Walk Slowly, Live Wildly

The blog Walk Slowly, Live Wildly is written by a woman named Sara Janssen. She wrote an incredible post about pregnancy and birth that I find to be everything I want to say but can't always articulate as well as great tips on a healthy, natural pregnancy. Here is the link to her post and also a beautiful video she put together about the homebirth of her second child. I can't say enough about it. So beautiful!

The Homebirth of Lucia Mae from Sara Janssen on Vimeo.

The Necessity of Home Birth

It's been awhile since we've updated this blog but the natural birthing spirit is alive and well! Life just gets kinda of crazy sometimes. Anyway, I just recently came across this article written by THE home birth guru Ina May Gaskin. She has revolutioned birthing practices since the 70's and has taught doctors a thing or two about birth.
Here's a link to her bio . She is amazing!

This article entitled "Home Birth- Why it's Necessary" is a short piece on the role that home birth has played in the evolution of all birthing practices, even hospital births. I really like that she puts in there how women have to give birth where they're most comfortable and if that is a hospital, then that's where they need to be. Of course I'm paraphrasing but it's all about making the choice that's right for us and that means educating ourselves.

It's About Time...

It's about time that statistics on the risks of C-sections and the "too high" maternal mortality rate in the USA are getting a little national attention. In this article, about 2/3 of the way down, it highlights a report that found that too many women don't have access to more women-centered care like midwives and that too many medical interventions are being used during delivery! If only this one sentence could become commonly-used in our culture, we would see a huge improvement.

Also, note the reference to the recent NIH conference in Maryland where they discussed the dangers of the recent climb in c-sections across the country and the disturbing policy of many hospitals to not allow VBAC's (vaginal birth after cesarean). In other words, they require c-sections for any woman who had one previously. I'll be receiving the email with the final outcome of the conference and will post it, but it sounds like they made a lot of ground in the effort to prove such policies wrong and against a woman's right to give birth the way she wants.

Read the article from TIME:
http://www.time.com/time/health/article/0,8599,1971633,00.html?artId=1971633?contType=article?chn=sciHealth

Enjoy!

Mom fights, gets the delivery she wants

Wow-this is a great article. Read it here. I saw this family in an article a couple of months ago when all this first became an issue. So, here it is-they did it and the mother was able to have a vaginal birth. I have to say though that it's scary to see this happening. Why should a woman have to do this in order to give birth the way she wants?

Also, I have to comment on the quote by Dr. Flamm, about halfway down-he says, (speaking about the decision to do a C-section), "It's a tough situation," says Dr. Bruce Flamm, a spokesman for the American College of Obstetricians and Gynecologists. "Mom is tired. Dad is tired and nervous, and most people haven't spent their lives reading obstetrical textbooks and don't know all the details involved."

Here is a perfect example of the problem with allowing hospitals and doctors to make decisions for women with healthy pregnancies. They think it's all about what's written in obstetrical textbooks! Although reading and educating oneself about birth is always recommended, you're definitely not going to find all the answers in a textbook.

Big Savings?

I found this quote the other day on "Midwifery News":

"$13 to $20 billion a year could be saved in health care costs by demedicalizing childbirth, developing midwifery, and encouraging breastfeeding."
— Frank Oski, MD

It got me thinking about what is going on with the health care reform. Will women have an easier time chosing the birth they want if we have national health care or will it become more difficult? They could save a lot of money but, as it is now, medicare won't cover homebirths. What do you think?

Quote

"We have a secret in our culture, and it's not that birth is painful; it's that women are strong."

—Laura Stavoe Harm

The Difference Between Right and Wrong

During the course of this blog, I've noticed a recurring issue that we haven't addressed directly yet-what's right and what's wrong in childbirth?...

We definitely have opinions about that here (if you haven't noticed :)) but we should make it VERY CLEAR that what we find WRONG with childbirth has nothing to do with the individual decisions a woman makes, and EVERYTHING to do with the imposing medical world that dominates childbirth in this country and the social and cultural environment we are born into that teaches us from a young age to trust it without question.

