Thursday, July 30, 2009

Another perk

I have now *twice* reveled in one of the lesser-known benefits of exclusively breastfeeding my wee ones...

Getting out of jury duty!

Thank heaven for boobs and babies! :-) Speaking of... here's a quick glimpse of my little milk-drunk sleeper a few days ago... P.S. Is it so sad and wrong that I'm so thrilled to be excused from participating in my civic duties?

Wednesday, July 29, 2009

Inspired by Martha: Part Two

How to have a successful unmedicated hospital birth, Martha-style...

1) Determination!
One of the things that makes Martha so inspiring is that she weathered her pregnancy and birth with TWO heart diseases (aortic valve stenosis and hypertrophic cardiomyopathy). This put her in a higher risk category than the average pregnant woman, but she was still determined to pursue a natural birth, despite the skepticism/concern of her cardiologist and OB. She said:
I left their offices many times over the next couple months sobbing all the way back to work. I felt trapped because I was in my final months of pregnancy and didn’t want to go to the trouble of changing doctors. I trusted them both to take care of the heart issues because they had worked together in the past on pregnant women with heart disease and that was very important to me. . . . [They] had no stats or studies to back it up, but their main concern was the risk natural childbirth would pose to my heart. I could never really get to the bottom of it, but I was CERTAIN natural childbirth would pose no extra risk to my heart. I felt just the opposite, actually.
2) Avoid being induced, if possible!
I remember the week or two before Martha gave birth. Our mutual friend mentioned that Martha's doctors were really pressuring her to be induced. I was so hopeful she would be able to avoid an induction! Pitocin would put an unmedicated birth virtually beyond reach (not to mention the stress it could put her body and her baby under). Here's what Martha had to say about that harrowing time:
The final month was the worst because they made me have extra fetal monitoring twice a week which made me anxious and worried because each visit threatened induction because my amniotic fluid levels were all over the map. I knew being induced would put all hopes of a natural childbirth out of my grasp so I prayed more fervently than ever to be spared from induction. . . . I also had many pep talks with Sienna. “Now, listen little lady. We can’t be induced. It’s not an option. So, I need you to just stay inside as long as possible and keep showing the doctors what you can do.” She was so obedient, I wanted to lean over and kiss her after every appointment but couldn’t reach my belly with my lips. Adam had to take care of that for me. The last couple weeks I was put on bed rest which nearly drove me to drink. I would not wish bed rest on my worst enemy. . . . The due date came and went. Due dates are a stupid, cruel thing. They mess with your mind and make everyone under the sun badger you about why your baby’s not here yet. Poop on due dates. I’m not telling anyone mine next time.
3) Faith!
I really believe one of the reasons Martha succeeded was because of her enormous faith. You really cannot tackle natural childbirth without faith... whether it be faith in God, faith in the birth process, faith in your body, or faith in yourself. Martha's deep faith is so inspiring to me:
I found great comfort in Ether chapter 12. The more I learned about faith, the more I knew it was my answer. Faith precedes miracles and I needed a major miracle. Faith brought about the impossible, like moving mountains, and I needed a mountain MOVED. Each time after fetal testing, I was sent home. Each time I KNEW it was a miracle. I still didn’t know what the end would bring, but I just kept my faith fine-tuned and told God what I wanted and left it up to Him.
4) Hang out at home as long as you (safely) can!
I really think the birth outcomes in our country would vastly improve if women would spend most of their labors at home. Rushing to the hospital too early is a mistake many women make. The artificial lighting, restrictive policies, and strange faces and environment lead many women's labors to stall or slow down, which leads hospital staff to either send her back home anyway or start intervening in the birth with Pitocin, etc. At home, a woman is on her own turf, can be upright and mobile, and can eat or drink as she wishes--all things that will facilitate her labor process. Martha was fortunately able to spend all but the very end of her labor at home. Here are some excerpts of her birth story. I hope you don't mind that I nearly pasted all of it, Martha! It was just so great, I couldn't help putting so much of it here:
Wednesday at 2 a.m. I got up to pee for the umpteen bajillionth time and also ate a plum and read my scriptures (Ether 12, I love you!). At 2:30 a.m. I peed again and heard a little PLOP. Water breakage, folks! This was the sign I was looking for. I woke up Adam and called Dr. Marralle’s operator. I told the operator my water had just broken and that I was ready to come in. The operator told me Dr. Marralle’s instructions were to come in when my water was broken AND when I was in active labor (contractions 5 minutes apart, lasting 60 seconds, for one complete hour). I thought this was odd because Dr. Marralle had told me several times that I’d need to come in if my water broke OR if I was in active labor. Huh. The operator seemed pretty confident so I agreed to call back when I was in active labor. Adam went back to sleep and I tried to lie down and wait for active labor.

