Lovely Article: "Hey, Doc!"

Never would I have thought that I would ever write enthusiastically about an article with this title, but hey... you just don't know what life will bring. Surprises, to say the least!

Anyhow. One of my - many! - passions in the birth world is questioning, and encouraging the cessation, of procedures during pregnancy and birth that in the end prove to be either pointless or harmful. Slaying sacred cows, if you will. Examples? Well, things in the old days such as enemas and pubic hair shaving (which are actually still done in something like 5% of births, according to a midwife friend of mine), and also modern-day sacred cows such as continuous electronic fetal monitoring, premature cord clamping, routine IV insertion - and vaginal exams during pregnancy and birth.

I've already written my own article on the subject of routine vaginal exams:

The Sacred Cow of Modern Pregnancy Care: Routine Cervical Exams

And a midwife friend of mine also wrote up the subject on her blog:

Cervical Exams: Who Needs Them? 

If you check out those two articles, you'll have the gist! But I saw this lovely new article come out this past week, and I wanted to post it:

Hey, Doc! Keep Your Fingers Out of My Vagina!

From the article:

"One of the things a lot of women get used to during pregnancy and birth is tons of strangers sticking their fingers in their vagina for cervical checks. It's invasive, and often embarrassing, but we grin and bear it as a necessary evil.

"Thing is, it's not necessary. Not in the slightest, and believe it or not, something so simple as just checking your cervix can cause a whole slew of problems, from infection to induction and even potentially a c-section.

"And most of the time, this check means absolutely, positively NOTHING."

The main points of the article:

- Cervical checks do not predict how soon labor will start or how fast it will go.
- Cervical checks pose many well-known risks with no known benefits.
- Competent birth caregivers have many other ways (listed in the article) of knowing how near or how far-advanced a mama's labor is.

Also - did you know?

"The US Public Health Service recommends no routine cervical exams until 41 weeks of pregnancy, yet a lot of practices not only check you early in your pregnancy, but start checking at every single appointment in the third trimester."

A new tidbit of info for me. She continues:

"And why? To just see if you're dilating or effacing ... no other reason.

"A woman can walk around dilated to a four or five for over a month. A woman can also be completely closed and have a baby a few hours later. The dilation and effacement don't always determine labor. The only time it's an issue is if your cervix opens and needs to be closed until the baby is viable -- an issue completely unrelated to third trimester checks."

Good stuff. This is definitely a sacred cow that needs slaying.

As I've said before, I went to my midwife's office fully prepared to strip down for the usual pelvic exam. It didn't happen then... or the next week... or the next week. My midwife eventually explained the above - that there is no point to routine, i.e. non-indicated, cervical checks, and that she therefore does not do them. I got through two pregnancies/births with her with a total of one cervical check.

Thanks for posting!

Unassisted Homebirth Video

Many thanks to my friend Kathy for posting this! I saw it this morning and watched it in pieces over the course of the morning and afternoon. Just wonderful! I thought I knew birth "up close and personal," but this one really takes the cake. Some midwifery or medical school needs to scoop up this gem pronto for use in teaching about birth.

Jaime's Birth 

Wouldn't it be lovely if med schools used videos like these to teach new doctors about birth?

I loved this because it is just a grand picture of natural, physiologic birth - birth as it should be. Loved the position, loved the hands-off nature of the birth, loved the encouragement of the surrounding friends/family... perfect.

This birth was titled as "unassisted," so I am assuming that there was no official midwife present, but the (unseen) woman who was talking to the mama did, in my opinion, act as a midwife in the place of the midwife - talking to the mother, coaching her, encouraging her. If she is not a midwife, she should be! I would be interested in knowing more about the actual dynamics present - was she a student midwife? A doula with midwifery aspirations? A woman who doesn't yet know her calling but will some day be a midwife? Interesting.

I will admit that not having intermittent fetal monitoring did make me nervous - or would have if I hadn't already known there was a good outcome. I suppose that it is because both of our babies have had problems with heart decels during second stage - one of them seriously - so I'm not personally comfortable without some sort of monitoring. What do you think?

I did love that second stage was so non-hurried... in many hospital births, unfortunately, the staff would have been yelling at the woman "Push! Push! Push! One! Two! Three!" This was lovely.

