Sunshine on my shoulders...

...makes me happy!

And even more now that I read about a study conducted by Boston University School of Medicine researchers. It appears that vitamin D can prevent cesarean births! I've fallen in love with vitamin D over the last few years as I've learned more and more about all the ways the "sunshine vitamin" improves our health and well-being, so when I saw this new study's findings, I couldn't believe it! ANOTHER reason to love vitamin D?! Are you kidding me?!

In a news release about the study, Dr. Michael Holick, director of the General Clinical Research Center, a professor of medicine, physiology and biophysics, and an assistant professor of medicine, explains, "In our analysis, pregnant women who were vitamin D-deficient at the time of delivery had almost four time the odds of Caesarean birth than women who were not deficient" (US News and World Report, "Vitamin D Deficit in Pregnancy Tied to Caesarean Risk").

Apparently vitamin D deficiency is tied with decreased muscle performance and strength, so it makes sense that women with low levels would struggle through the taxing muscle-endurance feat of childbirth.

These findings have made me ecstatic, but they've also got me pondering. For so long I've believed that the birth process is perfectly designed... that nearly all complications arise from medical interference in the process. But this study has shed some light (no pun intended) on a percentage of those complicated births. I guess I can't blame the medical establishment for everything... dang it! ;-) The truth is that multiple factors are always involved.

Even so, I still believe that even most vitamin D-deficient women can give birth normally. Chances are it will just take their bodies longer. And that's where the medical establishment steps in. 'Cause they're not typically very patient with those long labors, so interventions are introduced (pitocin, epidurals, instrumental or surgical deliveries). Women with muscle weakness aren't guaranteed a cesarean birth, but their weak muscles will stack the odds against them... at least in the hospital.

All the more reason I'm glad I live in the Valley of the Sun... where even the winters are sunny and pleasant. And all the more reason to get out into that gorgeous weather and exercise. 'Cause anything I can do to strengthen my body is going to improve my odds of a smooth and problem-free delivery!

Baby stuff I really didn't need

We've started getting a few things for the new baby, so I have baby stuff on the brain. And it got me thinking about all the baby paraphernalia that seem so essential when you're pregnant for the first time but really aren't necessary at all. Obviously everyone's different, but here's my personal list of useless baby stuff...

1) Changing tables. What a ludicrous waste of money and space. (I never bought one, thank goodness.) We got by just fine with a towel (for leaks) on the floor or on our bed. My goal was always to not leave my bed for night-time feedings and diaper changes... none of this going to a changing table in the middle of the night. They may be nice to store all the diapers and wipes, but a closet or cupboard works just as well.

2) Baby lotion. We got bottles and bottles of the stuff for baby shower gifts as first-time parents. And, guess what? I think I still have most of them in a box somewhere... or gave them away to other new parents... you know, let's spread the useless wealth, right? Here's the reality... babies have lusciously soft skin as it is, and baby lotion may actually be harmful.

3) Pacifiers and bottles. I realize that these are life-savers (or absolutely essential) for many moms, but they were useless for me. My babies simply wouldn't take any size or shape of pacifier (except our pinkie fingers or my own real-life nipples). And they wouldn't take bottles either... and, trust me, we wasted a lot of money trying different brands and styles in search of "the one." In the end, it was just easier to breastfeed exclusively... and the good news was that we never had to break our children of their binkie or bottle addiction. What happened to all those useless bottles and pacifiers we gathered back in the day? They turned into "toys."

4) Baby wash and wash cloths. This kind of goes with #2. Babies really don't get very dirty until they start eating real food and playing in the dirt. And, even then, plain old water will usually get them clean. My first baby had very sensitive skin (eczema), so we couldn't use any soaps on her body anyway. And, since our second always bathed with our first, we just carried on avoiding soaps. The only thing we really ever used the wash cloths for was to cover up private parts for bath photos. And we have tons of those wash cloths... sitting uselessly in the linen closet. Please don't buy me any for my new baby. Please.

5) Rocking chairs. I should preface this by saying that the wooden rocker I had wasn't very comfortable, but I really just didn't use it. It was awkward to nurse in, so I just nursed on the couch or on my bed. Plus it just didn't make sense to get up out of bed and sit in a chair for night-time feedings. If I could have a really comfy upholstered recliner/rocker, I think I just might actually use it. But anything else would sit in the corner empty.

Did you find these things useful or useless? Any more you can think of?

Health insurance exec calls for fewer c-sections

Check out this terrific opinion piece in the New Jersey Times--"Pre-term Cesarean Birth," by Michael McGuire, CEO of United Health Care of New Jersey. I love it. Especially his concluding paragraphs:

"There is a broader principle at work here, and it's called evidence-based medicine. . . . If health-care insurance companies and medical caregivers work together, we can identify from real-world evidence the best practices for a wide variety of medical conditions. As we can see in the case of early elective C-Sections, using evidence-based guidelines in medical care will lead to healthier outcomes for patients.

"And it's a funny thing about health care: Virtually everything that makes people healthier, be it preventive care or evidence-based guidelines, reduces the overall cost of providing health care, because it leads to healthier people, including babies, who use fewer health-care resources."

Like midwifery care! Hmm... evidence-based medicine... what a novel idea! ;-)

Hmmmm

"Since out-of-hospital midwives can help healthy low-risk women give birth safely to healthy babies with only 3 to 4% cesarean sections, why do hospital-based obstetricians find it necessary to perform cesarean sections on 19% or more of healthy low-risk women?" (Citizens for Midwifery fact sheet--"Out-of-Hospital Midwifery Care: Much Lower Rates of Cesarean Sections for Low-Risk Women")

Good question.

"A Woman Who Serves"

Doulas rock. I want to be this lady when I grow up.

Meet my midwives

Today was my first check-up with my new midwives, Mary and Nedra. I'm just loving these ladies, and loving that I get to have two birth attendents for the price of one! Not only are they personable, fun, and great with my kids, but they are also excellent midwives. I think you'd be hard-pressed to find any doctor or midwife with stats as impressive as theirs.

Mary, the senior of the two, has been practicing as a midwife for over 28 years. She graduated from the Arizona School of Midwifery in 1980 and has attended over 2000 births. Nedra has been attending birthing women for about nine years as a doula and apprentice midwife and received her midwifery license in March. Now check these numbers out:

C-section rate 1-3%
Hospital transfer rate 2% (for women like me who've given birth before)
Perineal tears "almost never" (maybe once a year they have a woman who needs stitches, approx 1.5%)
Infant deaths None (excluding those with defects incompatible with life)
Maternal deaths None

Can you believe those numbers?! Pretty incredible. The only bad outcome these midwives have ever seen occurred not because of a mistake on their part but simply because the parents refused to transfer to the hospital until it was too late (as a result, their baby's health was compromised). Since that time, Mary and Nedra have adopted a policy to only accept clients who agree ahead of time in writing that they will transfer if it becomes necessary. And I happily signed that agreement!

