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August 5, 2010

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The Complete Book of Pregnancy and Childbirth

May 5, 2010

Written by Sheila Kitzinger.

This was, by far, the best pregnancy book I’ve read.  It was very natural-friendly, birth center and homebirth advocating, and had none of the “here’s what could go wrong, ask your doctor how you should proceed at every turn” undertones that “What to Expect…” has.

It is filled with facts and statistics to back the claims it makes in support of natural birthing methods.

It is often claimed that, because far fewer mothers and babies die than say, 60 years ago, when most women had their babies at home, hospital birth must be the cause of this.  But, of course, the fact that two things happen at the same time does not mean that one causes the other.  Nor should we use statistics of home births from the past, or in developing countries.  Many other things are different, including our health, our access to contraceptives, and abortion, and our socioeconomic conditions.  These have a profound effect on perinatal mortality.  As the standard of living rises, fewer babies die at birth in every country, whether or not they are born in a hospital.  (pg 45)

There are full-color pictures of real-life people to demonstrate exercises to alleviates pain and strengthen the body, positions to try in labor, and examples of various other things to expect.

It also does a good job of explaining the why instead of just the how and what.

Childbirth is not primarily a medical process but a psychosexual experience.  It is not surprising that adapting your responses to the stimuli it presents should involve a subtle and delicate working together of mind and body. (pg 181)

Kitzinger explains the differences between locations of birth and stressed the importance of making the space a woman chooses her own and having privacy.

When women describe their birth experiences in hospitals, especially large ones, they often talk about all the people who wandered in and out, anonymous faces looking through the porthole window in the door, and conversation about them, not with them, conducted over their supine bodies.  Can you imagine the effect of having strangers and other observers around you when you took a bath, sate on the toilet, tried to sleep, or were making love?  Birth is a psychosexual activity that involves revealing that which is usually physically and emotionally private…To be watched by someone with whom you have you have no intimate and trusting closeness, to be inspected, criticized, applauded, and urged to do better, can interrupt and prove an obstacle to psychophysical coordination.  This is why it is important to create your own space for birth, and to arrange to have one or more companions with you with whom you feel not just comfortable but completely at ease…You need to choose a birth companion who will be like an anchor for you in a stormy sea. (pg 187)

She goes on to urge the woman to choose a female companion to attend the birth with her.

Research shows that if a woman has another woman with her during labor and birth she has a less need for pain-relieving drugs and her labor is shorter.  There are fewer operative deliveries (forcepts, vacuum extractor, and Cesarean sections) and episiotomies.  Babies are in better condition at birth and mothers are much more likely to look back on the birth as a positive experience.  Studies also have revealed that these women have fewer perineal lacerations, are more likely to be breastfeeding at six weeks, and are less likely to be depressed.

This all agrees with the research and findings behind professional doulas.  Statistics all favor doulas in every case.  Even women who end up with a necessary c-section are happier with the outcome because they feel supported and informed when making the decision instead of coerced into it as so many women feel these days.  Even in situations where the birthing mother didn’t know her female companion, such as a hospital-provided doula, reported benefits of a non-medical female support person.

Being in tune with the body and nature are big factors in a good birth experience.  “Purple pushing” consists of waiting for the beginning of a contraction, exhaling, then taking a deep breath holding the breath while pushing to the count of ten, then exhaling and repeating two more times before the end of the contraction.  But all evidence-based birth shows this is a horrible way to navigate the second stage of labor!

If we watch any mammal giving birth, a cat, for example, or a sheep, we notice that it does not take great breath and then “block” the birth canal by holding its breath.  A sheep gives birth with rather light, quick breathing. (pg 213)

Different positions for birth can help different situations.  While most OBs prefer a woman to be sitting or lying on her back, evidence shows that there isn’t a worse position.

There is no reason that you should have to be tucked up in bed.  there are definite disadvantages to the supine position (lying flat on your back) for your baby, since the blood flow in the large veins is in the lower part of your body may be obstructed by the heavy weight of your uterus, and this can reduce the blood flow through the placenta to and from the baby. (pg 213)

There is a chapter on the screens and tests that can be run to assess the baby’s health.  Doctors tend to rely too heavily on these tests and many times they give false-positives and lead to unnecessary interventions.

[Ultrasounds] are not good at estimating birth weight, although they can be more accurate with premature babies.  Research shows that the mother’s guess at her baby’s weight is more accurate. (pg 230)

So a woman must decide if the potential information that may be gained from the test is worth the risks involved.  In the case of ultrasounds, they are assumed to be safe.  But that has recently been called into question.

As far as we know, ultrasound is safe…On the otherhand, it is known that high-frequency sound waves continued for a long time can damage an adult’s hearing.  Questions have therefore been raised about effects on the baby’s hearing, since, although the sound waves are bounced off the baby for only a short time, the baby may be vulnerable at certain stages of its development…no one yet knows if any [babies] will suffer delayed effects in later life. (pg 231)

While many people will tell you there are different kinds of labor, many don’t know just how different labor can be.  Sadly, too many doctor have expectations of what “normal” birth should look like.  Women then get the impression that their bodies can’t give birth without help from drugs and machines.

