnobabies students experience. Of course, not all complications are related to psychological factors, some are physiological. We teach moms about how a healthy lifestyle in pregnancy can give them the best chance at staying low risk.

For those times when unpreventable complications requiring intervention occur, Hypnobabies has a wonderful Change of Plans script, included in the student materials, that can be read to the mom to help her accept changes and move forward. I used the Change of Plans script with a doula client who had a lot of changes to her plans come up, and she later told me she thought it was very helpful. In the end, this mom was satisfied with her unplanned cesarean birth and felt that everything that happened during it was for the best.

This study also looked at social support factors, such how well-supported the women felt by her family, friends, and partner. It also found lack of support to be associated with more complicated births, which makes sense with what we know about the benefits of doula support. The study found hypnosis to reduce complications in women with low support from friends and family, but not as much from her partner.

Armchair Quarterbacks

2011-09-19T13:00:00.000-07:00

Ok, I'm not talking exactly talking about that kind of "armchair quaterback," but with it being football season, it seems appropriate.

I recently stayed up late to watch a birth that took place a The Farm midwifery center broadcast live on the internet. A mom named Talina (@TalinaN on twitter, blog: Harvest of Daily Life) was giving birth to her second baby, and Pamela Hunt was her midwife, along with two midwifery assistants. I got into the event, and even posted a few tweets with the hashtag #twitterbirth. The first site I was watching it on stopped working, but I found it on another site. The second site had a live chat running to the side of the video, and, honestly, it started to really annoy me. I was really bothered by the "armchair quarterbacking" (or perhaps in this case, "armchair midwifing") of the birth. Many people were judging the birth and imposing their ideas about the best kind of birthing on it. People complained that the midwives were doing vaginal exams, that one of them was sitting on the birth bed while the mom was in the shower, that they were touching things and not changing gloves, that they were using a Doppler to listen to the baby's heartrate, etc. They also questioned Talina's birthing position (semi-sitting on the bed with her husband behind her), claiming that the birth would go faster if she squatted. As the birth was getting closer, I switched the video to full screen, both to see the birth better, and so that I wouldn't see any more comments from the peanut gallery. I watched a beautiful, healthy baby girl born with her daddy and (adorable) big sister in the room. The whole family seemed very happy with the birth, and in the end, isn't that all that matters?

A few days later, I followed updates on facebook of the birthing experience of Navelgazing Midwife's daughter, Meghann, giving birth to her first baby and NgM's first grandchild. Meghann was using Hypnobabies. I posted comments of support throughout a long and obviously challenging journey to the birth of her baby by cesarean. I did not see the actual birth announcement because I was at the park with my kids (and that was before I got my new phone, so I didn't get facebook on my phone yet!), and I also apparently missed some comments (deleted by the time I was reading) on the fact that Meghann had a cesarean section that were offensive to the new grandmother. She wrote about her feelings on this here. An excerpt:

But, when things shifted and it was obvious a cesarean was necessary, a couple of purists felt it was their place to comment… er, judge… what they thought was happening, without the benefit of actually knowing because I wasn’t expressing everything online.

My recent doula client also gave birth by cesarean because her baby turned breech during active labor. In my postpartum visit, she told me that she had shared her birth story online and she had people telling her that it was because she had her membranes stripped the day she went into labor (after three days of non-progressing pressure waves, and at the same gestation that her previous child was born) that she ended up with a c-section. Apparently, according to comments she got, having your membranes stripped is "just asking for a c-section." Come on, people! Are you kidding me?

I just think the judging of other people's births has got to stop. We don't have all the information, and even if we did, we are not that woman and we can't know her heart. What she chooses is her choice, and if she seems happy with it, can we please just leave it at that? Can we please leave the armchair quaterbacking to the sports fans and focus on supporting other women in whatever is the best birth for them?

To staceyjw: Reply-Turned-Post

2011-09-14T13:00:00.001-07:00

staceyjw left a comment on a post I previously had a link to in my list of "favorite posts" in my sidebar, which prior to receiving this comment, I hadn't updated in a very long time. I have now updated the list, and chose to no longer include that post, because I feel it no longer reflects the direction of this blog, and I have more recent posts that are "more favorite" for me currently.

The post, published October 23, 2010, was called Elective Cesareans as Commentary on a Failed Birth Model. In it, I explored one woman's writing about her view of the choice of cesarean vs. vaginal birth, and how her assumptions about vaginal birth, which, in my opinion, were largely informed by our culture's negative image of childbirth and common obstetric practices that are often seen as dehumanizing, appeared to color her view. I contrasted that with the view of birth held by the natural childbirth community, suggesting that perhaps if our system could make vaginal birth a better experience for the majority of women, perhaps less women would request cesareans.

This is the comment:

You don't have to think VB is dehumanizing or rape like to prefer the risks and recovery from a surgery to the risks and recovery from a VB. Sure, VB can go well, but when it doesn't, it can be very damaging (NCB or not, it happens). Personally, I would trade a belly scar and ab pain for vaginal pain and possible damage anyway. This doesn't mean we see "modern" VB as horrible, or anything else, just that when looking at all the ways to birth, we prefer one to the other.

This is because many Moms, including myself, see the actual arrival of our child as the life changing event- the act of becoming a parent, welcoming a new member of the family and enlarging our hearts with another human to love. How the baby gets out/into the family is irrelevant. I dont have to push a baby out my vagina to be a Mom! Focusing on a biological act to make a woman/Mom is also the very antithesis of feminism.

By focusing on VB as a "rite of passage", instead of the actual arrival of the baby (or child, in adoption) you cause a lot of hurt to Moms who didn't VB. This is not necessary, as women have enough to deal with without creating a distinction between Vb and CS, adoption, surrogacy as a way to parent.

Here is my response:

In this post, I was responding to the view of vaginal birth expressed in the Pregnancy Zone article. I was disturbed by the way the author described vaginal birth, and it did sound very negative and verging on sexual assault to me. I do think that particular writer's negative view of vaginal birth was largely formed by the negative image of vaginal birth in our culture and common medical practices that disrespect women. Obviously, each woman is different, and each woman's reasons for her birth choices are going to be different as well, so your reasons for your choices will be different from hers.

You are right that vaginal birth does sometimes cause serious vaginal damage. I don't deny that. With good care, though, it is relatively rare, just like serious complications from c-sections (that some of us NCB people are so afraid of) are also rare.

I understand what you are saying about the arrival of the child being the significant, life-changing event. I also believe that welcoming a child into your family is always special and sacred, no matter how it happens. I have problems with saying that the baby getting there is all that matters, because that is hurtful to all the women who are traumatized by the way they are treated while giving birth. Mistreating a women is never okay, even if you hand her a healthy baby at the end of it. I do believe that the process by which a woman brings her baby into her family matters a great deal. I do not, however, believe that there is only one correct way to go about it. If you read my post Why Natural Childbirth is Not Important, you will see that I feel that going through the literal biological process of natural birth or vaginal birth is not as important as being an informed participant in the process of a birth (which can also extend into other methods of acquiring a child). I was referring mostly to medically necessary cesareans in that post, but it also applies to elective cesearans. Only you know your body, your priorities, and your circumstances, and only you can make the best decision for you.

The way you have interpreted my use of the term "rite of passage," will lead me to use a lot more care in how I use that term in the future. There are some who believe women who do not experience natural childbirth will not be as good of mothers for not having gone through that experience. I may also have believed this in the past, but I was wrong. Just because one woman feels a certain experience was important or necessary to her development as a mother does not mean all women have to have that same experience to become a mother. We are all different and all of our "rites of passage" into motherhood will be unique. I believe that God gives us each individual experiences that best help us learn and grow in our own individual ways. I feel that whatever you go through to get your child is your rite of passage into motherhood. For some women, the rite of passage will be adoption or surrogacy--which are often very long and difficult journeys. For one woman the rite of passage is joyfully pushing her baby out with an epidural, for another it is choosing a cesarean as her preferred method of birth, and for another it may be having an unmedicated birth.

Many women have described their unmedicated birth experiences as significant self-discovery journeys, that made their baby's arrival into their life special in a way that was right for them. You may feel it wouldn't have be an awesome experience for you to give birth that way, and not all women who give birth unmedicated feel that way about it, but that shouldn't lessen the experience for the women who do. A woman may feel giving birth on their own terms, without feeling powerless to authority figures or controlled by an obstetric system (that many feel is patriarchal), was an important part of her life, motherhood (and possibly feminist) journey. Another may feel that having experienced the intensity of unmedicated birth is something she can draw strength from in the future. Another woman may feel that giving birth naturally brought her closer to God. To say that there is never value in the experience of natural birth is to discredit these women's experiences. Not every woman wants or needs that experience for her personal growth, but those who choose it should be free to attach whatever personal significance to it that they see in it. Seeing significance in the journey of birth doesn't take away from the joy of welcoming a child into your home, not any more than appreciating personal growth one might achieve through a challenging adoption journey would take away from that joy. It is not a one-or-the-other choice between appreciating the process and the product.

And for some women, the process has nothing to do with it. Some women will define their transformation into "motherhood" as being completely unrelated to it. I understand not caring about how the baby gets there. I used to say I was sure I wanted all the drugs I could get. My own paradigm shift was more about the belief that it would be safer to avoid drugs and procedures as long as there weren't complications (I do still believe this, and it would take a lot to change my mind) than it was about wanting some great experience. However, learning that it is possible to have a joyful, empowering experience birthing naturally, and that it wasn't necessarily the horrific ordeal I always assumed it would be was also part of it. Attempting to birth without pain medication in my first birth turned out to be harder than I expected, and I chose to have an epidural. For my second birth, I used hypnosis (Hypnobabies, which I now teach), and it helped me increase my endorphins and think of the sensations I was feeling in a positive light. It allowed me to remain mobile when I wanted to be, and feel connected to what was happening as my baby emerged, which was important to me. I was overall, really happy with the experience, and felt I learned a lot from it about my strength and the power of my mind, just like I learned a lot about being flexible and accepting change in my first birth. Both birth experiences were different, both were significant learning experiences for me, neither was superior to the other, and I don't think either gives me any advantage over any other woman--we all have different needs for our growth.

I admit that I have difficulty wrapping my head around the idea of a woman wanting to choose a cesarean without a medical reason. I know this is because of things in my background that influence my perception of the choice. It has to do with my faith--my belief that vaginal birth is God's design, as well as my desire to have the option of having a large family for religious reasons (since having cesareans is likely to limit how many children a woman can have), my lack of experience with major surgery, and yes, my history of exposure to natural childbirth literature. But I recognize that you may have a different background, beliefs, and life priorities than I do.

I take your point and I apologize, for myself and the rest of the natural birth community (though I guess I don't really have the right to speak for anyone else) for hurt feelings caused by the idea that there is any best way for all women to become mothers. There may be a best way for me to welcome my child (and that "best way" may not be the same for each child--it hasn't been for me so far), but what is best for me and my baby may not be best for another mother and hers. I will do my best in the future to avoid talking about vaginal birth or unmedicated birth in ways that are hurtful to those who do not have those experiences.

Tempering Extremism in the Natural Birth Community

2011-09-09T13:00:00.000-07:00

The online world of natural childbirth is often heavily influenced by extremism. People claiming things like "Birth is safe. Interventions are risky" sometimes leads women to believe that as long as there is minimal intervention in their birth and they listen to their intuition, there will be a good outcome. Worse yet is the belief that a bad outcome occured because the woman didn't "trust birth" enough or the ridiculous logic that anything makes a baby's preventable death okay.

Most people who promote natural childbirth also promote that women educate themselves, but as I have said before, the problem with not knowing is we don't know what we don't know. Many women may think that they are educated about birth when they really aren't. And if you really believe that "birth is safe," then what do you really need to know? The same is true of under-trained women who act as "midwives"--many of them follow this same mentality and are unaware of the information out there that they don't have. To be clear, I do not mean all direct-entry midwives. Some are well educated. Some are not. And having the CPM credential doesn't mean anything. Having a state license may mean something, depending on the individual state's requirements--they range from having a CPM (which, as I understand, at minimum, can be achieved by doing an apprenticeship involving at least 40 births, getting CPR and NRC certified, and passing the NARM exam) and being required to graduate from a three-year program at an accredited midwifery school, attend at least 100 births, and pass the NARM exam (Washington State).

I mentioned the homebirth midwifery laws in Oregon in a previous post. A recent tragedy in Oregon has opened debate about these laws, and many are calling for mandatory licensing. I think that this unfortunate event may be a consequence of extremism--untrained midwives thinking they were qualified enough to attend births and a poor mom who didn't know or believe that looking into their training was important.

There will always be extremists in every movement. The internet, with its power to bring people together, sometimes gives the illusion of normalcy to the extreme. Sometimes it is necessary to push back against the influence of extreme ideas--to nudge the proverbial pendulum back the other way a little. Those who do so will often be accused of being "from the other side" or "causing division." I think voices of reason are essential. I have recently come across a circle of bloggers who fight to temper extremism in natural childbirth and homebirth, and to raise standards for midwifery in the U.S. They promote Certified Nurse Midwives as the optimal caregiver for a homebirth and believe that the Certified Professional Midwife credential should be changed to match the CNM standard of education or be done away with. Amber and Jessie are both former CPM students who have now chosen to pursue CNM education. Deb ("The Sensible Midwife") is a CNM with a homebirth practice. While I may not agree with everything these women have to say, I do believe the natural birth movement needs voices like theirs to help keep it in check.

Temper (verb): to dilute, qualify, or soften by the addition or influence of something else: moderate (merriam-webster.com)

Tomorrow is the first day of our Preschool Co-op!

2011-09-05T13:00:00.000-07:00

During the school year, a friend of mine does a "music time" for young children and their moms on Wednesday mornings. She has instruments and cute paper cut outs that go along with the songs. It is great. After the singing, she opens up her playroom and the children play while the moms chat. It is lovely.
One of the moms was saying how she was trying to find a pre-school for her daughter for the fall, but was having difficulty because her child's late birthday meant she would not turn three until after school started. Somehow, we decided to just do our own preschool for 2- and 3-year-olds this fall. There are four moms in the group (and 5 kids--one of the moms has 2 who are close-spaced), and we will be doing preschool two days a week for a two hours and fifteen minutes a day. Each week, we will rotate to another mom's house. So, I get to teach preschool again for 2 days out of each month (Maybe I will write some about the lessons I teach on my days here, as a break from some of the birth stuff.) On weeks I don't teach, my daughter will have opportunities to be with other kids, learn to follow a school rhythm and how to act appropriately in school, and I will have 2 days a week to be with just my son (and probably go grocery shopping!) It will be good for me to have some one-on-one time with my current baby before the new baby comes.

It will also be good to help get a little more structure in our weeks. The mom who does "music time" will be starting it up again as well, so we will have "planned days" 3 days out of the week. The lack of structure has been making life kind of chaotic (and often very lazy) around here lately. I'm excited for it! It will be a school experience for my daughter, at a much lower cost and with more input from me than a more traditional preschool. The first day, which will be an "orientation," will be Tomorrow!

Video from One World Birth

2011-09-02T11:44:00.000-07:00

I thought this video related to what I wrote about in my last post.

One World Birth: Is there a conflict in birth?

For those who are not familiar with it, One World Birth is a documentary-in-progress that is uploading new footage from interviews with various experts in birth-related fields as it is ready to be viewed. The project seeks to build an online community to participate in the film-making process. It is an original idea and very interesting. The footage that is up right now is mostly from the U.K., but they plan to come to the U.S. and Canada to do more filming soon, and hope to travel all around the world to get a complete picture of all of the issues in birth all over the world. These short videos are great for sharing on social media--I am posting one video on facebook and twitter each day. Visit the site to view more videos and leave comments for the film producers.

More Thoughts on Research

2011-09-01T13:00:00.000-07:00

The comments on Homebirth Research: Another Side of the Story have been interesting. Thank you to everyone who has shared your thoughts or other information you found about the study. I think the letter to the editor from De Jonge that one anonymous commenter shared was interesting, especially the point about how the methods of data collection in the study may have inflated the perinatal mortality rate in the low risk group. If she is correct in this assessment, I believe it does call the validity of the study into question.

That said, I think that the Evers study raises a lot of questions that require further research.

is midwifery care, with referral to obstetric care if complications arise, optimal care for low risk women?
are there specific aspects the midwifery system in the Netherlands that are suboptimal (such as, protocols for intervals to check the fetal heart rate, as mentioned in the paper, or as one response to the study pointed out, the use of midwives assistants to watch over women until close to time of birth)?
how might midwifery care be improved to result in better outcomes?
how might collaboration between midwives and physicians be improved to result in better outcomes?

I think that many questions such as "Is homebirth safe?" or "Are midwives or obstetricians better caregivers for low risk women?" are questions that may never be fully answered with research. There will always be people who find a flaw in a study's design or some other way to discredit it, because most people have basic beliefs about birth that are not easily changed. There will always be people who focus (some because it is their job) on the cases where things go wrong and work their hardest to save those lives. There will also always be people who want put their primary trust in either a divine design for the process of birth or its thousands of years of improvement through natural selection (whichever is their belief, mine is these former) and who prefer to use the technology of the past hundred years or so as mostly a back-up. Most people find ways to dismiss "evidence" that does not support their basic view while accepting that which is in line with it. It is human nature.