You might remember this post explaining the extremely painful tearing I sustained when my first daughter was born. When Mary told me how anal retentive they are about preventing tears and that they "almost never" have a client who needs stitches, I think I heard the heavenly choruses singing "Hallelujah!" I am determined that I will give birth to my baby boy without tearing, and it's such a relief to know that my midwives will be doing everything they can to facilitate that goal!

I also love how kid-friendly their office is. They have the coolest wooden toys and puzzles (some with babies inside mommys' tummies), and they have given both of my girls a balloon at each visit. Here they are at our visit today...I love that "midwife" is a regular word in my girls' vocabulary and that it is easy for me to include them in the pregnancy process because of the efforts my midwives make to welcome young children into their office. I love that they get to hear the baby's heartbeat regularly and are already comfortable with Mary and Nedra. So, when their little brother is born, there won't be any strangers coming into our home. Just two women they will already know and love.

I am so thrilled to have chosen Mary and Nedra as my midwives. I know my baby and I are in the hands of remarkable women.

More good news about exercise

The studies keep rolling in... prenatal exercise is so worth it! The New York Times reported Monday about a small Brazilian study showing that regular prenatal exercise significantly reduced the need for pain medication during labor--"only 27 percent of the exercisers, compared with 65 percent of the controls, requested pain medication during labor"(click here for the full article). Here's the study's abstract.

Speaking of exercise... I'm supposed to be running a 5K this Saturday morning. And my Thanksgiving holiday vacation really threw off my exercise routine... yikes. Gotta get back on the ball!

Easing my conscience

This study makes me feel a lot better about "forgetting" to take prenatal vitamins (except for maybe once a month or so). The truth is I've just never felt good about taking them. I prefer to get my vitamins from real foods. So it's not that I didn't get plenty of folic acid in my early pregnancy. I did--peas, broccoli, greens, cereals, etc. Just not from pills.

I'd be interested to see whether folic acid from real food sources has the same negative effect on infants? I'd wager NO. Anyway... I've never been very good about taking prenatal vitamins and my kids have avoided asthma and have never had respiratory tract infections. Interesting.

gDiapers?

My friend, Sarah, told me about gDiapers today. In fact, she's so sweet she's going to buy me a "starter kit" for the new baby. Love you, Sarah! I've tried the cloth diapering thing off and on, but they really are such a pain to clean. We've mostly used disposables for my girls. But I like the concept of the gDiapers... all the eco-friendliness of a cloth diaper, but with flushable liners! No stinky garbage even! Check them out!

Horror story of the day

One in 1,000 c-sections ends in "catastrophic bleeding." Did you know that? I sure didn't. That seems like a LOT. Here's a really, really sad news story. Coincidentally, the whole ordeal started with preeclampsia (subject of my last post and all the more reason to do everything we can to avoid it). Preeclampsia leads to a failed induction leads to c-section leads to catastrophic bleeding leads to death. So, so sad.

Stories like this really put articles like this one into perspective. (See here for some facts about the demand for elective cesareans).

Roughage

Got fiber? Well, you will if you want to decrease your chances of developing preeclampsia by 70%! Check THIS out!

Oh! I almost forgot!

It's a boy! :-)

Did you know you could have an ultrasound in the comfort of your own home?Neither did I! But it was awesome!! Big thanks to Mary (one of the midwives I interviewed in the last couple of weeks) for the brochure that led me to it!

Thank you, Brookie!

Remember this post from last month where I mentioned wanting to get a birth kit to have around just in case? Well, now that I'm planning to give birth at home it's more than a "just in case" necessity. So my thoughtful, sweet, wonderful sister-in-law surprised me last night with this...You're the best, Brookie!

As promised

Why I'm planning a home birth...

1) Safety
First of all, medical research demonstrates that planned home births with skilled attendants are as safe as hospital births for low-risk women. My first two pregnancies were smooth and problem-free. This pregnancy has also been smooth and problem-free. There are no guarantees in childbirth—no matter where you are. Sometimes the worst case scenario arises. Fortunately, it is very rare (1-3% of births among midwives I've interviewed) that home birth midwives have to transfer to hospitals for true emergencies. Should an emergency arise, the hospital would be immediately notified of our situation, and we are well within the American obstetric standard of “30 minutes from decision-to-incision.” So, as long as no problems arise and I remain “low-risk,” home birth will remain a viable option for me.

In fact, I am in much better health nutritionally and fitness-wise than I was in my previous pregnancies. I plan to continue exercising throughout my pregnancy because of its amazing benefits for both myself and my baby. Women who exercise throughout their pregnancies have far fewer birth complications and need much less intervention (see here). I see exercise as a way to make myself even more “low-risk” than I already am and increase my chances of an even safer labor and delivery.

Midwife-attended home births also provide many advantages—much lower rates of complications and intervention (c-sections, etc.) and more constant and personal support and attention. Most women laboring in hospitals spend very little time actually attended by nurses or doctors. Instead, they are strapped to a machine and checked-on only occasionally by actual people. A midwife is constantly assessing both mother and baby’s condition throughout labor and watching for indications of arising problems. A skilled attendant is a much safer, more accurate, and more reliable “monitor” than a machine. Many midwives are simultaneously trained doulas or have assistants who are trained doulas. The presence of a doula has been shown to significantly reduce childbirth risks, complications, and interventions. So, being constantly attended by a supportive professional will also further increase my chances of a safe labor and delivery.

You can read more about research on the safety of home birth here, here, here, here, and here. If you’d like to read more, I’m happy to direct you to further resources and research.

2) Cost-effectiveness
Home birth is significantly less expensive than hospital birth. One study indicates: “The average uncomplicated vaginal birth costs 68% less in a home than in a hospital, and births initiated in the home offer a lower combined rate of intrapartum and neonatal mortality and a lower incidence of cesarean delivery” (“The cost-effectiveness of home birth”). Cost is a major issue for us this pregnancy because our maternity insurance only covers complications, so (barring any major crisis) we will be paying out-of-pocket for everything. It just makes economic sense to only go to the hospital if it becomes necessary rather than paying several thousands of dollars more than we likely need to.

3) The Experience
Of course a healthy and safe mother and baby is the most important goal in childbirth, but I believe the experience itself is also important. And I also believe that God intended the birth experience to be a wonderful event. I have frequently felt the impression that it breaks God’s heart to see the way some women are mistreated in childbirth. It breaks my heart, too. I’ve had two wonderful hospital births, and I probably could have had another. But I look forward to being at home and unencumbered by outdated hospital policies which have little or no evidence supporting their use—electronic fetal monitoring, lying on the bed for delivery, no food or drink, intravenous fluids, etc. I look forward to moving as I please, eating or drinking as I please, pushing as I please, and hopefully coming away from the birth without needing any stitches!

