Friday, January 29, 2010
The Baby Whisperer
Stephanie is one AMAZING woman. She owns what is probably the largest birth-services business in the state (it includes massage, chiropractic care, naturopathic medicine, midwifery, childbirth classes, doula training, childbirth educator training, henna art, bellycasting, pregnancy photography - and more!), is an incredibly busy midwife, and is also one of the most educated, thoughtful, and articulate women I have ever met. I always enjoy hearing her input at local birth-community meetings.
Here's a quote from her latest entry:
"VITA MUTARI – the literal translation from Latin to English is “Life Transformation”. That is the closest thing I could think of the feeling of labor/birth…what you are feeling isn’t pain, it’s life transformation. Is it dramatic? You bet! I think it should be!..... Language is powerful – birth is powerful – and I think that the language should be more accurate. I don’t believe “pain” is accurate…it’s not a powerful enough word to describe the feelings of birth."
I am expecting great things from this blog!
(Right now I can't get my "subscriber" to subscribe to this blog, so I'll have to check it manually until either I or they get that quirk worked out. I'll post when it is.)
Thursday, January 28, 2010
New Research Shows Why Every Week of Pregnancy Counts
With elective (and frivolous) induction rates soaring all around us, it definitely behooves us to know the dangers of unnecessary induction!
"Conventional wisdom has long held that inducing labor or having a Caesarean section a bit early posed little risk, since after 34 weeks gestation, all the baby has to do was grow.
"But new research shows that those last weeks of pregnancy are more important than once thought for brain, lung and liver development. And there may be lasting consequences for babies born at 34 to 36 weeks, now called "late preterm."
"A study in the American Journal of Obstetrics and Gynecology in October calculated that for each week a baby stayed in the womb between 32 and 39 weeks, there is a 23% decrease in problems such as respiratory distress, jaundice, seizures, temperature instability and brain hemorrhages."
I really liked what this doc had to say:
"There's also a perception that delivering early by c-section is safer for the baby, even though it means major surgery for the mom. "The idea is that somehow, if you're in complete control of the delivery, then only good things will happen. But that's categorically wrong. The baby and the uterus know best," says F. Sessions Cole, director of newborn medicine at St. Louis Children's Hospital.
"He explains that a complex series of events occurs in late pregnancy to prepare the baby to survive outside the womb: The fetus acquires fat needed to maintain body temperature; the liver matures enough to eliminate a toxin called bilirubin from the body; and the lungs get ready to exchange oxygen as soon as the umbilical cord is clamped. Disrupting any of those steps can result in brain damage and other problems. In addition, the squeezing of the uterus during labor stimulates the baby and the placenta to make steroid hormones that help this last phase of lung maturation -- and that's missed if the mother never goes into labor."
And I love the point made here - that doctors and hospitals have MAJOR impact on patient decisions that can lead to good or bad medical decisions (and thus bear a great responsibility to their patients and their babies):
"Making families aware of the risks of delivering early makes a big difference. In Utah, where 27% of elective deliveries in 1999 took place before the 39th week, a major awareness campaign has reduced that to less than 5%. At two St. Louis hospitals that send premature babies to Dr. Cole's neonatal intensive-care unit, obstetricians now ask couples who want to schedule a delivery before 39 weeks to sign a consent form acknowledging the risks. At that point, many wait for nature to take its course, says Dr. Cole."
Night-waking Protects Against SIDS
The first time I heard of the benefits of co-sleeping (or co-sleeping at all, for that matter) was in a class in primate anthropology that I took in college. The professor was talking about the fact that all primates, barring 1st-world humans, slept with their infants, and she mentioned non-co-sleeping as a probable causative factor in SIDS. It has always made sense that the stimulation of sleeping next to the mother would help prevent apnea in infants or simply help to keep them stimulated by the mother's breathing patterns and movement. Thoughts, anyone?
The author says:
"In order for the body to function there must be a balance of just the right amount of oxygen and carbon dioxide in the blood. In order to maintain this balance, tiny sensor cells called chemoreceptors are located along some major blood vessels. During sleep, the body is particularly dependent on these chemoreceptors to keep breathing going.
"In the first few months, the infant's automatic breathing mechanisms are immature. When watching a sleeping baby breathe, you will notice that his breathing lacks a regular pattern. Periodically he appears to stop breathing, sometimes for as long as ten to fifteen seconds, and then self-starts without any apparent problem. This is called periodic breathing and is normal for the tiny infant. The younger or the more premature the baby, the more irregular the breathing pattern and the more noticeable the periodic breathing. As the baby matures (around six months), breathing patterns during sleep become more regular and periodic breathing lessens. The episodes when the baby stops breathing are called apnea. Sometimes they are prolonged for more than fifteen to twenty seconds, and the heart rate drops significantly (greater than twenty percent). As a response to this sleep apnea, either automatic start mechanisms click on or the infant awakens. Either way, normal breathing resumes.
