Where I’ve Been!

Whew! What a whirlwind these last few months have been for me. I started this blog back when I wanted to get more involved in birth work and shortly thereafter, I found myself more involved with birth work, forcing this blog to take a major back seat! Funny how that works.

I’m still not sure where this is all going to take me, but I wanted to share with you just what I’ve been up to recently.

I am very excited to be involved with the organization, Improving Birth. The mission of this organization is: to bring evidence-based care and humanity to childbirth. You may be surprised to know that much of what is standard procedure in American hospitals is NOT based on evidence of what is best for moms and babies. In the words of Dawn Thompson, the founder of Improving Birth, our goal is clear: “It’s about women being capable of making safer, more informed decisions about their care and that of their babies when they are given full and accurate information about their care options, including the potential harms, benefits, and alternatives–then, within that decision, to be treated with dignity, respect, and compassion.”

My particular role within the organization was previously to be the local coordinator for the annual Improving Birth rallies that take place all across the country. I am still continuing in that role. However, in the last month or so, I have been fortunate enough to join the “advocacy branch” of this organization. We are specifically working to educate women about what exactly their rights in childbirth are. It saddens me to see how many women don’t understand that they can say ‘no’ to medical procedures that they do not desire – mostly because I WAS one of those women. So many women are surrendering to their doctors’ wishes – despite that they are very much against them! – simply because they don’t understand that they have a right to say no. And I’m not talking about doctors indicating a c-section because of placental abruption or persistent transverse lie. I’m not talking about induction because mom is having complications of pre-eclampsia. I am talking about women who have no medical indication of needing these interventions, knowing that they have no medical indication for these things, and yet not understanding that they can tell their doctors ‘no thank you.’

Even more troubling are the women I hear about who are legally threatened with medical procedures such as inductions and c-sections. In the last 2 months, I have talked with women who have been faced with a court-ordered c-section, received the threat of having CPS called on them for declining a c-section, and been required to take a psychological exam for declining intervention during labor. This is INSANE! Yes, these are the rarity – most women “give up” before the doctors go so far as to threaten them with legal action – but this is not OK. In America, we have the right to bodily autonomy and the right to make decisions about our own health care. In what other field would we be required to give up those rights? If a cancer patient was suggested chemo treatment and the patient declined, would they court-order the chemo? Of course not! That’s just insane!

The thing is, women have more rights than they think they do. It’s just a matter of educating them and connecting them with resources to support their decisions…. which is where the Improving Birth advocacy comes in. I am so passionate about this work and it is so fulfilling to be able to help these women – especially fellow VBAC women! – know, understand and receive the care they and their babies deserve.

You can find out more about the Improving Birth movement on their webpage at www.ImprovingBirth.org or on their Facebook page.

Nuchal Cord Basics

I was talking with an acquaintance the other day who mentioned that she was so thankful for her c-section because “the doctor saved her baby’s life because he had the cord wrapped around his neck twice”. This comment made me curious about the evidence behind nuchal cords and their management.

First, a nuchal cord is defined as: “a condition in which the umbilical cord is wrapped around the neck of the fetus in utero or of the baby as it is being born”. Research suggests that around 1 in 3 babies will have a nuchal cord and it is more common in male babies, and with longer gestation.

While I don’t want to completely negate the fact that nuchal cords CAN cause problems, I think it is important to point out that they more often do not. In fact, the cord is designed to be able to handle being wrapped around the neck – and even in some cases, in true knots – without causing problems. This is partly because the cord is coated in something called Wharton’s Jelly. This gristle-like substance actually cushions the cord and helps prevent it from compressing the arteries and vein that run through the cord. Secondly, the average cord is long enough to be wrapped around the neck and still have additional length leftover so as not to cause problems.