4) God’s Guidance
None of the previous reasons (even combined) would have been enough without this last one. I knew that I would not be able to take on the real, though minimal, risks of a home birth without God’s own support. Initially, when I prayed about the question back in early August, I felt a subtle impression that going with a certified nurse-midwife in the hospital was the best choice. For a time, this felt right. And I think God had some excellent reasons (I won’t go into) for suggesting I start out the pregnancy this way. Slowly, however, I began to feel uneasy about that path. So, once again, I began exploring the home birth option. I agonized over it, again. And I took it to the Lord again. This time, the answer wasn’t subtle. It was an overwhelming and profound YES. And accompanying that yes were some beautiful glimpses of why and how my taking this path will fulfill His purposes for me and those around me. I had wanted so badly to know without a shadow of a doubt that I was making the right decision, and God, in his tender, loving mercy, gave me that wonderful gift of complete assurance.

So, now, without doubt or hesitation, we are moving forward with this home birth plan. And I am thrilled about the blessings that are in store for us.

Stay tuned for details about the midwives I've chosen! They're incredible! :-)

Oh my... and Oh Yeee-ah!

I need to move. Do you? Mass exodus to Vermont, anyone?

Oh, and check out the new blog Unnecesarean where I heard about a fabulous study reaffirming what my gut has always told me. Here's a quick excerpt from Medical News Today that sums things up beautifully:

"Pregnant women whose labor stalls while in the active phase of childbirth can reduce health risks to themselves and their infants by waiting out the delivery process for an extra two hours, according to a new study by researchers at the University of California, San Francisco.

"By doing so, obstetricians could eliminate more than 130,000 cesarean deliveries--the more dangerous and expensive surgical approach--per year in the United States, the researchers conclude."

Oh, and THANK YOU, Aaron Caughey, MD, PhD (senior author on the study). His words were right on: "Given the extensive data on the risk of cesarean deliveries, both during the procedure and for later births, prevention of the first cesarean delivery should be given high priority."

(Full article here: "Many C-Sections Can Be Avoided By Waiting Out Stalled Labor, UCSF Study Shows," Medical News Today)

AMEN! Now let's see it happen!

Prego Pic #3

I can't believe we're one week shy of halfway! In fact, we're probably already over halfway since my babies come about a week early. Only five short days until our ultrasound. We're beyond eager to "see" the little person inside of me and find out whether we're anticipating some more testosterone or not. We've also had a change of plans in regard to our choice of birth attendant and setting... we're now planning a home birth! Stay tuned for more details about how and why we changed our minds. :-)

Heath Ledger on Birth

Heath Ledger and Michelle Williams chose to go natural with a doula in October 2005 when their daughter, Matilda, was born. Here's what Heath Ledger had to say about witnessing the birth:

"For man, birth is the realisation that you're just a hopeless, useless specimen of life and witnessing this innate, primal strength within women can be such an intimidating experience.

"When you come out of the birthing experience, you actually have a better understanding of how and why men have over-compensated in society by creating battles and wars and steroids, and why they go to the gym. It's because we want to be strong and tough, and we're not. And it's this endless quest to kind of find this strength that can equal women's. Experiencing those nine months with Michelle was incredibly humbling, and I just relinquish all kinds of respect and power to her. She's incredible" ("The Truth About Heath Ledger's Women," The Daily Telegraph).

I wouldn't agree that men aren't strong and tough (we're just strong in different ways), but it's sweet to hear a man's awe in witnessing his partner give birth, huh?

Change is in the air

I don't know if I've ever heard anything more fabulous. New York City midwives are getting inundated with calls from women seeking their services. Some have doubled and tripled the number of births they attend each month. More and more women are rejecting the medicalized model of birth and turning to midwives. Music to my ears!

For years I have pondered and schemed in my mind--what can I do to improve maternity care in the U.S.? Should we focus on making hospitals more mother-friendly? Should we create a new type of birthing facility--a hybrid of a high-level labor/delivery unit and a free-standing birth center? Should we focus on demanding evidence-based care from obstetricians? Should we try to help women make more educated choices in their pregnancies and births? Or should we just "let things be" since sometimes it seems that most women don't really care?

I don't know the answers to those questions, but I do know that ultimately we can really only change ourselves. As much as I sometimes wish I could force doctors, hospitals, the system, and women themselves to change, I know I can't and shouldn't ever have that ability. And, as I read in the New York Times about the increase in midwife-attended home births, I realized that change may come much slower than I'd like, but it is coming. And that change can only come as each individual woman decides to embrace it.

Do I have fantasies of a world in which all women give birth without drugs, attended by midwives? No. Of course not. The world absolutely needs the highly specialized and valuable skills of obstetricians. And thank heaven for the life-saving technologies and drugs available in hospitals for emergencies. There are countless women who would have been unable to bear children without modern medicine's gifts.

But I do have fantasies of a world in which women have faith in their bodies and the birth process and are given the support and encouragement they need to come away from their births empowered and strengthened. I envision a world with fewer post-partum scars and more smiles. I long to see the end of practices unsupported by scientific evidence and the ascension of truly evidence-based medicine. I do hope to see the Midwives Model of Care become the foundation of our maternity care system accompanied by true respect and cooperation between doctors and midwives as they mutually aim to give women and their babies the best possible care available.

What's happening in New York City with midwives and home birth is happening in other cities as well. Maternity care in the U.S. will improve only as women reject the broken system and choose a better model. Doctors and hospitals and insurance companies will have no choice but to adapt to the groundswell of change. I thank you brave women (and men) who are the beginnings of that wave. You are doing a tremendous service for women both now and in the future.

Have you seen this change happen within yourself? Do you see this wave of change happening around you? Please share!

"The baby was too big" cesareans and such

This doctor's blogpost and an email conversation with Fig got me on the subject, and I figured I might as well post my thoughts (cut and pasted from my email to Fig) here...

I really believe that most cases of "the baby wouldn't fit" c-sections are preventable. Women who are mobile, supported, and given whatever time they need don't typically end up with c-sections. My husband's sister delivered a 12 lb+ baby vaginally (at a birth center with a midwife). My mom's OB told her she wouldn't be able to deliver her children vaginally and wouldn't be able to breastfeed them either. She delivered all of us vaginally and breastfeed all of us too. Another woman I know got stuck at 5 centimeters or so, consulted with her doctor, and chose a c-section (it wasn't an emergency, there was no fetal distress, and the doctor gave her the choice to continue laboring if she wanted to). Each person will do what they do.

I do think that on very rare occasions a baby might be too big to come out. Here's one example. But I think doctors use the "too big" diagnosis far more frequently than is warranted... often because it's an easy out and women don't typically question it. Here's a good overview of some of the facts and misconceptions that I just found on a quick google search. A study I referenced in a previous Birth Faith post indicates that prenatal tests and diagnoses indicating that the baby is "too large" frequently lead to unnecessary c-sections and inductions without improving outcomes. Here's the original study's link.

But I'm convinced that most c-sections happen because something else (epidural, pitocin, lying down for extended periods of time, etc.) led to the distress or stalling of labor. There are certainly cases of genuine crisis when c-sections are warranted, and I wouldn't hesitate to let a doctor cut me open in those circumstances, but those crises are rare.

