Sunday, December 30, 2007

Don't want a doula or can't afford one?

Check out this post over at Hug the Monkey. It's a blog about oxytocin and has lots of great information, so I recommend browsing some of the other posts too.

Wednesday, December 12, 2007

Sunday, December 9, 2007

Treating Mastitis

Most women who've given birth and subsequently nursed their babies have at least heard about the possibility of developing mastitis (if not experienced it themselves). I have, on one occasion, developed what appeared by my estimation to be mastitis. It started out with what seemed like a plugged duct. I had experienced a plugged duct before, so I nursed frequently on that side while massaging the painful area. Eventually the pain was accompanied by flu-like aches all over my body. I didn't want to wait around for the fever to start, so I immediately opened up my Nursing Mother's Companion to see what suggestions were there. I was a little disappointed that it didn't offer many concrete natural treatments and encouraged women to see their doctor for a prescription of antibiotics to avoid having the infection progress into an abscess. I have only taken antibiotics twice in my memory--once for an ear infection as a teenager and later for a supposed UTI (which was probably not actually a UTI in retrospect). I am not a big fan of antibiotics, and I think we all know they're over-prescribed, over-injected, and largely responsible for the scary super-bugs we keep hearing about. So, needless to say, I didn't want to go to the doctor and get a prescription.

I turned, instead, to the trusty internet, found some ideas, and put them to work. I continued to experience breast pain and mild aches for another day and half, but by the end of the second day I was pain and ache-free. I can't promise that what worked for me will work for everyone, but here's my recipe for treating mastitis without a prescription...

Read the rest of this post at my new website!

And still rising...

Have you heard about the latest c-section data from the CDC? They just recently published the data from births in 2006. The c-section rate from last year is at a record high--31.1% of all births!

Eugene Declercq, Ph.D., Professor of Maternal and Child Health at Boston University School of Public Health highlights some concerns: “At a time when maternal and infant mortality rates are decreasing throughout the industrialized world, the United States is in the unique position of having both a rapidly increasing cesarean rate and no improvement in these basic measures of maternal and infant health.”

That's right. As cesarean section rates rise, so do maternal and infant deaths. Though it's no proof of a connection, it is a frightening snapshot of the state of maternity care in the U.S.

If you'd like more information about how to avoid a cesarean, how to have a vaginal birth after a cesarean, or need resources for recovering from a cesarean, check out the International Cesarean Awareness Network.

Monday, November 26, 2007

Down with the I.V. league

“You’re thirsty? Do you want some more ice chips?” Most women laboring in U.S. hospitals, no matter how thirsty or hungry they may be, must resign themselves to sucking and munching on ice. I munched my way through that rite of passage with my first baby. Enduring labor and birth has been compared to enduring and completing a marathon. Both feats are extremely physically taxing, but you would never expect a marathon participant to run without drinking or consuming any kind of fuel. Hospitals across the country expect laboring women to do just that, but is this deprivation really necessary?

When a patient must undergo general anesthesia for emergency surgery, there is a risk of stomach contents being inhaled into the lungs (also known as “aspiration”). Hospitals ask women to refrain from eating or drinking in order to reduce the risk of death from pulmonary aspiration. Even with these precautions in place, however, there is no guarantee that a woman’s stomach will be empty in the event that she needs general anesthesia. The risks of death from pulmonary aspiration are miniscule—1 in 1,250,000. Furthermore, deaths from pulmonary aspiration in these situations have more to do with anesthesiologists’ errors than whether a woman has had food or fluids recently. It is very uncommon for a laboring woman to require general anesthesia. Most of the problems arising in childbirth can be recognized and addressed without such extreme measures being taken.

What do hospitals offer as a “substitute” for food and drink? Intravenous fluids (IVs). Yes, IVs provide fluids, but quite often they provide too much, particularly when mother is given a “bolus” (large amount of fluid) before receiving an epidural (an attempt to prevent the blood pressure drop often resulting from epidural anesthesia). Fluid overload resulting from IV fluids can lead to other complications, among them:

* Fluid in mother’s and baby’s lungs.
* Diluted blood, leading to anemia and decreased oxygen supply to the uterus and fetus.
* Newborn jaundice, as excess fluid causes baby’s red blood cells to burst and release bilirubin (yellow product of red blood cell breakdown).

