Thursday, October 30, 2008

American Birth Movies and a Few Other Thoughts

Just a few comments:

My sister said that her husband is so impressed with my blog. I am not sure if that necessarily means content, as they have no children and no interest in that area. He thinks it is great that I am disciplined enough to sit and write all this out. I had to laugh because that is not where the discipline comes in! I am disciplined only when I am not writing! I would like nothing better than to sit here and write about these topics I feel so strongly about, but, as any mom knows, her house would fall apart, no one would be fed, they'd all be wearing dirty laundry, and crying at her feet.

I've had several people (you know who you are, you birth junkies!) tell me they wish I'd post more often, but I am forcing myself to not let my house fall apart! I am thinking about what to write about all the time. Let me know if there are topics you'd like addressed. I'm trying to get to them all. I did go through and answer some comments that have been posted over the last week or so.

I have someone in labor tonight. Her water broke almost 24 hours ago. Her doula is a former student of mine. We've been in contact most of the day. The baby is posterior, or sunny-side up, which usually creates a longer labor as the baby tries to turn. So far, so good. It's hard not to think about it all the time, wishing I could help... Ultimately, each woman has to dig down deep and find out what she is made of. No one can do that for her. It is truly a transformative, life-altering experience. I hope she continues on through the night. If she uses sleep as her friend in the relaxation process, instead of her enemy as an "excuse" to have an epidural, she'll be ok.

I watched another great movie the other night: "Orgasmic Birth." It follows 11 couples and their births. I think I might do a screening in my home. Let me know if you are interested in that. I did a screening of "The Business of Being Born" at the public library in April, but I don't feel like I can promote this movie because of the name. I wish it had a different name, and yet I completely understand it. Birth can be so different than how ER portrays it! In a word, orgasmic! In my experience, it wasn't physical, but definitely emotional. "Orgasmic Birth" -- a must see.

There is another birth movie out this year too, but I haven't seen it yet: "Pregnant in America." It was released in August, probably at nationwide screenings, but I never heard of one in my area. It is being released in December on DVD. Yes, I have mine pre-ordered!

I am so pleased with all these movies about birth in America. We need a giant spotlight on this problem! Be vocal in your communities. Encourage couples to see these movies. Share your birth stories. Empower those around you. Encourage normal birth.

Saturday, October 25, 2008

C-Sections

There was a screening of "The Business of Being Born" in the Dallas/Ft. Worth area in February, followed by a panel taking questions. The vast majority of questions and dialogue were addressing VBACs, or Vaginal Birth After Cesareans. Why so many questions? Like I've said before, in this area of the state, the c-section rate is 50%. No matter where you live, it's probably hovering around 30% -- some more, some a little less. We all know women who have had a c-section. This affects us all, even if you have never had one. Let me explain.

There are so many reasons for the high c-section rate. I am not aiming to explain those in this post, although I will touch on a few.

The phrase that gets me is: "I had to have a c-section because..." If women were not induced or did not have pain medications, they would most likely not have a c-section. Only about 3% of women TRULY need a c-section because of a true medical condition, such as placenta previa, cord prolapse, etc. The World Health Organization has recommended that the c-section rate not be above 10-15%.

And yet, every now and then, a student of mine will map out their labor that ended in a c-section, and I am stumped. I don't know what could have been done differently. More often than not, however, I can tell exactly where labor took a turn that headed down that path -- often introducing pitocin or pain medications.

I had a woman in class a couple of years ago who was attempting a VBAC. She was tiny. Less than 100 pounds and less than 5 feet tall. The first c-section was unavoidable -- cord prolapse -- but she was determined to have a vaginal birth the second time around. She hired a doula and labored beautifully for many hours. She loved labor, in fact. She was so prepared for the birth, physically and mentally. She never dilated past 9 cm. and the baby was not descending. They tried all sorts of positions and movements. She never had any interventions at all. After several hours at a 9, she said she would do it for one more hour. If there were no changes, she would have another c-section. The hour passed, there were no changes, and she had a c-section. She had no regrets though. She gave it her all, loved labor (which was so beneficial for both baby and mom), and ultimately, despite the 2nd c-section, is an advocate for natural labor and birth. She was a wonderful example of taking an active role in her health care and doing her part.

