One Birth At A Time

NIH VBAC conference

2010-06-15T04:31:00.004-08:00

In March, the National Institute of Health had a conference to assess the research in regards to VBAC and then made recommendations based on that assessment.

An AAMI student, Jessica, has separated the video that the NIH made available into easily watchable segments for anyone who might be interested:
VBAC New Insights Conference

I watched the entire conference. The presentations that I found most illuminating were Day 1 (#4) Overview of the Topic by Caroline Signore, MD and Day 1 (#12) Delivery after Previous Cesarean: Long- Term Maternal Outcomes by Dr. Cathy Spong.

NIH VBAC Conf, Day 1, #04 - Overview of Topic from Jessica, BirthAction Webmistress on Vimeo.

For those who may be unfamiliar with the issues surrounding VBAC- it is becoming increasingly difficult to find a care provider and/or institution that are willing to attend VBAC labors. Women are being forced to schedule repeat cesareans without being "allowed" a trial of labor. There are several reasons for this, the most cited is because of ACOG's recommendation that anesthesia be "immediately available" in case uterine rupture occurs. Many hospitals have instituted VBAC bans because of this policy, indicating it would be unsafe to attend VBACs because they didn't have anesthesia immediately available should something go awry.

There is no doubt that uterine rupture can be an obstetrical emergency. If it is caught too late, death or HIE can result. But, it is not the most common obstetrical emergency. Let's look at some numbers from Dr. Signore's presentation:

fetal/neonatal death following UR during TOL: 0.011-0.04%
HIE following UR during TOL: 0.046%
fetal death following midtrimester amniocentesis: 0.06- 0.5%
fetal death from cord prolapse: 0.01-0.06%
perinatal mortality from placental abruption: 0.7%

These other obstetrical risks are as high or higher than the risks involved in having a VBAC. And yet, there are not prohibitions against amnios. And there are no prohibitively stringent anesthesia policies for labors which are at risk of abruption or cord prolapse, which is to say, all labors. Hospitals tout themselves as the safest place to give birth, all the while saying they don't have adequate resources to deal with VBAC labors . If they aren't safe for VBAC, they aren't safe for any other labor in which an obstetrical emergency might occur.

The second presentation I mentioned, by Dr. Cathy Sprong, addressed the long term maternal outcomes of the various modes of delivery after a previous cesarean. The simplified version is this: the more cesareans you have, the higher the risk. For those women who are planning larger families, this is extremely important information. Too long the maternal risks of repeat cesareans (or multiple repeat cesareans) have been downplayed. It also makes a good case as to why the primary cesarean is a big deal and should not be taken lightly. The segment is 20 minutes long but it is so important.

NIH VBAC Conf, Day 1, #12 - Dr. Cathy Spong from Jessica, BirthAction Webmistress on Vimeo.

VBAMultipleC

2010-06-07T16:12:00.000-08:00

She is the life that she is about to bring forth

2010-05-27T10:06:00.002-08:00

"I am overcome. There is nothing to teach her. She pushes for life on her own... She makes herself comfortable, and I must accommodate myself to her position. She moves around. She is creative, inventive, full of life. She looks for what she wants. She is exhausted and yet so vital. As she throws herself upon me, I am covered in her sweat. I am obliged to do as she wishes. But she is beautiful, she is the life that she is about to bring forth.

...where women are free, we will learn how they give birth best. They will show us. They will trust us. Look at them. Listen closely..." --Dominique Pourre, midwife in Birth Reborn by Dr. Michel Odent

My thoughts on birth have evolved so much over the years. From 8 years ago, when it wasn't even a blip on my radar to now when learning and reading about it are an integral part of my life. When I first decided to enter birth work my focus was on empowering women. And at some point since then, it is becoming apparent to me that I can't empower women. To "empower" is to give power or authority to. And frankly, the power was never mine to give. The power has always been with mothers.

At this point, I can only impart knowledge. What a woman does with that is ultimately up to her. When I am midwife, I can provide the space for a woman to find her strength. I have so much to learn. And the mothers are my teachers.

The question of control in birth

2010-05-21T04:39:00.002-08:00

I was reading (or rereading, it has just been a while) Birth as an American Rite of Passage by Robbie Davis-Floyd and was reading the chapter on birth messages and how they are received by women. The word that stood out to me over and over was control.

