Monday, May 31, 2010

A Few Great Articles

These articles are on different topics, but all caught my eye for one reason or another.... As I don't have time for separate blog entries, here they are!

On the subject of the dangers of multiple cesarean deliveries:

Dangerous Delivery Shows Peril of Multiple C-sections

The ease with which cesarean deliveries are handed out nowadays fills me with both anger and grief. Mothers are pounded repeatedly with the "horrible perils" of VBAC, but never told the risks to both them and their babies of cesarean delivery, especially repeat cesarean delivery. This article deals with the dangers to the mother of repeat cesareans - primarily adhesions and placental attachment abnormalities - such as placenta percreta, when the placenta burrows too deeply into the uterus at the site of a cesarean scar, causing hemorrhage and usually necessitating an emergency hysterectomy.

Regarding a case of placenta percreta in a woman having a repeat cesarean, the author (an OB) says:

"But with my patient's placenta stuck and bleeding, only one option remained: removing the entire uterus with the placenta still attached. Because the pregnant uterus is large, swollen, and filled with blood, a hysterectomy after a delivery is very dangerous and performed only as a last resort.

"By the time we finished the surgery, blood covered the floor. Blood filled suction buckets, and saturated our sterile gowns and drapes. Blood-soaked sponges piled up in the corner.

"My patient lost three times the entire blood volume of a normal person, sixteen liters in all. Only a massive transfusion kept her alive. Anesthesiologists pumped in 51 units of red blood cells and seven six-packs of platelets.

"Vessels deep in her pelvis refused to stop bleeding, and instead of closing her, we packed her abdomen with surgical towels, hoping the pressure would stanch the slow, steady flow. She left the operating room and headed to the intensive-care unit with her abdomen still open."

How many OBs are quoting risks like these when handing out cesarean deliveries like hot cakes?


Regarding the other set of risks to cesarean sections - the risks to the infant - I absolutely loved this article:

"Natural Births Better for Babies"

The bulk of this article deals with the issue of bacterial transfer. During a vaginal birth, the infant - who comes from the womb sterile - is coated from head to toe in the mother's beneficial vaginal bacteria, and thus the bacterial population of his body is started off in a healthy and balanced way. During a cesarean section, not only does a baby miss out on beneficial labor hormones that he would get during a vaginal birth, but also misses out on the beneficial bacterial colonization. Instead, he is at the mercy of the bacteria of his surrounding environment. The same holds true for mothers whose bodies are artificially sterilized by GBS-protocol antibiotics. It really makes sense to me that cesarean babies have higher levels of all sorts of diseases, from dental cavities to diabetes to allergies to asthma (and why babies born to mothers on antibiotics have higher rates of E. coli infection). The author states:

"BABIES born by caesarean section are more vulnerable to asthma, allergies and infection as they miss out on receiving their mothers' good bacteria during birth, a scientist says.

"Professor Patricia Conway, of the School of Biotechnology and Biomolecular Sciences at the University of NSW, said babies delivered vaginally received protective bacteria as they passed through the birth canal. Left on the baby's skin, this bacteria could then colonise the intestine and help inoculate newborns against hospital bugs. Gut flora was also crucial for developing a balanced immune system, Professor Conway said. "With a C-section, the newborn baby misses an opportunity to pick up a lot of mum's good bacteria," she said.

"'This can have long-term health implications, as the development of a good intestinal ecosystem is necessary for health and immunity to allergies, from childhood right through to adulthood.'

'Professor Conway said emergency caesareans, performed after labour had begun, meant babies did receive some of the beneficial bacteria, particularly if the waters had broken. But elective caesareans were ''sterile'' and gave babies no chance to pick up any of the mother's good bacteria....

"In 2008, European researchers examined 20 previous studies on the link between type 1 diabetes and caesareans and found babies born surgically had a 20 per cent increased risk of developing diabetes.

"They hypothesised the increase could be attributed to surgically born babies having gut microbes picked up from hospital environments rather than their mothers' vaginas, having reduced or delayed exposure to infection in early life or being exposed to non-specific perinatal stress."

The author also dealt with the issue of labor hormones. Cesarean babies, especially those born by scheduled cesarean, miss out on the labor hormone cocktail which they experience during vaginal birth:

"Australian College of Midwives vice-president Hannah Dahlen said babies born vaginally had the advantage of hormonal surges during labour, which made them more wide-eyed and able to connect with their mothers.

"Both mother and baby experienced a surge in catecholamines - the fight-or-flight hormone - during labour, making babies more alert at birth.