The answer to safety in maternity care is not to convince one side that the other is "right." The answer is respectful collaboration. This is not the first time I have talked about this. In October 2010, I committed to make my blog a doctor-friendly zone, and I hope that I have held true to that promise. I believe now, as I did then, that peaceful dialogue between doulas/activists/midwives and obstetricians and other hospital providers is essential for improving our maternity care system to protect the lives and and best meet the needs of mothers and babies. I believe that hospital and out-of-hospital providers could learn a lot from each other, which I think could help improve the safety of the practice of homebirth and care in transfers, as well as improve the environment and the options available to women in hospital birth. I have started to see dialogue opening up a little more in the past months, as more physicians are creating online presences and the internet is becoming a larger platform for conversation. I'm curious also, to see where the upcoming Home Birth Summit will lead.

Homebirth Research: Another Side of the Story

2011-08-28T16:00:00.000-07:00

Information about this has been showing up everywhere for me lately, though I have not sought it out intentionally, and I feel like I would be irresponsible not to write about it.

For a long time, I stayed away from the topic of homebirth, partly because it is such a controversial topic. I have only started writing about it recently because I am pregnant and currently am under the care of a team of homebirth midwives. My post titled "How Homebirth Benefits Babies" was the first post I wrote that "promoted" homebirth (with caveats!). It is also has been the most widely read, currently at 1,788 pageviews.

I have discovered that the evidence really is not clear on the most important point I make in that post when I talk about homebirth research. My words:

First of all, and most importantly, the outcomes that have the highest significance are perinatal mortality and morbidity, because all mothers want a living baby who is not permanently disabled. Research indicates that babies of low risk women who plan homebirths under a supportive system with a qualified attendant are statistically no more likely to die or have serious injuries than babies of similar women who choose hospital birth (1, 2, 3, 4, 5, 6).

It has come to my attention that the results of one of the studies I cite in that post has been called into question by the results of another study--a study that nobody in the online natural birth community appears to be talking about, even though it was published 9 months ago.

The study I cited in my post was the de Jonge study from the Netherlands, which compared outcomes of home and hospital births attended by Dutch midwives among women classified as "low risk" by the Netherlands maternity care system. De Jonge found no difference in mortality or severe morbidity in the home and hospital groups.

The Evers study, Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study was published in the British Medical Journal in November 2010. It compared outcomes of term births classified as "low risk" by the Dutch system attended by midwives (primary care) with outcomes of births classified as "high risk" and attended by obstetricians (secondary care). It found higher rates of perinatal mortality in the primary care group, and no difference in rates of level 3 NICU admission (the measure the study used for severe morbidity). Yes, you read that right. More low risk babies died. There were 26 delivery-related perinatal deaths out of 18,686 who began labor in primary care(a rate of 1.39/1000) and there were 10 delivery-related perinatal deaths out of 16,739 who began labor in secondary care (rate: 0.60/1000). The transfer rate from primary care to secondary care during labor was 22.9%, and 12 if the delivery-related deaths occurred in those who were transferred. The number of intrapartum stillbirths was also higher in the group that began labor in primary care. The study excluded all instances of congenial anomalies.

This study calls into question the belief that the best and safest care for low risk births is low-intervention care. From the Discussion section of the paper:

This seriously questions the supposed effectiveness of the Dutch obstetric system that is based on risk selection and obstetric care at two levels. Of major concern is the fact that the highest mortality was among the infants of women who were referred from primary care to secondary care during labour because of an apparent complication. Hypothetically, this high mortality could have several causes. Delay can occur at three moments. Firstly, diagnosis in primary care can be delayed because the midwife is not always present during the first stage of labour and fetal heart beats are often checked only every two to four hours. Secondly, transport can delay treatment in case of an emergency. Finally, a delay can occur because the obstetrician underestimates the problem as the referred woman is a “low risk” patient. In addition, essential information can be lost during the referral. These factors should be subject to further investigation, especially to evaluate whether complications with the potential to lead to perinatal death can better be predicted.

And this is in the Netherlands, where there is a universal standard for midwife education and there is supposedly to be a good system of transfer of care. Would having low risk women also be cared for by obstetricians be a better system for the Netherlands? That is basically what we have in the U.S., and we have a 33% cesarean rate. Cesareans increase the risk of maternal morality (see Deneux-Tharaux, 2006), though maternal mortality occurs much less frequently than perinatal morality does. Considering the increased risks associated with pregnancies and births in women with prior cesarean sections (see Kennare, 2007) , some of which impact both the mother and baby, I just don't see how this can be the optimal way to care for mothers and babies either. I'm not even going to try to answer the question of how many mothers (and any future babies they may have) should have to accept the risks of a cesarean section to save the life of one baby. It is something to think about.

The choices we have are between sets of risks. The absolute risk of a baby dying at all is low, especially if there is access to fetal monitoring and some level of emergency care (such as midwives who can perform neonatal resuscitation). When are talking about a rate of 1.39/1000, it means an individual has a 0.139% chance of it happening (and a 99.861% chance of it not happening)--and that's all primary care deaths in the Evers study, including ones who would have died no matter what kind of care they received. The risk of preventable death is presumably lower, though we don't know how much lower because there is no obstetrician-attended low-risk comparison group in the study. I don't want it to seem like I am trying to "explain away" the risk of preventable death. The statistics mean nothing when your baby is the unlucky one who dies. I believe in informed choice, and I believe you need accurate information to make informed choices.

After I wrote this post and was waiting to publish it (I usually space posts out further, but I moved this one up because I felt I needed get it out there), I saw this post from Birth Without Fear in my facebook newsfeed, and felt it applied to what I am trying to say. Like her, I am not here to advocate that you have a homebirth. I advocate that you look at the information, weigh your options, and make whatever is the best decision for you.

giveaway of book for birth workers

2011-08-26T15:01:00.000-07:00

Sheridan at Enjoy Birth reviewed the book Keep the Fires Burning: Conquering Stress and Burnout as a Mother-Baby Professional by Mickey Jones, and she is giving a way a free copy! The life of a birth worker can be very demanding, and this book sounds like a great resource.

Click here to read the review and enter the giveaway!

Hypnobabies Certified!

2011-08-25T11:44:00.000-07:00

I received word a few days ago that my certification as a Hypnobabies Childbirth Hypnosis Instructor (HCHI) and Hypnobabies Certified Hypno-Doula (HCHD) is official! Yesterday, my information was posted on the Hypnobabies Instructor listing. If you are local and interested in joining my first class (most likely stating in late September or early October) please contact me here or through my website (link on sidebar). If you are not local, check out the link above for an instructor in your area.

New Website, Facebook Page, and Twitter Account!

2011-08-17T13:00:00.000-07:00

I bought a domain name for my doula services website, and I decided to do away with "Peaceful Waves Birth." The new website for my Yakima area doula services is:

www.birthspecialist.com

The new website which will also be the location of information on the schedule of my Hypnobabies classes, and updates for my Dancing For Birth™ classes, when I get them started. I also made an accompanying facebook page, which you can find at The Birth Specialist. I also finally joined Twitter. Unfortunately @BirthSpecialist was taken (by someone who apparently created the account, but never used it), so I just went with my first and last name: @BrittanyCromar. So, now you can like and follow me if you are on Facebook and Twitter!

I &hearts Dancing for Birth&trade!

2011-08-15T13:00:00.000-07:00

The Dancing for Birth™ training was awesome! I learned so much! I am currently planning on finishing up certification and teaching the classes, in addition to my Hypnobabies courses, but we will see if it works out.

In a nutshell, Dancing for Birth™ is a prenatal and postpartum fitness class and a birth and new motherhood support circle, with bits of birth empowerment and childbirth education incorporated into it. There is a basic flow to the structure of the classes, but the content is flexible--instructors can choose what to include each week based on the needs of their students. There is a huge list of benefits to dancing during pregnancy, birthing itself, and the postpartum time. Not to mention it is a whole lot of fun!

I had a wonderful time bonding with all of the other women who were at the training. It was a very passionate group, and the nature of the workshop allowed us all to become close very fast. Most of the other trainees were doulas, but we also had some midwives and belly dancers. One thing I really liked about the workshop was the opportunity to practice some comfort techniques, including the double hip-squeeze and several rebozo techniques.

I found that the vast majority of what was taught was very compatible with Hypnobabies. We talked about how having "sensation" is necessary to follow your instincts in childbirth, but there was not talk of "preparing for pain." There was some of the idea that "you don't birth in your brain, you birth in your body," which is not what we teach in Hypnobabies, because we teach that you most definitely do use your mind during birth--it is where your birthing hormones come from. However, I think "birthing in your body," it is just different wording for a concept that is taught in Hypnobabies--birthing in a state where our conscious, analytical thinking is pushed aside, a state we call hypnosis, but other people have different words for it. Dancing is a naturally hypnotic activity, so it makes sense that dancing during your birthing time would promote the ideal mental state.

We also did a game where music plays and everyone dances, then the music fades and people pretend to be having pressure waves (most people chose to stop dancing and lean forward onto something, which would work with using the Hypnobabies lighswitch), then the music fades back in and everyone gets up and dances again. This exercise reminded me a lot of something we do in Hypnobabies called a "birth rehearsal," and I could see how the techniques of both programs could work together as we did it.

We did another exercise where we compared the measurements of the pelvic outlet (from pubic bone to tail bone) in a deep squat (with hips below knees) versus a standing squat (hips above knees, pelvis tilted back, upper body leaning forward). I recommend trying this yourself--you may be surprised at what you find!

All instructor training workshop participants take home a copy of the Dancing for Birth™ DVD, and I have been practicing with it every other day since I got back. I have difficulty sticking to exercise routines, but since dancing is so fun, I'm more likely to do it (plus, I'm trying to get a good grasp on the moves for teaching it, if that works out) I am looking forward to having dance to use along with my hypnosis during this baby's birth!

Doula Certification!

2011-08-10T08:21:00.000-07:00

I submitted all of my forms to complete my doula certification yesterday and was notified today that they have been received. It is official: I am a certified doula! I will be changing the image at the bottom of my blog to this:

I'm going to the Dancing for Birth training!

2011-08-02T19:23:00.000-07:00

Ever since writing my Dancing Your Baby Out post, I have been really interested in dance as a form of prenatal exercise and as a comfort and positioning measure during childbirth. I have always loved to dance. Although my parents never signed me up for classes when I was growing up (I'm sure they had good reasons) and my high school did not offer dance as an elective, in college, I took a ballet class, a modern dance class, and two ballroom dance classes, and I loved all of them. My husband took ballroom classes, too (he is actually better at ballroom than I am!) Since marrying into a Tahitian family, I have also tried to learn Tahitian dance. Tahitian slow dances probably have some some things in common with what is in prenatal dance classes.

Performing Tahitian dance at a family wedding reception (I am second from the right)

I think that teaching pregnancy dance classes would be a great way for me to combine my interests in dance and birth. It also will be an opportunity to expand my market (women who typically might not be looking for a Hypnobabies class or a doula might come to a prenatal dance class and then might find out about my other services that way), and will give me another birth-related thing I can do that won't disrupt my family life too much. Like teaching Hypnobabies, it is something I can schedule around my husband's work schedule, which avoids needing a babysitter, and since classes are for both prenatal and postpartum women, who can do the dances while wearing their baby, I will be able teach it while babywearing.

When I first learned that there was going to be a Dancing for Birth instructor training at the Simkin Center for Allied Birth Vocations at Bastyr University in Seattle, I wasn't sure if I would be able to go, even though I wanted to, because I had a doula client whose due date was about 10 days after the training. She gave birth at 37 weeks gestation last week (I will write more about that experience later, if I get permission from the mom), so I looked to see if they were still taking registrations, and they were! So, after discussing it with my husband, I decided to sign up! I will try to write a blog post about the training after I go!

Homebirth Set Up Video

2011-07-26T13:00:00.000-07:00

A common question people have about homebirth is that there will be a big mess in their house and they will have to do a lot of work to clean up. This video shows a midwife setting up a home for a birth by putting a shower curtain under some old sheets on the bed and a garbage bag between pillows and the pillowcases, which helps make post-birth clean up easy. It also shows supplies for the birth, including old towels, the birth kit, and a bowl for the placenta. At the end, it shows how the midwives leave the room after the birth.

Back from the Hypnobabies Training!

2011-07-21T08:28:00.000-07:00

I had a great time at the Hypnobabies Instructor Training! It was so fun rooming with Felice. She had the manuscript of the book with her and was editing it. I got to see the piece I wrote as a guest post for the blog in print among articles written by many amazing women. Now to get all of the Hypnobabies final certification requirements finished up so that I can have letters after my name when the book goes to print!

We had the opportunity to have dinner with Sheridan and Malia, who are both working with Felice on the book, one night after training had ended for the day. I have been reading Sheridan's blog for a long time, and "knew" her from the Hypnobabies yahoo group before that, and it was fun to finally meet her in person.

Felice taught me some interesting theories about relationships that she learned in hypnotherapy school. She also taught me a technique for asking questions of my subconsious mind. We asked mine the sex of my baby, and it told us (in kind of a round-about way). It was the same answer I have been feeling all along. We are waiting until the baby is born to find out, so I will let you know if it was right when that happens!

I met a lot of other wonderful ladies at the training, who I hope will all be keeping in touch! Good luck to all of you ladies on completing your certification and beginning to teach your classes! I love this program and am so excited to be a part of helping women enjoy their births!

A Homebirth Midwife's Supplies

2011-07-15T13:00:00.000-07:00

This video shows and lists the supplies typically brought to a homebirth by a licensed midwife in Washington State.

The Gift of Giving Life release date and giveaway

2011-07-08T22:22:00.000-07:00

I am excited to learn that the release date for the book, The Gift of Giving Life, has been announced for November 1, 2011! Although I came into the project a little late in the process of its creation, I have submitted some content which may be used in it. I am very passionate about the subject matter of this book, and so excited to see its publishing becoming a reality. I will be meeting Felice Austin, the leader of the book project and writer of the blog, when I go to the Hypnobabies Instructor training this month--we are going to be roommates! I am excited to meet her in person and discuss our common interests. Click here to learn how you can enter to win a copy of the book!

Licensing vs Decriminalization

2011-07-02T13:00:00.000-07:00

Hope everyone is enjoying their Independence Day weekend. This post seems appropriate for this holiday, as it addresses freedom and law in the U.S.

One commenter on my post, How Homebirth Benefits Babies, said that she feels decriminalization of midwives would be a better way to legalize midwifery than licensing. I am aware of the division within the midwifery support community on the issue of licensing. Here is the issue, as I see it.

The arguments for decriminalization
Licensing puts restrictions on midwifery practice. States that license midwives have laws governing direct-entry midwifery that determine the criteria for acceptance as a midwifery client and conditions that require transfer to hospital-based care. These criteria may categorize a woman as "high risk" who is not really very high risk at all. For example, Arkansas law states that licensed midwives may not treat women who have previous cesarean sections, multiple gestation, maternal age greater than 40, or previous infant weighing more than 10 pounds. It also requires transfer for non-vertex positions and gives a set number of hours a woman can be in labor before she has to transfer. Here, in the state of Washington, transfer is required for women who pass 42 weeks gestation. I most definitely do not believe that all women that fit into these categories are only safe birthing in a hospital. These kinds of restrictions put many women and their midwives in tough situations, where the midwife could risk losing her ability to practice legally if she choses to help a woman have the homebirth they may both feel is optimal for her.

In theory, decriminalization would give midwives the freedom to set their own standards without the fear of prosecution for practicing medicine without a license (something underground midwives in states where homebirth midwifery is not legalized in any way have to deal with) and without having to worry about being punished for not following the terms of the state that gives them a license.

The arguments for licensing
The Unnecessarean reposted a discussion from their facebook wall on a status update that they shared from Big Push for Midwives'. It is an interesting conversation between midwives, consumers, lawyers, and advocates that I recommend reading if you want a good grasp of the different points of view on the issue. Here are a couple of quotes that address why licensing appears to be the best course:

Just “make midwifery legal”? How? By pushing for a blanket “midwifery is legal” law? How do you define midwifery? How do you define a midwife? How do you define what is NOT covered? All of these things would have to be done in order to “make midwifery legal.” All of these things are the same exact things done with licensure.-Tara ANaturalAdvocate

[A]s a practical matter, simply legalizing midwifery — that is, decriminalizing the practice of midwifery by statute and/or getting the legislature to pass a law to officially declare that midwifery will no longer be considered unauthorized practice of medicine or nursing — would be politically impossible. Organized medicine, and often organized brainy, fight tooth and nail against efforts by consumer groups to regulate midwifery. They win over many legislators by claiming that licensed certified professional midwives are unsafe. Can you imagine the field day the OBs and medical society would have, or how skeptical the legislators would be, if the legislation simply allowed midwives to practice without any state oversight? Even if this legislative option may have worked ever in the past, it would be truly impossible today. Really truly impossible. Our state groups are there “in the trenches” and know how difficult it is already to get licensed regulated midwives.-Susan M. Jenkins

Why push for the licensing of midwives? Because licensing legislation actually happens. Because states have the right to regulate health care providers who practice there. Because the majority of professions require some sort of license/certification/official credential to do their job. Because in order to legally recognize midwifery, you have to define it, and by defining it, you necessarily have to determine what it is not, which by definition will "limit" midwifery.