Aside from these issues, an IV will also hinder a laboring woman’s ability to move while in labor. Movement, particularly in early labor, is an effective way to cope with the pain of contractions. Lying strapped to a pole and a monitor in a bed will increase a laboring woman’s discomfort greatly. Additionally, when a laboring woman remains lying in a bed for an extended period of time, labor will not progress as effectively as when aided by movement and gravity.

I remember how strange it was to me when I came home from the hospital after my first baby was born and found that my legs and feet were swollen with fluid for a few days. I had heard plenty of pregnant women complain of swollen ankles and feet, but I had not experienced any swelling while pregnant. It surprised me to see swelling afterward. I also noticed swelling in my face and hands in the pictures taken of me just after my daughter’s birth. I can’t prove that it was the result of I.V. fluids, but I feel fairly confident they were to blame. Here's a picture of me in my swollen post-partum state...Lovely, eh?

When I gave birth to my second child, I chose to see a group of nurse-midwives who delivered at a small community hospital where they had, finally, convinced administrators to allow laboring women to drink. Instead of being given an I.V., I received a “hep-lock” which is simply an I.V. needle inserted in a vein but without the fluids. They like to have an “open vein” in case of an emergency. I spent less than three hours of my labor in the hospital because I had already progressed to about 6 centimeters upon arrival, and my labor progressed quickly afterward. I think I took a few sips of water when I felt thirsty, but not a lot. It was wonderful, however, to not be tied to the I.V. pole. I was also pleased to notice that I experienced no swelling afterward. Here's a much less frightening post-partum picture...
Not every laboring woman will be given the option to bypass IV fluids. Some hospitals have strict policies, and women who are induced, given narcotics or epidurals, or a c-section will have no choice but to submit to an I.V. Every intervention alters the birth process, however, and the more interventions, the more complicated the birth process becomes. I encourage women to avoid unnecessary interventions and trust the process of birth. Seek out care providers who honor and respect the birth process and will advocate for your right to experience birth as you wish, including eating and drinking if you choose. You and your baby are worth the effort.

For more info, see the "Evidence Basis for the Ten Steps of Mother Friendly Care."

Thursday, November 15, 2007

Tips for avoiding tearing and episiotomies

Giving birth for the first time was one of the most empowering experiences of my life. My water broke, my contractions started, everything progressed smoothly, and, less than six hours later, my baby girl was born. It was an ideal birth experience, except for one thing. That one thing made my next few weeks of recovery extremely painful. I tore. I really tore.

Despite the painful recovery, this was actually the lesser of two evils for me. Though some caregivers continue to cut episiotomies in as many as 80% of their patients, medical research does not support routine episiotomies. Studies from as far back as the 80s made it clear that routine episiotomies have no benefits and carry real risks. One of the most detrimental risks is that episiotomies can lead to further tearing, sometimes extending into the anus. These fourth degree anal tears almost never occur without an episiotomy. In addition, a spontaneous tear may only reach into the surface layers of skin, while an episiotomy cuts into far more layers. Episiotomies are rarely warranted and should be reserved for those unusual emergency cases. Ultimately, even without all the evidence, I just didn't want someone cutting me. I knew, going into my first birth experience, that if I had to choose between them, I would choose to tear. And, tear I did.

The best case scenario, obviously, is neither. The best outcome is a happy, healthy baby and an intact perineum. So how does a woman improve her chances of keeping her perineum intact?

1. Choose a midwife, or a doctor whose practice is evidence-based. The typical midwife's philosophy of birth is one of non-intervention. Most midwives tend to avoid episiotomy and are aware of the best positions and techniques to avoid tearing. I saw a group of certified nurse-midwives with my second daughter's birth, and was relieved to hear, at my first appointment, that 70% of their patients end up with intact perineums. I had only a very minor tear--what my midwife described as a "skid mark"--and my recovery was vastly superior to the first. If you choose to use a doctor, be sure that he/she practices evidence-based medicine, is aware of the research against episiotomy, and understands your desire to remain intact.

2. Exercise regularly.
We all know exercise is beneficial to our health, but it's also beneficial to your perineal tissues. Women who are physically active are less likely to end up with episiotomies and are more likely to retain strong pelvic floor muscles post-partum. General exercise is great, but doing exercises specialized for the pelvic floor--"Kegels"--will not only strengthen those muscles, but also increase your awareness of how those muscles function so you can learn how to fully relax them for birth.

