Tuesday, March 31, 2009

Boost your baby's health and marital bliss and diminish baby blues

It's amazing how much difference something so simple can make. Look at these stats:

Infant Health Problems at Six Weeks

Vomiting- 28% vs. 4%
Colds or runny nose- 69% vs. 39%
Cough- 64% vs. 39%
Poor appetite- 25% vs. 0%
Diarrhea- 33% vs. 19%

Satisfaction with Partner

Since baby was born- 49% vs. 85%
Relationship better right after birth- 30% vs. 71%

Psychological Outcome at Six Weeks

Anxiety- 40% vs. 28%
Self-esteem- 59% vs. 74%
Depression- 23% vs. 10%


Can you guess what makes the difference? Why are the second stats so much better in each instance?

It's the doula difference, my friends. Not only will doulas vastly improve your birth outcomes, their presence and assistance have amazing long-term effects as well.

The more I learn, the more clear and plain it becomes that what happens at birth matters... a lot. Birth experiences can have enormous ripple effects for good or bad. I wish all women recognized this simple truth. Birth matters! And having informed, supportive, and loving people around you during your birth will have profoundly beneficial immediate and long-term effects.

[Stats quoted in The Doula Book, by Klaus, Kennell, and Klaus. Study references: Wolman, W. L. Social support during childbirth, psychological and physiological outcomes. Master's thesis, University of Witwatersrand, Johannesburg, 1991, and Wolman, W. L., Chalmers, B., Hofmeyr, G. J. et al. Post-partum depression and companionship in the clinical birth environment: A randomized controlled study. Am J Obstet and Gynec, 168: 1380-1393, 1993.]

Front page news

I was thrilled when my doula told me about the article on the front page of the Arizona Republic newspaper today: "C-sections linked to future birth risks." Not thrilled about the sad facts in the article, but thrilled that the truth about cesareans is finally becoming front page news. It is my hope that articles like this one will lead to a reduction in unnecessary surgeries.

I was amazed to hear just how much each cesarean increases a woman's risk of placenta accreta. Here's an excerpt:
"Studies and textbooks suggest that the risk of developing an accreta is as high as 4 percent in women who have had two previous Cesareans; that jumps to 60 percent with three C-sections, their physicians said."
60%?! Holy cow.

And another:
"'In the 1950s, the incidence was something like 1 in 30,000 women,' Mills said, adding that newer studies, conducted within the last decade, suggest that the rate has climbed to as high as 1 in 2,500 or even 1 in 500.

"'So there is definitely an increase in occurrence,' he said. 'And in women with C-sections, that's where we've really seen an explosion.'"
This gave me hope:
"Hospitals also are encouraging more pre-natal counseling of C-section risks, particularly if a woman is interested in having multiple children. They say it is possible for a woman who has delivered her first baby via Cesarean to give birth vaginally the second time."
So often I feel discouraged as I hear about record cesarean rates every year. But maybe the trend is coming to an end? I really hope so.

Ask Busca: Finding a doula?

Linda asked:

I had a friend just give birth. She told me beforehand that she wanted to go without medication. I asked her if she had a doula, and she said she did not because hers was about to have a baby. I wanted to ask you where she could find another one because to me it doesn't seem like a good idea to go without medication without some knowledgeable help, but she had the baby early, so I didn't get to ask you about it. For the future, how should women go about finding doulas?

Busca's babble:

Thanks for your question, Linda. I hope your friend's birth went well. Here are some options for finding a doula...

1) DONA, ALACE, and Findadoula.com

DONA and ALACE are two reputable doula training organizations that have searchable databases on their websites for finding doulas. Their homepages have prominent "Find a doula" search boxes. Findadoula.com is a site I only just became aware of. DONA only lists names, phone numbers, and email addresses for doulas, but DONA's database is the largest and most comprehensive list of doulas (by far). ALACE and Findadoula.com have the advantage of giving you more information about each doula (experience, philosophy, website, etc.) which is helpful as you try to narrow down your search, but their lists include far fewer doulas. Other similar options are Doulanetwork.com and CAPPA.

2) Google search
Maybe this one's obvious, but sometimes doing a simple search such as "Arizona doula" will lead you in the right direction. For instance, "Arizona doula" brings up the ADOBE Doulas website--a great local resource for finding experienced and volunteer doulas. Most states have doula associations with lists of local doulas on their websites. And the directors of those organizations are usually "in the know" as far as helping to connect you with the right people for your situation.

3) Word of mouth
Sometimes the best way to find a great doula is simply by word of mouth. Put the word out that you're looking for a doula. There's a good chance you know someone (or know someone who knows someone) who has used a doula and might be able to refer you to them. Sometimes a personal connection makes the choice easier.

Once you have a list of names, you'll want to interview each doula to find the one who seems most compatible with your (and baby's father's) personality and your vision of what you want your birth to be like. Babycenter has a good list of doula interview questions.

I hope this was helpful!

Sunday, March 29, 2009

Friday, March 27, 2009

Songs for my birth

I realized, as I was burning my cd yesterday, that I never updated you all about the music I finally chose for my birthing playlist. I really appreciated all your suggestions. Thanks to you, I included some music I never would have considered or known about otherwise... Gladiator sountrack?! ;-) So... here's my list interspersed with commentary about why I included each song. My this post really got LONG.

1) Storm - Powerful, Exhilarating Thunderstorm Sounds (Calmsound, Nature Sounds)
This is a long track of a thunderstorm. It starts with a huge crash of thunder (a little jarring), but there's something about the power of it that soothes and energizes me at the same time. I love the sound of rain....
Read the rest of this post over at my new website!

Thursday, March 26, 2009

Long, rambling gestational update

First of all, the baby boy is still snug inside his cozy uterine dreamland. And I'm relieved... perfectly happy to have him take his sweet time... as long as he decides he's ready before my home birth window of opportunity has passed. I have a hunch I'll never see "post-dates" though, based on my history (5 and 9 days early) and my mother's six births (all exactly 6 or 9 days early). I'm pretty sure I had another contraction yesterday evening (as we were getting ready to go to the Jazz/Suns game). It made me a bit nervous. But we made it to the game, to my husband's relief. :-)

Tomorrow morning my midwife, Mary, will come over for our "home visit." She'll be sure she knows how to find the house, check that have everything ready, and drop off some equipment (I think) for the birth. I've been nervous the baby would come before she could make this visit, so it's a relief to be one short day away.