I loved one very amusing quote from the video (this isn't exact; I'm going from memory) - the woman coaching said something along the lines of, "You're looking just great! (Pause) Well, not literally." That cracked me up.

Also on the amusing side was my four-year-old, who was sitting in the room while I watched the video: "Mommy, she sounds like a jet plane getting ready to take off." Loved it.

The sounds this mama made while pushing brought back a ton of memories for me, because I remember making the exact same sounds.... pushing is not a fun time for me. But this birth showed me - again - how beautiful it can be!

Thank you for sharing your birth with us! Congratulations!!

Doulas Teaching Doctors

This was an excellent article from "Musings of a Montreal Doula" in which she talks about an experience of getting a chance to talk to doctors about birth support:

Doulas and Doctors

She writes:

"To be an excellent clinician in no way means you automatically know how to approach birthing women with wisdom..... to be a doctor means to interact with patients, in this case vulnerable, open, life giving women who are having peak experiences of pain and physical/emotional catharses. Some manners to keep that experience sacred, if you will, are important to learn."

She notes the following, which is absolutely spot on:

"I have known of and seen residents do the following (please don't judge them harshly...they are learning, and most of them are young and sweet...they make me want to feed them soup): talk about the baby in the next room who just suffered from major shoulder dystocia while they are standing between the legs of a woman whose baby is crowning...answer and talk on a cell phone WHILE doing a vaginal exam...allow a discussion to unfold, inspired by the fact that the woman in front of them has been pushing for a long while, about the baby earlier in the day who died from a complication and that that mom had been pushing for a long time too....tell a woman that she CANNOT deliver unless she BLOCKS her air and GETS MAD at the baby and PUSHES it out HARD........


And then - I love this! - she works on the solution rather than the problem (emphasis mine):

"So instead of us getting mad at them and irate about their insensitive treatment, why not get more pro active and guide them towards a bit more awareness of the quality of their presence? I believe in people's hearts, and I truly do not think any of these residents held bad intent in theirs. They are simply so busy learning how to be fantastic clinical care providers that it can be easy to forget that behind the pelvis is a woman and her partner...who are extremely vulnerable. The fact that doctors are entering into their practices NOT necessarily having been taught Ina May's words to live by: "If a woman doesn't look like a goddess in birth, someone isn't treating her right," means that there are gaps in medical training. Because as midwives and doulas, we are acutely aware that labour can malfunction when a mother becomes physically and emotionally distressed."

She spends the rest of the article talking about the talk/demonstration she was able to give about skills for dealing with laboring women in a supportive, encouraging, empathetic way - wonderful stuff. We need more activism like this! Instead of signs and picketing, how much more effective to teach classes to nurses and doctors so that change can come from the inside out.

Thanks for the article and for your work!

By the way, if you're not following this blog, you really should be - it is excellent! Great stuff in every post that I've read.

Open House Night

Tonight we spent two hours in Phoenix at Blossom Birth and Wellness Center's Open House - a lovely evening (music! food! bounce house for hyper children!) and an even lovelier birth center. I was absolutely astounded at the beauty of their gorgeous and spacious facility.... whoever did the decorating needs to mosey on over to my place for a few weeks. They have two or three beautiful birthing rooms, also a room with a labor/birth tub, plus a kitchen, a common room, rooms for prenatals and consultations, and rooms for a few other professionals (acupuncture, etc.). It was beautiful, beautiful, beautiful, and I am so excited about finally having a birth center to recommend to mamas who want something in between hospital and home.

Congratulations, ladies!

A Mother's Birth Story Collection

Jessica at Working on a Full House has posted an entry telling her four birth stories - with accompanying adorable baby pictures!

My Birth Stories

Her first birth was a hospital birth - epidural, episiotomy - that she describes as follows:

"I really regret having her in the hospital and that way. It was all so un-natural and off. They swooped her away from me and I did not get to hold my little girl for 45 LONG minutes because they said they needed to get stuff out of her nose and clean her up.......Then they left and I tried to nurse and it did not go well. The nurse was rude, I was clueless and just did what they said. I remember them wheeling me into another room and told me I needed sleeping drugs and I said "okay" then they took Gracie for the night and fed her formula from a cup without my permission and brought her to me the next morning. Also, they gave her a vitamin K shot without me knowing and put some antibiotic in her eye without me knowing(which I believe led to a year of a clogged tear duct for her) and it just disheartens me thinking about it all. We were so ignorant and young."
 
