Monday, December 27, 2010

The Gift of Days-Long Labor

Having a baby is such an exciting time, not just for the new parents, but for the grandparents, aunts, uncles, cousins, friends, sisters and brothers.  There are so many people that are invested in this new little person.  They all want to be called the minute you start labor so they can rush to the hospital and wait.

But what if labor isn't like the movies?  We know how often that happens, right?  First contraction and the baby's practically falling out.  Regardless, everyone is rushing around to get out the door and races to the hospital.  There is this idea, even subconsciously,  that if we head to the hospital, the baby will come. 

I recently had a couple start good contractions on a Sunday.  We thought for sure she'd have her baby and would not be in class Tuesday night.  We'd text or talk every several hours.  I knew her mom was nervous and wanted her to head to the hospital.  This woman knew it wasn't time.   She visited her chiropractor, and while it didn't seem to necessarily help speed things up, she didn't have back labor after that.  A success, for sure! 

I finally talked with her husband who had been a fun guy to have in class.  He said everyone was asking if this was normal -- labor taking so long.  All their comments were getting to him and he was starting to doubt their decision to stay home as well.  The pressure from family and friends can often lead to going to the hospital too early, which can lead to interventions that the couple didn't want in the first place.  Most people have never seen labor "take so long" because women don't labor outside the hospital very often.  And in the hospital, time limits are enforced.  So two days is unbelievable!  Surely, something must be wrong!

I believe that we'd see this so much more often if women:  a) waited until labor was very well established to go to the hospital, even if it meant days, not hours; b) were not dying to get an epidural, and thus, rushing to the hospital; and c) were not induced and simply allowed labor to start spontaneously.   If this couple were to go to the hospital, labor would likely be augmented either with pitocin or breaking water.  Were they ready to interfere with the natural process? 

Needless to say, they made it to class Tuesday night.  It sure was fun watching her contract all through class!  Some were super intense and she handled them beautifully.

This type of labor continued for a couple more days.  Baby B was born on Black Friday in the early morning.  I got news while I was in a line at Staples, or was it Sports Authority?  No drugs, no augmenting labor.  Just trusting that this labor was just what mom, baby, and even an emotional new father needed.  They are on cloud nine.

Another one of the couples from the same class has had a very similar week.  Contracting every 3 minutes, lasting about 60 seconds.  Still getting some good sleep.  Eating, resting, walking.  The story from the first couple has bolstered their confidence that this is normal.  They have had to remove "the family" periodically as well for the same reasons.  Both these women have amazing husband-coaches.

Like I always say, the baby will come out!  Labor will not last forever, although you may get to a point that you can't imagine it ending.  It will.  Enjoy your labor.  Take it as it comes.  Don't rush through it.  You'll treasure these hours -- or days! -- down the road.  Do something memorable with your labor.  Get creative.  Stay in a hotel, see a movie, take some long walks, build a fire, enjoy a warm bath, eat a yummy candlelight dinner, get a pedicure, eat chocolate, get a massage.  All these things can release endorphins that encourage oxytocin to get flowing.  Remember, oxytocin is a feel-good hormone.  It's hard to feel good when you feel rushed or watched.  So when I say enjoy your labor, I really mean ENJOY YOUR LABOR!

Friday, December 24, 2010

Recycled: Thoughts of the Birth of Jesus

With Christmas here, I was thinking about Jesus's birth. I was so struck by all the Nativities this year. Jesus is laying on a bed of straw with all around admiring Him. I have a hard time believing that Mary was anxious to lay her baby down. I think she wanted to hold and love and protect her baby -- what an enormous responsibility this new mother had.

I have also become so sensitive to the Christmas songs about the birth of Christ. "Away in a Manger" is a song that I've always enjoyed, but I have to say, surely it is an American-written song, as only in America would we sing, "No crib for a bed." I really don't think Mary thought this was a crisis, but we sing about it as though that is what they would have to have as new parents.

Jesus was a homebirth and I bet his parents were cosleepers!

Monday, December 20, 2010

The "F" Word

What is the "F" word in birth?  Got your attention?  You're thinking I'm going to start using profanity here, don't you?  OK, I'm not.  My least favorite word that is thrown around in regards to a laboring woman and a new mom is "Failed."

I've heard references here and other places about failing natural birth because they had an epidural or c-section.  I hate to think of a woman starting out motherhood with this forced -- or self-inflicted -- label.

"Failure to Progress" is the second most common reason given for a c-section -- second only to having had a c-section previously. If you have taken my class, you know how I feel about this "diagnosis."  I can't imagine who thought it was a good idea to tell a woman she "failed to progress."  What was the thought process, who agreed it was a good name, and why on earth do we keep calling it this?!   I don't really believe that it even exists.  I believe that what it really means is: 
1) You did not dilate on our time-clock and your time is out;
2) This induction has failed but we are in too deep at this point and you are expecting a baby out of this ordeal, so we'll throw the blame back on you by telling you that you failed to progress;
3) We might even throw in a CPD diagnosis (the your-baby-is-too-big phenomenon) for good measure;  
4) This is not the Olive Garden -- you cannot sit at this table all night.  The lobby is full and your table is needed.  The servers only have 3 tables and they need to make money.  They can't do that if you occupy this table for their entire shift.

There are many things that contribute to labor taking a long time, but that is not really the point of this post.  Suffice to say,  if a woman is treated respectfully and with encouragement and patience, with care providers trying to get to the root of the "problem," we would have more women birthing their babies vaginally.  

For the sake of this post, let's say that the first-time mom, recovering from a "failed-to-progress" c-section is now trying to breastfeed her baby.  Is she confident that her body is going to produce milk for her baby?  Her body just "failed" her in childbirth, so why should she expect any different from breastfeeding?  It may not even be a conscious thought, but the subconscious is very powerful.  Women who have a c-section are only half as likely to breastfeed their babies as women who birth vaginally.

I believe that people who get information, practice their childbirth method of choice (no matter what that may be), choose their care providers carefully, hire a doula, and basically put their ducks in a row, stack the odds in their favor.  Things might not go as planned, but you did what was necessary on the front end.

I may have told this story before, but indulge me -- now's a great time to bring it out again.  After my friend Jenni gave birth to her first baby (without pain medication), her baby was very lethargic.  She simply could not get the baby to latch on for hours.  There was so much pressure in the hospital to either get the baby to latch or to give the baby a bottle of formula.  She was pretty upset because she really wanted to breastfeed.  We were on the phone (I was in Albuquerque and she was in Salt Lake) and she made a comment about "one out of two wasn't bad."  She had had her natural birth, but just wasn't going to be able to breastfeed.  I told her if she was going to choose one of the two, it should have been breastfeeding.  Her response?  A very hoarse, "Now you tell me!"  Jenni went on to breastfeed her baby for 19 months.

So, yes, birth is so very important, but it is also a few hours of your entire life.  (It's hard for me to say those words, as you can imagine.)  If a mom is so upset about the birth, breastfeeding can be a lifeline for her and her baby.  The Pregnancy Edition of Mothering magazine just had a great article on this topic.  Those hours you will spend breastfeeding and holding your baby are gold.  Wearing your baby, holding your baby, sleeping side by side, getting to know his/her cues.  The kind of parent you become to your child -- this is what ultimately matters.

I am getting off on a tangent.  Coming back to the "F" word -- Ladies, let's not beat ourselves up!  Let's just remove the "F" word from our vocabulary, shall we?  It has no place in our lives.  It's impossible to build self-esteem in ourselves or our children when this word is a part of our lives.   I can't think of a single good reason to use the word "failure" or "failed."  For the record, I would never tell any of my students they "failed" if they had an epidural or c-section.  That is the absolute last thing I would ever want them to think or believe about themselves.  Motherhood is hard enough without being called the "F" word.

Monday, December 6, 2010

The Uterine Tilt -- What You Need to Know

This very well may be the most personal post I've ever written.  I feel like there are so many things that women don't talk about.  We suffer through things, ignore them, hope they'll go away -- I guess the word for that is denial.  Worse, we are just too embarrassed to bring questions or concerns to our care providers or even our friends or family (who may be suffering with the same symptoms).

My paternal grandmother died of colon cancer when she was just 59 years old.  She never had a pap smear her entire life.  To be honest, they don't even know for sure where the cancer started.  It may have started somewhere else, which is highly suspected.

When I was about 33 or so, I started having terrible pain when I had a bowel movement only in the first day or so of starting my period.  It was so painful.  If you have sat through my class, you know how I love "poop stories."  This is not one I particularly enjoy!  I am going to be really specific, as that is how I have gotten to the bottom of this (no pun intended!).  I'm amazed as I've shared my experience with other women, how many of them say that they experience the same symptoms.

Let me preface my story with the fact that I've never had "bad" periods with cramping, headaches, etc.   I always used tampons, up until an episode I had about 3 years ago.  It was in the first 24 hours of my period.   I was sitting at our kitchen table and started having a lot of pain, much like labor.  All my kids were around the table to top it off!  My husband was on his way to church for an activity and I had to call him home.  I really thought I was going to have to go to the ER.  I finally made it to my bathroom where I had to sound it out (again, just like labor).  Once I had the tampon out and pooped, I was fine.  That was the last tampon I ever used.

I had this pain on-and-off for a few years.  After that episode, I was pretty freaked out and just kept thinking about my grandmother.  I was convinced I had a tumor growing!  I scheduled an appointment with an OBGYN that some students had liked for their births.