Please allow me to diverge a little and tell you about a billboard I just saw-which I will really try to get a picture of soon-on the side of the freeway in Emeryville, CA (just after Ikea if you're on I-80 eastbound). It features a picture of a happy, carefree woman, dressed in a flowing blouse, half-reclined in the grass so that her pregnant belly is obvious, and smiling at her little toddler on her lap. It reads, "Kaiser Permanente...DELIVERS". Delivers what? Ignorance? Deception? Pressure? An incomplete birthing experience? Anyway, I thought MOTHERS delivered babies. This is the hold they have on the our society (I'll use the example of my own birthing experience at Kaiser in the next posting-and no, it's wasn't horrible nor am I bitter, it's just simply wrong). There is so much damage to undo here that it's hard to know where to start. But one thing is for sure-we have to be bold about it or nothing will change.

Now, we have to use individual situations and experiences as examples of course but, if women make "wrong" decisions during pregnancy and childbirth, it is the result of social conditioning. The main purpose of this blog is to help women realize this and to want to get out from under that shadow. That's the only way it can happen-little by little it will catch on as women help to enlighten each another but also so no one feels like they or their former births were "wrong" in any way because that's not the point. I know this is possible because I have seen it happen already in my small circle of acquaintance and it's wonderful! We are all victims of this deception in some way (even many doctors and health professionals themselves because it has been in place for generations) so we can't blame ourselves for what we didn't know-only for what we don't do to change it for the future.

We need to come full circle, where, instead of women giving birth, making choices, and taking classes within this false belief system that meshes medicine with childbirth, there are women doing all of those same things but in the light of the truth. They are raised and educated from a young age in a society that has completely exposed and eliminated the oppressive medical dominance over chidlbirth but not the accessibility of it for those who choose to utilize it. It's a society where the real truth of childbirth is understood by everyone and the joy is experienced by everyone and it is all naturally woven into the fabric of our culture.

March of Dimes

One of the points that my sister and I try to make on this blog is that while we believe that natural childbirth is best way to go if at all possible, it is an extremely personal choice. What we strive for is to help women choose what kind of birth they want so there are no regrets nor guilt. As long as women know the risks of ALL kinds of births they can make an educated choice for what's right for them. One problem that seems to be out there is that doctors tend to make homebirth look dangerous, natural birth look like a pointless martyrdom, and cesarean like an enlighted convienence. So because the American outlook on childbirth is heavily weighted on the doctor's side we try to balance that with opinions and articles in favor of natural childbirth and homebirth. Doctors tend to not give out all the information about the risks of c-sections and women don't seem to understand what a major surgery it is and it should be used as a last resort. So here is an article from the March of Dimes website that is very unbiased but does a good job of listing the risks of c-sections and the medical reasons that often lead to them.

Article

Here's a link to a great article from CNN about how to avoid cesareans. One interesting statistic they have is that 44% of inducements end up being cesareans whereas only 8% of spontaneous labors do. Read it here. It's a good one!

Stories

So, the other night I was out playing Bunco with 7 other friends. We all had kids and 2 of the ladies are expecting again. Always interested in talking about birth, I struck up a conversation with one of the pregnant ladies.

I casually said, "So who is your doctor?" (I know the names of all the doctors up here and their birthing "theories"/practices).

She says her doctor's name and it is the doctor who has the most inane view of birthing, a deep penchant for c-sections, and in my opinion the lowest regard for women. I have plenty of stories about him which I may or may not write about in greater detail later depending on whether or not I need to vent about it. She tells me the same thing about him that I always hear about this man.

"He has a horrible bedside manner but he's the best surgeon up here."

So she puts up with it. Let me explain that up where I live, the (only) hospital does not do VBACs, once you've had a cesarean that's the only way you can give birth again no matter how well you've been doing.

The other pregnant woman is going to have a c-section too because her last was a c-section. As we all started talking about our births I realized that of us 8 women only 2 of us had vaginal births! And ALL of the c-section births began with being induced.

The most difficult thing about it is all these women had seemingly valid reasons to be induced and have a cesarean. Now even if I did know exactly what went on during their pregnancies and births I wouldn't pretend to know if their induction or cesarean was necessary or not. But I can make connections and all these stories all began with too much doctor interference. One woman had high blood pressure, a few were overdue, one had a rash, one had a large baby... it just seems like minor excuses that scare the mothers and get the result the doctor wants whether for the doctors' own convenience or just to eliminate the worry of insurance problems. The point is these women made the decision to have a cesarean during a stressful, pressure filled moment not knowing all their options or all the risks and missed out on a great birth experience. They put their full trust in these doctors and were let down by them but made to feel that their bodies had failed them.