As far as the meconium in the doctor's example... meconium isn't generally a valid reason for c-section either. The medical establishment's own research indicates that: "Caesarean delivery does not improve the neonatal outcome when the amniotic fluid is meconium stained" (Journal of Obstetrics and Gynaecology 28(1): 56–59).

Doctors like to rattle off their expertise and claim they have science on their side (and sometimes it is), but it's hard to take them seriously when the research (published in their own medical journals) clearly contradicts them.

Have you delivered a large baby vaginally? Or have you given birth successfully through VBAC after a previous CPD (cephalo-pelvic disproportion) diagnosis and c-section? Were you one of those rare true cases of CPD? Please share your stories!

Painless Childbirth?

Off and on over the last six years I've heard people claim to have painless childbirths. Some attain it through hypnosis or other methods, some simply don't register their contractions as painful. I have to admit that I have a hard time believing people when they claim "painless childbirth." And even further than that, I don't know if I'd even want it myself.

The other night I was talking with my husband. We were on the subject of how this birth could go very quickly, and I told him I really hoped it wouldn't because I'd feel short-changed. I said, "I don't want it to be over quickly. At least give me a few hours." He looked at me sort of like I was insane. Why prolong the agony? no doubt he was thinking. But after a moment, his facial expression relaxed, and he said, "I guess I can see that." He's a hard-core running fanatic and marathon addict, so putting it through that lens, he acknowledged: "It's like why I would prefer to run a marathon than a 5K." Exactly. Some people see it as prolonging the agony, but for the one who chooses it willingly, it is simply magnifying and intensifying the satisfaction and euphoria.

Now, don't get me wrong. I'm not asking for an intense 24-hour labor. And I don't want to make it any more painful than it has to be. But "quick and painless" wouldn't be my ideal birth. Ecstatic and euphoric and beautiful... bring it on! But painless?

I just can't even comprehend it. I love giving birth! But I'm not going to lie to you. It hurt A LOT. But there's nothing like the relief and release that washes over you when that slippery little person emerges. I think that's how God and nature intended it--that it is your beautiful baby who brings you the gift of relief. Most women experience that glorious relief prematurely--as a gift from the anesthesiologist so many admit to wanting to kiss.

I've never given birth without pain, so I have no concept of what it would be like. Most of the women I know have given birth with epidurals. I wouldn't presume to claim that their births were any less miraculous and wonderful, but I just have no concept of what it would be like. As strange as it may sound, I don't really want to know what it would be like.

Am I totally insane? Thoughts?

Irksome and Infuriating

I've been reading a fabulous new document today--Evidence-Based Maternity Care: What It Is and What It Can Achieve--available through Childbirth Connection. I wish every female would read this info-packed document, especially those who are pregnant or ever plan to be in the future. Women need to know the real facts about the slew of medical interventions they could potentially encounter in childbirth. But that's not what irks me.

As I was reading along in the document, I got to the section about epidurals and found a statistic that felt like salt in an already festering wound. The estimated increase in cost from epidural use for low-risk experienced mothers is 36%. Why should that bother me? I'm not getting an epidural anyway, right? Ha! That's where the already festering wound comes in.

Back when I was investigating my birth options a few months ago, I contacted the hospital where my midwives deliver to find out how much they charge for normal vaginal deliveries without epidurals. The woman on the line gave me a number. Then I clarified, just to be sure, that it was the cost without drugs or epidurals. She said it's the same amount whether you have an epidural or not. Umm... what? Yeah, you heard that right. I have to pay for an epidural whether I want one or not. And I tell you what... it infuriates me.

I really thought we were going to save ourselves some big bucks with my natural birth choices. But now they tell me I have to pay for a bunch of crap I don't even want? If the 36% increase stat is correct, that's a huge increase in cost for someone who will be paying out-of-pocket. &$^%#%^@^! I also asked the lady on the phone if we'd save money leaving the hospital early... say if we didn't stay overnight. Nope. You pay for a two-day stay regardless of when you check out (unless, of course, you stay longer... then they'll of course take some more of your money). Awesome. This hospital and I have gotten off to a really great start.

Have I told you I really, really hate stupid, ridiculous, retarded hospital policies? I am thinking I may try to fight this one. It makes me want to vomit.

Birth "in place"

I wanted to make mention of a great blogpost and resource I just read. While most women plan ahead of time where they will give birth, sometimes birth happens too quickly to make it to the planned location or before a birth attendant can be present. There are also natural disasters or other emergency situations where women may be unable to reach or find space in a hospital. Though these situations are rare, they are still possibilities, and the best course is to be prepared. The American College of Nurse Midwives has a great resource-"ACNM Giving Birth in Place"--explaining how to give birth under emergency circumstances or wherever you may be--"in place."

My first labor went fairly quickly (less than 6 hours from start to finish). My second was a curve ball because my baby was posterior (27.5 hours start to finish with periodic stalls in labor). So I'm feeling fairly anxious about this next birth because I have absolutely no idea what to expect. It could be extremely fast. My sister's third child was born an hour and a half after the first contraction! Or maybe this one will also be posterior and take its time? I have no idea once the first contraction hits whether I need to rush or relax. It's nerve-wracking now... I can't even imagine how nervous I'll be in late March/early April.

But I plan to study up on "giving birth in place" and take whatever precautionary steps I can to prepare for the possibility that we have to give birth unattended. Maybe I'll even get us an "emergency birth kit" like this one--it'd probably be good to have around anyway for emergency preparedness in general. I hope these precautions will bring me at least a little peace of mind. I think they will.

Prego Pic #2

Here we are at 15 weeks. I swear my stomach suddenly popped out in the last few hours. Even my belly button is poking out now. I love getting beyond the "I look pudgy" phase to the "I definitely look pregnant" phase. We heard the heartbeat at our appointment a couple of weeks ago. I can't wait to start feeling movements. I really love being pregnant, and I feel sort of sad when I think that I'm already over a third of the way through. It's flying by too fast!

Let's get movin'

I just read some great news. Though it only confirmed what I already knew. Check it out!

"Moderate physical activity during pregnancy does not contribute to low birth weight, premature birth or miscarriage and may actually reduce the risk of complications, according to a Michigan State University professor who contributed to the U.S. government's first-ever guidelines on physical activity" ("Guidelines urge physical activity during pregnancy," Physorg.com).

I should say that, although I was dead set on exercising through this pregnancy, I've been woefully inactive for the past month or two (or has it been three?). But this little news flash may be just the boost I need to get back out there and run again. Maybe I'll even go tomorrow?

You Are a Queen

Perhaps you've heard of Stephanie Nielsen, or Nie. Her story is all over the blogosphere these days. She and her husband were in an airplane crash and both received burns over large portions of their bodies. They are still in the recovery process, and the blogging world has rallied around them through donations, auctions, and messages of good will. It's really a beautiful thing. Her sister has been keeping the world updated on their progress through her blog. And she's been moderating Nie's blog, reposting many of her past posts. One of them was a beautiful account of the home birth of Stephanie's son. I had to link to it. I love the sentiment... we are all queens... Check it out here.