She ran through several things she thought it could be, none of which sounded too great.  She did an exam and literally laughed in the middle of it.  She explained that my cervix was pointing directly at my rectum.  She said that when bowel was coming through, it would push against the cervix (swollen and blood-filled) and cause the pain.  Once the bowel passed the cervix, the pain stops.  Well, it wasn't life-threatening and at least I knew what was causing it.  Her solution?  Nothing!  She said there was nothing I could do and that it was a good thing I teach relaxation classes because I'd just have to practice what I preach.

And I've done that for the last few years.  The frequency and intensity has picked up since then, however.  Last spring I was reading a Mothering magazine (March-April) about womb massage and different reasons it's done -- infertility and difficult periods were at the top of the list.  I couldn't help but wonder if that was something that would help me.  But who the heck does womb massage?

This summer I was explaining my crazy situation to a Licensed Midwife and she said that I should visit Dr. Kristen O'Reilly, a chiropractor.  She said she had had a number of moms visit Dr. Kristen for a "uterine tilt."  I was, to say the least, intrigued.  Of course, life gets in the way, and I even forgot I have this issue -- until day 1 of a new cycle begins and I have this horrible pain again!

I finally scheduled a time to visit her, not knowing what to expect.  The uterine tilt was probably very similar to what I thought "womb massage" would be like.  My uterus felt tight and she "worked" on it for several minutes.  She adjusted my back and shoulders at the same appointment and I felt like a new person!  Seriously.  I've seen a number of chiropractors in my time, but this was amazing! 

I came back two weeks later, 4 days before starting a new period (yes, I'm that regular).  I could tell that I was more tender, but not as tight.  The true test would be when I started.  Guess what?  It was the easiest period I had had in years!  And, the flow was more steady.  An odd comment?  Maybe.  I've talked with a number of women who say theirs are not "even" either.  In other words, I had reached the point where I didn't really even need a pad.  The flow was almost entirely when I used the restroom.  I believe, now, that that was contributing to the pain I was having, with more blood accumulating and pooling. 

I visited Dr. Kristen two more times over the next month and we both could tell such a difference in the tightness of the uterus.  An easy adjustment, really.

This last period?  Not one bit of pain!  I am amazed!  I was skeptical going in.  Hopeful, but skeptical.  Do all chiropractors do a uterine tilt?  I doubt it.  I've heard so many chiropractors say they work on pregnant women and had many women come to class who visit chiropractors.  But recently, I had someone visit Dr. Kristen and could not believe the difference!  She said she'd seen chiropractors all her life, but Dr. Kristen was the best.  The difference is that she is trained in the Webster Technique and really uses it.  She works one day a week at a birth center and sees their clients.  She is good at working on pregnant women!  She's had great success with turning breeches too. 

I hope this post helps some of you out there.  That's why I wrote it.  After being told there was nothing that could be done, I was just hoping that menopause would get here quickly!   Women should know about this non-invasive treatment.


OK, I know this seems like the biggest endorsement ever, but there was no way around this post without talking about this chiropractor who has helped me so much.  I don't know if you can just walk through any chiropractor's door and ask for a uterine tilt.  I highly doubt it!  But maybe you'll have a better chance at a uterine tilt than a womb massage!

Monday, November 29, 2010

When to Reign In Your Birth Team

As most of you know, I teach a 10-week course on natural childbirth.  The first night of class, the number one question is, "When do we go to the hospital?"  Line-upon-line here.  We don't hit that until Class 5!

Over the years, I've learned that this question is really asking, "When can the professionals take over?"  It usually is asked by a dad-to-be.  It's interesting to watch these expectant parents learn and grow.  Education and information is unbelievably empowering!  Several years ago, I was teaching "emergency" (ie. unattended) childbirth.  By the time we get to that point, we've spent countless hours together, watched more than a dozen birth videos, and everyone has a very good idea of what normal childbirth involves and what to do -- or not do!  I asked this particular father-to-be how he felt about the possibility of this happening.  I should preface his answer with the fact that he didn't speak to me until Class 5 and was totally depending on his mother-in-law to help his wife at the birth.  He despised that he was forced into attending this class.  So, when asked this question, I was amazed at his cool reply:  "On the one hand, totally terrified, but on the other -- bring it on!"  I should also mention that the mother-in-law didn't make it to the birth and they were only at the hospital for 22 minutes before the baby was born!

The answer to the question "When do we go to the hospital?" often changes as you get more information.  Let's back up for a minute.  You know how I feel about hiring a doula.  Do it.  Who are the people you are inviting to your birth?  A sister?  Mom?  Mother-in-law?  Other children?  Your best friend?  Do you call them all the minute you have your first "real" contraction?  Of course not.

There is nothing like being pregnant with your first baby.  Not that the other pregnancies and labors aren't exciting, but they are undeniably different.  You've done it before.  You have distractions now that you didn't have the first time around.  Regardless of what baby number this is, enjoy early labor with your spouse.  I love early labor!  Get into a rhythm together.  Figure out what works, what doesn't.  Practice different positions.  Nap.  Eat.  See a movie.  Enjoy this time together.

Everyone's labor is different.  You may have several hours of early labor -- this week I had a mom that did this for several days! -- or it may not exist at all.  You may jump right into active labor and need your doula right away.  There is no way to know beforehand. 

But let's assume that you do have early labor -- you are contracting regularly but are able to talk, walk, or sleep during and/or between contractions.  If your husband is sleeping, and it's 2:00 a.m., let him keep sleeping.  A lot of moms don't like it when I say that.  Here's the thing -- yes, labor is exhausting, but it's also exhausting for your birth team.  This often doesn't get a lot of sympathy from moms, but if your labor is on the longer side, you are going to need your birth team to be able to step it up, and they may not be able to if they are utterly exhausted.  If you don't need his help, let him keep sleeping.  You'll both be glad later.  You may find yourself enjoying those early contractions, just you and the baby.

As things progressively get harder -- and you feel like you need some extra help -- think about who you want to reign in.  Maybe it's your sister or mom or maybe it is your doula.  Whoever it is, be sure that you are ready for the help.  And perhaps even more importantly, be sure they will be a positive influence on your labor.  For example, the mom who is freaking out that you didn't go to the hospital with the first contraction or the minute your water broke may not be the best person to be with you and your husband.  She may not be someone you want at your birth at all!  In the end, if you don't need help yet, you may feel like a watched pot, which won't be good for your labor.

There's not a set time that is right for all couples.  I hate it when couples are told to head to the hospital when contractions are 5 minutes apart lasting 60 seconds.  You could do that for hours!  It's really hard to explain, but there will come a time in your labor that you will know who you need.  With my 2nd baby, I had no early labor and wanted my friend there immediately.  It was a very fast labor.  But with my 3rd and 4th babies, no one was there until about an hour before the birth, including our midwives.  But I knew when I needed them.

Again, it's hard to explain, but there will be an urgency felt to be with your birth team as labor progresses, whether you are in the hospital or at home.  This will be different for each woman.  Some women feel this urgency earlier than others.  This is their emotional relaxation -- how they feel about where they are giving birth, who is there, are their wishes being honored?  I remember with my first homebirth -- 3rd baby -- the minute the midwife walked through the door, I felt like crying.  I felt such a release.  She wasn't there more than an hour and my baby was born.  My body held back until my birth team was in place.

I often think of it as involving people according to their skill set:  my mom was needed because I needed help with the other kids (1st called).  She cleaned up, made food, changed sheets -- a good one to have around!  Anyone else helping out with the kids was next.  They'd usually help my mom too.  One of these people was usually on video duty.   As labor progressed, if I had a doula or doula-friend, they'd be called in to help me and David.  Your chiropractor is also a great person to call in for a period of time.  Eventually, you'll want someone to catch the baby, so either calling your midwife or heading to the hospital will be necessary!  You'll know when this time is.  You'll be very serious, eyes closed, not talking or smiling.  Some women will be sounding out contractions and others won't make a peep.  Either is fine.  One is not better than the other.

My ultimate answer to the question "When do we go to the hospital?"  Alright, here it is.  There will come a point when she (talking to dad because mom won't remember this or be thinking logically) will not want to walk anymore.  She will still get up and go to the bathroom when you encourage it, but she doesn't want to.  She has to wait till the end of a contraction to get up and she will move quickly so she doesn't get caught standing up during a contraction.  Contractions are stronger and longer when she stands up.  Still willing to move, but not wanting to.  This is usually a good time to mosey on down to your birth place or call in your midwife.  Labor is very well established at this point.

Most of all, enjoy your labor.  Choose your birth team carefully and reign them in as you need them.  So many women wish for a fast labor, not understanding how hard a fast labor is -- just to get it over with.  A longer labor is not a bad thing.  Like I always say, labor and birth serve as a bridge between pregnancy and becoming this baby's mother and father.  Enjoy it.  These hours are unlike any in your whole life.

Monday, November 22, 2010

BabyWise vs. Attachment Parenting

Most of the people I know, or have known, that have "done" the Baby Wise method of parenting have gotten into it because other couples at their church do it. The people I have encountered have been interesting for me to observe. They tend to watch the clock instead of their baby. For example, baby is fussy, and instead of putting the baby to breast, mom looks at the clock and announces that he shouldn't be hungry yet, not for another 20 minutes! By the time she feeds him, he's hysterical.