Lately, the biggest reason I am seeing for c-sections is, simply, the time clock. You've been in the hospital too long. They are not going to let you hang out to labor for more than a day. Even a day is extremely generous. Usually, we are talking more like 12 hours. You are taking up space. They can "section" you, make twice as much money, and move you out, on to the next one. Will they tell you that is why you are having a c-section? Of course not. They will call it other things: failure to progress (in their time frame), CPD, or cephalopelvic disproportion, meaning the baby's head is bigger than the pelvic outlet (extremely rare, but very common reason for a c-section), or fetal distress. If any of these things are true emergencies, they will put you under with general anesthesia and do a c-section in a matter of minutes, or less. If they take their time, it's not an emergency. Fetal distress is rarely a diagnosis is natural labors. It usually begins to show up after the introduction of interventions, such as pitocin or pain medications, even continuous monitoring that prohibits mom from moving around.

Plus, if they can get you on the c-section path, as opposed to birthing vaginally, now you will likely (thanks to ACOG, again!) be having all of your babies by c-section. Of course, you can have a vaginal birth after a c-section, but it's very hard to find someone to do them, at least in the DFW area. Subsequent pregnancies become more and more dangerous to babies, as well as moms, who continue having c-sections. It's not just about the birth, but the actual pregnancy. The more c-sections you have, the more likely your baby is to have problems. It is not a good idea. Please, seek out birth attendants who do VBACs.

There are many reasons given for c-sections -- some are legitimate and some are not. I believe that if a woman will educate herself, stay healthy and low risk, trust in her body to start labor on its own, and not have medication to numb her labor and birth, it is highly unlikely that she will have a c-section. If she has done these things and then has a c-section, she can at least know that she did her part to try to not have one, like the woman in the story above. It all comes back to taking responsibility for ourselves and our health care. And ultimately, our babies.

Tuesday, October 21, 2008

Vaginal Exams in Pregnancy

Do I have your attention? Here's a topic that is never addressed, but affects all pregnant women. I'll tell you straight up that I am opposed to vaginal exams. No pregnant woman should have one. Let me tell you why.

First of all, there are a few bits of information that a vaginal exam can tell you. They can, of course, tell you if the cervix is dilated and softening, effacing, or thinning (all meaning the same thing), and what station the baby is at, meaning, where the baby is in relation to the pelvis. None of these bits of information will tell you when labor will start.

OBGYNs, and midwives alike, usually start doing vaginal exams between 36-38 weeks, just to see what's happening. Literally, just to see what's happening. Likely, nothing is happening!

You can walk around dilated for weeks. I recently had a student walk around 5 cm. dilated for about 4 weeks. She was even 90% effaced. It meant nothing. She gave birth nearly a week past her "due date." But her family had come to town when they found out she was that far along, plans were being postponed, and she was in the "any minute" mode. She was contracting too, but it would fizzle out after several hours. She finally had to send everyone home and just wait.

These women who are dilated, and know it, often are the ones that get induced. Not because of medical reasons, but because they just couldn't stand the emotional roller coaster anymore. Their labor should have been the easiest!

Let's say you are told that you are not dilated at all -- the cervix is hard -- not soft at all. How do you feel? Sad. Like your body doesn't work right. Like you might be pregnant forever! But if it's one of the first vaginal exams, you probably still have hope that the next one will be better. Well, what if it's not? What if even the next one tells you the same thing after that? Now how do you feel? You are probably signing up for an induction because you have no confidence in your body to do this on its own. Even if you aren't looking at your calendar for an induction date, you know that you are starting from "zero." Emotionally, this is so hard. You know that your body, when it does start labor, is going to have to work that much harder. You start doing labor math (your enemy), thinking your labor just got that much longer, and now you are resigned to have an epidural because it's just so hard and so long.

Do you see where I am going with this? Women can be dilated and not be in labor, and likewise, a woman who is not dilated can start labor and give birth that same day. I've been that person! It happens.

Vaginal exams in pregnancy put you on an emotional roller coaster that no pregnant woman needs to be on! The end of pregnancy is hard enough, physically and emotionally. It's usually an anxious time, and vaginal exams just add to that anxiety, often creating more stress.

Bottom line (no pun intended): There is no medical reason to have a vaginal exam, but loads of reasons to avoid them. I didn't even address the "accidental" stripping of membranes, even possible breaking of water. I've known lots of women who are worried about bleeding a few hours afterwards, not knowing that their membranes had been stripped. Again, adding to the anxiety...

It's hard to say no -- everyone is curious -- even me! But have faith in your body. The vaginal exam road is worth saying off of! It's like I always say, the baby will come out! Your body will start labor when the time is right for baby and for mom.

Saturday, October 18, 2008

I'm Famous!

For those of you who don't live in Mansfield, Texas, check out the Mansfield NOW for October. I am the feature for the Education article (pages 32-34). I was nervous it wouldn't run because there are four OB groups that advertise with the magazine. The magazine is distributed to every door in Mansfield.