"Sometimes the apnea is prolonged, and breathing fails to start again. Infants who are hooked up to apnea monitors show signs that the oxygen in the blood is at a dangerously low level: the heart rate becomes alarmingly slow, and the infant turns pale, blue, and limp. An observer must intervene and arouse the infant. Sometimes a simple touch will trigger the self-starting mechanism; sometimes the infant must be aroused from sleep in order to breathe; sometimes mouth-to-mouth resuscitation is necessary to initiate breathing again. Infants who have experienced an apnea episode that required outside intervention to restart their breathing are called near-miss SIDS. In other words, they would have died had someone not intervened. Tragically some infants stop breathing permanently, succumbing to SIDS.
".....Obviously, this [her study] was a very small sample group, from which it is impossible to draw statistically valid conclusions. However, it does suggest a theory that needs further testing: a baby who sleeps next to mother is likely to experience fewer apnea episodes and thus may be at lower risk for SIDS. While again, this is not scientifically tested evidence, I have had many breastfeeding and co-sleeping mothers in my practice tell me that they have noticed that their infants breathe more rhythmically lying next to mother in bed than they do in a crib. One mother, whose baby was monitored with an apnea monitor during sleep because of breathing difficulties, found that the alarm went off frequently when the baby slept alone, but not at all when the baby slept with mother."
Good stuff. When one notices that all primates and all mammals and most humans co-sleep, it becomes harder and harder to dismiss co-sleeping as a valid sleep solution for infants and mothers. Thoughts?
Wednesday, January 27, 2010
Sunday, January 24, 2010
Okay, here they are! They would be a yellow-colored stain to the baby's (1) fingernails, (2) umbilical cord, (3) vernix.
(Feel free to add additions or corrections.)
Where did I pick up such snippets? At this wonderful website! Check it out:
Stanford School of Medicine Newborn Photo Gallery
This site has a plethora of photos of newborns and various conditions, with descriptions and explanations. It is a super-helpful learning tool! I haven't gotten through it all yet, but I've learned a lot.
The Journal of Perinatal Education: Saying "No" to Induction
This is really good stuff:
"Women are between a rock and a hard place. It is so easy to be seduced into believing that the baby is ready for birth. It is also frightening to hear the physician talk about a too-large baby or a possible medical problem. In the first instance, potential problems are brushed aside; in the second instance, problems are suggested where none are likely to exist. In both cases, pregnant women do not have the full information required for making a truly informed decision.
"To make an informed decision—either informed consent or informed refusal—women need to know the value of waiting for labor to start on its own. The last days and weeks of pregnancy are vitally important for both the mother and her baby. The end of pregnancy is as miraculous as its beginning. It's a lot easier to say “no” to induction if the mother knows the essential and amazing things that are happening to prepare her body and her baby for birth."
Among others, there is an awesome section on the risks of unnecessary induction, most of which are not presented to women when they are being unnecessarily induced.
Check it out!
Saturday, January 23, 2010
This is an amazing article.... thanks very much to Kathy for tipping me to it. Check it out....
Living Dead Girl: Surviving HG
If you ever need an article to show to people to make them "get it" as to what hyperemesis is all about, this is a good place to start.
Her experience mirrors those of a lot of women whose stories I've read - mild HG with a first pregnancy, then even worse with a second:
"Our second pregnancy was planned. I had deluded myself into thinking that my previous sickness had just been stress-related, and it would surely be a thousand times better this time around. I thought I was prepared. How very wrong I was.
She writes about how hard it is to get people to take one seriously during a hyperemetic pregnancy:
"Sometimes I wondered if our marriage would survive, despite how very committed I was/am to him. He didn't understand what I was going through. He couldn't bear the thought of me truly being as sick as I looked. He preferred to think that I was being somewhat lazy and milking it. I had been very sick before, but had managed to still be up and around and at least fake being a normal human being. He couldn't see how this time was so different, and I didn't understand it either. I felt betrayed by my own body, and let down by the one person I was counting on the most. My own brothers would talk about how their wives had experienced morning sickness too, but had managed to lead normal lives. They couldn't see how it could be so different for me. My aunt was convinced that walking a mile a day would do me some good.
"No one knew how DESPERATELY I wanted to enjoy my pregnancy. How could anyone think I was enjoying this? I was in HELL. I was trapped in bed. I was starving and weak. My whole body hurt so bad that I could not sleep. I had this really odd and uncomfortable sensation constantly like my limbs did not have enough blood in them. My lips were so dry and cracked that over 2 years later, they are still not the same. I cried more in those months than I did in the rest of my life combined. I felt trapped in my body. I felt like I'd lose my mind. Sometimes I wondered if I already had. I WANTED to clean my house, and play with my little girl, and just be a normal human being. I wanted to enjoy my pregnancy in the way I hadn't been able to before. Instead, I felt like a corpse. I felt like I'd die if something didn't change, and no one would see it coming because they were convinced it was just "morning sickness" that I was milking. But of course even thinking like that meant I was being "dramatic", and I'd get further depressed over my inability to be happy. What a sick cycle....
