The irrelevance of home vs. hospital

Ever since a conversation last night with my brother and sister-in-law, I've had this phrase going through my mind:  "It's not where you are, it's who you're with."  It seems to me that traumatic births often prompt couples to choose an alternative path for subsequent births.  For those who experience that trauma in the hospital, home birth often provides the healing they seek.  Because of the trauma my brother and his wife suffered following their home birth (and I do think my brother has some valid and genuine post-traumatic stress), they will likely have all of their subsequent children in hospitals.  I think it's just human nature to associate those intense frightening emotions with the place where they occurred regardless of whether the place contributed to their occurrence.

We can strive to reduce complications, we can keep our bodies healthy and strong, but we can't control everything that arises as we give birth.  Complications can and do arise in all birth locations.  As long as a laboring woman is within the standard "thirty minutes from decision to incision," what matters most in the midst of a birth complication is who is taking care of her and how do they respond?  Do they have the skills, experience, presence of mind, and knowledge of evidence-based practice to ensure her safety and well being?  Being five minutes from (or even inside of) a hospital doesn't guarantee that a care provider will advise the best possible solution to a problem.  Likewise, being at home with a midwife doesn't guarantee that a birth will be peaceful and empowering.  Midwives can degrade and doctors can earn the title "Wonderful." It's not where you are, it's who you're with. 

Read the rest of this post at my new website!

The positive impact of prenatal exercise

The following is a re-post of my August 2008 post Wanna Improve Your Odds?:

I mentioned back in April that I had been skimming the book Exercising Through Your Pregnancy, by James F. Clapp M.D. I was really impressed at that time with the amazing benefits of exercising through pregnancy. But I didn't read the book in-depth. I decided earlier this week that I wanted to take a closer look. Now that I've read several of the chapters and examined the data thoroughly, I am telling you... it absolutely blows me away.

There are risks inherent in pregnancy and childbirth, but we can do things to minimize those risks. We all know that good nutrition is essential for pregnant women. Poor nutrition often leads to pre-term and low-birthweight infants as well as pre-eclampsia in mothers. Eating well is one of the absolute best things you can do for your unborn child's physical and neurological growth. But now I'm convinced that exercise may be just as important.

I won't go into all the benefits of prenatal exercise here. I'd just like to focus on one set of benefits in particular--the effects of exercise on the course of labor. You might remember my very early post about the benefits of doulas. Having a doula assist your labor and delivery reduces many chidbirth risks significantly. Prenatal exercise has even more pronounced benefits.

Women who continue exercising regularly through the end of their pregnancies (three times a week for at least 20 minutes at a moderately hard to hard level of exertion) demonstrated the following reduced risks during the birth process...

* 35% decrease in the need for pain relief
* 75% decrease in the incidence of maternal exhaustion
* 50% decrease in the need to artificially rupture membranes
* 50% decrease in the need to induce or augment labor with pitocin
* 50% decrease in the need to intervene because of abnormalities in the fetal heart rate
* 55% decrease in the need for episiotomy
* 75% decrease in the need for operative intervention (forceps or cesarean section)

In addition, check these out...

* More than 65% of the exercising women delivered in less than four hours.
* 72% delivered before their due date (but fewer of them delivered before 37 weeks--preterm--than the control group). The exercising women delivered, on average, 5-7 days earlier than active women who did not exercise regularly.
* Significant reduction in the incidence of umbilical cord entanglement.
* Much lower incidence of fetus passing meconium from distress.
* Umbilical cord blood samples indicated that babies of exercising moms remained relatively stress-free with plenty of oxygen. They seemed to tolerate the stresses of labor and delivery better than the control group.
* The exercising mothers' infants were, on average, 14 oz lighter but overall growth was not compromised.
* Placentas of exercising mothers are larger, more efficient, and healthier-looking.
* Infants born to exercising mothers were more alert postpartum and needed less consolation from others.

(All of these results are taken from Dr. Clapp's studies as reported in Exercising Through Your Pregnancy. See this fabulous book for even more amazing benefits.)

It blows my mind.

Imagine how huge the risk reductions would be if you exercised through pregnancy AND had a doula. Whoah. We can do so much to avoid the pitfalls of pregnancy and birth. It gives me so much joy and hope to know that I am not at the mercy of chance. I have a great deal of power over my circumstances when it comes to pregnancy and birth. It is a wonderful thing to be able to choose to pro-actively reduce risks and bring so much benefit to myself and my babies. I love it!

