Empowering Birth Blog

Blog about Breech, Twin, and Pre-term Births

I found the blog Breech Mama several months ago but it had not been updated in a long time.  Just checked it out and looks like the author is writing again.  Yay!  Check it out!  There is a lot more I would like to write but hate to take too much time away from my studies.  But I have a post or two in the works...  If you are considering a vaginal breech, definitely check out Breech Mama's great critique of the Term Breech Trial.

Too busy growing a baby

I know, I haven't posted for a week, but this baby growing thing takes work!  I am SOOOOO tired.  And I have also begun my apprentice-ship!  I've done a few births with my midwife but to date have not had a regular schedule nor have I been introduced as her apprentice.  Last Tuesday I woke up at the crack of dawn, hurriedly gathered my things together, ate breakfast, packed an ample amount of snacks, and headed up to Frederick, a good hour and fifteen minutes north of DC, without traffic.  I met my midwife and accompanied her for the day on home prenatal visits.  At each stop I palpated the mom's belly to determine position as each mom, took fetal heart tones, and assessed blood pressure.  I was introduced as her apprentice/student.  Oh the joy of riding all day long in a car and visiting mommies with a seasoned midwife that I love dearly.  I will be following my midwife around and/or accompanying her at one of her three offices for prenatals every other week and occasionally on additional days as well.  I am going to try and fit as many prenatal and post-partum visits in as possible before the baby comes, take six months off before I resume prenatal visits and two and 1/2 years after the birth before I resume attending births. 

So there just isn't that much time for blogging.  I am learning to acknowledge that I can't do everything and evenings, I am just too tired to blog.  I used to blog during nap time, and will continue to do so a couple times a week, but usually I end up sleeping the entire time Fen is down.  My midwife suggested that perhaps I am having twins but I think my extreme exhaustion is due to the fact that my body is still producing a lot of milk.  With Khady, my milk dried up by three and a half months but I am almost four months and my body insists on producing copious amounts of milk.  It is an awful lot of work to produce milk AND a baby.  No wonder I eat all the time!

And sometimes when I have free time I just want to relax, like right now.  I am reading a fantastic book, Eat, Love, Pray and I am making turkey stock and turkey soup. Time to check the broth!

Pregnant in America

First there was The Business of Being Born, now there is Pregnant in America!
The trailer for this upcoming film is out.  Check it out on YouTube: http://www.youtube.com/watch?v=R3WWNKurKjA.

And we should see Orgasmic Birth at film festivals next year.

It is great to see movies about birth hitting the mainstream.

VBAC Bloggers

I wish I had had a VBAC blog to follow when I was on the VBAC journey.  It would have felt supportive to know other moms were out there struggling with the same issues at the same time.  Here are the ones I've found (or who found me!):

http://visionsofavbac.blogspot.com/

http://hospitaltohome.blogspot.com/

http://labortrials.wordpress.com/

http://vbacadventure.com/

If you know of any other good VBAC blogs, please send them my way!

Cesareans are Risky

A recent study that looked at 97,095 deliveries in eight Latin American countries found that moms with cesareans had a higher risk of death and more complications for both mom and baby.

Regarding better outcomes with cesarean delivery for breech birth, I would have to add, based on my studies and conversations with midwives, that to ensure successful outcomes for vaginal breech birth, you need to be experienced (your average doctor has little experience delivering breech) AND you need to know your client (and how do you get to really know your client in 10-20 minute prenatal visits).  I wonder how outcomes are affected if you factor in the skill of the attending care provider and the length of prenatal visits.

Birth is AMAZING

A friend who is studying to be a midwife (much further along the path then I!) stopped by this morning for a home prenatal visit.  I heard the baby's heart-rate for the first time!  Ah, sweet baby!

She also shared this fantastic video with me:

http://www.themidwife.net/index_files/Page340.htm

Please note that this is a hospital birth.  Hospital birth CAN be amazing!  It is sad that in the U.S., so very rarely do we see births like the one in this video.  If the hospital births of normal healthy pregnant women were like the one in this video, I wouldn't be railing about hospital births all the time.  Did you notice that the care provider merely checks to see if there is a chord as the baby emerges?  No forced pushing, no holding legs back, betadine solution (which makes tissue more friable) squirted all over mom, just birth.

