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!

Book Review: The Science of Parenting

I'm catching-up on some things I've been wanting to write posts about for months. Like a book I checked-out from the library ages ago... I heard about The Science of Parenting by Dr. Margot Sunderland (director of education and training at the Centre for Child Mental Health in London) in a Canadian news article with the headline 'Crying it out' may damage baby's brain. Now that's a heavy headline, eh? I was definitely intrigued, so I decided to dig further into this. It took me weeks to read it (bit by bit while nursing), but I finally finished last month some time.

My initial reaction to the book was: it looks and feels like a text book. Lots of pictures, sidebars, bullet points, etc. The tone of the writing also reminded me of a text book--one that was giving you basic information without personality or fluff. But I was sort of disappointed because the book repeats phrases like, "There is a mass of scientific research showing..." but it only speaks in very general terms about what those studies actually show. I guess I expected a book called "The Science of Parenting" to delve more deeply into the science of parenting.

The book also struck me as somewhat biased. It kind of reminded me of Stupid Things Parents Do To Mess Up Their Kids which I read per a friend's suggestion. They're very different books written in very different ways, but they both support narrow visions of "good" parenting. It's no question Dr. Laura favors stay-at-home moms, so her book was like a big pat on the back for me (though I don't agree with everything she says). Similarly, The Science of Parenting leaves no doubt that it was written by a woman who is an advocate of attachment parenting and co-sleeping. For someone like me, it's validating. For an Ezzo-Babywise fan, probably not so much. (Actually, Dr. Laura herself would probably trash The Science of Parenting since Sunderland opposes spanking as a form of discipline.)

So where did the Canadian news headline come from? Sunderland devotes a whole chapter of her book to crying and separation. How does prolonged crying "damage" a baby's brain? Here's an excerpt:

Let's be clear at the outset--it is not crying itself that can affect a child's developing brain. It doesn't. It is prolonged, uncomforted distress. . . . It is the type of crying that goes on and on and on, and eventually stops when the child is either completely exhausted and falls asleep or, in a hopeless state, realizes that help is not going to come. . . . In a crying baby, the stress hormone cortisol is released by the adrenal glands. If the child is soothed and comforted, the level of cortisol goes down again, but if the child is left to cry and cry, the level of cortisol remains high. This is a potentially dangerous situation, because over a prolonged period, cortisol can reach toxic levels that may damage key structures and systems in a developing brain. Cortisol is a slow-acting chemical that can stay in the brain at high levels for hours. (p. 38-40)

I have heard similar explanations in previous reading and research, so this wasn't new to me, but I found Sunderland's explanation, visuals, and charts enriching. Despite these points, I personally feel that intuition trumps science and that we each are given promptings of how to respond to our children individually.

The part of the book I found most helpful was Sunderland's section about the two types of tantrums--distress tantrums and "Little Nero" tantrums. She explains that these two types of tantrums should be handled in very different ways.

Distress tantrums mean that rage, fear, and/or separation distress have sent "too-high levels of stress chemicals searing through his body and brain" (p. 122). These stress chemicals "hijack" your child's ability to think or reason or communicate effectively. Children in distress tantrums need help managing their big feelings. Sunderland encourages parents to remember that their child's distress is genuine and focus on giving physical comfort, emotional empathy, and safety.

Little Nero tantrums are another story. These tantrums are about control and manipulation and rarely involve tears. There aren't stress chemicals involved. Sunderland explains, "A Little Nero tantrum is about a child trying to get what he wants--attention, a particular toy, or food--through bullying his parents into submission. . . . Children who have Little Nero tantrums need to learn that they can't always receive the gratification they want at the time they want it, and that it's not OK to bully or control people to get what they want in life" (p.128). Sunderland encourages parents to ignore these tantrums, avoid trying to reason, argue, or negotiate with the child, remain emotionally calm, and be firm in saying, "No." Above all, don't reward these inappropriate tantrums with attention.

Reading her explanation of these two types of tantrums was one of those "aha" moments. I have seen both types hundreds of times but never really made that distinction or realized that they called for different parental responses. I'm trying to incorporate Sunderland's suggestions, when I remember. Fortunately, Little Nero rarely makes an appearance around here. But I definitely need to work on keeping my cool and ignoring those.