But she also says:

"I do however remember just being head over heals in love and like I was just given the best gift in the whole world. I remember praying and thanking the Lord and asking Him to make me better for her. I wanted to be a better person because of this little life. I remember crying with joy often because I was so in love and grateful for Gracie. She captured my heart like nothing else had before. She was the beginning to a new life of rewards and blessings that I could have never dreamed up."

What a sweet tribute to a new little one!

Her subsequent three births were all-natural births in a midwife-run birth center, which she rates very highly.

Thanks for sharing! Looking forward to hearing your next upcoming birth story! 

Arizona Birth Story

Check out this birth story of a very recent birth by an Arizona mama, attended by one of our wonderful local licensed midwives:

Birth Story

Congratulations to Alli & Jack on the birth of their little one!

Later note:

You can see their birth video/montage here:

Birth Video

Just lovely! I would so do this with our pictures/video if I had the know-how. Thanks for sharing!

It's 9:00 p.m. ..... Do You Know Where Your Midwife Is?

I know where mine is! She is currently - yes, really! - at The Farm in Tennessee, cavorting with internationally renowned midwife Ina May Gaskin and having a blast. May I say that I am dying of envy? I can't wait to see her pictures and hear all about it when she gets back! If she posts pictures publicly, I'll link to them.

For anyone to whom that was gibberish... Ina May Gaskin is one of the United States' (and the world's) most famous midwives - she was one of the founders of the United States grassroots midwifery awakening movement (I just penned that phrase) that got homebirth back as a reality in the United States. She has an obstetrical maneuver named after her - the Gaskin maneuver, for relieving one of birth's most serious emergencies, shoulder dystocia - and is an acclaimed lecturer and teacher on the subjects of homebirth, birth in general, and breech birth. She has authored the books "Spiritual Midwifery" (an early, hippy-type text) and the wonderful "Ina May's Guide to Childbirth," which is one of my favorites.

Have a wonderful time, dear friend!

Accidentally unassisted homebirth

I loved this birth! Wow, talk about fast!! One minute twenty-three seconds - at 0:00 she is getting into the tub, and at 1:23 she is cradling her newborn - and indeed, has been doing so for at least thirty seconds! Wow! (I watched it again later and found that the time from "woman climbing into tub" to "woman holding new baby" is about 22 seconds. Amazing!)

This is an accidental unassisted birth - the midwife was five minutes away, but didn't quite make it.

When I was watching this birth, my one concern was why the mum was so disengaged from the person videotaping. Why wasn't she smiling and talking and making eye contact?

And then I read the caption - not only did the midwife miss this birth, but so did her husband! He went down to meet the midwife, she got in the tub, and BAM! Hubbie and midwife both came back to find a mama and baby cuddled up in the tub. What a woman! Loved it!

(The video says disabled for some reason, but just click on it to watch it on YouTube.)

Update on Baby Ewan

This sweet little one did not make it through his difficulties - he died last night in his mama's arms, having just passed his 2-week birthday, due to a bacterial infection complicating all his other issues. You can read his sweet story here:

The Hope That We Have

Praying for his sweet parents in their time of grief and mourning.

Interesting Article: Birth Rape

I have been following the birth rape debate (i.e. the "do women have or not have the right to call certain birth abuses "rape"?) for a while now, and it's an interesting one.

Do I believe that birth rape exists? Absolutely. Try checking this out at Navelgazing Midwife:

Birth: Rape and Otherwise

And here's the thing: I have heard the same stories, over and over, from every doula with whom I have ever spoken. Laboring women being held down, being given forced, unwanted vaginal exams, being cut (given episiotomies) against their express, spoken wishes - all sorts of absolutely horrific abuses that come under both the categories of assault/battery and rape. This stuff is not being made up. If you want to know more, just google "birth rape" and you will find some of the ugliest, horrific stories you have ever known. (And perpetrators are not limited to obstetricians - they include also midwives and nurses and other healthcare providers.)