For most of these women, having control was very important to them. What was really interesting is that this led them to radically different choices, all for the sake of control. Some women wanted to schedule a cesarean so they could control when the baby was born. Some women wanted to deliver vaginally, but with an epidural so that they wouldn't risk being out of control. Some women planned homebirths so that they could control better what was going on around them. Perception is reality.

I would assert that there is an inevitability in having to surrender control to someone or something in order to have a baby, no matter which way you do it. I would love to hear other people's thoughts or experiences with this (if anyone is still reading, ha!)

Dipping a toe in

2010-05-10T11:46:00.002-08:00

I think of this blog often.

Life has been so wild. A baby. A move. Teaching my kids at home. Now I am enrolled in midwifery school- what a relief to be moving in that direction, however slowly.

I am not sure why I want to blog here- so many other birth bloggers have covered the same territory, and probably a lot more thoroughly. (see side bar for other midwives/birth activists).

So we will see where this goes.

The Trouble with Repeat Cesareans

2009-02-22T06:46:00.004-08:00

TIME magazine's recently published an article called "The Trouble with Repeat Cesareans" about the increasing trend in the denial of vbac to women who have had a prior cesarean.

"Indeed, the International Cesarean Awareness Network (ICAN), a grass-roots group, recently called 2,850 hospitals that have labor and delivery wards and found that 28% of them don't allow VBACs, up from 10% in its previous survey, in 2004. ICAN's latest findings note that another 21% of hospitals have what it calls "de facto bans," i.e., the hospitals have no official policies against VBAC, but no obstetricians will perform them."

So ICAN concluded that almost half of the hospitals they surveyed, either in policy or in practice, were denying women the chance to have vbacs. But why? Because vbacs are more dangerous than repeat cesareans? No one will deny that there is more risk to a vbac than a straightforward vaginal birth, but the documented risk of uterine rupture is 0.7% And repeat cesareans are not without risk. It is major abdominal surgery, and the risk of hemmorhage, infection, and death are all higher than with a vbac.

Which brings us back to why. The author wrote the a follow-up article called "Childbirth Without Choice" where she was told in frank terms why vbacs are becoming scarce:

"Or, as one ob-gyn put it when I asked why she and other doctors no longer allow VBACs, 'It's a numbers thing. It is financially unsustainable for doctors, hospitals and insurers to engage in a practice when the cost of doing business way exceeds the payback. You don't get sued for doing a C-section; you get sued for not doing a C-section.'"

So, basically, it comes down to money. It isn't about the safety of mothers and it isn't about the safety of babies, women are being denied the chance to have a vaginal birth after they have a cesarean because of malpractice insurance and because doctors are afraid of getting sued.

WHY DOESN'T THIS HAVE MORE PEOPLE OUTRAGED?! Women are getting cut open again and again, without frank discussions about the risks and benefits of vbac over repeat cesareans. Truly, how are we supposed to trust our doctor's judgment when it has been made clear that they don't necessarily have our health and safety in mind when they make decisions about our care? That they might be glossing over the risk of repeat cesareans because it isn't in their best interest to attend a vbac? How disgusting. How unethical.

But bless that doctors out there who are still willing to attend vbacs, who are truthful with their clients, who believe women should be given choices in birth and not railroaded into repeat surgery.

Where to go from here, though? How to change this, so that we don't go back to "Once a cesarean, always a cesarean"? So that women don't just hear about how risky vbacs are with no discussion about the reprocussions of repeat cesareans. To turn the tide so that the health and safety of women and their babies is more important than money?

Blaming mothers for choosing early surgical birth

2009-02-02T07:15:00.004-08:00

Let's play Operation!

This is a blogger's look at the article on the study "Timing of Elective and Repeat Cesarean Delivery at Term and Neonatal Outcomes”. The basic conclusion of the study was that more adverse outcomes are seen in babies born by repeat elective ceserean at less than 39 weeks.

The lead researcher goes on to suggest that it is because of the demands of mothers that obstetricians are preforming surgical births at less than 39 weeks. And I have to echo the author of the above mentioned blog's incredulity. Why does the responsibility rest with the pregnant woman? Presumably, these obstetricians know better than an average woman how important those last few weeks are, especially in regards to lung development. Doesn't the responsiblity lay mainly with them to educate woman about these risks? Where is the informed consent?