"I was terribly depressed. I was afraid of losing my baby. I was afraid of losing my husband. I was CRUSHED at the lack of understanding. I didn't want to be babyed, I just wanted them to stop doubting me. I wouldn't wish this experience on my worst enemy. In Hyperemesis Gravidarum forums, there are women who suffered so much that they resorted to aborting babies that they had desperately wanted and tried hard to conceive. There are some that considered suicide, or even attempted it. I must say, that if I didn't have some very important reasons to live, and a baby inside me counting on me, I would have wanted to die too. Instead, I just sometimes fantasized about it, logically knowing it was wrong, but still wishing for escape nonetheless."
Her conclusions echo mine:
"I'm terrified of becoming pregnant again. I have beautiful, healthy, amazing daughters that I absoultey adore. I have a husband that loves and supports us. We used to talk about having four children. Aside from the fact that it would be financially rather difficult for us at this time, I am deeply, profoundly fearful of being pregnant again...
"So many moms like me are afraid to ever try for another baby. Although we love our children dearly, there is a constant fear that another pregnancy will bring more hell with it, for mom and the entire family. There's a strong possibility of experiencing HG even WORSE with future pregnancies, and that thought can be so terrifying, that people would rather adopt, use a surrogate, or stop trying, than even think about going through that again. How can one even care for the children they have when they're trapped in bed, on the bathroom floor, or in the hospital?"
There is so great a need for awareness of this condition - it is one of the only serious illnesses in the world for which a woman will be scolded and blamed ("You really didn't want this baby or you wouldn't be making yourself sick! You're just being selfish and dramatic! You just need to get out and get some fresh air, and then you wouldn't deal with this, and it's all in your head anyway!"). Let's get the word out on this!
Thursday, January 21, 2010
Don't Get Me Started: Chop Shop
I have never wanted to birth in-hospital, but her writing makes me want it even less!
"Once her water breaks, she can’t leave her bed. Once we give you pitocin or an epidural, don’t even think about moving. Psychiatric patients are never put in restraints, never tied down (except for the worst of the worst situations) because it is “cruel and unusual punishment”. But laboring women? Laboring women are put in medical restraints. Pharmacologic restraints. We pump medicine through an IV, shove it into the space in your spine and say DON’T MOVE. YOU CANNOT MOVE. DON’T EVEN THINK ABOUT ******* MOVING.
"We don’t care that you hurt. We don’t care that it’s better and safer for the baby and for you to move, move, move. You can’t move. It’s hospital “policy”. “Policy” that was created for the convenience of clinical staff. There is zero evidence saying this is a good idea. In fact, the evidence states quite the contrary. To move, move, move. To shift positions and let gravity help you. To take a walk and have a massage and lay in a bathtub. Actual scientific evidence tells us that this is what women SHOULD be doing. Instead, the medical establishment drips an IV, pushes the meds and takes choice away from women. Every second of every minute of every hour in this country a woman’s choice is being ripped from her."
Frankly, I hear about the following way too often:
"And after a quick nap, it’s been decided. While she was out cold, and the baby’s heart rate slowed and that little swimming baby in the happy amniotic fluid struggles to keep it together, it’s decided. She hasn’t progressed. Not dilated far enough. Not effaced. Sure the meds caused this. Sure the meds we pumped in to her to “stop the pain” pulled the e-break on her labor. The very meds we gave her, we insisted that she take, stopped the body from doing the very natural thing that we’ve been doing for millions of years. The solution? Cut her open! Yay for sugery!....
"We call them “pre-dinner Cs” for a reason. Lord knows that obstetrician wants to get home for dinner so it’s no surprise that she’s induced at 2ish and delivers via c-section by 3ish. Knocked out in another drug-induced haze. Baby ripped out of her belly, placed in a plastic bin like a bag of lettuce at Safeway. Lay her on the mother’s chest? Heaven forbid the baby’s “yucky”. Heaven forbid the baby start breasfeeding, doing that other thing we’ve been doing for millions of years."
Her conclusion is very telling:
"I make no jugements about your own delivery. If you wanted to be drugged and not “feel anything” (*ahem* a ridiculous expectation that the medical establishment shoves into women’s psyhe) or scheduled your own c-section, that’s lovely. Hats off to you. I am not pointing fingers at you and saying we all need to do it the same.....
Definitely food for thought!
Tuesday, January 19, 2010
A Funny Thing Happened on the Way to the Birth Center
I did find it alarming how many "emergency personnel" showed up who had no clue what to do.... the policeman whose only intention was to avoid them, the 911 guy who thought the mama had "plenty of time".... doesn't build one's confidence in calling 911!!
The moment when she knew the baby was coming in the taxi rather than in the hospital is just priceless:
"I knew from every video that we watched that when a burning sensation comes on, the baby is coming. That and an utterly guttural desire to push. That’s when what I hoped I would never have to say, came screaming out of my mouth, which was, “He’s coming! The baby is coming!” I started frantically trying to rip my jeans off. Graham called the midwives, who said to pull over immediately and call 911. So that’s what we did. Gladys got out of the van and Graham was on the phone to 911 explaining what was happening while he ripped off my shoes and tried to help me pull off my jeans."
"You might be able to picture the terror and helplessness that Graham experienced in the van, pulling off his wife’s jeans, and trying his best to get help on the phone. I have no memory of this, but at one point he dropped the phone in the darkness of the van and while he frantically looked for it, I calmly handed it back to him."