Navelgazing Midwife also wrote another excellent article on the subject - I encourage you to check it out:

What Doesn't Feel Right, Isn't

I read another fascinating article on the subject today, which I encourage you to read - an excellent perspective:


It's Not RAPE Rape

Does anyone have thoughts on this? Discussion is welcomed. (Though it must be polite, calm, respectful and thoughtful. Any sort of hatefulness or rudeness will be, as always, deleted automatically and immediately without comment.) But this is a very thought-provoking topic, though a very saddening one.

I thank God that I have only known the most humane and respectful treatment from my pregnancy/birth care providers - some women aren't so blessed. A big thank-you to all the obstetricians, physicians, midwives and nurses out there who are out there providing wonderful, respectful, loving care to pregnant and birthing women! We love you!

Birth With Forceps

You find birth everywhere, don't you?

I am currently reading "The Late Talker" (Agin, Geng & Nicholl) in an effort to learn more to help our little one, who is likely going to have speech delays. In reading the forward, I ran across this:

"... Dakota, who had severe respiratory and devlopmental problems due to a traumatic forceps delivery. Dakota had suffered torn neck muscles, crushed facial nerves, and internal head bleeding - and he was a late talker. From birth he had been under the observation of a neurologist and receiving therapy."

Yikes.

I wondered then - how often are forceps needed during unmedicated births? I have never heard of an unmedicated mother needing forceps - the only times that I have heard of forceps being used have been with medicated (i.e. epidural) mums.

In looking it up, I found that there is a definite association between epidural use and forceps delivery. Here is one article that was very interesting (though it was quite old - 1985):

Epidural analgesia during labour: Why does this increase the forceps delivery rate?'

Here is a quote from the article:

"It is postulated that this rise in the incidence of forceps delivery is at least in part due to the abolition of the Ferguson reflex due to blocking of the pelvic autonomic nerves, as demonstrated by Goodfellow et al. (1983). Since there is an increased instrumental delivery rate in those patients with epidurals in whom cephalopelvic disproportion has clearly been excluded, the need for instrumental delivery must be due to deficient expulsive forces. Maternal bearing down effort is certainly compromised by the lack of sensation, but in the light of the above studies it is thought that there may also be a deficiency in uterine activity."

From the website Childbirth Solutions, I found this listed under epidural risks:

"Often slows second stage by reducing or eliminating the normal surge of oxytocin; and by reducing pelvic floor muscle tone, which may lead to more deep transverse arrests or persistent occiput posteriors. In addition, forceps or vacuum extractor are required more often (20-75%)."

Yikes.

Considering that homebirth midwives safely attend naturally-laboring women with no forceps or vacuum, it seems to be likely that forceps and medicated labors are inextricably intertwined, as are unmedicated labors and the absence of a need for forceps.

The only time that I have heard of homebirth midwives being unable to bring babies out naturally are when baby is good and truly stuck, and a hospital transport is made for a cesarean (as happened to a friend of mine two months ago). But if baby can fit, then forceps just don't seem to be needed with an unmedicated, mobile, and usually-upright mother.

Whatever the cause, forceps are associated with occasional incidents of gruesome injuries, like this story from last year (poor baby!) and others.

Definitely a reason to favor unmedicated birth whenever possible, and a reason to favor vacuum extraction when any sort of extra assistance is needed, rather than forceps. (As a matter of fact, I believe that the vacuum extractor was developed in part to avoid the injuries observed with forceps births.)

Thoughts, anyone? More data to share, or stories? Please share!

Lovely Birth Story with Pictures

A new acquaintance of mine, and a new member of our local birth community, recently posted her birth story, with associated pictures. Lovely!

Why a Midwife?

Her midwife, Stephanie Soderblom, is the owner of Nurturing Hearts Birth Services and the author of the blog Vita Mutari - she is amazing. Her doula, Rose, is one of the two doulas who attended my last birth - similarly amazing! I highly recommend them both. 

Here is what she has to say about her decision to switch from OB care to a midwife:

"After several classes, I decided OK, maybe I could do natural childbirth, maybe. So at about 32 weeks pregnant I began discussing this with my OB/GYN. She responded with a slew of questions and comments from, "define no medical intervention" to "you know, there is no medal for doing it natural". Now, mind you, these are the last things you need to say to an already scared-ish first time mom....