Even days count. Better outcomes are shown at 39 wks compared to even 38 wks and 5 days. This could be the difference between a baby and it's mother recovering together instead of the baby being separated and put into the NICU. I am willing to bet that most women would be willing to put up with another few days of end-of-pregnancy discomfort rather than go through the stress of having their baby in the NICU.

So instead of blaming mothers for choosing surgery early, I would love to see steps taken to ensure that proper informed consent is given.

My thoughts on why the birthing woman gets the final say in where to birth

2008-10-10T15:35:00.001-08:00

I have been sitting on this post for a while, because it is not my intention to offend. A conversation in August with a dear friend prompted me to write down my feelings on this. I feel very passionately about this and yet, I still recognize that I don't understand the dynamics of every relationship and it is up to the parents to negotiate what works best for them.

Our discussion revolved around whether a woman should submit to her husband if she wants to have a homebirth and he is uncomfortable with it.

A Christian Perspective
I suppose we should start with a discussion of submission. If you break it down into it's Latin roots you have sub= under and missio= sending (as on a mission, which obviously is where that word came from). "Wives should be submissive (under the mission of) to their husbands, as to the Lord"(Ephesians 5:22) Well, what is my husband's mission? What was he sent forth to do? For the purposes of this discussion, I suppose we would say that it is a husband's duty to protect his wife and his children. That is his mission. Shortly after that in Ephesians 5, we have the verse, "Husbands, love your wives, just as Christ also loved the Church and handed himself over for her"(Ephesians 5:25) We are called to be under his mission. He is called to sacrifice himself for us, mirroring Christ's sacrifice for the Church.

The Reality is that Homebirth is Safe
What does this have to do with birth? Reality- homebirth is as safe or safer than hospital birth for a low-risk woman. That is a fact, backed up by study after study. Most husbands who are reluctant to "let" their wives homebirth have not researched this issue at all. They are basing their ultimatum on their fear, which stems from the myths that society has fed them about birth: Birth is dangerous. If you don't go to the hospital, your baby/wife could died. Never mind that the reality is that the hospital creates most of the problems that it solves. Never mind that most of the practices that are hospital protocol (continuous fetal monitoring, i.v. fluids, staying in bed, nothing by mouth) are not evidence-based and have not been shown to improve outcomes. Most homebirth practices have a c-section rate of 5% or less. With as good/better outcomes than hospital birth. It is the hospital that husbands should be afraid of, that is the reality.

Why is it so dangerous to "submit" to a husband's wish for his wife to birth in the hospital when her desire is to birth at home/in a birth center? His mission is to protect her/his unborn child. He is not fulfilling his mission by forcing her into the hospital. He is risking her bodily/mental health. It is absurd that our husbands should ask that of us! What if our husbands requested that we have a cesarean? After all, it is easier to schedule for his time off of work, your vagina will still be "perfect". Ridiculous right? Where is the line drawn? If men demand that their wives birth at the hospital, when they prefer to be home, what is to stop them from demanding them to have a cesarean?

And that is the danger when you go to the hospital to give birth. 1 out of 3 woman that walk into the hospital to give birth walk out of the hospital with a big gash on their belly in charge of in infant and recovering from surgery, perhaps traumatized by the experience, their future children and their health at risk, and their birthing choices limited. And why? Because our husbands are uncomfortable with homebirth, which they neither have researched or understand? Because they are afraid of what people will think? Is that loving us like Christ loved the Church? Or is he wrapped up in his own fears and pride? I would never ask my husband to risk his physical and emotional health that I might be comfortable in my irrational fears and I hope that he would not ask that of me.

And that is why a woman's comfort during birth is paramount to her husband's/partner's. Because it is the woman, the mother that live with the consequences. He doesn't have to to live through the flashbacks of a traumatic birth, a woman does. He doesn't have to suffer from ppd. Women cannot let other people's irrational fears jeopardize their physical/emotional/spiritual health. They owe it to themselves, their babies and their marriages.

What about the Fathers?