Oregon is the one state I know of were there is "decriminalized" midwifery--midwives have two options--they can choose to obtain a license from the state (which allows them to file for reimbursement from the medicaid system) or they may legally practice midwifery without a license. However, practicing without a license means it is a felony for these midwives to use oxygen and pitocin, as the use of such drugs falls under the category of "practicing medicine." I believe that women and babies benefit when midwives have the ability to legally use life-saving medications in the home in the event of an emergency. It appears to me that there is definitely a trade-off. Either midwifery involves the occasional practice of medicine, or it does not. You can’t have it both ways.

Beyond the ability to have pitocin and oxygen available, licensing also ensures consumers a minimum standard for licensed midwives. No, being licensed does not guarantee that someone is a competent midwife, but it gives consumers some indication of the midwife's qualifications. When anyone can claim to be a midwife, it creates a confusing and unsafe environment for consumers.

Licensure also strengthens the credibility of midwives, both to consumers and to medical professionals. Knowing that licensed midwives have completed certain requirements may make physicians and hospitals more respectful of them, allowing for better collaboration, which also benefits mothers and babies.

Many states do have mostly good, evidence-based guidelines for the scope of practice of midwifery. It is not necessarily licensing that limits homebirth options, but rather certain state’s licensing laws. Those who are unhappy with their state’s licensing regulations are free to organize consumer efforts to change those laws.

I, personally, am quite convinced that licensing is the most feasible way to legalize midwifery and that it helps make homebirth safer for consumers. What do you think?

The Homebirth Difference for Birth Trauma, Video Illustration

2011-06-27T11:07:00.000-07:00

In a very short time, my post How Homebirth Benefits Babies has jumped to the #1 most viewed spot on my blog stats. I am working on a couple of posts inspired by some things that were said the comments on it, with respect to how we view the mother and baby's needs, as well as some thoughts on homebirth midwifery legislation.

In this post, I would like to illustrate one way homebirth causes less trauma to babies with some videos. Hospital births often involve the medical provider being very hands-on with the baby as it is born, pulling it out of the birth canal. The obstetrics textbook I had to read for my Hypnobabies Instructor training described the procedure of how to "deliver" a baby with, what seemed to me to be a lot of pushing and pulling on the baby. I had a homebirth midwife tell me that her goal is to "touch your baby as little as possible." In a birth with minimal disturbance, the baby will almost always emerge spontaneously, needing only to be caught, or, in a waterbirth, lifted out of the water. Of course, there are times when a pair of skilled hands is needed, for example, to help get a shoulder unstuck, but in most cases, avoiding pulling on the baby is ideal.

This video is made by chiropractors to explain the benefits of neonatal chiropractic adjustments to correct trauma caused by common birth practices. Some may find the angle the narration takes to be extreme, but the video footage itself is quite powerful. Some of the births it shows are typical hospital births, and some involve more extreme measures, which may be disturbing to some (TRIGGER WARNING).

Birth Trauma from Centre Quiropràctic Molins on Vimeo.

Contrast that with these homebirth videos

This is a home waterbirth video of a first baby, where you see the baby just slide out.

This video shows a homebirth in a sidelying position, where the midwife gently catches the baby:

The True Beauty of Motherhood

2011-06-21T13:00:00.000-07:00

A big thank you to Women in the Scriptures for sharing the link to Beauty Redefined, a project seeking to help women discard society's myths about beauty and focus on recognizing that true beauty is more than skin deep. They are preparing to launch a billboard campaign in Salt Lake City. I haven't been to Salt Lake in a while, but apparently, there are a lot of billboards advertising plastic surgery these days, and those plastic surgery businesses are very successful. So successful, in fact, that Forbes classifies Salt Lake City as the "vainest city in the nation." In Mirror Mirror on the Wall, Salt Lake City is Vainest of them All?, Beauty Redefined discusses one plastic surgeon's explanation:

One SLC plastic surgeon, Dr. Brian Brzowski, told hypervocal.com he believes the intense interest in breast implants can be attributed to both the fact that women have babies at a younger age than the rest of the nation and that Utah women lead an active lifestyle. “A thinner, fitter populace tends to have less breast fullness. This can complicate clothing choices and make fitting into swimsuits and the use of padded bras more of a reality,” he says.

While his point about young mothers is very accurate, the latter point about the thinner, fitter populace and their troublesome small chests is a bit off the mark, in our opinion. Sure, it might be true that a fitness-oriented population might not have as much ”breast fulness” as the rest of the population, but the assumed “complicat[ions]” of that fact are what’s bothersome. Women shouldn’t need to “fit into” swimmingsuits – swimmingsuits should fit THEM. And why the use of padded bras? Why the unquestioned, unchallenged pressure to visually enhance the parts that have likely been instrumental in nourishing the babies they’re so proud of? Why is the appearance of breasts such a dominant concern?

(And no, the emphasis is not mine, it is bolded in the original, though I wholeheartedly agree with the emphasis.) I could write a lot about this topic, but I want to expand on something briefly touched on here--the focus on appearance over function. I believe that a very large part of true feminine "positive body image" involves appreciating not the way the female body appears to the world, but all of the wonderful things the female body can do.

My breasts may not be up to some ridiculously unrealistic standard of "beauty," but I appreciate them for comforting and exclusively feeding my two children for six months each, being their primary source of nutrition for six additional months, and continuing to be a source of supplemental nutrition and comfort for a few months further. Breasts that can nourish children are, no matter the size or shape, far more beautiful than the perkiest, silicone-filled, sex objects on the market. Breasts are beautiful because of what they do.

My own husband was once trying to explain how I was still "sexy" to him when pregnant. But in the course of explaining, he discovered that it wasn't really "sexiness" but actually real beauty. Even though at the time I did not have the same body I have while not pregnant, which he is very attracted to, I was beautiful to him in a different way. It was beautiful to him that I was carrying his child--the beauty of true love manifested in physical form, the beauty of motherhood. The beauty of me as "pregnant wife" is more than the outward appearance. It stems from my husband's deep love for me and appreciation of who I am--his wife and the mother of his children, which, during pregnancy, happens to be obvious in my physical appearance.

This conversation shows me a lot about what true beauty really means. True beauty may sometimes be visible on the outside, but usually not in ways that society recognizes as beautiful, with our distorted, unrealistic images of what a beautiful woman is. True beauty is who you are.

"[F]or the Lord seeth not as man seeth; for man looketh on the outward appearance, but the Lord looketh on the heart." (1 Samuel 16:7)

How Homebirth Benefits Babies

2011-06-16T13:00:00.000-07:00

EDIT 8/28/11: Things are not always as simple as they first appear. There are multiple sides to every story. I have written a follow up post to this one that looks at another study that is relevant to the homebirth research I cite here: Homebirth Research: Another Side of the Story. It is important that you read it as well because what I talk about there has implications for everything I wrote about here.

I believe that having a good birth experience is and should be a factor in women's decision-making about where to give birth. But I don't believe it should be the primary factor, and don't believe it is for most women, including those who chose homebirth. There is no doubt that for a women who wishes to avoid medical intervention as much as possible, the experience will almost always be better in her own home where she can feel more in control of what is done to her and it is easier to relax. However, some women (myself included) would be willing to give up these advantages to themselves if it equated to better outcomes for the baby.

So, the question is, how does homebirth affect babies? Does being born at home harm them, have no effect, or help them? Theoretically, homebirth is a "more peaceful transition" and the baby "benefits from the mother's lack of trauma," but is there anything clinically measureable? What follows is my attempt to answer these questions with research. I have included citations and links to all the studies I cited so you can look at them yourself and make your own judgments about them. What I have linked to is what I read--in some cases full studies, and in others an abstract or the results cited in another article.

Clinical benefits of homebirth for the baby:

First of all, and most importantly, the outcomes that have the highest significance are perinatal mortality and morbidity, because all mothers want a living baby who is not permanently disabled. Research indicates that babies of low risk women who plan homebirths under a supportive system with a qualified attendant are statistically no more likely to die or have serious injuries than babies of similar women who choose hospital birth (1, 2, 3, 4, 5, 6). Babies of mothers who plan homebirths also:

are less likely to require resuscitation at birth (2, 3, 4)
are less likely to take longer than 1 minute to establish respiration (4)
may have higher 5 minute APGAR scores (4, 6)
are less likely to need oxygen therapy beyond 24 hours (2)
are less likely to experience meconium aspiration (2)
may be less likely to be admitted to the NICU (1, 3) though in one study (1) this difference disappeared when the data was controlled for risk factors
are less likely to be born by cesarean, forceps or vacuum extraction (4, 5)
are less likely to have birth trauma (2)

Why the differences?

Some possible explanations for the differences in neonatal outcomes:

Women who plan homebirths are less likely to have obstetric interventions, including electronic fetal monitoring, augmentation of labor, assisted vaginal delivery, cesarean section, and episiotomy (2).
Women who give birth at home feel more free to move and be upright during labor, which can promote progress without the use of oxytocin augmentation (7), thereby avoiding pitocin's potential side effects on the baby.
Women who give birth at home are not under any pressure (direct or subliminal) to push in a bed. Studies show that upright birth results in a shorter pushing phase (8), higher APGAR scores, and lower arterial pCO2 with unchanged pO2, which indicates less transient cord compression (9).
Women who give birth at home are not given any pain medications that have effects on the newborn's breathing or that increase the need for assisted delivery (10, 11). The vacuum extractor, the most common method of assisted delivery used today, is associated with slightly higher rates of neonatal cephalhaematomata and retinal haemorrhages (12)
Babies born at home do not have their cords cut immediately. Academic OB/GYN has covered the research about cord clamping timing--see this post and these videos. In my experience, delaying cord clamping in most hospitals is much easier said than done, though hopefully this is changing.
Babies born at home are almost never separated from their mothers. Most hospitals fail to implement immediate skin-to-skin contact as standard practice, despite the well-documented benefits for the newborn, including a positive impact on breastfeeding rates, breastfeeding duration, temperature regulation, cardio-respiratory stability, and infant crying (13).

It could be questioned whether the good outcomes were more related to midwifery practices than the place of birth. Some argue that midwives working in hospitals where there is immediate access to emergency care could get better results than they get at home. One study (2) found better outcomes for homebirths when comparing between home and hospital births with the same cohort of midwives. The difference could be attributed to different patient preferences in the two groups, such as a desire for pain medication in the hospital group. However, as I learned in my first birth, sometimes women who desire low-intervention births find that the hospital environment and protocols make this more difficult. Hospital policies often require providers to intervene in certain situations, such as slow or stalled labor, prolonged rupture of membranes, or a certain amount of time passing between full dilation and birth of the baby. Homebirth protocols are usually less restrictive, allowing more women to birth without intervention (without compromising results, if the protocols they are using are appropriate). Theoretically, women who birth at home will need intervention less often because being in a low-stress environment with minimal disturbance will promote optimal labor hormone release, resulting in less protracted labor and better natural pain control. And the research I've cited here indicates that when birth can safely occur with less intervention, better outcomes for babies result.

baby boy two hours after homebirth
(image originally uploaded by Fretwurst)

Some Caveats

Of course, it is important to recognize that we are talking about low risk birth here. Some higher risk women probably are taking an increased risk to their baby by choosing homebirth. I don't think all of them are necessarily "all about the experience" either. Most of them, I believe, are in a situation where they are certain or nearly certain to have a cesarean if they birth in a hospital, and they believe that the risks of surgery do not outweigh those of vaginal birth with their increased risk situation. However, these higher risk births would be much safer if they had immediate access to emergency care while still being able to give birth vaginally. While I am saddened by the lack of options for these women, homebirth is not meant to be a last resort for those in unusual circumstances that cause them to feel that the safest birth for them (vaginal birth in a hospital) is not an option.

It is also important to note the qualifiers "under a supportive system" and "with a qualified attendant." I believe it is very important to have a well-trained person you can trust to help you determine when intervention is truly necessary for the safety of you or your baby. The majority of homebirth research I have cited here is international. Many other countries have different requirements for midwife training than what we have in the U.S. In most of the countries where large-scale homebirth research has been done, homebirth midwifery is integrated into the maternity care system, allowing for smooth transfer in the event of an emergency. In the U.S., it is very important to ask questions about your midwife's qualifications, and be familiar your state's laws about direct entry midwifery (see Citizens for Midwifery) and requirements for licensure. Twenty-two states currently do not license direct entry midwifes. If your state is one of these, The Big Push for Midwives, is a resource that may help you get involved if you are interested. The requirements for the national direct-entry midwifery credential (Certified Professional Midwife or CPM) have been criticized for not being extensive enough, and are currently going through a revision process. It is also important to take into account the attitudes towards homebirth in hospitals in your area, as many in the U.S. are not supportive, which may interfere with transfer and care after transfer, should it become necessary.

Please review the the studies below, and, as always, consult with a qualified medical provider to help you make decisions about your care.

References:

Here is the link to the follow up post again: Homebirth Research: Another Side of the Story

Blessingway Traditions

2011-06-11T13:00:00.001-07:00

(I have accidentally posted this post twice before when I didn't want to. Sorry for any confusion or RSS feed issues!)

A blessingway is a gathering to honor a pregnant woman. It is loosely based on the Navajo blessingway, which is a religious ceremony to celebrate various life passages, of which giving birth is only one. The natural childbirth community has adapted this idea to develop their own celebrations, which are very different from a traditional Navajo blessingway. Out of respect for the Navajo, some choose to use alternative terms for the gathering, such as "Mother Blessing."

A blessingway is different from a baby shower because the focus is on supporting the woman as she prepares to give birth. There are no gifts for the baby and no melted candy bars in diapers (I've always found that game disturbing). Sometimes the mood is one of a fun and lighthearted girl party and sometimes it is more spiritually-focused, depending on how the mother wants it to be.

I fell in love with the idea of blessingways when a mom planning a HBA2C on my natural childbirth forum told about hers. I later read the book Birthing from Within, which also discusses blessingways and gives ideas for activities to do at them. I would have loved to have one with my last pregnancy, but we moved here when I was about 3 months along and I didn't feel like I had formed friendships close enough with people here to invite them to something that seems so much more intimate than a traditional baby shower. I also assumed I couldn't throw a blessingway for myself, but needed to convince someone else to do it for me (I have since learned that self-hosted blessingways appear to be acceptable.)

With this baby, I will probably not have a traditional baby shower, since we already have everything we need for the baby. I think this is a perfect opportunity for a blessingway, and I have been looking into some various activities that could be included.

Some common blessingway activities, with links to pictures:

Each guest is asked to bring a bead with some sort of meaning, and then the beads are strung on a necklace for the mother to wear during labor (see Rixa's necklaces she made from her son's blessingway. See also Busca's story about her necklace in Surrender, Part 2)
Making a Quilt for the baby from squares made by each guest (See Rixa's quilt from her son. She also made one at the blessingway for her second daughter. )
Sharing Poems or Positive Thoughts, which can be collected in a scrapbook for the mother to re-read later (A slideshow of Gina's scrapbook can be seen at the bottom of this post at Feminist Breeder)
Making Flags (see this post and this one)
Sharing Positive Birth Stories
Honoring the pregnant woman by braiding or putting flowers in her hair, bathing or massaging her feet, making a belly cast, or painting her belly (see Rixa's blessingway for her son's birth, this post and this post for some pictures)
Belly Dancing
Making Birth Art
connecting everyone's wrist with a string, then cutting the string and having each woman keep the string tied there until the baby is born and the umbilical cord is cut (a picture of this is found here, along with lots of other pictures)
making a phone tree so that everyone can receive a call when the mother goes into labor, and they can all light a candle for her
drinking herbal tea
eating yummy food and enjoying the company of other women (great pictures here, here and here)

Some other ideas that I have sort-of come up with myself:

Making hand-dipped candles for guests to take home and light when they get the call that labor has started
Decorating a t-shirt or sarong with everyone's handprints and/or positive words for the mother to wear during labor to have their support with her

Baby Signing Time giveaway at Enjoy Birth

2011-06-09T12:20:00.000-07:00

I first heard of Signing Time before I had kids. One of my really good friends in college was a Special Education major. She took American Sign Language for "foreign language" credit and she showed me one of the videos, explaining that they were produced by well-known LDS producer and composer Lex D. Acevedo (whose arrangements of instrumental hymns I listened to while in labor with my daughter). She also told me a little about the inspirational story behind Signing Time.

Soon after, I was in a language development class required for my Early Childhood Education major, and someone asked the professor about infant sign language. He admitted that he didn't know much about it, but he suspected that teaching children to sign would delay their speech because they would sign instead of talking. He obviously didn't know much about it, so he should have not answered the question. Research indicates that babies who learn sign language have significantly more advanced speech development than their non-signing peers when measured at 24 months and 36 months. There are many other benefits to baby signing, including reduction of aggression in toddlerhood and higher scores on IQ assessments at age 8.

Although I hadn't looked at the research, I was fortunate enough to have my negative conceptions of infant sign language challenged by my wonderful fellow daycare/preschool co-workers who used a few simple signs ("more" and "all done") to communicate with the one- and two-year-olds at mealtimes. I saw that it made it a lot easier to know what they wanted, and my mind was opened to the idea.