In the U.S., the most common reason for a Cesarean is the diagnosis of dystocia – prolonged labor.  Thirty-eight percent of Cesareans are done for this reason.  Another 20 percent are augmented with intravenous oxytocin in its synthetic form (pitocin) for the same reason.  As a result, women suffer more infection, bleeding, and a longer hospital stay – and many are left with the feeling that their bodies have failed them. (pg 285)

So how slow is too slow?  Many doctors will suggest intervention at 12 hours after active labor has started.  The assumption is that labor should progress at 1cm per hour and that 12 hours is longer than the body really needs.  But the average first labor, when left to labor and not in a hospital setting with strangers and monitors and interventions is 15-17 hours!  And nothing under 24 hours is really considered to be “long” in the natural birthing world.  No more babies or mothers die when labor is left to a natural course and time-line.  Many doctors will even suggest minor interventions to “speed up labor” after only a few hours, telling the mother that breaking her amnio sac will help things move along.  But this practice isn’t proven and can lead to more painful contractions and introduces bacteria into an other-wise sterile environment.  Plus, the minute the sac is broken, the clocked is watched because most doctors won’t let a woman labor more than about 24 hours with her water broken for fear of infection.

Many women think that birth has to be painful.  They can’t imagine a natural birth because they think that they won’t be able to deal with the pain.

People often think that pain is just a matter of a “high” or a “low” pain threshold.  There are very few women who think that they have a high pain threshold and can bear pain well.  in fact, the idea of pain threshold being like a wall, with some of us possessing high walls and others low ones, is a myth.

It is now known that the pain sensation threshold is the same in all human beings.  In one research study in the United States, members of Italian, Irish, and other ethnic groups were given electric shocks ranging from mild to fairly strong, and every single person said pain occurred at exactly the same point.  Yet obviously we do not all react to the pain in the same way, because it depends on what is going on in our minds. (pg 304)

So each woman needs to learn how to deal with her pain.  How to handle it in a constructive way instead of dwelling in it and saying she can’t get passed it.  There are different ways to do this and they are as varied as the women who use them.  Hypnosis is a fairly new option in the US.

[Hypnosis] has the great advantage over chemical anesthetics of not reducing the baby’s oxygen intake or making the woman feel drugged and drowsy.  In fact, about a quarter of women who have had hypnosis in childbirth say that they experienced no pain… (pg 310)

Acupuncture is another option if the mother can find a provider.

In labor, electroacupuncture may be used at points in the ear for analgesia, and with this technique the woman herself can control the degree of stimulation.  In Bejing today, acupuncture is performed in preference to epidural anesthesia for 98 percent of Cesarean sections. (pg 311)

There are many other natural remedies that can and should be tried before resorting to chemical therapies.  Aromatherapy has long been used to calm or excite a person.  A cold wash cloth with some lavender oil is very calming when the woman is warm and anxious.  There are also different types of homeopathy available if you seek them out.

Lavender can be put directly on the skin.  It can be mixed with one or two other essences…Some essential oils are overpowering if you use more than one or two drops, so sniff the bottles first before you concoct your recipe to make sure that it is well balanced. (pg 312)

Unlike conventional medial treatments, homeopathy aims to treat the whole person, including the mental and emotional states that have an adverse effect on physical well-being…The more diluted the remedy, the more effective it is. (pg 313)

There is a section on the medical pain remedies available.  It explains what each option does, how it is administered, and the risks involved for both the mother and baby.  After her own research, the author found that:

…18 percent of women very much regretted having had the epidural and said in effect, ‘Never again!’ (pg 322)

She goes on to conclude that the circumstances around the choice of the epidural has a lot to do with the feeling afterward.  A woman who plans to get it all along, or knows that she will wait as long as possible, and then asks for it is much happier with her decision that the woman who feels that it was her only choice, or that the doctors or other people around her were pushing her to get the epidural.  It has to be her own choice while the others in her environment are supportive of any choice she makes.

You have the right to decide what happens to your body before during, and after childbirth.  You are not bound, either by law or out of politeness, to agree to procedures and investigations to which you object.  If things are done without your consent, it is a form of assault on your body. (pg 324)

Many time women don’t think past the point that the baby emerges, but there is a whole third stage to go through.  The placenta needs to be birthed, the cord clamped and cut, the perineum needs to be checked and repaired if needed, etc…One question that comes up is when the cord should be cut.  Standard practice is to clamp it and cut immediately after the baby is out.  But evidence shows that it’s better to wait until the cord stops pulsing.

If the placenta is left to separate naturally, it may take about half an hour or longer.  Clamping the cord immediately at delivery may make the chances of a retained placenta more likely.  If the cord is not clamped until after it has stopped pulsating, there is much less chance of a retained placenta.  This is because when the cord is clamped, blood cannot flow out of it, which would encourage the now defunct placenta to peel away from the uterine wall.  A blood-packed placenta stays firm and full and is less likely to separate. (pg 334)

Inducing labor is risky.  There’s no question about that.  However, there are many doctors who push women to induce so they can plan it into their weekly schedules, or because they say it will be easier or faster, or just because the woman is over 40 weeks.  So, it’s important to know the risks.