Even though it wasn't really what I expected, I'm glad I read The Science of Parenting. It reminded me to respect my children's feelings and respond in a way that honors their identity as children of God. It helped me to better understand what is happening inside when my 4-year-old freaks out about something--as she often does. It has validated my efforts to create a secure attachment with my babies through responsive parenting--both night and day. I'd definitely recommend the book to others, but only after making them aware of the author's preference for the attachment parenting style.

A couple of Amazon reviewers' statements might be helpful:

I think it inflates the parents' role in child-rearing. It goes completely overboard about activating the wrong parts of your child's brain. I'm not saying there is no merit to this theory, but the book would make it seem a miracle anyone ever grew up halfway sane if their parents nevcer read this book. -SWB "Parent"

[T]he discussion of the science is extremely superficial . . . . To learn more about the science of how the brain actually works, I would recommend What's Going on in There?: How the Brain and Mind Develop in the First Five Years of Life by Lise Eliot. -sammy

I've already put What's Going on in There on hold at our library. It sounds more like what I was expecting The Science of Parenting to be, and the reviews promise lots of dense scientific details. Goody! I also have another parenting book on hold, The Wonder Weeks, per Heather's suggestion. Can't wait to check them out!

Do you have any other book recommendations, while we're at it?

Good news and bad news

The bad: Lyla's back. (Code name my h.s. girlfriends and I used in reference to our menstrual periods when our guy friends were around.) She arrived a few weeks ago, and she was heavy! Hey, I thought you might want to know, especially if you've been following my quest to "keep the monster at bay."

The good: She arrived without a demonic prelude! As in, no PMS! I was initially bummed to see Lyla's return, but the joy of having avoided my usual demons chased the woes quickly away. Plus I realized that Lyla's return will make following our preferred natural family planning technique possible again. Oh and I also didn't have any cramps which was unusual but delightful.

The most consistent changes I've made as part of my PMS game plan were eating (a lot) more mushrooms, purchasing/drinking organic milk and yogurt, using olive oil in place of lotion/moisturizer, taking more omega-3's and vitamin D, eating more almonds (huge stash in my fridge) and trying to get to bed earlier (I was doing pretty well until the holidays hit). I'm also in the process of a gradual weaning from shampoo/conditioner. I'm using a baking soda and water mixture with a bit of shampoo mixed in and vinegar for "conditioner" (Sorry if I smell like a salad these days... just blame it on the olive oil and vinegar). We also got BPA-free reusable water bottles for Christmas, and I've been really careful to avoid microwaving things in plastic (to avoid environmental estrogens). Apparently something's working. Yay! (Oops, I forgot olive oil in my pic. Dang.)

And, speaking of womanly cycles, I'm thinking of reading The Red Tent per Liz's suggestion. She says it's full of birthy-midwifey stuff. Sounds heavenly. I'll be checking it out from the library, I think... if I can ever figure out how to make time for reading books again.

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. ;-)

Pushed and preoccupied

I finally finished Pushed today. I've read a lot of books about childbirth, but this is most definitely one of the best I've ever read. The funny thing is that when I initially heard about the book in '07 and saw it sitting on display with the other new books at my library, I was turned off by it. Being the birth junkie I am, you'd think I would have eaten it up. For whatever reason, I couldn't bring myself to read it. But then my cousin-in-law read it and raved about it. And another friend. And a fellow doula-in-training. And I said to the universe... alright, already! I'll read it!

Thank you, universe. Thank you, thank you, thank you. Or, rather, THANK YOU, Jennifer Block. Too bad we can't mandate that everyone on the planet read the book. ;-)

I can't tell you how many times I read a sentence, statistic, or statement from a doctor or midwife and wanted to write a blogpost about what I'd learned. I think I was stunned, thrilled, appalled, and/or enchanted by something on every single page. I can't wait to read it again. Definitely buying my own copy for future reference and lending purposes!

Alright, enough gushing...

There's no question I loved reading this book, but it certainly wasn't an easy read. There were many times I felt sad enough that I wondered if I could keep reading it. The book also raised some important questions for me... questions I hadn't ever really considered before. And they are tough questions. I don't have time to address all of them here, but I do want to touch upon one or two.