I'm also relieved that my brother and sister-in-law will be arriving for their visit a day or two earlier than I thought. I invited them months ago to come down and be present for the birth. For a while we weren't sure if it was going to work out, but a business trip put them halfway between our locations at just the right time, so they decided they'd continue on afterward and spend a week-ish with us. In case you were wondering... really it will just be my sister-in-law in my immediate birthing vicinity. Here we are making apple dumplings last summer...I'm definitely not letting my brother see the birth (he wouldn't want to anyway... and he's a deep sleeper). ;-) They'll be having their own home birth in a couple of months for their first baby (a girl)! I will have the privilege and honor of being their doula, if I'm able to make it. I'm excited we get to share these beautiful experiences with each other! Random fun fact: my sis-in-law and I were born exactly one day apart. :-)

Yesterday I typed and taped-up lists of important contact info by our phones. My midwives', doulas, and local family and friends' phone numbers as well as the four closest hospitals (including their distance from us). I printed a copy for my purse as well... just in case I'm away from home when labor starts.

A friend of mine asked me yesterday if I was nervous. I said, "Yes and no." For a long time I was nervous about what might go wrong during the birth... would we need to transfer to the hospital? Thanks to God and my husband, those fears have all but disappeared. I really do feel (almost) totally confident that the baby and I will be safe and well. Instead, I'm nervous about other "what ifs" and unknowns... when will labor start? Will it be a convenient time? Will my midwives arrive in time? Will all the people I envision being present actually be there? Will my children be asleep or awake? How will they react if they're awake? And I'm nervous about the pain. I know I can handle it. But it's definitely not easy. And I do still have to get through it. Yes... Busca (the birth junkie) is a little scared of the upcoming labor pain... sorry, but I'm just keeping it real. :-)

Dreams... my 3-year-old told me yesterday that she had a dream in which she woke up and came into my room, and I was in the birth pool, and "Bubby" (the girls' nickname for the baby) came out in the pool. I've been wondering whether I will give birth in the water or not, so her dream intrigued me. I guess we'll see what happens!

I also dreamed I was having contractions at about 2:30 this morning. Then I woke up and wondered if I had really been having some. It kept me awake for a bit as I paid attention to my body and what I was feeling. I was experiencing some dull aching in the area where I usually feel contractions, but I couldn't tell clearly if it was coming and going. Then I fell back to sleep.

I also saw our baby boy in a dream... he had my husband's lips (one of my favorite of my husband's features). I was thrilled. :-)

I'm rambling. A little scatter-brained these days.

Today I will be nesting... washing sheets, folding and putting away laundry, emptying garbages, cleaning toilets, grinding wheat, and burning my birthing soundtrack onto cd among other things. I am kind of thinking I should remove and refold the baby clothes in the dresser upstairs... I have been so focused on preparing for the labor and birth itself that I haven't really been preparing myself for the actual baby we'll be welcoming. There's just something about holding and folding little newborn clothes that makes that baby real and gets the maternal juices flowing...

So... I'm off "to do."

P.S. I just looked over at my baby count-down widget. 16 days?! My heart is pounding.

Saturday, March 21, 2009

False alarm

My eyes flew open at 4:50 this morning 'cause I was feeling something... something familiar... something that took me back nearly three and a half years to the last time I had felt such a sensation. And, as it clenched around my lower back and abdomen, I thought to myself... "Oh crap... not yet... please not yet..."

I watched the clock until it was over. Then I watched the clock and waited. It hadn't been exactly "mild." Painful enough to make me pretty nervous. And I got freaked-out enough that my legs started shaking. Then I needed to use the bathroom... which made me even more nervous. It brought me back to the last time when I alternated between pacing the floor and using the bathroom in the few hours before we headed to the hospital. Oh boy... please not yet... please not yet...

I got back into bed, feeling almost like I needed to make another trip to the toilet. I contemplated waking my husband. But it had only been ONE, for crying out loud, and he had gone to bed late and needed to get up early to chaperone a youth basketball tournament with the boys from church. I tried to calm myself. I wrapped my hand lightly around his strong bicep (not enough to make him stir, but just enough to keep myself from hyperventilating) and watched the clock some more. After the longest 20 minutes of my life, I started breathing easy again, but it was another 30 minutes or so before I finally fell back to sleep.

Relief washed over me at about 8:30 when my girls woke me up (after several hours contraction-free) in their excited frenzy about the new addition to our bedroom. At least if I had gone into labor this morning, our birth pool was ready (thanks to an hour of my husband's time and air last night)...My midwives told me to blow it up three weeks early to make sure it didn't have any holes or other problems, and yesterday marked 37 weeks. Full term, officially.

So it wasn't "pre-term labor" that had me worried last night. It was just that I still thought I had at least one or two weeks left to prepare myself, and my midwives hadn't come to the house for my "home visit" yet, and my primary doula's out of town, and my husband really couldn't take this coming week off from work, and I really wanted my sis-in-law (who's coming to visit April 1-5) to be present for the birth, and, well, I gotta admit... that contraction and the memories that flooded my mind with it gave me a not-so-healthy dose of fear about the pain I'm in for. Sure, I say "I love giving birth!" all the time, and I do, but that love is unique and highly retrospective... and, honestly, I gotta say I'm scared to go to sleep tonight. I'm just not ready yet!

So yeah... I've now officially had my first non-Braxton-Hicks contraction. I remember how surprised I was when I went into labor the first time. I really thought labor would feel like my Braxton-Hicks contractions had... just more painful. But, for me, real labor feels completely different. Braxton-Hicks are all in my belly--just a tightening and hardening of my uterus. I don't even notice a hardening with real labor contractions... just cramp-like pain in my lower back, radiating around to my lower belly. Totally different.

Ah! I can't believe I could have a baby any day!

Thursday, March 19, 2009

The Doula Difference

I wrote this post last month for my personal/family blog, but I wanted to re-post it here for those of you who haven't seen it. :-)

I think every laboring women needs a doula. And here's why...

1) Doulas are nothing new.
A lot of people, when they first hear about doulas, think... oh, that's new. But it's not at all. For thousands and thousands of years women have been supported by other women during childbirth. We watched an awesome film at our training called "The Timeless Way" which showed the history of childbirth starting with ancient artifacts and moving to more modern depictions. I was struck how the very same image was represented through sculpture, wall carvings, pottery, and art over and over and over again. It is the "classic birth triad"--an upright laboring woman supported from behind by another woman, with a midwife in front ready to catch the baby. It has only been in the last century that this "classic birth triad" has all but disappeared. Doulas are not new. Modern obstetric practice is what has strayed (very far, I might add) from the time-tested norm.

2) Women need a "buffer" (i.e. Hospitals and drugs mess with birth).
Don't get me wrong. I am so grateful we have hospitals and drugs to handle birth complications (which do happen!). But, really, when used excessively (as they are) they mess with birth big time. The hospital with its policies (no food or drink, IVs, restriction to bed, bright artificial lighting, time constraints, flat on back or semi-recumbent positions for pushing, etc.) is really the least ideal place to facilitate the birth process. And pretty much any and all of the drugs hospitals introduce into the process screw up birth's carefully orchestrated hormonal responses, often leading to the need for further interventions to counter-act the drugs' side effects. So... here's my point... because 99% of American women give birth in hospitals (80-90% of those with drugs), there is a dire need for a buffer of sorts--something or someone to help women and babies come out of the modern birth machine as unscathed as possible. Doulas can be (and are being) just that buffer. And, I should add, sometimes epidurals just don't work (or only work on one half of a woman's body). Plus you still have to get through early labor (0-4 cm) before most doctors/hospitals will allow you to get an epidural. For some women, even early labor is killer. So it's a good idea to have someone present who is trained to help you cope with labor pain (even if you plan to get an epidural)!