"Recent studies had shown white blood cells in babies born by caesarean were different to those born vaginally, potentially altering the way their bodies responded to attacks on their immune systems for the rest of their lives.

"The studies could explain dramatic increases in rates of diabetes, testicular cancer, leukaemia and asthma among babies born surgically, Dr Dahlen said.

"'In labour, the baby has a gradual escalation in its stress response and then a gradual decline. Research has shown that this could prime our bodies to respond to stress in a certain way,'' she said.

"'With a C-section, there is a cold cut and the baby has a dramatic stress response. It could be setting that child up to always over-respond to stress.'"

How about those risks being quoted to cesarean mamas?


I LOVED this article on vaginal exams:

"The Dangers of Vaginal Exams"

There are two parts to this article - the first part shows those things that can be determined by vaginal exam (dilation, effacement, station, cervical position, fetal position, and cervical consistency). The best part, however, is the second section of the article which describes the reasons why vaginal exams are both unnecessary and often harmful.

Why unnecessary? Because in most cases labor progression can be determined in other ways. Additionally, when a labor is progressing normally with an absence of pathological symptoms, knowing numbers for each step of the way is just not necessary.

Why harmful? For too many reasons to count! Here are those reasons listed by the author:

- Premature cervical stimulation
- Risk of premature rupture of membranes
- Negative effect on mother's emotional state ("What do you mean, I'm only a 3???")
- Risk of infection

Good article. Check it out!


Then two articles on one of my pet subjects, premature vs. physiological umbilical cord clamping. Current in-hospital practice is to cut the umbilical cord within 30 seconds of birth, when it is still pulsing and the baby is still receiving blood from the placenta. Most homebirth midwives wait until the cord clamps down naturally, which happens within 10-20 minutes after birth (usually), and then cut the cord. Personally, I cannot believe that anyone could consider premature cord clamping as healthy. If it is necessary to disrupt a natural process that has been going on undisturbed in the animal world for millenia (and in the human world until the last 50 years), then (1) the human race would not have survived, and (2) the world would be filled with dying baby animals, staggering about and collapsing on the streets because no one thought to clamp their umbilical cords while they were still pulsing. Think about it.

Wait to clamp unbilical cord, study says

The author says:

"After reviewing the majority of research in the field, Sanberg and his colleagues concluded that delaying cord clamping could reduce the infant's risk of many illnesses, including respiratory distress, chronic lung disease, brain hemorrhages, anemia, sepsis and eye disease.

"The risk of such problems, and thus the potential benefit of delaying cord clamping, is particularly significant for premature babies and those born malnourished or suffering from other complications.

"Still, the researchers suggest delaying cord clamping may be beneficial for healthy, full-term babies as well — after all, it may be what we have evolved to do.

"'Evolutionarily, there is clearly value for this," Sanberg said, explaining that all mammals, including most humans through history, allow the maternal blood to finish being transferred before severing the cord. The squatting birthing position, only recently out of vogue in the West, may have even facilitated this transfer by harnessing gravity."

And also:

"Do We Clamp the Umbilical Cord Too Soon?"

(Short answer: YES. Long answer: YES.)

From the authors:

"At birth, the placenta and umbilical cord start contracting and pumping blood toward the newborn. After the blood equilibrates, the cord’s pulse ceases and blood flow from mother to newborn stops. In recent Western medical practice, early clamping — from 30 seconds to one minute after birth — remains the most common practice among obstetricians and midwives, perhaps because the benefits of delaying clamping have not been clear. However, waiting for more than a minute, or until the cord stops pulsating, may be beneficial, the authors said....

"“Several randomized, controlled trials, systematic reviews and meta-analyses have compared the effects of late versus early cord clamping,” said Dr. Park. “In pre-term infants, delaying clamping the cord for at least 30 seconds reduced incidences of intraventricular hemorrhage, late on-set sepsis, anemia, and decreased the need for blood transfusions.”

"Another potential benefit of delayed cord clamping is to ensure that the baby can receive the complete retinue of clotting factors...

"The researchers concluded that many common disorders in newborns related to the immaturity of organ systems may receive benefits from delayed clamping. These may include: respiratory distress; anemia; sepsis; intraventricular haemorrhage; and periventricular leukomalacia. They also speculate that other health problems, such as chronic lung disease, prematurity apneas and retinopathy of prematurity, may also be affected by a delay in cord blood clamping."

Premature cord clamping is a practice that needs to go the way of all antiquated medical practices, and the sooner the better. However, killing sacred cows in the obstetrical world is a world-moving task. Hopefully sometime!

Okay, I've gotten these articles off of my chest - now I can delete them from our browser and stop driving my poor husband nuts! Goodnight, all!

