Wednesday, July 31, 2013

The Value of Waiting

One of the most valuable things I have learned in the past 7 years of attending births, is to wait and do nothing. Yes, the emergency skills are incredibly important. Yes, knowing when to step in and intervene is incredibly important.

But in my opinion and experience, it is even more important to learn that when everything is going beautifully, you do nothing. Even if labor is on the longer end of normal. If baby and mama are doing well, do nothing. Check heart tones as often as mama has agreed to, provide emotional or physical support if mama needs it. But otherwise, do nothing. If you need to bring a crossword puzzle or a knitting project or a book to keep your hands busy, do it. But don't interfere with the beautiful dance of hormones just because you feel like you're doing nothing. You should feel like you're doing nothing, because nothing is exactly what's needed in the vast majority of normal births.

When I have couples thank me after a birth, I tell them that I really didn't do anything. Because most of the time, I don't. And I'm quite happy with that fact. There have been a few recent births in which I have needed to step in and be more hands-on, and it is hard for me to do. I am constantly weighing whether or not anything could have been done differently to have avoided things leading up to needing intervention. At a recent birth, I should have asked the large number of family members present, to go upstairs earlier than I did. Their presence was clearly inhibiting her labor. I saw it, my apprentice saw it. Yet, I didn't want to overstep my bounds because I know that this mama had wanted her family there. In the end, it was necessary, and should have happened sooner. And I will be writing soon about what the consequences can be with having too many people in the birthing space.

Doing nothing is what, again - in my opinion, all Midwives should strive for in the vast majority of their births. If they learn to do nothing, women are learning at the same time that their body works beautifully as it was made to work in birth. This is what is essential in women taking back their birthing rights in our culture. They must first learn that the birth process works most efficiently when left alone. They don't need vaginal exams, being told when/how to push, they don't need someone else catching their baby (unless mama and her partner don't wish to), and they certainly don't need someone assaulting their baby with a towel and a bulb syringe and a stethoscope as soon as the baby is out of the womb.

I say that it is one of the most important things to learn, because it is one of the hardest. During a longer labor, it is hard to not want to check dilation to see what progress mom is making. But there are other ways that can measure the progress of baby's descent without being invasive. There is the ever-so-interesting "purple butt crack line" (purple line on natal cleft), but the most telling is where you are finding fetal heart tones. You'll notice that it'll start somewhere near where the usual spot is, from prenatal appointments. Then as labor progresses, you'll find it lower in the belly. After mom has been laboring well and is vocalizing low through contractions, you'll find it in the center of the belly, above the pubic bone. This clearly shows the descent progress of the baby, without ever stopping mom's hormonal dance to put your hand up her vagina. And at this point (once heart tones are found right over pubic bone), if mom needs a boost of energy and resolve? She can check herself, and will, more often than not, find baby's head not far inside of the vaginal opening. I have watched a mom go from utterly exhausted and feeling defeated, to a sense of renewal and excitement when she feels her baby's head for herself.

Walk through the checklist - Does baby's heartrate sound normal and reactive? Is mom's blood pressure normal (I usually only check upon arrival, unless I have a client whose blood pressure has been elevated at the end of pregnancy)? Are you noticing descent progress via heart tone location? Is mom making progress as far as contractions being consistent and becoming more intense? Does mom have the option of total privacy?

If all are normal - do nothing. :)

Monday, July 29, 2013

The Bitter Homebirther's Wish List

I have a lot of friends who homeschool. There are a multitude of misconceptions surrounding not only kids who are homeschooled, but parents who homeschool. It becomes annoying. I was one of those homeschool kids who was asked, as I was at a social event, "Do you have any friends?". Nope. None. Mom keeps us in the basement, and today's the first time out in a year!  :facepalm:

Question layout credit goes completely to Deborah Markus at Secular Homeschooling.

My homeschooling friends posted an article, The Bitter Homeschooler's Wish List, on Facebook today. And I thought it was brilliant! I also thought that us homebirthers should have one that is just like it, since there are just as many misconceptions about homebirthing. So, here goes:



1. Please stop asking us if it's legal. Women have been having babies at home since the beginning of time. Literally. And even in states where it's not technically legal, women birth at home anyway, exercising their rights as an autonomous human being. 