I loved her description of the moment of birth:
"I felt that if I screamed loud enough my skin would rip off my entire body, like some popped balloon and that would be a pleasure. My eyes were closed deep into the screaming, but I remember distinctly the pop of his head coming and then another pop which told me he was out. I opened my eyes and there he was on the seat, pink faced, gurgling, looking wet and amphibious. I kept waiting fro the big cry, but he wasn’t crying, just gurgling. So I said, “Is he okay?” And that’s when the lady paramedic said something I will never forget as long as I live. She said, “Mama, he is BEAUTIFUL.”
I also loved what she said to close:
"Then again, I am also reminded of something else Shara said: Women have babies. Not doctors or midwives or anybody else. THIS woman had her baby, dammit. I had my baby in the back of a mother loving vehicle while a ton of people stood by. Am I proud of myself? Yes, I am. But next time I am staying home."
Sunday, January 17, 2010
Me: "I have a midwife"
Doctor: "Okay, goodbye"
Anyhow, I've been meaning to write to the practice about this ever since, and I finally (over a year later), got around to it! And so, without further ado, here is the letter which will be hitting the mailbox Tuesday morning. We'll see if it disappears into a black hole, or if it gets any response! I'll post on the end results.
In this letter, I have tried my best to use my three rules for activism letters:
(1) Be clear and concise
(2) Be calm, polite, and respectful (spiteful letters generally produce only angry readers, not true heart-change, which is the end-goal of all activism)
(3) Begin and end nicely, even with a complaint
(The name of the practice is two last names put together, so in the letter it appears as -------- & --------)
Dr. ------------ --------------
--------- & -------- OB/GYN
Re: My Experience With -------- & --------
Dear Dr. ----------,
I wanted to bring the following situation to your attention regarding my experience with -------- & --------, and I apologize for the tardiness of this letter.
In December 2008 I discovered that I was pregnant with our second child. During our first pregnancy I had received prenatal, labor/delivery, and postpartum care from an excellent Licensed Midwife, and I planned to do the same with our second.
However, with our first pregnancy I had suffered from hyperemesis, and I knew that I would need to find a consulting OB/GYN to prescribe medicine to control this condition, as Licensed Midwives do not currently have prescription ability. I posted this need on www.mamasource.com, and your practice was recommended by several valley mothers as having doctors who were extremely skilled in dealing well with hyperemetic patients.
I immediately called to make an appointment with your office. However, I knew that my situation was somewhat unorthodox, so I explained my needs in detail to the receptionist over the phone so that everything could be cleared before I came in. I told the receptionist in particular that I would not need prenatal care or birth attendance, just prescriptions and care to deal with hyperemesis. She spoke to a supervisor to clear my situation, and then told me that my situation had been approved by the supervisor and that a doctor would see me for this purpose.
I came in to the ------- location for my appointment the following day, on Thursday, January 8, 2009 at 9:10 a.m. I was immediately impressed with the efficiency and attractiveness of your offices. My appointment was with Dr. ------- --------, and she told me her general protocol for treating hyperemesis. I was extremely happy to have found a practice that treated hyperemesis efficiently and aggressively.
However, wanting to make sure that she understood my needs, I asked her if she had been made aware that I was not needing prenatal care, only help with hyperemesis. It became immediately clear that she had not been told anything of the situation and believed that I had come to -------- & -------- as a regular prenatal patient. When she learned that I was under the care of a midwife and would not need prenatal care, she immediately told me that she could not prescribe for me and that I could not be her patient. Our appointment then ended, though I was left with a very positive impression of your staff and offices.
I continued my search for a consulting OB elsewhere, and found an OB with a different practice who took me as a client and prescribed Zofran for my needs during my pregnancy.
Based on my experience, I would like to suggest the following:
(1) That patient needs be carefully communicated to doctors, so that confusion and wasted time be avoided, and
(2) That doctors at -------- & -------- would consider providing consulting care for clients of the valley’s Licensed Midwives. We have a wonderful community of Licensed Midwives here in Arizona who are always glad of the partnership of competent and caring OB/GYN physicians in order to be able to co-manage client care. I hope that in the future, -------- & -------- will be willing to provide consulting care for the patients of midwives and that I will be able to recommend your practice to friends who need pregnancy co-management.
Thank you very much for the services you offer to Arizona’s mothers and babies!
Thursday, January 14, 2010
2 cups rubbing alcohol
1/2 cup ammonia
1 teaspoon Joy dishwashing soap
Blue food coloring, optional
Put above in gallon container and add water to make one gallon. I just made this ten minutes ago and haven't had time to try it yet, but the reviewers on the original recipe all rave about it.
Homemade Dishwasher Detergent
Into a 32-ounce container place:
1/2 cup borax (laundry aisle)
1/2 cup washing soda (laundry aisle)
1/4 cup kosher salt (with the salt!)
1/4 cup citric acid (buy from brewery, herb shop, or health food store - I get mine in the bulk herbs at Sprouts)
Shake well. Ignore any clumps. Use 1 Tbsp. per load. Works beautifully!
Can also fill rinse compartment with white vinegar. I haven't figured out how this works yet, so I haven't tried this.