I had someone in class explain how the method is actually suppose to work, and I must admit, if I didn't have children, I might think it sounds like it makes a lot of sense. Here's the idea: You want your baby to learn to get good sleep and sleep for longer periods of time, because, like adults, they will learn better, grow better, etc., if they get good rest. They talk about the possibility of developing ADHD and having learning difficulties when the child doesn't get enough rest. (Have you been to Walmart at 10:00 at night and seen all the crying kids and frustrated parents? I'd have to say that I agree -- kids should be in bed when they have school the next day.) You are not to let the baby fall asleep at the breast, but keep the baby awake longer so that he will sleep longer. Baby Wise also does not want baby to always breastfeed to go to sleep.

My favorite part though was not having a baby that is a "snacker." The idea is that if you "let" your baby breastfeed whenever he wants to, he isn't getting "good protein" -- WHAT?! Whoever came up with that has no idea how breastfeeding actually works. Baby gets "good protein" at every nursing, long or short. They advocate for the baby to have "meals" instead of "snacks." Dr. Sears, in The Baby Book, talks about all the different types of nursing babies. Having breastfed 4 babies for more than 7 years of my life, I will tell you that all babies are different. My first did not ever nurse for less than 40 minutes at a time. His little head would sweat like crazy. I'd have about an hour, maybe 1 1/2 hours, before we'd do it all again. He is my healthiest child!

My 2nd baby was finished with nursing five minutes after it began. She would go 3-4 hours between feedings. I could never have made her nurse longer. I would have had a very frustrated baby, not to mention a very frustrated mom. She slept more than any of our other babies. She was the only baby who would not fall asleep nursing. She wanted to be left alone to go to sleep. Sounds like what every parent hopes for, right? Think again. She was not a cuddler. She has been my only child prone to ear infections. She is almost 10 years old and very smart, a very deep thinker. She likes to spend her time alone and has lots of self-soothing techniques that have become very disruptive in her life -- so much so that we are seeking counseling. Don't leave your child to soothe herself. My "squeeky wheels" seem to have more "normal" ways of dealing with life. I don't want to see parents do this type of parenting on purpose.

My other two babies were more in a classic category, as far as breastfeeding.

Some babies, especially newborns, will want to breastfeed every 20 minutes! This is a good thing. You will establish a good milk supply. It is the frequency of breastfeeding, not the duration, that stimulates your milk-producing hormones. So, snacking is great! Babies have very intense sucking needs those first few weeks. This is not a coincidence. It helps establish a good milk supply if your baby is at the breast very often. You absolutely cannot spoil your newborn baby! What will spoil this wonderful relationship is giving your baby a pacifier or bottle. Babies are built to breastfeed and so is the mother! Let yourself enjoy this time by following your baby's cues. He will let you know exactly what he needs if you will listen to him and not some kooky book that tells you your baby needs to teach himself how to go to sleep.

As far as sleeping goes, you cannot force a baby, or anyone, to fall into certain sleep cycles. Sleeping is an absolute basic need. Food, water, sleep, shelter. Honestly, no one needs to be taught how to sleep. Babies have very different sleep cycles from other age groups. A good book to read on this topic is "Sweet Dreams" by Dr. Paul Fleiss.

I was completely obsessed with sleep with my first baby. And then one day, I was trying to make him take a nap, and my aunt said to me, "You know, he will sleep when he's tired. He must not be tired. Let's go play!" This was so freeing to me. He was 3 years old at the time. He quit taking naps shortly after that, but his bedtime was moved to an earlier time. He is such a great sleeper since I quit obsessing over it. He's 12.

We had a big sleep progression over the years. I wish we could have just started with baby #4. We never even set up a crib with her. When we had a crib, we felt obligated to use it. (Dr. Sears tells a story of being in a foreign country and was asked, "Is it true that American mothers put their babies in cages at night?) Yes, it is true.

Let me tell you about sleep with Darcy: I nursed my baby to sleep every time she was sleepy! I would never recommend not doing that. It was stress free. I knew she'd fall asleep and if she didn't, we'd try again later. I knew this was my only time of her life that we would have this opportunity. I loved to nurse my sweet baby to sleep, to smell her milky breath as her mouth opened once sleep came and extra milk ran down the side of her cheek. I never had to pick her up and take her to her bed. Our bed was her bed. I simply laid her down and felt her body mold to mine. Unless you have experienced this closeness to your baby, you just cannot understand or imagine the sweetness. David and I both treasured that time, knowing it is too short.

Darcy was never afraid of sleep. It was a comfortable, safe, warm, happy place to be. What is wrong with nursing your baby to sleep, even every time your baby is tired? Why is this frowned upon in our society? I promised, it will not last forever! You will not create a monster.

Our bed sits high up. We taught her early on how to get off the bed -- "feet first" was a phrase all of our kids learned early on. When she was very small, we would put a monitor on the bed and get there as soon as we heard her wake up.

There were some sleepless nights. Sometimes, she'd be wide awake in the middle of the night and want to talk. Sometimes she'd kick David in the back. Sometimes we slept in the "H" position. This would have happened no matter what bed she was in. It would be very easy to ignore her if she were in another room. Usually, however, she would simply nurse back to sleep. I was her mother in the daytime as well as the nighttime. We have a king-size bed, and really, that is a better investment than a crib.

I hear parents say they are afraid the baby will never leave their bed. Of course they will. When Darcy was about 20 months old, we were trying to get her used to sleeping in another bed in our bedroom. We were going on a Tim McGraw cruise in a few weeks and wanted things to be easier for my mom who would be staying with the children. That was such a stressful time to try to make her sleep somewhere she wasn't comfortable with. After a few weeks of trying, I decided it just wasn't time for her to be out of our bed. What a relief.

She moved into her sisters' bedroom when she was 28 months old. We talked about it beforehand and felt that she was ready. She did not try to come out of the bedroom even one time! Again, sleep was never scary for her. It was an easy transition. She quit breastfeeding around the same time. She'll be 4 in March and is still a great napper, which always takes place on my bed. It's my favorite time of the day to snuggle up with her and feel her breathing sync with mine as we drift off to sleep.

Let's go back to the Baby Wise idea of not letting your baby fall asleep at the breast. First of all, I say this is nearly impossible. There are some major problems with this philosophy. When I am talking with a breastfeeding mom who has a baby that is not gaining weight, the first thing I ask her is, "Who is ending the feedings?" The baby should be the one ending it, usually because he falls asleep! Mom should not be ending it because the longer the baby stays at the breast, the more hindmilk the baby is getting. This is the fat, or "dessert," after dinner. Baby needs this to grow. Second, mom's body produces a hormone called prolactin which the baby also receives during breastfeeding. It is often called "the mothering hormone" because it causes her to be calm, even sleepy. Same effect on baby. Why would any mother not want to have this wonderful hormone surging through her body and her baby? Again, I ask, why is it bad to let your baby fall asleep at the breast?

Follow your baby's cues. Don't be a clock watcher. Don't schedule your baby. Together, you will fall into a natural routine. Routines are great. Schedules, not so much. Think of what is best for your baby. If it's best for your baby, it's most likely best for you too in the long run, even if it seems inconvenient right now.

Monday, November 15, 2010

Social Circumcising

We had a great meeting and discussion this week at the Tarrant County Birth Network meeting.  One of our topics was circumcision.  I've written quite a bit on the blog about circumcision, but I haven't addressed the social reasons that I hear so frequently regarding the decision.  So let's talk about them.  If I miss any, please comment below and we'll try to address them all.

If you have not read about the purpose of the foreskin previously, I want you to do that now.  Click here.

The foreskin is obviously not just a flap of skin.  It has many purposes.  So why are 50% of American males still being circumcised?  It's these social traditions or concerns that need to be addressed.


1.  We want him to to look like his dad.  A little boy looks no more like his dad than a little girl looks like her mother.  Things grow bigger and grow hair, which, in my opinion, is much more distracting than the foreskin!  Mostly, after the first couple of years of life, when does a boy ever see his father naked?  My 14-year-old intact son has no idea what his father looks like and vice versa.  Frankly, in my opinion, it's a really odd and disturbing argument.

2.  What about the locker room?  Won't he be made fun of?  Maybe 20, 30, 40 years ago, but with 50% of males not being circumcised, it becomes a matter of education in my opinion.  When my son went to 5th grade we knew he would be dressing out for PE.  We sat him down and told him about circumcision.  He was, to say the least, appalled -- very much the same way you were when you found out about episiotomies.  We explained that we researched it and felt there was no reason to do it and that most parents do it because of tradition.  He knows that those kids' parents probably just didn't know any better.  He politely thanked us for "not doing that" to him.

Last year, in 8th grade, I asked him if it was ever an issue, and he laughed.  He said, "No one is looking!  Creepy!"  As a side note, as a boy grows into a man, it becomes less and less obvious that he is not circumcised, especially when it is erect.  This is, again, in my opinion, an argument made by (jealous?) men envious of their intact friends who are, on average, 25% longer than the circumcised male.  Just saying.

3.  Isn't it cleaner to be circumcised?  There has been misconception about smegma, the tiny, white, ball-like substance that the foreskin produces.  In the past, by those that don't understand it's purpose, it's been thought to be unclean.  In fact, just the opposite it true.  The foreskin is self-cleaning, as smegma is antiviral and antibacterial.  No soap is required, just warm water in the shower, later, when the foreskin retracts on its own.  Next time you hear someone say in regards to circumcision, "I guess, as long as he is taught how to properly clean himself..." you can let them know that remaining intact is not unclean.  That is part of the misconception, created by a society that wanted males circumcised because they believed it prevented masturbation.  Seriously?  I guess when 20,000 nerve endings are removed...  Mostly, he'll just never know what he's missing.