2. Learn the differences between a woman choosing to have a home birth after she's researched it and has decided it's best for her family, and a teenager who gives birth in a bathroom stall because she's too afraid to go to the hospital. These are not one in the same. Statistically, the latter may be thrown in as "out of hospital birth", but bears no resemblance to the first. 

3. Quit asking my husband if he is allowing/okay with it. Even if he wasn't, I am the one who is birthing the baby. I have done extensive research, I am not choosing to birth at home because it seems "cool". Just as he would not be able to order me to have a cesarean for no reason, he is not able to order me to have a hospital birth for no reason. 

4. Don't assume that every homebirther you meet is birthing at home for the same reason, or will have the same experience. 

5. If the homebirthing woman you know is actually someone you saw on TV (and probably on I Didn't Know I Was Pregnant), the above especially applies.  

6. Please stop enthusiastically informing us of the horror stories you've heard of when babies are born at home. Because really, I have dozens of horrifying stories to tell about hospital births. If you want a pissing match, I'll happily beat you. I guarantee that I'm more informed than you are of the research and statistics regarding the safety in home vs hospital birth. 

7. We don't look horrified and start questioning you when you say you're birthing your baby in the hospital. Even though we want to. Because it is far more terrifying to birth in the hospital. Look at the statistics. I firmly believe the, "You're so brave!" sentiment should be given to women birthing in the hospital, not to those birthing at home. 

8. Stop assuming all homebirthers are religious. 

9. Stop assuming that if we're religious, then we homebirth because of religious reasons. 

10. I didn't go through all of the research and consideration and weighing of all of the information just to be a "rebel", or to be a hero. This was a very personal decision, one based on my experiences with childbirth. Stop thinking that it is your public duty to make us aware of the option of hospital birth. 

11. Please stop questioning my ability to give birth outside of a hospital, without drugs, without intervention. Once again, women have been giving birth since the beginning of time. Will it hurt without drugs? Sure. But to me, avoiding those is very important. Laboring in the hospital with drugs readily available is hard to resist, and I have committed to doing this not only for my baby, but for me. So I'm going to give myself the best shot possible at doing so. 

12. If we're birthing unassisted (sans Midwife) and you ask me how we'll know what we're doing, I will happily give you the equivalent of a 5-page rundown on how hormones work in labor, as well as the history of childbirth. If I didn't feel confident in birthing with just my partner, we'd hire a Midwife. 

13. Stop asking me if my baby will drown when I give birth in the water. Please take 2.5 seconds to think about what environment the baby lives in during his stay in my uterus, and if you don't have anything nice to say, don't say anything at all. 

14. Stop assuming that if I give birth at home, I'm going to eat my placenta. I might, but you shouldn't assume it. I'm more likely to encapsulate it, or plant it under a bush or tree. 

15. Stop asking, "But what about the birth certificate?" I'll say it again. Babies are born at home every day, all over the world. A good chunk are intentional, some are not. It's not going to be impossible to get a birth certificate or social security card, just because we birthed at home. 

16. Quit assuming that I am a hippy freak because I choose to birth at home. 

17. Quit assuming that I am more concerned with the experience, than I am about safety. 

18. Quit assuming that because I am concerned about what kind of experience I will have, that I'm not concerned about safety. A woman will remember the way she was made to feel at birth, for the rest of her life. Is it really such a wild idea that a woman cares to give birth in the most peaceful environment possible?

19. Quit assuming that my Midwife has only read books about childbirth, but has no actual training; only carries a biting stick and a bundle of sage to births; and wears Berkenstocks. 

20. Stop talking about all of the "luxuries" I'll miss by being in the hospital to give birth. I'll be in my own home, sans strangers walking in and out of my room, eating and drinking throughout labor, and then snuggled into my own bed with my baby and not being bothered in the middle of the night. You'll have strangers coming in and out of your room, an IV and ice chips as your only sustenance, transferred to a terribly uncomfortable postpartum bed, and you'll be woken up every few hours to have you and baby checked on. 

21. Quit asking me, "Your doctor let you do that?". First of all, where I birth is not my doctor's decision and I did not ask him/her for permission. Second of all, I feel sorry for you if you ask this question. Because it means that you probably have authority-figure beliefs about doctors, and would base your decisions on what he/she says. 