3) Birth is women's work.
We put a lot of pressure on dads (particularly first-time dads) to be the sole support for their wives in labor. The fact of the matter is that it's overwhelming to many of them. They are often at a loss when faced with their own difficulty in seeing their wife's pain while simultaneously trying to help support her through that pain. A study comparing first-time fathers' and experienced doulas' participation in birth showed that males touched their laboring partner only 20% of the time while doulas touched them 95% of the time. They also spent less time with the women and were close to them less than the doulas (Bertsch et al. 1990). I absolutely believe that a husbands' presence can be vital. I would never want to give birth without Ax by my side. But I also believe that the assistance of wise, experienced women is also vital for laboring women. As much as a husband's support is wanted and needed, he is a man and can't ever understand what his wife is experiencing. Experienced women offer a different and much-needed emotional support. Doulas are also trained to assist fathers, giving them suggestions for ways to help their wives when they are unsure how (or are reluctant) to step in and help. My first "doula" did this beautifully.

4) Doulas are proven to improve outcomes for mothers and babies.
Study after study has shown that doulas have a profoundly positive impact on birth outcomes. Check out these numbers (from one of my doula training handouts):
When all the studies are calculated together, the presence of a doula reduces:

* Cesarean sections by 50% (!)
* Length of labor by 25%
* Oxytocin [Pitocin] use by 40%
* Pain medication [opiates] use by 30%
* Forceps deliveries by 40%
* Requests for epidurals by 60%

Other findings:

* Decreased maternal fever
* Decreased newborn admissions to NICU
* Decreased sepsis workups on newborns
* Decreased infant health problems

Long term benefits:

* Increased mother/infant bonding
* Decreased postpartum depression
* Increased success in breastfeeding
Who wouldn't welcome those amazing benefits?! As my doula trainer so aptly pointed out, if a doula were a machine, every hospital would have three of them.

I'm not telling you all this to drum-up business for myself. Even if I was looking for clients, I wouldn't be charging anyone. I'm telling you this because I am (excessively) passionate about helping women have wonderful, satisfying birth experiences. Doulas can work wonders, but I don't think most women are aware of just how much difference a skilled doula can make. I just had to spread the word!

As for me... I've got two fabulous births under my belt, and I'm a trained doula myself, but I am still going to have TWO doulas (and two midwives) at my next birth. I am thrilled that we will be surrounded by supportive, experienced women as we bring our first son into this world. I feel confident that their loving presence will make this our best birth yet.

P.S. If you'd like to hire a doula but can't afford one, have no fear! There are always doulas willing to volunteer their services. It's a generally universal doula belief that all women should have access to doulas regardless of ability to pay.

Wednesday, March 18, 2009

Stop the madness! Please.

“The cesarean delivery rate rose 2 percent in 2007, to 31.8 percent, marking the 11th consecutive year of increase and another record high for the United States.”This quotation and table come from the CDC's National Vital Statistics Report--"Births: Preliminary Data for 2007."


Please. Please. Please stop this trend.

Need I remind you that certified nurse-midwives typically have cesarean rates below 15% and home birth midwives frequently below 5%... safely and with much higher levels of satisfaction with their care. (My midwives range between 1 and 3% depending on whether the mother has given birth before... and that's with consistently good outcomes.)

Is there really any question whatsoever about the solution to the U.S.'s cesarean epidemic?

Monday, March 16, 2009

More awfulness

I remembered reading that Pitocin can lead to newborn jaundice, so I was doing a quick bit of internet research and stumbled upon Drugs.com's page about Pitocin's side effects. I already knew they were bad, but I guess I didn't realize they were this bad. Holy moly. Click over and take a look. Be sure to read more than just the "for the consumer" portion for the real juicy details. If that list doesn't scare you away from an unnecessary induction or labor augmentation, I don't know what will.

P.S. If you've been told you "need" to be induced (or your doctor has offered to induce you without a medical reason), be sure to check out "Saying 'No' to Induction," by Judith A. Lothian, PhD, RN, LCCE, FACCE, before you make your final decision.

Awesomeness and Awfulness

I'll start with the awfulness, so we can end on a good note...

Remember this post? The one where I mentioned that baby lotions and soaps are basically totally unnecessary and possibly harmful? Well, last Friday's Washington Post warned: "Probable Carcinogens Found in Baby Toiletries." Though the manufacturers of these products claim the levels are very low and within government regulations, health and consumer advocates argue that repeated exposure could have a cumulative damaging effect. In any case, there are more natural alternatives out there, and warm water alone does the trick just fine for newborns. Remember... dirt is good for babies.

Now the awesomeness...

I met another home birthing momma at church yesterday. We had a fun chat and she gave me some helpful tips. But... get this... she pushed out a 12 lb baby in ten minutes with no episiotomy or tearing! My response: "That is AWESOME." I love hearing those stories. Don't let anyone tell you, "Your baby is too big." Mommy hips and baby heads are flexible for a reason.

Friday, March 13, 2009

My Second Birth

Here's the account of my second daughter's birth, written approximately three and a half years ago (and my present commentary in italics).It’s hard to say exactly when labor started with my second daughter’s birth. During the nights preceding her birth, I experienced an occasional painful contraction—usually around midnight or 1:00 in the morning. Sometimes I’d have a couple of contractions and wonder if labor was starting, but then I’d wake up several hours later (pain-free) and go through another day without any signs of labor.

It was early in the morning on October 16th that I guess I would say labor “started.” Around 12:30 in the morning I started having painful contractions about twenty minutes apart. Eventually the contractions started coming closer together, but they weren’t exactly regular. Sometimes they’d be twenty minutes apart, sometimes they’d be ten minutes apart. Occasionally they’d come only minutes apart. But they never got consistently closer together. It seemed that they were less painful when I was upright and moving around. And when I would lie down on my side they were much stronger.

I woke my husband up after I had felt enough contractions to convince me that something was really happening. We started getting things ready to go to the hospital because we assumed we’d be leaving soon. We both ate something so we’d have the energy we needed, and we took one last pregnancy photo (while I had a contraction, in fact). I had been sure that, once labor started, it was going to go very quickly. I had been terrified that we wouldn’t have enough time and we’d end up having the baby in the car. Well, it got to be about 3:45 in the morning and the contractions started coming further apart. Then around 4:00 they seemed to stop altogether. My husband and I had gotten back into bed, figuring we’d get some rest until things moved ahead. After a while I got back into my pajamas and fell asleep.