3. Have a doula present for your birth. A doula is a trained labor support professional. Research has shown that a doula's presence reduces a laboring woman's risk of requiring pain medications by 36% and forceps deliveries by 57%. Epidurals and forceps deliveries are both associated with increased incidence of tearing and episiotomies, so a doula is handy to have around when you're trying to stay intact. Doulas are the most highly rated providers of labor support and work wonders in improving women's birth experiences, so it won't just be your perineum that thanks you.

4. Deliver in an upright, hands-and-knees, or side-lying position. Research clearly indicates that the worst possible position for delivering a baby is the very position most hospitals direct women to take--on the back, legs stretched out wide, feet in stirrups. The best positions for avoiding perineal trauma are unconventional in most U.S. hospitals, but the evidence is clear. If you want to maximize your chances of staying intact, don't let hospital conventions hold you back. Be sure your caregivers know of your intention to deliver as you choose--upright, on your hands and knees, or on your side. Fortunately, the best positions for avoiding perineal trauma are also the ideal positions for a smoother, easier delivery, so you won't be sorry about breaking with convention.

5. Use "spontaneous" pushing rather than the conventional Valsalva method.
Most women in U.S. hospitals are encouraged to take a deep breath, hold it for ten seconds and bear down--the Valsalva maneuver. Breaking with convention in this case is also beneficial for your perineum. Women who push spontaneously are more likely to avoid tearing. Spontaneous pushing typically involves shorter periods of pushing and more breathing in and out which promotes relaxation of the perineal tissues. A woman following her body's instincts and impulses will deliver her baby far more easily, efficiently, and painlessly than one who is being coached to disregard her body's guidance.

Episiotomies should be rare, and tearing isn't inevitable. Women who arm themselves with information and support can travel through birth uplifted, empowered, and intact. I, for one, intend to do just that the next time around.

Tuesday, October 30, 2007

Back in the saddle again

No, I'm not pregnant. :-) But I jumped back in the saddle of being a "natural childbirth advocate" last weekend. I suppose when I put all my birth books on our new bookshelves in the living room, I also sort of "shelved" that passion for a while. Plus, having moved to a new place, I suppose I've been busy with other things--one of them being making new friends. And I guess I haven't felt ready to expose myself as a birth nazi and lose all those newfound friends just yet. ;-)

But, as most people who know me well are aware, if you bring up the subject of birth (and not in a "OMG! Give me the epidural!" sort of way) and seem interested or open to my views, you will find that I have a way of going on and on and on and a very difficult time shutting up. One of my favorite things in the world is to talk birth with others who are willing and eager. If you don't want an earful, well, don't bring it up.

Well, we were at a Halloween party last Saturday and we ended up sitting by some neighbors. We hadn't had the opportunity to really sit and talk with them before (partly because the wife has been awfully sick with her pregnancy), but we did get a chance to talk at the party. I don't even remember how the subject came up, but my new pregnant friend asked me if I had given birth without drugs. My radar detector started beeping like crazy, and I said, "Yes." Then she did what would make any natural childbirther salivate--she started asking me questions! And she seemed genuinely interested as she listened to me tell my birth stories! Oh my... I had forgotten how much I love talking about this stuff.

My new friend is pregnant with her second child. She had Pitocin with her first labor because her water broke and then her contractions didn't start. The Pitocin-induced contractions came one on top of the other without any breaks. She started screaming at the nurses to give her an epidural but they told her they couldn't until she dilated more. They reassured her that she would be able to get the epidural soon, but she yelled at them more: "You're lying!" She was in so much pain that she was out of control. Needless to say, she isn't a huge fan of Pitocin. She said, "Pitocin is evil." An now I have one more story to add to my list of reasons why I get irate and start foaming at the mouth when I hear the nasty word.

I can't recall now why, but she has a feeling that the labor with her second child is going to go very quickly and that she may not have time for an epidural. And she said that the booklet her doctor gave her has very general and fairly unhelpful information about how to cope with labor pain (surprise, surprise). I gleefully offered my collection of birth books for her to check out. Then we arranged that I would give her my copy of The Birth Partner, by Penny Simkin, the next day. I put a scrap of paper into the chapter on coping measures so she could find it easily. Oh how I love sharing this stuff!

I also hosted a baby shower for a new friend this past weekend. She is due to have her baby any day. And, just before she got into her car to head home after the shower, she happened to mention that she would really like to avoid drugs while she's in labor. I tried to restrain myself, though that inner radar detector started beeping like mad. I did my best in those few minutes to encourage her and give her a positive take-home message that might (just maybe, I really hope) help her make it through labor. But it's hard to make a huge difference in three minutes. I told her she could do it, that I love giving birth, that I'm practically addicted to it, and that I wouldn't do it any other way than au naturale.