When my daughter was a baby, I read a little more about infant signing, and decided it was a good thing to do. I taught her some signs, including "more," "all done," "hot," and "music." (There were a few more I tried to teach, but didn't have enough opportunities to practice them for her to learn to use them). With my son, I have use the sign for "milk" to refer to breastfeeding, which he uses (which cuts down on him trying to pull down my shirt). He also uses "more," though he won't sign "all done" for some reason, though I think he tries to say it. He doesn't have any discernible words yet, but he can communicate some things to me. I want to teach him more, but feel I don't know enough signs to be able to teach him as much as I would like.

Recently, we rented a Signing Time DVD from our local library. Most of the signs were not really useful for a baby, but my three-year-old daughter really enjoyed the songs. She watched it over and over and will show me the signs she learned from it. I think it would be precious if someday she were to meet a child who uses ASL and could communicate some with him or her.

I was excited to see that Sheridan at Enjoy Birth is giving away her used Baby Signing Time DVDs, CDs, and a used BabySigns book. I think these materials would definitely get use at our house--I think my kids and I would all enjoy them! If you think you would like some great resources for signing with your baby, visit her blog to learn how you can win!

Why you still need to take a childbirth class if you're planning an epidural

2011-06-04T13:00:00.001-07:00

I hear it all the time. "I hear childbirth classes are a waste of time. I know I'm going to get an epidural, so, what's the point?" Here are the reasons I think women who are planning on getting an epidural should take a childbirth class:

Take pain management into your own hands.
Most women will have to experience some labor before getting an epidural. You never know how long that will be. You may not be able to rely on an epidural to take away all of the pain because:

You may have a long, uncomfortable early labor. Some providers prefer to wait until active labor (usually 4cm+) when contractions are regular and strong before giving an epidural to reduce the risk of cesarean.
The anesthesiologist may not be immediately available when you ask for the epidural.
If your labor goes very quickly, there may not be time.

People always tell women who are planning natural childbirth that unexpected things happen, and it's important to be flexible, but no one seems to mention this to women planning epidurals--why not be prepared for natural childbirth, just in case? Pain management techniques taught in natural childbirth classes are often things you can do alone or with your partner, without having to rely on another person and you don't have to be in the hospital to use them--you can use them at home waiting for contractions to get regular, and in the car on your way to the hospital.

Epidurals Don't Always Work
Two of my first interviews with potential doula clients were with women who had negative epidural experiences where the epidural did not provide the pain relief they were looking for. These women had no other coping techniques prepared. They were both looking for a doula because they wanted other options for pain coping and were hoping to have natural childbirths rather than risk having a non-functional epidural again. I believe every woman who wants an epidural should be able to have one, and that it will work goes without saying, but this is not always what happens. If these women had prepared some natural pain reduction techniques, it is possible that their births would have been less traumatic

Also, it is important to take into consideration that pushing usually works best if the mom can feel something. Without some sensation, it is difficult to know when to push. The dose of the epidural is often turned down or off during pushing. It can be hard to know exactly how much medication is needed to achieve the right balance. If your goal is to feel nothing, an epidural may not actually live up to that promise.

A Good Childbirth Class Might Change Your Mind
I have said before that it is a common problem to "not know what you don't know." For the majority of my first pregnancy, I was absolutely positive that I wanted an epidural. I wasn't exposed to any good reasons why I might want a natural childbirth until late in that pregnancy. Once I discovered those reasons, I had an extreme paradigm shift. I had to scramble to try to prepare for a natural birth at the last minute. A good childbirth class will explain why many women consider natural childbirth desirable and help you gain confidence in your abilities not only to cope with labor, but also to make informed decisions for yourself and your baby.

What Makes a Good Childbirth Class?
In my opinion, you are not getting your money's worth if your childbirth class doesn't cover

the normal course of an undisturbed childbirth and why medically interfering in this process (to start labor, to speed labor, or to remove sensation) leads to the need for more and more medical procedures,
honest information about the benefits and risks of common obstetric interventions (such as pain medications, labor induction, labor accelerating medications, artificial rupture of membranes, restricting food and drink, intravenous fluids, continuous electronic fetal monitoring, episiotomy, etc.),
how to make sure your provider and place of birth will support you in the kind of birth you want,
your rights as a patient to informed consent for medical treatment and, in some cases, to refuse treatment,
more than one class period spent on pain management/reduction techniques. If you go over two or three breathing techniques and do one guided relaxation in class and then get a handout with some more ideas to practice at home, this is not enough!

Why not?
So, why not take a natural childbirth class? If you end up deciding to make natural childbirth your goal, the class will have given you valuable information and techniques to give you the best chance of meeting that goal. And if you decide you still want an epidural, you will be confident that you made that decision after truly considering all your options, and you will have good coping techniques to use in the time before you get the epidural, and to help you do the best you can if unexpected circumstances arise and the pain relief you want is not available to you.

Homebirth Midwifery Care Now More Accessible to Yakima Area Women

2011-05-29T13:00:00.000-07:00

I hope my out-of-town readers will indulge my sharing some local news.

Homebirth is growing in popularity among pregnant women here in Yakima, Washington. In February 2010, KIMA news published a story about more Yakima women choosing to birth at home. Although no homebirth midwives reside in Yakima itself, the midwifery team of Kristin Eggleston, LM, CPM of Sunrise Midwifery in Prosser, and Lorri Carr, LM of Highland Midwife Birth Services in Goldendale travel to Yakima to attend homebirths. Dr. Virginia Frazer, ND, LM, of Blue Heron Naturopathic Care and Shannon Bennett, CPM, both located in Tri-cities, also attend homebirths in Yakima.

Although homebirth midwives come to women's homes for a few appointments and for the birth itself, it is more efficient for them to have women come to an office location for the majority of their prenatal visits. Until recently, Yakima women would have to travel 50 miles to the nearest homebirth midwife office for prenatal care visits with a licensed midwife. I am very excited to learn that Kristen Eggleston and Lorri Carr have recently started taking appointments one day a week (Friday) at the home of the Naturopathic Medicine and Accupuncture practice of Dr. Heidi Robel, ND, LAC, PC, located at 307 S. 12th Avenue Suite 11 (map) in downtown Yakima. This location will increase the accessibility of midwifery care for women seeking homebirth in Yakima. This may allow more women to use their services, and will make using those services more convenient for those who no longer have to travel.

What makes Hypnobabies special

2011-05-24T13:00:00.000-07:00

Hypnobabies has a lot to offer. I have decided to compile a list of unique advantages of the Hypnobabies program.

Hypnobabies is comprehensive childbirth education. The founder of Hypnobabies comes from a childbirth education background and brought together her knowledge of childbirth with hypnosis in Hypnobabies. Hypnobabies includes information on the physiology of birth, nutrition and exercise, evidence-based pros and cons of interventions, making sure you have the right caregiver, and more! It is the only hypnosis for childbirth method that meets the requirements of DONA International for DONA doulas to observe for their certification.
Hypnobabies not only teaches women how to relax, it also teaches them to enter a relaxed state at will, using a self-hypnosis technique called the "finger drop." This relaxation response is embedded in her subconscious through practice and post-hypnotic suggestion.
The same relaxation response can also be activated by the mother's birth partner, doula, or maternity provider, with the "release" and "relax" cues, empowering them to help her better make use of her training.
Hypnobabies helps women look forward to birth by releasing fear and learning to expect the birth to be an experience that can be enjoyed, undoing all of the negative ideas about birth they may have absorbed through the media and stories told by others.
Hypnobabies teaches women that birth is a powerful and intense thing happening in their bodies, and helps them embrace that power instead of trying to run away from it.
Hypnobabies teaches women how to have more comfortable childbirths, both by interpreting the sensations of birth as "pressure" or "tightening" AND by learning to increase and direct their bodies' endorphins with Hypno-anesthesia, using the "peace" cue.
Hypnobabies encourages mobility during labor, which helps with positioning and descent (and may be a comfort measure if other techniques aren't working as the mother would like) and teaches a technique that allows them to use their relaxation and Hypno-anesthesia while upright or moving, called "eyes open childbirth hypnosis"
Hypnobabies offers a large assortment of materials for women to practice with during pregnancy, allowing them to practice daily without getting tired of listening to the same few CD tracks over and over.
Hypnobabies teaches about optimal fetal positioning and techniques to relieve back labor.
Hypnobabies gives women a wide variety of tools to pick from to use during their births--moving while using eyes-open childbirth hypnosis, going "off" and relaxing completely, listening to their CDs, having a birth partner read mini-scripts, using cues (relax, release, and peace), vocalizing, visualizing their "special place," chanting mantras from the scripts ("open, open, open"), or counting down from 5-1 (which also activates automatic relaxation). Women have the freedom to use as many or as few of these tools that feel right to them at different points during their births, and may integrate them with their own unique strategies.
Hypnobabies teaches instinctive mother-directed pushing (referred to as "gentle ahhh pushing") and encourages women to use upright pushing positions and listen for their bodies to tell them when and how to push.
For those for whom the wonderful Hypnobabies live course is not an option, Hypnobabies offers a homestudy course, the content of which is based on their live course and significantly more in-depth than any other hypnosis for childbirth self-study option available.

For more information,

Read Hypnobabies instructor and Hypno-doula Sheridan's post How is Hypnobabies different?, as well as her personal experience with taking HypnoBirthing with her second baby and Hypnobabies with her third.
Check out this comparison from Laura, who has used and taught both HypnoBirthing and Hypnobabies.
Stephanie, a homebirth midwife in Arizona, wrote about how impressed she was with Hypnobabies clients after some previous negative experiences with women who had done other hypnosis for childbirth preparation methods.
The Hypnobabies website has a great list of unique advantages of Hypnobabies, with testimonials from five women who have used both Hypnobabies and other hypnosis methods.
From the Hypnobabies blog: UNIQUE Benefits of Hypnobabies: "What makes Hypnobabies different from other Childbirth Hypnosis programs?"

Becoming the Mother God Wants Me to Be

2011-05-19T13:00:00.000-07:00

Mother and three children, By François Louis Lanfant, dit Lanfant de Metz (1814–1892) (http://www.zeller.de/) [Public domain], via Wikimedia Commons

I have had some challenging times in the past few weeks since I found out I am pregnant. I have been lucky to not have morning sickness, which I know is a huge blessing. At the time I found out, I was nursing a 13 month old, basically still on demand (have been working on cutting him back a little), and I think nursing has really contributed to the first trimester fatigue, which has, at times, been overwhelming. I feel like if I'm having this hard of a time taking care of two kids while pregnant, how am I ever going to take care of thee kids? I've also been moodier this pregnancy than in my previous ones. I feel like I'm not even the same person anymore, like my body gets taken over by a really mean person, and I am not being the mother I want to be.

I am constantly reminded that I can't do this alone. I have thought a lot about this verse:

There hath no temptation taken you but such as is common to man: but God is faithful, who will not suffer you to be tempted above that ye are able; but will with the temptation also make a way to escape, that ye may be able to bear it. (1 Corinthians 10:13)

I feel that God wants me to have this baby, so He will also provide a way to make me stronger so that I can handle the challenges of this pregnancy and adjusting to a new baby. In the April 2011 General Conference (which I found out I was pregnant the day before), I was very affected by the words by the talk What Manner of Men and Women Ought Ye to Be? by Lynn G. Robbins. He discusses how parenting provides opportunities for parents to teach their children Christlike attributes and for parents to develop their own Christlike qualities. I want to read this talk over and over again because this is the kind of parent I want to be. So much of it applies to me, but I want to share this quote:

A sweet and obedient child will enroll a father or mother only in Parenting 101. If you are blessed with a child who tests your patience to the nth degree, you will be enrolled in Parenting 505. Rather than wonder what you might have done wrong in the premortal life to be so deserving, you might consider the more challenging child a blessing and opportunity to become more godlike yourself. With which child will your patience, long-suffering, and other Christlike virtues most likely be tested, developed, and refined? Could it be possible that you need this child as much as this child needs you?

Although my current situation is not about struggles with one of my children's personalities, it helps me to remember that my goal is to become a more Christlike parent. I believe that the Lord has lessons to teach me, and this pregnancy is an opportunity for him to help me learn to have more patience, self-control, and love as a parent, not only when it is easy to do so, but also when it is very, very hard. If I am paying attention to His lessons, I hope that all my experiences in parenting, especially the challenging ones, will help me become the kind of woman and mother He wants me to be.

"Another Bun in the Oven": My Big Announcement!

2011-05-14T13:00:00.000-07:00

Yep, I'm pregnant! Baby #3 is due in December.

In March, we felt that the Lord wanted us to open ourselves up to having our next baby, and we decided to stop preventing. On April Fools Day, I took one of the new super-sensitive pregnancy tests that is supposed to be able to detect pregnancy as early as six days before your missed period (that is only 8 days after ovulation!). I figured I was about 10-12 days past ovulation at this point (wasn't keeping very careful track of my fertility signs that cycle, so I only knew a 3 day range of when ovulation probably occurred). At first, I thought the test was negative, but then, it appeared,--a very faint second line! Considering the day it was, I decided not to tell anyone else that day because I didn't want anyone to think it was a joke. I also wanted to confirm with another test and that was my last one (I'd taken some the cycle before because my luteal phase was suddenly not short anymore that cycle), so I bought a digital test that day to take the next morning (which came back as an unmistakeable "pregnant."). I wanted to tell my husband in a fun way, since I had never done anything fun to tell him the two previous times. I looked up some ideas online, and I found one I really liked...

I had mentioned to my husband that I wanted to try to make cinnamon rolls sometime. That weekend was the LDS General Conference, and since we have satellite, we planned to stay in all weekend and watch the conference on TV. My husband grew up in Utah, where conference is broadcast locally, and in his family, the tradition was to cook good food that whole weekend.

I decided it was the perfect time to try to make some cinnamon rolls, and I could use them as a way to tell my husband the big news. I found Alton Brown's cinnamon rolls recipe (I love his show on the Food Network, and although a lot of times his way of cooking is "the long way" it is also usually "the good way"), and I started the dough on Friday afternoon.

On Saturday morning, after the rolls were risen, I put them in to bake during one of the choir's songs. I sat down next to my husband on the couch and announced,

"The buns are in the oven!"

He gave me a questioning look.

I pulled two positive pregnancy tests out of my pocket as I said, "And they're not the only buns in the oven!"

My husband was so excited and thought my way of telling him was very clever. I had fun with it. My husband loved the cinnamon rolls. I don't really like cinnamon rolls that much--the frosting is too sweet for me, but they were good for what they were.

I didn't take a picture, but here is a picture I found that looks a lot like my "buns in the oven" when I put them in:

Image uploaded By Stacy (originally posted to Flickr as om nom nom) [CC-BY-2.0], via Wikimedia Commons

MamAmor giveaway at Bellies and Babies

2011-05-09T13:00:00.000-07:00

In honor of International Doula Month, Nicole at Bellies and Babies is giving away a MamAmor doll! MamAmor designs beautiful, handcrafted pregnancy, birthing, and breastfeeding dolls. The doll being given away is worth $145. If you win, you pay only the shipping to get her to you! Click here to enter the giveaway!

Motherhood: It's the Little Things

2011-05-08T17:52:00.000-07:00

A young mother of three spoke in church today for Mother's Day. She mentioned that life as a mother can be overwhelming sometimes, but it is important to recognize the little things that make it worth it. Here are some of my "little things"

Seeing my three-year-old daughter develop into a little artist. She can now draw "people" and "flowers."
Celebrating a successful trip to the potty.
Seeing my one-year-old son sign the word "more" for the first time.
Seeing my daughter gently nurture her baby dolls.
Hearing my daughter sing songs, including one I am pretty sure she made up, called, "Hurry Up and Put Your Shoes Back On."
Rocking my son to sleep.
Playing "long distance peek-a-boo" with my son, who likes to peek around doorways at people.
Building block towers with my three-year-old and watching my one-year-old joyfully knock them over.
Seeing the two of them laugh together.
Tender sibling moments like this one:

There's More to Back Labor than Fetal Positioning! (Review of "Back Labor No More")

2011-05-04T13:00:00.000-07:00

I recently read the book Back Labor No More by Janie McCoy King as part of the required reading for the Hypnobabies Instructor training. I didn't need any more reasons that Hypnobabies is the right childbirth education method for me to teach, but the inclusion of this obscure-but-downright-amazing book in the training requirements is another one. I have never seen this information anywhere else (in my 3+ years of reading books and websites on natural childbirth) or heard of any other childbirth education method teaching it.

Most people with a basic education in natural childbirth know that having a baby in the Occiput Posterior ("sunny side up"--facing the mother's pubic bone instead of her spine) position can cause back labor. I've never had back labor, but I've heard it can be excruciating. You hear a lot about optimal fetal positioning in the natural childbirth community, and if the techniques on the Spinning Babies Site work to get your baby in a better position, that is great for you. However, some babies will stay posterior no matter what, and, what's more...

Not all back labor is caused by the baby's position

Some women will have back labor even with a perfectly positioned baby. I have two good friends who both have had intense back labor despite having anterior babies. Back Labor No More explains that women may experience back labor if they have:

A "short rise" (short torso)
A swayed back (tends to stand with knees locked and pelvis tilted so that her rear-end sticks out)
pelvic abnormality
back injury

The author, Ms. King, has a short rise herself, and experienced painful back labor during her first three births. At the admonition of her father, King had majored in math in college. In her book, she applies her mathematical understanding of vectors to the process of childbirth. The book, which is short, fun, and easy-to-read, explains the concepts in ways that are easy to understand and internalize, with lots of drawings and activities that involve learning with your whole body. If you really want to be able to use the technique, you really need a good understanding of why it works, and to really understand, you will have to read the book.