Contractions did keep coming but they were quite irregular. I couldn’t get comfortable in bed and just walked around the house and leaned over the table or desk or wall, or knelt down over my ottoman when a contraction would hit. I timed and wrote down each contraction and from 5 – 6 a.m. they were in the ACTIVE zone. By this time I’d thrown up my plum – twice – and had much more water gushing out of me from below. Isn’t labor PRETTY? Adam awoke when he heard me groaning in the front room around 6 a.m. and came out to help. I hadn’t wanted to wake him up because I thought at least one of us should be well rested for the big day ahead. I also didn’t know how he could help me, since he couldn’t exactly BE me and that’s about all I wanted at that point. However, when he came in and started rubbing my back and encouraging me, it helped immensely.

I told him to call back the operator and she gave him the go-ahead to come in. We gathered our things, he ate breakfast and emptied the dishwasher (of course he did!) and we both showered. By this time my contractions were just a couple minutes apart, and I knew we needed to get this show on the road. I remember getting into the car and telling Adam, “I can do this,” signaling that I was ready to do this natural childbirth thing because I still felt in control of my contractions. However, in my head I thought, “But if this lasts all day, I CAN’T do this.”

I was making quite a bit of noise through my contractions and I liked it. Well, I wouldn’t say I liked it, I guess I just felt sort of cave-womanish, which freed the inner natural childbirth hippie in me, which I liked. Sitting in the car was totally uncomfortable. I did have a pillow behind my back which helped and a pillow in the front that I was squeezing to death. I closed my eyes and just wished away every bump on the road. Hoag Hospital is in Newport Beach, about 20 – 30 minutes from our house. We had two freeways to conquer but it was 7 a.m. and the traffic was moving great. I think I opened my eyes three times and knew we were making good time. We got there a bit before 7:30 a.m. Adam valet parked and I leaned against poles, walls, Adam, whatever I could to get me up to the 5th floor: Labor and Delivery! The nurses stared at me as I leaned against the wall and did this thing with my feet like a bull does when he’s getting ready to charge. I thought about that later and thought it was quite symbolic. Ha!

Adam was very calm in getting us checked in at the front desk and meanwhile the nurses could see they needed to get me to a room fast and acted accordingly. They tried to put me in the wheelchair but I declined. I didn’t want to have my grand entrance be as an invalid and, more than that, I did NOT want to sit. That is the LAST thing that felt good on my back. I got to the room and they made me strip down and throw on a gown. . . . They had me climb on the bed for fetal monitoring and a cervix check. I wanted to decline that up front as well and let them know from the start that I wanted to MOVE a lot and not be confined to the bed. But I figured we’d have a look to see how far I was dilated and then I’d voice up.

The nurse stuck her fingers up there and announced, “You’re dilated to a 9.5!” I looked at Adam and said, “That is the BEST news I’ve EVER heard.” We were both shocked. So were the nurses. The head nurse, Kim, tried to get to the bottom of why I had waited to come in so late. I told her my conversation with the operator. She wanted the name of the operator. I didn’t have it. In my mind I wanted to give that operator my first born, yes even the first born I was about to birth. I am convinced she was an angel sent from heaven and was the reason this natural childbirth was happening... and happening NOW! For some reason Kim asked if I wanted medication or an epidural. I answered no to both and thought it odd that she’d even ask since it was obviously too late. . . .

The nurse asked if I’d had an urge to push. I hadn’t put it together until she asked, but YES, in the car, I DID feel like I had to take a giant crap. I didn’t understand the urge, though, because I had thrown up all the food that would be necessary for a bowel movement. So THAT, my friends, is the urge to PUSH. Kim said, “Well, within the next half hour, you can push.”

Meanwhile, Dr. Marralle came in, the nurses (about five or six of them), were bustling around the room, hooking me up to all sorts of things, or just staring for general amusement. A sweet middle-aged nurse came to my bedside and introduced herself as Cindy, a student nurse that was on her first day here. I loved her immediately and grabbed her hand. I made her hold it the whole time while Adam was on the other side, holding my other one. When she let go at one point I grabbed it again. There was no way she was leaving my side. I needed her cold, thin, strong fingers as much as I needed Adam’s warm, bigger, strong fingers. . . .