Prego Pic #1

Two days shy of 11 weeks.

My first appointment with Tiffany, the midwife, last Friday went well. It was still too early to hear the heartbeat, but I'm "definitely pregnant" (surprise, surprise) and everything's looking good. Tiffany, who confessed that she "loves looking at pregnant women's pee," said my urine looked great. "You can tell a lot about a pregnant woman by the looks of her pee," apparently. It appears I've already gained at least 10 pounds, and I'm measuring big (like last time) because my uterus is tipped. The clinic was okay. I wasn't wild about all of the staff members and it's in a sort of sketchy part of the valley, but the overall experience was good. I look forward to meeting the other midwives!

Decisions, decisions...

I've been pre-occupied over the last month and absent on this blog because I'm 9 weeks pregnant! About a month ago, I was embroiled in a difficult decision-making process. It was eating at me and consuming my thoughts almost all day everyday. The question was... should I plan a home birth for this baby?

I've spent the last 5+ years researching birth, and I am a definitely believer that home birth is a wonderful option for low-risk women. (My two previous pregnancies and births were smooth and problem-free, so I anticipate remaining low-risk this time around.) I would vehemently defend each woman's right to choose home birth. And I have often wondered over the last several years whether my third child might be a home birth.

The decision was made all the more interesting by our insurance situation. I won't go into too many details, but home birth was looking really really appealing just for the mere fact that it's so much cheaper (as long as you don't transfer to the hospital). My husband, who has long feared the idea of a birth at home, was even coming around to the idea when he found out how much money we could save.

I agonized over this. I contacted a whole slew of home birth midwives to find out their rates and ask some questions. I google-mapped all the nearest hospitals to see how long it would take to transfer in the event of an emergency. I read and read and prayed and prayed. I had dreams of giving birth and strained to remember... was I at home or at the hospital?

In the end, I decided to go with a Certified-Nurse-Midwife-attended hospital birth. I think if we lived closer to a hospital, I would have chosen a home birth in a heartbeat. But it just didn't feel right this time. And I have had two great hospital birth experiences in the past, so I feel confident I can have another one.I have my first appointment with a midwife named Tiffany this Friday. I look forward to hearing my baby's heartbeat and getting a feel for the clinic I'll be visiting for the next 7+ months. Here we go!

Hargadon for Congress!

Check out this press release outlining Dr. Mike Hargadon's response to the AMA's resolution calling for anti-home-birth legislation. His words are so right on...

"Is this about safety or better birth outcomes? No, it's about money and it's about the AMA trying to protect its turf, plain and simple. . . . Midwifery is a fast-growing industry. More families are choosing to have births attended by a midwife, rather than by an OB/GYN. It also costs significantly less to give birth outside of a hospital setting. So it comes as no surprise that the AMA would support making homebirthing illegal. They're losing money and losing market share."

"Here you have a group of women who are successful and doing what they love. We need more of this in health care, not less. Midwives are giving people what they want and doing it in an affordable way. But the AMA wants to tell us it isn't safe, and run these successful women out of business or make them subservient to AMA. It's blatantly sexist, it's anti-freedom, and if this legislation passes, it will increase prices."

But I really hope he's wrong about this...

"My hope is that the Congress wouldn't be so foolish as to try to legislate birth choice. But if you want to know what Congress will do, just follow the money. In this election cycle alone, the AMA Political Action Committee has donated almost $740,000 to Congressional candidates and other party committees. My opponent, Congressman Elijah Cummings, has received $5000 in donations from them in the past four years. So my fear is that the AMA has already bought this legislation."

We cannot back down.

Wanna improve your odds?

I mentioned back in April that I had been skimming the book Exercising Through Your Pregnancy, by James F. Clapp M.D. I was really impressed at that time with the amazing benefits of exercising through pregnancy. But I didn't read the book in-depth. I decided earlier this week that I wanted to take a closer look. Now that I've read several of the chapters and examined the data thoroughly, I am telling you... it absolutely blows me away! Look past the cheesy/dated cover picture, my friends, and read this book! Or, if nothing else, keep reading this blogpost.

There are risks inherent in pregnancy and childbirth, but we can do things to minimize those risks. We all know that good nutrition is essential for pregnant women. Poor nutrition often leads to pre-term and low-birthweight infants as well as pre-eclampsia in mothers. Eating well is one of the absolute best things you can do for your unborn child's physical and neurological growth. But now I'm convinced that exercise may be just as important.

I won't go into all the benefits of prenatal exercise here. I'd just like to focus on one set of benefits in particular--the effects of exercise on the course of labor. You might remember my very early post about the benefits of doulas. Having a doula assist your labor and delivery reduces many chidbirth risks significantly. Prenatal exercise has even more pronounced benefits!

Women who continue exercising regularly through the end of their pregnancies (three times a week for at least 20 minutes at a moderately hard to hard level of exertion) demonstrated the following reduced risks during the birth process...

* 35% decrease in the need for pain relief
* 75% decrease in the incidence of maternal exhaustion
* 50% decrease in the need to artificially rupture membranes
* 50% decrease in the need to induce or augment labor with pitocin
* 50% decrease in the need to intervene because of abnormalities in the fetal heart rate
* 55% decrease in the need for episiotomy
* 75% decrease in the need for operative intervention (forceps or cesarean section)

In addition, check these out...

* More than 65% of the exercising women delivered in less than four hours.
* 72% delivered before their due date (but fewer of them delivered before 37 weeks--preterm--than the control group). The exercising women delivered, on average, 5-7 days earlier than active women who did not exercise regularly.
* Significant reduction in the incidence of umbilical cord entanglement.
* Much lower incidence of fetus passing meconium from distress.
* Umbilical cord blood samples indicated that babies of exercising moms remained relatively stress-free with plenty of oxygen. They seemed to tolerate the stresses of labor and delivery better than the control group.
* The exercising mothers' infants were, on average, 14 oz lighter but overall growth was not compromised.
* Placentas of exercising mothers are larger, more efficient, and healthier-looking.
* Infants born to exercising mothers were more alert postpartum and needed less consolation from others.

(All of these results are taken from Dr. Clapp's studies as reported in Exercising Through Your Pregnancy. See this fabulous book for even more amazing benefits.)

It blows my mind.

Imagine how huge the risk reductions would be if you exercised through pregnancy AND had a doula. Whoah. We can do so much to avoid the pitfalls of pregnancy and birth! It gives me so much joy and hope to know that I am not at the mercy of chance. I have a great deal of power over my circumstances when it comes to pregnancy and birth. It is a wonderful thing to be able to choose to pro-actively reduce risks and bring so much benefit to myself and my babies. I love it!

Alarming incidence of depression and PTSD

Just finished reading a blogpost over at Lamaze's Giving Birth With Confidence blog. They report some alarming facts from Childbirth Connection's "New Mothers Speak Out" follow-up to the "Listening to Mothers Survey II." Listen to this...

