Monday, January 21, 2013

The Mother-Friendly Cesarean - A Ceci Jane video debut

I have mixed feelings about writing this post.  I don't want to glorify the cesarean or make it look desirable.  It's become so common to elect for a cesarean section instead of experiencing childbirth.  I honestly believe fear is at the root of this epidemic.  I've been there with my first baby - I get it. But that is not the purpose of this post.

This post is about those women who want and have planned for an unmedicated birth.  They dream of the water birth in the quiet, dimly-lit room, where their baby is baby is placed immediately on their chest.  They want to experience the oxytocin and bonding that is held so precious in natural birth circles.  They want to be empowered through their natural birth.

Every now and then a cesarean birth becomes the only option.  I'm not talking about the mom who didn't do any classes and has placed all her trust in her OB who tells her it's dangerous to go past 40 weeks and her baby is too big anyway.  I'm talking about the mom who truly has no other options.  My graphic designer for Birth Boot Camp, who had a bicornuate, or heart-shaped, uterus.  She tried everything possible to get the baby to turn before finding out why her baby couldn't get head-down, or even butt-down.  It broke her heart to have a cesarean.

Sometimes a cesarean is actually even a better option than a vaginal birth.  I bet that surprises many of my readers to hear me say that.  I've been talking with a mom, who, at 18, gave her baby up for adoption.  She had an episiotomy which led to a 4th degree tear, or into the rectum.  For many years, she has lived with a poorly stitched perineum and has had many issues. She had a reconstructive surgery, but is still dealing with problems and pain. Now, at 9 months pregnant, she's been advised to have a cesarean.  She's getting a second opinion, of course, but she is devastated.  She's been preparing for and looking forward to a homebirth.  The doctor explained that the skin and muscles between the vagina and rectum are paper thin and she has a significantly shorter perineum.  He is convinced that the baby will tear things open as he/she passes through.  He said she is certain to be looking at another surgery with probable lifetime incontinence and even leaking fecal matter through the vagina.  Of course, there is no guarantee that is how things are going to go down, but at some point, you are left deciding which surgery do you want to recover from?  Which possible life-long effects from which surgery are you more "willing" to deal with? I am grateful I was never forced to make a decision like that.  I honestly am not sure what I would choose and it's not my place to tell her what I think she should do.  She is informed and she will make the right decision for her family.

The moms that have been in this position are left mourning the loss of what they didn't have - their natural birth.  All the "at least you have a healthy baby" comments often make them feel guilty for being sad about their birth. It's OK to be sad or disappointed.  If the sadness is interfering with bonding or parenting, seek help.  Talking about it with people who understand will help.

If you are in this situation of having an unwanted cesarean, it doesn't have to look so different from the immediate postpartum vaginal birth.  Many women want their baby immediately and they don't want to delay breastfeeding.  My good friend, Ceci Jane, recently filmed a birth video for a family desiring a Mother-Friendly cesarean.  She called me immediately after this birth, so excited!  She said it was amazing, that it "felt" very much like a vaginal birth. I've worked with Ceci on a number of projects, including Birth Boot Camp (read about her version of recording/editing the documentary-style classes), and I knew she had been asked to film this video a few months ago.  I am honored she allowed this debut to take place here on Banned From Baby Showers. The mother and father were treated with such respect and their wishes were honored.  Rather than spoiling this special video, I'll let it speak for itself.  Grab your tissues.

Uriah Nehemiah from Ceci Jane on Vimeo.

So, you've seen the video, but the question inevitably comes up - What makes this a Mother-Friendly Cesarean?  You are always hearing me talk about the Mother-Friendly Childbirth Initiative written by CIMS.  Many of those steps can be applied to cesarean birth as well.  A Mother-Friendly cesarean is a gentle cesarean, for one.  The baby - and the mother - is not handled so aggressively.  The cord is not immediately clamped, but rather the baby receives all of its cord blood.  Mother has the baby handed to her in a matter of seconds.  In this birth video, baby stayed on his mama's chest for a solid 2 hours.  Baby breastfeeds soon after birth, like a vaginally born baby would.  Newborn procedures, including weighing the baby, were delayed until parents were ready.  Like anything else, if the consumer demands things be done a certain way, eventually, we will see change.  If you find yourself in this situation, where a cesarean is the last - or best - option for you and your baby, request a Mother-Friendly cesarean.