I'll never forget the conversation I had that was the spark for my interest in natural childbirth. An acquaintance was pregnant with her first child and had some books from the library. I asked her about the books. I don't even remember what the books were. But she ended up mentioning that she would be giving birth without drugs. It floored me. What?! People still do that?! I couldn't believe it! But she explained that her mom had all her children that way and she planned to as well. She said there were lots of benefits, but didn't go into them much 'cause there wasn't time. But that little exchange is what started it all for me. It got me thinking and wondering and intrigued. So when I entered my first pregnancy, I went to the library and checked out some books and I was never the same.

So I guess I hope that even if my two pregnant friends don't have wonderful birth experiences THIS time, maybe our conversations will have been the spark that will intrigue them and inspire them to check out some books and prepare themselves in the future to have the kind of birth experiences their bodies were intended to have. I really do hope so.

In the meantime, I'll enjoy the natural buzz/high that follows a few good conversations about birth.

Tuesday, October 16, 2007

I know where I'm having my next baby!

Well, not really, but I wish... Check out Jennifer Block's article--"Childbirth in England--It's Shocking!"

Saturday, August 25, 2007

Childbirth Mortality Rate is Rising in the U.S.

"Valerie Scythes, a 35-year-old elementary school teacher, died in March at a hospital in New Jersey -- the state with the highest caesarean section rate. She had had a C-section, as did another teacher at the same school who died after giving birth at the same hospital two weeks later."

It's all over the news this weekend. See these links:
Experts: U.S. childbirth deaths on rise
Rate of death in childbirth rising in the U.S.
Rate of U.S. women dying in childbirth rising

US childbirth mortality rate increases

More and more women are dying! Do we really need any more evidence that maternity care in the U.S. needs an overhaul?! Raise an uproar, write a letter to the editor, spread the word, do whatever you can! Let's stop this madness!

Thursday, July 26, 2007

Seeking birth stories

Do you have an uplifting birth story? If so, I would love to get my hands on it, or my eyes, rather. I would like to put together a collection of uplifting birth stories for publication. My working title for the compilation is: Birth as Intended. Even if you aren't sure your birth story fits the title, I'd still love for you to send it my way. It may be that the title gets adapted to fit the stories I receive. Or it may be that I don't ultimately choose to include your story, but I'd still love to check it out. If you want to participate, send your story to me at laniaxman at gmail dot com. I'm looking forward to hearing from you!

Wednesday, July 25, 2007

"Reproductive war's new front line"

Read Jennifer Block's full article from the Columbia Tribune here.

Friday, July 20, 2007

"Soaring C-Section Rate Troubles Doctors"

Check out the full article from It's nice to see the truth getting printed out there.

Friday, June 22, 2007

"Three men in a tub"

For a drama-filled and comical birth story, check out Summer's blog. Birth works, despite all the busy-ness we sometimes add to it, and even without the hospital! And... what blows me away (but doesn't surprise me) is how hospitals and medical professionals will still come away with thousands of dollars even when they do next to nothing!

Saturday, June 9, 2007

Let's get angry and organized.

"We Americans are consumed with the need to believe that we are number one. But here's a wrenching fact: forty-one countries have better infant mortality rates than the United States does. In 2002, our infant mortality rate went up, not down, and if the United States had an infant mortality rate as good as Cuba's, we would save an additional 2,212 American babies a year. And mothers? Women are 70 percent more likely to die in childbirth in America than in Europe, and the rate of women dying in childbirth in America has been going up every year for more than twenty years. . . .

"Just as those who never make mistakes can never learn from them, so too those who must always be number one can never learn from others. . . .

"[S]omething happens in the countries at the bottom of the chart. It varies from country to country, but whatever it is, when things get really bad and women's reproductive freedom is abused severely enough, some precipitating factor or series of events finally brings women's attention to the power doctors hold over their reproductive lives. This leads to women's disillusionment, anger, and resentment and a call to action. . . .

"[Midwives] join with the angry women (often forming coalitions that also include scientists, journalists, some politicians, and some doctors and nurses) to start the long, difficult process of regaining women's autonomy in childbirth and reproduction, moving the country up . . . .

"It seems there is at least one thing more powerful than the medical establishment: women, when they are angry and get organized" (Marsden Wagner, Born in the USA, p. 212, 214-215).

Monday, June 4, 2007

Hug a midwife!