Related to the findings on the mental health of new mothers, what struck me most was that at the time of the survey 63% of mothers were likely to be experiencing some degree of depressive symptoms and 18% appeared to be experiencing symptoms of post traumatic stress related to their birth experience. Most startling, 9% of the mothers appeared to meet all the formal criteria for post-traumatic stress disorder. This is the first national survey of post traumatic stress disorder related to childbirth, and the high number has to be a surprise to most people. Just as troubling a finding, most mothers experiencing symptoms had not contacted a health care professional and only 2 out of 3 mothers who reported that their symptoms interfered with their ability to care for their baby had contacted a professional for help.

The mothers who reported signs of PTSD in the survey appeared to have a higher rate of medical interventions and describe feeling powerless in a threatening environment. I am not surprised. Childbirth educators and doulas have noted for years now the increased incidence of PTSD and have shared with each other women’s stories that seemed to describe a relationship with both the escalating rate of medical intervention..nearly routine induction, unnecessary and frequent internal examinations..and impersonal, routine, and, sometimes abusive treatment of women in labor. It’s not just the stuff that gets done to women…routinely, abruptly, and uncaringly. It’s the powerlessness that women feel in an environment that is inherently frightening at a time when they are vulnerable and literally at the mercy of the system. Gone are the days of kind words and encouragement and loving touch. Now it’s get the job done fast or you’re on the cesarean fast track.(Source)

I am appalled. How many more women will have to suffer before enough of us get angry enough to do something about it?!

And you thought folic acid was important...

Folic acid isn't the only thing pregnant women should be concerned about. Omega-3s are right up there on the list of things they should be ingesting daily. Unfortunately, most pregnant women don't. American Chronicle reports, "According to food consumption surveys, 85% of all women are deficient in the EPA and DHA fatty acids [two types of omega-3s]. Among pregnant women, only 2% have diets that meet their needs for EPA and DHA. The rest get less than 18% of the recommended daily allowance"(source). What's the big deal about omega-3s?

1. Omega-3s protect your brain. "Many pregnant women are deficient in a variety of nutrients, including Omega-3 PUFAs [polyunsaturated fatty acids]. In an effort to provide for the baby's needs, a woman may lose 3 percent of her brain mass during the last trimester" (Maryann Marshall, "Omega-3 Fats During Pregnancy Provide an Alternative to Anti-Depressant Drugs," emphasis added). Maybe that explains why many women experience "mommy brain" in the first few months after giving birth?! Which leads to the next point...

2. Omega-3s protect you from depression. Omega-3 deficiency has been linked to depression, and the loss of brain mass resulting from providing the baby's needs (as mentioned above) is thought to be one cause of postpartum depression. Depressed pregnant and postpartum women who were given omega-3 supplements saw significant improvement in their symptoms. (More info here, here, and here)

3. Omega-3s build your baby's brain and other vital tissues. "EPA and DHA are . . . vitally important to the optimum growth and development of the baby's brain, eyes and nervous system . . . . These essential fatty acids make up nearly 70% of a newborn baby´s brain, retina and nervous system" (American Chronicle). Studies show that children whose mothers consume fish (high in omega-3 fatty acids) during pregnancy demonstrate superior cognitive function. (More info)

4. Omega-3s prevent several pregnancy complications. Deficiencies in omega-3 fatty acids can lead to pre-eclampsia in mothers and prematurity and low-birth weights in babies.

Omega-3s are amazing. Unfortunately, it isn't always safe to get our daily dose from the local fish market. Mercury and other toxins have made their way into many of the fish available for consumption. How can you safely get your omega-3s? Select only high-quality wild (not farmed) fish or fish oil supplements. Some forms of omega-3 can also be found in plant products like flax seeds, walnuts, and some herb spices. (More info)

So throw back something fishy with your folic acid. It's definitely worth it!

References
"Omega-3 acids reduce postpartum depression, UA pilot study suggests"
"Omega-3 Fats During Pregnancy Provide an Alternative to Anti-Depressant Drugs"
"Omega-3 may ease depression during pregnancy"
"Omega 3 Fish Oil During Pregnancy"
"Prenatal fish intake benefits kids' brains"

Priceless

I love it when OBs speak up in defense of midwives and homebirth! Check out this excerpt from ABC News ("Controversy Brewing Over Homebirths"):

ACOG has also received letters from other physicians, including Dr. Lauren Plante, an associate professor of obstetrics and gynecology at Thomas Jefferson University in Philadelphia.

Plante wrote that she was "dismayed to read the ACOG statement opposing home birth, and specifically disallowing any support for individuals that advocate home birth."

Plante added that "home birth remains a viable option in several developed nations where birth outcomes are excellent. I personally know several ACOG members who, themselves, have chosen to deliver at home."

In a letter to the ACOG board, Canadian ACOG member Dr. Andrew Kotaska wrote, "If ACOG and the AMA are passive-aggressively trying to coerce women into having hospital births by trying to legally prevent the option of home birth, then their actions are a frontal assault on women's autonomy."

Gotta love Jennifer Block

So good.

Some Birth Research Headlines

Courtesy of the Lamaze Institute for Normal Birth Research Summaries:

Prenatal Diagnosis of Suspected Fetal Macrosomia Increases Risks of Cesarean Section and Maternal Morbidity without Improving Newborn Outcomes

Sadeh-Mestechkin, D., Walfisch, A., Shachar, R., Shoham-Vardi, I., Vardi, H., & Hallak, M. (2008). Suspected macrosomia? Better not tell. Archives of Gynecology and Obstetrics, doi: 10.1007/s00404-008-0566-y.

"An initial suspicion that the baby is large may instill fear in the pregnant woman which may impede both her confidence in her body and her labor progress. Slow labor progress reinforces the suspicion that the baby is big and more aggressive management ensues. This management often hinders the woman's ability to move freely and assume the positions that may help her baby negotiate through her pelvis, further slowing progress and reinforcing the perceived need for surgical intervention. Based on this study and previous evidence, women should strongly consider refusing tests late in pregnancy intended to estimate fetal weight.

"The estimate itself may be bad for her health because the care provider's expectation that the baby will be macrosomic appears to increase both unnecessary medical intervention and the morbidity that may accompany it" (exerpt from the Lamaze Research Summary).

Women Having Spontaneous Vaginal Birth Without Episiotomy Least Likely to Experience Postpartum Pain

Declercq, E., Cunningham, D. K., Johnson, C., & Sakala, C. (2008). Mothers' reports of postpartum pain associated with vaginal and cesarean deliveries: Results of a national survey. Birth, 35(1), 16-24.

"One argument made for elective cesarean surgery is that it avoids the pain of labor. Its proponents also allege that surgery occurring before labor offers advantages over intrapartum surgery. This study, however, finds that women having cesarean surgery are more likely to experience pain that interferes with routine activities and to experience long-term pain than women birthing vaginally and that timing of the surgery makes no difference.