2008-09-18T06:36:00.002-08:00

I am excited to see this addressed. I have thought much about how unnecessary routine intervention impacts mothers and babies, but have really never given much thought about how watching these things effects the partner/father. What an intriguing subject!

2008-08-13T13:25:00.012-08:00

I am still working on my response to the video. I started it, but can't really articulate my thoughts well, so I am mulling it over some more. Until then, however...

I found this exchange particularly interesting. ACOG responds regarding VBACs, I respond back This woman wrote ACOG (American College of Obstetrics and Gynecology) regarding their policies restricting VBAC. They wrote back, with gross misinformation and she responded back. Scroll down to read her initial letter, their response is in the middle and her rebuttal is the nearest the top.

I find ACOG's response alarming, though not surprising. They are willing to spout facts and figures, but where they got their "facts" has yet to be seen. No research backs up their response. None. It is hard not to laugh at the ridiculousness of their assertion. Just like their opinion on homebirth, their position is not based in safe, evidence-based practice. And the majority of American woman are putting their bodies, their reproductive health, their babies in the hands of these obviously delusional individuals. Scary.

Summary of the video

2008-08-08T06:35:00.006-08:00

In the previous post, I featured videos of Michel Odent talking about the importance of gentle, unhindered birth. If you didn't get a chance to watch them (or you got a couple of minutes into it and decided you didn't have the patience to discern the heavy accent. lol), here is my summary.

First, he speaks of the comparable safety of cesarean section to vaginal birth today. Cesarean section is undoubtedly safer than it was even 50 years ago. Then he poses the question... so, why not offer them to woman, if they are as likely to end up with a live infant as vaginal birth? He then speaks of the Scientification of Love, meaning love studied from scientific perspective. In all mammals there is a period shortly after birth that is critical in mother/baby attachment. And it is no coincidence that the primary hormone important in birth of a baby and delivery of placenta is the "love" hormone, oxytocin. There is a complex cocktail of love hormones to birth a baby, nature's way of ensuring we will accept our young.

Secondly, he speaks of the necessity to rediscover the basic needs of laboring women. Woman cannot properly release the hormones that facilitate childbirth if we do not meet these basic needs: to give her privacy, so as not to feel observed and to have no one but a motherly, low-profile, silent midwife present. The midwife present must be relaxed, so that the mother does not release adrenaline because adrenaline opposes the release of oxytocin.

And thirdly, he speaks of how societies have been disturbing birth and the immediate period after birth with belief and ritual for thousands of years. An example he used was the belief that colostrum is bad for the baby. The ritual that follows is that the baby is separated from the Mother shortly after birth. When the third stage is disturbed, there is a higher incidence of bleeding issues for the mother, since oxytocin causes the uterus to clamp down after birth. We must now rely on physiologists and not culture, which affirm that the safest place for baby right after birth is in the arms of the mother.

So, in summary, if we give laboring women what they need, privacy and an undisturbed third stage, the cocktail of love hormones will follow from which flow attachment and safer birth.

I'd love to give my reflection on this sometime soon!

2008-08-06T06:57:00.001-08:00

These are some of French obstetrician, Dr. Michel Odent, thoughts on the importance of normal, unhindered birth. He has a heavy French accent, so I suggest watching this when all is quiet and you can give it full attention.

2008-08-02T05:44:00.003-08:00

You know the digressions i talked about in this post? This is one of them.

For the last six months, I have been strongly considering and feel led to start pursuing my midwifery education. The course I have chosen is with the Ancient Art Midwifery Institute because the rumor is that it is the most comprehensive, most difficult program out there. And I figure, that if I am going to do this, I might as well do it right. The program is also committed to normal birth- to trusting birth. That is the model I want to be trained in.

So I keep coming back to the question, why now? And I find myself with no answer. It seems like a bad time- I have three little ones, and I can't say that there won't be more, we are starting homeschooling in the fall. But like so many times on this journey into birth work, I am caught up in a momentum that isn't of me. Until six months ago, I felt very content to put off my midwifery education until the kids were much older. That would be the smart, practical, easiest thing to do. But for whatever reason (maybe because I am basically very lazy and the challenge would be good for me?) I am feeling that the easiest path may not be the best in this case.