This is my midwife friend and me last Saturday at a party. She's awesome! I love midwives!

Sunday, May 20, 2007

Hmmm... Interesting...

"After working as a practicing physician for several years, I became a perinatologist and perinatal scientist, as well as a full-time faculty member at the Schools of Medicine and Public Health at UCLA. Then I became a director of maternal and child health for the California State Health Department. In that capacity, I learned that in the rural town of Madera, California, doctors had decided that they no longer wanted to attend births at the Madera County hospital. They complained that it took too much of their time and didn't pay enough. So in 1968, two out-of-state midwives were recruited by the county to fill the gap. After two years of midwifery practice at the hospital, the rate of babies dying around the time of birth in the Madera County hospital was cut in half. Alarmed that their style of maternity care was being made to look bad, the doctors in the town agreed that they would once again attend births in the hospital if the two midwives were fired. The hospital fired the midwives, the doctors returned, and soon the rate of babies dying around birth rose to its earlier levels" (Marsden Wagner, Born in the USA, p.99, emphasis added).

Thursday, May 3, 2007

Sad, but true

"We do not see childbirth in many obstetric units now. What we see resembles childbirth as much as artificial insemination resembles sexual intercourse." ~Ronald Laing, psychiatrist

Wednesday, May 2, 2007

Think you're better off with an epidural? Think again...

• Epidurals cause women’s bodies to stop or slow the release of oxytocin—slowing labor and removing the feel-good effects of the hormone. The first stage of labor tends to be about 26 minutes longer and the pushing stage 15 minutes longer in women with epidurals. Epidurals also eliminate the natural peak of oxytocin intended to occur at the time of birth to facilitate the delivery and bonding processes.

• Women with epidurals are nearly three times more likely to have Pitocin—to speed up labor—than those without epidurals.

• When the pelvic floor muscles have been numbed by an epidural, a woman’s body cannot guide the baby’s head to the ideal birth position as effectively. Babies are four times more likely to be posterior (facing up—a more difficult position for birth) in the final moments of labor when their mothers have epidurals. As a result of these complications, some women with epidurals experience difficulty pushing their babies out—doubling their risk of forceps or vacuum extractor deliveries.

• Other epidural side effects for mothers include: drop in blood pressure, difficulty passing urine, itchiness, shivering, sedation, nausea and vomiting, fever, breathing difficulty, inadequate pain relief, slurred speech, drowsiness, convulsions, postpartum weakness and/or numbness, postpartum back pain, mild to severe postpartum headache (sometimes lasting six weeks), temporary or permanent paralysis, cardiac arrest, respiratory arrest, and death. A woman’s risk of dying from childbirth complications triples when she has an epidural. (For a recent news story on the rise in epidural-related maternal deaths, see here.)

• When mother develops an epidural-induced fever, her infant tends to have poorer condition at birth, has an increased risk of having signs of brain damage, and will likely undergo an invasive sepsis evaluation to check for infection.

• Epidurals can lead to worrisome fetal heart rate changes also. This is in part because women with epidurals tend to lie down in one position for extended periods of time which can restrict blood flow to the fetus. Change of position will often improve the fetal heart rate abnormalities. When an epidural is coupled with Pitocin, the signs of fetal distress can be more prolonged and severe.

• Some data also indicate that babies born to women who had epidurals show increased risk of poor brain function at one month of age.

• As many as 85% of women in some U.S. hospitals receive epidurals.

Thursday, April 26, 2007

ACOG and "obstetric tyranny"

Have I mentioned how much I love Marsden Wagner? I have to share this:

To understand the absolute monopoly ACOG [American College of Obstetricians and Gynecologists] has established in American maternity care, it is helpful to look more closely at this organization. The American College of Obstetricians and Gynecologists is not a "college" in the usual sense: it is not an institution of higher learning. Nor is it a scientific body. With few exceptions, its members and leaders are not scientists but medical practitioners, and there is nothing in ACOG's mission statement about science. The ultimate proof that ACOG is not a scientific body? Too many of its policies and recommendations are not based on real science. . . .

In truth, ACOG is a "professional organization," which amounts to a trade union. Like every trade union, ACOG has two goals--to promote the interests of its members and to promote a better product, in this case, the well-being of women. But if there is a conflict between these two goals, the interests of its members come first. . . .

American maternity care, then, is under the control of tribal obstetrics. A small group, most of them men, are controlling birth in such a way as to preserve their own power and wealth while robbing women and families of control over one of the most important events in their lives. . . .