Co-Sleeping: Does It Really Need to be Explained?
Seriously, I don't know how people go WITHOUT co-sleeping. I didn't co-sleep for the first two months with our first, and it was beyond horrible. Baby does not want to go back to sleep on his own, so he cries.... and cries.... and cries. So baby was up all night, I was up all night, and the misery was excruciating. I would dread evening because I knew it was the beginning of another night of being up all night.
And then.... enter our wonderful, amazing pediatrician, who said "Take him to bed with you!" Bingo. Problems solved, misery over. Not only is co-sleeping the most precious, wonderful, snuggly (and SAFE!) thing to do with a newborn, but it (almost completely) cuts out up-all-night marathons. Baby nurses when he wants and sleeps when he wants, and all is beautiful.
Sometime I'll write a better article on co-sleeping (like in five years when the kidlets are in school), but for now... I love co-sleeping!!
Woman, Uncensored: Nursing in Public
Be prepared for some strong language and a strongly-worded message, but be prepared also for brilliance! Love it.
Many thanks to Kathy at Woman to Woman Childbirth Education for posting this!
Monday, January 11, 2010
"The rate of neonatal death in monozygotic (one placenta) twins starts to increase to a level we consider unacceptable after 36 weeks, which is why most OBs induce at that time. Dizygotic (two placenta twins) are lower risk for intrauterine demise, and usually are delivered at 38 weeks. Pulmonary maturity for twins is accelerated relative to term babies, and these babies tend to not need any special care after delivery. Stillbirth/fetal demise is a heartbreaking outcome that we will do a great deal to prevent."
I really love getting opposing opinions on this site. That's really one of the main points of this blog - bringing the midwifery and obstetric communities together, rather than trying to widen the divide between them. Civil intercourse between the two camps is a wonderful thing, and I appreciate when we can get together to discuss issues in a non-hostile manner in order to understand each other!
Saturday, January 9, 2010
I was watching a friend's thread on Facebook today... she made a comment about homebirth and how great it was. Unfortunately, she got plastered. After reading some of the posts, I had to come blog about it.
Why is homebirth a reasonable and safe option for birthing women?
(1) Midwives attend only healthy, low-risk women
We're not talking homebirths for out-of-control-diabetic women who have pre-eclampsia and placentia previa at the same time. Midwives accept only women who are healthy and do not have predisposing health factors that would make homebirth unacceptably risky.
(2) Midwives offer the same prenatal care that OB/GYNs do
Yes, really! Midwives perform the same routine tests that OBs do (urinanalysis, blood tests, weight, fundal height, fetal heart tones, blood pressure). They also offer the choice for other prenatal tests (ultrasound, gestational diabetes screen, GBS, etc.). The only difference is that homebirth midwives provide highly superior prenatal appointment times, in that they typically give clients one hour of time per visit, as opposed to 5-10 minutes for the usual OB visit.
During these prenatal visits, midwives have the same opportunity to diagnose complications that OBs do - and when diagnosed, at-risk clients are either referred to OBs for "co-care," or risked out completely and sent to an OB for obstetrical management and hospital birth.
(3) Many in-hospital emergency scenarios during labor are iatrogenic (doctor-caused)
Some common examples:
- Labor is induced, baby goes into distress from failed induction, cesarean done for non-reassuring fetal heart tones
- Elective cesarean done too soon results in a premature baby who needs time in the NICU
- Doctor breaks a woman's water too early in labor when the fetal head is high in the pelvis, resulting in a cord prolapse, necessitating an emergency cesarean
Hospitals also commonly utilize routine procedures that are harmful to healthy, physiologic birth. Some examples: lack of privacy for the laboring women, routine and frequent vaginal exams, continuous electronic fetal monitoring, time limits on labor, episiotomy, directed pushing, prone pushing positions, premature cord clamping/cutting, etc.
(4) Most naturally-occurring problems during labor are slow to start and are non-emergency in nature, i.e. there is plenty of time for both diagnosis and remedy
- A truly obstructed labor
- A pattern of non-reassuring fetal heart tones
- Maternal blood pressure rising
- Maternal exhaustion
All of those allow plenty of time to diagnosis, think through, attempt at-home remedies, and transfer safely if needed.
Two real-life examples:
- A friend of mine planned a homebirth with one of our local midwives. When she started laboring, her blood pressure started to rise. The midwife kept an eye on it, and after a couple hours of labor she said, "Okay, that's it. Your blood pressure is going outside of my homebirth protocol limits, and we need to head into the hospital." So the mother got dressed, they packed up their things, hopped in the car, and went to the hospital. (As a matter of fact, she got horrible treatment in the hospital and probably wasn't any better off than at home! But that's a different story.)
- Another friend of mine planned a homebirth, but during her labor got stuck somewhere around 8 centimeters. After a reasonable amount of time, her midwife said, "I think we need to transport, and I want us to go in now, before we run into problems with exhaustion." So they packed up, hopped in the car, and went to the hospital, where after a couple more hours of labor, my friend did end up with a cesarean for true cephalopelvic disproportion (CPD).
In both of those cases (and most homebirth transport cases are similar), the midwife and the family realized that they needed to transport, but in a non-emergency manner.