[If I could go back, I would have handled this early labor quite differently. First, I wouldn't have turned all the lights on (so I could keep my melatonin levels up). Second, I would have immediately done some baby-spinning techniques. My doula trainer said it's wise to just assume every baby starts out posterior and try to turn them. I even suspected, when my labor stalled, that she was posterior, but I didn't have the knowledge I now have of the best techniques for turning her.]

I had an occasional contraction during the next several hours, but nothing consistent or too painful. Just enough to bring me to a state of semi-awareness, but I’d just slip right back into sleep. When we woke up at about 8:30 in the morning, we were really confused about what had happened and whether or not labor had actually “started.”

Since it was Sunday morning, we needed to decide whether we were going to church. I didn’t feel up to going--having had very little sleep and not knowing if or when labor would start again. So my husband called and let the Primary president know we wouldn’t be there to teach our Primary class. I also called my sister and stepmom to let them know that we might be having a baby that day. My sister had agreed to watch our 2-year-old during the birth. And we had invited my stepmom to be with us for the birth. So they brought their cell phones to church with them in case we called.

I was still having an occasional contraction, and throughout the morning they were coming between twenty and ten minutes apart for several hours. In the afternoon they had stopped again. So we decided to go for a walk. After we got back, we decided we’d call Grandma and see if we could come over--we were getting tired of sitting at home. On our way over to her house, I started having contractions again. Our 2-year-old had fallen asleep in the car, so the three of us took a nap on Grandma’s bed. After less than an hour, I was having contractions often enough and painful enough that I couldn’t sleep anymore, so I got up and sat talking with Grandma until my husband and toddler woke up. Over the next few hours I had contractions between twenty and ten minutes apart again. During dinner, I was quite uncomfortable, gripping the table through contractions every ten minutes or so.

After dinner, the contractions continued but still weren’t really coming closer together. I had a few that were especially painful. I told my husband if I had any more like that we’d be heading for the hospital. But then I’d have several mild ones, and so we kept waiting.

We headed over to my dad and stepmom’s to visit them around 7:30 or 8:00 pm. At this point the contractions had basically stopped again. We hung out with them, and decided we’d sleep at their house so we’d be that much closer to the hospital should something happen in the night. Plus we felt better knowing we wouldn’t be alone in the event that we had an unplanned home birth or roadside delivery.

Before everyone headed to bed, my dad and husband gave me a priesthood blessing. I don’t remember everything Dad said, but I do remember that he said that we would know the right time for each step in the process and that things would happen as they should. It was a comfort to me.

We went to bed around 9:30 or 10:00, but I never fell asleep. I was having contractions every ten to twenty minutes and using the bathroom almost as often. Sometime around 12:30 or 1:00, I was feeling so exhausted, confused, and discouraged that I woke my husband up. I needed to talk, and I didn’t want to be alone anymore. I cried a little as I told him how I was feeling... not knowing whether the contractions were “real” or causing any cervical dilation or whether labor was progressing, hating being in limbo, feeling fed up and just wanting to sleep, etc.

The contractions had become painful enough that I knew for certain they couldn’t possibly be “false labor.” But they still weren’t coming closer together. Finally, I just decided that it was time to go to the hospital. Because of the intensity of my pain, I didn’t dare wait any longer. My husband and I got dressed and ready, and I woke my stepmom sometime around 1:30 am.

We headed to my sister’s (my stepmom said she’d meet us at the hospital). We expected our toddler to cry and cling to us when we dropped her off, but she went to my sister just fine and we kissed her good-bye. Once we left, my contractions started to get closer together. During the drive they were coming about five minutes apart. As we walked up to the door at the hospital, I had to stop and lean on my husband through a contraction. My stepmom was walking up behind us--she asked, “Was that a contraction or a prayer?” Afterward I thought a prayer would have been a good idea! It wasn’t long after 2:00 in the morning when we arrived.

They put us in a temporary room and gave me a hospital gown to change into. My husband came into the bathroom with me to help--thank goodness! I had two or three contractions just while I changed, and it was a relief to have him to lean on. The nurse hooked me up to the monitors and asked some questions. Meanwhile, I was having some increasingly intense contractions and also feeling really nervous... I was afraid she’d check my cervix and I’d only be one or two centimeters dilated. The nurse ventured a guess that I was five centimeters. She checked and said, “I’m good,” and then added, “Actually, you’re almost six.” I couldn’t have been more relieved. I said, “Hallelujah!” We moved to our actual room, and the nurse contacted the on-call midwife--Betty.

It wasn’t long until I started moaning. I remember the nurse asking more questions, checking my blood pressure, and a student nurse asking more questions while I was having a contraction (I put up my finger signaling that I’d answer when it was over!). The nurse also came in and used some strange device to make a loud noise on my belly--saying that they needed to “wake this baby up.” It was a little concerning to me because she never really explained what she meant by that. I guess they had to make sure the baby was “responsive” before I could get into the Jacuzzi tub (I had expressed interest in getting into the tub when the nurse mentioned it as an option earlier).

Meanwhile, the contractions were coming fast and hard. I remember closing my eyes and holding my husband’s hand through it all. And I remember stepmom’s reassuring voice in the background saying things I needed to hear. I remember hearing them turn the water on in the tub. I remember Betty arriving and saying she didn’t think it would be much longer till the baby came. And I remember her pushing on my hip through a contraction and asking me to tell her if it helped. I don’t think I ever said yes or no. Oops. Betty wanted to check my cervix before I got into the tub. I think she said I was seven-plus, or maybe it was eight?

I used the bathroom and got out of my gown. Once I was in the water, they needed to draw some blood and put in my “hep-lock” (an I.V. needle without the actual fluids). I guess Betty asked them if they could do it while I was in the tub, and my husband said our nurse pulled a face as though she was exceptionally bothered by the thought. In any case, it was a different nurse who actually did it. And I was glad because she was much more friendly, cheerful, and upbeat. She seemed excited to do her first tub-side I.V. Miraculously, I didn’t have any contractions while she inserted the needle and taped-up my arm.

All the while I was in the tub (which was nice... I’m glad I got to try that... wish I could have spent more of my labor in there!), my husband was holding my hand, and my stepmom was speaking soft soothing words. I’m sure they wondered if they were helping at all, but just knowing they were there made all the difference in the world. They were doing exactly what I needed. I remember my stepmom saying over and over that I was “doing great.” It seems like such a simple thing, but it was so encouraging to hear. The nurse who put in my hep-lock agreed and said that most people were “climbing the walls” when they were seven centimeters. I told my husband afterward that at no point did I feel like I couldn’t handle it anymore. The contractions never overwhelmed me to the point that I lost it. They hurt... a lot. But I savored the sensation when each contraction eased up and the (often very short) breaks between.