Mothering at the breast

Back in January, my baby was admitted to the hospital with a bizarre rash and swelling.  During his illness and our hospital stay, I'd say he was at my breast at least 70% of the time.  When the nurse wanted to give him an I.V. for fluids, fortunately I asked, "Are you worried he's becoming dehydrated?"  After assuring her that he was breastfeeding almost constantly, they agreed to hold off on the I.V. as long as I kept track of all his feedings and he continued to have lots of wet diapers. So they gave me a chart to mark all his "feedings."  It was kind of a joke.  When a baby is almost constantly nursing both day and night?  Ha.

One of the mornings, when the nurse asked about the feeding chart, I mentioned that it was hard to keep track in the middle of the night because he was nursing so often and sometimes I fell asleep mid-feeding and wasn't sure when it officially "ended." It was clear from her facial expression that my nursing style was totally foreign to her.  She replied, "Well, then that's not breastfeeding... that's just for comfort."

I was perplexed by her response.  What's the difference? Of course he wanted extra comfort... he was very sick, sleeping in a foreign place, being awakened repeatedly (after finally, blessedly falling asleep) for nurses and doctors to "take a peek" at his rash, being poked multiple times for blood draws and tests... of course he wanted and needed extra comfort!  But that "comfort" and my breastmilk were inseparable. Even if a baby is suckling only for comfort, the breast doesn't know the difference.  The breast responds to suckling by giving milk.

And how grateful I was that the only thing he wanted to do was nurse!  While many babies with his illness develop gastro-intestinal discomfort, blood in the stools, and other more serious problems, he never did, and I attribute that to the vast amounts of breastmilk he consumed during that time.

In my mind, nursing is so much more than "feeding."  I have never wanted to restrict my babies' suckling time to conform to when they "should" be hungry.  When one of my babies becomes distressed, the first thing I almost always offer is my breast, even if they just "ate" two minutes before.  If they don't seem interested or aren't calmed by suckling, then I try other ways to soothe them.

I was talking with a friend last week about how my babies have never taken to bottles or pacifiers.  I mentioned that my baby boy will happily drink water from a bottle when he's thirsty, and he would probably even drink milk from a bottle (though we've never tried).  The other day he found an old pacifier and sucked on it for a bit for fun.  But if someone tried to stick a bottle or pacifier in his mouth when he was grumpy, tired, afraid, or distressed, he would cast them away and only scream harder.

I am his pacifier.  I am the only answer to his deepest cries.  Nothing and no one else can give him what I can give.  Call it "just for comfort" if you want, but it's all the same to me.  In my mind you cannot separate breastfeeding, nursing, and soothing... they are all one.

There are many who would say my son no longer "needs" breastmilk or night-feedings because he's 14-months-old.  There are some who would have said he didn't need them when he was in the hospital at 9-months-old.  I say that the time when I am able to provide this gift to him will pass in the blink of an eye.  This time when only my body can comfort him is precious and fleeting.  If it means I will lose a few years of uninterrupted sleep, so be it.  If he's three years old before he's able to soothe himself back to sleep on his own, so be it.

Because of my own history and struggles with abandonment issues, there is almost nothing more important to me than establishing a secure, unbreakable attachment with my babies... telling them with my every touch and action that I will always be here... that I will never abandon them, especially when they need me the most, no matter what time of day or night.  I've never regretted one moment of nurse-comforting my children, and I feel confident that I will look back when I'm past my childbearing years with gratitude that I didn't push those precious nursing relationships away for the sake of independence or convenience.  (P.S. Moms who don't continue nursing through the second year are really missing out on the best trick up their sleeves for dealing with those daily toddler tantrums.)

Me and my almost 15-month-old nursling last weekend

I appreciate these words (shared by Sarah, one of my facebook fans) from lactation consultant, Diane Wiessinger:

Easy, long-term breastfeeding involves forgetting about the "breast" and the "feeding" (and the duration, and the interval, and the transmission of the right nutrients in the right amounts, and the difference between nutritive and non-nutritive suckling needs, all of which form the focus of artificial milk pamphlets) and focusing instead on the relationship. . . . [T]he real joys and satisfactions of the experience begin when they stop "breastfeeding" and start mothering at the breast.  (Source)

Maybe that nurse in the hospital was right, after all.  I wasn't really "breastfeeding" in that hospital, I was mothering at the breast.