Now, I am happy to give information to those who are genuinely interested in learning more about homebirth. But, let's face it. Most people who come up with these comments or questions do so because they simply cannot believe that we'd actually plan to birth at home. A good chunk just want to argue, or call us stupid without actually calling us stupid. 

Saturday, March 23, 2013

ACOG Smartens Up While DONA Throws Baby Boys To The Wolves...

I know. Has the world gone mad?! You read the post title right. I woke up this morning to find a published position from ACOG that discourages elective inductions and cesareans overall, and especially discourages either for macrosomia (big baby). Whaa??

Here are a few highlighted quotes from ACOG's statement:

“Let nature take its course.” Over the years, I’ve found this saying particularly applies to the process of giving birth. My personal experience as an ob-gyn and reams of scientific research demonstrate that Mother Nature knows best when a child is ready to be born."  - James Breeden, President of ACOG

Wait. Did you read that too? He said to let nature take its course. Sadly, I fear that these words are going to fall on the deaf ears of women who will still believe, due to long-time conditioning by Obstetricians themselves, that as long as baby is "term" then baby is ready. The funny thing is, state medical boards are ALL OVER regulating Midwives, citing the safety of women and babies as the reason. Where has the regulation been with Obstetricians who are happy to perform elective inductions and cesareans, which put baby's life at higher risk than home birth does? Where is the outcry for public safety?

Okay, okay...I give ACOG serious credit for taking a stance on this again. Yep, ACOG has long since discouraged elective anything, in favor of labor starting naturally. But, it seems that Obstetricians have not been held responsible when they do otherwise. Here's another quote from an article on Improving Birth:

"For one, induction or surgery for “suspected big baby” (macrosomia) is not medically indicated. This is one myth we hear about all the time, even though ACOG has been talking about the “imprecise” nature of diagnosing macrosomia for at least ten years. Bottom line: induction for big babies is NOT medically indicated.

Elective inductions prior to 39 weeks gestation is, again, not recommended. Studies have shown that babies do better when they are able to remain in utero until 39 weeks. In the article above, ACOG sais, “Early-term infants have higher rates of respiratory distress, respiratory failure, pneumonia, and admission to neonatal intensive care units compared with infants born at 39 to 40 weeks gestation. Infants born at 37 to 38 weeks also have a higher mortality rate than those born later." - Dr. Capetenakis, OBGYN in Encinitas, CA

So again, I have to ask where the accountability is? I am very excited that ACOG has published this. However, I am skeptical that all of a sudden Obstetricians will start practicing evidence-based medicine when it is more profitable for them and the hospital in which they have privileges to keep doing what they've been doing. And going back to the factor of women in all of this - it's going to take a LOT of effort if there is ever going to be a hope of women waking up and realizing that being uncomfortable is better than putting their baby at risk.

I was recently told a story. A friend of a friend is a L&D nurse. She kept saying that she was not going to term. She got a stomach bug at 36 weeks, contracted from the vomiting, and went in to L&D. Even though it was not causing any cervical change, she decided it was just time to get baby out. Because she was 36.6 though, they waited until just before midnight to induce, because otherwise it was against hospital policy. But she went ahead with it, with an epidural in place before the induction was started. Kept saying that she KNEW she wasn't going to term. After the delivery, she told everyone about what a blessing it was that she was in the hospital (and not at home, like my crazy friend) because baby ended up having complications.

I will keep my comments to myself here, because they aren't nice. They even include much foul language. But THIS - THIS is the type of system that women are in. The one where it's perfectly acceptable to choose to rip your baby out of the womb, just because you don't feel like being pregnant anymore. The one where it's perfectly acceptable for Obstetricians to manipulate, coerce, and even FORCE women into intervention, procedures, and consent when they had previously denied consent. My heart is heavy in knowing that we have a loooong way to go.

I also woke up this morning to a find that DONA (Doula certification organization) has published an article in their magazine that is in favor of routine infant circumcision.

"A family's decision about circumcision should come from personal values. Religious and cultural reasons usually win out over all other arguments. Otherwise, you can make the case that circumcision is mainly a cosmetic procedure, with some potential medical benefits. It typically takes less than five minutes, and complications are very rare."