4.  Circumcision was a law in the Old Testament so we should follow that law.  It must be noted that circumcision was nothing in the Old Testament like it is in America today!  Removing as much as 80% of the penile covering is not what was going on back then!  It was more like a nick in the foreskin.  Of course, circumcision is still a part of religions today, so I am mainly addressing those of the Christian faith at this point.  If you continue reading the New Testament, it's very clear that the law of circumcision, along with many other laws, were done away with through the blood of Christ.  I'll encourage you to search that out.  For my LDS readers, it is stated many other places as well -- The Book of Mormon and the Doctrine and Covenants.  

5.  Circumcision prevents being sexually active at an early age.  Seriously? 

6.  His future wife will think it's ugly and wish he was circumcised.   Who comes up with this stuff?  Very likely, she won't even know the difference.  I have friends that had no idea their husband wasn't circumcised until he told her. 

 7.  I'm leaving it up to my husband to decide.  Why?  It's not his penis in jeopardy!  Your baby cannot speak for himself and he needs his mother to advocate for him.  This is where we get into informed consent issues.  I'm convinced that one day a boy/man will sue his parents over this issue.  If you think that "he has a penis, he knows what it's like," it's a different time today than it was 30 years ago.  Parents are educating themselves and questioning (foolish) traditions.  This is surgery for your baby.  Both parents should be making this decision, not one or the other.  What about letting your son decide for himself?

8.  Better to do it now since he won't remember it.  Babies feel pain more acutely than adults, they just can't say so.  This argument also implies that it will have to be done later, which is highly unlikely.  See the argument below.

9.  It's better to do it now than later when it's more painful.  I compare this argument to elective cesarean (surgery that is not needed) and cesarean with an OB or midwife who has an extremely low cesarean rate (only doing surgery when it's truly required).   Some doctors or pediatricians have no idea about the intact male.  They try to pull the foreskin back at each appointment because they haven't researched it or know any better.  They are looking for things to go wrong.   We all know what happens when you have an OB like that -- you have surgery.  The same is true for an intact male.  It is very important that you have a pediatrician/family practice doctor who is up-to-date on the intact male.  If they are supportive of not circumcising (supportive, not compliant) and for whatever reason believes that your son needs to be circumcised (extremely rare), then you won't need to second-guess that decision.   It's always best to get more than one opinion, regardless.

10.  His brother(s) is circumcised, so we have to keep doing it.  Two wrongs don't make a right.  The cycle has to stop somewhere.  I've had guys in class tell stories about some of the boys in their families being circumcised and others not, and not once have they made it to be a big deal.  They all knew why some were and some weren't.  I even had one guy say that he and his brother didn't know that one was and one wasn't until they were adults and their mom was talking about it as they were making the decision for their baby.  As far as who is envious of the other, I can't help but think it will be the circumcised male that is envious of his intact brother.

Just a couple other things to touch on:  Female circumcision has been in the news quite a bit lately.  When we mentioned it the other day at our meeting, everyone cringed.  Why do we do that when we are talking about females, but not males?  Why?  It's the same thing.  Think about it.

I like to see parents take this bold step in protecting their sons.  Some are breaking tradition and bucking the system.  Chances are, if you are reading this blog, this isn't the only area you are breaking out of the mold!  When we chose not to circumcise our son, 14 years ago, we had no friends that didn't circumcise their sons.  As the months went by, we found out that most of his male cousins aren't circumcised either.  We found it was more prevalent than we had thought when we made the decision.  That is great, but it is so important that we share this information with expectant parents.

The 9th step to the Mother Friendly Childbirth Initiative is to discourage non-religious circumcision.  Discourage is an action word!

Monday, November 8, 2010

TCBN Meeting this Week -- Newborn Testing & Procedures including Circumcision

This Thursday, November 11th, is our monthly Tarrant County Birth Network meeting.  We meet on the Texas Wesleyan campus in the Sid Richardson building on the 2nd floor from 7:00-9:00 pm.   We invite all expectant couples to come learn about newborn testing and procedures, no matter where you are planning to give birth. 

We are excited to hear from Christy Martin, a member of TCBN and Certified Professional Midwife, speaking on newborn procedures under her care either in a birth center or your home.  We will also hear from a nurse from one of Tarrant County's hospitals as to what to expect with newborn testing and the different procedures that take place when the baby is born in the hospital.  When do these things take place?  Why is it done?  Are they optional?  Come find out.

We strongly encourage fathers-to-be to come to this meeting this week.  Very often, it is the dad who is with the baby at this very important time, and we want him to be informed about what is being done to his baby.

In addition, we will have a great discussion about circumcision at this meeting.  Again, I hope you'll encourage the men in your life to attend this meeting.  So often, brand new parents just go along with tradition -- testing, bottle feeding, immediate cord clamping, eye ointment, vaccinations, and of course, circumcision -- because they simply don't have the information about why these things are being done. You may find that one or both of you is not okay with certain procedures.   It's a lot for mom to have to go home and explain all this information to her husband, so just bring him with you!  Then, the two of you will be able to make informed decisions in regards to your newborn.

Last month, it was so fun to have all the babies and toddlers at our Babywearing meeting.  With all the kiddos, we had 75 people in attendance!  This month, however, we are back to our usual request:  Please only bring immobile lap-babies.  We hope that expectant couples can get the information they are looking for, and sometimes it gets quite noisy!  (Remember what it was like before you had children!)  I am on the prowl this week for a microphone for future meetings, so that will help tremendously. 

Just a reminder, it's only $25 for a Consumer Membership and there are some fantastic benefits offered by our Professional Members if you are a member of TCBN (pick up a Resource Guide to check them out). You can join online.  Thanks for your support of TCBN and Mother-Friendly maternity care.  See you Thursday.

Monday, October 25, 2010

The Doula -- or "Dude-la" -- Post

Some of you might remember reading about one of my couples that accidentally gave birth at home last year.    The plan was to have their doula - who was at the birth - have a doula-in-training shadow her at this upcoming hospital birth.  Frank, the father-to-be, referred to the student doula as "the dude-la" -- she was to be his doula!  His "dude-la" was actually at another birth when Nancy gave birth at home, much to Frank's dismay.  I wish I could take credit for coining this term, but I have to give credit where credit is due.  It makes me laugh every time I think of it.

I always have a couple of doulas that I refer my students to, usually for a bargain price, as my students are usually very prepared for labor and birth.  A bit less work for her -- certainly less educating on her part.  I am very picky about who those doulas are.  Like lactation consultants, doulas are not all created equal.  I knew of a doula in Albuquerque that had a 90% epidural rate! Certainly not the doula I wanted for my students!

The first question I always ask is why she wants to be or why she became a doula.  I am amazed at how many women become doulas because of a personal traumatic birth experience.  They want to help other women not go through what they went through.  That is totally respectable, but not necessarily who I want at my couple's births.  She will often be defensive and looking for things to go wrong.  Her "bad" birth experience led her down this road and she is, in my opinion, trying to right a wrong.

I have been writing about the birth team a lot lately -- doulas, midwives, and OBs.  I've decided that it is 50% of the "requirement" to having a happy birth experience.  Education is great, an absolute must, but if you are surrounded by people who do not believe in your ability to birth your baby without medication or intervention, you likely will not be doing so, no matter how prepared you and your partner are.

If I were looking for a doula, these are things I would want to know:


Has your doula given birth?  (It is hard for someone who has not gone through labor and birth to understand the thoughts that go through a woman's head during labor.)


Where did she give birth and why did she choose that location? (If you are planning a homebirth and you are hiring a doula who has only given birth in a hospital, you might ask her why she chose to not birth at home.  She may, deep down, be fearful of birth.  Or maybe it was an issue with insurance.  Or maybe her husband was too fearful.  Find out why she birthed where she did.)

Did she have medication or intervention?  (When the going got tough, how did she handle contractions?  What seems to be her general attitude about medications and interventions in labor?  Does she really believe that these things are usually not needed?  On the flip side, is she willing to use intervention if required?  Does she recognize that sometimes a woman may need intervention or medication?)


Has she ever been "overdue" and how did she deal with that?  (A woman will naturally doubt her body's ability to start labor on its own towards the end of pregnancy.  Having an encouraging doula by her side, reminding her that her baby and body knows just when the time is right, is crucial.  The "overdue" woman is bombarded with questions of when she is going to finally induce, and her doula will be her rock in refusing induction.)


How long were her labors?  (There is an emotional tug-of-war here.  Most women hope for a short labor, but that is often much harder, physically, than a longer one.  A long labor is not only physically challenging, but very mentally difficult.  It's just interesting to hear her perspective on length of labor.)

What is her c-section rate?  Epidural rate?  (Some things are obviously out of her control, but if her rates are higher than you think they should be, she may not know how to really help a laboring woman - which may be a physical or mental issue.  If she doesn't know her rate, ask her to figure it out.  You'll be doing her a favor, trust me.  She should know this information if she's never figured it out.  If her rates are high, she can evaluate what she can/should do differently, and if they are low, it will help her in talking to potential clients.)


Where is her favorite place to doula?  Hospital, home, or birth center? (Listen to her answer on this one.  This tells you who is the most supportive of doulas at a birth.  It's usually the places where she feels like she has the freedom to work with a couple and her opinions and experience is valued.  These are usually good places to birth.  If a doctor or hospital is not at the top of her list, it's usually because they have policies and procedures in place that make it hard for her to really help you. They are usually resentful of her presence and feel that she is interfering with their work.)