There are three things that I need to clarify: It is quoted that I said the c-section rate in "North Dallas" is 50%, but what I really said was "North Texas." People down in my neck-of-the-woods might not think they are affected, but they most certainly are. Arlington hospitals do not have a good track record. They definitely are contributing to this high c-section rate.

The second thing was that I said that giving birth naturally is the "ultimate girl-power experience." I don't think a phrase like that has ever come out of my mouth, although I do think it is very empowering.

The third clarification is that I am not teaching at the MAC. I tried that, but everyone who contacted me was looking for a Bradley class. I designed my own curriculum on some various classes, but generally, I am back to Bradley, with a few additional classes here and there.  Overall, I think it was a good article. Let me know what you think.

Interesting comments since it came out. The people who have really approached me with enthusiasm about it, have largely been 50+. I've thought a lot about this, and I think these women have seen the c-section rate rise over the years, along with all the over-use of medications and testing and interventions. They are shocked by it and don't understand it.

I'm almost 38, so most of my students are younger than me now. They do not have the shock that the "older" generation does when it comes to the c-section rate. They have largely grown up hearing women say things like, "I had to have a c-section because..." or "My induction date is set for..." We have become so accustomed to these phrases, we have forgotten to question their safety or necessity.

Thursday, October 16, 2008

To Circumcise or Not to Circumcise?

This summer, I was talking to the head honchos at Babies 'R Us about doing a seminar on a Tuesday night as a trade for displaying my brochures. I was trying to be creative, get people thinking outside the box, so I suggested a class on circumcision. There were a couple of people standing there, and an older woman said, "Oh, that would be good! They could learn how to take care of it afterwards." I told her that, no, I wanted to teach about NOT circumcising. Her entire disposition changed. She became defensive. She paused for a minute and said, "Well, that would be fine, as long as you present both sides." Ironic that she wanted both sides presented now, but not a minute ago!

When I was pregnant with Daymon, I was all about the drugs, remember. But when it came to reading about the procedure and recovery of this type of surgery -- and that's exactly what it is -- I started to ask questions. I couldn't imagine putting my baby through this. Is it necessary? Do I, medically, need to have my baby boy circumcised?

The answer is an emphatic NO!

Let's talk numbers for a minute: Only about 10-15% of all males worldwide are circumcised, the majority being Muslim. In the US, the rate is about 50%. That usually surprises people that it's that low. In some states, Medicaid has cut spending by not covering circumcision, which is considered to be cosmetic surgery. Even the American Academy of Pediatrics, which is notoriously conservative, has said to "leave it alone."

The definition of circumcision reads, "the permanent removal of healthy tissue."

OK, so what is the foreskin? It counts for about 80% of the penile covering. It consists of more than 3 feet of veins, arteries, and capillaries; 240 feet of nerves, and more than 20,000 nerve endings. It acts as a protection for the glans, which is actually an internal organ before circumcision. Like eyelids, the foreskin provides moisture and protection against infection. At the time of birth, the foreskin is attached to the glans, or penis, like a fingernail is attached to the finger. As the child grows into puberty, and then adulthood, the body will produce smegma, an antiviral and antibacterial substance between the penis and foreskin. It is white and forms in tiny "balls." Smegma contains protective enzymes called lysozymes, which are also found in tears and breastmilk. The foreskin is self-cleaning.

An intact male, or his parents, should not pry the foreskin back in order to clean it. Gradually, over time, it will begin to retract. A boy doesn't need help with this! Some boys will be fully retracted by a year, others 5 years, and others will be well into their teens. Rinsing with warm water is adequate. Cleaning with soap actually would destroy the beneficial bacteria, just like douching does in women.

There are some other interesting tidbits about circumcision that I'd like to share:
*Boys who are circumcised have a lower pain tolerance that boys who are not, and even lower than girls.
*
Circumcision severely interrupts sleep cycles and patterns
*
About 1/500 circumcisions have surgical complications (infection, severe bleeding, complications from medications) and about 1/500,000 will result in death.
*Circumcision causes the penis to be about 25% shorter.
*Better sex for both partners when male is NOT circumcised.

Finally, what do they do with all those forskins?! It is actually a multi-million dollar industry. They are used to produce artificial skin, wrinkle creams, and moisturizers. It is also used as research material and as raw materials for a type of breathable bandage.

I feel like the information I've given you here speaks for itself. If you would like more information, feel free to comment and we can keep the dialogue going. As always, Mothering is a great resource on this topic. I will also mail out a lengthy circumcision packet to anyone requesting one.