Currently, ACOG recommends checking for nuchal cords after the head is born and if the cord is loose enough, unwrapping the cord from around the neck. If the cord is wound too tightly around the neck, ACOG recommends that the cord is clamped and cut. However, these practices are based on inconclusive evidence, and in some cases, can even cause damage because a baby’s “built-in life support” is cut prematurely. “There have been successful malpractice actions against obstetricians in the U.S. who cut nuchal cords prior to shoulder dystocia.” (Midwife Thinking, July 29, 2010) In other words, baby got stuck at the shoulders after the head was born and suffered some degree of oxygen deprivation since the cord had been clamped and cut before baby was using his/her lungs to breath.

Another thing to keep in mind is that babies are often “diagnosed” with a nuchal cord in hindsight. Meaning, a baby may show signs of distress or labor may be labeled as “failure to progress” when a c-section is performed. It is then that the doctors point to the nuchal cord and indicate that as the reason for distress, when in reality the cord may have had nothing to do with either.

This post is not to deny the stories of women whose babies have had complications due to a nuchal cord. It is only meant to encourage parents to rest assured that a nuchal cord does not necessarily present problems and to urge them to become aware of what the best evidence-based practices are in dealing with a nuchal cord so truly informed choices can be made.

Please read here for further information about nuchal cords and their implications.

Know Different, Do Different

I was reminded of this blog post I made on my personal blog over a year ago – before I decided to go for my HBAC – and felt compelled to share it here. I know it is not evidence-based in the strictest sense, but I feel it does give insight in to where I come from and why I am so passionate about birth. Information is power!

May 1, 2011: Why What I Know Now Will Change Forever the Way I Feel About Birth

I apologize ahead of time for how long this post has become, but once I started I couldn’t stop.

Three months. Just three months until we welcome another new little one into this world. While I should be excited and happy and filled with joy at the prospect of this new arrival, instead I am filled with fear and quite frankly, dread.

I cannot WAIT to meet this new little person. I cannot wait for our other children to meet their new sibling and to watch our family open our hearts to another one of God’s blessings. What I am dreading is HOW this baby is going to enter the world.

All of my babies have been born via c-section. It is a bitter pill that for some reason, I cannot swallow even as the years pass. Maybe it’s because knowing what I know now, I look back and realize that I got robbed and coerced and completely misguided into thinking my c-sections were medical necessity. The only reason they became medical necessity is because of what the mainstream medical community did to my body.

With my first pregnancy,  I was 2 days overdue when my water broke spontaneously on a Friday night at 10:30pm. We had just finished watching the news and I stood up from the couch to fold up the blanket I had been using and whoosh!! I remember shaking with excitement as I prodded Ryan and said “My water just broke!” My contractions started within 15 minutes of that and as we called the hospital to let them know, they said to come right in.

Mistake #1: Not staying home longer to let my body get through the first, slower part of labor.

As labor slowly got under way, the nurses were telling me that my body “just wasn’t getting into a predictable labor pattern” and they told me I needed some pitocin to get things moving.

Mistake #2: Letting them pump me full of a chemical to force my body along instead of just letting my body and baby work things out.

Of course, once the pitocin was started, that meant I needed continuous fetal monitoring. Which in turn meant my movement was from then on restricted by wires and IV lines. Which means I spent a lot of time on my back in the hospital bed.

Mistake #3: Spending too much time on my back.

And the pitocin was not a one time thing. They continued to increase the dose and increase the dose so much that I remember lying on the bed in so much pain, the nurse coming in and doing something over at the IV pump. I remember looking at her with tears in my eyes saying “No! Don’t increase my pitocin again!” But she just smiled and said that I needed to “keep things moving”.

Mistake #4: Not ripping that blasted IV out of my arm right then and there.

After enduring the pitocin-induced back labor for some hours, I finally caved and requested an epidural. I was exhausted, sore, panicky about not having any control over the process and I thought “I can’t do this anymore!” and got the epidural.

After that, things went downhill even further. For the rest of my labor, I laid on my back in pain (because apparently I am one of the lucky 2% of people that epidurals don’t work for) unable to go anywhere or do anything constructive for my body. They continued to poke my body 4 times in an attempt to get an epidural to “take” but none of them worked.

