Friday, October 30, 2009

Happy dispatch

My cousin(-in-law) has two adorable boys. She had hoped to give birth unmedicated with both of them, but pitocin threw a huge wrench in things and necessitated pain relief, so she's extremely determined to avoid induction/Pitocin with the birth of her current baby-in-utero. So I was positively giddy with excitement when I got this email from her this morning:

I had my first prenatal appointment today. Long story short, everything is great. She had no trouble finding the heartbeat - about 165 bpm, loud and strong. I love that noise. :)

And the practice I'm going to? GOLD MINE. Seriously, I could not be more impressed. They will let me go two weeks overdue without inducing, and when they do induce, pitocin is sort of a last resort. They had a sign up boasting their statistics (and I would too if I had their numbers):

* 7% cesarean rate
* 32% epidural rate
* 11% induction rate
* less than 1% of newborns are admitted to the NICU
* 6% vacuum delivery (no forceps)
* 72% intact perineum rate (no tears or cuts)
* jacuzzi tubs are encouraged for use during labor and delivery
* eat and drink whatever you want during labor
* no IVs unless medically necessary
* no routine episiotomies
* no continuous fetal monitoring unless medically necessary
* birth in any position you would like
* have as many family members and/or support people at your birth as you would like, including baby's siblings

I mean, seriously!? Are you kidding?! And this is at a HOSPITAL. I could not believe it. I actually asked if they do VBA2Cs, and while they don't advertise it, they will definitely sit down with women, look at why they had two previous cesareans, and the practice has attended successful VBA2Cs in the past. I think I might email [my 2-cesareans friend] about it, just in case she wants to have another kid and wants a hospital option - we're only like 1.5 hours away.

Anyways, I was there for over an hour and a half, explaining my past experiences and what I'm hoping for this time. I met with the NP who does most of the prenatal visits (since the CNM is often busy doing deliveries), and she's great. I'll meet with the CNM (who does all of the deliveries) at least 2-3 times before I go in.

Oh, and the walls were covered with birth announcements (as you often see at OB/CNM clinics), and what struck me was how big these babies were - most were over 8 pounds, and there were quite a few that were over 10. I was so impressed to see these big babies next to this poster of amazing birth statistics and such a low cesarean rate. Seriously, can we never move?! If we lived [here] forever, I think I would end up having 15 babies with these people.

Anyways, all is well. I'm getting so excited about this little one. :)

Sunday, October 25, 2009

No medals here

Wow. Huge thanks to Jill (The Unnecesarean) for sharing this fabulous post by Arwyn: "Just like athletics: exploring a childbirth analogy." Jill described it as her "favorite breakdown of the childbirth-athletics analogy," and I have to agree that it is definitely my new favorite as well.

Arwyn eloquently discusses how our culture is quick and eager to praise, admire, and encourage those engaged in athletic feats--marathons, sporting events, and even local 5Ks, but when a woman attempts natural childbirth (a likewise challenging physical feat), she is lucky if she finds one or two supporters to cheer her on. Instead, far too often, it is those on the sidelines who should be her loudest cheerleaders who tell her she "can't do it."

I am personally saddened and disheartened when I (frequently) hear women tell me that it is their husbands who say, "You're definitely not tough enough for a natural birth," or who "can't bear to see her in pain," and thus push her toward an epidural. Would they also suggest that she's not tough enough for a marathon, if that was her goal, or stop her in the last grueling miles of the race and say, "You need to stop... I can't stand seeing you in so much pain"? I certainly hope they wouldn't. All this stuff has brought to mind this post from last June--"Nobody thinks you're a hero."

Here are a couple of teasers from Arwyn's post:
Everyone has heard of and no one doubts the existence of “runner’s high”, so why do we start plugging our ears and rolling our eyes and flapping our tongues when we speak of “birthing high”? Just as in athletics, in the absence of intolerable pain and unnecessary interferences (the latter of which is all too often responsible for the former), birthing has the potential to produce the most delicious chemical cocktail which feels good. (Divine even: I certainly felt like a birthing goddess afterward.) Even discounting that, or in its absence, there is potential for pride and a sense of accomplishment: something we value so much in athletics, yet scoff at in childbirth, where our effort benefits both us and another. We deny women that pride in accomplishment (for which support of athletics is so vital to girls’ sense of self and women’s equality), that boost in self-esteem and feeling of competency, right when we need it most: at the start of parenting, one of the most demanding journeys a person can undertake. . . .