A simplified explanation is that, in back labor, the force of the contraction (the vector) is directed at the woman's spine. You can solve this problem by changing the direction of the vector, which is done using a relatively simple technique called the belly lift. King is not the first to use this technique and have it work, but she is the first to explain why it works. Vectors. Read the book. You'll get it.

Misty used Hypnobabies and the belly lift to have an easier birth with her posterior baby. This video was uploaded two years ago. In the comments section, Missy explains that she had a wonderful experience using hypnosis with her third baby (anterior), but then her fourth baby was posterior, and she found that hypnosis didn't help as much with the back labor as she wanted. After that birth she found out about the belly lift, and used it for the birth of her fifth baby, from which this footage comes.

This technique is not only reported to get rid of the back pain (though apparently it may have to get worse before it gets better), it also sometimes speeds dilation significantly. It has also been reported to help women have faster births who don't have back labor. I believe this may have been the case in the video below, which I saw on Bellies and Babies, who posted it because she liked the way it was edited, with the music, narration, and combination of still shots and video footage. In it, Jodi explains that her midwife recommended the belly lift to her because of her posture (possibly she was sway-backed?), and it shows her husband helping her with the lift.

I'm serious when I say that Back Labor No More is a must-read for all doulas, childbirth educators, doctors, midwives, maternity nurses, and pregnant women, especially pregnant women who have had back labor before, think that one of the categories above may describe them, or have a baby who tends to hang out in the posterior position (or the right occiput transverse position, since these often rotate to posterior). Although you won't find this book in your bookstore or local library, the information makes it worth ordering. It is very easy to pay for it through PayPal on the author's website, and if you are paying with a credit card, you don't even need a PayPal account. You can also order it through Amazon.

The Trap of Idealizing the Quiet Birther (part 2)

2011-04-29T13:00:00.000-07:00

I think it is a common misconception that a goal of using hypnosis is to have a quiet birth. I think many natural birthers are quieter using hypnosis than they would be without it. Partly I think this is because they often experience less pain because of the high endorphin levels they are able to create for themselves. I think many women not using hypnosis get too caught up in pain and tension to get to a place where they can birth in a focused state that may be natural for them. Sometimes, the screaming or moaning is a response to pain (and its not a bad response, if the woman finds it helpful), but not always. I have read birth stories where Hypnobabies mamas have said that they reassured their birth companions that the noises they were making were not because of pain. Less pain may often equal less noise, but it does not always equal no noise.

The clear impression I got when I was studying Hypnobabies is that instinctive vocalization is good if it helps you. They actually call the type of pushing they advocate "Gentle Ahhhh Pushing," which is not the"Breathing the Baby Out" that I read about in Hypnobirthing by Marie Mongan (which I, for one, find confusing) nor is it the provider-directed prolonged breath holding of the Valsalva("purple pushing") method. Hypnobabies advocates pushing when and as long as feels right, and says that your instincts will guide you to you use breathing, vocalizing, holding your breath, or some combination of these. The Hypnobabies materials explain that many women instinctively vocalize with an "ahhhhh" sound when they start to feel their babies moving down. This is what I did, and having read that, I was not afraid to do so.

Hypnobabies actually doesn't teach that being quiet is the only way to have a good birth, but I think there may be some contribution to the idealization of quiet birth with the videos that are used to promote it. While videos of quiet birthers do a good job of showing one type of birth that is possible with hypnosis (and I believe possibly more common with hypnosis than without it), they may not necessarily show the whole spectrum of what a good birth with hypnosis can look like. I looked through the Hypnobabies birth videos that I could find online. A few did not include video of pushing (totally understandable if the video shows the baby emerging and you don't want your "bits" on the internet!). Of those that did, there were some where the mama was mostly quiet during pushing, but they were not all like that.

Sierra's Hypnobabies Homebirth video shows her "ahhh" moaning transforming into a powerful roar as the baby is born, and is beautiful.

I think that if I had the freedom to follow my body's instincts instead of being instructed to not push and later, to hold my breath, I can see how making birthing sounds similar to Sierra's would likely have come quite naturally to me. I hope that when I am a Hypnobabies instructor, that I will be able to help my students know that being loud (or having the expulsive reflex trigger an "out of control" feeling, like I talked about in Part 1) is not failure. I want then to know that what happens to your body when you give birth is incredibly powerful. While for some women, the best way to respond to the power may be to be quiet and focused the whole time, others may find at some point that it helps to release some of the intensity with their voices (I would be surprised if I am not one of these!), and this is okay. In fact, it is more than okay. It is another wonderful way to give birth.

The Trap of Idealizing the Quiet Birther (part 1)

2011-04-25T13:00:00.001-07:00

Rachel, a midwife in Australia who writes the blog, Midwife Thinking, recently shared her thoughts on the habit our society has of Judging Birth. I really liked the second section where she talked about judging birth choices. My last post, The Trap of Idealizing the Intervention-free Birth covers some of the same ideas. I also generally agree with the ideas of the part about judging women's behavior in birth, though at first I wasn't sure I did. As I was looking through the comments on the post, I came across this:

I find the general rule of thumb for making noise has to do with a woman’s sexual style. If she is a noisy lovemaking person, then chances are it will feel natural for her to express herself loudly while in labour. If she is a quiet lovaking [sic] person, then she will follow suit when she is in labour. We birth in accordance with the way that we live.

My reaction was, "There are really women who can be quiet during sex?" (I guess that shows what my "sexual style" is!) At first, I didn't think this rule of thumb applied to me, because, using Hypnobabies, I was rather quiet. But then I remembered that wasn't exactly true. I began to spontaneously vocalize as I felt the pressure of my baby beginning to come down. I wasn't moaning in pain, it actually felt better to make noise, and I remember saying so. I was also very vocal while trying to wait for the cervical lip to move.

At first, I was a bit put off by a mention in the post of feelings of failure caused by "childbirth preparation programs aimed at learning how to be quiet and in control during birth" and some more direct implications of hypnosis for childbirth by some people in the comments. I went back to the post later and saw some new comments and a discussion between Rachel and a mom who used Hypnobabies that clarified some things. Here is part of one of Rachel's comments.

You did something based on your prior birth experience that worked for you… an individual… which may, or may not work for another woman. There is nothing wrong with learning to relax during birth with the help of breathing or any other technique. These techniques are extremely helpful for many women. However, if they become prescriptive and women feel like that is the only way, or that they must not lose control then they can cause harm. As you found in your own experience the techniques can work up to a point for some women. You did not worry that your body took over at the end of labour. However I know some women how consider their body taking over at the end as a failure to remain in control. It makes me sad when women express disappointment because they ‘lost it’ just at the end.

I also had a "losing it" experience at the end of my birth with hypnosis. I still attribute some of that feeling to confusion about not knowing whether to listen to the instructions on pushing (and on "not pushing yet") or to try to do what I had learned about in Hypnobabies and my own research. However, I now realize that it is highly possible that the panic, that feeling like I was drowning, at the very end might just be the way birth happens for me. That sudden "swept under" feeling might be just what I needed to...push me into pushing, I guess. I don't think it is that way for everyone. But it being that way for me doesn't mean there was anything wrong with me or with my level of preparation. It doesn't mean that I failed to use hypnosis correctly during that part of my birth. I had kind of hoped that I would be able to "calmly breathe the baby out" thing with my next birth, but maybe I will and maybe I won't. If I don't, then maybe that is the way it needs to be for me.

My thoughts will continue in Part 2.

The Trap of Idealizing the Intervention-free Birth

2011-04-21T13:00:00.001-07:00

Sometimes we get caught in a trap of holding up a spontaneous, drug-free vaginal birth as an ideal, because, well, most women should be able to give birth without interventions, right? Then, we end up comparing an individual birth to this standard. I doubt anyone would actually say this out loud, but I think something like the following happens in some women's minds, though it is probably not this specific.

Completely intervention-free vaginal birth? A+! Great job!
Vaginal birth with IV and artificial rupture of membranes? B. Good effort!
Induction and epidural? C. Mediocre.
Epidural, episiotomy and vacuum extractor? D. It could have been worse.
Cesarean? F. Better luck next time.

But this is not how it works. Your childbirth educator isn't going to give you a grade, because your baby's birth is not an exam! You are not "most women" and every birth is different. It is not your responsibility to prove that birth with minimal interventions is best. As a wise woman once said, "that's a pretty freakin' huge burden to put on one vagina." Interventions are sometimes needed. You can't know in advance that you won't need medical help, so it doesn't do any good to believe that getting it is a negative reflection on you.

After my first birth, I did feel like a C student. I felt like I hadn't done a good enough job at practicing tools for reducing or coping with pain. I thought that if I had prepared better, I possibly could have avoided the epidural. But how in the world can a woman expect to know how to prepare for something she has never done, having no real way of really knowing what it is going to be like for her? Can someone who has never given birth before really prepare for a long, slow, sleep-depriving early labor? An intense, lightening-fast, precipitous labor? Constant pain in her lower back that gives her no break? An emergency cesarean? How can we expect a first time mother to predict what techniques might be helpful for her so that she can practice them? How is she to know how much time she needs to put into practicing so as not to forget everything she practiced immediately when her birthing starts? And how is she supposed to devote any time at all to it when society tells her to "just enjoy the pregnancy" and "don't worry about the birth" until it is less than three months away?

I wish we could irradiate the word "failure" from our vocabulary in conversations about childbirth. I do not call doing something differently from what you wrote on your birth plan failure, I call that a change of plans. Changes of plans can be in response to medical necessity (because intervention sometimes does save lives and improve outcomes), or they can be for psychological reasons. If a woman who wanted a natural childbirth has crossed over from "coping" to "suffering," and nothing is working to bring her back, the decision to use pain medication is not failure. In that kind of situation, medication is probably the best choice to avoid trauma and allow the birth to be a good experience for the mom. As many have pointed out, a traumatized mom is not a "healthy mom."

If a woman had interventions in her birth she wouldn't have chosen with more information or if her options had been presented in a different way, it is not her fault. I hear a lot that a woman has a responsibility to inform herself, but the problem with not knowing is that we don't know what we don't know. Can we really expect a woman to be responsible for understanding all of the situations that may come up in her pregnancy and birth and all of the benefits and risks of available medical procedures? In an ideal world, her care provider (whose job it is to know these things) would present the facts about her choices as objectively as possible, and leave the decision to the woman. In most cases, reality is pretty far from this ideal, but I don't believe in blaming women for not finding out for themselves what their doctors should have told them. (Though getting angry about what doctors should do doesn't do us any good--Felice recently posted about this here.)

As always, the language we use is important. We have to pay attention to the implications of what we say--what a woman may read between the lines of our words. The phrase"sucessful VBAC," implies that a planned-VBAC-turned-repeat-cesarean is a "failed VBAC." Criticizing high rates of medical intervention by saying things like "I find it hard to believe that X percent of women's bodies are broken" implies that the body of a woman who has an honest medical need for that intervention is broken, and "Your body is broken" is not an empowering message. Besides, we don't consider it failure for our bodies to not function optimally all the time in life--I don't usually think my immune system failed me if I get a cold or stomach virus--I usually attribute that to bad luck. I think sometimes birth is the same way. Preparation plays a role in whether or not you get the birth you planned for, but so does chance.

Maybe those of us who have had that idealized birth shouldn't get cocky and maybe need to recognize that it didn't happen all because of what we did, and hopefully those of us who had a birth other than that one can recognize that it didn't happen all because of what we did either. At the same time, I do not wish to invalidate other women's feelings. If "failure" is the word you choose to describe how you feel, then that is your reality. If reading my thoughts on this does not bring you any healing, I wish you healing wherever you find it.

Stay tuned for the next post in the series!

Birth Idealization Traps--Intro

2011-04-19T13:00:00.001-07:00

In my opinion, the only ideals in birth are

the best outcome for mom and baby possible under the circumstances, AND
the best (meaning promoting empowerment and avoiding trauma) experience under the circumstances.

Because every woman and every birth is different, this may look different in different births. For one woman, promoting empowerment and avoiding trauma might mean a homebirth after prior negative hospital experience, for another, it might mean a scheduled repeat c-section after a traumatic VBAC, and yet another may find getting an epidural the best way to avoid trauma. For one birth, minimal intervention may lead to the best outcome possible, while for another, interventions may help lead to the best outcome. For one woman, being quiet and peaceful during her birth may be empowering, while another my find loud vocalizing to be her way to be empowered.

The problem comes when we compare birth experiences and look at one type of birth as if it is the "perfect" birth and all others are somehow second-rate. I believe that this is a harmful way of thinking. In my next three posts, I will explore some of "idealization traps" that the natural birth community sometimes falls into.

Oh, and guess what? This is my 100th post!

A Special Relaxation and Pregnancy Celebration Idea

2011-04-14T14:23:00.000-07:00

Okay, I admit that part of my reason for writing this is to brag about my amazing husband, who, for my birthday yesterday, arranged childcare for the kids and scheduled a spa package for me at a local day sap called Ummelina. It is a really nice spa and I had a great time.

They have a prenatal spa package called the Mother's Creative Journey, a 3 1/4 - 4 1/2 hour experience which includes hand and foot massages, facial, and full body massage. It sounds absolutely heavenly. I was thinking how awesome it would be to have an expecting mother's friends meet her either before or after the spa journey for a baby shower or blessingway in their Tea Spa. The atmoshere would be perfect for something like that. You may want to check with spas in your area and see if they offer anything like these options.

Of course you could always save money by doing home spa treatments at your shower or blessingway instead. I am going to work on a list of various blessingway activity ideas (complete with links to where some women have shared their own blessingway experiences) and hopefully get it organized into a post sometime soon.

How to get your partner on board with your birth plan

2011-04-10T13:00:00.000-07:00

So, you want to change maternity care providers but your husband doesn't understand why you should go through the trouble? You want a natural birth, but your husband says, "why have pain when you don't have to?" You want to write a birth plan, but he thinks it is disrespectful to tell professionals how to do their jobs? You want to hire a doula but your husband doesn't see the benefit? Or maybe you want to give birth at home or in a birth center, but he thinks you should just go to the hospital like "everyone else"?

Here are a few ideas that might help him see why this matters to you:

Get him to read a book, such as The Thinking Woman's Guide to a Better Birth or maybe a selected article or blog post, such as Dr. Sarah Buckley's Epidurals: risks and concerns for mother and baby or Navelgazing Midwife's Pointless Hospital "Rituals".
If he is the kind of guy who doesn't like to read, have him watch a birth documentary with you. Some possibilities are The Business of Being Born and Pregnant in America.
Set up a meeting for the two of you with the midwife or doula you would like to hire. She may be able to address some of his concerns.
Get him to take a childbirth class with you. Choose a class that covers the benefits and risks of your various options, rather than one that only teaches what is standard practice at the hospital.
Sit him down and have a heart-to-heart. Explain how much your baby's birth matters to you and why you want to be involved in the decisions about it.

I hope he becomes the supportive partner you want him to be. Or at the very least, he will decide to just leave the choices up to you and go along with it. Good luck!

First Blog-iversary

2011-04-05T13:00:00.000-07:00

One year ago, with my tiny month-old baby boy on my chest, I signed up for blogger and wrote my first post. Pretty soon, I will be up to 100 published posts!

So far, blogging has provided me with a lot of great opportunities to learn and grow and share what I learn with others. I am still figuring out how to balance blogging with the rest of my life. One thing that seems to help is scheduling posts in advance so that I'm not putting pressure on myself to finish a post within a certain amount of time so that my blog doesn't sit stagnant for too long. AI like to schedule them five days apart. You may have noticed that sometimes this causes me to publish a post quite a while after I read the thing that inspired it (this is the case with both my Brewer Diet post, for which I was really surprised at the response--it is now my 4th most viewed post ever, and my last post on Doulas and Cesareans). So, if I'm really behind in the online discussion, sorry. This is what is working for me right now!

Stay tuned for more interesting and exciting posts!

Doulas and Cesareans

2011-03-31T13:00:00.000-07:00

I have written about how a doula can help with different plans for hospital births and for homebirths. A post by Navelgazing Midwife made me realize that I left out yet another group of women. A follow-up guest post Doula-ing for Cesareans on Navelgazing Midwife's blog by Kristen French, of Central Washington's own Three Rivers Birth Services, (small world, huh?) addresses this much better than I ever could. A lot of people assume a doula can't really do anything for a woman having a cesarean, but Kristen's comprehensive post does a great job of explaining otherwise.