I had about eight pushing sessions and it all lasted about 25 minutes. Adam was tremendously helpful throughout it all. Long ago we had established that he would be my “focal point” during labor and delivery and several times when it seemed like I was losing it, he would say, “Martha! Look at me! You’re doing great.” He was very reassuring and my #1 cheerleader. He just kept telling me how wonderful I was doing and I was believing it!

Something that was making me lose a bit of focus was every time I put my head up to push, I could see three nurses in the back of the room just watching me. I think two were the baby nurses and one was a student nurse. I wanted to say, “Are you enjoying watching this? My crotch? My pooping and peeing all over the doctor while I try to push this impossible baby out? My head turning all sorts of shades as I nearly explode? Oh, good.” . . . I was annoyed, but tried to stay focused on the people that were helping me: Cindy, Kim, Adam and Dr. Marralle. I chalked it up to either it being protocol for baby nurses to wait in the room until the baby comes out or maybe, since Hoag has a 98% epidural rate and a 30% cesarean section rate, they had never seen the spectacle that is natural childbirth. I forgave them later as they helped me breastfeed and told me how amazingly I had done. One of their great compliments was, “I didn’t even hear one F-word!”

I didn’t feel the baby’s head pop out, I think because of the local anesthetic on my perineum. I was waiting for that infamous “ring of fire” feeling, but it didn’t come. Anyway, the head DID finally pop out, wouldn’t you know it. Adam said, “Martha, the head’s out!” I think I gave a little squeal of disbelief with a, “REALLY?” Just one more push and out came the slithery little body! It was incredible. Dr. Marralle held her up and I said possibly the dumbest thing ever, “It’s a baby!” Wow. Way to state the obvious, Marth. But there she was, seriously, a baby, a big baby, one that was just moments before making me totally miserable and ugly and grunty and fat and purple and crampy! She was out and it was allllll over. I immediately felt SO much relief. They put her on my chest and the first thing I noticed were her long scraggly nails. Baby nails are tiny miracles unto themselves. I just looked down at her head of black hair while the nurses wiped her off. Dr. Marralle asked me to give one more push and out came the placenta. I looked at Adam and said, “That felt gross.” He said, “That looked gross.” Dr. Marralle had Adam cut the umbilical cord, then she got busy sewing me up. Dr. Marralle’s comment after it all was, “Well, don’t plan on it being that simple next time, young lady.” Classic Dr. Marralle. I didn’t care, though. Nothing anyone could have said would have ruined that moment.
Are you feeling warm and fuzzy now? Me too. :-)

Friday, July 24, 2009


Or we could call this "Part One" of the "Inspired by Martha" series. But not Martha Stewart. A different Martha. I'm finding, over time, that I hear variations on the same conversion story over and over again. My own story fits the pattern as well. Here's a rundown...

1) Woman feels certain she'll say, "Bring on the drugs!!" when she has children.
2) A friend/stranger (or two or three) recommend a "natural" birth book or plant little fact-seeds about the benefits of going natural.
3) Woman begins to let those seeds take root and proceeds to do her own reading/research.
4) Woman is astounded by what she discovers and is changed forever.
5) Woman feels certain she'll say, "No drugs for me!!" when she gives birth.

And, often, we can add a final...

6) Woman has successful, wonderful drug-free birth and feels driven to help other women achieve wonderful births as well.