Thomas Jefferson said once (he was referring to elected officials but I think the same holds true for doctors) that we are not obligated to trust those who hold the power. Doctors hold the power in the medical world but we don't have to trust them nor their judgements. They can give us their suggestions but it's up to us to find the truth and what's right for us individually whatever kind of birth that means.

Now, like I said, I can't make judgements on whether a c-section was necessary or not but the last conversation I had with one of the ladies was a woman in her mid 20's and it just made me so sad. It went like this:

me:"Did you say you had a cesarean too?"

her: "Yes, my baby wasn't breathing. While I was pushing, they don't know what happened but she just started to fail so I had an emergency c-section. When they got her out she wasn't breathing so they had to medi-flight her to Oakland. They don't know what happened."

me: "Really?"

her: "Yeah, the pregnancy was perfect, and labor was going just fine. It was just all of a sudden for no reason." she shrugs

me: "Wow, how scary. Were you induced?" (I had to know)

her: "Yeah, and I had an epidural."

me: "Oh."

Now maybe this was one of the cases where a c-section was necessary, who knows. But it is just such a coincidence that this happened, it just has to make one wonder.

Books

Just wanted to write a quick post to tell you that we've added a books list to the sidebar. We will add to this list as we read and hear about other birthing type books. Soon we hope to link these to book reviews explaining what we like about them. But for now it's just there to let you know what's out there if you want to know more. If you have any recommendations for us, let us know what they are.

Links

I've just added some links that I found very informative.

Choices in Childbirth website is great to find information on hospital statistics, questions to ask your health care provider, and you can order the Guide to a Healthy Birth which lists certain rights that a mother has with her birth, it's great. However, the organization is based in New York. Great if you live there, not so much if you don't. But it still has other resources for non-New Yorkers.

MANA is the ultimate page if you have question about midwives. It will give you more information about midwifery and childbirth than you even knew existed and find a midwife for you in your area.

Midwifery Today is a website that is geared towards midwives but has such good information for everybody. Great articles, book suggestions, resources, support communities, education information, newsletters, and new and up coming research in the birthing field. Everything to keep you up to date on what's healthy and what's not in childbirth.

Business of Being Born

I just watched the movie The Business of Being Born by Rikki Lake and Abbey Epstein. I have to say that it was an excellent movie. It really makes a strong argument that home birth is safe and a preferable way to give birth. I have heard that the movie glorifies home birth and vilifies hospital birth and doctors too much. Considering how much hospital births have been unjustifiably glorified in this country I cannot see the justification behind this argument. It was so interesting to see how it depicted the way women lost their control over their births and how it is still regulated by different factors other then the women themselves. Even if a person is not considering a home birth or even a natural birth it would still be a good movie just to see how important it is to trust their body and be comfortable in taking control during their births. During my first birth I was too worried about being a "good" patient. I look back now and I wish I had had the courage to just tell everyone what I wanted when I wanted it. It would have made my experience much better. I really recommend this movie to anyone who is pregnant or just doesn't know that much about home birth. It is really eye opening. Anyone else seen it? Tell me what you thought!

Pretty Funny!

I saw this online and thought it was so funny. I think it can also have some deeper meanings, too, if we try and think like an artist. So, you can decide what it means to you!

C-Section craze!!!

I was going to write "my story" about my birth experiences since our blog is still new and we're trying to give some background but I've had something else on my mind and today was THE LAST STRAW! Yet another friend's doctor has given her the option of having a C-section for no particular reason. Perfectly normal, healthy pregnancy-sure, she's never gone overdue before and now she's two days over and the baby isn't fully engaged in the pelvis yet, blah blah blah. So, doesn't this mean that the baby isn't ready to come out yet? If you ask that question you get, "well, maybe, but you don't want the baby to get too big". Oh, so that's the real reason-which, again, is basically a fallacy. Why aren't women thinking this through? Why do we let medical professionals give us advice about our births based on our fears? Since when has it ever done us any good to listen to people who nurture our fears?

