Empowering Birth Blog

Be informed but follow your intuition

It is studies like this one that remind us to be careful when looking at the research.  So high consumption of caffeine might lower our risk of ovarian cancer.  Wonderful!  Lets all go out and up our caffeine intake!  If for one LOVE lattes (my weakness).  But be careful before you run out that door, however, caffeine is also linked to miscarriage.  I think the same is to be said for GBS testing, and many other topics.  One study might encourage you to call your doc and schedule the test or request a particular intervention but another study will call for judicious use of testing/interventions and warn of unintended/harmful side effects.  Do the research but don't forget to check in with your intuition. 

You can't Compare Hospital Birth and Home Birth

Thanks to The True Face of Birth for reminding us that there is no comparison between hospital birth and home/birth center birth. I was at my friend's house for a baby shower the other day (our friend is having her second at a birth center and she had her first at a birth center) and she pointed out a picture on her refrigerator of her, her partner and baby just after the birth.  She remarked, whenever I get pictures from my friends who have just had babies, I remark at how sterile they look, the white walls, the tubes running in and out, the hospital gown... we look like we are at home.  And there they were, the three of them snuggled up against a pillow in a room that looked just like home.

When people hear that I decided to have a third baby (my husband ALWAYS wanted three, I always said well maybe we will adopt a third but I am only birthing two) after the birth of my second, they seem surprised.  After my VBAC every fiber of my being proclaimed, I WANT TO DO THAT AGAIN!  Now of course that seems crazy.  The mom in front of me is probably visualizing that picture of the pale exhausted mom with tubes stuck in her holding baby against those sterile hospital walls or maybe they are seeing a picture from a sitcom, mom flat on her back screaming where is that epidural as her husband wrings his hands helplessly.  How can I explain to them that the birth that I know is an experience so primal, so empowering, so full of love and power and strength, that tears well up every time I reflect on its awesomeness? 

"Natural" Cesarean

Now I am not really keen with the idea of calling it a "natural" cesarean (compassionate or humane might be a better choice) but if  you need a cesarean for medical reasons (i.e. vaginal birth would most likely bring greater harm to mom/baby then cesarean birth) shouldn't your cesarean look like this?*

*Thanks to The True Face of Birth for sharing this link.  Check out her blog for a great compilation on recent blogging/news on VBAC and cesarean birth.

Why Doctors might be Afraid of Big Babies

Perhaps doctors are very right to be concerned about big babies.  One of the biggest risks associated with a big baby is shoulder dystocia and epidurals may be associated with an increase risk of shoulder dystocia (see  http://www.ubpn.org/awareness/A2002riskfactors.html and http://www.midwiferytoday.com/enews/enews0103.asp for example).

As cesarean rates rise and the rates of women having normal births plummet, obstetrical skills, like successfully managing shoulder dystocia, are lost.  In the hospitals in our area, around 95% of the women receive an epidural.  I attended a birth at a prominent hospital mid-March of last year which drew an enormous crowd of both residents and OBs.  When the mom inquired why there was such a large crowd in the room, she was told that it was the FIRST un-medicated birth of the year. The FIRST un-medicated birth, at a large metropolitan hospital, in March!  So doctors might be seeing some scary shoulder dystocia cases...  It must be hard to get moms into an all-fours position (the Gaskin Maneuver) when a mom has had an epidural. Just a thought...

VBAC after Multiple Cesarean?

Reasons to try a VBAC after multiple cesareans:

Serious maternal morbidity increases with multiple cesarean sections.  Given increased maternal morbidity, several studies suggest taking into account the number of intended pregnancies when counseling women on their options for repeat cesarean or trial of labor.  Below is a great article on one such study.  In other words, if you want more than one or two children, avoid that cesarean!

http://www.greenjournal.org/cgi/content/full/107/6/1226

Uterine rupture is NOT associated with women attempting a VBAC after multiple cesarean deliveries.  Check out the complete study available below:

http://www.greenjournal.org/cgi/content/abstract/108/1/12

And the BIG reason to avoid a repeat cesarean after multiple cesareans:

From an article  in OBG Management, I found this rather scary suggestion in a list of precautions that should  be taken after the 4th cesarean:

"Consider a tubal ligation at the time of the 4th cesarean section." (Accessed 1/24/08)

Hmm... if the docs are recommending a tubal ligation after the 4th cesarean section, they must be a tiny bit worried about the effects of multiple cesareans.

Preventing Uterine Rupture

So you are planning your VBAC (vaginal birth after cesarean) but are a bit nervous about uterine rupture.  Here are somethings to think about.

If you had a "rupture" in a previous birth, find out if you had a rupture or a dehiscence.  They are not the same thing, a rupture is much more serious but a dehiscence is often called a rupture.  With a dehiscence, the serosa, known as the perimetrium in the uterus remains intact.