I feel frustrated. I want to do the best for my kids. I don't want to sacrifice their childhoods for my dreams. And let's face it, midwifery doesn't have the most predictable hours. But I also want to model perseverance and following through with something that is worthwhile and important.

And it is important. Birth is important... how it happens is important. I would like to explore that more in my next post though.... why gentle birth is important to us individually and as a species.

So I trudge ahead, hoping I am doing the best thing. Hoping I can strike the balance. I want to get most of my book education out of the way before I start an appreticeship, for several reasons: to have an increased knowledge base prior to actually getting into the work, to get more time with the littles before being on-call is a part of life, and to grow in life experience. I walk on in faith.

Vaginal Exams (Part II)

2008-07-24T06:17:00.002-08:00

We have discussed how a vaginal exam is performed and what it measures, along with the pros and cons of vaginal exams prenatally. In this post, I want to discuss vaginal exams during labor and birth and their impact on the birth process.

What is the point of a vaginal exam during labor? In a typical hospital birth, labor is "supposed to" follow a pattern, called Friedman's Curve. Here is a chart depicting what is expected of a laboring woman's cervix:

This typically equates to the cervix opening about 1cm an hour. And so, dilation is usually checked about every hour, to make sure a woman is following the curve. If they are not, their labor is labeled "dyfunctional" and often, pitocin is used to augment labor. If that doesn't work after a few hours, this is where the diagnosis "failure to progress" comes in and a cesarean is performed.

The problems with this? There are many. The most glaring being that Friedman's curve is based on averages. What do we know about averages? That they are the mean, that there are normal labors that are shorter and there are normal labors that are longer. It is ridiculous to put a time limit on a physiological process, as long as mother and baby are doing well. It is based on the idea that Birthing Woman are Machines.... if the Machine doesn't dilate X number of cm in X amount of time, the Machine is dysfunctional and we try to "fix" it. If the Machine won't be fixed with pitocin, it must be broken, so let's open it up and do a baby extraction.

So many things are involved in birth, the position of the baby, the strength of the contractions, the mother's comfort and mental readiness for birth. Because the medical establishment likes to believe that the mind and body are separate, it completely discounts that if a woman is uncomfortable in her surroundings, her labor will not progress smoothly. But we are mammals. Most mammals make their nest and need darkness, privacy and quiet to birth. If they are disturbed, labor stalls. Humans are the only mammal that make their nest and then leave it to give birth. It is no wonder labor often slows down once a woman gets to the hospital (or when the midwife arrives at the home in some cases), the mammal part of her says, "New environment, people poking me and asking me questions, not a safe place/time to birth"

The physical aspect of it is that it can be, and often is, very painful. During a time when a woman's body is trying to open up and push down and out a baby, fingers up into the vagina are invasive and counterproductive. In addition, the more vaginal exams, they higher the incidence of infection, especially if the water is broken. If the bag of waters breaks before labor starts, one of the most harmful things a care provider can do is a vaginal exam. As long as things stay out of the vagina, the risk of infection is minimal, but as soon as anything foreign is introduced (sterile gloves included), the risk goes up.

The psychological aspect of vaginal exams during labor is that they can be extremely discouraging if things are not progressing "normally" The language used during vaginal exams is often negative... only 3, just 7, not quite 10 cm. And let's go back to the fundamental truth about vaginal exams that we discussed last post: They only tell what the cervix is doing at that moment. There is no accurate predictor of how long the rest of labor will take. It is entirely possible to go from 4 or 5 cm to complete and pushing in a matter of minutes. In the absence of an actual problem (and a long labor is not a problem) it is a completely pointless procedure.

Vaginal Exams: Helpful or Harmful? (Part I)

2008-07-16T06:30:00.007-08:00

For our purposes, let's break this into two categories: vaginal exams during pregnancy and vaginal exams during labor/birth.

And what is a vaginal exam? A woman's care provider inserts his or her two fingers into the vagina in order to ascertain the following information:
Ripeness: The cervix goes from being firm (like the tip of the nose) to soft (like the lips)
Dilation: How far the cervix has opened. It starts closed and opens to 10 cm
Effacement: The thickness or thinness of the cervix.