"Women considering elective surgery to avoid labor pain should be advised that while labor pain can be controlled, cesarean surgery substantially increases their risk of experiencing many months of pain postpartum or pain that affects their quality of life. Instrumental vaginal delivery likewise increases the probability of experiencing perineal pain in both the short and long term compared with spontaneous vaginal birth" (exerpt from the Lamaze Research Summary).

Prenatal Yoga May Result in Less Labor Pain, Shorter Labor

Chuntharapat, S., Petpichetchian, W., & Hatthakit, U. (2008). Yoga during pregnancy: Effects on maternal comfort, labor pain and birth outcomes. Complementary Therapies in Clinical Practice, 14(2), 105-115.

"This study provides evidence that regular yoga practice in the last 10-12 weeks of pregnancy improves maternal comfort in labor and may facilitate labor progress. The researchers offer several theories for these effects. First, yoga involves synchronization of breathing awareness and muscle relaxation which decrease tension and the perception of pain. Second, yoga movements, breathing, and chanting may increase circulating endorphins and serotonin, "raising the threshold of mind-body relationship to pain" (p. 112). Third, practicing yoga postures over time alters pain pathways through the parasympathetic nervous system, decreasing one's need to actively respond to unpleasant physical sensations.

"Prenatal strategies that help women prepare emotionally and physically for labor may help reduce pain and suffering and optimize wellbeing in childbirth by providing coping skills and increasing self-confidence and a sense of mastery. More research is needed to confirm the findings of this study. However, yoga's many health benefits and the lack of evidence that yoga is harmful in pregnancy or birth provide justification for encouraging interested women to incorporate yoga into their preparations for childbirth" (exerpt from the Lamaze Research Summary).

No wonder the mermaids do it...

Seashells. Who'd have thought? I just finished reading Amanda Dumenigo's article at Mothering.com ("Seashells"). Apparently women have been placing seashells on their breasts for thousands of years. They are used to treat all types of sores, infections, cracking, and bleeding. For Amanda Dumenigo, they were a life-saver as she struggled to get a proper latch and establish breastfeeding with her infant. Her story hit close to home for me. I, too, struggled with these same breastfeeding trials. I used all sorts of man-made objects to try to make things work. Eventually, I was breastfeeding without any trouble at all. But I wish I had known about seashells back then. It sounds a little strange, but at the same time so right and natural. I'm always amazed when I see how God and nature have given us everything we need.

Solace for Mothers

I just became aware of a website devoted to helping women recover from traumatic birth experiences--Solace for Mothers. I often wonder whether the incidence of postpartum depression is so high in the U.S. partly because the incidence of negative birth experiences is also very high. A positive birth experience is surely a strong springboard into motherhood. Solace for Mothers explains:

For many women, childbirth is an empowering, expansive experience. And for some, childbirth brings dashed dreams, grief, and the unshakable sense that your body and your mind are damaged. Some women feel betrayed by their care providers and the place in which they birthed. Sometimes fate itself interferes when the baby comes too soon, bearing health problems or even, tragically, when the baby does not survive. Even when birth is “normal,” some women are stunned to discover that bonding with their babies grows over a period of time rather than unfolding all at once. . . .

Solace for Mothers provides healing after traumatic childbirth through support. Support—in the form of a free telephone call with a trained peer counselor, in-person facilitated meetings to listen to and share birth-related stories in a safe and confidential setting, as well as referrals to community resources—is available by calling one number: 1-877-SOLACE4 (1-877-765-2334). We are also in the process of launching an online community for women dealing with these issues. (source)

The creators of our new discussion board would like you to know that you are not alone. Other women have felt traumatized, deeply disappointed, or even violated by their birth experiences. Birth trauma is very real. We are here to offer you an online meeting place to share and connect with other women who have had similar experiences, and a place for you to begin your healing journey. (source)

I'm so grateful for groups like Solace for Mothers who recognize the way birth experiences can profoundly affect women for good or bad. I never lose hope that as more and more people become aware of the problems with maternity care and demand change, more and more women will come away from their births being affected profoundly for good.

Two Tidbits Courtesy of Midwifery Today

I subscribe to Midwifery Today's weekly E-News, and found a couple of things in today's email worth mentioning.

Induction and Meconium Aspiration Syndrome

Part of this issue of E-News contained an excerpt from a Midwifery Today article entitled, "The Problem Is Induction, Not Meconium," by Gail Hart. Meconium is the fetus's thick, dark-colored first bowel movement, and, when found in the amniotic fluid, it is a sign of fetal distress. Meconium itself is not generally a problem unless it gets into the fetus's lungs--meconium aspiration syndrome (MAS). It is generally accepted that meconium is more common the longer the pregnancy goes, but that may be simply because those pregnancies are most likely to be induced. Gail Hart shares the findings of a study indicating that the factor most strongly associated with MAS was induction, not being postdates. This makes sense when you remember that drug-induced contractions can be abnormally intense and long, restricting oxygen supply to the fetus. It follows that fetuses being born by induction would experience more distress. Just one more strike against pitocin/induction in my book, as if I needed any more. Check out the actual excerpt from Gail Hart's article here.

Infant Formula and DHA/ARA

The other tidbit I wanted to share was especially disturbing. I have for the past few years been a big proponent of everyone making sure they get their omega-3 fatty acids, especially DHA, but this issue of E-News shared the dark side of the omega-3 craze as it applies to infant formula.

Based on a report presented by the Cornucopia Institute (a corporate watch-dog group), the DHA/ARA added to many infant formulas is created from fermented algae and fungus and is structurally different than the DHA/ARA found in breast milk. The FDA isn't even convinced of the safety of these algal and fungal DHA/ARA additives! Apparently some infants fed DHA/ARA formula have even suffered from severe diarrhea, vomiting, dehydration, and seizures until being switched to a non-DHA/ARA-supplemented formula. Some infants even suffered death. Despite the FDA's reservations, these additives were somehow still approved for infant/human consumption.

Formulas supplemented with DHA/ARA are marketed as being "more like breastmilk," suggesting to consumers that they are somehow healthier than other formulas. In fact, scientific studies are inconclusive regarding the benefits of these DHA/ARA additives. Martek Biosciences Corporation, a manufacturer of these additives even acknowledges: "Even if [DHA/ARA] has no benefit, we think it would be widely incorporated into formulas, as a marketing tool and to allow companies to promote their formula as 'closest to human milk'"(source). Here's what the Cornucopia Institute concludes about the motives of infant formula manufacturers: "Given the safety concerns and doubts within the scientific community, it is clear that the infant formula manufacturers’ claims are marketing tools designed to sell more formula, and sell it at a higher price"(source). So what it really comes down to is money. Are we really surprised? Of course not. They're corporations and it's their job to make money. Adding DHA/ARA sells more formula, regardless of the fact that it's very different from the DHA/ARA in breastmilk and may actually be dangerous.