There are things you can do to help prevent rupture and up your chances for a successful VBAC.  Get lots of exercise (excessive weight gain is associated with decreased VBAC success and with fetal macrosomia and fetal macrosomia is potentially associated with increased uterine rupture) and have a good diet (LOTS of green leafy vegetables and red raspberry leaf tea).  Midwives swear by red raspberry leaf tea as a uterine toner/ strengthener.  Why the focus on diet?  Because the uterus is a muscle, and like any muscle, excellent nutrition enhances performance.  My brother-in-law, who is training to be in the Olympics, can attest to that.  He has one of the strictest diets you can imagine!  Like any muscle, excessive strain (unusually long labor, or abnormally strong contractions with a baby presenting his head at a wide diameter1) can mean complications.

You might be interested in knowing that you are more likely to have a serious fire in your home during the next year or die in an accident if you ride a bike on the street then a uterine rupture.  Check out this page from one of my favorite midwifery websites for more: http://www.gentlebirth.org/archives/vbacrisk.html.

1Eggleston, Kristin. "Midwives and Uterine Rupture." Midwifery Today 83(2007)24.

Are you in labor?

So the second question my friend's birth brought up is when are you in labor?  My friend noted that she was a bit confused as to when her midwife wanted her to slow down labor and when she was supposed to follow her labor instinct, which included choosing positions that would speed up labor.  So deciding when to slow down labor and when to let it run its course probably depends a lot on answering the question, "Are you in labor?"  The midwife seemed to think my friend was in active labor because she was 4 centimeters dilated and requested that my friend stay at the hospital because things could happen very quickly (she was sent home 24 hours later and returned the next day to birth her baby).  There is, however, a lot more to labor then dilating.  How strong are the contractions, how effaced are you, how ripe is your cervix?   Again I have to reference the tape on Prolonged Labor by Diane E. Barnes, CNM and Gertrude L. Welsh, CNM, NP from "Midwifery Today's Clinical Tape Package".  In order avoid improperly labeling a labor as prolonged, the midwives take a good hard look at whether a mom is in labor.  They look for adequate contractions (your uterus should feel as hard as your forehead during a contraction) and cervical change (softening, ripening, change in the position within the pelvis as well as dilation).  They look carefully for other reasons, such as lack of rest/nourishment/hydration, infections (especially UTI) and build-up of lactic acid in the uterus, that might cause contractions but don't indicate labor.  The midwives warn against starting the labor clock until there are adequate contractions AND cervical change in order to avoid labeling a labor prolonged when it hasn't even begun.   I think it is even more important to be careful about noting when labor starts if your client is going to give birth in the hospital. 

My friend began to experience regular contractions on Tuesday morning and had her baby on Friday morning (72 hours later), but did she really have a 72 hour labor?  Did the clock start on Tuesday or did it start when the contractions started to really pick up despite the wine/rest/hot bath?  If you start the clock later, perhaps mom won't feel as though she has been in labor forever.  And was it the fact that it was a pre-term labor the reason the midwife was less clear about when it was ok for my friend to assume positions that would speed things along?  Until it was determined that there was no turning back, why speed things along?

And wouldn't it be nice if caregivers were better at explaining prodromal labor and didn't tell their client's that there will be a baby around the corner just because mom is 80% effaced and 3 centimeters dilated (a mom can hang out like that for days, even weeks).  Babies come when they come.  There are times when we would all love to know when they will come but that is knowledge we can't have.

So much to think about!  So much to learn!

Premature Labor?

My friend just had a 72 hour labor.  WOW, 72 hours, now there is a number that could get a mom really discouraged.  It was preterm labor (35 and 1/2 weeks) and her midwife offered morphine to help her rest (which would mean staying at the hospital), I suggested home, rest, hot bath, and wine.  So this birth has gotten me thinking about two things.  One, when is a mom in labor, and two, what is a good way for mom to get rest/slow down contractions.  I don't think I am ambitious enough to tackle both in one blog post so let's start with helping mom rest/slowing down labor.

In Spiritual Midwifery, Ina May writes:

"If there is no bloody show and there is no or very little dilation of the cervix (less than 1 cm), give the mother a full glass of water followed by a glass of wine.  Alcohol is a depressant, and it suppresses the release of oxytocin from the pituitary gland.  It works well for stopping labor in the third trimester.  Alcohol should not be given in the first two trimesters to inhibit labor because of possible damage to the developing baby.  The woman should stay in bed and everything should be as nice and quiet around her as possible."1

Now my friend was 4 centimeters dilated, not one, but the midwife was offering morphine so my thought was, if wine works (and there is no history of alcoholism in the family), why not?  And the wine was indeed a tremendous help.  It slowed down my friend's contractions, helped her manage a long labor, and possibly helped keep the baby in her an extra two plus days, which got the baby a lot closer to 36 weeks.