(As always, thoughtful and polite discussion and comments are always welcome. Rude or offensive comments will be deleted without response.)

Saturday, May 15, 2010

Making a Difference: Your Assignment for This Week

Earlier this week I posted the video from this amazing hospital waterbirth, which was attended and conducted more like a homebirth (and a great homebirth at that!). The mother informs me that this type of birth (non-interventionist waterbirth) is not widely available at this hospital (her waterbirth was the first and only waterbirth to occur at this location).

What can we do to help? Send a quick email to:


Tell her how much you appreciate the wonderful treatment this mother received, how amazing this birth was, how much you hope the hospital will support future waterbirths, and whatever other praise and encouraging input you can think of! Emails from women will be a big help to show the hospital that waterbirth is both desired and a practical option for them!

So send an email! Even if it's just "Just saw the waterbirth video from the waterbirth at your hospital; loved it, so happy that you have waterbirth and will be recommending your hospital" etc. etc. etc.

Thank you, Sarah, for providing this information! Email me if I've botched anything!

Friday, May 14, 2010

Great Birth Quote

I am currently re-reading through ICAN's birth-story blog festival from April, and I found this quote that I loved from Sherena's HBAC story that mirrors a lot of what I felt about natural birth:

"I came away from my birth experience feeling, “Wow, what was that? THAT was amazing.” It was traumatic. It was awesome. It was painful. It was cool. It was frustrating. It was a triumph.

"Since my daughter’s birth, I’ve read off and on some of my birthing books and stuff on websites. I’ve watched birth videos. I’ve read birth stories. I’ve been looking for something—an explanation. Why did I think that was so cool? I didn’t expect this transformation of sorts. How do I explain how I felt about giving birth naturally? I thought I knew how I would feel. I was wrong. It was more awesome than I expected. Why do I feel like it affected me so greatly? Am I becoming the sappy female that I’ve always vowed I’d never be? I can’t find the words. In the reading I’ve done, I’ve come across two words that are used often in describing natural childbirth. Those words are “empowering” and “transforming.” Do I think these words apply? Sure. Can I explain what they mean? I don’t know if I’m there yet, but am ok with leaving their meaning a mystery. Perhaps it’s meant to be a mystery—maybe something given to us at creation. I recommend the journey of natural childbirth. Don’t be afraid of the challenge. I believe women are stronger than they often think they are."

Love that.

Wednesday, May 12, 2010

Free E-book: "I Will Carry You"

Barnes and Noble is carrying the e-copy of the new book "I Will Carry You" for free right now, so if you're interested, hop over and download it! The offer is ending soon, maybe even today, so don't wait if this is something you'd like to have. I personally want the hard copy sometime, but since extra money around here is not happening right now, I'll settle!

The author Angie Smith, wrote this book (and her blog, see above link) after the pregnancy and birth of her daughter, Audrey Caroline, who lived only three hours after birth due to severe birth defects (that the parents knew about before the birth). Her journey has had an incredible impact on my life, and if you haven't read her story yet, you can just click to the beginning of her blog and read the entire thing. Highly recommended!

Can't wait to read this book!

Tuesday, May 11, 2010

The Birth of Malakai Thomas Reeves

This is probably one of the most beautiful hospital births I have ever seen! Ever! Check it out!

The mother stated that this was her fourth birth, her first three being homebirths, and that they birthed in-hospital after finding that there was a chance baby would be born with hemophilia (he wasn't).

I was so impressed with the hospital staff in this movie. If all mothers birthing in-hospital could look forward to this kind of treatment and birthing environment, then our problems would be over. I do believe that homebirth has some inherent advantages over hospital birth on the whole, but since many women will always want to birth in-hospital, this is what hospital birth should look like. Loved it!

Thanks to Bellies and Babies for posting this!!!


Later addition: You can read some comments and an interview with the mother, Sarah, by clicking on this here. Good stuff!


Even later addition: The hospital where the above birth took place is unfortunately still not waterbirth friendly (this birth was an exception, not the rule). Want to make a difference?Email Robin Piaggione at and tell her how much you appreciate, admire, and love this birth and the fact that this mother was able to obtain a non-interventionist waterbirth - she is working hard to make waterbirth available for other mothers, and all letters received will help her to make this happen. Off to email.....

Unassisted Birth Video

I loved this video! Check it out!