The rate of unnecessary C-sections has increased over the last couple of years to an astounding degree and this new "trend" is becoming very popular all over the country. Medical professionals attend conventions where this topic is discussed and have come to a general agreement that it's more than just normal to suggest a C-section to any woman (without going into all that detail about the disadvantages and risks of course)-it's widely preferred! They contend that women are now given another choice in childbirth that previously was restricted to those with actual complications-that we should be in complete control and have all options open to us-sounds great, right? Do I really have to say...beware of things that sound too good to be true?

Over the years, we've let the "induction trend" slowly creep into our culture until now it's considered normal and also very much over-used, ill-timed, and presenting a whole new set of risks to the mother and baby that need to be dealt with. But now we've regressed to just skipping over that and going straight to the C-section! I mean, what is this-1945? When our grandmothers were knocked out, induced, and the baby pulled out with forceps and not meeting its mother until she woke up? Sure, this new way sounds more sophisticated and women are told that they're getting the "best of both worlds" and, most important, the doctor is happy-oops! Did I say that? Ladies, we're all smarter than this and most importantly, WE KNOW BETTER. Just listen to your womanly instincts for a moment and then tell me what you think is right.

Patronizing

I have to say that I can't stand it when a doctor tells a pregnant woman who wants to have natural childbirth that she can do that "as long as everything goes well." That is so patronizing to me! It's like saying "you do whatever you want to do to make yourself feel better, little mother, I'll be over here doing all the important work with the baby because that's all the really matters." How many women who want to do natural childbirth would be so irresponsible to do natural childbirth under any circumstances! Of course we know that if something goes horribly wrong, natural is not an option. To have to say that is just insulting our intelligence. It makes it seem like the doctor is in charge and doing all the work and the mother's presence is inconsequential. All the effort the mother is putting into labor is not important, just the end result of a healthy baby. I know that doctor's are just trying to cover their rear but I believe that is only because they don't have enough faith in the birthing experience. And there is a small number of women out there who are crazy enough to have a natural childbirth under any circumstance but we should not all be talked to like we are in that small percentage. We need to find the healthcare providers out there who will give us the trust and respect we deserve and recognize that the mother is the one in charge!

Laura's Story

Well, here's my birth story and how I came around to natural childbirth. With my first pregnancy I was 21 years old and thought the only rational way to have a baby was with an epidural. I didn't give it any thought and did not receive any encouragement to go natural from my doctor. So I had a completely fine and healthy delivery (with an epidural)and gave birth to a completely fine and healthy (and adorable, etc...)little boy. Of course I was happy.
Then my sister got pregnant a few months later and mentioned she was going to do it natural. What? Why? People still did that? So, she had her baby, a great delivery and a beautiful baby girl, no problems. Now, for some reason, I have been blessed with easy and fast labors. I credit my hips (cursed in high school now extremely grateful for). My sister was not. However, with her labor being about 3 times and long as mine and her starting off with pitocin, she still had more of a complete experience, if you will. There was more depth, more satisfaction, more meaning in her experience. I had no idea there was that kind of experience to be had in childbirth.
So, when I got pregnant again (girl this time) I got the name of my sister's midwife and went natural in the hospital. What a difference! Yes, it did take more involvement from me and I did need to prepare much more but it became something I was doing and not something that was being done to me. It was an accomplishment and haven't we all learned that the harder we work at something the better the reward? Yes, there was pain but it wasn't "break my ankle" pain it was different (in the words of Caroline Ingalls "a joyous pain"). And the recovery time was nothing!
The next baby, another girl, same thing. Wonderful! Then for my fourth, another girl, I had the opportunity to have a home birth. I could never wish for a better experience. I feel like I had my perfect birth. My midwife was so wonderful as was her assistant. My husband, as nervous as he was, was on the ball and did everything. I called the shots, said what I wanted and we did it because I knew my body better than anyone and what was going on. I felt so in control. I could go on for a long time about this experience so just trust me, it was ethereal!
My first birth was great, but I feel sort of robbed from having a deep experience just because I wasn't educated on the different methods of childbirth. I was also lucky that my first birth went so well with the medical intervention that I did have. With this blog I just hope to educate other women and let them know what possibilities are out there. Don't just brush off childbirth with "as long as the baby's healthy that's all that matters!" There is so much more to it than that. It is our right to know the ABSOLUTE truth about every kind of childbirth method, no exceptions. It is truly empowering!