Martha is a friend-of-a-friend whose own story fits this pattern to a T. I never tire of hearing these conversion stories. They make me happy and giddy and all warm and fuzzy. So I want to share her story with you, 'cause I figured you'd love the warm fuzzies too. :-) Here's what Martha had to say about her conversion:
It all began in about my sixth month of pregnancy when I was at a baby shower for two ladies [from church]. I was the only soon-to-be new mom and the others all had little kids. Someone asked me, “So, are you going to get the epidural?” I said, “Pshhh. Yes. That seems like a no-brainer.” The others laughed and agreed. About a week later I started reading The Birth Book by William and Martha Sears as recommended to me by my friend. When she handed it to me months earlier, I thought, “What’s there to know about birth? You just go to the hospital and the doctor takes care of everything.” Three pages into the book, I had an epiphany: I wanted to have a natural childbirth. No one was more surprised than me to discover this. Martha Sears was recounting each birth story of her seven kids. Her last six were without medication and the way she talked about those births in contrast to her first, where the doctor definitely “took care” of everything, was something else. It moved me spiritually and emotionally. I was on my lunch break reading the book and remember walking back to the office with tears in my eyes. For the next months I devoured that book and every other resource I could get my hands on. The two other helpful books I read were Natural Childbirth the Bradley Way by Susan McCutcheon, as recommended to me by my friend, and Birthing From Within by Pam England, as recommended to me by [another] friend. I also watched the documentary "The Business of Being Born" as recommended to me by [another] friend. Natural childbirth just made sense to me and the more I learned about it, the more my testimony of God’s greatest creation, the human body, grew. I had complete confidence in my body’s ability to do what nature intended, and I knew God would not give me an experience they couldn’t deal with. (Caveat: I also know that God made skilled doctors and drug makers who make and use miraculous drugs that many people have a great experience with. Still, I knew that route wasn’t for me.) I became obsessed with the topic of natural birth and it became all I wanted to talk about. Adam totally understood my desires but that didn’t mean he didn’t glaze over several times when I’d bring up the subject yet AGAIN. He was very supportive, but he wasn’t the one giving birth. I was. So I decided I would learn everything I could, give him the information he needed and be prepared to work together to make this happen.
I love this stuff! And it has inspired me to be more open. It's so easy for me to keep my mouth shut in conversations about birth. I don't want to offer unsolicited advice or offend anyone. I rationalize that I'm "doing my part" by blogging here and posting articles on facebook, but I could reach more people if I'd use my vocal cords as well. I always assume the women around me don't want to hear it, but how do I know? It could be as simple as asking a question, such as, "What are your plans for your birth?" It's a risk-free way to open a dialogue on the subject. Why don't I do that more often? I will be forever indebted to the woman who introduced me to the beauties of unmedicated birth. So, Martha, thank you for this reminder to open my mouth.

Stay tuned for "Part Two" where you'll get to hear how Martha's birth experience went.

Monday, July 20, 2009


Emily passed along a link to a NY Times article: "Updating a Standard: Fetal Monitoring," by Jane E. Brody.

Electronic fetal monitoring (EFM), rolled-out in the 70's, hasn't done what doctors thought it would do--"reduce the risk of cerebral palsy and death resulting from inadequate oxygen to the fetal brain." In fact, EFM has had some negative consequences. The NY Times article reports:
¶Electronic monitoring has led to a significant increase in both Caesarean deliveries and forceps vaginal deliveries.

¶Monitoring results are widely used by lawyers to bolster malpractice cases of spurious merit, which has led to soaring costs for malpractice insurance and, in turn, prompted many obstetricians to stop delivering babies.

¶Electronic monitoring has not reduced the risk of either cerebral palsy or fetal deaths.
I wish it were possible for hospital staff to implement intermittent monitoring by human beings. I've said it before, and I'll say it again... the best "monitor" for childbirth is a trained person, not a machine. Unfortunately, most nurses are too busy to spend the necessary time personally listening to fetal heart tones on multiple patients, and few doctors are present before pushing time. So EFM isn't likely to be replaced by person-al monitoring anytime soon (or ever).

So improving the use of this technology is definitely in order. I'm heartened by the efforts of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and Dr. George A. Macones who are encouraging obstetricians to refine and improve the way they interpret electronic fetal monitor tracings. Especially considering the somewhat frightening inconsistency of doctors' interpretations of EFM tracings, as the NY Times article reports:
In a study in which four obstetricians examined 50 fetal heart rate tracings, they agreed in 22 percent of the cases. Two months later, the same four doctors re-evaluated the same 50 tracings and changed their interpretations on nearly one of every five. . . .

And in more than 99 percent of cases, predictions based on the tracings that the baby would have cerebral palsy have proved wrong.
These new EFM recommendations sound like a step in the right direction. I love that OBs are being encouraged try "giving the mother oxygen, changing her position, treating her low blood pressure and stopping stimulation of labor if that is being done" before jumping to a cesarean for abnormal fetal heart tones.

It's so easy to get caught up in villainizing OBs and the medical establishment. It's too bad a few "bad eggs" can taint our view of the profession. So I'm always grateful to be reminded that there are docs and medical researchers working hard to protect women and babies. I hope to see the day when MDs, midwives, researchers, nurses, doulas, and parents can come together for the betterment of maternity care. I really hope to see that.

Friday, July 17, 2009

Post induced by Pushed

I'm rereading Pushed. 'Cause it really is that good. And I swear I want to quote a sentence from every paragraph... but I'll limit myself to a few quotations.
"An induction absent a solid indication absolutely increases all risk to mom and baby. . . . Just by the mere fact of induction, you've now intervened in a pregnancy that otherwise would have continued, and you've already increased the risk of C-section."