Jennifer Block spent a chapter discussing doulas and childbirth educators. I've dreamed for several years about becoming a doula. I've been trained, I've read the books, and I've felt certain I wanted to pursue this path. Until now. Yup... thanks to Jennifer Block, now I'm just not so sure it's for me. Reading the experiences of the doulas she interviewed, I had to ask myself... can I really do this?! Here's an excerpt that hit me hard:

"Many doulas are emotionally devastated by the treatment they're privy to. 'If you care about birth, doing hospital births is very hard on your psyche,' says Barbara Stratton. 'It's hard to watch what they do to women.' And yet part of the doula's mandate is to make the woman regard her experience as a positive one. The doula ultimately can't throw herself in front of the scalpel, but she can figuritively throw herself in front of the woman's psyche. . . .

"As doulas 'reframe' the birth experience for their clients, they are also shielding the hospital and its care providers from criticism and complaint. . . .

"'The unanswered, fundamental question is whether [doulas] are making birth better for women, or just making women feel better about their births,' write sociologists Bari Meltzer Norman and Barbara Katz Rothman. They raise a fair critique of the doula as an enabler. By supplementing the handholding and informed consent conversations that nurses and doctors should be doing, and by buffering the level of intervention, they are perpetuating the very system that they are in the business of changing. . . .

"'This is is the hidden story of what goes on in birth. We've got folks talking about it as medical rape. Doulas are witnessing these things, and it's eating them up inside'" (p. 160-161).

This section caused me some serious self-reflection. Am I capable of throwing myself in front of the psyches of my clients? Could I really stay positive in the face of abuse? Can I allow myself to be an enabler of this horribly broken system? Can my own psyche handle the emotionally challenging task of witnessing "medical rape" on a regular basis? I really just don't know if I could do it... Maybe I'm better suited to prenatal education? I just don't know if I can handle working in the trenches.

But then I think of the enormous impact doulas have. I think of the women who desperately need a supportive presence as they give birth. Can I leave these women alone?

So many questions... and I'm still not really sure what the answers are.

Pitocin on the brain

I've got Pitocin and induction on the brain. In large part because I'm about halfway through Pushed, by Jennifer Block, and just finished reading about the consequences of Pitocin and labor induction. Here are some sobering excerpts...

"A British midwife told a researcher that the sounds women make when they're on artificial oxytocin [Pitocin] are hauntingly different: 'It's a panic, it's a scream and it's different from the noise they make when they're working with their bodies. . . . It sounds like someone's being murdered'" (p. 135).

"And with an epidural deadening the body's natural pain threshold, staff can keep upping the dose, which can lead to contractions that fire like a machine gun or that last for minutes, during which time the fetus is oxygen-deprived. This is called hyperstimulation. It is not uncommon and would be considered a trauma--beyond what is normal" (p. 137).

"A recent ACOG survey found that in 43% of malpractice suits involving neurologically impaired babies, Pitocin was to blame" (p. 137).

"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).

"A 2004 study out of Australia found that autistic children were twice as likely to have been born without natural labor, either by elective cesarean or induction" (p. 139).

Pitocin use in U.S. hospitals has increased alarmingly in the past couple of decades. In 1990, only 9.5% of labors were induced. In 2006, in a study of 5500 low-risk, first-time mothers, 40% were induced and 70% received Pitocin at some point during labor (see Pushed, p. 5-6).

I can see these stats reflected all around me. I know very few women who have given birth without Pitocin dripping through their veins. If it's true that 70% of low-risk first-time mothers are given Pitocin, then it's no wonder birth horror stories and epidural use are the norm. How strange that so few women know what normal birth actually feels like. Instead they have a warped and painfully skewed misrepresentation. We are human beings, but yet so far removed from the most basic human experience.

The truth is that we really don't know how these highly-medicalized births may be influencing and possibly damaging our society. Oxytocin is the hormone of bonding and love, so some suspect that these births (virtually devoid of natural oxytocin) may be partly to blame for the increased violence, autism, and other mental and psychological disorders running rampant in our modern world. Pitocin (and cesarean sections) may also influence how we bond and how we respond to our children as parents.

I've never had Pitocin in labor, but I was given Pitocin through my IV following my first daughter's birth to help slow my bleeding. It wasn't until a couple of weeks ago that I had an epiphany about that Pitocin drip. It's almost certain that once Pitocin was introduced into my system, my body stopped or slowed its own oxytocin production. Artificial oxytocin doesn't produce the same bonding effects as the hormone produced by our own bodies. It wasn't until roughly a week after her birth that I "fell in love" with my daughter. I thought there was something wrong with me... why didn't I love her right away? I'm now quite certain that Pitocin interfered.

