Empowering Birth Blog

It's the baby's birth too

I just attended a beautiful birth (whenever I am not blogging, it usually means I am attending a birth, and then catching up on sleep).  I don't usually attend births where the mom has decided from the get-go that she will choose an epidural but if my intuition says go for it, I make an exception for some couples/moms and of course for VBACers (moms pursuing vaginal birth after cesarean).  This birth clarified my reasons for being choosy about the moms I work with and affirmed that though I am definitely not a fan of epidurals (primarily because they are abused) in some cases they are appropriate and don't always seem to impede the bonding process between mom and baby. 

Mind you, this is purely speculative, I have only recently started down the path to midwifery, but I have been thinking a lot about a recent blog, where I posted a quote from Dr. Sarah Buckley about the effect of epidurals on mom's hormones.  Dr. Buckley hypothesizes (see referenced blog entry) that even when feeling returns in an epidural, mom might miss out on that cocktail of hormones that help with bonding.  Now I haven't talked things over with the mom at yesterday's birth yet but I know when those hormones are present and when they aren't.  As I mentioned in that blog post, I missed out on the cocktail of hormones because I stayed behind to clean up in a hospital transport.  But there was NO mistaking the presence of hormones at this birth.  I was fighting hard to keep back the tears as I felt the waves of hormones wash over me, through me and wrap around the room and mom looked ecstatic (of course baby went right to mom's chest and chord was not clamped until it stopped pulsating).  I have to speculate that perhaps if you back off on the epidural and feeling is allowed to return (which we did in this birth) that those stretch receptors do indeed send the message to the brain to release those good end of birth drugs. 

So why am I so "choosy"?  I guess deep down inside, and I am being completely honest, it is because I get very frustrated with our culture's tendency to choose the option that represents instant self-gratification over the option which is harder thing but is better for us/our kids in the long run.  The best example that comes to mind has nothing to do with birth but perhaps it will resonate with some of you moms out there.  You are at a friend's house (this just happened to me by the way, sigh) for lunch and after several warnings your child continues to misbehave (harshly pinching her brother, screaming and yelling etc.).  After you have issued your call for better behavior, your child will no doubt insist that she should have YET another chance.  You can A, give her another chance (easier for you, you get to stay and enjoy lunch and chat with your friend)  B, say, I am sorry, you have had your chances and were informed of the consequences, we are going home, and then promptly leave, or C, can bribe your child with icecream if they behave and stay.  Too often I see parents choosing option A or C. 

When it comes to the epidural I think moms are too quick (and this is reinforced by the medical industry) to opt for the comfortable option of an epidural (but later wonder why they end up with the fourth degree tear or have trouble bonding with baby or why they have trouble breastfeeding etc. etc. etc.).  Mom chooses the easiest/best option for her but not the best option for baby.  Yesterday's birth represented a beautiful compromise.  Mom chose what was best for mom AND baby.  Mom spent most of her labor upright using gravity to help her body open and got the epidural 12 hours after labor had begun, as she was nearing transition.  Mom also backed off on the epidural when it was close to pushing time so that she could feel the stretching and the contractions for more effective pushing.  I ask that the moms I work with seek to be fully informed, primarily because informed moms, after carefully processing what they have learned about birth, tend to instinctively choose the option that is best for mom AND baby. 

Childbirth Death Rate Rises in U.S.

Sometimes I wonder what the consequences will be, thirty years from now, if 1/3 of our babies continue to be birthed by cesarean.  At the very least, it seems that maternal and infant mortality rates, will go up.

History of Midwifery

Ok, so my first post didn't work out today, not everyone could open the link.  So I am trying again.  This is a short post because school starts next week for the kids (three days a week for Khady and two mornings for Fen, yay for some me time at last!) and there is much to do!  I am reviewing the history of midwifery for the new midwifery study group that I've joined.   We have real homework to do, I am a bit overwhelmed and not sure how I am going to keep this blog up and get homework done for our monthly study group meeting but we shall see....  So here is a link to a good article on the history of midwifery in the U.S.