This is my advice if you just can't decide: Your baby will be given Vitamin K at the time of birth (unless you are at home and then you will make the choice to give it or not). It is given so that his blood will clot sooner. If you choose to circumcise, he needs to have been given Vitamin K. If not given Vitamin K, he will be getting it through breastmilk and his body will start producing it on day 8. In Biblical times, circumcisions were done on the 8th day. Interesting. (On that note, the law of circumcision was taken away and no longer exists.) It is probably easier to send your child to the nursery to be circumcised when you have not bonded with him. My recommendation is to wait those 8 days and then make your decision. You will find two things: The pee comes out just fine, and you can't imagine putting your sweet baby boy through this unnecessary, medically unjustified procedure.

Oh yeah, in the end, Babies 'R Us said that they didn't think there would be enough interest in the topic of circumcision. Half of all new parents, every year, will have to make this decision for their baby boy. Not enough interest?

Monday, October 13, 2008

ACOG vs. Homebirth

ACOG (American College of Obstetricians and Gynecologists) released a statement opposing the choice of homebirth for women earlier this year (specifically, after the release of "The Business of Being Born"), saying, "Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby." This is a ridiculous statement on their part. I chose to birth my babies at home because I believed it to be the best and safest place -- with no time constraints, augmentation of labor, or restricted laboring and birthing positions.

ACOG is the one failing, not midwives! The statistics coming out of the majority of American hospitals are disgraceful. We have the worst statistics and spend more per birth than any other country in the world. I am outraged by the suggestion that by birthing at home, I am putting my baby at risk. The statistics are on my side, not on theirs. I am a mother that loves my children -- how dare ACOG accuse me otherwise. I am an educated woman, with a Bachelor of Science -- my husband has a Master's Degree and is a CPA -- we are intelligent people who researched our options and made an educated decision about where to birth our babies.

ACOG is using the fear of childbirth to scare women into keeping birth in the hospital. I am so tired of scare tactics when it comes to childbirth. This is a normal, natural process! How on earth did we ever make it to this point in time? Doctors have been attending birth in a hospital for less than 100 years. Both my parents were born at home.

This is a woman's rights issue. It's not about health care. ACOG is trying to take away our choices. The insurance companies listen intently to what ACOG has to say already. I am always talking with women who want to have a homebirth, but their insurance will not cover it. A homebirth will cost anywhere between $2500-$5000. That is significantly less money, so it just seems absurd that the insurance won't cover a midwife. This is a perfect example of the influence ACOG has in taking away our rights and choices as birthing women. Instead of attacking the midwives and homebirth, ACOG needs to fix their own set of problems. And here's the kicker: Only 1% of women give birth at home. Why do the doctors care so much?

ACOG wants to interfere with the licensing of midwives. Really, OBs are almost in a different profession. That sounds crazy to the average reader, I bet. Doctors are trained to look for something to go wrong. I believe that they want something to go wrong so they can be the hero, save the baby, save the day. They talk about the goal of having a healthy baby, but they are all scheduling inductions and c-sections. Anyone who has done any research at all knows that these are not in the best interests of the baby!

I really take issue with ACOG dismissing women who value the birthing process, as if it doesn't matter. It is okay to want a good birth experience. How dare them make a woman feel bad about that, like she is being a bad mother for desiring that for herself and her baby. Birth matters! It is a doctor's way of dismissing women's valid requests for good health care and respectful, positive births. Recently, a report on NPR stated that the level of empathy a mother has for her child is directly related to whether she had a c-section. So obviously, the birth process does matter. As I've mentioned before, there is a link between postpartum depression and not feeling the birth, whether the birth is a c-section or with an epidural. The birth hormones are not released naturally when the process is tampered with. These hormones play a role in bonding and breastfeeding too.

Our maternal death rate and infant mortality rate in this country are outrageous, so don't tell me that it's about a healthy baby! Mothers and babies are dying in hospitals as often, or more, than at home. This is about pride. They need us to believe that we need them. Don't get me wrong, about 3 % of women actually do need a c-section for various reasons. We need doctors trained in this type of surgery. But when a woman wants a natural, unmedicated birth, she should go to a midwife, not a surgeon.

I can't help but laugh at the timing of ACOG's statement. If you have not seen "The Business of Being Born," you absolutely must. Link to it, watch the fantastic trailer, and just buy it. You'll want to watch it over and over and pass it on to your pregnant friends. If you don't want to fork over the $30, rent it on Netflix. These are the only two ways you can see this movie. If I were a doctor, I wouldn't want my "patients" to see it. I've picked up a number of students who saw this movie, fired their doctors, hired midwives, and have had wonderful, intervention-free birth center births and homebirths. Birth is great, but I believe it's better when you get it out of the hospital.