There are certainly plenty of women who fell in love with their babies at first sight even with Pitocin or cesareans. But not all women do. Everyone's individual body chemistry is unique. If I could struggle even having had an unmedicated, wonderful birth experience, I have to wonder what it would have been like for me if I'd had drugs or a cesarean... I shudder to think where those paths might have taken me...

Then I contrast those struggles with my most recent birth, and I'm in awe. As my births have gotten progressively more "natural," bonding has gotten progressively easier. And my parenting style has gotten progressively more responsive. I spent the first couple of weeks after my son's birth feeling blissed-out and totally and madly in love with him. In fact, I could hardly bear to be separated from him. What a change from my Pitocin-jolted postpartum experience!

Pitocin has its time and place. But there's no question that it--and the droves of women and babies receiving it needlessly--are being abused. Will we stand by and let this abuse continue?

Hodgepodge

I've missed this blog. And I've had a lot of things I've wanted to post here. But my poor baby boy was somehow exposed to Staph and contracted a horrible infection (bullous impetigo), so we've been preoccupied with that. Fortunately, he appears to be nearly back to normal!


Here's a quick hodgepodge of things I've been wanting to share...

International Midwives Day Celebration

If you live in AZ, be sure to attend this awesome event. If you live elsewhere, hopefully your local birthing community is planning something. If not, maybe you could plan something yourself! Here are the details:

WHO: Midwives, Families, Doulas, Childbirth Educators, the Birth Community, and anyone interested in supporting midwives and learning more about the Midwifery Model of Care

WHAT: A Celebration of Midwives, including a potluck (bring a dish to share!), raffle with prizes, kids area, maternity and children's clothing exchange (bring your stuff!), and informational booths

WHERE: Papago Park, 625 North Galvin Parkway, Phoenix, AZ 85008, Ramadas 9 and 10 (Please park in Phoenix Zoo Parking Lot)

WHEN: Tuesday, May 5th From 10 a.m. To 2 p.m.

WHY: Midwives provide the highest level of healthcare to the pregnant women and families they serve. Let's get the word out and celebrate these amazing women!

An Award for Ina May

Ricki Lake and Abby Epstein (the creators of "The Business of Being Born") will be presenting Ina May Gaskin with their first "Best Birth" Award on May 5 in honor of the huge contribution she has made to American midwifery and maternity care. As part of the presentation of their award, they want to present Ina May with a large donation toward her Safe Motherhood Quilt Project and her efforts to raise awareness about preventable maternal deaths. Ricki and Abby will match every $5 donated. Please consider making a donation! Here's how:

Please make your $5 donation for Ina May via paypal.com to the account barrancaprod@gmail.com. If you prefer to send a check, please make it out to "Business of Birth LLC" and mail it to: Business of Birth, 15 W. 11th St. #3A NY, NY 10011. Email info@thebusinessofbeingborn.com if you have any questions.

Birth Models That Work

I really wish I had a spare $65 to order this new book!

Courtesy of my 3-year-old

In reference to her baby brother: "Mommy squished his head out. Like a big poop. And the midwives catched him. And then they washed their gloves 'cause they got all messy."
Birth Photos

My doula brought over a disc with my birth photos last week! I've selected the "appropriate" ones for public viewing and plan to make a slideshow (or something) soon. Stay tuned for those! :-)

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.

You never forget the first time

"How will she remember this?" -Penny Simkin

I got a packet in the mail from my doula trainer a week or two ago. It included info about our upcoming workshop as well as some pre-workshop homework and readings. One of the items is a reprint of Penny Simkin's research published in 1991 in the journal Birth: Issues in Perinatal Care--"Just Another Day in a Woman's Life? Women's Long-Term Perceptions of Their First Birth Experience. Part I." So I sat down and read it last night, with pen in hand, of course.

And I just gotta say... wow... I learned so much for this piece. The points that struck me most...

1) We've come a LONG way, baby! Penny Simkin's research reports her findings from interviews conducted with women who participated in her childbirth education courses between 1968 and 1974. So she gives a list of typical features of intrapartum care in that time period to develop a context for her research. For example... no private labor rooms, enemas/pubic hair shaves, restriction to bed, fathers rarely present, formula feeding (fewer than 20% of women breastfed), baby in nursery except for daytime feedings, and 4-5 day hospital stays for vaginal births. Wow. We still have a long way to go, but, man, I'm glad so much has changed.