(5) Midwives are equipped to deal with emergencies
Homebirth midwives are completely equipped to deal with common obstetrical emergencies such as shock, hemorrhage, shoulder dystocia, and neonatal depression.
Example: Our last baby was a slow starter - his heart tones took a dive in second stage and he didn't start breathing automatically. Our midwives went right into action with suctioning, stimulation, warming, etc., and he was fine. If it had been more serious, they would have moved into more advanced techniques of neonatal resuscitation (bagging with oxygen, etc.). They are prepared!
(6) Homebirth midwives utilize techniques that facilitate safe and straightforward birth
A few examples out of many:
- Respecting the laboring woman's right to undisturbed concentration and privacy
- Using a variety of mother-led positions during labor and birth
- Delayed cord clamping and immediate skin-to-skin for baby and mama
- Water for labor and birth
- Continuous attendance by midwife, instead of constantly rotating strangers
- Continuous observation by midwives so that problems can be caught early
- Upright positions for labor and birth
- Perineal massage, perineal compresses, etc. rather than episiotomy
- Letting the mother push when she has the urge to push, rather than rushing or demanding pushing once she is completely dilated
(7) There are some risks no matter where you birth
Are there occasionally babies/mothers who die at home who would not have died in-hospital? Yes. It's extremely rare, but it has happened occasionally. The other side of this issue, however, is that there are also babies and mothers who die or are injured in-hospital who would not have died had they been born at home. We saw an example of this two weeks ago with the Miracle Mom story, in which a baby and mother were nearly killed due to an epidural side-effect. Other examples are babies who spend time in the NICU unnecessarily because an elective cesarean was done too soon, babies who have died or been injured in Cytotec-induced/augmented labors, mothers who have died due to cesarean-related aftereffects. This is not a blame game. This is simply the reflection that there are risks to wherever a mother chooses to birth - it's a matter of examining one's choices and deciding which risks one wishes to live with. Unfortunately, culture is on the side of hospital birth - in other words, a hospital-birthing mother whose baby dies due to hospital care will be told, "It's not your fault; you did the right thing," while a homebirthing mother whose baby dies will be told, "It's all your fault - you risked your baby's life." Not true, but it's the cultural norm right now.
There is a lot more to be said, and sometime I'll probably write a longer article on it. However, the main point is this: For healthy, low-risk women, homebirth has been repeatedly shown to be as safe or safer than hospital birth, and with significantly fewer interventions and intervention-caused morbidity, and much higher patient/client satisfaction. Homebirth bashing may be culturally acceptable, but it has no basis in fact. Hopefully at some point we can, as a culture, reach a point in which homebirth is widely accepted, both culturally and medically, as a viable and safe option for birthing women.
Until then, I'll keep blogging.
Comments, questions, things to throw? Let me know! Please keep all comments civil, polite, and kind.... I love dialogue, but only within the rules of common civility!
Friday, January 8, 2010
Yesterday at Bible Study was no exception. I attend a large, monthly Bible study at a local church, and at this past month they were holding a diaper drive for a mama who is currently pregnant with twins (and who, when the twins are born, will have four kidlets age two and under - yikes!!). Good so far.
So they get this sweet girl up on the stage to present her with the diapers, and she has to go through the usual good-natured teasing and jokes, and then they ask her the big question - "So, when's your due date?" And (though I'll pass over all the underlying issues with "due dates"), she replies, "I'm due on [date X]......." (pause for delighted applause and cheering) "...... but they'll be inducing me a month early, so the babies will be here by [date X - 4 weeks]."
You can guess my original reaction. It was something along the lines of:
That semi-coherent thought continued as such: "Oh, my goodness! Why are they doing this? Are they TRYING to create premies who will be spending their first weeks in the NICU after a failed induction leading to cesarean and increased respiratory morbidity (plus other problems), or even just vaginally-born twins who were NOT READY to come out yet? Don't they know that even ACOG has recently recommended against elective induction before 39 weeks?"
Then I thought: "Hmm. Induction. That means vaginal birth. That means that her doc is not sending her for an automatic cesarean, which is unfortunately what many doctors are currently doing with multiples. That's cool. Very cool. So why is he trying to sabotage a vaginal twin birth by intentionally complicating it? Is this a compromise, i.e. Mom says "I want a vaginal birth" and doc says "Okay, but only if you agree to a 36 week induction"?
I don't know. There are a hundred possible scenarios. I'm really just thinking out loud here.
Of course, I should add that I do not KNOW that there are no complications calling for an early induction. But I suspect that there are no serious complications, simply because (a) this girl was the talk of the morning's Bible study, and no complications were mentioned - it was just excitement for her pregnancy, (b) when the item was discussed from the podium, it was the same - just lots of excitement and congratulations, no "Let's keep so-and-so's babies in prayer, as they are suffering from complication X, etc., (c) the girl herself mentioned nothing when given the microphone. So, while I will freely admit that I do not know all the details, I think that this is most likely an elective or doctor-led induction.
Then I went and posted on my local birth network group to find out what people had to say. Here's what one lady had to say about twin induction at 36 weeks:
"It's because they say twins mature faster than singletons, so a 36 wk twin baby will have the lung maturity and placental maturity of a 40 weeker."