My moaning got louder and longer. I wouldn’t doubt other patients could hear me. But I had to make noise. That was my way of coping with the pain. As long as I could make noise, somehow it seemed like I could make it through. Betty and the nurses were in and out of the bathroom. It seems like they were doing things and saying things, but I wasn’t very aware of much beyond my own body. I only opened my eyes for brief moments. Betty said I was starting to sound “pushy.” She asked if I felt like I needed to push--she wanted to be sure I made it out of the tub before that point. I told her that I didn’t feel the urge yet. But it wasn’t much longer until I asked if I could get out because I was concerned that if we waited much longer I wouldn’t be able to move. So they wrapped some sheet-like thing around me and helped me back into bed.

I think Betty checked my cervix again. But I can’t remember how far dilated I was just after getting out of the tub. I was lying on my side with my legs together, and she had me turn and open my legs out wide to open up more. I guess part of me didn’t want to because I was afraid of the added pain. It wasn’t long until she checked my cervix again, and she said all I had was just a lip of cervix left. So she decided to break my water. Within minutes I was completely dilated. They tried to get a gown back on me, but I guess they decided against it because all the maneuvering was too painful for me.

Betty told me I could start pushing if I wanted to. But I hadn’t really felt the urge yet. And I wanted to wait until I had felt the urge and just push with the urges (“spontaneous pushing”). After one or two contractions, Betty told me to go ahead and push with the next one. I wasn’t in a mood to refuse, so I started pushing. I also didn’t want to push very hard because I wanted to take it slow and easy so I wouldn’t tear. My husband and stepmom were at my sides, helping to support my legs. As the baby descended down the birth canal, I remember hearing Betty tell one of the nurses that the baby was posterior. It made sense to me because I was having a much harder and more painful time pushing than I did with my first baby. I was making all kinds of noise.

[I would have handled the delivery differently too. Again, I would have requested to try different positions for pushing (side-lying or supported squat, etc). Second, I would have given more time for my body to tell me to push. I think I started pushing before my body and baby were ready and made it more difficult for myself.]

I’m not sure exactly when, but sometime just before the birth I looked over at my husband and he looked like he might faint. He put his head down. I thought I heard him throwing up, but I think he was just coughing or something. He said he lost feeling in his hands and legs. The nurses helped him, and I got back to business pushing.

My stepmom and husband kept saying, “She’s almost here!” and “You’re doing great!” And I remember seeing and hearing my stepmom get choked-up. At the time I thought it was happy crying--seeing the miracle of birth. But afterward she told me she cried because it was so hard to watch me in so much pain.

I guess with all the noise I was making, the nurse thought I was losing control. Anyway, she said something like, “[Busca], look at me. You need to stop making noise and put all your energy into pushing.” I remember being mildly perturbed, but at the same time being essentially oblivious to anything but my own body. Somewhere inside I thought... who is she to tell me how to focus and channel my energy? Making noise was helpful for me. Anyway, I sort of toned it down for the next contraction or two--to humor her, I guess. But, I mean really, can you actually push out a posterior baby without making noise?!

Eventually I decided to really push because I just wanted it to be over. So I started to push hard, and the head was crowning in just a few contractions. I remember feeling Betty tucking her finger under the baby’s head and stretching my skin--I guess to prevent tearing. I think she applied warm compresses and counter pressure also, but I couldn’t really see what she was doing down there. It was only moments and my baby’s head was out followed by her slippery, wiggly body.

Betty placed her immediately up on my tummy. I was so glad to be able to see her instantly. She was kind of purple when she came out. I guess it freaked my husband out. But as soon as they suctioned out her mouth, she started breathing and pinked right up. I remember seeing her face for the first time and thinking... she looks different than my first baby. And I also remember thinking I’d never been so glad something was over and that I didn’t want to do it again for a really long time. For those first few moments of seeing her, it was almost like slow motion, at least in my memory. I loved getting to see and touch her immediately after her birth instead of having them hold her up briefly before taking her away like they did when my first was born.

They asked my husband if he wanted to cut the cord, but he said he didn’t think so (he still couldn’t move his hands). So my stepmom cut the cord. Then they wisked her away to poke her and weigh her and assess her and all of that, my stepmom helped my husband to the couch and covered him with a blanket, the nurses put a gown on me, and Betty started tugging on the umbilical cord to deliver the placenta (far more vigorously than I would have liked, in fact). Meanwhile, my stepmom was snapping pictures for us. It turns out that I did have a second-degree tear (through the skin and muscle). But not nearly as severe or painful as the tearing I sustained with my first birth.

Eventually things quieted down, we dimmed the bright lights, and took turns holding our new baby girl. It didn’t take long before I knew without a doubt that I would do anything for this little person, and my love for her grew a little each moment.

Tuesday, March 10, 2009

Speaking of birth stories

I just read Rixa's account of the unassisted birth of her first daughter. It's pretty incredible. These excerpts were especially touching to me:
"I asked Eric for a blessing the next day. I have always felt peaceful about going without medical or midwifery care during the pregnancy, but I wanted reassurance as the birth drew nearer. After the blessing, I knew that this was the right choice and had no more doubts or fears."
And later:
"When Eric came back from running his errands, I asked him to give me a blessing. I had to stop him once in the middle to breathe through a contraction. It was very specific that everything would go smoothly, that the baby would be healthy, and that I could trust my body. I don’t remember any more specifics but that is not surprising! That blessing, plus the one he had given me the night before, gave me total confidence that everything would turn out perfectly. When I was a little discouraged during pushing, feeling that nothing was progressing, I thought back to what he had said and took courage, knowing that I just needed to do whatever my body wanted to."
Reading Rixa's account reminded me, once again, of my own spiritual confirmations that giving birth at home is the right choice for us and that God will keep us well and safe. It was a much needed reminder. Thank you for sharing this with us, Rixa. I don't doubt that I will think of you as I give birth to my son at home.

My First Birth

As my baby boy's birth draws closer, I find myself reminiscing about my first two birth experiences. I thought my readers might enjoy reading the accounts of those births. So... here's my first daughter's birth, written five and a half years ago. I'll also add present commentary about things I would have done differently knowing what I know now in italics. Enjoy!Ax (my husband) and I were lying in bed on Monday night, September 22, 2003. We had been talking about the baby and wondering when she would be born. A few weeks before, Ax had guessed that she would be born on September 23. He was getting impatient and kept telling the baby, “Come out and play!” Even though I was nervous, I was also starting to get impatient. I just wanted to get on with things.

It was a few hours later (about 12:40 a.m. on September 23) when I felt and heard a “pop-pop.” My first reaction was, “What was that?” And then I was suddenly afraid because I figured that maybe my water had broken. I didn’t want to move because I was sure that fluid would start to come out. Eventually I did move and, sure enough, I felt a warm trickle of fluid. I made my way to the bathroom, and by that point it was certain. I was sort of in denial. A part of me was excited and happy, but another part of me was terrified because I knew there was no turning back. I knew that I would have a baby in the next 24 hours and I knew that a great deal of pain was coming. It didn’t seem real.