2) 5% ?! There is ONE thing I'm NOT glad has changed. The cesarean rate at this time was a mere 5%! Good heavens. So in the past 40 years doctors must have figured out that they could avoid malpractice lawsuits and sleepless nights best if they just played the "hero" card and sliced babies out of their mothers rather than letting nature take its course. Then, of course, placing the blame on the women: "Your body just wasn't built to handle birth," or "Your baby would have died if I hadn't cut you open," or "More women are asking for cesareans." Whatever helps them sleep at night, right? Clearly there are cases when cesareans are warranted, but 5% to a whopping 31.1%?! Unfortunately, just as the cesarean rate has increased, so have the rates of serious complications associated with them.

3) Even highly-interventive births can be highly satisfying. This one was a shocker for me. Simkin divided her research participants into two groups based on how they rated their level of satisfaction with their births--high satisfaction and less satisfaction or dissatisfaction. I was surprised to see that more women in the "high satisfaction" group were given Pitocin, episiotomies, and forceps deliveries than in the less satisfied group! How could it be?! Simkin concludes that what really makes the difference for women is not necessarily what happens to them during their births but how they felt throughout the process. The women in the satisfied group remembered their interactions with doctors and hospital staff as positive. The women in the less satisfied group all reported negative interactions with doctors and staff. How women are treated makes an ENORMOUS impact.

4) When will they listen?! I became livid when I read one woman's account of her negative experience: "Anyway, the doctor wanted to give me a spinal. And I was just sure I could push this baby out if I could just get up there and get some leverage, I could squat and push the baby out. 'Nope, not that, couldn't do that,' so about it seemed like 20 or 30 minutes, he said that I should have a spinal. So I had a spinal. . . . I was no only put down by the doctor and the supporting staff, but by that point there were a couple of other doctors that had come in and some interns, and I felt like this guy partly wanted to show off."

$*#&^*&%^@^@%#&!^&@^!! The sad thing is... this could have happened yesterday. In fact, I'm sure it's happening somewhere right now.

5) This sounds familiar... Another woman's account brought back fond memories of my own first birth experience: "One nurse had been there the whole time, and then when she was off shift, she still wanted to stay with me. She seemed like she was really interested and involved, and that she really cared. I thought it was neat and it made me feel very special." I will never forget my nurse, Eve. In fact, I like to call her Saint Eve. Heaven bless that woman and all the other nurses like her.

To close let me share Simkin's own conclusions:

"The way a woman is treated by the professionals on whom she depends may largely determine how she feels about the experience for the rest of her life. A woman in labor is highly vulnerable. Her most private body parts are exposed; she is in pain; she sweats, trembles, moans, and cries out while among strangers; she is in a strange environment. If she is treated without respect, if her efforts to maintain dignity and control are rebuffed, or if she is taken advantage of, the negative impact is permanent. If she is nurtured, treated with kindness and respect, and feels like a participant, the positive impact is permanent. . . .

"Because the woman may remember her caregiver forever, the question, 'How will she remember this?' should be in the caregiver's mind at all times. . . .

"[M]uch more is involved in the outcomes of 'a healthy mother and healthy baby' than coming out of it alive with no permanent physical damage. The potential for psychological benefits or damage is present at every birth. . . . In addition to a safe outcome, the goal of a good memory should guide their care."

Oh, I love you, Penny Simkin. I've loved you ever since I first opened The Birth Partner nearly four years ago. If you don't already love her, my friends, you will. Especially after you read this.

I'm so excited to join the doula ranks Penny spurred into action. :-)

Giving Birth, so far

I'm about a third of the way through Giving Birth: A Journey into the World of Mothers and Midwives, by Catherine Taylor. So far, I find it fascinating! It is exactly what it says it is--a journey into the world of mothers and midwives. It has opened my eyes to just how unique each mother and each midwife/doctor is. Though we can say that most midwives have common philosophies, they are by no means a uniform group. Midwives' practices vary widely depending upon where they deliver, who their back-up physicians are, what insurance companies they're affiliated with (if any), and where they received their midwifery training. Even within ONE midwifery practice each midwife will have her own style and leanings. Catherine Taylor also masterfully weaves-in statistics and research about birth and various medical interventions. Here are some excerpts I found informative, eloquent, right on, or though-provoking...