After 21 hours of my water breaking, they told me that the baby needed to come out because she was exhibiting “some signs of stress” and they feared that I was developing an infection in my uterus that could affect the baby. They told me a c-section was the safest way to get baby out. Even though I was 9cm with “just a little lip” and my body was already wanting to push, they told me “No, don’t push. You’re not ready yet.” I was so close and didn’t realize at the time that the next 20 minutes would change my life forever.

Mistake #5: Not knowing then that 24 hours is the “magic number” of the amount of time that most doctors like to let a woman go after her water breaks. Upon approaching that magic number, it seems that all babies are immediately in danger of an infection and must be extracted post haste. (insert sarcasm here)

Mistake #6: Not telling the doctors and nurses to keep their fingers out of my vagina since each vaginal exam has the opportunity to introduce bacteria! I don’t know how many times I was checked for dilation, but again, knowing what I know now, I would decline all vaginal exams.

Our little girl was born via c-section on Saturday night. While she came out with extremely low apgar scores (a score of 1 at 5 minutes and a score of 5 at 5 minutes) and looking more gray than pink, I believe this is due largely to the amount of pitocin that was causing my uterus to clamp down so hard that she was probably getting decreased oxygen. The cited fetal distress as the reason for this c-section, and I wholeheartedly agree: fetal distress caused by all the interventions that led up to it.

With our second pregnancy, I vowed that I was going to have a better birth experience. My doctor agreed that a VBAC was safe with one caveat: I would need to be induced 1 week prior to my due date so baby would not “get too big”. (I won’t even get into how ridiculous that reasoning is.)

Mistake #7: Allowing the doctor to induce me. Statistics prove that induction raises the c-section rate significantly. But of course, at that point, I still trusted that the doctors knew what was best.

So, on Friday, May 13th, we went to the hospital at 6:30 in the morning all excited to bring another baby into the world. They broke my water around 8:00am and after that we walked and walked and walked up and down those halls trying to get contractions to start. Finally by 10:00, I started to feel that contractions were coming and once again, I vowed to have a different birth experience. I was NOT getting in that bed, I was NOT letting them give me pitocin, I was going to DO THIS!

So we walked and walked until the contractions started to get a little more intense and I asked to go into the tub. I laid in that tub and was actually able to get a good handle on the contractions for a while. Suddenly though, I just felt this incredible urge that I needed to get out. I was getting panicky and I know now that I was entering transition. I got out of the tub and my body was wanting to push so the nurse checked me and said that I was 7cm. I panicked. Labor was moving so fast this time (for me!) and I was afraid I wouldn’t be able to do it without drugs. I told them I wanted an epidural. (Knowing full well that it wasn’t going to work again, but in my transition-state of mind, I wasn’t thinking straight.)

Of course the epidural didn’t work. All it did was make them continuously monitor me again and keep me on my back in that hospital bed. After a while, our baby’s heartbeat started dropping (I still don’t know exactly what they meant by that… how deep and when exactly the decels were occurring) and after some careful monitoring by the doctors, they decided an emergency c-section was necessary, fearing a uterine rupture.

Mistake #8: Getting that epidural. When baby’s heartbeat started to dip after that, the doctor automatically assumed uterine rupture. Never mind that babies’ heartbeats normally dip during a contraction and that an epidural can cause even more decelerations. Because I was a VBAC, uterine rupture HAD to be the default scenario.

Our second little girl was born Saturday afternoon, only 7lbs 9oz (remember how concerned they were with her getting “too big?”) and healthy as can be. My uterus was fine. Although, I wasn’t aware of any of this until some time later as I was completely put to sleep for her delivery and had to spend time “waking up” in the recovery room.

When we got pregnant with baby #3, my doctor recommended a scheduled c-section due to the “risk” of uterine rupture after having 2 previous c-sections. He sang the praises of having a scheduled c-section such as being able to pick the baby’s birthday, coming in and having a baby a few hours later, and an “easier” recovery from my last birth which he said was ‘a horrible disaster’. Babies #3 and #4 were both born via scheduled c-section, each c-section dragging me further and further away from ever giving birth the way our bodies were designed to birth.