(after switching)

"From the start, Stephanie cared more about me as an individual instead of a statistic. We met in her beautiful, small, cozy office. Neil and I sat on a couch, not a paper covered table (why do I have to sit on a sterile, paper wrapped table to be weighed & have my tummy measured on the outside?) . She talked with us about what kinds of parents we would be, what our fears were, how she could help us have the birth WE wanted.  It was, after all, our child. Our appointments were an hour, not ten minutes. She used organic lotion on your belly that smooths in, instead of that cold goo at the doctors office. She taught Neil how to feel the position of the baby on the outside of my tummy. She listened to his heartbeat the old school way."

Her labor description is the essence of midwifery:

" Shockingly, there isn't much to do for a naturally laboring woman besides well, supporting her.  So I labored (and labored) like they did in the old days, in the company of women (and my husband) that had walked that path before. That is where Rose, our doula came in.  That was her job, to help me.  Every minute I had her support, I was in my own space, comfortable (well... you know what I mean) confident and safe. I don't think I possess the right words to accurately describe what a room full of women, who have been called to help bring babies into this world, really feels like. It is probably like the safest hug you ever had, contrary to mainstream thought.  Every well wish, positive vibe, good energy was present in my bedroom.  The baby's heart rate was monitored, I wasn't disturbed or hooked up to anything.  It was intense, but beautiful.  While I labored, Stephanie and Rose massaged my arms and back and Stephanie knitted baby caps outside in the hall.  That's what she does.  Knits caps for all "her" babies they day they are born. No generic pink and blue stripes. Homemade, heartfelt, perfect.  Every knit a prayer for the mama and baby in front of her."

This is how she concludes, regarding her decision to choose a midwife:

"So, for those people that are wondering about the quality of care and expertise that a midwife has, I think it is safe (no pun intended... really :) to say we hit the jackpot.  This is not to say that people that see doctors are get less than quality care, not at all.  There are fantastic doctors/nurse midwives/ nurses and hospitals. Don't misunderstand me. I am so glad that there are OB's out there, I am also so thankful that we were not in a situation that we needed one.  This is just why we chose a midwife, what was best for our family. 

 

"So there it is, the biggest and best choice we made to date.  This is why midwife?.  I love Stephanie so much at I am forever grateful for her presence in our lives.  I am glad that there are people like her on this Earth.  It gives me hope.  I hope she is there for all of my babies births, that each one of my children get a cap made on the day of their birth and get sang "Happy Birthday" in their first hour Earth side.  Having a baby is not just about the labor but the experience, and without Stephanie, it wouldn't have been as sweet.  I am leaving out details how amazing our doula was too, maybe the next post. All these reasons are why we chose a midwife. I feel incredibly blessed to have had this kind of birth story.  I wish a personal version of this for every woman/family.  Stephanie (et.al) helped me, my husband and my son become a better unit, a better family.  I now have the confidence and power to make my own choices regarding my family, my body and my life.  And there is no better feeling than that."

 

Thank you for sharing! 

Birth Story & Prayer Request

This is an absolutely beautiful all-natural (after a medically-indicated induction), doula-attended hospital birth.... check it out:

Ewan's Birth Story

And what a lovely OB she had - I loved how sweet, gentle, and concerned she was - really concerned about both baby and mama, but giving choices and respecting decisions. Just lovely.

"She explained to us what our options were. She could send us home, seeing as the baby was obviously doing fine at this point. Her concern was that there might be a drop in activity that we wouldn’t know to be alarmed about and that they wouldn’t be able to get him out in time. That’s what my heart can’t handle, she said, choking up and her eyes misting over. The other option was to stay and induce. She would try some natural means first, stripping the membranes and seeing how that worked before we tried anything like pitocin. She left us so we could discuss, and would come back to check and see what kind of progress I might have made already."

Just lovely! What a great doc. 

But now, for the most important - really important - part of this post: a serious and urgent prayer request for this baby and his family. This family needs your prayers right now.

The parents knew that baby Ewan would have problems, but he has turned out to have far more extensive health concerns than was believed. He is currently not doing very well, and his parents may have to make end-of-life decisions very soon if he does not pick up very quickly. Would you pray for this baby? For his healing and his health to progress, and also for peace and strength for his parents. You can follow their story as it develops at the above link.