"Macrosomia is not a reasonable indication for induction."

(Laura Riley, MD, medical director of labor and deliver at Massachusetts General Hospital and former chair of the ACOG practice committee, qtd in Pushed, p. 8-9)

"That one kills me [said in reference to the idea that babies can't fit]. The maternal pelvis is a very well-constructed and flexible body structure in late pregnancy."

"The predictive ability of amniotic fluid volume as an indicator of anything for an otherwise healthy pregnancy is extremely low. There's just not evidence to support it."

"It just defies logic that half of women get an artificial version of a hormone that the body normally produces during labor."

(Ellen Hodnett, professor of nursing at the University of Toronto, member of the Cochrane Collaboration's Pregnancy and Childbirth review team, qtd in Pushed, p. 10-13)
Alright... now I'm going back to my book. You probably don't need me to tell you to expect more quotes over the next week or two. ;-)

Saturday, July 11, 2009

Response to a resident's comment

I received a comment on this post today:
As a resident physician I'd like to note that your rant on pitocin was pretty uninformed. You were given oxytocin following delivery for uterine atony, to prevent HEMORRHAGE, the cause of much maternal mortality before your god-awful pitocin was synthesized.

Furthermore, take a look at the medical literature concerning fetal death rates before and after the discovery of oxytocin. Placental abruption, cord compression, hypoxia in utero, chorioamnionitis secondary to prolonged labor times...these were all huge killers of newborns, but you'd likely not KNOW it because you know nothing about medicine. If you're going to complain publicly please try and do it in an informed fashion, lest you mislead women and have them make bad decisions at the hospital.
I started a response in the comments section, but decided the exchange was worth its own blogpost. So I'll paste my response here.

Dear Anonymous resident physician:

I think you're referring to this post. I'm curious what parts of the original post were "uninformed."

You, not having been present at my birth nor privy to my medical charts, can't claim to know the circumstances that led to my being administered Pitocin. I don't have a doubt that stopping a postpartum hemorrhage is a valid use of the drug. Postpartum hemorrhage remains one of the leading causes of maternal death to this day. In fact, prolonged use of Pitocin during labor is one of the risk factors for postpartum hemhorrage. A friend of mine bled excessively following a long induced labor.

I never said I shouldn't have been administered Pitocin. Honestly I don't know because I haven't looked at my charts myself, and I was never given the details while in the hospital. It's possible that the hospital where I delivered gives every woman Pitocin following labor as a precaution. Regardless of those details, the fact is that it interfered with our bonding as I suspect it does for many mothers. Drugs, even when needed, are unfortunately not without harmful side effects. You can read the list of Pitocin's side effects (including postpartum hemorrhage) here. I shared my own limited experience with Pitocin merely to illustrate one of the possible harmful side effects of the drug. So far I'm not seeing anything I've said that qualifies as "uninformed."

I never said Pitocin shouldn't be used when necessary. I'm absolutely grateful for the fetal and maternal deaths prevented by Pitocin. As I said in the original post, "Pitocin has its time and place." But I am simultaneously appalled by the injuries often inflicted when Pitocin is unnecessary. You can't debate the fact that Pitocin is being abused when used without medical reason. You can't ignore the voices of those women and babies harmed by the drug either. I don't have a problem with Pitocin when it's necessary, but I definitely have a problem with it being used "like candy in the OB world" and leading to unnecessary suffering.

You're right that I know nothing about medicine, and I never claimed to. But I have spent the last 6 years of my life passionately studying birth--which is a natural process. Birth has little need for medicine most of the time, but I have always acknowledged that I am grateful for modern medicine for those cases when doctors and medicine become necessary. The lives of women and babies I love dearly have been saved by those wonderful modern advancements.

You're right that I like to rant about Pitocin. And I will keep ranting until doctors stop abusing it. If you aren't aware of those abuses, try googling the new birth buzz-words "Pit to distress" for starters.

It is certainly not my intention to mislead women. On the contrary, I'm on a crusade to educate women so they can make truly informed decisions. I would definitely appreciate and welcome any feedback that would help me to better inform women or to correct any misinformation I may be disseminating, but so far I think I've only shared the facts.

Friday, July 10, 2009

I'm back!

I just got home from a 2 week vacation, and I can't wait to get back to posting regularly here. Stay tuned for some posts once I get my house cooled-off and my head back on straight! Missed you all! :-)