So assuming that it's safe (which is questionable), the question becomes, regardless - WHY? She added:
"There are a lot of docs that routinely induce at 40 weeks so I assume they would give the same reasons - concerns about , stillbirth, and the thought that "if we're going to have to induce anyway why not do it before the baby gets bigger and makes it harder." ACOG doesn't recommend routine induction at 40 weeks or routine induction for a suspected big baby but of course many OBs still do it anyway.
"I wanted to add though that for what it's worth, I had a friend who had a vaginal birth with twins, an induction at 36 weeks, and she thought her babies seemed premature despite what the official textbooks say. And I have heard some doctors (and not necessarily very natural-minded ones) inducing at 38 or even 40 weeks with twins. So the 36 week recommendation thing isn't a
hard and fast rule even among OBs...it seems to be a little bit of a personal preference."
Another lady replied to the thread:
"My only question would be, if they are "full term" and fully " mature" at 36 weeks, why do they naturally stay in for 40? And of course when born early, they are obviously smaller than average and often must stay in the NICU, are those not indicators that they were meant to be in longer? I have never had twins. But I've had babies and they seem to come out when they are supposed to...."
One final lady added this:
"When I was pg with my girls and talking to my ob about the twins he had delivered before, he told me about two moms that went to 42wks before they did their c/s (they were breech). The moms didn't want to schedule a 39 wk c/s like most moms do, and so he honored their choice. They were born healthy and were really great sizes from what I remember. He never said anything about inducing early and I have to agree that 36wks is NOT a good rule of thumb to go off of. A lot of times they are off when it comes to due dates and I would think it wise to leave the babies in as long as they and mom are fine. I could see that if there is some IUGR going on or some other complication, but inducing early without medical reasoning doesn't make any sense. I had NSTs done starting at 35wks and as long as everything was looking good, they weren't going to do anything. Hopefully there is a good reason, like you say."
Anyone have any thoughts? It just seemed a less-than-optimal situation, and my heart hurts for the very real possibilities that this mama is going to be facing, albeit unknowingly - a failed induction, an unnecessary cesarean, babies in the NICU because they were forced to come too soon, etc. etc. etc. ad infinitum.
I remember when my pastor's daughter had twins, they were working like mad to KEEP her pregnant past 36 weeks, because she had problems with preterm labor. When she hit the 36 week mark they conceded defeat and let her body go into labor, and her babies were still in the NICU for quite a while because they were born too soon. We need more doctors (and hospital midwives) who recognize the value of a natural gestational term. In other words, when the baby is ready to come, the mother will go into labor. Seriously. We really don't need to be inducing an ungodly percentage of pregnant mamas into premature labor. Really.
Comments, corrections, things to throw? Please let me know (politely, of course!).
Thursday, January 7, 2010
10 - Babies aren't breathing inside your body!
I can hear some of you now...saying you knew this. If you know this, then why is a waterbirth so scary to you? Baby is underwater RIGHT NOW...spending an extra 5 seconds in water isn't going to cause the baby harm.
9 - There is no reason to cut the cord immediately.
What reason would there be? The blood in the cord is all baby's blood, not moms...they don't mix...so if you lift baby up, blood won't go into MOM, it can't. And mom's blood won't overfill baby, it can't. In fact, if you NEVER cut the cord and carry baby AND placenta until it falls off naturally, baby would be just fine!
8 - Midwives are MEDICALLY TRAINED care providers.
We aren't just people who think births are cool and bring teas...we are medically trained to facilitate a healthy pregnancy and birth, recognize when things are becoming unhealthy or risky, and are prepared to respond appropriately when issues come up.
7 - Your BODY knows how to give birth!
I am slightly amused that we can get pregnant without supervision or classes, we never question our body's ability to GROW the baby, we don't have to think about whether our uterus will know how to grow or think about whether the placenta will grow for our baby...yet when it comes to birth, we are highly skeptical over whether our bodies will know when/how to go into labor and whether it will know how to give birth. If your body has functioned perfectly until now...WHY are you questioning it??
6 - You are the boss when it comes to your prenatal care.
Your care provider (doctor/midwife) can't MAKE you do anything, and can't LET you do anything. You have hired THEM and YOU are the boss. If you don't follow a recommendation or a hospital policy...what are they going to do to you? You are also responsible for your care - it is up to YOU to keep yourself healthy, not your care provider. S/he will just be able to tell you if what you're doing to keep yourself healthy is working and give suggestions...but it's up to you!
5 - Be patient!
You will only be pregnant with this little baby ONCE in your entire life! Be patient for baby to come out...you will probably miss this once it's over! And when you're in labor, allow your body and baby to do what it must - worrying about the time will not make it happen any faster. (quite the opposite) so rather than cervical exams and clock-watching....just rest and allow it to be as short or as long as it needs to be.
