Wednesday, October 8, 2014

Options in Childbirth: Does It Really Mean What You Think It Means?

Just over a year and a half ago, I spoke at a VBAC information event at Dixie State University. To my surprise, the labor and delivery hospitalist along with a nurse or two showed up. The hospitalist and one of the nurses asked several questions - unfortunately while I was in the middle of my presentation - of which some I clarified, and some of which I disagreed. What stuck with me more was something she said a few times - she said that hospital birth can be just like home birth, if women just ask for it to be so.

While I will wholeheartedly agree that sometimes, with a midwife who does not respect autonomy, home birth can be just like hospital birth in some ways, I cannot agree that hospital birth here in our small town, can be like home birth for whomever (low-risk) asks for it to be so.

Why do I disagree?

1. Dixie Regional Medical Center does not allow for complete refusal of an IV line - they are adamant that women receive a hep-lock just in case an emergency occurs.

2. DRMC does not allow for water birth. You may labor in the tub, if you happen to get into one of two rooms with a tub, but there are no exceptions for birthing in the tub. I know of a doctor who tells his patients that he cannot force them to get out, but what he does not tell them is that the tub can be drained in 90 seconds, and the nurses will drain the water immediately.

3. It is hospital preference to break the amniotic sac (water) within a few hours of admission for all patients - and is often presented as a benefit (can speed up labor, etc) without giving patients full disclosure of risk, which also includes a subsequent time limit since they worry about infection after the protective barrier is gone.

4. I have heard of some fathers/partners being able to catch their own baby, but it is rare and certainly not encouraged. You need to have the right doctor, and the right circumstances in order for this to happen.

5. You will not be able to eat and drink freely without either sneaking food, or repeatedly defending your right to do so.

6. Achieving a successful VBAC (Vaginal Birth After Cesarean) depends on so many factors, that the odds seem nearly stacked against many women. IF circumstances line up perfectly - right size baby, no blips in prenatal care, right doctor who is not only 'VBAC friendly' but actually VBAC supportive (HUGE difference), right pregnancy week, right amount of time in labor, zero variation in how baby sounds during labor, etc - you might just end up achieving a VBAC.

7. You are highly unlikely to have a full hour, completely uninterrupted, with baby immediately following birth. Right doctor, right nurses, right circumstances...maybe, if you're adamant and repeat your wishes often.

8. You are unlikely to be able to refuse routine checks and tests on baby, without receiving information about how risky it can be to forgo. (I personally cover tests, options, etc prenatally and don't need to ask again after the family has done research and made a decision).

9. Depending on the season, your children are not likely able to be present for the birth.

10. Intermountain Health Care has a policy in place which bans photography and video at the time of birth. It is my understanding that you are allowed to photograph or video tape before and after, but not during birth. This is again, something that can vary widely. Some doctors allow it (there's that pesky word again - allow), others strictly reinforce the policy. It will also depend on the nurses in the room at the time of delivery.

I am not vilifying hospital birth. I am incredibly grateful for the technology and skill of hospital staff, when a hospital birth is medically warranted or chosen. I needed the hospital with my last baby.

What I am saying is that a simple statement, such as, "hospital can be just like home for those who ask", is risky. It may give women false hope, only to find that there was much fighting for this simple right, and/or the right doctor, right nurses, right circumstances.

Monday, July 7, 2014

Summer Baby PSA

It's summer in Southern Utah (and all over, obviously), which brings temps often between 105-110 throughout the summer. It's HOT. But it's not just hot for adults, it's hot for everyone. Even that itty bitty new baby. The general rule of thumb for summer with a newborn is to dress her how you're dressing.

This is why I want to cry every time I see a new mama whose new baby is not only fully clothed in the summer heat (meaning onesie, shirt, pants, socks), but also has one of those adorable car seat covers draped over the car seat for the duration of a shopping trip to Target, Costco, or wherever.

Image from Cluck Cluck Sew Tutorial

Mamas, I know you mean well. I do. But imagine if you were baby. Not only is it hot out, but someone has you fully dressed, even if in light clothing. Now you're in a car seat - lying on fabric that is going to heat up with your body temp as well as the heat outside. Add to it a cover that cuts off any fresh air. So now not only are you hot, uncomfortable, but you're shortly going to be recycling your own CO2.

I'm an advocate for leaving car the car. I recommend baby wearing baby instead. Yes, it gets hot, but baby is still going to be more comfortable on you, barely dressed (think a diaper and onesie), breathing fresh air throughout the shopping trip. And you can find slings in breathable summer fabrics! But if you can't, or choose not to wear your baby ... please only use the cover for the wind and/or sun outside, and flip it back during your shopping trip so that baby has fresh air and isn't exposed to even higher temps under the cover.

Same goes for nursing covers, mamas! Sure, they may be super cute. But they're unnecessary, and they lead to the same as the above. Only now baby is cradled against fully body heat, in the heat of summer, and cut off from fresh air. There are a number of ways to nurse very discreetly without wearing a cover. In fact, wearing a cover screams, "I'm NURSING!" (which, I personally don't care whether or not people know what I'm doing), whereas most people don't even know what you're doing when you nurse discreetly. It usually looks like you're just cradling your baby.

This summer (and always), please remember that babies need fresh air more than you and I do. They are still regulating their tiny bodies, and we need to do whatever possible to not hinder this. Cute covers just aren't worth overheating your baby, and drastically decreasing fresh oxygen intake.

For rules on appropriate breastfeeding, read this. It's hilarious!  ;)

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

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.