Empowering Birth Blog

Forty Weeks and Four days (but who is counting)

At the park the other day a nanny looked me up and down and remarked, "soon, baby will come very soon."  I replied, "I hope so, my due date was Monday."  Nonplussed, she remarked "oh that is normal, very normal, baby come early, baby come late, all normal."  And once again I found myself wishing I could transport myself to another country where birth is considered a normal event for the remainder of my gestation.  I don't mind being late, which is a big statement given the fact that patience is NOT my strength.  I told this baby it could come when it wanted to.  I do mind the oh, you are still pregnant, vibes I sense from people on the street.  I much preferred the calm certainty of the nanny in the park who knew that eventually, the baby would come out, and that all was good.
I think I willed Khady, my first, to come early.  A good month away from my due date, I had already planned the closing of our Chicago house which we were selling AND the closing date of our new DC house that awaited us just a short 13 hour drive or so away (a drive that would be lengthened by stops for frequent nursings and walks around the car to improve circulation in my newly postpartum body).  And of course the baptism was scheduled as well.  There was no margin for error and I am sure this was what encouraged me to ask my midwife to vigorously strip my membranes the day before I went into labor.
With Fenimore, my VBAC baby, I spent most of my time calm and sure of my ability to birth but VBAC anxieties gripped me from time to time and of course I hoped baby would come sooner then later.
With this baby, despite the house rehabbing and selling and the house hunting, I have remained committed to the belief that all will work out and baby will come when he/she needs to.  Of COURSE I am overly excited to meet this baby and I do sing "baby come out" songs but I do not feel she/he absolutely must come out now.
I am also feeling a lot of empathy for moms with caregivers who talk induction after 40 weeks.  It is hard enough to push away the culturally ingrained feeling that baby should come out around 40 weeks.  To remain calm and committed to the belief that baby will come when he/she needs to while your caregiver is ordering any number of tests and setting your induction date must be very stressful indeed.
Once I am attending births again, I will over-emphasize that my clients should not etch a due date into their heads.

The Birth Survey

Wouldn't it be great if we could get the inside scoop on birth attendants and their intervention rates etc.?  As a doula, I belong to a listserv and we discuss experiences with doctors but we have no hard data.  For example, we might ask, has anyone had a successful VBAC with doctor x?  We all know that certain hospitals must have high cesarean rates because the moms we attend there tend to have cesareans for questionable reasons, but again, no hard facts.  There is a project out there that aims to collect better information from practitioners so that women will truly have more choice when deciding where and with whom to birth.  Here are the goals of the project as found on their site, The Birth Survey.

Objective 1        
        Annually obtain maternity care intervention rates on an institutional level for all fifty states.

Objective 2
        Collect feedback about women’s birth experiences using an online, ongoing survey, The Birth Survey.            

Objective 3
        Present official hospital intervention rates, results of The Birth Survey, and information about the MFCI in an on-line format.             

Objective 4               
       Increase public awareness of differences among maternity care providers and facilities and increase recognition of the MFCI as the gold standard for maternity care.

It is hard to have an empowered birth if you can't get good information!

                    

Scrubs Star's Wife has Home Waterbirth

Maybe the ACOG statement "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre" was referring to the recent press on celebrities having home birth.  After Ricki Lake's home birth, I was strongly leaning towards following in her footsteps but now that the wife of Scrubs star John C. McGinley has had a home birth, I will definitely have one!  Just kidding.  I do appreciate the positive press for home birth though!