4 - Baby's size matters VERY little.
our bodies don't want to grow babies too big to come out - that wouldn't help our species very much, would it!? Head's 'cone' and shape to fit the pelvis (they are made to do that!), fat bellies and thighs squish to fit through, our pelvis separates and opens up... HOW baby is trying to come out is infinitely more important than how much fat is on the baby's little butt. (if baby's head is crooked to the side so the ear is trying to come out first, for example) The difference in birthing a 10.5 pound baby vs. a 7.5 pound baby is actually very little.
3 - Not all newborn babies cry.
Sometimes the birth is so gentle and easy and smooth....babies come out and they don't cry. And that's okay!! so long as baby is breathing and happy - what's the problem??
2 - Children are usually totally fine seeing birth.
They take cues from those around them about what's happy, what's scary, etc. Almost always children are totally fine seeing their siblings born - so long as the adults in the room are happy and excited and not scared. If the father is scared....doesn't matter over what...the children tend to get scared. (you should see how scared my kids get of spiders because of how I react!)
1 - HAVE FUN!
You are having a baby...have fun with it! Enjoy the end of your pregnancy, don't forget to smile in labor, and don't worry about diaper counts and such to the point that you forget to enjoy your baby. when you are on your death bed looking back over the events of your life - you will likely look at this point of time and say, "THAT is the best time in my life...it doesn't get better than right there!" Prime of your life, growing and raising your babies....HAVE FUN WITH IT!
Tuesday, January 5, 2010
Frank Breech Birth Video
Breech birth is almost non-existent in hospitals nowadays, as modern obstetrical care is shunting all breech babies into automatic cesareans. A pity. The Society of Obstetricians and Gynecologists of Canada (SOGC) has recently reversed their cesareans-for-all-breeches policy, and is now advocating vaginal breeches, and it is to be hoped that other national societies will take note as well.
Two things I have heard advocated for safe breech birth - (1) an upright birthing position, and (2) "hands off the breech" - non-interventionist birth - are both exemplified in this video.
Friday, January 1, 2010
... Has anyone else out there been as intensely bothered by the Miracle Mom story as I have?
Story recap: Mom in labor at hospital is getting epidural, suddenly codes and loses all vital signs (blood pressure, etc.), doctor does emergency crash cesarean to save baby, which is also lifeless; however, baby is revived and the mother also miraculously revives.
First of all, Praise the Lord that this story ended happily - it was very nearly a double tragedy, and instead has a wonderful ending. No problems with that!
But I have been intensely bothered by what has been left OUT of the media coverage on this story - completely ignored - and that is the fact that the entire emergency and near-tragedy was most likely caused by the epidural administration.
One cannot, of course (without more information) say that the epidural was definitely the causative factor - there's always the rare coincidence. But healthy, low-risk laboring women do not generally go into cardiac arrest! (Again, there's always a rare chance. Not discounting that). But the only outside factor (that we know of) was the epidural... and epidurals have the rare side effect of "death."
After all, if you give a man a shot of something and 30 seconds later he keels over dead.... well, there's a good chance that the shot killed him! And if you give a healthy, laboring mother an epidural and during the administration she codes, well, the connection is there.
But the media has completely ignored the "why." They're not postulating anything else, just completely ignoring the "why" altogether and focusing on the miracle of the double-revival.
And really, this is not to bad-mouth epidurals. Like all drugs, they have their uses (though the epidural is greatly over-used). However, there are possible side-effects, and one of those rare side-effects is death. Women deserve to know that, and the public deserves to receive honest reporting in a near-tragedy like this. It would not need to be sensational: "Epidural Kills Two! Thousands Flee in Horror!" Etc. etc. etc. Something along the lines of, "Although the cause of the woman's arrest is not known, it is known that one rare side-effect of epidural anesthesia is death/cardiac arrest, and that possibility is being considered by medical staff."
(Not being a nurse or doctor or midwife, I am not up on all of the factors that could cause a laboring woman to go into cardiac arrest. One of the only other possibilities I know of is Amniotic Fluid Embolism (AFE). However, since that has not been mentioned in any article that I have seen, I would gather that that has been ruled out.)
You can follow some of the thought on this issue by reading the article and comments on the story over at Reality Rounds.
So, to close: It cannot (without more data) be said that the epidural caused all of this. But it is a definite, and a likely, possibility. All that I am requesting is honesty in reporting - not a blatant cover-up that is so big that it amounts to dishonesty.
Comments, anyone? I don't want to be over the edge with this. It's just been eating on me all week, so I thought I'd share thoughts. I'd be glad to amend this article if I have written anything inaccurate or unreasonable.
Oh, and another BIG thing.... Homebirth detractors are fond of saying "if an emergency happens at home, you can't get in to the hospital fast enough to take care of it" or "that baby would have died if he had been born at home." Occasionally (though rarely) that can be true. But guess what? This is a baby and a mother who nearly died, and most likely because of techniques used only in hospital birth. If the epidural truly was responsible, this tragedy would not have happened in a homebirth. Like babies and mothers who have died because of Cytotec inductions, this story shows that it goes both ways - there are risks at home that hospital mothers don't have (such as distance from emergency facilites), but there are also risks in-hospital that homebirth mothers don't have (the inappropriate use of interventions which can lead to problems and occasionally deaths).
* Later note: You can see what Henci Goer has to say about this event here - good stuff.