Power without wisdom is tyranny. There are plenty of intelligent obstetricians who have lots of knowledge, but intelligence and knowledge do not guarantee wisdom. I have known wise individual American obstetricians, but I see no evidence of wisdom in organized obstetrics in the United States. The maternity care we have in what we like to believe is our free country is obstetric tyranny.

(From Marsden Wagner's, Born in the USA: How a Broken Maternity System must Be Fixed to Put Women and Children First, p. 33, 35-36.)

Recent attacks on midwives...

A bill was proposed earlier this year by members of the Utah state senate, Margaret Dayton in particular, which would have severely restricted the number of women who could choose a licensed midwife as a maternity care provider. They claimed they were simply trying to define what "normal birth" was and clarify a law that was passed in 2005 which gave midwives the ability to become legally licensed to practice in Utah, but their definition of "normal" somehow only included a very small percentage of women. Nearly all of the women involved with the Utah Friends of Midwives, many of whom have successfully given birth at home multiple times with excellent outcomes, would have been required to be referred to a physician under this bill.

The state division of professional lisencing and Utah's midwives had already spent two years clarifying their rules for licensure defining when they must refer their clients to physicians, etc. These things were already taken care of by the proper groups. This recent bill was simply trying to do what had already been done, but doing it in a much more restrictive way. And, it is interesting to note, that the bill was created by a woman who spent many years as a labor and delivery nurse, married to an obstetrician. It was also written by the Utah Medical Association whose membership includes many obstetricians. We can only assume this had a lot more to do with a "turf war" than concern for safety.

I wrote the following on a Utah State Senate comment website:

I am a mother of two--both hospital births. I am not a midwife nor do I have any relatives who are midwives. But I am a concerned person who finds it highly unsettling to see the rights of Utah's women so trampled upon. Whatever happened to the limited government and freedom the Founding Fathers fought so long and hard to ensure? . . .

I am concerned that Senator Dayton and those responsible for this bill have so little faith in mothers. I am concerned that they do not respect women enough to expect that they can make responsible decisions for themselves and their babies. Even if you disagree about the safety of homebirth, it is not your place to infringe upon mother's rights and require that they do what you may think is best. You say you are not restricting women's rights to choose, but the ramifications of this bill will do exactly that.

Thousands of unnecessary c-sections and other questionable medical interventions occur every day in hospitals in this country--putting mothers and babies at increased risk. So do not tell me that you are doing this out of concern for safety. If the medical community was really concerned about safety, hospitals would completely revamp their policies and most obstetricians would completely revamp their practices. We aren't so behind in the world's infant and maternal mortality rates because we've been making the safety of mothers and babies a priority. We certainly haven't made it a priority.

The issue here is not whether hospital or home is the safer place of birth. And I don't believe that is why the bill was initially created. The issue here is will we uphold freedom and have respect for the women and mothers of Utah, or will we trample upon their freedoms by essentially legislating their place of birth because we feel that they are incapable of acting responsibly?

Fortunately, this bill did not pass in the recent legislative sesssion, but supposedly Senator Dayton is "reworking" the bill for a comeback. Thank goodness for the outraged response of Utah's midwives, the Utah Friends of Midwives, and other concerned Utahns.

I'd like to quote Marsden Wagner's account, testifying in behalf of midwives in California who were trying to pass a midwifery bill:

I recently testified before a state legislative committee in California on pending midwifery legislation. Among other things I said in my statement that midwives are perfectly capable and that planned home birth is a healthy option for many women. I finished by suggesting that if anyone said otherwise to the committee, they should ask, "Where are your data?"

Thirty minutes later, a representative from the California Medical Association stood before the same committee and said that midwives are less safe than doctors for low-risk pregnant women and that home birth is not safe. Lo and behold! One of the legislators on the committee immediately asked, "And does the California Medical Association have any data to support your statements?" Not surprisingly, it did not (there are none). Instead, the spokesperson retreated to the familiar position: Trust us, we're the California Medical Association. That legislator took note, and the midwifery legislation was eventually passed. Slowly but surely, times are changing
(see Marsden Wagner's Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First, p. 35).

Thank goodness for freedom and concrete scientific evidence.

Wednesday, April 25, 2007

Little known facts about Pitocin and induction

"Pitocin is the most abused drug in the world today." ~Roberto Caldreyo-Barcia, MD, former president of the International Federation of Obstetricians and Gynecologists

• Pitocin is not approved by the FDA for elective (patient or provider convenience) inductions or stimulation of labor (moving things along).