Extremely strong contractions are likely to interfere with the blood flow through the uterus.  In one study it was discovered that fetal distress was significantly more common in women taking pitocin, that babies were more likely to have low Apgar scores, and that far more of them than usual went to the nursery for special care. (pg 338)

Electronic Fetal Monitoring is very helpful when used sparingly.  The problem occurs when it is relied upon solely, instead of using it as a tool among others.

A major disadvantage of EFM is that it increases the Cesarean section rate by 160 percent, without any benefit to the baby.  The rate is reduced if fetal blood sampling is done before the decision to proceed to operative delivery, but there is still a 30 percent increase in the Cesarean section rate, again without any benefit to the baby. (pg 342)

Interpretation of electronic monitoring data sometimes causes more harm than good.  Half of all babies show some irregularities of heartbeat during labor.  Usually this is of no significance.  We don’t know how they manage it, but babies actually sleep during labor…But it has now been discovered that the baby only has to be roused a little for the heartbeat to pick up.  One way of doing this is to touch the top of the baby’s head.  Mothers have their own ways of achieving the save result – changing position, for example – and this may reassure the doctors. (pg 344)

Emergency Cesarean sections are often performed because of changes in the fetal heart rate that are judged to be signs of asphyxia.  Yet more than 50 percent of babies delivered by Cesarean section turn out to be in good condition, so operating was unnecessary.  What has actually occurred is a series of complex changes in the baby’s heartbeat as a result of a normal catecholamine (stress hormone) surge.  These alterations have then been misinterpreted as signs of fetal distress.

The Amercan College of Obstetricians and Gynecologists (ACOG), the Society of Obstetricians and Gynecologists of Canada (SOGC), and now the British Royal College of Obstetricians and Gynecologists (RCOG) support a policy of regular, frequent listening with an ultrasound stethoscope as equal or superior to electronic fetal monitoring in a low-risk pregnancies.  Despite this reversal of support for electronic fetal heart monitoring, most doctors and many midwives and nurses have not been well trained in auscultation, which also requires more staff time, and so continue to rely on EFM.

If the fetal monitor suggests that the baby is under stress, the baby’s blood should be tested in order to check the findings.  if the baby is having difficulties, this shows up in the blood chemistry.  But this testing is not often done.  A biochemical test carried out in order to assess the pH level of the baby’s blood cuts down the number of unnecessary Cesareans. (pg 345)

C-sections are also covered in a manner that both explains when and why they may be needed and when  and why they should be avoided.  It includes quite a lot of information about what to expect if it comes up, and the safety information needed to make a decision if the doctor says it’s necessary.  Many women feel pushed into a c-section that isn’t totally necessary, but just because it’s been a while and the doctor claims to be worried about the baby after a “long” labor.  But there are also medical reasons that doctors claim necessitate when they actually don’t have much benefit.

Research has been carried out on the outcomes of automatic Cesarean sections for multiple births and when women have diabetes, and it has been shown that this practice is unlikely to be of benefit.  Delivering all twins by Cesarean section does not save lives or produce babies in better condition…

…The Cesarean rate in the United States is approximately [33] percent and in some hospitals 50 percent or more.  But there has not been a corresponding rise in the fetal survival rate…

…Some doctors like to do Cesarean sections just because a baby looks as if it is going to be big.  This is not a good reason…(pgs 348-349)

And finally Kitzinger covers the “Once a section, always a section” mentality against VBAC, saying that many are unnecessary but aren’t given a chance at a trial of labor.

One professor of obstetrics says that problems of scar separation are ‘much less than the one percent that is often quoted,’ and that even if the scar is pulled open by strong contractions, “careful monitoring of the fetus and mother usually means that any harm to either is rare.’ (pg 349)

Many women don’t know about the ongoing and future problems a Cesarean can cause.

A Cesarean may have long-term effects, too.  A study in the British Journal of Obstetrics and Gynacology reveals that nearly half of all women who have a baby by Cesarean section do not go on to have other children – almost one in three because of infertility problems, and one in five because the Cesarean experience was so awful they could not face another birth by this method.  Three times as many women are infertile following a Cesarean as those who have a spontaneous vaginal birth, and six times as many women suffer from the effects of emotional trauma. (pg 350)

Too many women aren’t told these types of statistics.  They look solely at present situation.  That is understood when the baby or mother is in immediate danger, but most the time there is time to take a break and reassess what is going on and maybe even try something differently before charging off to the OR.  Most c-sections are life-or-death situations, they are done “just in case”.

After the section about the medical side of birth and the hazards it can bring, the author delves into “Gentle Birth”.  She stresses the importance of a low-key vaginal birth.

…in spite of the relentless onslaught of contractions as full dilation approaches, the baby who is pressed through the cervix and down the 9-inch (23-cm) birth canal responds more vigorously to life than do most babies who are merely liften out through an abdominal incision. (pg 359)

The Gentle Birth section takes issue with many hospital policies,  practices, and attitudes.  Against all research, many hospitals continue to demand that certain things happen.  Unless women specifically demand otherwise, the vast majority of hospitals take the baby from birth to be cleaned, measured, and then placed in the warmer to keep warm or given to the mother swaddled in a couple blankets.