I had been having frequent Braxton-Hicks contractions for a couple of weeks, and they had intensified, but I hadn’t had any contractions that were really painful. As soon as my water broke, though, the contractions started to feel like cramps. Since I hadn’t had any real labor contractions until that point, I was worried that it was going to be a long labor. And the contractions didn’t seem to come at any regular interval--nothing like I had expected. I figured they would have started out 20 minutes apart or so and then gradually they would have come closer together. Instead they started coming suddenly and they were between three and eleven minutes apart. Anyway, we gathered our stuff, got into regular clothes, and took one last pregnancy picture before we got in the car.

When we arrived at the hospital, the security guard by the elevators saw us and automatically said we could head up to the fifth floor--I guess he could tell why we were there. We checked in at Labor and Delivery and they put me in a room. It was strange to be there. There was a warming table with a blanket all set up on one side of the room. I remember thinking... that’s going to be for my baby... holy cow, I’m having a baby. After I had changed into my hospital gown, we met the nurse who would end up helping me through my entire labor and delivery--Eve. She hooked me up to the fetal heart monitor, the contraction monitor, and the blood pressure cuff. She checked my cervix and I was 3 centimeters dilated and 90% effaced.

The contractions were still pretty mild at this point. I breathed through them--the “slow-paced breathing” we had learned in our Lamaze class. Next she gave me my I.V. She said I had “good veins,” but, even so, she had difficulty getting a good spot for the needle. She had to try twice before it worked, and my hand was bleeding and swelling up. I still have bruises and sore spots from it all.

[If I could go back now, I think I would have taken a different prenatal class--Hypnobirthing or Bradley. Though they probably would have been too expensive for us to afford. The Lamaze "focal points" and funky "hee-hee" breathing techniques were totally useless, though I've heard the classes don't teach those breathing techniques anymore. In retrospect, I would also have hired a doula. And I would have requested a heplock instead of IV fluids.]

Eve asked me a bunch of questions and had me sign several forms. One of them was a release form for epidurals. It talked about the risks involved and explained that 80% of the patients at that hospital received epidurals. They had me sign it just in case I decided I wanted one. I had already thought a lot about the decision and done a lot of research, and I wanted to try to go natural. But I was also open to pain relief if it became necessary. Eve was really friendly and let us know that she was more than willing to help us if we needed anything and that if I wanted to go natural she could give us ideas of different positions to try and other coping strategies--that was wonderful to hear and such a relief. I knew I would need a supportive nurse, and I definitely got one! She said she would be back in an hour or so to check on me and left.

The contractions were slowly becoming more intense, but I was still cheerful and excited. I just breathed through them and sometimes utilized a focal point--something on the wall, the clock, or Ax’s face. I noticed that if he was talking to me, it distracted me from the pain, so I had him talk me through several contractions. He massaged my feet also. So far, things weren’t too tough, and I was feeling good.

[If I could go back, I wouldn't have spent this time reclined in a hospital bed. Sheesh. I would have asked for a birth ball right away to sit and rock on and would have remained upright and mobile during these easy early labor contractions.]

When Eve came back and checked me, I was dilated to “4 plus” centimeters. My first thought was... that’s all?? But she and Ax both seemed to think that was an accomplishment. I thought... boy this is going to be a long night. Six centimeters to go. The contractions were becoming even more intense. I started closing my eyes and pulling more inward. I was feeling a lot of the pain in my back, and I had heard horror stories about “back labor,” so it worried me. Eve showed us a position that was supposed to help with back labor. She raised the back of the bed to almost a 90 degree angle and had me sit with my back against it and my legs over the end of the bed. She showed Ax how to push on my knees during the contractions so that the bed put counter pressure on my back. I’m not sure whether it really helped, but just the sheer fact that we were doing something was better than just sitting there through the pain.

I had lost track of time by this point. Time had dissolved into short intervals--contracting, not contracting, contracting, not contracting. All I could think about was getting through each contraction and trying to utilize the breaks between them. I tried to focus on keeping my body relaxed. I knew that if I created tension elsewhere in my body, the pain would only intensify. And I also knew that the more relaxed I was, the more of my body’s energy could be focused on my uterus, and the more effective the contractions would be--which would mean the labor would be shorter.

After a while, the position Eve showed us was no longer as effective. But she surprised and thrilled me when she asked if I wanted to get in the shower. I had read and heard a lot about how water and heat can help to ease the pain. Getting from the bed to the shower was difficult though. I had expected that standing would ease the pain because I had seen so many pictures of laboring women standing--supposedly as a means of handling the pain. For me, though, it seemed like standing up made the contractions even worse. A couple of them hit as I headed to the bathroom. All I could do was lean on Ax and rock backward and forward. Then, once I got to the bathroom, I sat on the toilet for a while and leaned forward onto Ax some more. I think it was then that I started moaning.

Finally, I made it into the shower and Ax took the hand sprayer and sprayed hot water on my back. First, I kneeled in the tub and leaned over a stool, rocking back and forth. Then I stood up for a while and rocked some more. And again I kneeled and again I stood up. I was completely oblivious to everything but what I was feeling. I’m not sure how long I was in the shower, but I knew by the intensity of the pain that my labor was certainly moving forward--which was both good and bad. Eventually, I decided to get out, and promptly sat back on the toilet for several more contractions--still moaning. We managed to get my robe back on between contractions and we headed back into the room.

As soon as I got out of the bathroom, Eve offered the birth ball for me to sit on. I sat and rocked through a few contractions, but it wasn’t really working for me. At this point it seemed that nothing eased the pain. Really, all I wanted to do was lie in the bed and curl up in a ball. So I did. Eve checked my cervix and I was at six centimeters. I was relieved to know that I only had four more to go and that all that pain had brought results. She asked if I wanted anything for the pain, and I toyed with the idea but decided I could wait a little longer. So I just lay there on my side, moaning and breathing through each contraction.

I had been told that, if I could get to seven centimeters, I could make it all the way without medication/epidural. I could tell by the pain and by my own responses to my situation that I was likely nearing “transition”--the seven to ten centimeter span. With each contraction, it seemed I could feel the baby descending and opening my cervix--pushing and stretching, lots of pressure. As I lay there, I focused on only a few things--Eve’s and Ax’s reassuring voices and touches and my own breathing. I was essentially oblivious to everything else.