Here are a few key things a doula can help with for a cesarean:

helping the mother understand the procedure and prepare emotionally for a cesarean
helping the mother develop a birth plan that allows her cesarean to be a special birth for her and her baby in whatever ways he woman would like. Kristin's guest post contains a list of options, and some possibilities are shown in this amazing video:

supporting the mother in the moments just before the surgery, where intense emotions are likely to arise
helping the mother develop strategies for coping with the emotional intensity of the cesarean experience
being present in the OR, if the hospital will allow it
if the mother and baby must be separated, staying with the mother while the father stays with the baby
helping with establishment of breastfeeding, which is often more difficult after a cesarean because the incision can make it necessary to use less common breastfeeding positions
helping the mother process emotions from the birth to help her memories of it be as positive as possible

Traditional Birth Secrets: Dancing Your Baby Out

2011-03-26T13:00:00.000-07:00

When a woman is giving birth, moving her hips can be helpful for her to feel more comfortable and can encourage rotation and descent of the baby. In childbirth education, we try to teach women how to do "hip circles" during pregnancy, but it usually feels a bit awkward. Some cultures have got it figured out: teach these movements to girls long before they ever become pregnant as part of fun dances, and then it will be natural to do it during birth. Many traditional cultures have dances that teach movement of the hips or abdomen, including the hula and other dances from the Polynesian Islands, the various dances of Latin America, and Middle Eastern "belly dancing."

Dancer discovers link between birth and "belly" dance in 1961

Morocco (Carolina Varga Dinicu) is a world-renowned dancer, choreographer, dance researcher, and dance instructor in the Mideastern and North African styles of dance (she does not use the term"belly dancing," because she considers it offensive. She prefers the traditional name, Raks Sharki, or its correct translation "Oriental Dance"). Creator of the acclaimed dance company and school, Morocco & the Casbah Dance Experience, Morocco has won multiple awards for her work. She has dedicated over 50 years of her life to studying, performing, and preserving traditional dances from these regions. Morocco says she hopes to keep performing, teaching, writing, and lecturing "'till 6 weeks after I'm dead."(quote from Morocco's bio, used with permission) Click here to see a video from 2006 of Morocco dancing the Bahlam Beek and Drum solo.

In the 1960s, Morocco had some interesting experiences that allowed her to discover that two of the movements in Oriental dance, the "flutter" and the "camel," were based on movements women instinctively do during childbirth. She learned that these movements were historically part of childbirth rituals, a tradition that was continued only in small villages at that time, where women surrounded the birthing women and did these movements so that she could easily imitate them. In 1967, Morocco had a rare opportunity to witness a birth in a Moroccan village where this tradition was still practiced. The entire (very interesting) story is told in her article, Dancing the Baby Into the World.

Videos of Women Dancing during Birthing

The video below shows Elisa, who stars in The Perfect Pregnancy Workout, Vol 3: Belly Dance for Labor narrating video footage of herself in the hospital during the birth of her first baby. She talks about how her dance training and practice helped her remain mobile and comfortable during her birth.

In this video, Catherine is about 8 cm dilated with contractions 2 minutes apart. She is using a TENs machine, so you can see when her contractions start and end by when she pushes the button, but she doesn't stop dancing! She danced for much of active dilation, and her baby was posterior before the dancing, and rotated anterior during it.

This video shows Alexandria, in the hospital a few hours before the birth of her first baby, dancing to a lullaby version of the Guns 'N Roses song Sweet Child o' Mine. She took a class that combined moves from various types of world dance. She has two contractions during the dance, and keeps dancing right through them without missing a step! I can't even tell when she is having them!

You can read Alexandria's birth story by clicking "show more" beneath the video on YouTube.

If you are interested in finding an instructor near you or in getting certified to teach a prenatal dance class that focuses on birth empowerment and incorporates dance movements of traditional dances from around the world, including the Middle East, Africa, Central and South America, and the Caribbean (the method Alexandria in the last video took her class in), visit www.dancingforbirth.com

Reality Check: The Brewer Diet is Not Evidence-Based

2011-03-21T13:00:00.000-07:00

Many Childbirth Education methods teach that following the Brewer Pregnancy Diet will reduce the expectant mother's risk of complications, including pre-eclampsia. I have promoted the Brewer Diet myself in the past. The truth is that the Brewer Diet does not have any good research out there backing it up. Dr. Brewer's statistics from his patients are very un-scientific. It is hypocritical for people to accuse obstetricians of not following evidence by requiring intravenous fluid and continuous fetal monitoring (procedures not proven to be beneficial), and at the same time encourage pregnant women to follow a specific nutritional plan that has no randomized controlled trials backing it up. "But isn't good nutrition always a good thing?" you ask. Well, yes, but there are some specific problems with the Brewer Diet itself (many of these I learned from reading a comment response by Navelgazing Midwife on her blog post, Hypocrite in the Middle).

Drawbacks of the Brewer Diet:

The Brewer Diet can create stress in the pregnant woman by encouraging her to agonize over all of her food decisions. I would think that stress could have the opposite intended effect by actually causing high blood pressure.
The Brewer Diet is a lot of food. It is not natural or healthy for women to eat more than they feel hungry for. There is some concern that the caloric requirements of the Brewer Diet may grow overly large babies in women who are adequately nourished.
The high amounts of protein in the Brewer Diet may put stress on some women's kidneys, if their kidneys are over-taxed, and women usually do not know whether or not their kidneys are over-taxed.
There are many, many women who have followed the Brewer Diet and still gotten pre-ecampsia.
Claiming that the Brewer Diet prevents pre-eclampsia equates to patient-blaming and making women feel like their pre-e diagnosis is their fault.

Instead of promoting a specific one-size-fits-all diet, why don't we focus on a few sound nutritional principles?

Sound Nutritional Principles for Pregnancy:

Try eating frequent small meals during pregnancy. This may help with nausea (no guarantees, though) and will accommodate for the decreasing size of your stomach as your baby grows. Listen to your body about how much to eat.
Avoid eating too many high-carb and sugary processed foods (white bread, baked treats, etc.) and opt instead for whole grains--oats, multigrain bread, brown rice, whole wheat pasta, etc.
Include protein in your diet each day, but don't worry too much about getting a specific number of grams. Meats, eggs, dairy, beans, and nuts can all be good sources. Many beans and nuts are not complete proteins by themselves, but create a whole protein when eaten along with whole grains. (Edited to Add: Experts now recommend 60-80 g of protein for pregnant women. If you don't eat much meat and/or dairy, you may want to keep track to be sure you're getting enough.)
Include a variety of colorful fruits and vegetables in your diet, especially ones where the flesh is colorful, not just the skin. Leafy greens are especially healthy--romaine lettuce, spinach, kale, etc.
Include healthy fats and oils in your diet, but remember that a serving of fat is very small and there is some fat in other foods you are eating.
Have water on hand throughout the day and drink enough that you are not getting thirsty.

If you are at risk for high blood sugar, have insulin issues, have been diagnosed with gestational diabetes before, or have a history of large babies, there are other considerations for you.

Unexpected Parenting Lessons

2011-03-16T13:00:00.000-07:00

I had an interesting experience recently that is a bit off topic from my usual posts, but since birth is about becoming a parent, I thought it wasn't totally inappropriate to share here.
One day, towards the end of my children's and my recovery from an icky cold/cough, my daughter was using drawers and chairs to climb around in the kitchen, and I discovered her with a bowl and a wisk trying to combine cornstarch, salt, and an egg. (Yes, she is very independent for a three year old.) At first I was angry at her for making a mess, but I soon realized that she was, in fact, showing an interest in baking, so I decided to stop yelling at her, get out my measuring cups, and let her help me bake something.

Since I suspect my son is has a problem digesting dairy, if I was going to bake, I needed it to be something without dairy and something without margarine, since I was out of Earth Balance vegan margarine (did you know that many commercial margarines have whey in them?). I decided on the Amazing Vegan Brownies recipe from www.godairyfree.org. One thing I love about this recipe is how food-storage friendly it is--everything in it can be stored for a long time since it doesn't use milk, eggs or even any milk or egg substitutes. (and I had just a few weeks before this taught a lesson for a Relief Society activity on the importance of and how to start a home supply of food). The taste and texture were a little strange, but they were still brownies to me. My husband thought they were awful, but he pretty much hates all "health food," especially unusual desserts.

When the brownies were in the oven and I was cleaning up the kitchen, I thought about the Waldorf idea that parents should try to incorporate their children into their daily work routines. I haven't completely figured this out yet, but I like the idea of involving my kids in my chores instead of putting on a movie or a TV show off the DVR (we have 90+ episodes of Dora the Explorer recorded) for them while I work. My daughter watched a lot of tv while the sickness went through the house--of course that makes sense when she was so sick she couldn't get up to play, but she was getting better and I didn't want her to get too used to it, so making the brownies was a good opportunity for us to actually do something. I haven't fully figured out involving her in my cleaning, but she does like to help scrub the toilets when I do swish and swipe, likes to help wipe the table, and she will help me make beds sometimes. She also loves to help me bake, and there are lots of things she can do--I let her dump the ingredients into the bowl after I measure them.

As I finished cleaning up the kitchen, I noticed that my daughter had disappeared to her room. I went to check on her, and found her sitting on her bed looking at a book. It was one of my favorite picture books, The Seven Silly Eaters by Mary Ann Hoberman. I thought, "Of course!" We had just read the book at bedtime the night before and in her cooking experiments, my daughter was trying to apply what we had read in the real world to the book. By baking with her, I had just taught an integrated literacy/math lesson without realizing it! The Seven Silly Eaters is about cooking and baking. It tells the story of a mom of seven children who each only eats one food, and the mother works constantly to keep them all happy by making each food for each child. In the end, they combine the foods together and make a cake. A recipe for the cake is on the authors website, and I hope to make it with my daughter some time to further expand her experience with the story (though I will have to use a milk substitute in it if I make it while I'm still dairy-free).

I learned from the experience to always pay attention to what my children show interest in, (even if they are making a mess with it) because where there is interest, there will be opportunities for learning.

Chile becomes 45th country to join Human Milk 4 Human Babies milk sharing network

2011-03-15T21:58:00.000-07:00

Fellow Childbirth International Emma Kwasnica founded the mother-to-mother breast milk sharing network Human Milk 4 Human Babies Global Network (formerly Eats on Feets GLOBAL--I believe the name change occurred because of a trademarking issue, but I actually prefer the new name). The network is rapidly expanding, and yesterday, Chile became the 45th country to create a HM4HB facebook page! To see a list of all current chapters, click here, and if you are interested in helping to support this cause by becoming a co-admin for a page in your area, visit The HM4HB Global Network page on Facebook.

You're invited to join Zulily!

2011-03-11T13:00:00.000-08:00

Zulily is an online store with great deals on awesome brands for apparel and other great products for moms, babies, and children. Discounts are exclusive to site members, but the account is free--you just need to enter your name and an e-mail address and create a password. They send you daily e-mails with what the new sales are for that day, which is great, because the sales are all limited-time and products tend to sell out fast! I recently bought my daughter some adorable green sunflower mary janes from Pippytoes on Zulily for only $18.99 plus tax and shipping (they retail for $35.00).

The best thing about Zulily is that you can invite friends using a special link, and when they make their first purchase, you get a $15 credit to put towards any of their already discounted products! If you would like to take advantage of this great members-only online store, please click here to sign up for zulily using my invite link!

My Son's Magical Birth Story

2011-03-06T09:00:00.000-08:00

My son is one year old today! In the spirit of Pam England's #2 Way to Change Birth in Our Culture, I wrote a magical birth story for my daughter last month to celebrate her 3rd birthday. I decided to also write one for my son to celebrate his birth today.

My Son's Magical Birth Story

After we moved to a new state while I was pregnant with you, I found a really great obstetrician, Dr. I, who I knew would help us have the best birth possible. I was really looking forward to your birth, as I used Hypnobabies to prepare to have a gentle birth without having to use medication. The first time I listened to the Hypnobabies Special Place relaxation track, you became very active in the womb and I knew you wanted me to know you were your own unique spirit who would bring something special to our family.

The day before you were born, I felt a need to get the house ready for you, so I did some cleaning. When I woke up from taking a nap with your sister that afternoon, I began to feel the pressure waves telling me you were on your way to meet us. I listened to the Special Place track again and you moved a lot again during it and I felt very connected to you.

As your father drove me to the hospital late that night, it was cold, but clear out. Dr. I and our nurse Dianne did a wonderful job creating a calm atmosphere in the room where you would be born, just like I wanted. My womb was very close to completely opened when we arrived in the room. The water that surrounded you in the womb came out of the birth canal not long before you did. Your father's kisses helped me relax so that I could open the last bit I needed to for you to come out. You were truly born into a room full of love. With no medication numbing me, I felt very deeply "in the moment" as you came into the world into the hands of Dr. I. Before you were even all the way out, I reached down and grabbed you under your arms and pulled you up to me so that I could hold you. I was so happy you were here and so proud of myself for having a drug-free birth. Your dad did such an amazing job supporting me while I gave birth to you. He was so excited and proud to meet his first born son. You looked at him like you knew him already.

I hope you will learn from the example shown you by your father of how to love a wife, and grow up to be just as wonderful of a husband and father as he is.

I love you, my Little Man, Happy First Birthday!

Photo by Jordan and Chelsea (JCPhotography, Utah)

Two Quick Things

2011-03-04T10:53:00.000-08:00

1. Rixa of Stand and Deliver had her baby! It's a girl! Part 1 of the birth story, including video of her catching her own baby, is up on her blog. Rixa uses the Hypnobabies program some, but adapts it to fit her own needs. She has said before that she doesn't use it to try to avoid feeling pain, but to instead embrace whatever sensations she experiences.

2. MamAmor dolls is having a giveaway! If you don't know about MamAmor, you should! They are handcrafted dolls that can be pregnant, give birth, and breastfeed. Check out the MamAmor Doll Shop to see some of the dolls and doll accessories. Also, see Rixa's review of the custom doll she ordered for her daughter as a gift to celebrate the birth of the new baby. Then go to the Doll Giveaway at the MamAmor Blog, and enter to win the contest to win this $135 doll for FREE (you only pay shipping!)

Birth Dream

2011-02-28T13:44:00.000-08:00

After reading Rixa's post Supporting Your Own Perineum yesterday, I had a dream last night that I was birthing at home. At least it felt like home, but it did not look like the house we live currently live in or any house I've lived in before. Ina May Gaskin was my midwife. She sat cross-legged in the corner of the room and quietly watched while I crouched on the floor and provided my own counter-pressure as I birthed a baby boy into my own hands. It was a beautiful dream.

Rixa also recently shared the link to the story of this beautiful birthing quilt. Read the story, it is very special. I love the image on it--I think that is the position I was in in my dream.

Making baby food is easy. Toddler food, not so much.

2011-02-24T13:25:00.000-08:00

I have made baby food for both of my kids. I mostly did purees frozen in ice cube trays. The Wholesome Baby Food website has been my go-to resource for this. I have found it is pretty easy to make purees, but really struggled when my babies got old enough to not want purees but not quite old enough to always eat everything the rest of the family was eating (say we were having pork chops and a baby spinach salad for dinner--not exactly 11-month-old friendly). I often end up resorting to the expensive pre-made "todder food"--those sauce-less ravioli things are pretty neat, after all.

But I would love to have some resources for more homemade options for my son's current age. Especially because I'm pretty sure my son has problems digesting dairy. I'm not sure if it is a problem with the milk sugar (lactose) or the milk protein (casein) yet--still trying to figure that out (that matters because some dairy foods, such as cheese, do not contain lactose). Many commercial toddler meals contain dairy, so I have to check the labels, and it limits the selection for him.

I was intrigued back in December when I read Enjoy Birth's review of the book So Easy Toddler Food and thought it might be something our family could use sometime. This was before I discovered my son's dairy issues and before he decided he didn't want to be spoon-fed anymore. I forgot about the book at the time, but now I realize that I also think some of the info in the book would also be helpful for my 3-year-old, since food battles are pretty common with her. And I could use the recipes for both of my kids. I was excited to learn today that Enjoy Birth is having a giveaway of a free copy of the book. Click here to find out how you can enter the giveaway.

Blurry Lines

2011-02-21T13:00:00.000-08:00

Focus by Tomasz Sienicki

A few months ago, I read the collection of midwife stories, Sisters on a Journey: Portraits of American Midwives by Penfield Chester. I mentioned it in a previous post. I wanted to go into a little more detail about the lessons I learned from this book, most specifically about the various roles that are all part of midwifery.

Midwife as Childbirth Educator

Ideally, the role of a midwife is not just to provide medical care that is less technological than the medical model, while still being the "birth expert." The role of a midwife is to foster independence in the woman. This is evidenced by the practice of showing the woman how to dip her own urine strips and read the results herself. The midwifery practice I went to for my first couple of appointments when pregnant with my son, before we moved here, used this method. Midwifery is supposed to be about teaching the woman how to take responsibility for her own health. A good midwife will help prepare her clients for childbirth. In some respects, a midwife is a childbirth educator.

As I have read blogs by midwives discussing unassisted birth, I find it interesting that some midwives feel that having a midwife teach a UCer how to perform assessments on herself makes it not "unassisted" anymore. But where is the line between "childbirth education" and "midwifery"? If a UC mom takes a childbirth class, that wouldn't be considered "having a midwife." What if a childbirth educator taught women how to do their own prenatal and birth health care?

Midwife as Doula

Midwifery care is holistic--midwives treat the entire patient, body and mind. They believe that a woman's emotions can have a direct impact on her body's processes, and works to help her feel emotionally supported during pregnancy and birth. A good midwife is skilled in natural pain relief techniques and helps her clients use them during labor. A doula's role is said to be "mothering the mother," but isn't this also what midwives do? A midwife is also a doula.

When I wrote my post on Doulas and Hombirth, I realized that line between midwife and doula becomes blurry when you consider the possibility of a doula attending a UC. How is a doula-attended planned UC different from a planned homebirth with an unlicensed midwife? On paper, they are virtually the same thing.