The caption says:

"What happens when you go to use the bathroom and you feel your baby start crowning as you sit on the toilet? This mom was only in labor for a short time and fully intended to go to the hospital, but she had to go to the bathroom first. (Often feeling like you need to take a BM is really the baby‘s head!) Sure enough, instead of a BM she looked down to see the baby starting to come out as she pushed on toilet. No time to go to the hospital, so she stayed calm, stayed where she was, and gently pushed her baby’s head out and then the rest of the body on the toilet with her husband‘s help."

Find more videos like this on My Best Birth

This mother was an amazing birther - wow! She is head and shoulders about me in birthing technique. And the daddy - WOW! This fellow needs to drop his day job and become a midwife! He was terrific!

The only thing that made me nervous about this birth was that the mother stayed on the toilet almost to the moment of birth - having seen how fast babies catapult out at the end of birth, I would definitely be nervous of baby falling into the toilet! But the dad did an awesome job and caught the baby quite professionally. And did I see a caul?

Congrats to this family!

More on Daddies and Doulas

A year or so ago I wrote on the Daddy-Doula Dynamic, or why doulas are an awesome choice even when a husband is present and actively participatory. Birthing Beautiful Ideas has written another article on the same subject, and it was great! Check it out: "Doulas are for (Women Who Have) Birth Partners." Thanks for the article! I love any chance to promote doulas and the great things they do for birthing women.

Friday, May 7, 2010

New Birth Network Blog: San Diego, CA

Very neat! Just ran across this new blog for the San Diego Birth Network today on Facebook; should be good! Our Arizona Birth Network already has a blog, and it's great to see that other birth networks are following suit. What better way to get the word out there? And what's better, they already have a great article on placenta medicine (my personal passion!) up!

"San Diego Birth Network is a group of dedicated professionals that support mothers, babies, and families during the prenatal, birth and postpartum period. Pregnancy, birth, and the postpartum period are milestone events in the continuum of life. These experiences profoundly affect women, babies, fathers, and families, and have important and long-lasting effects on society.Our mission is to create a place that allows families the confidence that the professionals listed believe in the normalcy of the birthing process and empower families with knowledge so that they can make educated decisions about their care."

Welcome to the blogosphere, San Diego!

Blog List Updated

I read something like eighty birth blogs (thankfully most of them aren't very active!), but my sidebar blog list has had only about 20 of those listed - I got in the bad habit of adding blogs to my reader but not to my sidebar, and was too intimidated by the task of copy-paste-copy-paste-etc. to get around to updating. Today I accidentally found that it's much easier than I thought, so my sidebar of blogs is now pretty much updated!

Arizona Birth Network Family Picnic - Pictures!

Here are the lovely pictures from the Arizona Birth Network Spring Picnic of a week or two back -an event which I missed due to needing to deal with the aftermath of stomach flu! Goodness, I'm missing out on everything this spring! We haven't been sick a lot, but when we are, it seems to fall on top of a lot of cool stuff on the calendar! Hopefully I'll be able to attend their next event without the drama of stomach flu!

Tuesday, May 4, 2010

Fall Midwifery Picnic Pictures

My wonderful midwife has posted pictures of our last client-reunion fall picnic (from Fall 2009), so if you click on this link and then click on "Fall Picnic 2009" you can see lovely pictures of this event! All of our midwives, apprentices, and tons of clients are pictured!

Fall Picnic 2009

I am pictured occasionally in these photographs, along with both our elder son and baby (who was then 4-6 weeks old). This was a hard time for me - I was out by myself with both kids (for probably the first time), dealing with some yucky back pain, and also pretty much a single parent (DH was out with that broken rib that he got falling in our flooded kitchen... such a fun time!). It was nice to get out and see people, but also very stressful to care for baby and try to watch our eldest run about at the same time! Definitely a learned art. During the big group picture, I am trying to smile for the camera while frantically scanning the playground trying to find our son (he went AWOL for quite some time). Ah, well - thankfully, life is not quite as stressful as it was during that month!

We love our midwives! Tomorrow is the International Day of the Midwife - celebrate! And hug a midwife while you're at it!

Where Am I?

Good question!

Any readers will have seen that my posts on this blog have been a bit sparse lately, and those that I have posted have more often than not been "Hey! Someone at blog X wrote a really good post, so go and read it!" - i.e. not my own writing.

Two reasons:

Reason #1: My time for blogging (or anything non-essential) has been reduced to almost nil lately. Blogging mothers of more than one child, I salute you! I really don't know how you do it! Between meeting the needs of my two children and my own need for sleep (and a reasonably clean living space), my personal time has vaporized. On the rare occasion that both children are sleeping at once, my instinct is to snatch a nap. Or scrub baseboards with a toothbrush, depending on my obsession for the day. (No, I don't scrub baseboards - no time - but they are driving me crazy to look at! Who thought of these crazy dust-collecting fixtures, anyway?) But anyhow, blogs have had to take a backseat for now.