The Struggle Between Midwives and Doctors

I was out of town reading a fantastic novel, The Birth House, when ACOG decided to release its latest "Statement on Home Births."   Much of the book is about the battle between midwives (traditional wisdom) and doctors ("science").  In her Q and A at the end of the book Ami McKay, the author and journalist, writes: "When I began researching the history of midwifery in North America in the early 1900s, I was horrified to find how aggressive the obstetrical community had been in campaigning for the elimination of midwifery....Doctors actively went to women's organizations and club meetings, discrediting midwives and telling women they were bad mothers if they didn't choose a hospital birth with a physician."1

ACOG's statement made me realize that the campaign against midwives presented in The Birth House continues today.  ACOG notes: "Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death."  This statement is no less of a fear-mongering tactic then those used by obstetricians in the time of The Birth House.  Midwifery Today offers a snapshot of one of these prominent obstetricians (c.1920):

Dr. Joseph DeLee, author of the most frequently used obstetric textbook of the time, argued that childbirth is a pathologic process from which few escape "damage." He proposed a program of active control over labor and delivery, attempting to prevent problems through a routine of interventions. DeLee proposed a sequence of medical interventions designed to save women from the "evils" that are "natural to labor." Specialist obstetricians should sedate women at the onset of labor, allow the cervix to dilate, give ether during the second stage of labor, cut an episiotomy, deliver the baby with forceps, extract the placenta, give medications for the uterus to contract and repair the episiotomy. His article was published in the first issue of the American Journal of Obstetrics and Gynecology. All of the interventions that DeLee prescribed did become routine.2

There have been some fantastic responses to ACOG's misguided release.  Check out  ICAN's response (The International Cesarean Awareness Network).  The Big Push for Midwives Campaign tells it like it is: "ACOG: Out of Touch with Needs of Childbearing Families Trade Union claims out-of-hospital birth is “trendy;” tries to play the “bad mother” card."  And for a fabulous blog response, check out House of Harris.

Instead of struggling, perhaps midwives and doctors could work together!  Check out this joint statement on home birth from The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists.

1 Ami McKay, The Birth House (New York: Harper Perennial, 2006) p. 5 of the QandA.
2 Adrian E. Feldhusen, The History of Midwifery and Childbirth in America: A Time Line (Midwifery Today, 2000) http://www.midwiferytoday.com/articles/timeline.asp.

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...

Why are moms so threatened?*

So I posted yesterday's blog post on my neighborhood news group and it warranted a strong attack from a fellow mom.  Perhaps I should have added the below blurb at the top of my post.  This blurb is from a post on a pregnancy/birth blog about big babies**.

(this is not meant as medical advice, this is to remind moms everywhere that you have rights.... choose to use them!  Trust your body!  Choose care givers who trust your body!  Make educated decisions.  Care providers give you information... you have to decipher it and choose how to use it, ask questions, get answers you are satisfied with, if you aren't satisfied remember it is never to late to change to a new care provider or you can choose to just say NO!.) (http://www.pregnancybirthandbabies.com/Big_baby.htm)

I thought the above information was self-evident but I guess it isn't.  Why do moms feel so threatened when I provide them with information?  Why is a public attack necessary?  I know there are many more attacks around the corner given the line of work that I have chosen but I do not relish the thought.  What is wrong with helping women trust their bodies?  If women would rather not read my posts, they can delete them in their in box or choose not to visit my site.  My post was prompted by the sad reality that more and more women have been reaching out to me in my neighborhood informing me that their doctors bring up induction and the big baby worry.  In my mind, that is a threat.  When an "expert" declares you need to induce because you are going to have a big baby he/she is making a threat, not a suggestion.  The threat is, if you don't induce, your baby will "be too big" and you may "tear", "baby may get stuck," etc. (this is what the doctors say to their clients, in reality induction will not reduce complications associated with a big baby).  Moms are going to believe the doctor/expert.  You may have nagging doubts but in the end most moms seem to choose induction because "if the doctor is telling me I should be induced, I probably need to be induced."  My goal is to provide more information so that moms are encouraged to question their care rather than blindly accept the opinion of an expert.