You know you're a birth junkie when...

...you see a photo like this one (taken by yours truly this very morning in the woods near Payson, AZ)...

...and think:  Placenta!

Rejoicing with a friend

We must not, in trying to think about how we can make a big difference, ignore the small daily differences we can make which, over time, add up to big differences that we often cannot foresee.  -Marian Wright Edelman

Back in January, I got a surprising email from a local friend.  I discovered:

1) She was pregnant with her first baby. 
2) She had been following my birth blog.
3) She had chosen a practice of fantastic nurse-midwives. 

She also said, "I've loved reading about your home birth... I just am not 'courageous' enough to go that route on a first (maybe our next?)." 

All of these discoveries made me giddy with excitement.

Then at the end of April, she and her husband attended my "Birth Coach Boot Camp" where I shared what I believed were the best ways husbands can help their wives in childbirth.  Her due date was right around the corner, so I sent her home with my birth ball and my copy of The Birth Partner, by Penny Simkin.  And then we waited. 

Nine days after her due date, she sent me an email announcing that her daughter "was born last night at 10:44 p.m.  She is 7lbs 14 oz and 20 inches long.  We're both doing well."  I couldn't wait to hear all about the birth, but I didn't want to pester her about it, so I waited.

A couple of weeks later, I got a knock at my door.  There was my friend.  She said, "I have a bunch of things for you," returned to her car, and came back with my birth ball, my book, an envelope, a typed document (multiple pages of birth details!), and a sweet treat.  We chatted for a few minutes while she told me about her birth.  With the exception of having her water broken, everything had gone as she had hoped--intervention-free and unmedicated.  She was full of thanks for my help.  I was full of giddiness with joy for her.  It made my day.

After she left, I opened the envelope.  It was a thank you card.  She said, "I feel like I owe you a big thanks for so many things.  I've appreciated your passion and encouragement during this pregnancy."  More warm fuzzies.

Then I read the document with all the wonderful birth details.  Oh what a joy to read.  Because her midwives had three clients in labor that night, it was a little chaotic for them.  In the end, my friend's baby was caught by the nurse.  Her thoughts afterward:  "I felt empowered, like we could really do this on our own--we practically had!"  When the midwives came back in, they began talking about her needing to be stitched-up and delivering the placenta, but my friend remembers "not caring what anybody was saying and just happy to have the baby on my stomach."  The very last thing she wrote in that document was that she remembers:

Feeling grateful for the birth coach class our friend had offered.  It helped me feel empowered to say what I needed without fear. . . . It also helped me to put special emphasis on making sure I provided positive feedback by telling them the things that helped.  Finally, it introduced us to techniques of providing counter-pressure.  That turned out to be the only pain relief we needed!

 There are days when I throw mini birth-tantrums, and say, "Forget it!  I'm wasting my time trying to make a difference!  Nobody even cares!"  And then there are days when I know that I can never stop sharing what I know and love about childbirth.  The day my friend said, "Thank you," was one of those days.  A magical day.  

Never stop sharing, my friends!  Never give up.  We are making a difference.  Maybe only for one woman here and another woman there, but those women are worth it.  And so are their babies.  And there is nothing in the world like rejoicing with them as they bathe in the joy and empowerment they feel from their positive birth experiences.  Nothing in the world.

Is water birth safe?

(Trying out our birth pool a week before my home birth.  
I labored in the water, but delivered on my bed.)

I realized several weeks ago that there was a fairly important gap in my personal research on the subject of water birth.  While I have read a lot about it in books, heard rave reviews from friends, and seen countless water birth YouTube videos, I hadn't personally delved into the scientific literature about water birth.  Anecdotal and second-hand evidence can be very helpful, but I wanted to see the nitty-gritty facts myself.  Especially after I did a google search and found an OB's blogpost slamming water birth and all its dangerousness.

What I found was that most of the scientific journal articles that come up through a water birth Google search were anecdotal reports and/or case studies of individual cases where doctors suspected that a water delivery contributed to a child's death or poor health.  The general sentiment among doctors is fairly well summed-up in this concluding statement (from an article in the journal Pediatrics) penned jointly by a pediatrician, nurse, and obstetrician:

After reviewing the literature, we stop to ponder: what evidence of harm would be enough to convince us to stop the practice? Should the report of a single drowning be enough? Apparently, it was not. At this point, we are convinced there is no evidence to support any benefit of underwater birth for the neonate, and plenty of evidence to suggest harm. (source)

Another doctor was so bold as to say:  "Water births currently provide no apparent benefit in childbirth" (source).  The introductory paragraph of his article had me chuckling to myself:

Despite an absence of supporting evidence, proponents of water births claim benefits and disregard concerns while continuing to fail to subject this approach to the rigors of scientific inquiry. This desire to ignore the facts may be particularly prevalent among individuals who prefer nontraditional delivery techniques.

