A midwife and "Birthing From Within" mentor, I am passionate about informed decision making and helping moms and partners birth in awareness. My blog chronicles my journey from cesarean to vaginal birth after cesarean and my quest for information to help families have EMPOWERING births.
I really love the prenatal packet that Birth Wise Midwifery Care passes out to their clients. Included in the packet is a sheet recommending foods to build a strong amniotic sac. A strong sac reduces the chance of premature rupture of membranes.
Eat lots of:
Fruits and vegetables containing beta carotene (orange or deep yellow)
The subject of race has been strongly on my mind the past week. If you look at the picture from our retreat (scroll to the bottom), you will notice that women of color are lacking representation. I am absolutely certain there are African-American Women in West Va. who would have enjoyed the retreat. Now I can be angry, or I can try to work on improving communication in my community. We have to find a way to keep midwifery inclusive, to stand together, or traditional midwifery might slowly disappear.
While I am on the subject of race, I would like to rant just a tiny bit. I would like to know why my daughter is the only white child in her ballet/tap class. There are two other ballet classes that I know of in the area. One is very expensive, the other is the same price but quite a distance away. Thankfully Khady has not yet been taught that it isn't an every day occurrence to be the only white kid in a group. Things that make you go hmm...
My white sisters and brothers, we have so much work to do. We have the opportunity to make a difference with the next generation. Sending our kids to a class where everyone looks like them in an area with a tremendous variety of cultures and ethnic groups is not sending the right message. Our kids pick up the messages we give them, and at a very young age. My friend, who has an almost four year old, mentioned that there will be a diversity training at their school. A diversity training at a pre-school? Apparently a few of the kids made comments about brown dolls being poor. Now three and four year olds don't come up with statements like that up by themselves...
At our retreat we discussed keeping your personal bias out of the equation when speaking with clients (I think we are all guilty of this at some time or another, aren't we?). Despite the uniform emphasis on repressing personal opinions, I noticed a clear bias on absolutely and always accompanying your mom to the hospital during a transport. I try not to believe in absolutes and always. What about the midwife who risks arrest if she transports a couple to the hospital? If arrested, she leaves her clients (perhaps someone in early labor) without a care provider. And what if the transporting midwife is a woman of color and thus more likely to receive harassment in a hostile climate? Let's be real, it is easier for us white women to work within the system, even when faced with a sticky situation.
The solution proposed was that perhaps the midwife shouldn't take on the client who is putting her at risk (for example, if you are in a state where it is illegal to attend a woman who would like to give birth vaginally after cesarean, then you shouldn't attend VBACs). Let's say for a moment that a VBAC client who is determined to have a VBAC feels pushed to birth at home unassisted but is not comfortable with that choice. She feels unsafe and torn between two equally unwanted options, birth in a hospital or unassisted birth. Is that the alternative? Putting women in a place where they feel pushed to make a choice (unassisted birth) that they are making only because they are denied care? Now there are plenty of women who choose unassisted birth but it should be a choice, not a situation a a woman is forced into because the alternative, another cesarean for example, is not acceptable to the mother. I hesitate to go there but what if the mom's fear of an unattended birth interferes with the process of normal labor and the baby is compromised?
I would argue that there is a difference between "dumping" your client at the hospital (something I think midwives should never do) and educating your clients on the legal status of midwifery in their state and choosing, for example, not to attend non-emergency transfers. I've heard that back in the day, couples would regularly tell their midwives, "please stay home, we don't want to get you in trouble." People were protecting a valuable asset in their community, the midwife. A compromise could be to accompany the couple to a hostile hospital as the client's doula rather then the midwife. Let's face it, there are some hostile hospitals out there and midwives have been arrested during transports.
If you choose to transport with your clients, despite the risk of arrest, good for you, but be careful of judging the midwife who does not. Readers, I would love to hear your thoughts on the matter.
I did learn some great tips on transports which I will share in another blog. Remember that many midwives who attend home birth have transport rates under 5% so this is NOT a common occurrence.
Some of the most interesting information from my recent retreat in West VA came from a midwife who is also a doctor. Since she is a doctor, she must support vitamin K for newborns, right? Of course not! Though a big believer in informed consent (I admired the emphasis she places on encouraging her clients to educate themselves and make their own decisions while keeping personal bias out of the equation), she personally believes that babies must have historically been born with "low" levels of vitamin k for a reason (imagine that!). She explained that babies are born with fetal hemoglobin and must make the transition to adult hemoglobin. The fetal hemoglobin must break down and be processed by the liver and vitamin K might interfere with this process. She suggested I order Sara Wickham's book (which I intend to do) but here is an article on Vitamin K, written by Sara Wickham, that I thought I would share. I think Ronnie Falcoa's website has done a good job of summarizing the issues and research (or lack of research) on administering Vitamin K to newborns.