Does she have backup with similar rates and philosophies?  (I don't want certain doulas at my student's births, so I want my doulas-of-choice to have doulas backing them up with similar styles and philosophies.  Things come up in life, and your doula could have the flu the day you start labor.  Ask about her backups.  You will all be more comfortable if you know these things in advance.)
  

Does she have "time limits" of being away from home (nursing baby, child care, husband's job, etc.)?  This is one reason I don't doula.  I have lots of kids, all attending different schools.  I don't let them ride the bus, so I spend half my day in the car.  I don't live near family to depend on either.   Oh yeah, and I have a husband with a demanding job.  Lastly, I don't have the patience necessary to be good doula!  If she does have "time limits" she may be very distracted.  Know what the issues are and how she deals with them.  For example, she may need to pump breastmilk every 4 hours during your labor.  If you are fine with that, great.  If that will drive you crazy, she's not the doula for you.)

Lastly, ask her what she literally brings to a birth? (One of "my" doulas is a massage therapist so she doesn't bring a lot of physical items to a birth.  She brings her hands, ready to work.  She knows acupressure points that stimulate labor and actively uses them throughout labor.  Other doulas have a bag that they bring, full of "birth toys" to help throughout labor.) 

It's nice to know what your doula brings to a birth, both literally and figuratively.

I hope this list helps you in your search for a doula.  They are such an important part of the birth team.  I see more epidurals and c-sections at births without a doula than those than have a doula.  And if your husband is resistant and wants the job all to himself, start calling the doula a "dude-la" and remind him that she is there as much for him as she is for you!

Monday, October 18, 2010

The OB at 38 weeks

I am not out to make anyone a bad guy here.  OK, maybe a little.  I have worked as a Natural Childbirth Educator for long enough to make some generalities and feel pretty comfortable with saying them.  I am fully aware that there are exceptions to what I am about to say, but they are so few and far between.  I hope what I am about to say will be listened to and not just heard.

There are two types of maternity care:  the Medical Model and the Midwifery Model.  Briefly, the Medical Model perceives pregnancy, labor, and birth as a disaster waiting to happen;  something a woman needs to be rescued from.  Medicine improves upon the "natural" process.  Labor is all about the cervix and birth canal, always looking for something to go wrong.

The Midwifery Model of Care, on the other hand, trusts a woman's body to grow her baby, start labor at the appropriate time, and labor without time constraints.  A midwife takes into consideration, not just the cervix and birth canal, but the entire woman and her environment.  Birth is as much mental as it is physical.  Medical doctors almost always ignore this fact, usually because the hormones are not working properly when a woman has an epidural.  They just don't see natural normal birth often enough to know what to do -- or more appropriately, what not to do! 

So when couples come to take my Bradley class, I worry about those that have an OB.  And rightfully so.  Most of them will see the light and switch to a midwife, but sometimes the couple is fed so many lines by their OB and hospital nurses, they don't switch, believing their doctor is different. 

From the L&D nurses:

"We have birth balls, showers, tubs, squat bars, dim lights -- everything you want for your natural birth."  (In labor, these things are nowhere to be found.  Only one room has a tub that works, no one can find the squat bar, lights are bright so the doctor can see -- it's all about him, right?  The atmosphere is not what was promised.)


Some of my favorite lines from OBs are:

"As long as everything is going fine, you can do whatever you want."


"As long as your water isn't broken, you can walk around as much as you want."


"We can do intermittent monitoring as long as baby is handling labor okay."

"We don't need to talk about induction unless you are more than a week past your due date."  (No one thinks they will be 'overdue' when they are pregnant.  No one.  They believe this won't apply to them.)


Don't these sound great?  I've got a great OB, right?  Did you hear the clause in each statement?  Remember, an OB is trained to look for things to go wrong.  Statements like these pacify the pregnant woman at monthly/weekly appointments because it seems like she is hearing what she wants to hear.  The problem is, an OB can make up all kinds of reasons to keep you on a monitor in labor, or restrict food and water, or induce labor for a million different reasons.  Seeing this as often as I do, a local doula called this the "Bait and Switch."

Something happens at 38 weeks with an OB, where all-of-a-sudden pregnancy becomes very dangerous.  The placenta starts to deteriorate, amniotic fluid levels rapidly drop, blood pressure is through the roof, and vaginal exams must be done to ensure that your body knows what to do.  Oh yeah, and your baby is getting much too big to fit through your pelvis.  We either need to look at inducing right away or just scheduling a c-section to save you from having to go through the trials of labor.  You'll probably just end up with surgery anyway.

I wish I was making this stuff up.  I'm not.  I see it all the time.  If you stay with an OB who makes "reassuring" statements with a clause and you ignore these red flags, and then you have a c-section, you will always wonder if you really "needed" surgery.  If you change care, even at 39 weeks, to a midwife who trusts birth and encourages you along the way, and then end up with surgery, then you probably did need it. 

I recently had a mom who changed care from an OB at 39.3 weeks to a group of CNMs.  Her baby was over 10 pounds and she pushed for nearly 4 hours.  She had back labor most of her labor and did have an epidural.  Had she stayed with the OB, I am 100% certain she would have had surgery.  Her previous hospital has a 60% c-section rate and they would never have allowed her to push that long.  Sure, she did not have an unmedicated birth, but the switch saved her from surgery.  A good move.

Be on the lookout for these statements from your OB.  The end of pregnancy is so exciting.  You are about to meet your baby for the first time!  A good care provider will reassure you that your baby and body know just when the time is right for labor to begin.  Your care provider should fill you with reassurance, not fear.  And that, really, is the difference between a good care provider and a bad one.

Monday, October 11, 2010

Want an Unmedicated Birth -- Or Even Just a Vaginal Birth? Hire a Midwife and a Doula

I have recently had a bad run -- lots of cesareans and epidural births.  I've thought about them a lot over the last several days and weeks, and there are some significant numbers that I want to share.

Up to now, my stats have been about 79% of people that take my class give birth without medication.  14% have a cesarean, and about 7% have an epidural, the majority of the time to avoid a c-section.

These last few months have been the worst statistics I've had in over seven years of teaching.  It's hard for me to put this out there, but I've gone back about 4 months to include a couple of classes and several DVD couples.  There are some interesting things to note, and I hope this improves future outcomes.

In the last 4 months, I've had 23 couples give birth.
10 had unmedicated vaginal births.
5 had epidurals (but still had a vaginal birth).
8 had c-sections. 

Let's break this down, starting with the 10 unmedicated vaginal births.  (This is what everyone was shooting for.)
6 hired midwives (mix of CNMs and CPMs).
4 hired an OB.
6 hired a doula.

Of the 5 epidural births:
3 had a midwife.
2 had an OB.    
Only one of these women hired a doula.  
It should be noted that a few of these women started with OBs and switched to midwives.   Length of labor and/or pushing would have certainly resulted in c-sections had they stayed with their original OBs and hospitals.
 

Of the 8 c-sections:
2 had a midwife.
6 had an OB.
Only 2 of these women hired a doula, and only one had her doula present.
Obviously, these c-sections happened for a variety of reasons, some valid, some not-so-much.  Can't ignore that 80% were with OBs.  Honestly question if they would have happened with a midwife.

Summary:  If you want an unmedicated birth, your birth team is crucial.  All the education in the world won't matter if you have a doctor who is determined that you or your baby "need" a c-section.  As for a doula, the statistics speak for themselves.  A woman who has the support of another woman in labor will almost always have a better outcome, or at least feel better about doing all that she could do to prevent having an epidural or a c-section. 

If you are birthing in a hospital, you need to hire a midwife instead of an OB and you need a doula by your side.  End of story.

Thursday, September 2, 2010

"Birth" Will Be on Stage September 25, Martin Hall, Fort Worth, TX

No, not a real live birth!  How could we possibly time a birth to be at an exact moment?  We won't even go there today...

For the first time ever, "Birth" will be performed in North Texas.  Mark your calendar for Saturday, September 25, 2010.  The matinee is at 2:00 and the evening performance is at 7:00.  Each performance will be followed by a Talkback, hosted by DFW's own Joe Gumm.  (Not only is Joe a sportscaster and funny guy, he wrote a book about birth called "From Humor to Hormones" -- geared for dads-to-be, of course!  They birthed all four of their daughters at home, so he actually knows what he's talking about!) 

The play will be performed at Martin Hall on the Texas Wesleyan campus.  It will run 2 hours with a 15-minute intermission.  Eight women, eight birth stories.  You'll laugh.  You'll cry.  Make it a girl's night out.  Come for the play and stay for the Birth Fair.   

The Birth Fair will be held across the street in the Baker Building with vendors and a huge silent auction.  Lots to be had (I've got my eye on several things!) and it's not just birth and baby stuff.  I love me a good silent auction!  The Birth Fair will run from 12:00-6:30.  The first 500 visitors will receive an awesome goody bag.  You snooze, you loose, so don't be visitor number 501.

All proceeds will benefit the Tarrant County Birth Network.  You can buy your tickets online at: www.boldfortworth.org.  They are $10 per ticket in advance and will sell for $15 at the door. 

This will be the most memorable "Birth" you'll ever attend!  See you there!