Station: How far the baby is engaged in the pelvis. Measured in relation to the ishchial spines in the mother's pelvis. 0 station is engaged. Negative numbers means the baby is not engaged in the pelvis and postive numbers means the baby is past the ischial spines. +4 is on the perineum.

Postion of baby: If the woman is far enough dilated, the baby's position can be ascertained by feeling for the fontanels (soft spots)
Position of cervix: The cervix moves from posterior to anterior

Now that we have a good idea of what exactly a VE is, let's look at vaginal exams during pregnancy. Care providers that practice within the medical model of care often start doing vaginal exams at 36-37 weeks of gestation. This can be a helpful practice, but is largely harmful. Let's look at the positive aspect of it. A woman may feel heartened to hear that her cervix is changing in preparation for birth. Especially if there is progress over the weeks leading up to birth. And encouragement is a great thing in those last, trying weeks of pregnancy.

Why is it harmful? From a physical standpoint, anytime anything foreign is inserted in the vagina, you run the risk of infection. There is an increased chance of rupture of membranes. But what I think is even more detrimental is the havoc it can wreak on a pregnant woman's emotions. It is not an accurate predicter of when labor will begin. The only thing a vaginal exam tells you is what is going on in your body at that moment. Many a woman has been largely discourged because she was 3 cm dilated at 37 weeks and is still 3 cm dialated at 40 weeks. Conversely, a woman's cervix can be closed and firm and she can have a baby a day later. And vaginal exams are often painful.

In the absence of a suspected problem, vaginal exams during pregnancy do more harm than good. If the goal is to satisfy curiosity, it is possible for a pregnant woman to check her own cervix. It is less risky this way, since we are accustomed to our own germs And it can be empowering for some woman. Why go to a doctor or midwife for information you could obtain for yourself?

I'll continue this post soon. Part II is Vaginal Exams during labor and birth

Some thoughts

2008-07-14T06:54:00.004-08:00

I realize that my posting on this blog has been a little random and ranty. I should say, first of all, that i didn't ever intend to get into birth work, it chose me. And therefore, i feel compelled to explore it, to support it, to study it, to devote time to this passion, this mission of mine. I have a 5-year-old, a 3 1/2-year-old and an almost 2-year-old. They are my first priority- I will never have these early years back with them. And so birth work gets a backseat. But i know that i need to be involved, i know that God intends for me to incorporate this into my vocation.

And thus, this blog. I feel like i have these tremendous secrets- Birth doesn't have to be scary! you don't have to let them take your baby from you right after he or she is born! natural childbirth doesn't necessarily mean uncontrollable pain! homebirth is safe! too many woman are getting cut open unnecessarily!

I know i am covering ground that many authors and bloggers have already covered and more comprehensively. So why do it? I don't really know. To feel like, even though my active participation in birth work has to take a back seat right now, i am making some contribution? To affirm what i know? All i know is that it is in me, and i have to get it out.

In an effort to make this blog a little more smooth and readable and a little less ranty, i am going to try to take it one issue at a time (although i can't promise i won't digress ocassionally). When i have some more time, the first subject i would like to tackle is "The mandatory Vaginal Exam"

Good article in the LA Times by Jennifer Block

2008-07-10T15:58:00.003-08:00

I'll post my thoughts later, but this is a good article and reflects a lot of my feelings on the same issues.

Big Medicine's blowback on home births

And a birth video

2008-07-07T20:53:00.004-08:00

Joe and i were talking and i realized that a lot of this blog is ranty and what is bad about the business of birth in the United States. So, to balance that, i wanted to share one of my favorite natural birth videos. That "natural birth high" is so apparent and i love the look on her face.

Note: Full nudity and vaginal birth shown.

The little mentioned risks of Cesarean Sections

2008-07-07T19:07:00.005-08:00

The subjects of primary c-sections, repeat c-sections and vbac (vaginal birth after cesarean) are near and dear to my heart, for obvious reasons to anyone who knows my story. We have two things happening in the United States right now: a rise in cesarean sections (slightly over 31% at last count) and, alarmingly, a decrease in the availability of vbac. There are places in this country where woman have to drive hours, yes, hours to find a care provider to attend their vbac. There are many factors to this: a rise in malpractice insurance for doctors who attend vbacs, malpractice insurers that refuse to insure doctors who attend vbacs, ACOG's wishy washy stance on vbacs and the subsequent vbac bans at hospitals around the country.