But the current cultural construction of birth must change: not by moving backward to a time when women had no options in childbirth, and were expected — even encouraged — to suffer, and in which there were no medical interventions for when they were truly needed; but forward, to a time when our bodies are valued, our spirits are supported, and the work of birth is seen as hard, yes, and even sometimes painful, but within reach of most of us, and oh so worth it: just like athletics.
And some pics, for fun...

My dad (in the blue hat) finishing the Boston Marathon as a 50th birthday gift to himself, with his friend, and my (now deceased) brother, Steven, running the last 5 miles with him (behind my dad)...Me and my husband with his Boston Marathon finisher's medal (April '08)...My husband helping me run my first 10K, the longest race I've ever run...And then again, helping me through one of the most difficult (and best) experiences of my life (with my doula as another cheerleader)...So much better than a medal...

Tuesday, October 20, 2009

Ask Busca: Vitamin K?

Ali asked:
My first question is about Vitamin K injection given at birth. I had two [nursing] teachers tell me they are necessary to jump start the blood coagulation. They also said the dose given in 20,000 times the amount you need. This seems way out of control to me, and also unnecessary. so I was just wondering what you thought about it.
Busca's babble:

I should start off by saying that all three of my children have received a vitamin K injection at birth. I should also admit that except for the brief handout/consent form I received on from my midwives during my last pregnancy, I did zero research on the subject before my children were born. Sad, I know. I guess my only excuse is that I was so busy educating myself about other things that I just never got around to it. So I'm really glad you asked this question because it gave me a chance to do some digging.

The medical establishment's explanation for routine administration of vitamin K is that all babies are born with "low levels" of vitamin K. This begs the question: If all babies are born with "low levels," then aren't their levels of vitamin K "normal" for newborns?

Midwife Sara Wickham explains:
"The risk of a baby who is not given vitamin K developing HDN [Hemorrhagic Disease of the Newborn] is between 1 in 10,000 and 1 in 25,000 (Von Kries and Hanawa 1993). We also know that the babies most at risk from HDN are those who have traumatic births (clinically, this might include babies who are delivered by forceps, ventouse or emergency caesarean section, or babies who show bruising)" (from "Vitamin K - An Alternative Perspective," AIMS Journal, Summer 2001, Vol 13 No 2)
It doesn't surprise me that birth trauma would be highly associated with newborn bleeding disorders. Midwife Ronnie Falcao's has a wealth of helpful information. She starts her vitamin K discussion with these points:
Early or "Classic" HDN (also called Vitamin K Deficiency Bleeding) occurs in the first week of life. It is an iatrogenic condition, meaning that it is caused by medical care:

* premature clamping/cutting of the umbilical cord deprives babies of up to 40% of their natural blood volume, including platelets and other clotting factors
* the use of vacuum extractor or forceps often causes bruising or internal bleeding, which uses up the baby's available clotting factors
* the use of antibiotics inhibits the baby's generation of clotting factors
I'm always quick to believe that God/nature got things right, and it's us fallible humans who got things wrong, so this information just felt right to me.

She also shares fascinating bits of articles and research on vitamin K for newborns. Among the details I found most interesting and pertinent were...

* Colonization of the newborn gut with the mother's fecal matter and microflora is essential to jumpstarting vitamin K production in the newborn. Antibiotics and efforts to make the mother's perineum "sterile" will interfere with this important transfer of beneficial bacteria. "Babies are born next to the anus for a reason!" Yet another reason to avoid a cesarean whenever possible! (More info on how the newborn gut produces vitamin K here.)

* There is little clear-cut evidence that vitamin K injections are themselves harmful, but we can't ignore the fact that an injection will always be a potential avenue of infection. When administered in a hospital, the potential for serious infection is a cause for concern.

* There are situations where a vitamin K injection would be necessary. Some medications taken by the mother may interfere with vitamin K, babies who receive antibiotics have disrupted clotting mechanisms, and an extremely rare liver disorder can inhibit vitamin K production.

* Formula-fed babies receive sufficient vitamin K through feedings to supply their bodies' reserves, so it appears there is little need for these infants to receive vitamin K injections.

* Oral doses of vitamin K are sometimes even more effective at boosting newborn vitamin K levels than injections.