Research has shown that even a low-birth-weight baby keeps warmer when in flesh-to-flesh contact with her mother and nestling against her breast than when wrapped and put in a crib.  So ask a helper to slip your gown down over your shoulders or take if right off before the birth.  A blanket can easily be thrown over you and your baby or a heater can be placed over you both. (pg 365)

The immediate clamping of the cord comes again in this section as well.

Immediate clamping may reduce the baby’s red blood cells by over 50 percent. (pg 365)

Many hospitals also insist on bathing babies soon after birth which can be problematic as their bodies can’t yet regulate temperature.

But babies who have received drugs from their mothers’ bloodstreams, including narcotics, are not only sedated but also unable to prevent heat loss efficiently.  So if you want a bath given, you should not have had narcotics in the last five hours, your baby should be full term, weigh more than 5 lb (2.5kg), and not have breathing difficulties at delivery, and the room should be warm. (pg 367)

The book is very pro-breastfeeding , but a short segment explains how a baby will feed for pleasure and how a bottle-fed (formula or expressed milk) baby can be accommodated.

When bottle-feeding, remember to hold the baby close, cheek against your breast, just as if you were breast-feeding.  Although it may produce a less comfortable cushion for the baby’s head, a man can also do this.  The baby may sometimes like to lie nestled against your partner’s bare skin, and fathers who give a feeding like this in the middle of the night say how much they enjoy it.  Never feed a baby while he is lying in a crib or stroller, or even worse, prop up a baby to feed on his own in a crib, however rushed you are.  It can be dangerous. (pg 408)

The book concludes with a chapter covering baby care and postpartum recovery.  It stresses the importance of keeping healthy, both mentally and physically, in order to take care of the baby.

It’s best to do as much research as you can on your own, but if you don’t have the time or drive to do so, this is a great place to get the information you need to make solid decisions based in facts instead of assumptions.  Happy Learning!!

Helpful info for Daddies, Partners, and Doulas

April 5, 2010

Quotes are from The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions by Penny Simkin

For most women, the peak of pain in the dilation stage seems to be reached by 7 or 8 centimeters.  Electronic recordings made from within the uterus…show that after 7 or 8 centimeters contractions do not continue to increase in intensity, though they sometimes come closer together.   Contrary to most people’s assumptions, the contractions do not keep getting worse until dilations is complete or the baby comes out. (pg. 85)

This illustrates that if a woman waits as long as she can and then asks for drugs at 8-9 centimeters because she doesn’t want it to get worse, she need not worry.  It won’t get worse.  If you can handle it up to that point, you know what’s worse, you know what is to come, you can make it without drugs!

[Dads] Try not to take it personally if the mother criticizes you or tells you to stop doing something that you expected to be helpful.  Just say, “Sorry,” and stop doing it.  don’t try to explain why you did it or express frustration with her.  She is really saying that labor is so difficult right now that nothing helps.  You are the safest person for her to lash out at…(pg 88)

Men just don’t get it.  They can’t get it.  No matter what they have or will go through, they cannot relate to giving birth.  So, try everything you can think of to help, stop when she says something isn’t working and try something else.  It doesn’t matter if it’s massage she usually enjoys, or if it worked last time she was in labor.  It’s not personal, it’s not you, it’s just not working at this moment.

Seventy percent of cases of shoulder dystocia…happen in average-sized babies, and this problem cannot be predicted.  When this serious complications occurs, doctors and midwives use well-practiced techniques to resolve it. (pg. 228)

So, when the doctor plays the “Big Baby” card and fears that the baby could get stuck, just remember, ANY baby could get stuck.  It’s not reason to plan a c-section based on guesstimated size.  Especially since late-term ultrasounds are rarely correct and can be up to 2 pounds off in either direction.

The chances of a cesarean increase by two to four times in first-time mothers who have elective inductions, when compared to first-time mothers who have labors that begin spontaneously. (pg. 230)

So in other words, unless you want a c-section, just say “no” to non-medical induction.

[After the baby is born]…The warmest place for the bab (and the place where he will be happiest) is against his mother, skin to skin, with the two of them covered by a warm blanket.  Unfortunately, many hospitals customarily keep a baby in a warming unit while the nurse does all the newborn procedures.  Then the baby is usually wrapped and given a hat.  If the baby is presented to the mother all wrapped up, she should…place the baby naked against her skin with a warm blanket over both of them.  You should not uncover the baby or remove the hat.  If a newborn gets chilled…it may take a long time for him to regain his temperature. (pg 105-106)

Kangaroo care. Studies have shown that being held skin-to-skin against a parent’s chest and covered with a blanket keeps a baby warmer than does a heated baby bed.  The baby benefits not only from the parent’s warmth but also from his or her movements, soothing voice, touch, and even heartbeat sounds.  Both parent and baby are more content when they spend some hours each day in this “Kangaroo Care”.  Babies who have been “kangarooed” gain weight faster, suckle better, cry less, and are discharged from the hospital sooner.  Kangaroo Care has been done even with babies who are receiving oxygen or tube feedings or who are very premature or sick….(pg. 263

There is nothing the nurses or baby catcher needs to do to a healthy baby that can’t be done while the baby rests on mom’s chest and explores the breast for the first time.  Baby can be seen, watched, checked, and listened to all while mom hold him.