Midwife as Healthcare Provider

The other role of a midwife is to observe the mother and baby for signs of problems and treat them if treatment is in her scope of practice or refer to another healthcare provider. This part of a midwife's role is similar to a physician, though her perspective on how to go about providing this healthcare is usually different than that of an obstetrician (though I would think a family practice physician might have a more midwife-like approach). And because midwives practice low intervention care and treat low-risk patients, the healthcare provider part of her role is a small part, though a very important one.

The professions of "childbirth educator" and "doula" are both relatively new because their roles were performed by midwives and their partners or apprentices before birth moved to the hospital and began being attended by physicians. The majority of physicians view the practice of medicine as dealing only with the body, not the mind, and those who are specialists like OB/GYNs are only concerned with the specific parts of the body they specialize in. Women have invented our own systems for filling the holes left in our healthcare by modern medicine, and have created the childbirth educator and the doula--and thus, the "team" of physician, childbirth educator, and doula together does all the jobs of midwifery.

Me, a Midwife?

I have recently been seriously considering the possibility of becoming a midwife someday. I have been considering the pros and cons of various paths to midwifery--ideally, I'd like to train as a midwife in another country, but I'm not sure that would work for my family. It won't happen until our own family is complete, and I feel that I won't know it is time for that until it happens. I want to be a midwife, but as I've said before, I'm quite intimidated by it. I realize, though, that what I am doing now allows women to have all aspects of their maternity care needs address (just not all by one person), so I am already helping women have care that is as close to midwifery care as they can get without actually having a midwife--to some extent, I might consider that being "part of midwifery."

Continuous Labor Support Reduces Risk of Cesarean Section and Other Adverse Outcomes in Women and Newborns

2011-02-16T12:42:00.000-08:00

The following press release comes from Childbirth Connection, it is available in PDF here.

FOR IMMEDIATE RELEASE - 11 am ET, February 16, 2011

Continuous Labor Support Reduces Risk of Cesarean Section and Other Adverse Outcomes in Women and Newborns
Type of Caregiver Can Make a Big Difference in Labor Experience

New York City — Women who labor with a dedicated support companion are less likely than women without such support to experience a series of risky birth procedures, according to a review published in the current issue of The Cochrane Library. The comprehensive study of experiences of 15,061 women who participated in 21 randomized controlled trials confirms previously known benefits for maternal health, identifies an additional benefit for newborns, and finds no downsides. The study was carried out through the prestigious Cochrane Collaboration, an independent international organization that prepares and keeps up to date rigorous systematic reviews of evidence from the best available studies.

Overall, women who received supportive care from a companion throughout labor were less likely than women without such support to have a cesarean section, to use narcotics or any other pain medication, to use regional pain medication such as epidural analgesia, to give birth with vacuum extraction or forceps, and to rate their childbirth experience poorly. Having continuous support shortened labor and increased the likelihood of having a “spontaneous” birth with neither cesarean nor vacuum extraction nor forceps. These results confirm previous research. With the inclusion of six new randomized controlled trials, the present systematic review, identified another benefit of continuous labor support: reduced likelihood of a baby with a poor “Apgar score” rating of well being five minutes after birth. The authors conclude that all women should have continuous support while giving birth.
Ellen D. Hodnett, RN, PhD, Professor and Heather M. Reisman Chair of Perinatal Nursing Research, University of Toronto, and co-authors of “Continuous Support for Women During Childbirth” limited the study to randomized controlled trials. This type of research helps ensure that study groups are similar and that results are a true reflection of the effects of the care being studied — here, continuous labor support.

“Cesarean section, vacuum extraction and forceps, and pain medications are interventions that increase the likelihood of adverse short- and longer-term effects in women and babies. Continuous labor support is an important way for women to avoid overuse and harms of these practices, and to have a positive experience at this special time,” said Carol Sakala, PhD, MSPH, Director of Programs at Childbirth Connection. Dr. Sakala is a co-author of the report.

Supportive care during labor and birth does not involve clinical care, and may include:
• helping women with physical comfort
• providing emotional support
• offering information
• helping women communicate their wishes to caregivers
• engaging women’s husbands or partners, as desired by the couple.

Impact Depends on Type of Caregiver
The study provides new knowledge about effects of continuous labor support under different conditions. A major finding is that the impact of this care appears to differ, according to the type of person providing the care. Effects were strongest when the caregiver was neither a member of the hospital staff nor a person in the woman’s social network, and was present solely to provide one-to-one supportive care, such as a doula. Compared with women who had no continuous support, women with companions who were neither on the hospital staff nor in the woman’s social network were:

28% less likely to have a cesarean section
31% less likely to use synthetic oxytocin to speed labor
9% less likely to use any pain medication
34% less like to rate their childbirth experience negatively.

When compared with no continuous support, continuous support by members of the hospital staff did not appear to reduce the likelihood of having a cesarean section or improve ratings of the childbirth experience and may have increased the likelihood of using synthetic oxytocin. These results may reflect the fact that hospital staff can experience divided loyalties, additional duties, and constraints of institutional policies when providing continuous support. Continuous support from a person in the mother’s social network (for example, her partner, husband, other relative, or friend) appeared to increase the mother’s satisfaction with her childbirth experience, but did not seem to impact her likelihood of undergoing a series of labor and birth interventions.

Background
Historically, laboring women routinely received support from female companions. However, more recently in hospitals worldwide, continuous labor support has become the exception rather than the norm. “There is concern about widespread dehumanization of women’s birth experiences,” said Dr. Hodnett. “Concern about institutional routines, high rates of intervention in healthy women and newborns, limits on women’s autonomy and control, unfamiliar personnel, and lack of privacy is leading to calls for making continuous labor support widely available to childbearing women.”

Leading options for continuous labor support in the United States include trained labor support companions known as doulas and — for satisfaction with the childbirth experience — the help of a friend or family member who is invited to be present when a woman gives birth. Childbirth Connection’s second national Listening to Mothers survey found that just 3% of women who gave birth in U.S. hospitals in 2005 experienced the most beneficial type of labor support, in the form of doula care. Although insurance coverage of doula services is limited, trained doulas are available in many communities throughout the United States. Typically, a woman (and her partner, if she has one) selects a doula during pregnancy, and they discuss the woman’s goals, preferences, and concerns. Some hospitals sponsor doula programs to increase access to continuous labor support. In addition to continuous presence during labor, birth doulas may provide some support in the days after birth.

“Hiring a doula was one of the best decisions my husband and I made during pregnancy,” said new mom Jenny McElroy. “Though we prepared by reading books, taking childbirth classes, and practicing comfort techniques, we were inexperienced with childbirth. Our doula knew exactly how to help my husband support me, help me cope with the pain, and help us stay calm and have the birth experience we wanted.”

Effective Strategy for Improving Maternity Care Quality and Value
Medicaid programs and taxpayers cover about 42% of the nation’s births, and private insurers and employers cover about half. The review authors encourage policy makers to provide coverage and hospitals to provide programs for continuous labor support. “The benefits of continuous labor support for mothers and babies are numerous, well established, and compelling, and warrant economic analyses of the relative costs and benefits,” said Maureen Corry, MPH, Executive Director of Childbirth Connection. “Medicaid programs and others seeking ways to improve maternity care quality and value and women’s experiences of care should consider continuous labor support as a key component of a high-quality, high-value maternity care system.”

Resources for Childbearing Women, Health Professionals and Policy Makers
Childbirth Connection’s website includes an in-depth evidence-based section to help childbearing women understand the benefits of continuous labor support, decide whether to have a continuous labor support companion, and arrange for such care (see www.childbirthconnection.org/laborsupport/). The professional area of the website includes a summary of results of the updated review and provides access to the full review, at www.childbirthconnection.org/laborsupportreview/.

Doulas and Homebirth

2011-02-10T22:00:00.000-08:00

In a previous post, I discussed how doulas can benefit women with various different birth plans and support scenarios, but a commenter notified me that I left one out...

How can a doula benefit me if I'm having a homebirth?

Part of the answer to this question relates closely to another post I started a long time ago but haven't finished yet about the similarities and differences in the roles of doulas and midwives. I will try to get that finished soon so that it can complement this post. I believe that the role of a midwife is meant to encompass the role of the doula, but it doesn't always happen that way.

I think that the degree of necessity for a doula in a homebirth is going to vary depending on several factors. The following are some situations where it would be to your advantage to have a doula at your homebirth:

busy midwife: If your midwife is at another birth when your labor begins, she may send a partner to be with you. You should be given an opportunity to meet any partner your midwife works with before your birth, but you may not have the same relationship with her you you have with your own midwife, but you will have that relationship with your doula.

absent partner: If you are a single mom or there is a chance your partner may not be present for the birth, a doula can act as your primary birth partner. This may also apply if you have a husband who is uncomfortable with playing an active role in the birth, disturbed by blood, etc.

sometimes even homebirthers need to be protected from trauma: Unfortunately, not all midwives are as gentle and respectful as what most homebirthing moms are looking for. I recently came across some birth stories of women (the blogger at Mandala Mom and Dy at Complete Beginnings) who hexperienced trauma because of the way they were treated by their homebirth midwives. I will give the founder of the midwifery method implicated in these posts the benefit of the doubt, and say that I don't think she intended for her ideas to be used this way, but I think it is important to understand that things like this can happen, and would like to propose that a good doula can help you find your voice when a provider (even a midwife) is trying to do something to you that you do not want. The women in the stories above both said that they had no indication of their midwives having anything in their philosophy that they disagreed with. All birthing women need to watch out for themselves, and a doula can be your watchdog.

What if I want an unassisted birth?

I am by no means an expert on UC. I imagine that for some women, hiring a doula may not align with their reasons for choosing an unassisted birth. Others may see a benefit to having an extra person around who knows about unmedicated birth is experienced in birth support in case you need an another pair of hands for something.

Giveaways for moms and birth workers

2011-02-07T11:42:00.000-08:00

Sheridan at Enjoybirth is doing two giveaways on her blog. One is for birth workers and one is for moms. (Since I am both, I'm entering both giveaways).

For Moms: Tag*a*Long Giveaway

The Tag*a*Long is a handle you can attach to a stroller for a child to hold on to while you push the stroller. I think this is a great idea. We don't own a double stroller because when my son was smaller, I'd wear him in my wrap and my daughter would ride in the stroller. Now that they are bigger, I like to put my son in the stroller and have my daughter walk, but she needs something to hold on to so she doesn't wander and the Tag*a*Long would be perfect because if she holds onto the stroller itself she is in my way.

For Birth Workers: $25 Injoy Gift Certificate Giveaway

Injoy supplies birth and parenting educational materials, including videos and web-enhanced booklets. Many of the materials would be a great supplement to any childbirth education program or could be used as an informative resource for doulas or for healthcare providers.

If you are interested in either giveaway, check them out today!

Three years ago today...

2011-02-02T14:17:00.000-08:00

...I gave birth for the first time. That's right, my baby girl is three years old today. We are doing the celebration with a little party with a few friends on Saturday. I have spent a lot of time thinking and writing about her birth over the past three years--trying to understand exactly what happened and why it happened, how I felt and what caused me to feel that way. I even wrote a very extensive paper about it for my doula training course. In the end, I realize that it really was a good birth. Would I do some things differently if I were doing it all again with the knowledge I have now? Yes. But what happened is what happened and it was really not bad. I really was not adequately prepared for labor and I think that even without the pitocin, I would have needed to re-evaluate my plans for unmedicated birth when I got into active labor. I really believe that.

Pam England, author of Birthing From Within, has a blog called Birth Peeps. Her current theme for her blog is Fifty Ways to Change Birth in Our Culture. Change #2 was Tell Children A Magical Story of Their Birth, and I really love the idea.

So, here is my daughter's magical birth story:

I wanted to have the best chance at a great birth for you, so I switched to a group of midwives late in my pregnancy. I was supposed to try to see all the midwives at least once before you were born, but through some random chances, I ended up seeing, one midwife, Mindy, a lot more than any of the others. I think our Heavenly Father knew that you would be born when it was Mindy's turn to be at the hospital, and it was a blessing that she knew us as well as she did.

The night you were born was very dark and there was snow on the ground outside. Your dad and your Grandma were there in the room. The room had a big window with a view of the Mt. Timpanogos temple, which was all lit up. The curtains were open, and the light from the House of God guided you into the world.

When it was time for you to be born, my womb opened and you came down my birth canal and into midwife Mindy's hands. She put you on my belly. I was so happy you were here. I looked at the window, and I saw the reflection of me holding you, while the temple glowed in the distance. I pray that the Lord's Holy House will always be your guiding light.

I love you, Princess, Happy Birthday!

Photo 12/23/2010 by JC Photography

Video of an OBGYN speaking on timing of cord clamping

2011-02-01T17:19:00.000-08:00

I wanted to share the link to the video Dr. Nicholas Fogelson posted on his blog of him speaking at a Grand Rounds on the topic of Delayed Cord Clamping. It is a 50 min talk shown in four parts, check it out if you can make the time.

Delayed Cord Clamping Grand Rounds--Academic OB/GYN

From Dr. Fogelson's conclusion:

Delayed cord clamping clearly increases fetal hemoglobin, blood volume, and iron stores. The evidence supports a clinical benefit of delayed clamping. There’s really no strong evidence against delaying the cord clamping. When we talk about interventions in medicine, really, the burden of evidence is on the intervention. And I think people say. “Delayed cord clamping, you can't prove that that’s an intervention that helps.” And I’m like, oh, no, no, no, no. Delayed cord clamping is what we evolved to do. We evolved to get the blood that’s in the placenta. I don’t have to prove that that’s right. You need to prove to me that phlebotomizing the baby of forty percent of its blood volume is right."

I personally would see it from a perspective of God's design, and not evolution, but I think his point about the burden of evidence is spot-on. I think it would make sense to look the same way at a lot of other common routine maternity care practices.

How a Doula can Benefit You (yes, YOU)

2011-01-24T12:30:00.000-08:00

This is a post I started a while ago and left it unfinished. When I found out about the Support Doulas Giveaway at Birth a Miracle Services, I decided to take the opportunity to finish it so I could enter. Today is the last day to enter the giveaway, so check it out if you are interested in winning some homemade natural hand cream!

What are the benefits of having a doula?
I am becoming a doula because I want more women to have all the benefits of doula support. Scientific studies have found clear benefits to having a professionally trained doula with you during childbirth. These include:

* 26% reduction in cesarean sections,
* 41% reduction in use of vacuum extraction or forceps,
* 28% reduction in need for pain medications, and
* 33% reduction in dissatisfaction with the birth experience
(Hodnett and colleagues 2004).

What benefits does having a doula offer over just having my husband as my birth support person?
It is wonderful that the "father pacing in the waiting room" has become a thing of the past, and fathers are now able to participate in the births of their children, to whatever degree they are willing and comfortable. The support that a loving, in-tune partner can provide a woman is of great value. However, it's important to recognize that the birth of your child is a highly significant experience in the life of your partner as well. Expecting the father, for whom the experience is extremely emotional, to meet all the emotional and physical needs of the laboring woman is a lot to ask. He may be worried about you and the baby and may find it difficult to watch you struggling with the obstacle of labor. He may not know or remember what he needs to do to help you. Doulas can be great for reminding or teaching the partner ways to better support the birthing mother. Having a doula also may allow the partner to take breaks if labor is long, without you having to be left without emotional and physical support.

How is a having doula different from having a female friend or family member at my birth?
Having an extra support person can be beneficial, and I recommend this if having a doula is not an option for you. A professional doula does offer unique benefits. She has more knowledge about the birth process, the medical procedures that may be offered, and pain reduction or coping techniques. She may be better equipped to support your plans than a friend or family member may not understand the choices you make. A friend or family member may also find it scary to watch you go through labor, while a doula is more objective and more familiar with labor and what is normal and not normal for women.

What is the benefit of having a doula in addition to the medical staff who will be there?
Most doctors are only able to be with their patients at the very end of labor to catch the baby. A midwife will typically spend more time with you, though in some situations, she will have to care for more than one laboring woman at once. In a hospital, you will have never met the nurses and they may also not be able to stay with you continuously. Some nurses are much better than others at support techniques, and you may not know in advance how good yours will be, though sometimes your choice of hospital plays a role. A doula is a person you choose, who you can get to know in advance, and who will be with you constantly during your labor and birth. Also, the primary responsibility of your medical care providers is to be concerned with the safety of you and your baby. A doula is primarily responsible for your emotional and comfort needs. The medical staff also has to worry about regulation by the hospital and their malpractice insurers. A doula works for you, not your doctor or hospital, and can often offer a more balanced perspective on your options.

Doulas sound great for women who are planning unmedicated birth, but I'm planning on having pain medication. Do I still need a doula?
Many women do choose to hire a doula to support them in their choice for an unmedicated birth, as such support can be difficult to find. However, having a doula can benefit all women, regardless of what kind of births they have. Most women will have to cope with some labor before they receive pain medication, and a doula's support can be beneficial to help the woman get through while she waits for it to be administered. Also, pain medication does not take away a woman's needs for emotional support and unbiased information. Even if a woman needs to have a cesarean, a doula can help keep her calm before and during the procedure and stay with her while the partner stays with the baby. A good doula will support the woman completely in whatever she chooses.