Monday, July 26, 2010

ACOG's Bittersweet VBAC Statement Issued July 21, 2010

The American College of Obstetricians and Gynecologists (ACOG) issued a long-overdue statement this week regarding Vaginal Birth After Cesarean (VBAC):  "Attempting a vaginal birth after cesarean is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines released today...  The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC...  These VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy.  Moving forward, we need to work collaboratively with our patents and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate..."

OK.  My reaction after reading their statement should have been joy.  The natural birth community has waited a long time for this.  To be honest, my initial reaction was anger, followed by sadness.  My eyes even welled with tears thinking of all the millions of women who have been lied to for the last decade about how risky VBACs are and as a result had unnecessary surgery.  Babies suffered.  Mothers suffered.  Doctors benefited. 

We have a generation of doctors who now believe that VBACs are risky -- because ACOG said so for so many years-- and now they are being told that they are not dangerous and to go ahead and allow women a TOLAC (Trial of Labor After Cesarean).  I probably don't need to tell you that a trial of labor can easily make an OB look like he tried to allow a VBAC and (s)he may have no intention of allowing moms to VBAC.  If you are in this situation, ask your care provider what a "trial of labor" means to them.  Will you have time limits imposed on your labor?  Likely.  Do you require continuous monitoring?  Can you get up and walk around?  Are they going to treat you  like a "normal" woman in labor or like an accident waiting to happen -- IV fluids, restricting food and water, continuous monitoring, regular vaginal exams, etc. -- because attitude is everything when a woman is VBACing.  She requires a lot of emotional support.

Who is going to be involved in these changes?  It's not just about an OB and his patient.  It's about hospitals and insurance companies.  There are more than 800 hospitals across America that have banned VBACs over the last decade, the majority of those fairly recently.  Can we expect these changes to be immediate?  Unfortunately, probably not.  If you are a VBACing woman, be very familiar with this statement and fight for your right to a VBAC.  That is probably the first step.  Change is not going to occur immediately.  Women may even find themselves quoting this statement to their insurance companies.

I believe that what led to this statement was not evidence or the demand for VBAC by women.  The evidence against repeat cesareans is strong and always has been.  What led to this statement was another agency getting involved in the cesarean epidemic.  The National Institute of Health (NIH) held their conference in March and at the top of the list was addressing America's insanely outrageous c-section rate.  The number one reason for a cesarean is because a woman has already had a c-section.  If we could raise the VBAC rate, we'll automatically lower the cesarean rate, improving lives while saving money all at once.  A win-win. The statement had to come from ACOG.  The pressure was on.

According to the statement issued, 60-80% of women who attempt a VBAC will be successful.  I interviewed a group of CNMs in Albuquerque several years ago who loved doing VBACs, and as a result, their VBAC rate was 92.3%.  The care providers in the DFW area who support VBACs also boast 90%+ VBAC rates.  The Mother-Friendly guidelines state that the VBAC rate should be at least 60%.

I have written about the safety of VBACs in the past, so I wont rehash that here.  You know what I believe.  There are a couple more quotes I think are worth repeating here that appeared in the statement.

"Our primary goat is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC."   However, in another paragraph, it says "The College maintains that a TOLAC is most safely undertaken where staff can immediately provide an emergency cesarean, but recognizes that such resources may not be universally available."  (Remember, the risk of uterine rupture is between 0.5% and 0.9%.)  A statement very similar to this is what led to the VBAC bans in so many hospitals.  Not crazy about it appearing in the statement.  I think we'll see doctors referring to it in defense of continuing with not allowing VBACs. 

The last paragraph says "The College says that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC."  I could not help but think of Allison's story I wrote about last year.  How things would be different for her if this statement had been issued less than a year ago.  Honestly, it makes me feel sick, angry, and sad.  I called her tonight after rereading the statement.  She had read it this afternoon.  We had the what-might-have-been conversation.  It's a moot point.  But now she has 3 cesareans under her belt (pardon the pun -- really not trying to be funny here), but the statement doesn't address women with more than 2 c-sections.  But because she was literally forced into the third c-section solely because of a hospital policy, if they decide to have another baby, she is still going to have to fight for a VBAC. 

So, yes, I am glad that ACOG issued the statement.  The price was high.  Women, I believe, are still going to have to fight to make this a reality.  A friend of mine, former Bradley student turned Bradley teacher, Sarah Clark, aka Mama Birth, titled her post on this topic "ACOG Still Sucks."  And that about sums it up...

Monday, July 19, 2010

What IS Mother-Friendly Care?

I've been tossing this phrase, Mother-Friendly, around for months now, but I am beginning to realize that people have very different ideas of what constitutes true Mother-Friendly care, as defined by the Coalition for Improving Maternity Services (CIMS).

First, let me say that Mother-Friendly is short for the Mother-Friendly Childbirth Initiative (MFCI).  There are 10 steps, which I will address in this post.  They are very specific and some steps are harder to achieve than others.  Do not just assume that your care provider is Mother-Friendly.  Put them on the spot.  Ask them.  These steps are based on the evidence. 

A Mother-Friendly Care Provider, Hospital, Birth Center, or Home Birth Practice:

1.  Offers all birthing mothers access to a doula, or anyone else they wish to have at their birth.  She also has access to professional midwifery care.

2.  Provides their statistics to the public about all aspects of their birth care, including measures of interventions and outcomes.

3.  Is respectful and sensitive to the beliefs, values, and customs of the mother's ethnicity and religion.

4.  Provides the birthing woman with the freedom to walk, move about, and choose her positions during labor and birth and discourages the supine (flat on back) position.

5.  Has clearly defined policies and procedures for collaborating with the original caregiver during the perinatal period when transfer from one birth site to another is necessary.  They will also link the new mother and baby to appropriate community resources, including during and after the pregnancy and follow-up breastfeeding support.

6.  Does not routinely practice the following procedures that are unsupported by scientific evidence, including by not limited to the following:
*shaving
* enemas
* IVs
* withholding food or water
* early rupture of membranes
* Electronic Fetal Monitoring (EFM)
* Induction rate of 10% or less
* episiotomy rate of 20% or less, with a goal of 5% or less
* total c-section rate of 10% or less in community hospitals and 15% or less in high-risk hospitals
* VBAC rate of 60% or more with a goal of 75% or more.

7.  Educates staff in non-drug methods of pain relief and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.

8.  Encourages all mothers and families, including those with sick or premature infants, to hold, touch, breastfeed, and care for their babies to the extent compatible with their conditions.

9.  Discourages non-religious circumcision of the newborn.

10. Strives to achieve the WHO-UNICEF "Ten Steps of the Baby-Friendly Hospital Initiative" to promote successful breastfeeding:
  
     1.  Have a written breastfeeding policy that is routinely communicated to all health care staff.
     2.  Train all health care staff in in skills necessary to implement this policy.
     3.  Inform all pregnant women about the benefits and management of breastfeeding.
     4.  Help mothers initiate breastfeeding within a half-hour of birth.
     5.  Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants.
     6.  Give newborn infants no food or drink other than breast milk unless medically indicated.
     7.  Practice rooming in; allow mothers and infants to remain together 24 hours a day.
     8.  Encourage breastfeeding on demand.
     9.  Give no artificial teats or pacifiers to breastfeeding infants.
     10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics.

This is the criteria the members of the Tarrant County Birth Network support, believe in, and ultimately practice.  Next time someone says they are Mother-Friendly, you'll be able to know exactly what that means.  It's not just a catch-phrase - sure, no one is hostile towards mothers - but are they truly supporting these mothers and fathers in becoming a family?  Step number six is pretty intense and where a lot of care providers do not qualify for Mother-Friendly status.

Mother-Friendly status is what all care providers should be striving for.  Ask your care provider if he/she is Mother-Friendly and what they are doing to become Mother-Friendly.  This is the way we are going to change maternity care in the US.  This market is consumer driven, and you are the consumer.  Demand Mother-Friendly care. 

Monday, July 12, 2010

Centering

Centering is coming to Fort Worth!  No, it's not a yoga pose.   It is actually a method of maternity care.  I hope this post explains the Centering program and you will be as excited as I am.

Centering is typically done by midwives -- at least I haven't heard of any OBs doing it.  In very simple terms, it's group prenatal care.  Often, "patients" have the option of doing their prenatal appointments in this manner where it is offered.  If a woman chooses to "center" she'll be put in a group with other women who are due about the same time or month, depending on the size of the practice. 

The women arrive at the same time at the clinic, birth center, or office.  They will each weigh themselves, as well chart their own blood pressure and do their own "pee stick."  This puts their health care directly in their own hands.  Then, each will have a couple of minutes with the midwife to measure fundal height and listen to the baby. The midwife will typically ask if she has anything she wants to talk about that is too personal for the group.  If not, she goes to the circle and waits for the other women to join the group.

The group usually sits in a circle.  It is not a classroom by any means!  There will usually be a topic, such as the size of the baby, typical pregnancy symptoms, etc.  Your midwife is sitting eye to eye with the group.  This puts her on a different level with her clients.  She has the opportunity to get to know these women in a very different setting than a  provider-patient setting.

Because less than 1/4 of pregnant women take a childbirth class, this also meets a need -- whether they know it or not! -- to become educated on the process of labor and birth.  This is very empowering to have this knowledge.  Many women find that the fears they previously felt about giving birth are replaced with excitement and anticipation.

The group cheers each other on.  They become a resource and support for one another.  The midwife may not know the best place to buy a nursing bra, but I bet someone in the group does!