When we decided, at 33 weeks, to have a homebirth, I had people say to me, "That just seems so dangerous, so irresponsible." I have to tell you, for every single thing that happened -- whether it was the Group B Strep test at 36 weeks, or where to deliver the placenta (it was a water birth), whether to give the baby the eye drops or a Vitamin K shot after the birth -- I had to give the midwife an answer to all these questions. I had to be informed on what these things were. I was in total control. All the responsibility was placed squarely on our shoulders. When you birth in a hospital, it's so easy to just turn all the decision-making over to the doctor or nurses. You just follow along with procedure and protocol.

I absolutely believe that birth, in this day and age, is safer outside of a hospital with a capable midwife attending your birth. We must fight for our rights as birthing women, even if you are finished having children or don't even have children, to stand up to ACOG and demand that this right to birth at home not be taken away. ACOG should not be allowed to be in charge of licensing a midwife to practice. They really don't even know what a midwife does -- if they did, they would learn from them and adopt their practices!

Saturday, October 11, 2008

Testing, Procedures, and Interventions in Pregnancy and Birth

This list is really long -- so long, in fact, I am not going to even begin to touch on them. This is like a teaser. I talk extensively about all these things in class. If I explained them all here, you wouldn't have to take my class! Gather as much information as you can on these topics, and more.

Wasn't the Consumer Reports article great? http://www.consumerreports.org/health/medical-conditions-treatments/pregnancy-childbirth/m aternity-care/overview/maternity-care.htm?loginMethod=auto There are a few things I'd like to hit on from that article:  
1) Electronic Fetal Monitoring, or EFM, "unnecessarily adds to delivery costs." While this is true, it is used, largely, for 2 reasons, neither of them being medical. (In fact, intermittent monitoring has been found to be just as effective, maybe more than EFM.) The first reason is for legal reasons -- if you were to come back and sue them, they have documentation of what the baby's heart rate was doing. Ever since the introduction of EFM (early 80s), the c-section rate has risen dramatically. It has a very high false-positive rate. Babies heart rates fluctuate in labor. This is much less likely to be a problem if you do not have drugs of any kind in your system. The other reason EFM is used so often is because hospitals are short on nurses. One or two nurses can monitor several women at once from the nurse's station. You are now being watched by a machine, not a human being. Isn't that great health care? Also, if you have drugs in your system, you have to be on a monitor because drugs do affect the baby and your labor.

2)Never let anyone break your water! This may speed labor, and it may not. You should hesitate to do anything that is not a part of the natural process. There are several reasons to not break water. Suffice to say, I've seen many c-sections occur because of this poorly-handled situation. It should be a part of the natural process, letting it break on it's own. Women need to be told what to do and what not to do when their water breaks -- not be put on a time clock that eventually leads to surgery.

3)The use of epidurals is so much more far reaching that just causing "adverse effects" of baby's heart rate and newborn assessment tests. It is a cascading downward spiral of events all started because a mom was afraid of the "pain" of childbirth. You are putting your baby and yourself at risk when you choose to have an epidural. I make no apologies for that statement. It is the absolute truth. Get informed, not drugged!

4)Inducing labor is a huge problem in this country. Your baby does not have a little calendar in utero with the date circled in red pen like you do! He has no idea when he is expected. Some babies will show up early and some will easily be "overdue." If you have a doctor who is excited about induction and happy to schedule you an induction date even before the baby is due, you have a lousy doctor. Now, I've heard women say things like, "He's a great doctor. He won't make you go over your due date." Like a doctor is torturing you by "making" you stay pregnant! Give me a break! Trust me, he is doing what is best for you and the baby. You actually have a doctor who is to be respected, as least from the standpoint that he respects the onset of labor. Remember, if you are induced, especially with a first baby, you are twice as likely to have a c-section. I could go on and on about induction. One more thing before I move on, though: the baby triggers labor when he/she is ready. Be patient. You will not stay pregnant forever!

5)C-sections. This is its own post. Another day.

I really liked what the article had to say about the "normal, hormone-driven changes in the body that naturally occur during delivery..." No one ever gives those hormones credit! In the end, they were advocating high-touch, instead of high-tech! Just a recap of what is good for mom is good for baby: 1) Prenatal vitamins;  
2) Use of midwife or family doc;
3) Hiring a doula;  
4) laboring and birthing upright; 
5) VBAC (Vaginal Birth After Cesarean) is encouraged; 
6) Early mother-baby skin-to-skin contact. This is what I believe in!

Other procedures and testing that I think are not necessary, and even possibly harmful, include, but are not limited to: ultrasound (EFM is continuous ultrasound -- another reason to avoid it), vaginal exams in pregnancy and in labor, IV if you are having an unmedicated birth -- just drink water!, restricted food and drink in labor -- you need energy!, episiotomy -- should only be done if baby is in trouble, and immediate cord cutting depriving baby of 1/4 of its blood volume, etc.