Ten Things about my journey to Empowered Birth

I got tagged again, this time by Solo Mother!  I am supposed to write about ten things that happened to me but I am, of course, going to write about birth.  So here we go, ten things that happened to me on my journey to empowered birth.

1.I tend to be very type A (though the years of yoga have mellowed me out) and a big planner.  I planned to have my first child before I turned thirty and did just that.  I gave birth six months before my 30th Birthday. 

2. I am the child of a mom born at home who had very easy births and so I never thought twice about my ability to have a medication-free normal birth in a hospital.  Since I didn't read Henci Goer's The Thinking Woman's Guide to a Better Birth (or anything else for that matter), I ended up with a cesarean that could have been prevented with the presence of an experienced doula.

3. I listened to African music, mostly the Mahotella Queens and Salif Keita during my labor with Khady.  I LOVE African music of all sorts.  There was a quote in our yoga class today, something about the drums beat and the dance begins and your pain is taken away, so true.  The drums helped me get in my labor groove.

4. Khady snuggling in her sling, close to my heart, took away the sense of failure that tried to settle in after my cesarean. 

5. To reassure myself that this baby-slinging nursing on demand thing that I was doing was indeed the right thing to do, I sought out a group of girlfriends who also slung their babies (one of whom is responsible for this tag :-)) and together we struggled through our evolution into moms.  There is nothing like the support of good girlfriends with similar ideas about birthing and parenting.

6. When I became pregnant with Fenimore, I began reading the books I should have read while pregnant with Khady.  I wanted to have this baby at home but Matt was not comfortable with the idea and I wanted to have his support so I pursued a practice with both midwives and physicians. 

7. I had pretty severe hemorrhaging with Fenimore, the kind that sends you into the emergency room in the middle of the night.  I was scheduled for numerous ultrasounds and began to question why my pregnancy had become so medical.  When it became obvious I would not have a VBAC with a practice well entrenched in the birth is a medical event model, I began to research other options.

8.  I found a great birth center but couldn't give birth there because VBACs are not "allowed" in birth centers.  After spending time in the birth center, one thing became very clear to me, I would not have a VBAC in a hospital.  A friend encouraged me to continue the home birth quest and that Matt would come around, with time.  A little after 7 months, Matt looked at me one day and said, you aren't going to be able to have a VBAC in a hospital are you?  I said, no, I don't think so.  And shortly after that I was calling my midwife to schedule my first visit.

9. I had an mind-blowing VBAC experience and started questioning everything.  The next thing I knew I was drinking raw milk, ordering cotton menstrual pads (yes, I admit it, haven't used them yet but in a very green moment, I added them to my latest cloth diaper order), and making my own broth from free-range local chickens.  If Matt had been told I would make my own broth when we started dating I think he would have fallen over backward with laughter.  Yes, I have gotten pretty crunchy.

10. The first birth I attended was a VBAC at home when Fenimore was just over four months.  During the birth I knew that I wanted to be a midwife.  The incredible connection to the Divine that I feel at births helps drive my passion to be a midwife.  The presence of the Divine is so palpable at empowering births.

Ten Things I love about Me

My good friend Madame Meow tagged me.  After a quick phone call to clear up exactly what tagging was, I am now, as I understand it, supposed to blog on the ten things I LOVE about myself.  I feel slightly like a fifth grader sitting in front of a composition topic due tomorrow, staring longingly at my feet which ache to be shoe-less and outdoors.   I tried to get out of the exercise by thinking, hmm, this is an empowering birth blog, what does this have to do with birth, but since I rarely write about myself I thought, hey why not?  Perhaps people might be a bit curious about who I am and what better time to think about what you LOVE about yourself then when you are pregnant and perhaps not loving yourself enough.  So, modesty aside, here goes....

1. I love that I am a WOMAN (or womyn as my friend Sazz would say, and yes Sazz, I am going to tag you (this does feel like a game of chase!).  I didn't fully understand what it meant to be a woman until I gave birth/began attending births.  After attending a long exhausting labor I often hear the husband remark, wow, I don't think I could have done that.  And I think DAMN are we strong!  It must be the incomprehension/fear of our awesome strength that drives men's desire to oppress women.  Don't we tend to insult that which we really fear?  Ah, there is nothing like the face of a woman in her labor groove; radiant, riding on top of an enormous, uncontrollable energy, and fully in the moment.