Some of the other videos on this site are equally wonderful.  Check them out!

http://www.themidwife.net/index_files/homebirthmidwifestudentwomanshealthvideos.htm

Wait on the Epidural

I don't know why I couldn't get epidurals off the brain last night, probably the conversation I had with a wonderful friend walking home from School Information Night.  Too often I feel that if I can just find the right way to put things, the perfect example, people will understand my point of view on an issue.  Not that they have to agree with me, but they will say, "oh, I see what you are trying to say, that makes sense."  Of course I cause myself a lot of grief with this particular way of looking at the world, but I must admit, I am quite satisfied with the latest gimic I used in my prenatal yoga class.  It wasn't my idea, a friend and fellow midwifery apprentice suggested it, took me a bit to figure out how to pull it off, but it worked!

So here's what I did.  At some point in the class I have the women kneel, tuck their toes under, and then sit back on their heels (yes, it puts a LOT of pressure on those tucked toes, if this is easy for you, wait a minute, it probably won't be after awhile).  The pain caused by sitting on your tucked toes simulates a contraction, and I help the moms work through the pain using different breathing techniques, etc.  It was the last class and we have been working on this for awhile so I had them sit through a couple minute and thirty second contractions instead of the usual minute contractions.  On the last "contraction," as I could see the face grimacing begin and sense the shooting pain that was going through each mom's toes, I pulled out a bottle of Vodka and offered everyone a shot.

The first reaction, every mom burst into laughter.  Lesson one, humor can be a life-saver in labor.  Each mom stayed on her tucked toes and laughter rolled through the room.  The moms returned to sitting as I explained the second reason for offering the shot.  Pregnant moms should take the same wariness of having drugs in yoga class into the delivery room.  Is there a difference between having a shot or two of vodka at 36 weeks pregnancy or an epidural when you are only 3 centimeters dilated?

If you absolutely must get the epidural, choose it only if the benefits outweigh the risks.  In my opinion, the biggest risk is ending up with a cesarean for failure to progress or an OP baby that fails to rotate and can't find his way out because you have lost your mobility.  Once you have assessed that you really need an epidural to relax and give birth, FIRST make sure that:

1. you are at least 5 centimeters dilated (not 4-5 but a solid 5)
2. the baby is at 0 degrees station
3. the baby is in a favorable position for birth

Finding out the baby's position is going to be the hardest task ahead of you.  Chances are you might have a resident laboring with you because your doctor is in the OR performing a cesarean.  A resident is probably not going to be able to tell you your baby's position.  In this case, WAIT.  You don't want to get an epidural only to find that your baby is asynclitic or OP.  These positions require a mobile mom to facilitate turning the baby or, if the baby won't turn, finding the position that increases the width of the pelvis/hip squeezes etc., so that the baby can be born in the position he/she is in.  Yes you can turn a baby once the mom has had an epidural but you need a labor doula who knows her stuff and a partner and their job is a HECK of a lot harder with the epidural in place (the Labor Progress Handbook by Penny Simkin and Ruth Ancheta can show you how.) 

Here is a link that offers some more ideas for giving birth successfully with an epidural:
http://pregnancychildbirth.suite101.com/article.cfm/childbirth_with_an_epidural
Giving birth successfully with an epidural is a LOT of work.  I would argue that it requires having a doula present who knows her stuff because your hospital is most likely not going to have the time or the resources to provide you with a doctor who can hang out with you during your entire labor, catch a poorly positioned baby, and make sure all goes smoothly. 

So if you can do it without the epidural, I say GO FOR IT.  The the rewards are worth it.  Stay tuned for a clip of an AMAZING birth video tomorrow.  You only see the kind of glee and ecstasy shown by the mom in this video in normal, unmedicated birth.

That said, I it is definitely not useful to be completely against the use of drugs in labor.  There are times when an epidural might mean the difference between having a vaginal birth or a cesarean, in which case, go for the epidural.  I know a mom, for example, who had incredible sciatica during labor.  The intense pain of sciatica, which was far worse than labor pain, prevented her body from softening and opening up.  A light epidural helped her get some relief and birth her baby.  Do your research and choose a provider who will not push an epidural on you unless he/she feels it is TRULY necessary in your case.