So a few days after my friend's birth, I was listening to the tape on Prolonged Labor by Diane E. Barnes, CNM and Gertrude L. Welsh, CNM, NP from "Midwifery Today's Clinical Tape Package" and the CNMs were discussing ways to help mom sleep when she is faced with a potentially long labor or just really needs some rest.  Instead of morphine, they recommend 50mg of Vistaril and 1000 mg of Tylenol.  If the mom's contractions are more painful, they suggest giving a Tylenol #3 (with codeine) in addition to two regular Tylenol). Apparently the midwives have had success promoting the Tylenol/Vistaril combination to hospital doctors as an alternative to morphine.   Among other things, lack of rest, nourishment and hydration can also encourage pre-term contractions, so before tackling the problem of how to help mom rest/slow down those contractions, you should ask mom are you hydrated/how much rest have you had/what have you been eating, etc. etc.?

Which brings me to another thought.  One of the midwives on the tape noted that she didn't believe in Braxton-Hicks contractions before 36 weeks.  She felt that contractions before 36 weeks were due to an irritable uterus or a sign of potential preterm labor.  What an interesting way to think about uterine contractions.  If there is no such thing as Braxton-Hicks contractions before 36 weeks, then if you experienced contractions before 36 weeks, you might think to yourself, I need to hydrate/rest/nourish myself.  If Braxton-Hicks contractions can be experienced before 36 weeks, you might think to yourself, oh, there goes my uterus again.

In any case, my friend said no to the morphine, returned home after laboring in the hospital for a while, took a few hot baths, rested, had a glass or two of wine, and these things seemed to slow her labor down, keep baby inside for a few more days, and gave her the energy she needed to birth her baby when the time came.  I should add that my Midwifery Tape on Prolonged Labor did not recommend wine due to fetal alcohol syndrome, but if Ina May recommends it, alcoholism doesn't run in the family, and you are in your third trimester, I can't help but think it seems like a good idea.  A mom I know who is German mentioned that a glass of wine or beer is a common recommendation for moms in early labor.  What do you think?  Oh, and if you have Spiritual Midwifery, there is a great birth story on page 70 of a mom who uses wine to stop pre-term labor.

Post to be continued....

1 Ina May Gaskin, Spiritual Midwifery, Fourth Edition (Summertown, TN:Book Publishing Company, 2002) 425.

Bellies and Babies

Do visit this blog, it has had some great posts recently!  And I particularly LOVE this video posted on Bellies and Babies. It reminded me of Fenimore's birth, how wonderful for the mom to share her experience through video!  I sang between contractions at Fenimore's birth and smiled during them (that is me to the left, during a second-stage contraction, on this website).  Sometimes you have to capture that on video/photos to believe it (especially in a birth culture where happy birth usually means good anesthesiologist).  I was hoping to make a movie of my May birth but my private husband is a bit worried about what his very public wife might do with the video.  But we have a compromise, there will be a photographer, yay!  This is probably my last birth and I hope to capture it in black and white photography.

Waterbirth International Needs Your Help

Fenimore was born at home in water, caught by my own hands. I am joining the many birth blogs and birth listservs spreading the word.

Waterbirth International needs your help!!

 

For twenty plus years WBI and Barbara Harper have been guiding mothers and their providers, providing education and birth pools all over the world. Waterbirth International is facing the very difficult truth that the Gentle Birth World Congress - a fabulous success in every way for international and local attendees - drained all of our resources. We may have to close the doors permanently by January 31st.

 

We need to raise $200,000 in donations to cover the debts from the Congress.
With such a large sum to raise, we need each of you to support this cause.  When you support waterbirth, you are making a statement that you want and need options, choices and more control.

Can you help us stay open to take the next phone call?

- to convince the an obstetrician to incorporate waterbirth into his/her practice

- to work with the nurse midwives to install pools in their facilities

- to educate an entire hospital on the benefits of allowing women freedom of movement in the water

- to continue our resource services for parents and professionals

 

We have freely given these services over the past 20 years. We want to continue to give them freely, but we need your help to keep the phones turned on and the volunteers working.
 

How much is it worth to see waterbirth become the norm in the US, like it is in the UK?  I think we only need a few more years to make that happen.
Women really do want waterbirth to be an available choice in every hospital.  They need choices now, more than ever. 

If we need to call every single waterbirth parent personally, we will. We don't want 25 years of pioneering work to end and the vision of safe and beautiful waterbirth to go away.

 

Please do the following:

  ~DONATE any amount you can
  ~Become a MEMBER of Waterbirth International

  ~Buy a birth pool for your local midwives
  ~Buy a birth pool for yourself

  ~Buy a birth video and donate it to your local library
  ~Spread the word around the world - Post this message on other sites and blogs