:scream:  Actually, the medical need for a circumcision later in life is less than the risk of DEATH from routine circumcision. Complications are not, "very rare". From Dr.Momma.org:



Out of 100 Circumcised boys:

75 will not readily breastfeed post-op

55 will have adverse reactions from the surgery

35 will have post-op hemorrhaging to one degree or another

31 will develop meatal ulcers

10 will need to have the circumcision surgery repeated to fix prior surgical problems/error
8 will suffer infection at the surgical site

3 will develop post-operative phimosis

2 will have a more serious complication (seizure, heart attack, stroke, loss of penis, death)

1 will require additional immediate surgery and sutures to stop hemorrhage

1 will develop fibrosis

1 will develop phimosis

1 will be treated with antibiotics for a UTI (urinary tract infection)

1 will be treated with antibiotics for surgical site infection

Of those who do receive pain medication for the surgery (about 4% of those boys undergoing circumcision in the U.S.) some will have adverse reactions to the pain medication injected

Out of 100 Intact boys: 

2 will be treated with antibiotics for a UTI (fewer if the foreskin is never forcibly retracted)

1 will be told to get cut later in life for one reason or another (fewer if the foreskin is never forcibly retracted)


Note: One reader of these statistics (a man cut against his will at birth with 4 intact sons today) critiqued (quite accurately) that it is actually 100 of 100 circumcised boys who experience negative consequences as a result of circumcision. Each and every one has lost an organ responsible for a great deal of his life-long normal health and functioning.

DONA is taking a defensive stance, saying that the article does not reflect the organization's belief as a whole. If that's the case, I wonder if they would allow a guest post about elective inductions and cesareans being a perfectly acceptable choice? Or, as Gloria Lemay put it to them, what about an article endorsing the cutting of females? They have now pissed off a whole lot of people. Personally, I'm not a fan of DONA. Or of any organization, really, that capitalizes on making labor-support a certified position. I've always found that to be completely and utterly ridiculous, especially when said organizations are clear in restricting many Doulas from attending women who choose to birth unassisted, and who have made it a thing of status and income in disproportionate ways. And, as I have heard Nancy Wainer speak about the atrocities that occur in hospitals every day, and the doulas who stand by and are essentially part of the rape and injuries that happen, by holding the woman's hand and telling her that "it's okay".

But this is really a low point for DONA. Another quote from the doctor who wrote the article:

"Often dads have strong feelings about circumcision, so fathers should definitely be included in the decision-making. If the parents care about their son looking different from other boys in the neighborhood, they may research the rate of circumcision in the area." 

Right. Forgot about teaching our children that they need to look like everyone else. Except for the fact that intact is, right now, the majority. Does this apply to girls in the neighborhood who have smaller or larger breasts than average? Should we encourage breast enhancements or reductions in order for our daughters to not be made fun of? Should we start young children on contact lenses so that they will not be made fun of for wearing glasses? What about those who need to wear braces? What about children with Autism and Downs Syndrome? Should they be hidden from the general public so that they never face teasing?

This is a really shitty reason to permanently alter an infant's body without his consent. Period.

Another gem:

"But once they decide, they should be encouraged not to drive themselves crazy with second guesses - in the long run, it will probably be fine either way." - Marjorie Greenfield, MD. 

Yes. We wouldn't want parents to consider the gut feeling that they may be doing the wrong thing. After all, that's lost money! Err, I mean a child who might be ridiculed by his peers! I'm sorry, am I the only one seeing dollar signs here?!? Am I the only one seeing, "Doulas, keep your mouths shut. Do not encourage in-depth research into circumcision."?

Shame on you, DONA. Shame on you for allowing an article of this type in your print. Shame on you for essentially agreeing with the idea that Doulas should NOT be encouraging parents to keep their sons whole. I'm not sure it's possible, but I'm less of a supporter now, than I was before. You just made a joke of your entire organization.


