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).
Sunday, November 30, 2008
Monday, November 24, 2008
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!
You're the best, Brookie!
Sunday, November 23, 2008
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! :-)
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! :-)
Saturday, November 15, 2008
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!
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!
Friday, November 14, 2008
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?
Thursday, November 13, 2008
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!
Friday, November 7, 2008
"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!
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!
Tuesday, November 4, 2008
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?
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?
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