2.  I love the passion with which I feel.  Most of my emotions are visceral.  It drives people crazy because if I eat a piece of pie it is the BEST piece of pie I have ever had.  If I read a good nonfiction book, it is the best nonfiction book I have ever read.  My in-laws recently lamented, "everything is always "the best" for you."  It wasn't until recently that I realized that maybe I am better at living in the moment then I thought.  I mean, at that particular moment, it really was the best.

3. I even love the fact that I am full of ups and downs, that I rarely hug the middle of the road.  I am working in my yoga journey to learn how to better hug into the mid-line (an important alignment principal of Anusara yoga), and with this I expect to find greater balance in my life, but I also love that I feel passionately about things.

4.  I love the fact that I have found a way to open up to the spirit and take a yoga pose deeper then I've ever taken it before.  I did that this again last weekend in my Anusara Immersion workshop.  I do not have a super-flexible spine by nature but I've been working for several years to create more space in my pelvis so that I can get deeper back-bends.  And then when I stop trying to control and just ride the spirit, WOW!  Now if only I can learn how to always remain open to the spirit.

5. I love the fact that I am in really good shape.  It is all yoga.  (Well maybe a tiny bit nursing mom. Who would've guessed it takes that much work to make milk!)  I was a field hockey player, swam, and ran in high school but I don't think I was ever as toned as I am now, and this is after two kids!  I certainly don't do yoga for the yoga butt but I will admit, it is a welcomed bonus!

6.  I love my intuition.  It has rarely failed me.  I can sense when it is ok to trust and when I need to be wary of something/someone, though I won't know exactly why.  And I love the palpable connection between people from which that intuition flows.  We are all one.

7. I love that I have an enormous amount of energy.  My energy is the biblical well that never ran dry.  While my abundance of energy can be a curse as well as a blessing (I work very hard to be content with stillness) I love the fact that I can go to the beach with the kids, cook a fancy dinner for a friend, schedule a prenatal, and still have the energy to get my blog done before bed.

8.  I love my blue eyes and the fact that they can look almost Lapis Lazuli in color when I am wearing a deep blue.

9. I love my laugh, I love to laugh.  It has been suspected that it is forced but I protest against that slandering claim.  It is full, loud, joyous, and without containment. 

10. I love that I can still be a kid.  When I go to a pool that has water slides and someone can watch the kids, I will go down them again, and again, and again, each time shouting with glee, thrilled to my viscus with raw joy.

Phew, I'm done!  Ok, I am going to tag Sazz, VBAC Adventure, LaborTrials and Blueberry Baby.  I think we should all spend time thinking about why we love ourself and I have a sneaking suspicion we don't always think about this as much as  we should.  Have fun!

The Business of Being Born, Spread the Word

I received this from a listserv that I am on and am passing the word!

I can't WAIT to see this movie:

Hello Friends:

If you are receiving this email it means that we have been in touch
at some point over the past three years while
making our documentary "The Business of Being Born."
We are thrilled to announce that the film has been bought for North
American distribution by New Line Cinema and Netflix/Red Envelope!
The film will have a limited theatrical release in New York, Los
Angeles, Washington DC, and 11 other cities beginning in October
2007.

So, now we need everyone's help SPREADING THE WORD! We'd love this
film to become the "Inconvenient Truth" of childbirth and in order
to achieve that, we need a grassroots movement and momentum behind
it. Several of you have contacted us over the past months to inquire
about HOSTING A SCREENING in your area. Well, now is the time!
We have arranged a way to "lease" advance copies of the film to
individuals and organizations over the next 3 months.
You can host a screening as a big fundraising event for your
organization or just to raise awareness in your community or
University. It could be in a professional theater or in your home  the idea is
just to get it out there and get people talking!
We have spoken with a few BOLD organizers about including the film
in their events, which could be great too.
The time window is ideally September, October or November 2007, but
screenings could happen later as well.