Ultimately, no matter how your baby enters the world, you are becoming his or her parents.  We wish a gentle birth for all babies, but so much of that is about the first minutes and hours of his/her life.  We talk so often about natural birth being empowering, but empowerment also comes from knowledge and making informed decisions and having those wishes and decisions respected. Some of the best mothers I know had cesarean births.  You can still breastfeed, co-sleep, and wear your baby. Ultimately, it doesn't make you a better mother just because your baby came out of your vagina.

Monday, January 14, 2013

Oxytocin Decreases as Age Increases?

So, I'm in my hairdresser's chair and she tells me that she read somewhere that some hormone, or something, that is really strong when women are young decreases as they get older.  (She's about 10 years older than me and her kids are grown.)  As we keep talking - she keeps calling it serotonin, but I looked it up and can't find anything like that - I decide she must be talking about oxytocin. 

Follow me here:  She was talking about when you are young, having babies, you nurture them, hold them, are so full of love, you might burst.  They are the center of your universe.  Yes, I'm with her.

Then she started talking about as they grow older, they are people that you are living with, trying to guide and set on a good path.  She said by the time they are 18, those levels of "oxytocin" have decreased significantly and you are pushing them out the door!

When my babies were little, I couldn't imagine them leaving home or ever living in separate houses, let alone in separate states!  Now, with the oldest a junior in high school, I have moments of panic, thinking, "What if he goes to a local college and wants to live at home?"  Only slightly joking.  Seriously, if these levels stayed high, how could we ever let our children go live lives of their own? 

I know of several families recently that have gone through divorce.  They all have several children.  The reason I am mentioning it is because in all of these families, the dads are the ones who are the main caretakers now.  I find it perplexing and definitely not the stereotype of the mom keeping the kids.  All of the moms are near or over 40.  Maybe there is something to this...

With that being said, I'm not one looking for an excuse to make, in my opinion, bad choices.  However, I must admit, personally, at almost 42 (the end of this month), I feel less... nurturing.  There's honesty for you.  If I had a baby tomorrow, would those levels of oxytocin surge?  I certainly hope so.  Don't worry - that ain't happening!  But with my baby at almost 8 and a house full of teenagers, I definitely don't feel oxytocin gushing love from every pore!  They were so easy to love as babies - snuggling, reading books, singing songs, breastfeeding, co-sleeping, babywearing.  Finding different ways to express love to each growing child can be challenging.

My husband, on the other hand, is much more loving and patient with the children now than when they were little.  I find it an interesting.

Every now and then I have a mom come through class who is much older, like closer to my age.  Often, they seem to have a harder time adjusting to motherhood than the younger moms.  Granted, if I was "single" without children for that many years, I feel it would be hard to adjust.  For the sake of discussion, is it possible these levels really do diminish and that contributes to things being more difficult for the "older" mother?  The flip side is that she might have the maturity and patience to handle being a mother more-so than when she was younger.

I have a sister that has never had or wanted children.  She seems to not have a nurturing bone in her body.  She might actually read this, or one of her friends might, and I think they'd all agree.  Is it possible that her oxytocin levels are so low, that contributed to not ever wanting children?

I admit, I haven't looked this up.  I've done no research on this topic.  This post stems from a conversation at the beauty shop.  But there were parts of it than rang true to me.  I thought I might throw it out there and see what y'all thought.  Think of your own mothers.  And, I guess, in some cases, try to do better.  Find new ways to love your babies, even when they can't sit in your lap anymore.

Monday, January 7, 2013

Hospital Nurses and Natural Birth

A few weeks ago, I was in the emergency room with my son, thinking he had a staph infection.  Long story short, he didn't.  But it was an eventful night, to say the least.  I heard a nurse on the phone with a doctor, panicked, as a baby boy was bleeding profusely from a circumcision-gone-wrong (I don't know what happened - he was still bleeding when we left) and was quite traumatizedI also heard a room full of nurses talking about labor and birth.  I posted a few of the things on my BFBS Facebook page I heard (which were quite crazy if you asked me), and one of my former students-turning-Birth-Boot-Camp-Instructor, who happens to be a nurse, asked if she could write a blog post for Banned From Baby Showers about why nurses know so little about birth.  How could I refuse?  Thank you, Shazia, for helping us understand, not only the situation, but how we can improve the current state of affairs.