In my first birth, when the doctor asked me if I was ready to have a cesarean, she did so after several comments along the lines of "you aren't bringing the baby down,"  "you aren't going to be able to birth this baby vaginally" etc.  I remember her placing her hand inside my vagina while I was pushing and her comments about the ineffectiveness of my pushing (those types of comments certainly don't help a mom push!!!).  Of course I consented to the cesarean.  Though the question was disguised as a choice, neither I nor my husband felt that we had been given a choice.  A doctor told me I couldn't birth my baby vaginally, I didn't know enough about birth to question her statement, so I agreed to go ahead and have a cesarean.  For at least a year after the birth I made a story up to myself about how I HAD to have a cesarean, that it was an emergency cesarean (it wasn't an emergency, I was given a "choice," after the doctor left the room the midwife offered that I could have the baby vaginally, though she couldn't "guarantee the condition of the baby" but after the strongly given opinion of the doctor, I couldn't really hear the midwife).  If you had suggested that perhaps my cesarean was unnecessary during that first year, I probably would have felt threatened, I may not have been ready to "hear" what you were trying to say, but I would like to think that I would not have attacked the messenger.

* I wrote a follow-up/clarification of this post entitled Thoughts On Blogging.

**Please note, I am not trying to imply that complications are not associated with big babies, I am well aware that there are, but rather that the oft proposed solution, induction, is not the answer.  I think it would be much more useful for care providers to tell their clients that their pelvises are ample and that most women will have no problem birthing a big baby.

At Your Cervix

This looks interesting: http://www.atyourcervixmovie.com/.  After I saw this clip I thought, I would be a gynecological teaching associate (what a fancy term, smile).  Not now of course, I am pregnant, but I can appreciate the benefit of learning about women's bodies with a more personalized hands on approach.  I am so grateful to the moms who patiently let me fumble around to determine how far dilated they are, after the midwife has already checked them, or take their blood pressure even though I sometimes leave the cuff tightened a bit too long.  I wonder if there is a program like this in my area...  Might be something to do on the side while the kids are younger and before I attend a lot of births.  Someone needs to help medical students view patients as women rather than vaginas and breasts and the gynecological teaching associate program sounds like a great way to do that!

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.

Learning to Trust your Body

It isn't easy.  As women we are trained not to trust our intuition.  I am reading a great book, Women's Sexual Passages by Elizabeth Davis.  Lots of good info on our culture's impact on womens' sexuality.  Growing up as a Catholic School girl, I could tell you all about repressed sexuality, let me tell you.  But this doubting of our bodies seeps insidiously into adulthood and pregnancy.  I've done a lot of work and thought I've moved past those nagging doubts but a simple pregnancy test unearthed them. 

I first suspected I might be pregnant the day my period was due.  My husband, excited by the prospect, suggested we take a pregnancy test.  The line on our last pregnancy test that indicates you are pregnant was almost invisible.  I thought my eyes might be playing tricks on me.  Was there really a line?  I wasn't sure.  For the next five-six weeks or so I would wonder from time to time if I was indeed pregnant.  I was nauseous, I had not yet had my period, I had strange food cravings, and even harder to ignore, I was dog-tired, every bone in my body ached with exhaustion.  And yet I had that little nagging voice repeating, well, you never really had a definitive pregnancy test.   I came very close to running to the CVS several times but managed to keep my doubts under control.  At 11 weeks, my belly poking out slightly, I no longer doubt that I am pregnant but marvel that it took me so many weeks to kill those doubts.  Ah ladies, how many times do we let "science" or what the "experts" say squash the voice of intuition.

1 in 3 Babies are born by cesarean

This link was shared by a doula listserv that I am on: http://www.youtube.com/watch?v=2dRF4RtdJdo.
When I watched it I was filled with a deep sadness.  Sadness because my first birth was an unnecessary cesarean and yes, I still have fleeting moments where the sadness returns, I am working on it, don't we always want to give our children the best and occasionally rue the times when we didn't know enough to give them the very best?... Sadness because the world of birth that I know is so completely different from what at least one in three women know...  Sadness because while in some of the pictures, the cesarean meant the difference between having a child or losing a child, in many of those pictures, a woman was most likely the victim of an unnecessary cesarean and robbed of the incredibly empowering nature of birth...  Let me know your thoughts.