There are lots of tests done in pregnancy. Find out what they are for! Is it routine, or is there a reason they think you, personally, should have it? Even the American Diabetes Association has stated that not all pregnant women should be given the glucose test at 28 weeks. Only those who are at risk or there is an indication that she may develop or have gestational diabetes. This is a very small percentage of women, yet, it is routine testing for 100% of pregnant women.

Remember years ago, not all women had a 20-week ultrasound? It depended on if insurance would cover it, in most cases, or if the doctor found a reason to order one. Now, it is deemed necessary 100% of the time. Do you know a single woman who has been denied an ultrasound in the last 10+ years? The jury is still out on the effects of ultrasound. We just don't know. Let's think about some diagnosis that are very common today, that weren't around, or at least not common, years ago. For example, autism. We always talk about the link between vaccines and autism. What about ultrasound? 1 in 150 children will be diagosed with autism. Nearly all babies are exposed to ultrasound in utero, some much more than others. It is also linked to left-handedness. This may not seem like a big deal (2 out of 4 of my kids are left-handed), but things didn't connect within the brain the same way they do with the majority of people. My lefties are my hospital births. With routine ultrasounds, EFM, and listening to the heartrate with a doptone, they were exposed to much more ultrasound than my other babies. Another diagnosis we hear so much about these days -- ADD and ADHD. The numbers are through the roof and it didn't even exist 30 years ago! Is it possible that ultrasound could be a contributing factor? Again, food for thought...

Know your hospital's policy on monitoring. Fight it if they want you on continuous monitoring. This is not good health care. Evidence is on your side. You need to be upright and mobile to help your baby out. You must be proactive if you live in North Texas and don't want a c-section! If they won't budge on the monitoring, find another place to birth your baby. This is your birth, your baby, and your body. Doctors do not necessarily have your best interests at heart. They will always think of themselves and their practice before they think of you. They will not think twice about doing a c-section. You probably won't be their first of the day.

I really could talk a lot more about this topic, obviously. I love to talk about interventions and how unnecessary most of them are. Ultimately, the bottom line is this -- question your doctor or midwife about every test, procedure, and intervention that they want to do. Know the benefits, and especially the risks, of having it done.

Birth Interventions -- Are they Necessary?

I just read a fantastic article sent to me by a fellow Bradley instructor. It is a Consumer Reports article on Childbirth in America. It is titled "Back to Basics for Safer Childbirth: Too Many Doctors and Hospitals are Overusing High-Tech Procedures." You must check it out.

Jenni, you had asked about interventions and testing that doctors tell us we should have, but really don't need, and this article answers many of those questions. There is a questionnaire to click on that will give quite a bit more information on those interventions that most women think they have to have.

I have mulled over how to answer your question, and I was actually going to write a post about it tonight. This came at such an appropriate time. There are other things that were not listed in the article that I will address tonight. For now, check out this report and pass it on to your pregnant friends and family.

http://www.consumerreports.org/health/medical-conditions-treatments/pregnancy-childbirth/m aternity-care/overview/maternity-care.htm?loginMethod=auto

Tuesday, October 7, 2008

Types of Midwives

I am finally getting back to answering questions. The one I want to talk about today is the difference between a CNM (Certified Nurse-Midwife) and a CPM (Certified Professional Midwife).

There are a lot of different types of midwives out there. It can become very complicated. I am not going to go very in depth, as the laws are different depending on where you live.

Some states do not allow for homebirth, but most do. Some are very good states to work in if you are a midwife, and others make it hard to practice. If ACOG, the American College of Obstetricians and Gynecologists, gets their way, things will become worse for a midwife to practice anywhere. I would encourage all people -- men and women -- no matter where you are, to be an advocate for midwifery care. Check out www.thebigpushformidwives.org for more information on midwifery care in the U.S.

First of all, I am asked quite often what the difference is between a doula and a midwife. Simply, a doula provides labor support to both the woman and her husband. She is a knowledgeable woman, trained in physical and emotional support before, during, and after the birth. I highly recommend seeking out a doula for your birth. You are less likely to have interventions or a c-section with a doula by your side. Ask your local Birth Boot Camp instructor for recommendations. Some instructors will work as doulas, as well as educators.

A Certified Nurse-Midwife, or CNM, usually works in a hospital, but not always. They have attended nursing school and then specialized in midwifery usually for another year. I have seen a wide range of CNMs over the years when it comes to their attitudes towards birth. Some are very comfortable with interventions and medications. I don't like this. Some view birth as a normal process that works better without intervening. Unfortunately, when you work in the hospital, I believe that your view of birth becomes warped. 95% of women have medication in labor, and this requires a number of interventions as a result. One leads to another. Whether the CNM wants this or not, this is what she is usually surrounded by in the hospital.