I have heard many stories from moms about a nurse being unsupportive and discouraging of natural birth. Perhaps you may have had one of these nurses attend your labor. I am a registered nurse and even I encountered a less than helpful nurse during the birth of my son at a local hospital. Nurses are often very knowledgeable and supportive of evidence-based practices in other specialties. If natural birth is evidenced to be the best option for achieving optimal outcomes for both mom and baby, why are some nurses unsupportive and even discouraging of natural birth? I hope to answer that question from a nurse’s perspective in this post.
A nurse’s knowledge base comes from their education and their experiences. To help me write this post, I polled several other nurses who work in various specialties and attended different nursing schools. I have my BSN from the University of Texas at Arlington. I went through a wonderful nursing program that consisted of 120 course hours. Birth was discussed in one 4 hour course. The course was a general women’s health course that covered pregnancy, birth, and the neonatal period. I was blessed to be taught by a Clinical Nurse Specialist who had homebirthed her own children and a Certified Nurse Midwife.
Not every nurse was so lucky during their nursing education. Some nurses that I polled stated that birth was such a small part of their nursing curriculum that they learned very little about birth. Some nurses said that birth was discussed more in depth, but comparing common maternity practices in the United States and evidence-based maternity practices were not part of the discussion. Not teaching evidence-based practices seems ridiculous to someone outside of nursing, but nursing schools in the United States are preparing nurses to work in healthcare settings in the United States. Labor and delivery nurses attend hospital births. Our hospitals do not routinely practice evidence-based maternity care. Nurses in the United States are expected to assist with planned cesarean sections, elective inductions, epidural anesthesia, and other medical interventions in birth. Unfortunately, that is what hospital birth looks like in our country. Natural birth that is intervention and medication free is rare, and most happen out of the hospital. Many labor and delivery nurses, much like obstetricians, have never observed a natural birth. In order to prepare a nurse for the patients and procedures she would encounter on a labor and delivery unit, the natural birth process is not always a priority for educational institutions.
I also polled a few nurses who work in labor and delivery. Their input was insightful. They verified that natural, intervention free birth was a rare occurrence on their labor and delivery units. They stated many moms came in to the hospital with a birth plan to have no pain medication and limit medical interventions. However, the majority had done NO preparation for their birth, other than typing out a birth plan. They said most of their coworkers view the birth plan as a joke, because most of the moms who write them end up asking for everything they wrote they did not want. One of my professors in nursing school said that you can plan all pregnancy long, but it means nothing if you don’t prepare. If you don’t take the time to prepare, you might as well forget the planning too. It’s like writing down that you are going to make an A on the test, but never actually studying for it.
When a mother is not prepared for birth, but seeks a natural birth, the demands of their nurse are drastically increased. Nursing units are often understaffed and nurses are overworked. There is a tremendous demand on a nurse when a mother is not prepared for birth, a father is not prepared to be a birth coach, and a doula isn’t present to assist mom throughout the birth process. This can create animosity towards the patients that seek a natural birth, but due to lack of preparation rely on their nurse for all of their needs during labor. Even though more women are asking for a natural birth in the hospital, many still end up with unnecessary medical intervention due to their lack of being informed and prepared. Unfortunately, this means that even labor and delivery nurses lack experience in the natural birth process, because the majority of patients are not giving birth naturally. They also doubt the ability for women to birth naturally, because they see many unsuccessful attempts. When a well-prepared and well-informed mom comes in to the hospital, they are often faced with judgment and animosity because they are categorized with the moms who aren’t prepared and informed. They assume that they will be unsuccessful also.
What can we do about this and how can we ensure that women having a hospital birth have supportive nursing staff? We can demand evidence-based practices. We can choose doctors and hospitals that have practices in place to support the natural birth process. If we demand better care during our birth and evidence-based practices, we can work towards a society where medical staff at hospitals have seen natural birth and are experienced assisting moms who wish to avoid medical interventions and are well-prepared to do so. If we continue to blindly follow bad medical advice and fail to advocate for ourselves, hospitals will continue to utilize their policies that inhibit mothers from achieving the type of birth they want. The more we demand for better births, the more experience nurses and other hospital staff will have with natural birth.
If we can change the way women choose to birth and prepare them well, we can change the way our hospitals handle birthing women. If more moms educate themselves and prepare for an intervention free birth, we can ensure that our labor and delivery nurses gain experience with the natural birth process. If we change the norm of birth in our society, the nursing schools in our area will also have to change their way of teaching to prepare nurses who want to go into labor and delivery to effectively provide care to a birthing mom.  
~Shazia from Above & Beyond Birth blog can also be found on Facebook.