You'll note that not one of these reasons has to do with the health of mother or baby. Nope. Not one. Why? Because all the studies point to vbacs being safer for both mom and baby. For mom, obviously, avoiding surgery and all the risks that accompany that. I always hear c-sections being "easier on the baby" which is a ridiculous assertion. Babies were meant to come out of vaginas. The contractions, the trip through the birth canal, all play an important part in the health of the newborn (and into childhood), especially of the lungs and gut.

But what i want to address is the reprocussions of the increased c-section/decreased availablity of vbac phenomenon. One of the most alarming, not often mentioned, risks of cesarean section is the risks to future pregnancies/fertility. With every c-section a woman has, her chance of placenta accreta/increta/percreta goes up in subsequent pregnancies. This is where, in a pregnancy following the c-section, the placenta embeds too deeply into the uterine wall. There is an excellent article about it here With this condition, complications include hemorrhage, necessity for an emergency hysterectomy, and death. And yet, vbacs are discouraged, because of malpractice issues, because of convenience for doctor issues (don't you know it is easier to schedule a c-section than have a client in labor for hours, delivering at all times of night?!) This is of special concern to woman who plan to have a large family. Women are losing their wombs, women are dying because of this.

IT IS SO INFURIATING!

So, what is the solution? Prevent the first cesarean. Be a well-informed consumer. Obstetricians do not know everything. Most of the time, they are not practicing evidence-based medicine, they are practicing out of fear of litigation. Continuous fetal monitoring? Not evidence based, studies show as good outcomes, with less cesareans with intermittant monitoring. Nothing but ice chips? Totally not evidence based, you need food and drink to do the hardest workout of your life. The list goes on and on. Be extremely choosy when picking your care provider, because care provider and birth place are the two biggest indicators of how your birth is going to go. Pick someone with a low surgical birth rate, someone who attends vbacs, someone who believes in a woman's ability to give birth without unnecessary intervention

Changing our perceptions

2008-05-01T11:50:00.004-08:00

Note: This video contains sensual birth sounds. You might want to view it in a non-public area.

Birth can be pleasureable.

The trailer for this movie is awesome. I love the idea that they are taking on the cultural myth that birth is only ever excrutiatingly painful and that the sensations of birth are something to avoid. Yes, birth is painful. It can also be intense, pleasureable, otherworldly.

Birth and Spirituality

2008-04-24T10:08:00.010-08:00

With three little ones, my life is often a series of thoughts, broken by getting someone a drink of water, or helping someone in the bathroom or making dinner or one of the other activities that takes up the day of a Mom who stays at home. So rarely do i get to sit down and just reflect upon things. So it was nice today to have some time to do just that... sit with a cup of coffee and my thoughts.

I have found that my views on pregnancy, birth, breastfeeding and mothering are considered quite radical. I never intended for this to happen, one thing just led to the other and this is what resonated with me. It just fits. At times, i wish i didn't feel so passionately about things... it makes it rather exhausting to be in my head. But it is what it is. Those who know me, know i am a devout Catholic. My Catholicism and relationship with Christ have really brought me to where i am in the way i view things.

So how does this pertain to birth? Well, i believe that we are created in the image and likeness of God. Heavy wording, but it is such a powerful phrase. Image and likeness of God. We are the best thing He created, the only thing to be in His image. As childbearing women, however, under the medical model of care, we are told that we are created faulty. That childbirth is a dangerous and perilous journey and we are lucky to make it out alive. That our bodies, although they safely housed our children for nine months , became more dangerous as birth became imminent. That doctors must save our children from our bodies.

This is deeply inconsistent to what i hold as a believer in God. What an awesome design God had for bringing children into the world! When a man and a woman make a child, they are co-creators with God by providing the body in the creative act while God creates the soul. The woman has a singular role in this process. The woman provides the womb, the place for the child to dwell as he grows. The woman nourishes the child. When the time comes, it is the woman, the mother, who labors and works as she has never worked in her life, to bring forth this life. And God is with her and her child. It is the world that tells us that God designed us faulty.