So, please FORWARD THIS EMAIL to your all of your colleagues and
friends across the country and encourage them to sign
up on our website: TheBusinessofBeingBorn.com to stay
updated about the film.

Thanks to everyone for all your support!

Warmest,
Ricki and Abby

Ricki Lake, Executive Producer
Abby Epstein, Director & Producer

Guidelines for Hosting a Screening
"The Business of Being Born"

DATES
Your screening could take place anytime after September 1, 2007 but
we encourage scheduling before Thanksgiving for maximum word-of-mouth
impact.

VENUES & FORMATS
The screening could take place in a home theater, local cinema, or
basically anywhere that you can project a film digitally or watch on a TV
screen. The formats we have available are HD CAM, Digibeta, Beta SP or DVD. We
do not have a 35mm film print. . If you have a small venue, it is
possible to do multiple screenings. The film is 85 minutes long.

SCREENING FEES
The film can only be viewed for a screening fee, but you can set
your own ticket prices and collect whatever donations you¹d like to cover
your expenses or to raise funds for a non-profit. *The rates per
screening are: DVD: $200
HD CAM, DIGIBETA OR BETA SP: $800

*These rates are based on screenings for 100 seats or less.
Screening fees will be adjusted for larger venues.

PUBLICITY
The concept is that these screenings would be one-night-only events
followed by Q&A or panel discussion after the screening. There is
also the possibility that Exec. Producer Ricki Lake and/or Director Abby
Epstein could attend the screening based on budget and availability. The
grassroots screenings should not become confused with the commercial
theatrical release, so advertising to sell tickets to the general public is prohibited.
Local press is more than welcome!

CONTACT
In order to host a screening, just email us at
news@thebusinessofbeingborn.com
and outline your proposed venue, city, date and format. We will get
you a simple screening contract and then coordinate shipping your
screening copy.
We can also provide you with press notes and still images.

Enjoy No Wine Before it's time, It's Time!

For those of us who believe that truly listening to our bodies can be more reliable then listening to our doctors, here is a study that supports what many of us have always suspected (smile).
And yes, I admit, I do have a glass of wine or beer occasionally during pregnancy, when my body feels up to it.  Wine is not of course recommended if there is any history of alcohol abuse in your family.

This blurb is from www.ORGYN.com's  weekly news update (accessed August 16, 2007).  I highly recommend subscribing to the email updates provided by this on-line magazine.  They are FREE and full of information.

Low-moderate alcohol exposure 'may not harm fetus'
Source: BJOG: British Journal of Obstetrics and Gynaecology 2007; 114: 243-52

Reviewing the evidence on the impact of maternal alcohol consumption on pregnancy outcomes.

A systematic review published this month has found "no convincing evidence" that low-moderate prenatal alcohol exposure harms the fetus.

However, the study authors, from the University of Oxford, UK, admit that methodological weaknesses in many studies preclude the conclusion that drinking alcohol during pregnancy is safe.

J. Henderson and fellow investigators reviewed the literature for studies comparing low-moderate alcohol consumption (less than 12 g/day) with abstention among pregnant women.

A total of 46 studies, involving 713,826 women, were included in the review.

Henderson et al reveal that there was "no consistently significant" effect of alcohol consumption on any of the pregnancy outcomes considered. These included stillbirth, miscarriage, impaired intrauterine growth, low birthweight, preterm birth, and birth defects (including fetal alcohol syndrome).

Indeed, low levels of alcohol seemed to have a mildly protective effect on several outcomes, such as stillbirth and growth retardation.

Nevertheless the authors urge caution in interpreting their findings and note that many studies were of suboptimal quality.

"More studies concentrating specifically on low-moderate levels of alcohol consumption would be of benefit and would allow for more detailed analysis of this area," Henderson et al conclude.