Thursday, January 3, 2013

Midwifery Under Attack in California

After serving not just women, but women who need Midwifery care the most for 22 years, Brenda Capps was arrested in California for "Practicing Medicine Without a License". However, she did no such thing. She didn't break any laws. She never perpetrated herself as anything but what she is - a Traditional, Christian Domiciliary Midwife. She had every single one of the families under her care sign a religious exemption that outlined the fact that she was NOT licensed by the state of California, and that she is practicing the ART of Midwifery, not medicine. Most families chose her because of her calling to not be licensed, not in spite of.

The Licensed Midwifery Practice Act of 1993 states that it is a misdemeanor (not a felony, as she has been charged with) to perpetrate oneself as a Licensed Midwife when one is not. Brenda never did this. She was flagged and warned to stop practicing after she was named in another case against a Midwife a few years ago. She upheld her commitment to her families, and agreed to be the Midwife of a couple who was undercover, posing for the Medical Board. That's it. No one died. No one reported her. Brenda's record is IMPECCABLE!

The medical board is saying that women are too stupid to choose a safe care provider. The irony here is that women in CA have had far more injury, permanent consequences after births with fully licensed Obstetricians than ever with Brenda in 22 years. She has a safety record to rival MOST Obstetricians, when comparing her clients to an OB's low-risk patients.

If this pisses you off, and it should, please sign this petition. The hope is to reach at least 2,000 signatures (we're almost there!) and take it to the Governor's office. We want to show them that WOMEN should have the right to choose their care provider. As of right now, the Medical Board is shuffling their feet. They know they don't have a case. Court dates have been cancelled because of this, and Brenda hasn't even been formally charged yet! This is nothing more than a circus.

Please sign it. Please share it. Pass it on!



Petition to the Medical Board of California - Brenda Capps 

Friday, August 24, 2012

St. George Home Birth Article and My Response


This article came out online yesterday. I take issue with much of what is said in it, and even the picture of the Midwife holding baby while mom is nothing but a blur in the background. One thing that I have learned is that I have to fight to be seen as credible. I do this by knowing what the research says. Writers and Obstetricians need to be held to the same accountability. 


My Response: 

Dear Alexa Morgan,

I recently read your article about home birth in Southern Utah, and find myself asking where the research is. I am a Home Birth Midwife here in St. George – one with a zero transfer rate in labor – and a birth advocate. I see that you mentioned a study that was released, highlighting why some women might choose to birth at home, but then you erroneously stated:

A myriad of studies have been conducted on the risks of home birth versus hospital birth with no conclusive results, due mainly to the low percentage of babies born at home.

Yes, many studies have been done comparing home birth to hospital birth among low risk women since the 1970s. In fact, there have been 17 studies in the last 15 years alone. Even more when you include the number of studies done outside of the U.S. which shows better outcomes over all, outside of the hospital. But they all have one thing in common: They all show, very conclusively, that not only is home birth just as safe as hospital birth but that there is a much lower incidence of maternal morbidity when birthing at home. Fewer unnecessary interventions such as induction/augmentation of labor, artificially rupturing the amniotic sac, delivering in the lithotomy position, episiotomy, and instrumental deliveries lead to much better outcomes on the level of injury to mom and/or baby. 

While I have had nothing but an amazing professional relationship with several Obstetricians in town, and while I thoroughly respect Dr. Fagnant for the positive changes that he has made within the labor and delivery department of DRMC, I disagree with a few of his statements. 

There is no research to back up his blanket statement of which conditions preclude birthing at home. While there are most definitely situations and circumstances that may preclude a woman from birthing at home with a Midwife, it is not evidence-based to simply state: 

“Any woman who has an illness, has had uterus surgery, is before or after their (due date), (is carrying) multiple babies, a large baby or (breech) baby should not deliver at home,”

It entirely depends upon which illness he speaks of. One cannot simply state that any women with an illness should not birth at home. While there are certainly illnesses that would necessitate a hospital birth, some chronic illnesses may not require it. Some conditions that might require hospital birth would be uncontrolled, insuline dependent diabetes; illness with medications that caused abnormalities in the fetus; certain heart conditions, etc. 