Life is slowing down and I am making good on my promise to share pictures from Nettie's Rebozo session. A rebozo is similar to a shawl and is worn by women in Mexico. It has many uses including carrying babies and as a tool to help baby get into a good position before or during labor. Check out this video of using the rebozo from Spinning Babies. Here my friend Sonija is checking in with baby to feel her position. The rebozo is the shawl folded up next to my belly.
A bit about my friend Sonija. She is the senior doula and midwife birth assistant with Birthing Hands with extensive experience providing birthing services in the United States and internationally. She just recently returned to Washington, DC from Cuernavaca, Morelos Mexico where she also serve as a traditional midwife. And she is an expert with the rebozo!
Below, Sonija is using the rebozo to shake my hips, coaxing Nettie into a better position (Matt, Khady and Fenimore are helping out).
I WISH I had a picture of myself upside down with my legs slung over Sonija's shoulders, the final rebozo move and the one that did the trick. Nettie was hesitant to dislodge from her LOT (left occiput transverse), almost LOP (left occiput posterior) position!
Now I know many posterior babies come out just fine but I figure that if I can do something about position that results in a smoother labor, I'll do it! For more information about optimal fetal position, visit Spinning Babies.
I've posted this story about a vaginal birth after three cesareans before but I met the mom in the video (and the midwives!) and feel compelled to post again. I think that sometimes, when we are VBACing, we can see videos like this and nagging doubts might cause us to ask, did it really happen? Well I can vouch for this video! The mom gave a powerful talk at one of our sessions and I put two and two together and asked her afterwards if she was the mom in the video. Watching her beautiful son run around all weekend and being a witness to the strength of this amazing woman was one of the highlights of the weekend midwifery retreat. Growing up my heroes were almost always people I knew and this momma is certainly one of my heroines. I have to remember to pass this video along to the mom who will be celebrating her own VBA3C in the next couple of months. I have much to write about after an energizing, hope-filled, community-building weekend but first I need to finish unpacking.
Prenatal day! Oh how I love my Wednesday prenatal days. We've had a lot of VBAC'ing moms lately and so I thought I would quote a bit from Jennifer Block's book Pushed today. (Have I mentioned how I LOVE this book?) I think Block does a great job of demystifying the whole uterine rupture fear-mongering that VBACers are subjected to. Here are two snippets from the chapter that covers the ins and outs of VBACs (I should add, and Block does as well, that a lot of the VBAC studies involve managed care so the rate of rupture, when birth is allowed to proceed physiologically, may be lower then one in 200.)
the rate of uterine rupture kept coming up the same in the literature: roughly 1 in 200, even in women with multiple cesarean scars, and the rate of neonatal brain damage or death among VBAC attempts was consistently about 1 in 2000. Those are excellent odds-the risk of a U.S. baby not surviving labor in a low-risk pregnancy is about 1 in 1000.1
The risk-benefit analysis of VBAC versus repeat cesarean breaks down something like this: If you are a woman attempting a VBAC, you have around a 75% chance of delivering vaginally and avoiding another major surgery and at least a 99.5% chance of not suffering a uterine rupture. If you choose a repeat cesarean , you have a 99.8% chance of not suffering a uterine rupture (it can still happen) and a 100% chance of having another major surgery, with all the risks and drawbacks that entails.2
When doctors discuss VBAC with their clients, do they discuss the above research with their clients? Do they carefully go over the possible physical effects of a cesarean on mom (longer hospital stay, higher risk of infection, organ damage, adhesions, hysterectomy, to name a few)? In my experience, Doctors seem to like to repeat something along the lines of, "well, they say the rate of rupture isn't high but it certainly seems high when its your baby." Well isn't that true about everything we do? Riding a car seems pretty safe until we are in a major car accident but does that stop us from getting into a car every day? Recently, I can't remember where, I saw the quote that sums up the whole VBAC/home birth safety debate pretty neatly:
"Birth, As Safe As Life Gets."
1 Jennifer Block, Pushed The Painful Truth About Childbirth and Modern Maternity Care (Philadelphia: Da Capo Press, 2007), 88.
2 Jennifer Block, Pushed The Painful Truth About Childbirth and Modern Maternity Care (Philadelphia: Da Capo Press, 2007), 20.
We have a new midwife in town! We chatted last week over tea while the kids explored. Of course it was raining and so we headed upstairs for a bit more space. Am I glad that our tiny one bedroom temporary quarters is located in our friend's house and that we are always welcome upstairs.
Next weekend I am off to West Virginia for a Midwifery Retreat sponsored by Friends of Midwives. I am looking forward to a weekend of learning and will give a full recap upon my return. I am especially curious about the session on "Smooth Transport" as apparently transports have not been so smooth in the area.
And the other news is, DRUM ROLL PLEASE, we found house! Only six more weeks of living in our teeny tiny little apartment. My goal of moving before winter comes will be met.