Sunday, September 27, 2009

Snapshot of the state of things

I attended a large gathering of women from church last night. During the dinner portion, one of my table-mates asked me, "So you're into the au naturale birth stuff, right?" I responded, "Yeah, actually it's more of an obsession. You probably don't want to get me started." But then the conversation topic remained with birth for most of the rest of the evening. Over the course of the conversation, I was shocked (but not really) to discover that I was surrounded by cesarean moms. Here were the stats at our table...

Friend A: one primary emergency cesarean (general anesthesia) prior to start of labor for reduced fetal activity and distressing heart tones.

Friend B: three planned cesareans for breech, transverse, etc.

Friend C: one primary cesarean during pushing phase for non-reassuring fetal heart tones, posterior presentation, "stuck" baby.

Friend D: one emergency cesarean for her second baby (I'm not sure the details).

Friend E: currently pregnant with her second baby (I don't know the details of her births).

Friend F: four unmedicated vaginal births attended by nurse midwives.

Me: three unmedicated vaginal births (two of them attended by midwives).

So... four (possibly five) out of seven women at that table had scars on their uteruses. I was almost tempted to get the attention of the rest of the women in that large gathering and ask, by the show of hands, how many others had cesarean scars. But I'm almost too frightened to find out the answer.

Friend A described how strange it was to be put under and then have her baby brought to her several hours later... "Who is this?! Where did you come from?" She said she kind of wants to have the childbirth experience, having her baby placed immediately on her chest and all... but wonders if it's "stupid" to feel like she wants to experience that. I shook my head and told her "No, it's not stupid." But I didn't feel comfortable getting into it too deeply for fear of offending all the women at the table. I think it's sometimes hard for cesarean moms to hear about the magic of normal birth. All births are miracles, of course.

I spent quite some time, later in the evening, discussing the dinner discussion with my carpool driver (from another dinner table, Friend G: survivor of three cesareans--one of them an attempted VBAC). We both sadly agreed that, as much as we'd like to see cesarean rates decline, we just really don't think it's going to happen. At least not as long as trained surgeons remain the primary care providers for 99% of pregnant American women.

There's some birth faith for ya, eh?

Tuesday, September 22, 2009

The Birth Song

I found this video via Kathy at Woman to Woman Childbirth Education, via Jill at Unnecesarean's "Best of" week. Watching it brought me back to my births instantly. For those of you who've never experienced an unmedicated birth, this is a great video to give you an idea of what normal birth is like. The "song" this woman sings is nearly identical to the "song" I have sung three times as I have given birth. To the unseasoned, it may sound frightening. But I think it sounds beautiful...

Wednesday, September 16, 2009

Bugs and Guts

I've been wanting to post about birth and healthy guts for a while now. Years ago I read an article that had a profound impact on me. It was Jeff Leach's "C-sections, breastfeeding, and bugs for your baby." His piece changed the way I viewed the birth canal. Cesareans aren't just another way to give birth. Being born through an incision bypasses an extremely important step in the birth process--being colonized by the "base population" of the mother's vaginal and fecal microflora. Following birth, breastfeeding continues the transfer of healthy microflora (probiotics) from the mother to the infant. Jeff Leach explains:
Studies have shown that at one month of age, both breast-fed and formula-fed infants possess bifidobacterium but population densities in bottle-fed infants is one-tenth that of breast-fed infants. The presence of a healthy and robust population of bifidobacterium throughout the first year or two of life contributes significantly to the child’s resistance to infection and overall development of defense systems – not to mention the physical development of the intestinal system in general. Aside from the substances secreted by these specific bacteria that are known inhibit the growth of pathogenic bacteria, they also work to make the intestinal environment of the infant more acidic, creating an additional barrier against invading pathogens. In short, breast-fed babies are sick less, are less fussy, have fewer and shorter duration of bouts of diarrhea, and have more frequent – and softer – bowel movements. (source)
Cesareans can save lives, but they also put babies at increased risk for infections, allergies, asthma, intestinal problems, skin problems (such as eczema) and future health problems. When there is an absence of breastmilk, those potential problems can become exacerbated.

What are the best ways to ensure a healthy and strong population of gut microflora for your baby?

* Give birth vaginally.
* Keep baby and mother together immediately following birth (to prevent the colonization of harmful bacteria, especially when giving birth in the hospital).
* Breastfeed as soon as possible following birth and frequently thereafter.
* Consume probiotics (in foods or supplements) yourself during pregnancy and while breastfeeding.
* Avoid giving your infant antibiotics, if possible.
* Give birth in a location far-removed from harmful bacteria, if possible.

I was delighted (not long after giving birth to my son at home) to discover a study whose results indicated: "Term infants who were born vaginally at home and were breastfed exclusively seemed to have the most 'beneficial' gut microbiota (highest numbers of bifidobacteria and lowest numbers of C difficile and E coli)" (Penders, J, et al, Factors influencing the composition of the intestinal microbiota in early infancy). I wasn't surprised by those findings one bit. It has been informative and eye-opening to see how much impact the events following birth can have.