Unfortunately, parents are too busy or too trusting to ask any questions about it. I know for a fact that, if I had needed to feed my infants formula, I would have gone with the DHA/ARA version because I would have believed it was better. Get this... just yesterday I bought some Yoplait drinkable yogurt. Which kind did I pick? The one that said "with DHA" on it, of course! I looked at the label this morning, and, sure enough, it has "omega-3 DHA algal oil"--the very stuff implicated the Cornucopia Institute's report! Marketers certainly aren't stupid. They know omega-3 DHA is all the rage. I'm especially prone to buy into the notion that anything with DHA is better, regardless of where that DHA came from. Oops.

Included in the Cornucopia Institute's report is the following disturbing tidbit (evidence that infant formula marketers have done their job very well): "According to the National Alliance for Breastfeeding Advocacy, mothers have contacted health care providers asking the following: 'I want the breast milk formula,' or 'I want the formula with breast milk in it,' and asking questions such as 'whose breast milk is in the formula?'"(source). Oh my.

While I do find all of this disturbing, I also recognize and accept that infant formula is a life-saver for infants who are unable to breastfeed. And, given this fact, I do believe that formula manufacturers should do everything they can to create a product as close as possible to breastmilk. Unfortunately, in the end, it's just a sort of lost cause because breastmilk is something technology, no matter how advanced, cannot duplicate. While formula saves some lives, it will never be ideal. I'll end with this quotation from the International Baby Feeding Action Network:

"While researchers fiddle with the balance of fatty acids in infant formula, and deal with the additional uncertainties of the complex cascade of interactions that each adjustment provokes within the omega families, breast milk will always be the simple, perfectly balanced source of each essential nutrient."(source)

For more info, see...
Midwifery Today, Volume 10, Issue 11
"Replacing Mother — Imitating Human Breast Milk in the Laboratory"
"C-sections, breastfeeding, and bugs for your baby," by Jeff Leach

New Citizens for Midwifery/Coalition for Improving Maternity Services Fact Sheet

I just got this email from Susan Hodges:

Dear Friends,

CfM created a well-received poster for the Coalition for Improving Maternity Care (CIMS) conference in February titled “What Does Good Maternity Care Look Like?”, and we have made a hand-out version. The colorful flier (which also looks good in black and white) includes the Midwives Model of Care, CIMS’ Ten Steps of Mother Friendly Care, and Lamaze’s “Six Care Practices that Support Normal Birth”, side by side, with their urls, with the caption “Supporting evidence-based care, and promoting healthy mothers and babies!”

We have now posted this flier at: http://www.cfmidwifery.org/pdf/ThreeModelsofCare.pdf

Please feel free to print it out and use it for classes, conferences, whatever. It gives a powerful message of “you don’t have to take my word” for what constitutes good maternity care!

Sincerely,
Susan Hodges

Enduring a mile (or a centimeter)

My husband ran the Boston Marathon last Monday, and I was so inspired by it that I decided I want to run it as well. So, yesterday, my husband and I decided to see how fast I could run a mile. We ran a warm-up mile at a medium-effort pace, and then I threw myself like crazy into the 2nd mile. It was misery. It was horrid. It was an intense mental tug-of-war between "I can do this! Keep going!" and "What was I thinking?! I have to stop!" But somehow I kept going.

This really does have something to do with birth, I promise... just hang with me. After finishing my run yesterday, I thought a lot about the experience. I speculated that it was probably like a mini-marathon--a condensed version of the marathon experience. And I also recognized that the same things that helped me to navigate the journey of childbirth also helped me to get through that mile (and would probably help me get through a marathon as well). Here's a play-by-play:

1) In the beginning, chatting works wonders. The first part of that mile, I kept telling my husband to "Talk to me!" When he was talking to me, running felt easier. The conversation was a welcome distraction--especially when it was about topics completely unrelated to what we were doing. The same was true in childbirth. Talking was extremely helpful through the early intense contractions (around 4 centimeters).

2) Eventually, chatting is not possible. Somewhere in the middle of my mile, a switch flipped. Suddenly I reached a point where I didn't want/need dialogue. I didn't want to talk. I couldn't formulate sentences or contemplate options. All I could think about was my own body and enduring to the end. Distraction was no longer helpful. Instead all words had to be pure fuel--encouragement, positive energy. I pulled into myself, but I could hear my husband's occasional words of encouragement: "You're doing awesome! You can do it!" Those simple statements carried me on. This was eerily similar to the way I felt as I navigated "transition" (7 to 10 centimeters dilation) giving birth to my daughters. The same things that helped me get through transition were the things that pulled me through that mile--minimal distractions and LOTS of quiet, gentle encouragement.

3) What you say to yourself matters most of all. In the midst of my misery, when I felt like I couldn't possibly push myself any harder or faster, I found my mantra: "The faster I run, the sooner I'm done." As soon as I spoke it out loud, I felt an instant surge of energy and was able to leap ahead, lengthening my stride and picking up speed for several yards. Whoah. So cool. The words you speak to yourself have so much power--for good or bad. Make those words only positive and you will find power within yourself to do anything--be it finish a mile or reach 10 centimeters in labor.

4) There's nothing more motivating than the finish. When my husband said, "I can see the finish!" I felt instantly encouraged, "You can?!" Thank the heavens!! Once the finish was in sight, I knew I could make it the rest of the way even though my strength was spent. This is much the way I felt when I had reached full dilation in labor and was ready to push--pushing was like seeing the finish line. Somehow the pain seemed less intense because I knew I was so close to the end.

Maybe all of this is self-evident, but I had fun drawing parallels between the experiences. It was fascinating to me, and helpful to recognize that I have done hard things in the past and found the strength to endure. I have given birth twice without pain relief. If I can do that, I can run a marathon. And, if you've ever done something difficult and intense like running a marathon (or even a mile), you can definitely get through childbirth. And, I guess, the ultimate point is... if you can find enough strength within yourself, you can do anything. Anything.

Sharon, you will be missed

I got word today that my favorite midwife passed away after a 12-year battle with breast cancer. I knew she had been fighting breast cancer and had taken time away from midwifery for treatments, but, for the time that I was a client of the New Beginnings Nurse-Midwives, she was working and appeared to be doing well. I wasn't close enough to her to pry about her health, but I was hopeful that she had triumphed over the disease and would live long into the future.

Sharon Sims was my favorite of the midwives in the practice. I had my first appointment with her, and I was so impressed by her kindness and gentleness. She was genuine, down-to-earth, and unassuming. I felt immediately at ease in her presence. After meeting the other midwives, I still felt most impressed with Sharon. I hoped she would be the one to deliver my second baby. Ultimately, another midwife was on-call when I finally went to the hospital to give birth, but Sharon was the one who visited us at the hospital the next day to check-in and give us the go-ahead to return home. Once again, she put me at ease, emanating a warmth and love and gentleness I soaked up thirstily.

I am certain that I am one of many hundreds of women who will always have a special place in my heart for Sharon Sims. She was a wonderful midwife, and I feel honored to have been blessed by her life.