It didn’t seem like much time had passed before Eve asked me again if I wanted some pain relief. I wasn’t in much of a state for making a decision. I remember moaning, “I don’t know.” I also remember asking if it was too late. Eve said it wasn’t, but said, “Let me check you first.” She checked my cervix and said I was nine centimeters dilated. I was shocked and relieved that I was so close. She said I could still get an epidural but other drugs wouldn’t be possible. I decided that I could make it the rest of the way--only one more centimeter. She said that she had delivered naturally before and that it felt good once you could push. I was grateful for her experience and her encouragement. At some point, she asked me if I would mind if a resident came into the room to observe/help. I really could not have cared less if the entire hospital staff was in the room. I said, between moans, that I did not care. So, Dr. Ron Hansen came in.

All of the sudden, during a contraction, I felt an involuntary convulsive pushing motion in my lower abdomen. It was happening on its own. I told them, “I need to push.” Dr. Hansen checked my cervix again and said that I was fully dilated--finally ten centimeters! All I remember after that was being given the go-ahead to push. And I couldn’t have been more ready. I started pushing with the contractions, and Eve was right. It did feel better to push--at least the contractions didn’t seem as painful. It felt good to be doing something proactive. It took me a few pushes to get the hang of how to really be productive. Unfortunately, to my embarrassment, I pushed out more than I had bargained for even before the baby was born. Dr. Hansen and Eve had to clean up a few messes, but they said it was normal and expected since the same muscles control the vaginal opening as well as the rest of that region.

[Umm... yeah... make sure you use the bathroom a few times before you get to pushing.] :-)

I remember looking at the clock when I started pushing. I think it was five or ten minutes after 6:00, but I can’t remember exactly. I had heard and read that some women push for hours. That prospect sounded horrible. I wanted to be as effective as I could be so I could get the pushing over with as soon as possible. I didn’t even care about the pain anymore--in fact, I don’t even remember feeling painful contractions. What I remember is the burning sensation when I would bear down.

At this point it was time for the nurses’ shift change. But Eve said she didn’t want to leave, so she ended up staying until the birth. So, I had two nurses. The other nurse (I wish I could remember her name) was also wonderful. She gave me a perfect piece of advice as I was pushing. She said not to stop pushing when it started to burn--to push into the burn. That bit of advice made a huge difference. A couple of pushes like that and the head was crowning. That’s when I knew what they meant by “ring of fire.” I remember Dr. Hansen saying she had lots of hair, and I remember looking down and seeing part of her head as it was coming out. They told me to stop pushing just as her head was coming out so they could ease it out. I had to kind of pant/blow to keep from pushing. Dr. Hansen said I was “stretching well.” I was glad to hear it because I really didn’t want an episiotomy.

It was a strange feeling having her head there between my legs. Not very comfortable, actually, but it was exhilarating at the same time because I knew how close the birth actually was. It seemed unreal that this could be happening to me. And I couldn’t believe how quickly the past few hours had flown by and how crazy it was that I was about to have a baby. The shoulders were the widest part, so it burned as they eased out, but then the rest of her body just slid right out, slippery and wiggly. It was 6:24 a.m. I remember breathing in and out quickly and heavily, full of unbelief and wonder at what had just happened. They held her up for a brief moment--she looked so small and red. It was unbelievable. I couldn’t believe I had done it! And I couldn’t believe I had a baby.

[I really wish I could go back and re-do this delivery. Oy. First of all, I would have pushed with my urges rather than doing the stupid hold-your-breath-and-count-to-ten maneuver. Second of all, I would have requested an upright delivery position, or at the very least a side-lying position. Third, I would have taken my sweet time. Pushing "into the pain" was a horrible piece of advice, actually. Sure, the baby came out fast, but she also tore me up inside. If I had taken it easy and listened to my body, I really don't think I would have torn as badly as I did. Lastly, I would have requested to hold her immediately. Instead, it was a considerable amount of time before I was able to hold her, and it certainly wasn't skin-to-skin like it should have been. I really think our initial separation messed with our bonding.]

I was in a state of bewilderment and shock and wonder. I tried to take in everything that was happening as everyone bustled around, but it was hard to focus. I was still so overwhelmed by the intense experience my body had just gone through. I watched Ax cut the umbilical cord. They took her over to the warming table and I remember hearing her start to cry. I remember turning as Dr. Lohner walked in the door with a shocked look on his face. He was supposed to be the delivering doctor, but he arrived too late. He went straight to work on me though--delivering the placenta. I remember turning to Dr. Hansen and Eve and thanking them over and over. And I asked them if the baby was okay--they said she was fine. Dr. Hansen seemed impressed with me. He said some people push for several hours, and “You don’t see many natural births around here.” Dr. Lohner said, “You’re a brave girl.” I was so grateful I was able to obtain my goal. I know everyone’s experience is different, and I was grateful mine had gone so smoothly.

I also asked Eve if I had been given an episiotomy. She said I hadn’t, but that I had torn. It turned out that I had torn quite severely in several places. Dr. Hansen looked so apologetic--he seemed to feel really bad. Dr. Lohner looked agitated and told Dr. Hansen he ought to have cut me. Personally, I’m glad he didn’t. Dr. Lohner gave me a local anesthetic and stitched up my tears, not very gently I might add. It was quite unpleasant, and he kept telling me to put my bottom down (I was tensing and lifting up). They never told me exactly how severe the tearing was, but before the local anesthetic had even worn off, the nurses were giving me a cocktail of pain killers--Tylenol with Codeine, Perkacet, and Motrin. I was in a bit of a drugged daze after that to say the least.

Back to the stitches... Dr. Hansen continued to look sympathetic and compassionate throughout the ordeal. I was grateful for his gentle kindness. I was so relieved when Dr. Lohner finished. Then Dr. Hansen took over to “clean me up.” He was so much more gentle, as though he felt really bad about the tearing and the way Dr. Lohner had stitched me so roughly. When he came back later to say good-bye, I thanked him again and again and was so grateful he had been the one to deliver my baby.

After they got my baby cleaned up, they brought her to me to hold--all bundled up. I couldn’t believe I was holding my baby. She was so beautiful. The nurse said we had a “good recipe.” I spoke to her softly and she seemed calmed by my voice--she seemed to know me. That was a wonderful feeling, knowing that my voice could calm her cries. I could see the tears in Ax’s eyes. He was so full of love and joy. We just looked at each other in amazement. I had never felt so much closeness and intimacy--the three of us together.

Friday, March 6, 2009

Where do they come up with this stuff?

After watching BoBB the other night, my friends and I were talking. One told us about a discussion she had had with an OB resident. She mentioned to him that she was looking into her options for her next child's birth and considering choosing a midwife (for a hospital birth). Apparently he tried to talk her out of it, saying midwives were much less safe. It almost made me wish I had been there... so I could have asked him, "Based on what? Show me your research." I don't know if I would have had the guts to actually say those words (being non-confrontational by nature). But I can't stop thinking about it. And it's got me on the defensive and all riled-up 'cause, clearly, I'm a huge fan of midwives. So I'll just refute him here . Since my friend is only considering midwives who can deliver at a hospital, I'm going to focus my proof on certified nurse-midwives (since they're the only kind of midwives who can deliver in hospitals).