• Pitocin generally produces contractions that are much longer, more intense, and more painful than normal contractions....

Read the rest of this post over at my new website!

Tuesday, April 24, 2007

Why you really do want a doula...

When I gave birth for the first time, I didn’t know what a doula was, but I recently realized that the care and support of a “doula” is what actually carried me through that birth.

Her name was Eve. She was the labor and delivery nurse assigned to me when I entered the hospital for my oldest daughter’s birth. She was gentle, unassuming, and kind. When I told her that I was hoping to “go natural,” she mentioned that she could offer positions to try and techniques to cope with the pain of labor. She said she had given birth without drugs before, and knowing she was supportive and experienced gave me courage.

As labor progressed, Eve showed my husband how to provide counter-pressure to ease the discomfort of contractions. She pulled out the rarely-used, water-proof telemetry monitor so my husband could spray my back with hot water in the shower. When I got out of the shower, she brought in a birth ball and helped me to sit and rock on it. Later, she coached me to keep my vocalizing low, deep, and relaxed instead of high-pitched and tense. When I doubted myself and contemplated drugs as I struggled through the hardest contractions, she said, “Why don’t I check you first—you might be almost fully dilated.” Sure enough, I was only a couple of centimeters from the end. She told me that, in her experience, it felt good once you could push (and she was right). She rubbed my feet and sat by my side through those last intense contractions, encouraging me with her reassuring words. Although her shift ended before the pushing started, she chose to stay with me until after the birth. Ultimately, I did it! Giving birth for the first time without complications or drugs was one of the most empowering experiences of my life.

At the time I didn’t realize it was rare to find such a supportive, encouraging labor and delivery nurse. But, after my daughter was born, all I could do was mumble over and over to Eve, “Thank you, thank you, thank you.” I knew that if it hadn’t been for Eve’s patience and support I would not have had such a wonderful, satisfying birth.

Maybe you’re still thinking… what’s a doula? Doula is a Greek term—“a woman who serves another woman.” The tradition of women helping other women through childbirth is centuries old. The practice of hiring professionals to fill that role is fairly new. A modern birth doula is a hired labor support professional who provides comfort and advice but does no clinical tasks. According to the Doulas of North America (DONA) website, “The doula offers help and advice on comfort measures such as breathing, relaxation, movement, and positioning. . . . Perhaps the most crucial role of the doula is providing continuous emotional reassurance and comfort” (see DONA). Eve was a hospital nurse, not necessarily a trained “doula,” but she filled the doula role in my case. Based on my personal experience, I can attest that every laboring woman ought to have a doula’s aid.

Research supports my belief. Gathering and analyzing the results of 15 studies, a team of researchers found that, compared to women laboring without a doula, women who labored with a doula were:
• 26% less likely to have a cesarean section
• 41% less likely to have a vacuum extractor or forceps delivery
• 28% less likely to use pain medication or epidurals
• 33% less likely to rate their birth experience negatively
(Hodnett E, Gates S, Hofmeyr G, Sakala C. Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews 2003. Issue 3. See DONA).

Another study showed that women who were supported by doulas were more likely to have success with breastfeeding as reported in a questionanaire at six weeks postpartum—exclusively breastfeeding on a flexible schedule with few problems (see Hofmeyr, Nikodem, Wolman, Chalmers, and Kramer; 1991, South Africa. British Journal of Obstetrics and Gynaecology 98 (1991):756-764).

With such significant benefits, it’s no surprise that doulas are the most highly rated providers of labor support according to the “Listening to Mothers” survey published by Childbirth Connection (formerly the Maternity Center Association, see website). Despite such rave reviews, few women are even aware of doulas. Fortunately, now you are one of them.

So, how do you find a doula, and how much does it cost to hire one? It’s really quite simple to find a trained doula. You can search on the DONA website (and other doula association websites) for lists of doulas in your area. Once you have a list of names, it’s a good idea to interview each one to find the right “fit.” Cost varies depending on training and experience, but most doulas have packages ranging from $200-$800 which generally cover one or two pre-birth visits, labor support, and one or two postpartum visits. Doulas typically espouse the philosophy that cost should never be a roadblock, so most will work with clients to barter, create payment plans, or even volunteer their services. Ultimately, the cost is insignificant considering a doula’s ability to help reduce complications and costly medical interventions, not to mention improve your overall birth experience.