Pregnancy is Not a Medical Condition

Okay, so there’s a lot to discuss concerning this topic but to start off, we would like to share the thoughts of a friend who is a Certified Nurse Midwife. Her main topic here is homebirth which is something that too many people do not understand. But, she also gives some great insight on C-sections which is a pretty hot topic right now. Whether you are interested in having a homebirth yourself or not, Jamie addresses some really important and misunderstood issues concerning childbirth in general so please read...


By Jamie Glenn, CNM
Butte, Montana

Home birth is an excellent and safe method of childbirth for a woman with an essentially normal pregnancy and few to no risk factors. I think most people's concerns with home birth are that complications cannot be dealt with in as timely a manner as they might in hospitals. Here are my arguments to the contrary.

1. Any well-planned home birth includes a plan for timely transfer to the hospital should the need for surgery arise. I don't advocate home births that occur out in the boondocks, a 4-hour drive from emergency services. I understand that there are some people who opt for this, but that is a risk they are willing to take. It comes down to weighing risk vs. benefit and that is a personal choice for each pregnant woman/couple.

2. The notion of "emergency C-section" is misunderstood in a lot of instances. A woman in labor is often in such a state of concentration/anxiety/pain/distraction that her memories of birth can be quite skewed as compared to the "outsider" point of view of the health care provider. Similarly, a woman's support person, boyfriend, or husband can be in a heightened state of anxiety/worry/concern during the birth and the events leading up to it. It's a phenomenon that happens quite often that a mother or father will make a statement about something that happened during a birth that is quite inaccurate, or they will ask questions that make it obvious that they were not aware of what was happening in the moment. And that's perfectly understandable! It's a high-stress time for many people. Things happen quickly in certain instances. Birth is not something that happens every day in a typical person's experience. We as providers, who are around this sort of thing regularly, have a clearer outlook than many of the birth parents. That's why I like to sit down with my patients after births and debrief them. I give them a chance to ask questions and I review the events, interventions, and indications for interventions. It helps clear up any misunderstanding, and gives us a chance to discuss at length the things that may have happened too quickly to adequately discuss at the time of birth.

One of the most common reasons for "emergency" C-section is fetal distress. This is manifest to providers in the form of fetal heart rate decelerations on a monitor strip.

[Quick lesson for those unfamiliar: It is a sign of good fetal neurologic health when the fetal heart rate shows beat-to-beat variability as well as periodic accelerations in the heart rate. It means that the fetus's autonomic nervous system (the one that works without thinking about it) is functioning properly. Decelerations in the fetal heart rate can occur normally as reflex responses to head compression or cord compression during contractions, or if the fetus is in a position that is pinching its umbilical cord. It's hard for me to talk about fetal heart monitoring without getting too detailed, so I'll just stop there. Just know that there are 500+ page books about interpreting fetal heart monitoring strips.]

A normal baseline heart rate for fetuses is 120-160 bpm. When decelerations are repetitive, prolonged (lasting greater than 3 minutes), or especially deep (the heart rate drops below 90 bpm), these are indicative of "fetal distress". It is a strong sign that the fetus's nervous system is no longer coping well with the stress of labor, and that the fetus is being deprived of needed oxygen. If this continues for too long, the fetus can sustain brain damage because of the lack of oxygen and/or the acidotic state it enters (blood pH becomes lower than it should be).