I read a book by a Licensed Midwife, or LM, a couple of years ago. She practiced homebirth for more than 10 years. There came a time in her life, however, where she needed to have a more regular schedule. She decided to work in a hospital solely because of the hours. It is interesting to hear her experience there and how it affected her views and feelings towards birth. She found she started to fear the process of birth and use intervention more because this was the attitude she was surrounded by. She would have to step back, attend a handful of homebirths just to be around normal birth again, and then return to her shifts at the hospital.

A CNM, or group of CNMs, in a hospital will practice under a group of doctors. There are certain procedures that a midwife is not allowed to do, such as a vacuum extraction of a baby or a c-section. If there is truly a complication, the doctor will "deliver" the baby. Often, you will not know which midwife will attend your birth. It is good to rotate through so you can meet all of them during your pregnancy. Some groups encourage this and others frown upon it. Remember, attitudes vary and it's good to know which midwives support natural birth and less intervention. Another thing to remember is that this type of midwife has other patients when you are in labor. She will be in and out to see you, similar to a doctor.

There are Licensed Midwives and Certified Professional Midwives, depending on the state you live in. Requirements vary. These are often women who have worked as an apprentice under an out-of-hospital (homebirth or birth center) midwife. They have to attend, literally, hundreds of births. In order to receive their license to practice they have to pass a very intense exam. In some states there are other requirements as well, some type of "schooling," but generally, this midwife has hands-on experience and has thoroughly studied pregnancy, labor, birth, and postpartum. If you are or become high-risk, you will be referred to the midwife's back-up doctor. This type of midwife will be with you as much as you want her to be when you are in labor.

There are also lay midwives. These women have been around birth most of their life and often "work" where there are no other options, maybe where people live far from healthcare or are very poor. This midwife has no license, just varying degrees of experience. In this day and age, a lay midwife is likely someone who is practicing homebirth in a state where homebirth is illegal. These women believe that women should have the right to choose homebirth and are willing to take risks to make that possible.

I hope this answers some of your questions. No matter which type of midwife you think you'd like to try, interview them just like you would a doctor. You should feel very confident in who you choose. Remember, as long as that baby is still inside, you have choices!

Saturday, October 4, 2008

Children at Birth Class

This is a class offered for children who will be attending a birth of a new brother or sister. Some birth places are happy to allow siblings to attend the birth. This may be something you've never even considered. If so, I encourage you to gather information on the subject.

There are many benefits to allowing, even encouraging, your other children to attend and be a part of the birth. When I was having my 4th baby at home, I wanted my other children to be a part of that experience. We prepared by talking about birth, what contractions are, some of the sounds I would make, and even the facial expressions I might have and why. We watched birth videos where other children were present. It was helpful for them to see how the other children behaved and reacted.

If you are interested in having your children attend your birth, I would recommend that they are at least 4 years old. You will need to have another adult, besides your husband, to be with and support that child.

You are encouraged to attend the class with your child(ren). It will be held in either your home or my home. I will prepare your children the same way I prepared my own. Birth is a wonderful experience for the entire family. It is healthy for our children to grow up believing in this natural process and not fearing it.

Contact me if you are interested and we'll put a class together. donna@birthbootcamp.com.   I charge $25 per family.

Birth Boot Camp 1-Night Refresher Course

I only teach this class to couples who have given birth previously without medication and need a refresher course. 

This is a popular class. Students will learn several relaxation techniques, dealing with the three types of relaxation: mental, physical, and emotional. Bring 2 pillows per person. I charge $25 per couple to attend the class.  I also have a Birth Boot Camp mini-booklet (22 pages) available to purchase for $15.

I organize this class on an as-need basis. Email me if you are interested: donna@birthbootcamp.com.

Thursday, October 2, 2008

The VBAC Debate

In response to Sarah's request on VBACs...

I have already started writing this once, but saved it under a c-section title. I am having a hard time writing about VBACs (Vaginal Birth After Cesarean) without writing about the reasons for all the c-sections in the first place.

So many women are having c-sections, as we already know. Some women are requesting them, and some don't care if they have one or not. The majority of doctors are very comfortable with them, so it's become very commonplace. Every now and then, a woman truly feels "ripped off" by not giving birth vaginally. If you have had a c-section, I would recommend getting in touch with the ICAN support group.