Which brings me to today. I have 3 months to gear up for yet another c-section. I’m not sure I will be able to willingly sign that consent form that day that states that I understand the risks involved of what I am about to do. I feel like I am signing my life away. I have a 3.5% chance of needing an emergency hysterectomy on the operating table. In talking with my doctor, a hysterectomy during a c-section is a very risky procedure. Not only do you have the blood loss from the c-section, now you have blood loss from multiple arteries that are enlarged 10 times in size due to the enlargement of the uterus from pregnancy. Controlling bleeding during this operation is not easy and most women require blood transfusions. Some die.

How can I gamble with a 3.5% chance of having this happen to me when my chance for uterine rupture during a VBAC ranges from only .07% – 2%? Not to mention that only 6% of those ruptures result in infant death. Statistically, it seems like a no-brainer to me. While neither option is completely without risk (what in life is?), doesn’t the 98% chance of having everything go well sound better than the 96.5% chance? And yet, the medical community still says that a c-section is safer.

Safer for whom?? THE DOCTORS? Because then they can’t get sued that things went wrong because I signed a waiver saying I understood the risks?

My birth experiences are not anything I can change at this point. My only hope is that other woman out there are better educated than I was and that they have the faith in their bodies that I lacked.

One Year Ago Tonight

Exactly one year ago tonight, literally to the minute as I type this, I woke my husband up from his nap on the couch and asked him if he could start helping me get through the contractions. It would be an hour and a half later when my water would break. It would be another 5 hours and my vision of myself would forever be altered.

Growing up, I listened to the women in my family talk about birth. They all seemed to have one thing in common: labors that were long and hard. The women in our family had forceps births and c-sections. Labor that would go on for days and days. They talked of excruciating pain, failure to progress and babies that just wouldn’t come out on their own. I think before I was even pregnant for the first time, I had already “learned” that my body was just not made to birth.

So when my first birth was long and hard, with a body that didn’t seem to progress fast enough for the nurse’s timetable, I was not surprised when it ended up in a c-section. This is just what happens to the women in my family, right?

Despite that, I wanted another go at it. I figured, now that I knew what labor was like, I could do it “better”. It would be different the next time. So, baby #2 was an attempted VBAC…. that ended up in an emergency c-section. I was devastated and it glaringly reinforced the ugly truth that I was, indeed, broken.

When baby #3 and #4 came along, for some reason, I still longed for another try. I pleaded with my doctors, even looked into other care providers searching for someone who would believe in me. Believe in my body. But instead, everyone told me I couldn’t do it. They used words like “Too risky”. “Not a good candidate”. “High failure rate”. Even the doctors believed I was broken.

And this changes a woman. To constantly be told that your body doesn’t work changes you. At least it changed me. I mourned the loss of a “normal” birth like one would mourn the loss of a beloved friend. I ran over the scenarios in my head over and over trying to reconcile what had happened and figure out why I just couldn’t do what other women did so easily.

And I remember once, I dreamed about it. I dreamed about giving birth. In my dream, I actually had a baby slide out from my body on its own and it was so vivid that I could feel it. Literally feel how it would be to give birth. I was amazed at how vivid the dream was, especially since I obviously had no idea what it was like.

That is, until a year ago in the wee hours of the morning, when I realized that it was all a lie. My body was not defective! It worked! It actually worked! One year ago tonight, I had midwives at my side helping me climb through the tangle of my own personal Mt. Everest. And together, we triumphed! Not only did I receive the gift of a son that night, I gained the gift of trusting myself again. The gift of knowing that I will never again let someone tell me what I am or am not capable of.

One year ago tonight, I gained the gift of knowing my own strength.