While a woman’s right to have a cesarean without medical justification is often unquestioned, her right to a vaginal birth is seriously jeopardized. (pg. 321)

The reasons for the sudden downturn in the VBAC rate are not clear.  No new evidence has revealed that VBACs are more dangerous than they were in the mid-1990s, when VBACs were promoted by insurance companies, government agencies, and many other organizations of medical professionals.  Researchers have found that uterine scars are more likely to separate with two recent practices: the use of a single-layer rather than a stronger double-layer closure after a cesarean delivery and the use of prostaglandins to induce a VBAC labor.  Provided that women have had double-layer suturing with their cesareans and that prostaglandins are avoided in their subsequent labores, VBACs are as safe as they were when they were very common…With modern surgical techniques and a supportive birth environment and caregiver, between 60 and 70 percent of women who attempt a VBAC will have one. (pg. 321-322)

It’s so sad that even though evidence shows that VBAC is a safe option when done correctly, many doctors continue to tell women that it’s safer to be sliced back open.  What’s sadder is that women believe them:(

The cord is often cut immediately, but a recent scientific analysis has found benefit to waiting for at least two minutes or until it stops pulsating – in five minutes or so.  Less likelihood of anemia for as much as six months exists in babies whose cords are cut later.  Until the cord is clamped or stops pulsating, the blood passes back and forth between the baby and the placenta.  It goes from placenta to baby whenever the uterus contracts, squeezing the blood from the placenta through the umbilical cord to the baby. (pg. 333)

There is no proven benefit to immediate clamping of the cord except in emergency cases when the baby needs care or the cord is wrapped around the neck and the baby can’t be delivered safely.

“Labor of Love” by Cara Muhlhahn

March 2, 2010

These are my favorite quotes from “Labor of Love”.

The implication of his comment was that I was too intelligent to be a nurse of midwife.  It’s ironic, because in Danish society, midwives are the ones with the best grades.  They are more highly revered than doctors. (pg. 45)

In the United Kingdom, A joint statement written by the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) in April 2007 states, “The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists support homebirth for women with uncomplicated pregnancies.  There is no reason why homebirth should not be offered to women at low risk of complications, and it may confer considerable benefits for them and their families.  There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby. (pg 166)

From experiences like those that happen most often in hospital births, a woman doesn’t learn that her body is an amazing vessel of creation that can do things she never dreamed.  This feeling, that I exist to defend, is an intangible that is very difficult to study and often lost to articulation.  Instead, in hospital births, all to often a woman learns that her body can’t do these things, and she is left with feelings of inadequacy. (pg. 172)

That’s right:  home is definitely safer in terms of exposure to germs!  The mother’s body has already dealth with the germs that inhabit her home.  In Good Germs, Bad Germs: Health and Survival in a Bacterial World, author Jessica Snyder Sachs states, “Children absorb the good bacteria they need to have populating their own digestive tract from birth on.  A Caesarian birth for example, results in a baby who is not exposed to the bacteria found in the mother’s perineal area, which raises the risk of developing autoimmune problems like asthma and Type 1 Diabetes.” (pgs. 173-174)

Why do so many women sign up for the disempowerment and added risks that come with hospital birth?…A woman in an ob-gyn’s office feels she needs to cooperate even though her instincts might be telling her to disagree, or question, because this person is going to deliver her baby.  Her life and her baby’s life will eventually be in the doctor’s hands. (pg. 174-175)

This results in the insidious process of turning one’s own instincts and intuitions over to the advice of the experts, even and especially when it contradicts a woman’s intuition.  Many women make this unfortunate and unnecessary mistake.  They choose a doctor they hear is “good” and then turn off their own voice, replacing it with “the voice of reason” — that of the expert.  This process is facilitated even more by the hormonal state of pregnancy, which creates an unusual psychological vulnerability in the pregnant woman.  By the time labor begins, the hierarchical power relationship has been conveniently laid down.  It’s almost impossible at the late state for a woman to take back the power. (pg. 175)

All medical practitioners trained in this country, including nurse-midwives, are trained to ensure safety in potentially risky situations while simultaneously minimizing the risk of litigation in the event of a bad outcome.  There two themes are always presented together, enmeshed like Siamese twins.  Preventing a malpractice suit becomes integrated into every clinical judgment call.  The reason why doctors place so much emphasis on minimizing risk and liability is that they have come to see themselves as ultimately responsible for every element of every outcome.  This simply isn’t true.  We are all only players in a complex chain of events. (pg. 179)

And hospitals aren’t all bad.  We couldn’t do without them in cases of emergency.  They have lots of intelligent doctors and machines and equipment and medications on hand that are great to have at your disposal when things are abnormal or become dangerous.  They’re just not great places for normal birth. (pg. 181)