* Eating lots of fresh, leafy green vegetables will boost the vitamin K content of breastmilk and further protect newborns from late-onset HDN.

When/If I have more babies, I hope to do what I can to prevent HDN by giving birth in an environment where my baby will be exposed to beneficial bacteria to jumpstart vitamin K production, avoid birth trauma, delay cord clamping/cutting, and boost my own vitamin K levels through nutrition to increase my breastmilk's vitamin K content. As long as all of these preventative measures are achieved, I think it's unlikely that my future babies' "low" vitamin K levels will be problematic, but I plan to consider oral vitamin K as opposed to an injection if I feel it is necessary.

If all babies could be born under such natural/normal circumstances, I'd wager there would only very rarely be a need for vitamin K administration. As Sara Wickham argues, perhaps newborns and breastmilk are "low" in vitamin K for a reason? Should we really be messing with nature? Ronnie Falcao aptly concludes, "Until we have the definitive answers to these questions, parents have to choose between a system that's been in place for less than a hundred years and one that's been in place for thousands of years."

Any other research, facts, tips, and/or experiences from my readers?

Sunday, October 11, 2009


As I rocked and nursed my baby boy to sleep about an hour ago, I got thinking about something an OB said to me the morning after my first daughter was born. He was an OB I had never met before. I can't even remember his name. But he was one of the doctors from the practice where I had received my prenatal care. I suppose he was the one on-call that morning, so he was doing the postpartum hospital check-up rotation (or whatever they'd call it).

It was early in the morning, still dark. Dr. Whatshisname was asking how breastfeeding was going, I think. We'd had a rough start and some latching troubles, but I don't think my response to his question was an unusual one: "I'm feeling some nipple soreness." Of course I was! Nursing hurts like the dickens in the beginning. Even when you're doing it right. At least it has for me. Every time. Maybe it's not painful for everyone, but I have met very few women who haven't experienced soreness in the beginning.

I was still drugged-up on Perkacet and Tylenol with Codeine, and too fresh and naive to realize how ridiculous Dr. Whatshisname's response was to my extremely-common-sore-nipple-ness. I can still hear his pompous, patronizing tone saying:

"You're not a pacifier, you know."

Looking back on that moment, I feel such a surge of mixed emotions... indignation, pain, shock, irritation... it makes me want to cry and vomit at the same time. I don't know why I have such a strong negative response to it, but I do. I suppose it's because his statement was a powerful indication of the way he viewed my body and my purpose as a mother. I'm "not a pacifier?" How can he say that?

Could there really be a more fitting description for a mother than that? Pacifier. Yes. It is exactly what our bodies, hearts, and souls were designed to be. We--our arms, our bodies, our kisses, our breasts--are the ultimate and best source of peace and comfort for our children. We allay, soothe, settle, restore to a tranquil state, calm. A mother's smell and touch are life-giving, healing, and far more soothing than anything else in a baby's world. We are peace-givers and peacemakers. We are the original, supreme, and ultimate pacifiers.

I wish I could stand before Dr. Whatshisname now with my three nursed-on-demand-and-to-sleep children around me and in my arms and boldly and proudly declare to him:

"Yes, I am a pacifier. I am a mother."

Saturday, October 10, 2009

Precious motherhood

May I never, ever, take it for granted...(Thanks for sharing, Amber!)

Thursday, October 1, 2009

Speaking of the rising cesarean rate...

Rixa shared this article from right here in AZ. Joy, a mother of three, pregnant with her fourth, has only one hospital in her vicinity, and they will court order a cesarean delivery if they must... even though Joy delivered her third child via VBAC at the very same hospital two years ago. The hospital says they are no longer equipped to handle VBACs because of reduced staffing. Joy says their logic doesn't hold up:
"They don’t want to allow VBACs because she said they aren’t equipped for emergency c-sections, but if they can’t do emergency c-sections, they shouldn’t be having labor and delivery at all. That’s why women go to the hospital to have their babies – in case there is an emergency."
Can you really argue with that? If there's one place in our culture where women are told they should feel "safe" giving birth, it's the hospital. The hospital is supposed to be the place you can count on in an emergency. Have they informed the women of Page that they're no longer that equipped safety-net women think they are? I somehow doubt it.

Joy has her feelings painted in protest on the back of her minivan: "Page Hospital enter my body without my permission... sounds like rape to me." (Read the article here.)