A woman's birth experience matters!
Research conducted by doula, childbirth educator, and author Penny Simkin indicates that women remember accurate details about their births 20 years later. Simkin's research also found that the most significant factor in the satisfaction rating a woman gave for her birth experience 15-20 years down the road was not the length of labor, whether there were complications, or whether or not she had pain medication, but how she was treated by those who cared for her. All women deserve the loving, continuous emotional and physical support of a knowledgeable professional while giving birth. (from Simkin, The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions, Third Edition, pg xi-xii)

Review of Nonichai Nursing Mothers (Part 2)

2011-01-19T13:00:00.000-08:00

Read about the ingredients found in Nonichai Nursing Mothers in Part 1.

I began taking my two-week sample of Nonichai Nursing Mothers in early December. On day 2 of taking it, I noticed the distinctive maple syrup odor in my sweat from the fenugreek. I drank herbal tea made from whole fenugreek seeds I bought at the health food store several months earlier, so I was familiar with this effect of fenugreek.

whole fenugreek seeds

Towards the end of the first week on the supplement , I began menstruating. Many women report experiencing dips in milk supply during menstruation. I have never really noticed, but I do think the supplement may have helped a little with this.

I missed a few days taking the pills here and there since we were traveling, but overall I did notice an increase in my milk supply. Not enough that I started experiencing engorgement or felt a need to pump excess, but enough that my son seemed to get all the milk he wanted faster. He actually started spitting up small amounts after nursing--probably a sign that there was more milk there than he needed, and something he hadn't done since he was quite a bit smaller (he was much more of a spit-up baby than big sister was, though).

All said, I would recommend the Nonichai Nursing Mothers supplement to any breastfeeding mom dealing with low milk supply or slow let-down.

my handsome son, age 9 1/2 months
photo by the owners of JCPhotography

The Federal Trade Commission16 CFR, Part 255 Guides Concerning the Use of Endorsements and Testimonials in Advertising requires that I disclose that I received one or more of the products mentioned above as a free sample, which was offered to me by an email inquiry. Reguardless, I only recommend products I have used myself and that I believe could benefit my readers.

First birth as a doula!

2011-01-18T10:46:00.001-08:00

Please forgive the detour from the schedule of posts I had planned. I just have to share that I had my first birth as a doula early this morning. The timing was perfect for me because my family was all sleeping the whole time I was gone. Everything went very well. It was a really fast birth, so I didn't have much time to provide support, but I feel lucky to have gotten to be there. And I got to cut the cord!

Review of Nonichai Nursing Mothers (part 1)

2011-01-17T13:00:00.000-08:00

I was recently given the opportunity to try a free sample of the Nursing Mothers herbal supplement from Nonichai Health. (The page for the supplement has some excellent pro-breastfeeding information on it). This is the first offer I've received to review a product. I have looked up all the ingredients in the supplement. They are

Marshmallow, fennel, and fenugreek are all traditional herbal galactophages. Cardamom is a spice used in Traditional Chinese Medicine to treat digestive issues. I was very interested in the use of noni leaves. I am familiar with the use of the juice of the noni (Morinda citrifolia) fruit as a dietary supplement. My mother-in-law grew up using noni juice as a tonic in her native country of Tahiti.

the Noni (morinda citrifolia) plant

My husband's family is friends with the owners of the Tahitian Noni company, who have managed to create a blend of the juice with other fruits that is not completely impossible to swallow to people who have never tasted the fruit before (though the noni juice is still a very pungent flavor in it--it is kind of an acquired taste--I can tolerate it, while my husband actually likes it).

Tahitian Noni brand juice and lotion

I did not know before getting the offer to review this product that the noni leaf has also been traditionally been used as a medicine in Tahiti. The site I linked to above on Noni Leaves claims that tea made from these leaves is rich in antioxidants and flavinoids and aids in digestion and maintaining blood sugar levels.

Since my son is a bit small (issues with his doctor over this is another story for another day) and occasionally he has to work hard to get as much milk as he wants in the evenings, I decided I would give the free sample of Nonichai Nursing Mothers a try.

In my next post, I will talk about my experience taking this supplement.

The Federal Trade Commission16 CFR, Part 255 Guides Concerning the Use of Endorsements and Testimonials in Advertising requires that I disclose that I received one or more of the products mentioned above as a free sample, which was offered to me by an email inquiry. Reguardless, I only recommend products I have used myself and that I believe could benefit my readers.

"Preaching to the choir" and what is in store for 2011

2011-01-11T17:41:00.000-08:00

I have been online a lot more the past few days as my son has a fever, so I have spent a lot of time just holding him with my laptop open in front of me instead of cleaning or doing other things. I suspect the fever is a reaction to the Pneumococcal Vaccine (Pc, PCV, Prevnar) he received at his well-child visit on Dec. 30--it was his third time getting the Pc shot, and he didn't have a reaction the first two times, but reactions to Pc are very common, so I'm guessing it would be from that one and not the Hep B. He has been clingy and fussy the past few days, but no digestive or flu-like symptoms--kind of unusual. The fever is responding to acetaminophen, though.

But I see that taking more time away from the internet over the past month or so has been good for me in a lot of ways. I have been reminded of what Courtroom Mama wrote last summer in her call for submissions for the Crisis in the Crib blog carnival (which I participated in) about how time away from the internet can give you fresh perspectives.

I have been considering what the point is for writing this blog. I think, for the most part, blogs are read by same-thinking individuals, creating a "preaching to the choir" effect. What good am I doing if I find just the right words to express the way I feel if the only people who are reading it all feel exactly the same way, they just couldn't find the right words to say it? How much of what I say actually gets outside the circle of like-minded birth and parenting bloggers and onto the screens of women who actually need to read it? Who may actually consider options they hadn't considered before reading?

I would venture to say, not very much. This is why many of my posts in the past have focused not on proclaiming the message of the natural birth movement, but on turning our eyes on ourselves and discussing in what ways we are failing in our efforts to present our point of view effectively--tendencies towards things like name-calling, forgetting that others might see things from a different point of view, doctor-bashing, creating fear of medical interventions, and focusing too much on what choice is made rather than why it is made . I hope to have more posts like this in 2011. Because nobody is perfect the choir still needs preaching to, just a different message than what the congregation needs to hear.

Mormon Tabernacle Choir and Organ (Public Domain)

In 2011, I hope to write to the audience I have, rather than the one I'd really love to have, and perhaps I'll also try to find new ways to reach the people out there I'd love to reach. I also aim to write shorter posts, since they are more likely to be read, and to break up posts into multiple parts if they get too long.

(I was going to schedule this post for tomorrow, but I realized the date, and I wanted to post something on 1/11/11)

A New Year is kind of like a Birth

2011-01-07T16:47:00.000-08:00

Think about it...the newness, the celebration, the hopes of great things to come...I'm suddenly reminded of a Gilmore Girls episode when for some reason they ended up using old New Years decorations for a baby shower "Happy New Baby!"

It's about time for my blog to join 2011! I realize I've been MIA in the blogosphere for the past month or so. The week of Christmas, we had a wonderful stay with my parents at their new house in Florida(they moved the same week my son was born--my dad moved without my mom because she got on the first plane she could get when my husband called her from the hospital after finding out I was at 8 cm) the week of Christmas. Being with family and all, and having my sweet husband not working, I didn't spend my usual (excessive) amount of time on the internet and I realized, I don't need the internet. Not only can I survive without checking everything I used to check daily (and often multiple times a day), I don't need to depend on it for my happiness. Since I've been back, I've been making an effort to enjoy other things in life, including my kids, mastering the art of maintaining a clean home (thanks in huge part to FlyLady, without her, I would have never even known where to start), and I've even had time to read some fiction novels (The Scorch Trials, sequel to The Maze Runner by James Dashner and Paranormalcy by Kiersten White), and I have always really enjoyed fiction.

The point is, I think for a while there, my vision became to narrowly focused on birth (as birth is the main focus of most of what I do on the internet). While I think birth will always be part of my life, I need to remember that birth is not the only thing in my life. In fact, birth is not even the most important thing in my life. Before I discovered doula work and childbirth education as potential careers, I always really wanted to be a stay-at-home-mom. Sure, I enjoyed stuyding Early Childhood Education, and liked working with young children in the classroom, but I never wanted it more than I wanted to have children of my own. I always figured balancing home and career wasn't going to be an issue for me, but then I found my career, and although I don't actually make money at it yet, that is what it is for me. I am blessed that my husband's salary makes it so I don't have to work, and I want my children to have me present for them and not just physically. When they are older, I can put more time into my career. I feel that it's important for the amount of time I devote to things should reflect what my highest priorities are. Don't worry, though, I'm still planning on continuing this blog and still planning on getting my doula and Hypnobabies certifications and teaching Hypnobabies.

I will write another post soon (hopefully) explaining the direction I want to take this blog in the New Year. I will end this post with my goals for 2011:

Continue to keep my home in order using the routines I established with the FlyLady Beginner Babysteps.
Play with, sing with, and read to my children daily.
Devote time each day to developing myself spiritually.
Find more ways to let my husband know how incredibly much I appreciate him.
At least finish everything in the CBI doula course except for the two births (I'm very close to doing this! I will probably also get the births in, but if I don't, it's not a big deal)
Do the hypnosis at-home course and the required reading before the Hypnobabies Instructor Training in July!

And just because I didn't do this yet, here is a list of the Top 10 Most Viewed Posts on Birth Unplugged in 2010:

Being Motivated "Towards"

2010-12-23T13:45:00.000-08:00

I just read a really interesting post about motivation by Felice at The Gift of Giving Life. Since I haven't blogged in a while, I would like to respond to her ideas in my own post.

I think it is interesting that motivation towards something is more effective at generating action than motivation away from something. I used to clean my house to get away from messiness, I now clean it to move towards control, order, and a more peaceful atmosphere. Towards motivation does seem to be more effective in this particular instance.

Felice's post focuses on motivation for choices while preparing for childbirth. Fear of pain (an away from motivation) is a common motivation for women in this situation,. Early on in my first pregnancy, when I was planning on getting an epidural, I was motivated by fear of pain. When I discovered the risks of epidurals, I was still motivated by fear--fear of complications resulting from overuse of medical interventions. This is still an away from motivation, even though it was movtivating me in a completely different direction--to have an unmedicated birth. I started to discover other motivations in that pregnancy, but did not have a lot of time to explore them.

In my second pregnancy, I was not so afraid of intervention. I'd had a medically managed birth that turned out fine. I had some fears, but they were more fears of "failing" (in quotes, because I now realize that the word failure has no place in birth) than of complications. I was determined that (of course as long as there were no complications) I was going to do it without drugs. I was motivated to prove that I could do it. I was motivated away from failing. I was also motivated towards an enjoyable birth, a safe birth, an empowered birth--and I worked to keep my choices in line with what these words meant to me at the time, which I'm sure was very different from what they would have meant early in my first pregnancy. They probably mean something slightly different even now.

When we move away from being motivated away from pain and away from "failure" and learn to be motivated towards the most positive safe birth experience we can have, it is then that we discover that gettting a "perfect" birth experience doesn't matter so much and are able to embrace whatever birth gives us and learn and grow from it.

Doula mini-documentary

2010-12-09T17:51:00.000-08:00

This video, created by the doula credential organization DONA International, explains what a doula is and how having a doula can benefit you. Every birthing family can benefit from a doula, no matter what kind of birth they are planning. It includes interviews with researchers who did some of the original studies on continuous labor support. Although I am certifying with Childbirth International, I think DONA did a great job with this 15 minute documentary and it describes the role of the doula very well.

The Myth of "Early Labor"

2010-12-06T09:00:00.000-08:00

Expecting Mother By Petercantfail at en.wikipedia [Public domain], from Wikimedia Commons

As a science, medicine seeks to define things in specific terms. As a natural process, childbirth doesn't always fit into perfect little boxes. Childbirth education often uses the explanations from medicine in attempts to help women understand the birth process. However, based on my own observations, the "textbook labor" does not apply to the experiences of a very large proportion of birthing women, and I wonder if we are, by using it, doing women a disservice by creating false expectations.

The general model that is taught is that there are three stages of birth: dilation, pushing, and birth of the placenta. Within the dilation stage, three phases are taught: the early/latent phase, active phase, and "transition."

Early phase is usually defined the time when the cervix is going from 0-3 cm dilation, and is characterized by pressure waves that are spaced far apart and my be irregular.
Active phase is defined as cervical dilation from about 4-7 cm, and is when the waves get regular and increase in intensity and frequency and cause measurable cervical change.
"Transition" is when the cervix goes from 8-10 cm, and is usually explained by its physical and emotional intensity and the presence of symptoms such as shaking, nausea, and vomiting.

There are a few problems with this construction.

If this is the "normal" birthing women whose births do not fit this pattern may consider what they experience as "abnormal."
It relies very heavily on measuring the cervix as a basis for knowing how far along a woman is.
Some women's cervices will be reach dilations where thy should be in "active phase" but stay there for days or weeks before the baby is born, and there is nothing pathological going on
I specifically disagree with the way "early/latent phase" is characterized.

The impression that this model gives is that from "not in labor" to "in labor" is a one way street; once "labor" begins, you are "in labor" until your baby is born. I feel that this construct, together with unrealistic media portrayals of childbirth (where it always seems like a woman is going along minding her own business, suddenly her water breaks, chaos and rushing ensues, as well as some screaming, and then someone is handing her a "newborn" the size of a 3 month old), encourages women to head to the hospital as soon as they have contracting sensations that they can tell are more intense than the Braxton Hick's they have been having.

I have been participating in an online support forum for women who are planning natural births for about 3 years now. On our group, we have a fun tradition called Lodges, which are a sort of journal for pregnant women that lasts from 36 weeks to about 1 month postpartum. I have followed many lodges in the past three years, so I have read updates from women as they are nearing the births of their babies. From my own informal observations, it appears to me that a majority of women experience periods of regular and intense pressure waves (not Braxton Hicks, but the same kind you have during birthing) on and off for days, weeks, and in some cases months, before giving birth. They will go long periods with no pressure waves, then have them start again for a few hours, then they'll go away. So, does early labor stop? Can early labor last for two weeks? Or is our idea of "early labor" a myth?

Some people would call the off-and on periods of pressure waves "false labor," but I really dislike that language because it implies that the woman doesn't know what she's feeling. In many cases, the only way to tell the difference is in retrospect: sometimes they go away and sometimes they continue to the birth of a baby, they usually don't really feel much different from each other, contrary to what some will tell you. "False labor" also implies that it is not doing anything, and I am of the opinion all pressure waves do something, even if it is not causing measurable dilation. It could be effacing the cervix or encouraging the baby to rotate into a better position. In some cases, dilation is occurring, just not quickly enough for it to be measurable. For women who have "false labor," it may just be that their body does the "early labor" work incrementally, with long periods of rest.

The problem is that I suspect that the majority of women don't know how common start-stop labor (as I like to call it) really is. I recently read a blog post by a nurse (shared on facebook by The Deranged Housewife) who blamed the "need" for hospitals to use pitocin on women going to the hosptial and getting epidurals too early. Comments on the facebook link suggested that the problem is not the patients themselves, but that someone is failing to adequately inform them what the end of pregnancy is really like. The nurse's post really made me wonder how many women are getting pitocin for "stalled labor" when actually they were having an episode of pressure waves that would have gone away? How many of these babies would actually have come days or weeks later without the pitocin?

(On a similar note, I also love this post by midwife Stephanie of Vita Mutari questioning the logic that it is "safe" to "labor at home as long as possible" in order to avoid crowding the labor and delivery floor and avoid interventions, yet "unsafe" to plan a homebirth with a midwife.)

The concept of "early labor" is misleading because it is so easy to mistake start-stop labor for "early labor," and if women assume "this is it"and run to the hospital at the first sign of a pressure wave, they are guaranteed to either be sent home disappointed or have a whole lot of interventions, and neither of those is a desirable thing. I know I fell into the "early labor" trap myself with my first birth--I remember thinking "I've been in early labor for two days and I'm only 1 centimeter?"

For real, human women, not mythical "textbook" ones, the onset of the birthing time is a fluid process that they may move in and out of at their own unique pace. The last few weeks of pregnancy are the orchestra tuning up before the concerto, the engines revving before the race.

Order in Our Lives, Even with a Baby

2010-11-30T13:49:00.000-08:00

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.

A Birthy Thanksgiving

2010-11-23T13:35:00.000-08:00

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 :)

painting by Jan van Kessel the Elder [Public domain], via Wikimedia Commons

Happy Thanksgiving, everyone!

Traditional Birth Secrets: The Rebozo

2010-11-22T10:00:00.000-08:00

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.

Research-backed Benefits of Hypnosis for Childbirth

2010-11-20T10:00:00.000-08:00

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.

Joseph B. DeLee: Obstetrics that Sucks

2010-11-17T21:33:00.000-08:00

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.

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

2010-11-13T15:28:00.001-08:00

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!

Results Are In: Austrailan Study Supports Physiological Third Stage!

2010-11-09T18:00:00.000-08:00

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.

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

2010-11-08T15:04:00.000-08:00

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."

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

2010-10-29T16:05:00.000-07:00

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

2010-10-26T12:51:00.000-07:00

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

2010-10-23T09:00:00.000-07:00

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?