I am a member of the International Childbirth Education Association (ICEA), who publishes the International Journal of Childbirth Education. There were some fantastic articles in the journal this month. One woman was commenting on the stress of having a c-section and the after effects (it didn't give a reason for the c-section): "My baby was next to me but I didn't want to touch him or look at him. I was mourning the loss of a child who never came through me. I was unable to give birth. He was stripped from me." There is a strong link between postpartum depression and cesarean birth and also with epidural birth. Typically, women who experience childbirth and breastfeed their babies do not experience depression.

I hear people say this all the time: "Well, at least the baby is healthy," or "It doesn't really matter how the baby got here, as long as it's healthy." Does this mean that if you have an unhealthy baby, you don't want it? Likely, women just want their baby, whether it's healthy or not. And it does matter how they get here. No woman would choose a good birth over a healthy baby. Accusing women of doing so is a way of dismissing their valid requests for good health care and respectful, positive births. Whatever the case, and whatever the reason a c-section was performed, during the next pregnancy, she should find a provider who does VBACs and believes in their safety.

This is what happened: VBACs were on the rise in the 90's, until Cytotec appeared on the scene in the late 1990s. Cytotec is a drug that is FDA approved to treat people with stomach problems, such as ulcers. A side effect is that is causes the uterus to contract. Women were receiving this drug as an induction drug who had previously had a c-section, and as a result, many lives were lost -- both mothers and babies. The makers of Cytotec have requested that it not be used to induce labor, but let me assure you, it is alive and well. In fact, one of my students received it just last week.

Your OBGYN will tell you how dangerous it is to have a VBAC -- that your uterus could rupture. Did you know that you have less than a 1% chance of that actually happening? Did you also know that a woman who has never had a c-section can also have her uterus rupture from the use of induction drugs? I have never heard of a woman being told that when they are scheduling an induction.

I was talking with a woman several months ago and asked her what month (not what day!) her baby was due. She said she was having her baby on such-and-such date. She had scheduled another c-section. She wasn't even sure why she had had the first one! I told her that there were doctors and midwives in this area who would do a VBAC, but she said that she liked her doctor and she was "really nice." This is not a reason to let your doctor surgically remove your baby from your body! This is not good health care! A repeat c-section carries far more risk than a vaginal birth after a c-section! The evidence backs this statement over and over. You need to truly understand why you had the first c-section. What are your chances of having the same "complication"?

So, first of all, if you want to have a VBAC, you will not be induced. You need to seek out a birth attendant who is supportive of VBACs. They should have a VBAC rate of at least 75%. In Albuquerque, when I was doing my Bradley certification, (5 1/2 years ago), I was interviewing a group of midwives at one of the hospitals, and they were very proud of their 92% VBAC rate. ACOG has gotten very strict with the allowance of VBACs now, which is completely absurd. What has changed in womens' bodies to all-of-a-sudden make a VBAC dangerous? It doesn't make any sense.

When you find a birth attendant that does VBACs, they will request your medical records from your previous birth. They will examine the records of the surgery and determine if you are a candidate for a VBAC. It has become popular, because of the recent denial of VBACs by OBs, to perform a single suture instead of a double suture when sewing the uterus back together. They know that you'll be having another c-section with subsequent babies, so why bother securing it for a VBAC? Be sure that you are double-stitched if you have a c-section! Also, if you have a vertical incision (more common in other countries), you will likely not be having a VBAC.

When you introduce any medications or interventions you are more likely to have another c-section. To really understand this concept, you need to understand how the body works in labor and birth. You need to know how medications work and why you are 4 times as likely to have a c-section with an epidural than without one. The bottom line is this: Prepare yourself -- mind and body -- to give birth without drugs.

What I have seen over the years is that women who have had a c-section become so focused on having a vaginal birth, they don't even contemplate not having an epidural (probably because they assume them to be completely safe). I would like to share the 4 factors that research has found to make the greatest contribution to a woman's degree of satisfaction with her birth experience. I thought these could easily be said of a VBAC:  
1) Having good support from caregivers (who support VBACs); 
2) Having a high quality relationship with caregivers (who likewise respect you and your body's abilities to give birth vaginally);
3) Being involved with decision making about care (even if this means another c-section); 
4) Having better than expected experiences (or having high expectations). "The best predictor of a woman's experience of labor pain is her degree of confidence in her ability to cope with labor." Confidence in yourself is everything.

So, this is the bottom line: If you are planning a VBAC, don't make your focus the previous c-section. A few months ago, I was on the phone with a woman in labor, having a VBAC, and everything kept coming back to the c-section. I finally said, "Let's just forget the c-section and that this is a VBAC. It's getting in the way of this labor. You are just a woman having a normal labor." Use the experience to learn and grow from. If you know where things "derailed" last time, do what you can to not have it happen again. Your chances of rupture are about the same as a woman having an induction who has never had a c-section.

You are simply a woman who is going to give birth.