I'm not about to suggest that water birth was the norm among our ancestors, but I would hardly call stirrups+hospital bed the "traditional" delivery technique.  Women have only been giving birth strapped to beds for a tiny portion of human existence.  And I won't waste my time addressing his claim that ignoring the facts is prevalent among those who prefer to deliver in "nontraditional" ways.

It can be frustrating and confusing trying to find the facts when it comes to water birth.  The most comprehensive review of the water birth research (that I'm aware of) is the Cochrane review.  Here's what the Cochrane researchers concluded in 2004:

There is evidence that water immersion during the first stage of labour reduces the use of analgesia and reported maternal pain, without adverse outcomes on labour duration, operative delivery or neonatal outcomes. The effects of immersion in water during pregnancy or in the third stage are unclear. One trial explores birth in water, but is too small to determine the outcomes for women or neonates.

So, basically, what we know from the scientific literature is that immersion in water can make labor less painful, but apparently we don't have rigorous enough scientific evidence to demonstrate the relative safety of water deliveries when compared with land deliveries. 

There are other studies demonstrating many benefits of water birth (though I can't personally vouch for the level of scientific scrutiny used by the researchers).  While these studies seem to have been primarily ignored or dismissed by the medical community, they can still be helpful as we strive to explore all the evidence. Here are some of them:

Waterbirths: a comparative study. A prospective study on more than 2,000 waterbirths.

Experience with water births: a prospective longitudinal study of 9 years with almost 4,000 water births

A retrospective comparison of water births and conventional vaginal deliveries.

Effects of water birth on maternal and neonatal outcomes.

Midwife Ronnie Falcao's website also contains a wealth of information on water birth safety.

I think it's helpful to keep in mind that adverse outcomes can occur regardless of mode/location of delivery, and that many modern obstetric practices have been shown by scientific study to be risky or questionable.  So I'm a little baffled by some doctors' outrage about water birth and their claims that it shouldn't be allowed to continue without rigorous scientific support.  If only they required the same standards for their own practices.  Back in April 2009, I quoted Jennifer Block from Pushed:  "A recent ACOG survey found that in 43% of malpractice suits involving neurologically impaired babies, Pitocin was to blame" (p. 137), and again: "Even Williams Obstetrics offers a sobering history: 'Oxytocin is a powerful drug, and it has killed or maimed mothers through rupture of the uterus and even more babies through hypoxia from markedly hypertonic uterine contractions'" (p. 138).  Yet many doctors still pump women full of Pitocin, often with little or no medical necessity.  Given that the percentage of women giving birth underwater is miniscule compared to the number of women being routinely administered Pitocin (a powerful drug with known and frightening side effects), I think tackling the Pitocin problem is far more urgent.

I would love to see a huge randomized controlled trial exploring water birth.  I would love to see this matter rigorously addressed.  In the meantime, what can we do?  I suppose each of us must use whatever tools available to us to determine what is best and safest for our individual circumstances.  For me, that includes my own intuition and Spiritual guidance from my Creator who knows the birth process and my body better than any other being.  I may not be able to determine, with certainty, that water birth is safe for you or anyone else.  But I feel confident I will be able to determine down the road whether it's right for me.

I'd appreciate any wisdom, stories, and insights you might have.

Re-post: Tips for avoiding tearing and episiotomies

Things have been quiet in my corner of the blogosphere despite my having one or two posts in the works in my head.  I just haven't had a block of time to get them on "paper."  In the meantime, I thought I'd re-post and oldie but goodie from the early days of my blog since some of my newer readers might not have seen it and might find it helpful.  (Stay tuned for a post about waterbirth next.)

Giving birth for the first time was one of the most empowering experiences of my life. My water broke, my contractions started, everything progressed smoothly, and, less than six hours later, my baby girl was born. It was an ideal birth experience, except for one thing. That one thing made my next few weeks of recovery extremely painful. I tore. I really tore....

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