My first daughter was born vaginally in the hospital, lifted-up briefly for me to see following her birth, taken to the other side of the room to be weighed, poked, smeared, wrapped, and finally brought to me. We were talked into giving her formula during her first night because she wasn't latching well. We did establish a good latch with the help of the lactation consultants and some contraptions. We stayed in the hospital an extra day largely because of my perineal trauma (we spent two nights there). Of all my children, she was the most irritable/fussy. She was also the only one to experience troublesome eczema and diaper rash as well as frequent bouts of croup throughout infancy and childhood. She is also the only one of my children to exhibit a possible food allergy.

My second daughter was born vaginally in the hospital, placed immediately on my chest, breastfed exclusively following birth, and spent barely over 24 hours in the hospital. She experienced only minor diaper rashes, no eczema, has never developed croup, and rarely gets sick.

My son was born vaginally at home, placed immediately on my chest, spent his first hours at my chest and breast, and never entered a hospital. He developed a skin infection a week after birth, but recovered quickly (through oral and topical antibiotics, but I chugged probiotics to prevent thrush and other problems). I have consumed more probiotics while breastfeeding him than I ever have before. He has been my least fussy baby and has never needed diaper ointment nor developed eczema.

The more I learn, the more convinced I am that what happens during and after birth matters A LOT. Do you think you baby's postpartum gut microflora had an impact on his/her behavior or health short-term or long-term?

Related links:

Allergies, Asthma, and Eczema: Response to Disturbance of the Microbiota of the Newborn Gut

The potential for probiotics to prevent bacterial vaginosis and preterm labor

Improved appetite of pregnant rats and increased birth weight of newborns (following probiotic feeding)

Probiotics may aid postpartum weight loss

Probiotics during pregnancy, postpartum, breastfeeding, and their impact on immunity

Probiotics in infants for prevention of allergic disease and food hypersensitivity

Saturday, September 12, 2009

Time Warp

Has it really been five and a half months??

Friday, September 11, 2009

First baths, etc.

I've got this new theory. I'm not going to suggest that I'm the first to come up with this. It's only "new" in the sense that it's "new" to me. I'd love to see it tested with some research on mothers and infants.

A few weeks ago I got thinking about the profoundly intense bond I developed with my son following my home birth. I had never experienced anything like it. Sure, I developed a deep love for my daughters, but it took much longer and came far less naturally. I have come up with many possible explanations for the intensity of the bond with my son...

* No Pitocin to interfere
* More intense oxytocin rush being in a comfortable, private setting
* Immediate and prolonged skin-to-skin contact
* First feeding within 15 minutes of birth (I can't remember exactly, but it was the first thing we did after holding him and delivering the placenta.)
* No hospital staff coming in and out of our room at all hours

As I was thinking, I realized another factor I hadn't thought of before...

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

Friday, September 4, 2009

My birthday comes early...

I was ordering a book for my little brother and decided I might as well get something else (I'm a sucker for Amazon's Super Saver Shipping). And I told my husband it could be part of my birthday present. 'Cause I simply had to have my own copy. And it came in the mail today...Isn't it lovely? :-)

Tuesday, September 1, 2009

More information on the Canada Home Birth Study

Per Amy Romano's exellent explanatory post:
The researchers compared outcomes in the planned home birth group with those of two groups of women who met eligibility requirements for home birth but planned to give birth in hospitals instead. One of the two comparison cohorts had planned hospital births with midwives (n=4752); the other with physicians (n=5331).
Now that changes things! I was wrong in my last post. Apparently they did weed out the high risk women!

So... go read the rest of Amy Romano's post. Great info in there. Thanks, Amy!

More evidence on home birth safety

A friend shared a link to a news article reporting a new study out of Canada. The headline: "Home Birth With Midwife As Safe As Hospital Birth: Study." Here's an excerpt with a summary of the study's findings:
The authors of the new study compared three different groups of planned births in British Columbia from the beginning of 2000 to the end of 2004: home births attended by registered midwives (midwives are registered in Canada), hospital births attended by the same group of registered midwives, and hospital births attended by physicians. In all, the study included almost 13,000 births.

The mortality rate per 1,000 births was 0.35 in the home birth group, 0.57 in hospital births attended by midwives, and 0.64 among those attended by physicians, according to the study.

Women who gave birth at home were less likely to need interventions or to have problems such as vaginal tearing or hemorrhaging. These babies were also less likely to need oxygen therapy or resuscitation, the study found.

The authors acknowledge that "self-selection" could have skewed the study results, in that women who prefer home deliveries tend to be healthier and otherwise more fit to have a home birth. (Source)
The study doesn't appear to distinguish between low-risk and high-risk births--something most doctors would raise a red flag about. Doctors attend more high-risk births, so it's not surprising to see a higher mortality rate under their care. It's a tricky thing trying to compare different types of births because so many factors are involved in birth outcomes. But I still find this news encouraging.

As for the "self-selection" factor, I can definitely attest that I took a far more proactive role in my health during my home birth pregnancy than I ever had before. I exercised, I ate much more healthy food, and was more educated than ever about how to make my pregnancy and birth smooth and healthy. I wanted to do everything I possibly could to increase my odds of a healthy outcome for me and my baby. Whether home birth inspires women to be healthier or healthier women choose home birth, I say it's a win-win either way.