The homebirth midwives with whom I associate in New York City are all equipped to deal with each of these outcomes.  I’ll venture to say that more often than not, their vast experience can promote patient safety better than the judgment call of a first-year resident, fresh out of medical school, who may be the person attending to the labor floor of a hospital. (pg. 190)

Regardless of where a birth takes place, safety is conferred by the ability of the health-care provider to make a quick diagnosis and then to stabilize the patient.  This happens as a result of clinical skill and the provider’s paying attention, which is where the one-to-one patient-midwife ratio at home wins. (pg 190-191)

The ability to remain unseen and not only to allow the birthing woman to have her power, but to help her achieve it, instead of stealing that spotlight, is what makes a midwife…amazing. (pg. 225)

Lord knows I had said many pithier things about empowerment and other aspects of homebirth…I read that article and felt once again, Are these people for real? They have come so close to such a huge, sacred event, with such immense political repercussions, and then profaned it, oversimplified it, and reduced it once again to the black and white of one of the usual themes: those who choose homebirth do so to prove that they don’t need the establishment.  To them, it’s some sort of crusade of rebellion against pain medication that somehow involves healthy eating.  People who oversimplify homebirth miss the real meat of the matter. (pg. 226)

Born in the USA

October 14, 2009

I read this wonderful book a couple years ago.  I think it should be mandatory reading for women and doctors (especially if you are contemplating kids in the near future).

Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First

by Marsden Wagner


This book is written by an obstetrician who has been in practice as well as research.  He worked for the WHO in London and still consults on cases when needed.  Keep in mind that this is a book by a doctor who believes that his place is ONLY in high-risk pregnancy – a far different opinion than most OB/GYNs these days.  An OB is a specialized surgeon.  Having an OB attend your low-risk birth is the equivalent of having a brain surgeon check out your head when you bump it or a heart surgeon do your yearly physical.
It was one of the scariest things I’ve read and if you had an “emergency c-section” I suggest you do read it for information on VBACs but you will probably want to skip over all the facts regarding c-sections because you may quickly come to realize that your surgery was pre-emptive and not truly needed, had the doctor just slowed down, stepped back, and let the laboring woman’s body do its job.
He answers the question “Are Epidurals Safe?” Though your doctor may lead you to think otherwise, they can hardly be considered safe when 23% of women receiving one have complications.  There is a longer excerpt at the end about how unsafe an epidural block is if you are interested.
Following are some facts for the book and a few excerpts you may be interested in.  It’s sad that SOOOOO many women are scared about something that women have done for tens of thousands of years.  Only in the last 100 years has giving birth become a medical process needing “treatment”.  The question is, when statistics show that women don’t need medical help, why do we seek it?  This book gives the information on pregnancy and birthing that so many doctors don’t tell you and many don’t even know.
I only wish I had read this before having Eli.  Feel free to comment based on your own experience, but until you have read the book, know that you don’t have all the facts!
Just keep in mind, if my friend could go through 17 hours of labor, 5 hours of pushing, and have a 10-pound baby with a 15-inch head all the in comfort and safety of home with no complications, then you, too, can have an average-weight baby without the need for medical intervention.

Quick facts (pgs. 242-246):
There are twenty-two industrialized countries with lower infant mortality rates than the US.  All 22 provide universal prenatal care.

25% of US women receive little or no prenatal care. 1 in 2 of these women with give birth to a low-birth-weight baby (less than 5.5 pounds) or a premature baby (less than 37 weeks of gestation).

60% of infant death is linked to low birth weight.  It costs 2.5-times as much to raise a low-birth-weight baby to the age of 35 than a baby of average birth-weight.

Intensive care for one infant: $20,000-100,000.  This amount would cover prenatal care for 30 women.

Percentage of births attended principally by midwives:
US: 10%
European nations: 75%
Percentage of countries with lower infant mortality rates than the US in which midwives are principal birth attendants: 100%

Average cost of a mid-wife-attended birth in the US: $1,200
Average cost of a physician-attended vaginal birth in the US: $4,200

Number of scientific studies in which routine electronic fetal monitoring during every birth has been proven more effective than the use of a simple stethoscope to monitor the fetal heart: ZERO
Cost per year of using routine electronic fetal monitoring during every childbirth: $750 million

US C-section rate:
1965: 5%
2004: 29.1%
C-section rate targeted by the WHO and the U.S. Department of Health and Human services: 12%

Percentage of women in the US with C-sections who undergo repeat C-section: 91% (totally unneeded in eight-nine out of ten births).

Ratio of women dying from C-section to women dying from vaginal birth: 4 to 1

Average cost of C-section: $7,826

Evidence shows that when the c-section rate goes over 15%, the maternal mortality rate increases.
Evidence shows that midwives are safer than doctors to attend low-risk births.
Evidence shows that planned home birth for women with low-risk pregnancies is as safe as hospital birth.