Reason #2: I have felt called lately to turn my energies (or what remains of them) inward, toward my family, my parenting skills, my faith life, rather than outward toward my involvement in the birth world. Birth-junkie-ism can be rather all-consuming, and I believe that God is calling me to put that on the back-burner and focus on my kids, my marriage, and my relationship with Him - all of which could use some work! Thus, I have been limiting my involvement in the birth community, blogging less than I would like, and putting most birth-related reading on complete hold. Instead, I've been trying to focus on my Bible time, reading parenting and marriage books, and focusing on learning the skills I need for a happy and healthy home life. That is challenge enough to occupy my time!

Back-tracking has not been easy for me. As birth junkies know, when the birth bug bites, it bites hard. And it bites for good. I am in the birth world for good, and hopefully there will be a season of my life when I can participate more fully.

Believe me, I will still be around (I think!). And all of this could reverse tomorrow. But for now, if I'm not around as much as I used to be, you'll know why!

One project I have been meaning to tackle (and will hopefully get to soon) is writing out my breastfeeding stories. With both babies I have had incredibly hard times establishing breastfeeding (for completely different reasons with each!), and I want to write those stories down before I forget them any further! Hopefully in the next week or two.

And now, off to bed! A busy day ahead tomorrow!

Historical Mystery: Death in Childbirth

I love the writings of Jane Austen, and I also love reading biographies. What better then to read than a biography of Jane Austen? Pure pleasure.

This past week I devoured "Jane Austen: A Life" by Claire Tomalin and thoroughly enjoyed it. A great read! I thoroughly recommend it.

It is often said that "three of Jane Austen's sisters-in-law died in childbirth." In this book only one of the deaths is described, and I find it puzzling - for two reasons; firstly, because the death was due to unknown causes, and secondly, because it occurred (seemingly) about a week after the baby's birth. Is that really counted as "dying in childbirth"? What is the definition of dying "in childbirth" according to the lens of history? Was this woman's death even due to childbirth? It would seem to be so, but it could also have been due to a non-childbearing cause. Very puzzling.

(Someone told me a long time ago that in historical times, a woman who died during pregnancy or up to one year postpartum was considered to have died "during childbirth," and it was partially for that reason that reported historical rates of women dying in childbirth were so high.)

Here is the describing passage:

"Fifteen-year-old Fanny wrote in her diary on 27 September, 'Mama as usual very low,' but on the 28th, 'About three this afternoon to our great joy, our beloved mother was delivered of a fine boy and is going on charmingly.' On 4 October 'Mama got up for dinner,' and the next day 'Papa to Quarter Sessions.' On Saturday the baby was named Brook-John, names from Elizabeth's family. Three days later, the mother was dead, leaving a family stunned by the suddenness of her collapse. The doctor could offer no explanation; she had eaten what Fanny called a hearty dinner only half an hour before the end. She was thirty-five; a well-to-do, well-born, well-looked-after woman who had married for love at eighteen, and been pregnant almost permanently ever since." (Tomalin 1997, p. 204-205)

Any guesses? My own guess would be that the death was not due to common childbirth complications (childbed fever, hemorrhage, etc.), as the symptoms of those complaints are and were well-recognized by physicians.

Oddly enough, the wife of one of my husband's co-workers experienced almost the exact same situation this past week - she had her baby last week and several days later collapsed from a brain hemorrhage. She is in the ICU and is expected to survive, but most likely would not have survived 200 years ago in the same situation.

Three of Jane Austen's sisters-in-law died "in childbirth" - one after her fourth child and the other two after their eleventh (!!!).

If anyone has any information or guess as to any of the above-mentioned mysteries, bring it on!



As usual, my friend Kathy shares some insight! :)

"Maternal mortality is defined as the death of a woman during pregnancy or within either 42 days or 365 days of the end of pregnancy (whether miscarriage, stillbirth, live birth or abortion), and somehow due to her having been pregnant -- car wrecks don't count; malaria and hemorrhage do. I think most people still think that "maternal mortality" equals "dying in childbirth", whereas I think of "dying in childbirth" as a death that happens during labor or immediately after (due to hemorrhage or something like that) and directly attributable to the birth.

"Often, deaths were not well-understood -- was it a heart attack, stroke, aneurysm, internal hemorrhage, bacterial infection, etc.? Was it somehow complicated by her having been pregnant, or was she a ticking time bomb with an unknown problem, and just happened to die a few days after birth as opposed to a few days before or a year before or after?"