As a mother who has had a VBAC (Vaginal Birth After Cesarean) at home, as a woman who has been researching VBAC for the past seven years, and as a Midwife who fully supports women who have had prior cesarean surgery, I also disagree that this precludes women from birthing at home. The research shows us that the main risk associated with VBAC is uterine rupture, and this occurs in 0.3-07% of VBACs. Less than other emergencies, such as cord prolapse, that would necessitate immediate hospital transfer. With a care provider who knows the research, who is experienced with VBAC, and who isn't afraid to transfer if anything seems to be off, VBAC at home can be very safe and continues to be a reasonable choice. For many women, it is the hospital or physician protocol which puts them in the position of choosing to birth at home after a prior cesarean. Some hospitals have banned VBAC altogether. Most have certain criteria for VBAC labors that must be closely followed. Sadly, many VBAC hopefuls find themselves in the operating room again, and know it was avoidable. 

As to his statement about not birthing at home if you are before or after your due date, again I ask where the research is. Any skilled Midwife that I know would not attend a woman at home who is less than 36/37 weeks gestation. However, 37 weeks is full term and is normal for some women. For others, it can be completely normal and a part of their maternal history to gestate until 42/43 weeks. With proper monitoring, research shows us that expectant management is completely acceptable in terms of risk/benefit. Many women do not understand that normal gestation length is 38-42 weeks. Most believe that they are "overdue" and at risk beyond 40 weeks. This is simply not true. 

Twins and breech babies can also be birthed at home without complication, with a skilled care provider. A Midwife who is experienced with multiples and breech knows what to look for in risk assessment, and knows which women should be in the hospital and which are safe to deliver at home. In the hospital, moms of multiples or of breech babies are often limited to cesarean surgery. Or may be allowed to birth twins vaginally, but in the operating room. Understandably, some women don't want to spend this most incredible and life-changing event in a cold, bright operating room with the thought of surgery being so close. 

As a mom of ten pound babies, I am concerned with the blanket statement that women carrying a large baby should not birth at home. Weight is not nearly as relevant as head circumference. So much is misunderstood about the ability to birth babies of all sizes, particularly when there are no abnormalities causing the size of baby. There are things that make a dramatic difference in the ease of birthing a large baby. Mobility, ability to get into different positions that open the pelvis more than the semi-sitting or lithotomy position, and patience. Most often, these things are not available in the hospital. While there are wonderful Obstetricians who are thoroughly researched and are willing to offer these things to women, it is more the exception than the norm. One also takes into consideration that it is the structural size of the baby that matters, not how many pounds the baby weighs at birth. I have often heard of care providers stressing induction of labor at 40 or 41 weeks because, "The baby looks to be getting quite large.". However, the baby's structural size does not change between 40-42 weeks. For example, my 10lb 10oz VBAC baby, who was born onto my bed at home, had the same exact head, shoulder, and chest size as my friend's 8lb baby. It is simply not evidence-based to say that all women with a large baby should not birth at home. 

I can completely understand Dr. Fagnant's concern with the transfers that he sees each month. I am concerned with particular things as well, regarding the health and safety of moms and babies at home. There are certain practices and beliefs in our community which have caused incredibly concerning transfers. I know that sometimes all care providers are lumped together, and I find this particularly true of the reputation of Midwives as a whole. But it is damaging for Dr. Fagnant to mention transfers, and then mention the deaths that he has seen in his time as an Obstetrician. An Obstetrician is simply going to see more death than a home care provider, because Obstetricians deal with not only higher risk pregnancies, but also have much higher rates of intervention in labor. Obstetricians deal with things like labor-inducing drugs which have side effects - including death - to go with them. They deal with emergencies that are more prevalent with intervention, such as cord prolapse, hemorrhage, and embolism. 

So many aspects of pregnancy, labor, and birth are misrepresented and risks are inflated. Unfortunately, most people are less likely to do research than they are to take an authority figure's word as gospel. The concrete research is there. It is vitally important for families to thoroughly research their options in childbirth, and their potential care provider. But there has to be balanced information based on empirical research. 

http://www.greenmedinfo.com/blog/myth-safer-hospital-birth-low-risk-pregnancies
http://www.greenmedinfo.com/blog/myth-safer-hospital-birth-low-risk-pregnancies http://www.cmaj.ca/content/181/6-7/377.abstract
http://www.bmj.com/content/330/7505/1416.abstract
http://www.ncbi.nlm.nih.gov/pubmed/9271961?dopt=AbstractPlus