In a hospital setting, it is most often the labor nurses that are continually watching the fetal heart monitor, looking for non-reassuring signs like decelerations. When decelerations are first noted, the labor nurse will usually ask the mother to change positions or roll to her other side if she is in bed. This resolves a large number of decelerations. Other things that might be done in a hospital: starting an IV and giving extra fluid to the mother, putting an oxygen mask on the mother, or placing an internal monitor on the baby's head to more accurately read the heart rate. If the decelerations continue after all of these interventions have been done, the decision may be made to deliver by Cesarean. The point is that in many, if not most cases of "emergency C-section" for fetal distress, there has been a period (sometimes hours long) of warning before the decision is made to do a C-section. If a woman is laboring at home, her midwife or birth attendant is well trained in monitoring labor progress as well as ausculatation of the fetal heart. S/he will recognize early warning sign and his/her threshold for tolerating non-reassuring signs is much lower than it would be at a hospital. At the slightest sign of concern, the woman could be transferred to a hospital for closer monitoring, and to be closer to an operating room should the need arise.

I think a lot of women who have delivered by "emergency" C-section are told that she and/or her baby would have died if the decision had been made as little as five minutes later. This makes the mother/parents feel very grateful and relieved, as they are given the impression that they narrowly escaped death. And now there is a healthy mother and a healthy baby, and that's all that matters. I agree that a good outcome is always something to celebrate. I also feel that people are not informed of the several minutes (sometimes hours) leading up to the decision to do a Cesarean, during which a low-risk woman laboring at home would have plenty of time to be transferred to a hospital.

There are reasons for Cesarean section that are truly emergencies and are life-threatening with little advance warning. Some of these are placental abruption (the placenta separates before the baby is born), uterine rupture (the uterus gets a hole in it), or umbilical cord prolapse (the umbilical cord comes through the birth canal before the baby does). In the instance of home birth, these risks are miniscule because of the screening that occurs to qualify a woman for safe home birth. Abruptions happen most frequently when labor is induced. Inductions do not happen at home deliveries; labor begins on its own. Uterine rupture most often occurs when an old C-section scar is reopened by the force of labor. VBACs (vaginal birth after Cesarean) are most commonly done in hospitals with an in-house surgical team ready in case of this complication, and even then, rupture is extremely rare when labor begins on its own. And a baby with umbilical cord prolapse can be kept safe during transfer from home to a hospital. These are also most likely to happen when the water breaks and the fetal head is not well-applied to the cervix, or the head is not the presenting part, and is a rare complication.

[Whew! I could write forever... Take a minute to go get a snack or use the bathroom if desired.]

In general, over the past 50 years or so, our society has completely medicalized birth. No matter that women have been successfully giving birth and populating the earth since the beginning of time. Sure, we can save more of the premature babies and we can do surgery for women whose babies don't tolerate labor or are in a position that is not conducive to vaginal delivery. I think that's wonderful. But we still have a CRAPPY infant mortality rate. People probably feel that they are getting the best labor and delivery care here in the U.S., but the truth is that even though we spend more money than anyone else in the world on pregnant women and babies, we are not getting the best outcomes. In fact, we are second to last among developed countries! There are European countries that have dramatically more home births than ours (or consider home birth the norm) and have much better birth statistics than we do. Just because we have technology for women whose births are medically complicated, doesn't mean that it should be used for even the normal, uncomplicated births. In fact, the widespread use of continuous fetal heart monitoring has only increased the rate of vacuum- and forcep-assisted vaginal births and Cesareans, and has not improved maternal/fetal outcomes compared with intermittent auscultation.

About 1/3 of births in this country are by Cesarean. And a LARGE number of these are unnecessary. Don't even get me started on C-sections. Midwives have anywhere from a 5-10% C-section rate as opposed to the national statistics. Our birth statistics and outcomes are better than those of obstetricians even after taking into account the differences in patient population. Shouldn't midwives' wonderful statistics reassure our society about the safety of low-intervention hospital, home or birth center births? Most midwives actually do deliveries in hospitals, but our philosophy is to intervene with normal labor and birth as little as possible. Low-risk women have much smaller chances of developing life-threatening complications during labor, and those who choose to give birth at home are actually saving tremendous health care dollars! If we get out of the mindset that all births must happen at a hospital, and encourage the low-risk, healthy mothers to deliver at home or in birth centers, imagine the money we could save, and how our birth statistics would actually improve!

There are so many good research articles out there. I think it's so important to try to educate ourselves and our daughters about the options for childbirth and start reversing the medicalized view of childbirth, and start revering childbirth as a normal part of a woman's life again. Pregnancy is not a condition that needs to be treated.

We welcome your comments and questions!