1) Mortality Rates
There are many levels of "safety" when it comes to birth. When doctors use the word, I think they're generally referring to the most basic level of safety--a mother and baby who are alive. So what does the research say about CNM vs doctor mortality rates? Here are a few excerpts...
"After controlling for social and medical risk factors, the risk of experiencing an infant death was 19% lower for certified nurse midwife attended than for physician attended births, the risk of neonatal mortality was 33% lower" (MacDorman, M.F., Singh, G.K. (1998). Midwifery care, social and medical risk factors, and birth outcomes in the USA. J Epidemiology & Community Health, 52).
Regarding the above study: "Certified nurse midwives attended a greater proportion of women who are at higher risk for poor birth outcome: African Americans, American Indians, teenagers, unmarried women, and those with less than a high school education. Physicians attended a slightly higher proportion of births with medical complications. However, birth outcomes for certified nurse midwives were better even after sociodemographic and medical risk factors were controlled for statistical analyses" ("Infants Delivered by Certified Nurse Midwives have Lower Mortality Rates," National Center for Health Statistics Press Office, May 19, 1998).
"A nurse-midwifery program providing for the education of nurse midwives and integrating them into the existing health team helped reduce dramatically the infant mortality rate in a Mississippi delta county from 39.1 to 21.3/1000 live births in less than 3 years" (Meglen MC; Burst HV, Nurse-midwives make a difference. Nursing Outlook. 1974 June;22(6):386-389).
"[A] search of the scientific literature fails to uncover a single study demonstrating poorer outcomes with midwives than with physicians for low-risk women. An advantage to midwifery care is that evidence shows primary care by midwives to be as safe or safer than care by physicians" (Marsden Wagner, MD, MSPH, "Midwifery in the industrialized world").
2) Other Measures of Safety
Coming out of birth alive isn't the only thing that matters (a fact that many medical professionals seem to forget). How do certified nurse-midwives compare in other measures of safety? Let's take a look...
"Significant differences . . . between the obstetrician and nurse-midwife groups were found for seven clinically important outcomes: . . . infant remaining with mother for the entire hospital stay (15 versus 27%), third- or fourth-degree perineal laceration (23 versus 7%), number of complications (0.7 versus 0.4), satisfaction with care [higher with CNMs]" (Oakley D; Murray ME; Murtland T; Hayashi R; Andersen HF; Mayes F; Rooks J. (1996). Comparisons of outcomes of maternity care by obstetricians and certified nurse-midwives. Obstetrics & Gynecology, 88).
"The obstetric outcomes of a primary-care clinic for low-income women staffed by certified nurse-midwives is compared with the obstetric outcomes of a group of four obstetricians’ private practice patients. The birth outcomes were comparable with a significant reduction in cesarean sections (13.1% to 26.4%) for CNMs’ patients" (Source [Blanchette H. (1995). Comparison of obstetric outcome of a primary-care access clinic staffed by certified nurse-midwives and a private practice group of obstetricians in the same community. American Journal of Obstetrics & Gynecology, 172, 1864-1868]).
"The Medical University of South California Twin Clinic study demonstrated a lower rate of very early pre-term births, very low birthweight infants, Neonatal intensive care admissions, and perinatal mortality in a CNM directed Clinic where CNM care is given when compared to a MD directed team where MD care is given. This demonstrated that the contributions of CNMs to high-risk prenatal care can be considerable" (Source [Ellings & Janna, et al. (1993). Certified-nurse midwife directed twin clinic reduces very low birthweight delivery & perinatal mortality. Journal of Obstetrics and Gynecology ]).
"The risk of delivering a low birthweight infant was 31% lower. Mean birthweight was 37 grams heavier for CNM attended than for physician attended births. The authors, from the Centers for Disease Control and Prevention, National Center for Health Statistics, conclude that national data support findings of previous local studies that certified nurse midwives have excellent birth outcomes, and CNMs provide a safe and viable alternative to maternity care in the United States, particularly for low to moderate risk women" (MacDorman, M.F., Singh, G.K. (1998). Midwifery care, social and medical risk factors, and birth outcomes in the USA. J Epidemiology & Community Health, 52).
I could keep cutting and pasting, but this post is getting rather long. Is there really anything unclear about the research?

So... where do they come up with this completely false notion that midwives are less safe?! When will medical schools, the media, and popular opinion reflect the actual truth about midwives?? When, oh when??

Thursday, March 5, 2009

Thank you, girl whose name I can't remember

Last night I went to my first West Valley Birth Advocates meeting. We watched "The Business of Being Born" and then discussed it. I brought along three friends who hadn't seen the film. I'm so glad we went. But that's not really what this post is about...

Our discussion reminded me, once again, how incredibly lucky I am. Many of the women at the meeting talked about how sad it is that they had to learn so much the "hard way." So many women have negative experiences with their first births and are then prompted to do research and seek a better experience with their subsequent births.

I was reminded, again, of a brief moment in my past. I was a newlywed and childless. I had an acquaintance who was pregnant with her first child. We crossed paths one day as she carried a stack of birth-related books. We chatted briefly about her pregnancy, and she happened to mention that she was planning to give birth without drugs. My response was something like, "Are you serious?! I didn't know people still did that!" Really... that's what I said. She responded, "Yeah! My mom had all her babies that way. There are tons of benefits!" Those two sentences changed my life forever.

I'm fairly convinced that I wouldn't be the person I am today if this brave woman hadn't been open about her birth plans. If no one had ever informed me that YES, in fact, people DO still give birth without drugs (and for good reason), I don't think I ever would have considered it.

So I'm feeling grateful for her today. Extremely grateful. Thanks to her, I got my own stack of books from our library (a very small library, but gratefully well stocked with natural birth literature!), determined to explore the benefits she had mentioned. Thanks to her, I was informed and able to avoid so many of the pitfalls of hospital birthing.

I can't remember her name. But I will never forget her.

Sunday, March 1, 2009


My doula, Cassie, came over with her cute kids on Friday morning to have lunch and fill out all the paperwork for her to use my birth for certification purposes. I just gotta say... I've got the best doula ever! She's totally spoiling us.

Listen to all this... She brought her massage tools and oils to show me and test out, her hand-held fetal heart monitor so I could listen to the heartbeat for a bit, some baby boy clothes her son had outgrown for us to have, and her super spiffy camera to take some belly shots. In fact, she'll be taking photos at the birth as well, and she said she'll take some postpartum shots too. AND she's going to give us a tote bag (with a birth saying and logo) and a newborn onesie that says "Born at Home" after the birth too! And all of this as a volunteer! Cassie, you rock! You better believe you'll be getting client referrals from me! Here are some of the photos she took...