More Thoughts on Research

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.

Order in Our Lives, Even with a Baby

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

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

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

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

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

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

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

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

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

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

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

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

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

Condescending, much? Here is another

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

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

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

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

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

Spirituality of my Birth Experiences

Some blogs I read have mentioned the recent Lamaze press release, New Data Show Connection Between Childbirth and Spirituality. After my second birth, I was introduced to The Gift of Giving Life, a blog that explores the spirituality of childbirth in depth, and focuses primarily on women who are Latter-day Saints like me. I kind of thought that I didn't really have spiritual birth experiences because I didn't write about my births in a spiritual context when I wrote my birth stories, but with some more thought, I recognized that there were things about both that were very spiritually significant for me, and I'd like to write about them here.

I don't think I realized it at the time, but it is likely that the Lord led me on my quest of knowledge during my first pregnancy. The motto for BYU, the church-owned university I attended, is "The glory of God is intelligence" (from D&C 93:36). I believe that my desire to find greater knowledge and truth about birth was directed by the Spirit, since all light and truth come from God. Looking at it now, it's hard to see how the Lord could not be involved in such a drastic transformation.

My first birth itself had some very spiritual moments. I remember feeling kind of sad after the epidural was in because it wasn't what I planned, though I realize that, under the circumstances, it was really a blessing that I could get the epidural and get some rest. I listened to my iPod after I got the epidural, and chose at that time to listen to a collection of instrumental arrangements of hymns by Lex De Azevedo. I remember the soothing music giving me peace and helping me sleep despite my conflicted feelings about the situation. Because the birth took place on a Saturday at a small hospital, we got our pick of the rooms on the floor, and chose the one with a great view of the Mt. Timpanogos Temple. There are large windows in the maternity rooms, and the drapes were open when I gave birth at 9:52 pm and the temple was all lit up. I looked at the window while I held my daughter on my belly with the cord still attached, the delivery lights in the darkened room lit us up in the glass, and the temple glowed on the other side. I think it will be very special to tell my daughter that she was born under the glow of the temple.

Mt. Timpanogos Temple at night (source: wikipedea commons)

During my second pregnancy, I did some journaling, and in explaining why I wanted a natural birth, it came together to me that I feel that God designed the birth process with perfection, and that interference in the process causes trouble. I realized, while studying Hypnobabies, that the Lord has given us everything we need to create comfortable childbirth within our own minds and bodies. I found ways to tie the Hypnobabies philosophies in with my religious beliefs and even found some hymns that had the word "peace" (a cue used for comfort in Hypnobabies) in them. I thought it would be a nice option to have hymns to sing during my birthing time. I didn't end up doing that, but tying the hypnosis tools to a religious idea was good for me.

During my second birth, I did not think much about spiritual matters. I focused on listening to my Hypnobabies tracks and using my hypnosis techniques. For much of my first stage, I feel Hypnobabies helped the atmosphere be more reverent because it kept me calm. Second stage was very intense, but the sudden change from feeling overwhelmed by the intensity to the complete joy of having my baby in my hands and knowing I had done it was very similar to how some people describe spiritual events like conversion or repentance/forgiveness.

17 And it came to pass that as I was thus ^aracked with torment, while I was ^bharrowed up by the ^cmemory of my many sins, behold, I ^dremembered also to have heard my father prophesy unto the people concerning the coming of one Jesus Christ, a Son of God, to atone for the sins of the world.

18 Now, as my mind caught hold upon this thought, I cried within my heart: O Jesus, thou Son of God, ^ahave mercy on me, who am ^bin the ^cgall of bitterness, and am encircled about by the everlasting ^dchains of ^edeath.

19 And now, behold, when I thought this, I could remember my ^apains ^bno more; yea, I was harrowed up by the memory of my sins no more.

20 And oh, what ^ajoy, and what marvelous light I did behold; yea, my soul was filled with joy as exceeding as was my pain!

21 Yea, I say unto you, my son, that there could be nothing so exquisite and so bitter as were my pains. Yea, and again I say unto you, my son, that on the other hand, there can be nothing so exquisite and sweet as was my joy.
(Alma 36:17-20)

This passage from the Book of Mormon illustrates being "born again," which I think may be just as much like giving birth as it is like being born (the latter is something I'd like to explore more in a future post). I saw, in giving birth naturally, a metaphor for what it feels like when we allow Christ to take our burdens. Although I didn't recognize it at the time, this was something I learned a lot spiritually by experiencing.

I believe that all pregnancy and birth is spiritual. It involves working with God to bring a new soul into this life so that an individual can progress on the path to exaltation. It is the expanding of a family unit and, in the case of first births, it is the moment when people become parents. These are very spiritually significant things. I feel we can make birth more of a spiritual experience for us if we try, and I hope to do so even more with my future pregnancies and births.