“The key issue in the question of where to give birth, however, is who is in control.  Physicians, hospitals, electronic fetal monitors, and drugs do not have babies – only the mother of the child can do that. . .All maternity services should reflect this fundamental fact and should be designed to assist and support the woman.  Most of the present care system for birthing women in the US is designed not to assist the mother but rather to control her.
“Doctors control women with fear.  They have succeeded in convincing the great majority of American women that they cannot safely give birth outside the hospital; that nearly half of them have uteruses that are non-starters and need to have labor induced or augmented with powerful drugs; that up to two-thirds of them cannot tolerate labor pain and must be made numb from the waist down with an epidural block so they cannot feel the birth of their babies; that one-third of them cannot push out their babies but must have it pulled out with forceps or a vacuum or cut out by c-section.  When we try to make women believe that they can’t give birth without the help of men, machines, and hospitals, we take away their confidence and their belief in their own bodies – and with their confidence gone, any feelings of power and autonomy also disappear…” (pg. 190)

“Women who have epidural block for normal labor pain have risk of dying that is triple that of women who do not. . .”A woman also has a 15 to 20 percent chance of developing a fever after receiving an epidural block. When a woman in labor developed a fever, it means that a diagnostic evaluation must be done to determine if there is an infection in her body or in the baby’s body. These diagnostic procedures can sometimes be invasive, including doing a spinal tap on the baby, which is a painful and risky procedure in and of itself.”Another known complication of epidural block: between 15 and 35 percent of women who are given an epidural will suffer from urinary retention after the birth, a condition which, if it continues, necessitates putting a catheter in the bladder until bladder function returns.”. . .Studies show that around 10 percent of epidurals don’t work at all; there is no pain relief. Even when pain is blocked during labor, about one-third of the women given an epidural will trade a few hours of pain-free labor of days, weeks, or months of back pain after the birth. Studies show that 30 to 40 percent of women who receive an epidural during labor will have severe back pain after the birth, and 20 percent will still have severe back pain a year later.”The fact that when an epidural block is given labor does not progress normally has consequences as well. A great deal of scientific research has shown that women who receive epidural block for normal labor pain will have a significantly longer second stage of labor, and thus the epidural block means a four times greater chance that forceps or vacuum extraction will be used to extract the baby, and at least a two time greater chance that a C-section will be performed. . .”Although many women might be willing to take risks with their own bodies for pain relief, very few women are willing to put their babies at risk. But that is what a woman does when she agrees to an epidural. One common complication when a woman has an epidural is that there will be a sudden drop in her blood pressure, leading to a sharp drop in blood flow through the placenta to the fetus. This drop in blood flow can result in mild to severe lack of oxygen getting to the fetus, which if not quickly treated can result in brain damage in the baby. . .Studies have shown that in 8 to 12 percent of cases in which a woman is given an epidural block for normal labor pain, the electronic fetal heart monitor will show a severe lack of oxygen to the baby. In a further study, after having an epidural, three-quarters of the babies of healthy women in normal labor had episodes of slowing of the fetal heart rate, a symptom of fetal distress” (pgs. 54-55).

Epidurals also lead to sleepy babies and if you want to get off to a good start in breastfeeding with as few complications as possible, a sleepy baby is the last thing you want right after birth.

Pregnant in America

October 13, 2009

I liked this more than “The Business of Being Born”.  Here is what I took from it.

http://www.pregnantinamerica.com/

“Some of us have found that the process itself, the actual process of birth, is quite an extraordinary event, and would chose not to just miss that.”

“There is not cultural valuation any more on women’s bravery and courage in pushing their babies out on their own.”

“A mother and baby are designed to work together during labor, and when drugs are used they both are drug-impaired so they’re not working together.”

“There are studies linking labor drugs to teen-age drug addiction and suicide.”

“We have been brainwashing Americans about childbirth, about how dangerous it is, how all the terrible things that can go wrong, and how you need to be in the hospital where all the doctors are, all the machines are, and all the operation tables are so that we can take care of horrendous emergencies when they occure.  It’s absolutely not true.”

Ina May’s Numbers:

  • 2000 births
  • 95% needed no medical intervention or hospital transfer
  • <30 got a c-section (that’s less than 1.5%)
  • her mortality rates were still below the US documented rates for low-risk pregnancy and birth

“I don’t know but one person that can have a baby and that’s the mother.  Mather nature knows best.” – Father of a home birthing woman, also a horse breeder.

Section Stats:

  • Between 1990 and 2000, induction doubled from 10-20% and the number of babies born M-F went WAY up.
  • 50% of inductions end in c-section
  • section rate in 1975 = 7%
  • section rate in 2008 = 33%
  • the infant and maternal mortality rates have not declined in response to the quadrupled section rate

“Why is our section rate high?  Because surgeons are in charge of birth.  To a man with a hammer, every problem looks like a nail.  To a surgeon, every problem looks like surgery is the answer.”

“Everywhere women are getting cut open because they are being told it’s safer even though all the evidence is to the contrary.”

“If I have a reason to do a section, I can be home in 30 minutes.” – Ron Sancetta, OB/GYN

“Breech [birth] isn’t even taught at most schools anymore.  Insurance companies to hospitals they’d pull support if they taught breech anymore.”

“We are victims of our insurance.”