The Decision to Breastfeed

Most pregnant moms today are informed of the benefits of breastfeeding. Science has shown that breastmilk offers many benefits to baby, from aiding in their brain development to supporting their developing immune system.

Take a look at this: What’s In Breastmilk Poster

Isn’t that amazing? Breastmilk offers so much more than just nutrition. It really is a super food!!

We know that a baby can be formula fed and turn out to be an amazingly healthy, wonderful, intelligent kid, but this post is aimed at those mothers who may be questioning their decision to breastfeed, and are looking to overcome some of the hurdles that may come with making that decision.

1. Breastfeeding is painful.
Breastfeeding can hurt at first. There are so many times I read breastfeeding information that basically tells women “if it hurts, you’re doing it wrong.” Sadly, I think this sets women up for frustration and ultimately, the end of the nursing relationship because they think they can’t do it right. In my experience breastfeeding probably is going to hurt a little bit at first… sometimes a LOT bit. But here’s the good news: it doesn’t have to stay that way! With practice, patience, and most importantly, the right support, the pain CAN go away and breastfeeding can be enjoyable. If breastfeeding hurts, it doesn’t mean that you’re doing it wrong or that your body isn’t meant to breastfeed – it just means that some extra work may be required to get it figured out.

2. Breastfeeding is too demanding for the mother.
For a breastfeeding mother, it’s true that a baby fully relies on mom’s breasts – 24 hours a day, 7 days a week. It is definitely time- consuming, but this is nature’s way of making sure that we moms slow down, rest, and recover from the marathon called ‘birth’. Our bodies can benefit from all this downtime and while spending hours upon hours with a baby in your arms can be a bad thing for the laundry pile, it is good for your body and soul. Once mom and baby have developed a good, strong nursing relationship, bottles can be introduced so that dad or other caregivers can give baby expressed breastmilk. That also means that moms can return to work and still continue to provide breastmilk for their babies.

3. Breastfeeding is weird.
I have heard from some moms that they have a hard time with the idea of using their breasts in this manner. I think this sentiment comes, at least in part, from our society’s view of a woman’s breasts. The media constantly tells women that it’s OK to show a little breast for the sake of sex appeal, but will tell the same woman to cover up if she is going to breastfeed her baby. Breastfeeding is the way mammals feed their young. Breastfeeding is normal. If you are struggling with these concerns, I would encourage you to find support and talk to a lactation consultant or even other mothers about your feelings.

4. Breastfeeding is starving my baby.
I have no science or studies to back me up on this, but in my opinion, this is probably the biggest reason why women who fully intend to breastfeed decide to call it quits. I think there is sometimes a misconception that babies should eat every 3 to 4 hours consistently around the clock and then suddenly when the breastfed baby wants to eat every 2 hours – sometimes even every hour – moms worry that they are not producing enough milk. While this may be physically true for some women, it is actually pretty rare. For the majority of us, our bodies have a beautiful supply and demand system at our disposal: the more you nurse, the more milk you will make. In general, as long as baby is having 6-8 wet cloth diapers (or 5-6 wet disposable diapers) in a 24 hour period after your milk comes in, you are making enough milk – even if baby wants to nurse every hour on the hour.

There is a really great article here about WHY the breastfed baby eats more often and sleeps for shorter stretches of time.

Also, I think it’s important to point out that women cannot measure how much milk they are truly producing by how much milk they are able to pump. This is another area where I think women sabotage themselves thinking they are not producing enough. Babies are always more efficient at getting milk out of the breast than a pump is. Again, if baby is having 6-8 wet diapers a day, it is usually best to ignore the pump!

If you are currently breastfeeding your baby and you have concerns about your supply or the health of your baby, please see a lactation consultant. They will be able to properly weigh your baby before and after a feed to help determine if there is a problem that requires further investigation.

At the end of the day, breastfeeding is a highly personal decision that all mothers must make on their own. Given what we know about breastfeeding, it is a decision that I hope all mothers do not make lightly. With a good amount of support, practice and patience, breastfeeding can be a wonderful experience that benefits both moms and babies!