I believe that for some mothers and babies, medical care is good and beneficial. Let us not pretend, however, that our meddling with childbirth, our over-monitoring, over-surgicalizing, over-medicating has made birth safer. Numbers show this is absolutely and unequivocally not the case. Our meddling has caused more damage to mothers and babies and future children to be conceived than we will ever know or understand. God designed birth the way he did for a reason. Working within the design allows childbirth to be safe. Thinking that if you disregard the design, you can improve upon it, leads to poorer outcomes. That is why the United States has an abysmally high infant mortality rate amongst developed countries.

Do i believe that problems never occur in labor or childbirth? Absolutely not. Sometimes babies die and sometimes mothers die. This is not inconsistent with my belief in God. For reasons that we will probably never know on this earth, some souls are called to God earlier than others. It can happen in the hospital, at home, in a birth center.

So what is the solution? A return to the midwifery model of care. For all. What does this mean, that everyone has a midwife? Not necessarily, no. The midwifery model of care is a philosophy of care more than a title of a care provider. Midwives sometimes practice within the medical model and occasionally a doctor practices within the midwifery model. The midwifery model acknowledges that birthing women are more than just a body. That pregnancy encompasses our physical, emotional, intellectual, spiritual components. Because we are all those things and our experiences of pregnancy and childbirth are no different. Within the medical model, women are just bodies from which to extract a child. One potential pathology after another. Within the midwifery model, even women who had high-risk pregnancies would be treated with respect to all of our components, not just our physical. Medically necessary c-sections would be done with respect for the woman and child as physical, emotional, spiritual beings, not just a number in a line.

I think that this is one of the biggest lies that women are told... that we are just machines. That a healthy baby is all that matters. That we can be sliced and diced and treated less than human; poked and prodded in the name of medicine and a safe birth, but as long as we have a healthy baby, our emotional, spiritual intellectual components don't matter. They lie and say if our cervix doesn't dilate at 1 cm per hour, like a good machine would do we must be broken, our body failed.

WE ARE NOT MACHINES.

God intended women to birth with our whole body, emotions, soul. Everything. Because it is with everything that we must mother.

Homebirth as safe for healthy women as hospital birth

2008-03-17T14:52:00.002-08:00

Here is a summary of the 2005 study in the British Medical Journal that concludes that homebirth is as safe for low risk woman. (If you are interested, here is the full text of the study)

Let's examine some of these numbers: Medical interventionrates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%),vacuum extraction (0.6%), and caesarean section (3.7%); theserates were substantially lower than for low risk US women havinghospital births.

The number that really catches my attention is the caesarean section rate. In the United States in 2006, the c-section rate was 31.1% About one out of three women that walk into the hospital are going to end up with a surgical birth. Why? Are one in three women's bodies not capable of giving birth? Or are the very things that supposedly make the hospital a superior place to birth (continuous fetal monitoring, liberal use of pitocin and epidurals) the very thing that makes it more likely to end up with unnecessary surgery? The World Health Organization indicates that a 5-10% c-section rate is optimal (which, this study confirms with a rate of almost 5%) and that no place is justified in having more than a 15% c-section rate.

Arguably, the hospital is indeed a more risky place to birth, when you factor in that roughly 20-25% of women are receiving unnecessary c-sections and all the attendant risks that go with it. Higher mortality and morbidity for mother and higher morbidity for baby.

So we have established that physically, it is as safe or safer for a mother and child to birth at home. In my next post, i would like to examine why homebirth is better emotionally and psychologically for mother and baby.

Question CPD

2007-12-13T16:10:00.002-08:00

There is a large number of cesareans being performed with the diagnosis being CPD (cephalopelvic disproportion). This is when the baby's head is too large to pass through the mother's pelvis.

And in most cases it is a completely bogus diagnosis. Sometimes this diagnosis is made without the woman even laboring! In the absence of a pelvic deformity there is no way to know whether a woman can birth vaginally until she has labored and pushed in positions of her choosing with a baby that is presenting correctly.

The diagnosis is made during labor sometimes because of a care providers failure to wait or a malpositioned baby.

This video shows women who had their first cesareans for "CPD" and then went on to birth vaginally, often giving birth to babies that were larger than the one that was supposedly too large to pass through their pelvis.

Very rarely does a woman's body grow a baby too large for her to birth.