“Most Cytotec cases are settled with a gag order which is why we don’t hear about it.”

“It’s sad that a country with the technology we have could institutionalize medicine.”

Doctors play the ‘dead baby’ card so often women believe that it happens very often in non-medicalized births.

“We’re just concerned about your baby.”

“Doctors in America do not want any significant change in the present system.  They have all the power, they have all the control, and they’re making the big bucks.”

“A loving midwife does what she does because she wants to help other women experience the miracle of childbirth.”

“Thank goodness for epidurals and Pitocin when they are truly needed.  But in countries where they don’t use it just as a normal management of labor technique or protocol, they have much better statistics and outcomes, and we can learn a lot from that.”

“[Birth is] as close to magic as human beings can know.”

“There is no more empowering experience that a woman can possibly have than giving birth herself.”

“It’s so sad what women are missing and they don’t know they are missing it.”

Books that the experts in the film have written:

“Gentle Birth Choices” by Bruce Lipton, PhD

“Magical Child” by Joseph Chilton Pearce, PhD

“Orgasmic Birth”

October 12, 2009

I watched this DVD and loved it!  There are so many good quotes, facts, and links that I’m just going to list them in the order they come in the film and let them speak for themselves.  I wish I would have thought to note who said each of them.  Here is a link to the website, you can see all the experts they talked to listed there.

Orgasmic Birth

“We were meant to have babies.  Don’t just turn your body over to medicine.”

“Women of the Earth: Take back your birth!  Just as you enjoy sexuality, you can enjoy your birth.”

“The [fetal] monitor was designed to prevent over-intervention in birth and it got used in exactly the opposite way.  The section rate in the US soared from 6% when the monitor was first introduced to 23% in just 10 years of use.”

“As long as women really know why they are choosing hospital, home, or birth center, then go with that 100%.  But if you go to the hospital because that’s what everybody else does, or expects you to do, then you’re missing out on something.  You just surrender to something that’s not so truly your own.”

“It’s like a sacrafice, I think, that a mother can offer.  ‘I’m gonna go through this pain for you to really come out in the way you need to come out.  Because it’s no just me.'”

“You need to birth at your own pace, in your own time.”

“‘Emergency’ c-section is more common Monday-Friday only in America.”

“Don’t look at the contractions as something you have to go through, or get over, or get past.  Look at it as embracing your child into this world.”

“Physiologically, birth doesn’t happen the same way around surgeons [and] medically trained doctors as it does around sympathetic women.”

“When a woman births on her own power, and finds her rhythm, and her postures, and her sounds, and her moment of ecstasy at birth, then she is a changed woman and she is a fierce mother.”

“To be realistic is to expect your birth to be wonderful.” – Naoli Vinaver, CPM

Books to read:

“Inner Strength” by Stoger

“Birth As We Know It”

“Birth by the Numbers” – a segment after the film about US birth statistics. These are not quotes unless noted.

When America is compared to like countries, large, industrialized, democratic nations, there are 16 to compare.

The US is last in prenatal care sought in the 1st trimester.  (All other countries have government-funded health care.)

We have the highest death rate.  When you look at just white, non-Hispanic, native-born we are still last.

If you only look at those who got prenatal care in the 1st trimester, we go up to 13/16.

If you add more than 16 years of education (through at least college) then our rate is much better: 3/16.  But how much of our population has their first child after getting a college degree?  Not a big percentage.

All the other nations mortality rates started low and dropped over a 5-year period.  We started higher and were the ONLY nation to have the rate increase over the same 5-year period.

Maternal death went up along in the US when it went down in every other country.

Comparing all age groups, the c-section rate went up 50% over 10 years (1990-2000).

All elasticities go up at the same rate (which means that no one group is skewing the results).

There is evidence that maternal request is not what is propelling the rates to continue up.

“If there’s even a 1% chance of a terrorist act occurring, we must treat it as if it were a certainty,” VP Dick Chaney.  “When you set up a system that focuses on the 1% of problems that might occur, you undermine the care of the 99% of mothers who don’t need those services,” John Whitridge Williams speaking about c-sections.

Books and links they suggest at the end of the “Birth by the Numbers”  segment.

“Our Bodies, Ourselves”

“My Body, My Baby, My Choice”

“The Medical Delivery Business”

http://www.motherfriendly.com

http://www.thebirthsurvey.com

http://www.childbirthconnection.com

http://www.cfmidwifery.org

http://www.birthnetwork.org

http://www.mothersnaturally.org

http://www.imbci.org

http://www.lamaze.org

http://www.dona.org

http://www.internationalmidwives.org

http://www.waba.org.my/

Down with ACOG!!!

October 8, 2009

I have decided to start this blog as a place to think out-loud and to gather information as I do more research on pregnancy, birth, and parenting my growing boys.

Did you know that ACOG is not a professional organization?  It’s not a peer-review board either.  It’s little more than a membership club or professional fraternity!  Why do so many women adhere to the recommendations of a club?  I get that doctors who belong want to use it as a way to convince their patients that their decisions are backed by a peer board.  But why do women listen as if ACOG is a governing board?