Oxytocin- The Love Drug

Oxytocin is a big part of our reward for making it through a medication-free labor. Although midwives and Michel Odent sing the praises of oxytocin, the love hormone, there hasn't been a lot of evidence that oxytocin prepares mom for bonding with their babies.  In this new study, moms with higher oxytocin levels "engaged in more personalized bonding-related behaviors that facilitated a more exclusive bond with their infants -- behaviors and actions not easily duplicated by another person, like singing a special song to the infant or bathing and feeding them in a special way."1  Additionally, ""We found that initial levels of oxytocin (first trimester) predicted bonding-related thoughts...as well as maternal 'affiliative' behavior to her newborn."2  Now if only those studies had looked at the affect of epidurals and other drugs in labor on oxytocin levels and bonding.   Studies have shown that epidurals in labor interfere with the release of oxytocin:
http://www.blackwell-synergy.com/doi/abs/10.1034/j.1600-0412.2002.811107.x?journalCode=aog

http://www.compleatmother.com/epidural.htm

So when labor gets tough, remember, the good drugs (oxytocin) are just around the corner.


1 Megan Rauscher, "'Love' hormone helps mom and baby bond," Reuters Health Information, Tuesday, October, 23, 2007, http://www.nlm.nih.gov/medlineplus/news/fullstory_56520.html, accessed, October 27, 2007.
2 Ibid.

The Farm and VBACs

Of course I had to get The Farm's take on VBACs.  VBACers on The Farm will have an ultrasound to find out the location of a placenta.  If the placenta is near/on the uterine scar, the midwives do not recommend a VBAC.  If ultrasound is not available, you can use a doppler as placenta sounds are very different from maternal and fetal heart tones.  They sound similar to the sound of the ocean as heard through a large conch shell.

Ina May Gaskin is very big on single-layer versus double layer closure.  Other Farm midwives, other the other hand, feel that the health and diet of the mother is the most important to prevent rupture.  To illustrate the strength of the scarred uterus, one midwife narrated the story of a Ghanian mother under OB care who had a cervical cerclage to close her uterus but the cerclage was NOT removed by 37 weeks as indicated.  The mom, a VBACer, went into labor and labored at home by herself all night long (much to the doctors' horror of course).  She went into the hospital in the morning and her cervic had dilated to 5 centimeters!  Imagine the stress on that uterine scar!!  Did she rupture?  No!  The midwife questioned the mom afterwards and discovered that the women was extremely healthy with an impeccable diet.

Speaking of diet, I have been amazed at the dietary needs of my third baby, now almost 13 weeks!  I have cut out all caffeine and virtually all refined sugar.  I crave protein and greens and vegetables and eat about five times a day.  I have never paid such close attention to my body before, I am usually too busy ( I renovated my house in our last pregnancy, acting as the contractor, I handled most of the renovation details).  This time I am taking it easy and listening to my needs and WOW is this baby hungry.

Heavy Exercise Linked to Miscarriage

I had bleeding in the end of the first trimester of my first pregnancy.  I was running, lifting weights, spinning and doing step aerobics.  I had severe hemorrhaging around 9-10 weeks with my second pregnancy.  I was practicing Ashtanga yoga (a physically intense practice) five days a week.  I have often wondered why I had complications in my pregnancies. I often suspected the Ashtanga might have been the culprit, but now I am almost certain.  A new study  carried out at the University of Southern Denmark, looking at the exercise routine of more then 90,000 women, reveals a higher miscarriage rate among women who exercised heavily.  After 18 weeks of pregnancy, the link between exercise and pregnancy disappeared.  Now the study isn't perfect (are any?) but the reality is you need to take it easy until a pregnancy is well-established.

Why did I work out so intensely in early pregnancy?  I have an immense amount of energy and had not yet learned to use mindful meditation to slow myself down.  Exercise, yoga, was a way to extinguish some of my fire.  Prayer, meditation, being a stay at home mom of two, has taught me to slow my pace down and I no longer need a hard run or an intense ashtanga practice to stay balanced.  Interestingly enough, I have taken excellent care of my body this first trimester, am past the the 12 week mark, and remain complication-free.  Moms, take care of yourself!  Slow down for a few weeks.  If you really must run that marathon, save your intense training for after the first trimester.