Click here to find a lactation consultant in your area.

Conscious Decision-Making

There is an old story that goes something like this:

A young woman is preparing her very first roast. As she is preparing the meat, she promptly cuts off the ends and puts the roast into the pan. Watching her, her new husband asks why she cut off the ends of the meat and she says, “That’s just the way my mother always did it.”

The next time the young woman sees her mother, she asks her why they always cut off the ends of the roast before putting it in the pan. Her mother replies, “Well, that’s just the way Nana always did it.”

Now more curious than ever, the young woman decides to pay a visit to her Nana. “Nana, why did you cut off the ends of the roast before putting it in the pan?” To which the old woman replied, “Well, otherwise the roasts didn’t fit in my pan.”

Cute story. But unfortunately, many of the practices in current obstetrics are based on this theory: it’s just the way things have always been done – despite new medical evidence to encourage otherwise.

Therefore, I encourage you to read current research on the following topics so you can make fully-informed and deliberate choices based on this information.

- Artificial rupture of membranes
- Delivering in a supine position
- Umbilical cord cutting
- Placing baby in a warmer after birth
- Eye ointment
- Vitamin K (injection or oral)

My hope is that One Birth will continue to bring you current information on topics such as these so you don’t risk lopping off the ends of your roast just because that’s how it’s always been done.

Tips For a Natural Hospital Birth

My fifth baby was born at home and was by far the most amazing experience of my life. Should there be a sixth baby, barring any unforeseen medical reasons, we would plan for another home birth. However, I know that home birth is not for everyone. I realize that for some, knowing that an OR is just down the hall in the event of an emergency is of great comfort, and perhaps in some cases even necessary, in order for labor to progress due to the mother’s comfort level. For all of those people, these are my recommendations to help you get your natural birth in a hospital.

1. Avoid third trimester ultrasounds. Unless there are definite concerns about the health of the baby, do not consent to an ultrasound this late. Third trimester ultrasounds are notoriously inaccurate in determining baby’s size and sometimes doctors will start pushing for induction if the ultrasound indicates that baby is getting what the doctor considers “too big”. Which brings me to item number 2:

2. Avoid induction. Again, unless there are definite concerns about baby’s health, it is so important to just let baby come when baby is ready. I know the last month can be really uncomfortable. I know the anticipation of meeting a new little person can feel almost too much to bear. I know it can happen that doctor is on vacation the week after your due date. But not only does waiting ensure that baby is strong and physically ready to be born, it also gives your body a chance to warm up to labor naturally… which means labor at the pace and intensity that is right for YOUR body.

3. Avoid constant fetal monitoring. In fact, keep fetal monitoring to a minimum unless there is cause for concern. Some fluctuations in heart tones are completely normal for baby during the course of labor and sometimes over-analyzing these benign changes cause doctors to worry needlessly. Read here for an article about recent studies that show that constant fetal monitoring does not necessarily provide better outcomes for mom and baby.

4. Avoid vaginal exams before and during labor. I know it’s reassuring to know that progress is being made, and indeed, there are times when a caregiver may want to check progress. But the number of centimeters dilated is essentially a meaningless number. A woman can be at 3 cm for hours, days – weeks even – and 3 hours later, be in active labor at 7 cm. An attentive care-giver will be able to read progress without once checking dilation. (Read this great article here for more on that!) Not to mention that if they don’t check vaginal progress, there will be no such thing as “failure to progress”.

5. Hire a doula. I cannot stress this enough. If a woman desires a natural birth in an American hospital setting, I believe it is imperative to have a knowledgeable, assertive support person that can help ensure a successful outcome and provide emotional and physical support for both mom and dad. I believe it is specifically beneficial to have FEMALE support during birth. A doula will also help ensure that if you are about to deviate from your birth plan, you are doing it consciously and because the circumstances call for it.

Natural birth CAN happen in the hospital setting! It just may require some extra diligence and conscious decisions on your part to make it so.