DONA wishes to provide “A Doula For Every Woman Who Wants One,” and I’m convinced that most women, if educated about their benefits, would want one. Few women are lucky enough to have a supportive and attentive labor and delivery nurse like Eve. Birth has been given a bad rap over the years largely because women haven’t had the support they need to navigate labor’s journey with confidence, and society has, for the most part, lost faith in women’s bodies and the beautifully orchestrated process of birth. Birth can be a beautiful, satisfying, empowering experience—it has been for me. It could be that way for all women, and doulas are taking huge strides toward making that happen.


“Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine--nil nocere [do no harm].” ~G. J. Kloosterman, Dutch Professor of Obstetrics

(Qtd in. Sarah J. Buckly, “Ecstatic Birth: The Hormonal Blueprint of Labor,” Mothering Magazine Issue 111, March/April 2002. Source: "Universal Aspects of Birth: Human Birth as a Socio-psychosomatic Paradigm," Journal of Psychosomatic Obstetrics and Gynecology 1, no. 1 (1982): 35-41.)

Findings from the "Listening to Mothers" Survey

Report of the First National U.S. Survey of Women’s Childbearing Experiences published in October 2002:

“About one-third of all of the mothers reported that they either had a limited understanding or none at all about their legal right to clear and full explanations of any procedure, drug or test offered them, and their right to refuse or accept any care offered them. . . . Caregivers, facilities, and childbirth educators should provide women with clear information about their right to fully informed consent, and caregivers and facilities should fully implement ethical and legal standards for informed consent.”

“Doulas and midwives were the most highly rated providers of labor support, yet were used for this purpose far less frequently than other types of providers (5% and 11% respectively).”

“Compared to first-time mothers, experienced mothers were less likely to . . . use pain medications and various other labor interventions, report negative feelings during labor, have a physician as a birth attendant, or give birth by cesarean.”

“Although immersion in a tub, showering, and use of ‘birth balls’ received high ratings for help with labor pain, these approaches were used by 8% or fewer women.”

(Maternity Center Association. Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences Executive Summary and Recommendations Issued by the Maternity Center Association. New York: Maternity Center Association, October 2002. See website.)

To the women of the world

After two years of reviewing 15 years of medical literature, a team of national experts has come forward with this reality: Many of the routine medical interventions used in births in the United States do not improve outcomes for mothers and babies. Some even cause harm.

Their findings demonstrate increased risks and problems with many prevalent interventions including labor induction, cesarean section, continuous electronic fetal monitoring, routine use of IVs, amniotomy (artificial breaking of water) and withholding of food and liquids. Though these interventions have become commonplace and viewed as part of "advanced" and even "superior" medical care, this study indicates these practices are not improving outcomes in most cases. In fact, they often create more problems than they eliminate. These findings will appear in the winter 2007 supplement to "The Journal of Perinatal Education" in a summary report entitled "Evidence Basis for the Ten Steps to Mother-Friendly Care."

This is not the first time these facts have been brought to the nation's awareness. Time and again researchers, activists and organizations, such as the Coalition for Improving Maternity Services, have tried to create change by raising awareness about the problems with maternity care in the the United States. Generations of women have recounted their birth horror stories over and over to each other. Scores of women wear the physical and emotional scars of unnecessary medical interventions.

Who is listening?

Does anyone care?

Let me use the words of Thomas Paine from his fiery call to arms, "Common Sense," with just a few of my own insertions: "Every quiet method for [change] hath been ineffectual. Our [appeals] have been rejected with disdain; and only tended to convince us, that nothing flatters vanity, or confirms obstinacy in [an old, broken system] more than repeated petitioning." The methods we have used thus far have been passionate and have brought about small victories, but the changes most needed have yet to be recognized or addressed by the mainstream medical community. We need a new approach.

Buckminster Fuller said, "You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete."

Women and mothers of the world, I call on you to "build a new model." The time for complaining, pleading and persuading is over. Those methods have been tried, and they have done little. It is time to say, "Enough!"

Let us no longer accept mediocrity and "go along blindly" with any procedure. Let us no longer tolerate practices that have been shown to cause us or our babies harm. Let us stop playing the victims and start creating the reality that we all deserve — the absolute best maternity care possible. Let us demand the best of the best for ourselves and our babies.

We cannot underestimate the power of women united in behalf of themselves and their children. "There is a woman at the beginning of all great things," said Alphonse de Lamartine. Imagine what we can accomplish if we unite our efforts. Imagine what we can create.

(Opinion piece I wrote for The Deseret News.)