Posted: 27 February 2007

© 2007 Current Medicine Group Ltd, a part of Springer Science+Business Media

Gorillas and Breastfeeding

Breastfeeding is a learned behavior.  Please be patient with yourself if you are struggling.  I learned in a lactation class that at some zoos gorillas are shown videos of other breastfeeding gorillas in order to teach them how to breastfeed.  Breastfeeding is mostly a learned behavior so unless you grew up watching your mom and Aunts breastfeed on a regular basis it might take you some time to get the hang of it.  But hang in there!  It is well worth the effort.

Two Baby Gorillas Are Born*

14/11/2006

This summer, two baby gorillas were born in the Zoo. N'tua, the daughter of Virunga and Xebo, arrived on 5th June, and N'goro, the son of Machinda and Xebo (again), on 25th August. They belong to the west coast sub-species of gorilla Gorilla gorilla gorilla. For the first time, the little ones have been brought up in the gorilla unit, without being separated from their mothers, thanks to a complicated method of bottle feeding. Machinda had already had some offspring, but these were bottle fed by their carers in the nursery, as she did not know how to breastfeed correctly. Females need to be brought up in the company of their mothers in order to learn proper maternal habits, as the greater part of behaviour in most primates is learnt, and instinct plays a small role. Virunga grew up with her mother, but the problem was that she did not have enough milk to feed her baby. As soon as Virunga returned a positive pregnancy test, a programme of patient training was started to help the carer get close to the mother, and so let the gorilla get very used to the presence of the bottle. This technique enabled the young to be properly fed without having to separate them from their mothers. They are growing at a very satisfactory rate and can already be seen for a few hours a day, together with the mothers and their father, in the gorilla unit.

*Accessed August 17, 2007

Bonding and The Breast

Some moms are concerned that when they have their baby, they will look at the baby and think, argh, I'm not ready yet, this is too much.  I have a few thoughts on this.

It is COMPLETELY normal to feel like you need to take a break after the birth, before welcoming baby, and you should be reassured that this is ok.  I mean you just spent hours preparing to and then pushing a rather large sized baby through a rather small hole and that is HARD work.  You deserve to relax for a bit, take a deep breath, have a glass of champagne (just kidding, you might have to wait a bit for that).  Hey, baby might need a moment too.  Place baby skin to skin on mom's tummy where he can hang out for a minute while you come back into your body and make sure your partner or doula affirms that what you are feeling is normal. 

When breastfeeding is initiated, your body will go through a hormonal shift that will help you fall in love with your baby.  So when you are ready, try to initiate breast-feeding.

Prolactin and oxytocin are released in response to stimulation by the baby's sucking at the breast. Prolactin is responsible for milk production, and oxytocin for milk letdown. However, these hormones are beneficial in other ways. Prolactin is sometimes called “the love hormone.” In animals, it is responsible for mothering behaviors. Oxytocin is responsible for the relaxed, sometimes sleepy, calm feelings that accompany milk letdown. Together, these two hormones keep mothers relaxed, calm, and ready to care for their babies (Uvnas-Moberg, 2003).1

And PLEASE keep baby with you!  If I had to guess why so many moms are having trouble bonding with baby I would say it is because so many hospitals are taking baby away from mom for several hours during the critical bonding period.  Baby is alert the first hour or two after the birth, then he/she turns into sleepy baby.  It is very hard to initiate breast-feeding when you have a sleepy baby and no breastfeeding means no rush of prolactin and oxytocin.  There is a hospital in DC that is notorious for keeping baby in the nursery for hours on end and for no reason other then the fact that it is perhaps easier to keep an eye on babies when they are lined up in neat little rows.  Moms, please don't let them take your baby in the first few hours after birth.  If the hospital insists they must take baby away and you are too exhausted to protest (a very real scenario) send your partner to the nursery with baby.  This way your partner can ensure that the time baby spends away from mom is kept to a minimum.

1 Judith A. Lothian, "The Birth of a Breastfeeding Baby and Mother," Journal of Perinatal Education 14(1): 42–45 (2005), http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1595228.

Wait before you Clamp

Visit this great site for lots of information on the benefits of waiting to cut the cord (preferably until it has stopped pulsating).  I particularly like this easy to understand article (from the same site) on the benefits of delayed clamping.