The appointments run about an hour in length.  94% of women who have centered say they would do it again.  From a business standpoint, this is such a smart model.  It saves the midwife hours in her day.  Centering groups are usually made up of 8-12 women.  From the consumer standpoint, women are not sitting in a waiting room and then only getting their provider's attention for a few minutes each month. 

The UNT Midwives are beginning Centering in August.  There are midwives practicing Centering all over the country, with great success.  I expect we will start seeing more and more of this trend.  It's a good thing and I am grateful it has found its way to Fort Worth!

Thursday, July 1, 2010

BOLD Fort Worth

I know, I know, everything revolves around "Birth" (aka BOLD - Birth On Labor Day)  and the Tarrant County Birth Network these days.  I have a great post that I'm working on, but I have to get this information out.  Bear with me.

The date is set for our local production of "Birth" -- September 25, 2010 -- with proceeds benefiting TCBN.  It will be held at Martin Hall on the Texas Wesleyan University campus.  There will be a matinee and also an evening performance with a Birth Fair linking the two.  Each performance will by followed by a "Talk Back" -- led by DFW's own Joe Gumm -- with a panel of birth professionals from our community.  We are so fortunate to have such a strong birth community with so many talented birth advocates. 

We need help in several areas including:  marketing, sponsorship, printing, concessions, vendors, silent auction, community calendars, tickets, "goody bags," childcare for event, etc.  Some jobs will be on the day of production, but many will need to be done before the big day.  Some are people-oriented and others can be done from your computer.  There is something for everyone. 

You can also find updates on Facebook.  Join us online to keep up with what's happening:  Volunteer Page and BOLD Fort Worth page.  Our first Volunteer Meeting will take place this Tuesday, July 6 in Keller.  You can find out more about it at "Events" on our Volunteer page on Facebook. 

We are so excited for this BOLD event.  We hope to make it an annual tradition, making people aware of their choices in maternity care.  BE BOLD FORT WORTH!

Monday, June 21, 2010

Mark Your Calendar

We have some exciting meetings for the Tarrant County Birth Network over the next 3 months. I wanted to be sure everyone is aware of what is going on. We have over 30 members and our attendance is growing like crazy. Last month was, in my opinion, our best yet. We want YOU to join us whether you are a professional or a parent consumer. The Birth Network is for everyone concerned about birth and birth-related topics.

Our Monthly Round-Up meetings take place every second Thursday of every month.

July 8: DOULA EXTRAVAGANZA!
Place: Texas Wesleyan University
1103 S. Collard St.
Ft. Worth, TX 76105
Time: 7:00-9:00 p.m.

Kathy O'Brien, Doula, will address us on all the ins-and-outs of what a doula does. You'll learn about the doula's role at your birth, how much it costs, the different types of doulas, what their training involves, and how statistics fare by having a doula at your birth vs. not having a doula. In addition, Jamie Hinton, Birth Doula, will show us her doula bag and explain what she brings to and does at a birth. Tina Valle, Postpartum Doula, will also be sharing her expertise as a woman working with moms and dads after the baby arrives.

If you are contemplating hiring a doula, I hope you'll join us for this informative night. There will be plenty of doulas in attendance to mingle with afterwards. You may find your doula that night!

AUGUST 13: Share YOUR Birth Story
Place and Time: Same as July
All women with a child have a birth story. Maybe it was the greatest experience of your life. Maybe it wasn't. Sharing your experience with others is so important on many different levels. We are asking everyone to submit their birth stories to the Tarrant Co. Birth Network via email by August 1st. We will be picking (at least) 3 stories to be read by the mothers. We are asking that it be limited to 2 pages in length (single-spaced is fine!). We are looking for all different types of births, in all different settings.

We will also be discussing The Birth Survey: what it is, how to use it, and its effect on our community. Truly, every birth matters.

Lastly, we will discuss the Tarrant Co. Birth Network's online and printed Resource Guide as a way of finding Mother-Friendly care providers in our community.

SEPTEMBER 9: Infant Mortality
Place: The Child Study Center
1300 W. Lancaster Ave.
Ft. Worth, TX 76102
Time: 7:00-9:00 p.m.

In honor of Infant Mortality Awareness Month, Faith Ellis will be addressing us on this topic. Very much involved in collecting data and research for Tarrant County, she has some very important information to share with us. She is putting this meeting together and has promised some very important people and data that evening.

These meetings are free to the public. We do invite everyone, however, to join the Tarrant County Birth Network. Consumer memberships are just $25 for the year, and Professional Memberships start at just $50 a year. It's as easy as the click of a button to join online.

Monday, May 24, 2010

Hooter Hiders

I started to write a post last night, but to be honest, my heart just wasn't in it. This morning, the topic of Hooter Hiders has been brought up a couple of times, and I've gotten fired up.

If you are not familiar with the term "Hooter Hider," (still sexualizing the breast by referring to it as "hooters" and implying that they should be hid for the purpose of breastfeeding) you are probably familiar with what they are. I've seen them called different things - Udder something-or-other (we are not cows and we do not have udders), etc. -- but they are all pretty much the same thing. It's a piece of fabric that ties around a mom's neck and acts as a cover-up while she breastfeeds her baby. They have become quite trendy, like an "accessory" I heard one mom describe, and this is my concern.

One of the reasons I am such as advocate for breastfeeding is because of the closeness this provides for both mom and baby. Baby gazes up into mom's eyes and often smiles while nursing -- getting emotional just remembering this tenderness -- and mom can look into her baby's eyes, stroke her baby's hair or cheek. It's a very comfortable exchange.

By putting this cloth between the two of you, you miss out on that exchange. It becomes only about nourishment, not "nursing." Breastfeeding is hidden, but everyone knows what she's doing. I feel more uncomfortable around a mom using one of these cover-ups than I ever felt with her casually nursing her baby.

Have you ever heard that when a woman nurses her baby around other women, it gets oxytocin flowing in the other women? I love to see a woman nursing her baby, stroking her baby's head, so in love with this baby. In contrast, when I know a baby is under there, all I can think is how hot he must be (I had a baby that sweat like crazy every time he nursed) and how sad it is that he can't look at his mama and she's not looking at him.

So, are women that embarrassed of nursing in public? Are you afraid of offending people? Are you afraid of people seeing part of your breast for a split second? Or are you afraid of the roll of fat hanging over your jeans? (I was always much more conscious and concerned about that!) What has driven women to start using these cover-ups?

I should quickly point out that I would much rather see a mom using a cover-up than a bottle, whether it's breastmilk or formula. If you really can't get over the embarrassment factor, by all means...

I would just like to see women taught by other women how to breastfeed comfortably without all the cover-ups. Breastfeeding should be casual and comfortable for mom and baby. I can't imagine that either one is very comfortable with this cover-up situation, especially baby. Mom might feel more emotionally comfortable, but I highly doubt that she is physically comfortable. Let's get to both places.

There are lots of companies that sell nursing clothing. A few of my favorites include: Motherwear, Expressiva, and Glamourmom. Ladies, this is much more empowering to be able to have a simple opening in your clothing to have access to your breast to nurse your baby. You don't have to lift any clothing. No blankets or cover-ups. No sweating. Your baby will thank you.

Ultimately, let's not hide breastfeeding. Let's make it casual and comfortable, as it's meant to be. Happy nursing!

Thursday, May 20, 2010

"Standing Outside the Fire"

So, I'm cutting onions and jalapenos this morning. No one is home. I have a Garth Brooks box set playing (sorry Tim!) with videos, concert clips, and interviews. I've had it for years but never watched it until this morning. It made the time go so much faster.

They showed the video for "Standing Outside the Fire". I love the song, but had never seen the video. I am such a sucker for sap! I want you to watch the video and then come back to me... (Yes, I have put videos on the blog before, but I can't remember how to do it, but if you click on the song, it'll take you right to the video.)

OK, did you love it? Are you bawling your eyes out? I was really a mess with all the onions!

Everything in my life relates back to birth. But before I went there, I couldn't help but be in awe of this mother's support for her child. The love was so evident and he had so much confidence because of her love and support. It made me think of my own children -- do I support them in their talents and ambitions? Some yes, some, not-so-much. It was a good moment for me as a mom.

Next, I couldn't stop thinking of a woman who plans and prepares for an unmedicated birth. She doesn't want to take the "easy" way out. Nearly all women will "stumble" in labor -- even if it's not obvious, maybe it's thoughts in her own head. What happens from there depends so much on her support team. Do they run to her? Do they cheer her on? Do they tell her, "Get up! You can do it!" Do they tell the doctors to "back off! Let her finish the race!"

What if this young man's parents had just sat in the stand? What would that boy have done? Do you think he would have finished the race? I do not believe he would have. It was his dad's encouragement -- the one who thought he would fail or get hurt -- who was at his side telling him he could do it! The look in the boys eyes -- my dad believes in me! -- was priceless.

And then to finish the race, running into his mother's arms, so proud. The prize at the end of labor, to hold your baby, knowing you did it!

Moms and Dads, it is not just about what mom is able to do. It is so much about her support team (doulas, nurses, midwives, doctors, mothers, mother-in-laws, sisters), cheering her to the finish line. Who would have thought that a Garth Brooks song would lead to such as inspirational birth song and post this morning! Sorry for all the crying. I hope you'll ponder this video and it's meaning in so many areas of our lives. Gotta love Garth! Now get on with your day.

Monday, May 17, 2010

Due Dates

I just wanted to make a couple of comments about due dates. I've had two students -- one who is a Bradley instructor now -- give birth this weekend. Both were "overdue." There was some anxiety leading up to the actual birth day, which I believe was inflicted by society's expectation of when the baby should be here. Surely it's dangerous to go past 40 weeks, right? 40 weeks is considered overdue in some circles these days.

I always joke that the baby doesn't have a little calendar in the womb with a little red pen with his/her due date circled like you do. You've probably heard the numbers on this one: only 5% of babies are actually born on their due date. And yet, so much hinges on that date.

If you have been given more than one due date, you always want to go with the later one, not the earlier one. This buys you time at the end of pregnancy. You may not think this is a big deal right now at 21 weeks -- surely you'll have your baby early -- but as 40 weeks comes and goes, it becomes a big deal.

You need to know your care provider's policy on going past 40 weeks. Maybe they won't even allow that to happen (red flag - get out of there!). Maybe it's one week, 10 days, or maybe they'll "allow" you the full 2 weeks. What if you have 2 dates that are, say, 4 days apart. At the end of pregnancy, every day is significant. This all goes back to believing that your body knows what it's doing. There is evidence that shows that it is the baby that triggers labor, so that must mean that the baby comes when he/she is ready. Labor will be better and baby will do better when he/she is born.

One of these moms that had her baby today had been induced with her other children. What I usually see in these situations is that the mom truly believes that her body is incapable of starting labor on its own. That was not necessarily the case with this particular mom, but I see/hear this quite often. Induction really does a number on a mom's confidence with future babies. This mom declined having her membranes stripped and water broken because she believed in her body. After weeks of contractions, her water broke last night, contractions picked up, they headed for the birth center, and had their baby 6 hours later. Beautiful.

The other mom I referred to, had her first baby at 42 weeks and was quite convinced that this one would come early. Needless to say, she was inching very close to that 42 week mark again! She may have all her babies closer to 42 weeks than 40. All 4 of mine came between 39 and 40 weeks. The more regular your cycle, the more likely you are to be closer to 40 weeks. I am exactly 28 days.

My favorite example when talking about due dates is comparing babies to popcorn. We pop popcorn every Sunday night for dinner in a Stir Crazy popcorn popper. You'll always hear a kernel or two pop much sooner than the others, but generally, they all pop real close together. Despite being exposed to the oil and the heat the same amount of time, there will always be several kernels that pop after all the rest are finished, even when I'm pulling the plug on the popper. And so it is with babies. They generally come around the same time, but it's impossible for the kernels to pop all at once -- that would be quite a sight in the popcorn popper! Some babies need more time than others, some a little less. Let's be respectful of the time they need to "cook." I know that some women truly believe they would have stayed pregnant forever, but I promise, it just ain't so!

Monday, May 3, 2010

Forced Into a Hospital Birth or Unassisted Homebirth

One of my former students-turned-Bradley-Instructor asked me a question this week on Facebook, in light of all the midwifery issues going on in NY.

If Donna Ryan was forced to have a hospital birth, or an unassisted birth, which would she pick? This was my answer.

First, there are many things to consider. I believe in prenatal care. If you choose unassisted birth, you are likely choosing no prenatal care. A Licensed Midwife evaluates each woman and pregnancy and determines if she is a good candidate for homebirth. Most women are.

I know everyone thinks my answer will be a resounding "Yes, go unassisted!" It's not that simple. I believe in having a good midwife at your side, no matter where you are giving birth. Women have the right to a midwife and they have the right to birth where they feel safest. For many women, this is at home, and for many, it is in the hospital. Educate yourself and make the best decision for you and your family.

As far as what is happening in NYC, the problem is that they are shutting down the hospital where most of the out-of-hospital midwives have backup from an OB. In order to be a LM in NYC, you have to have an OB back you up. St. Vincent was a very midwife-friendly hospital, and they have shut their doors. The midwives cannot practice, legally, without that backup. So, they either need to find other OBs to back them, not practice anymore, or do it illegally.

One of my friends birthed a baby at home in ID before it was legal for midwives to practice openly. (It is legal for them to practice in ID now.) There are still a number of states where homebirth is illegal, but midwifery is alive and well. You know the risks as a midwife, but also as a consumer. I just talked with a local midwife this week who is originally from Missouri, where homebirth is illegal. She would love to go home, but she said she's not ready to deal with the risks of practicing illegally. The state of TX has some great laws in place for out-of-hospital midwives.

So my point is, that a woman doesn't really need to be forced into the hospital if she doesn't want to be there. She also doesn't have to choose an unassisted birth as her only other option. I've known women who have jumped state lines. There are midwives that are willing to risk their own hide so that women have access to homebirth.

I will never tell a woman I think she should have her baby unassisted. That is a risky position for me, as a childbirth educator. I do not give medical advice, but I think my opinion is weighed pretty heavily by a lot of my students. If you know me, you know that I am so NOT a fear monger (trust your body, trust in birth), but I've seen strange things happen in labor, birth, and immediate postpartum. Things that I would want a midwife attending to. I know women who have had unassisted births and everything was great, actually with all of them. And I do believe that it will be fine most of the time. I still like to see a midwife by all womens' side, no matter where they are giving birth, and whether they are practicing legally or illegally.

Monday, April 19, 2010

MY List of Things You Can Do to Avoid a C-Section

I've seen a couple of lists lately about the top 5 things a woman can do to avoid a c-section. While I think these lists are good, they differ from my personal list. I thought I'd take the time to write out my list. I guess I'll keep it to a top 5 as well, so as to not overwhelm anyone.

Education for both husband and wife: Some women are able to advocate for themselves in labor, but most are not. Preparation on the front-end is huge. Dad needs to know what is going on and how he can help. He needs to know what's normal and what's not. He needs to know the questions to ask. Having a doula will help with a lot of this. The doula cannot speak for mom, but dad can. I love The Bradley Method for this reason. Both individuals take responsibility for their role in the birth.

Careful Choosing of a Care Provider: Also huge. All the education and preparation in the world won't matter a bit if you have chosen a care provider and/or hospital who is determined that you need to be rescued from your pregnancy, labor and/or birth. This is the step where, if you ignore the red flags popping up during the education/preparation phase, it will bite you in the end. If you are getting information and statistics about your doctor or hospital that make you second-guess their philosophies, don't ignore them. It's never too late to switch care providers. I've had people change in the middle of labor! Typically, care providers like to see you for the last month of your pregnancy. I changed care providers at 33 weeks with my third pregnancy. A bit nerve-racking, but worth it for a great outcome. You will only give birth to this baby one time. Don't take on the "maybe for the next baby" attitude. Do it this time! Do it for this baby! If you don't know where to start, ask your out-of-hospital educator or doula for referrals.

Keep Moving - Don't Lay Down and Take It: Remaining in a hospital bed is one of the worst things you can do. They can/will strap a monitor on you and "watch" you from the nurses station. Health care at its finest! Laying around for your labor leaves it all up to your baby to make its way out. Baby needs movement. He is moving around, changing position, trying to find the easiest, most comfortable way out. If mom is moving -- walking, sitting on birth ball, pelvic rocking, rotating hips, even standing -- she's using gravity and movement of the pelvis to help her baby descend and get into a good position. Mom will have less vaginal exams (which often lead to Failure to Progress diagnosis), less time on a monitor (which often leads to a false-positive signaling fetal distress), and usually a more comfortable and faster labor. What's good for mom is usually what's best for baby.

Drug-Free Birth: I'm not just talking epidurals here. I'm talking inductions as well. Pitocin is a drug. Prostaglandins (cervical ripeners) are drugs. Baby may react "fine" to induction drugs, and he may not. There's no way to know how your baby will react. So trust in your body to start labor on its own. Don't be induced. Stadol, Nubain, Demerol -- they are all drugs that go to the baby. There will be physical results to the baby when they are born if they received these drugs -- more sleepiness, "laziness" at the breast, depressed breathing. If mom had educated and prepared herself during the pregnancy, she probably skipped this step. It's a tough thing to hear a mom's birth story and realize that her c-section was a direct result of her own actions -- induction, pain-relieving drugs, trusting her doctor, and not educating themselves on the normal process and what to do and what not to do. A woman is 50% more likely to have a c-section if she is induced, and four times as likely to have a c-section if she has an epidural. These are numbers that we simply cannot ignore.

Remain Low-Risk: If you do not take care of yourself and become high-risk, you give up a lot of power. You need to physically prepare your body to give birth by regularly doing pregnancy exercises. You need to eat the required nutrition to grow a healthy baby. A well-balanced diet with plenty of protein will benefit both mom and baby. The old saying "eating for two" does not mean eating for two adults! Be wise and mindful in your life choices. Practice relaxation every day. This will help with all aspects of your life, even after the baby comes. Keep stress out of your life as much as possible. Choose pre-natal tests wisely. There are so many that are done these days. Find out why it's being done and what they expect to do with the results. You can opt NOT to do them. Some may unnecessarily put you in the high-risk category if you test positive.

Of course, I must mention that every now and then I do have couples that do everything right and still have a c-section. I recently had one of these and it broke my heart. This mom worked so hard. I truly do not know what she could have done differently. You can't feel bad about a c-section that comes out of a situation like that. I feel sad for her. She really wanted a natural, unmedicated birth, and was so prepared. ICAN will be an important part of her healing.

My c-section rate of people who take my class is 14%. Some of those were necessary and some were not. Most that were not necessary can be traced back to one of these steps. One other way that can often help prevent a c-section is not rushing off to the hospital the minute your water breaks or you realize you are in labor. The longer you are there, the more excited everyone is to intervene.