I don't understand the hospital's need to separate mother and child; I don't understand their need to immediately quantify everything about the baby. Can't that wait an hour? And couldn't any observations that need to be done to assess the newborn's health be done with the baby lying with or on the mother if she wants it there? (p. 38)

"Most clients ask about ultrasound," Sarah comments. "A decade ago we did them routinely. But the cost to the system is high, and routine use has not been shown to improve birth outcomes," she explains. In situations where the doctor bills for every service and the patient's insurance pays for these kinds of tests, some doctors still order them automatically. In fact, I have one friend whose doctor ordered an ultrasound for every visit. When she asked why this was necessary, he brushed her off, saying, "Oh, it gives us important information," without explaining what that information might be or what they might be expected to do with it. In fact, the American College of Radiology recommends that ultrasound screening be done only when there is a "valid medical reason," and the World Health Organization finds that "routine ultrasound assessment has not been shown to decrease morbidity and mortality" (p. 42-43).

On this final item [epidural-induced fevers], Nancy's statements are backed up by research done by Dr. Ellice Lieberman of Harvard University and published in the journal Pediatrics that shows epidurals are indeed associated with a hugely increased frequency (fourteen-fold) of fevers in birthing mothers and finds that the resulting "neonatal sepsis workups and administration of antibiotics are not necessarily benign." . . . She concludes, "Given the cost, risk, and pain to the newborn, the higher proportion of sepsis workups that may be attributable to epidural use is cause for concern" (p. 58).

[Liz] explained, "If you have a midwife manage the same population as a physician, the midwife is going to order fewer tests, she's going to have fewer expensive interventions and procedures, and she's going to have better outcomes, despite the fact that she didn't throw all this technology at the patients" (p. 73).

More good stuff to come!

"Running for Two"

I just finished reading this great blogpost over at "Running for Two." Lisa is chronicling her first pregnancy as a runner and is nearing the finish. She draws a great analogy between the role of a "pacer" in an endurance race and a labor coach. Check it out!

Also, I've been skimming a book from the library--Exercising Through Your Pregnancy, by James F. Clapp. Based on the research presented by Clapp in this book, I'm totally convinced that exercising (safely) through pregnancy is one of the best things you can do for your unborn child (and yourself). I am definitely looking forward to exercising through my next pregnancy. Here are some of the benefits Clapp discusses:

* Limited weight gain
* Less physical discomfort
* More energy
* Easier, shorter, less complicated labor
* Newborns who "readily self-quiet" and "need less consolation from others"
* Some evidence that the children of women who exercise throughout pregnancy have heightened intelligence and oral language skills (as measured at 5 years of age).

Good stuff, eh? Have you had experience with any of these benefits of exercise in pregnancy? Please share!

P.S. It can be tricky to find active wear to accommodate a growing belly, but Fit Maternity will have you covered. Be sure to check out the support belts!

Improving Fertility

It seems that more and more women are struggling with infertility. I’ve heard several explanations for this increase. Some say it’s the result of estrogen-like pesticides in the environment. Others blame the increasing trend of delaying childbirth. Regardless of the cause, I worry that far too many women feel helpless in their struggle with infertility. I was lucky to become pregnant with my first daughter after only nine months of trying off and on. Some women try for years without luck, many of them being pumped full of expensive drugs and chemicals supposedly designed to help them. Several women whom I love dearly are currently struggling with this heart-breaking problem. I’m always looking for natural solutions to health problems, so I decided to do a little internet research about infertility and see what I could come up with. Here are are some tips for boosting your fertility (and your overall health).

1. Attempt pregnancy during your peak years of fertility (age 20-27). A woman reaches her peak of fertility sometime between the ages of 24 and 27, depending on which expert you ask. Eggs released between the teens and late 20’s are the most fertile and highest quality eggs released in a woman’s lifetime. (more info, more info)

2. Avoid alcohol and caffeine. Alcohol and caffeine decrease both female and male fertility. One website indicates that alcohol and caffeine consumption (more than a cup of coffee a day) can each decrease your fertility by 50%.

3. Avoid refined carbs. High insulin levels are associated with infertility (source). Though every person’s insulin response is slightly different, in general, the more refined the carbohydrates, the stronger and faster your body’s insulin response will be. Limit your intake of refined carbs such as sugar, high fructose corn syrup, white breads and pastas, etc. Choose whole grain carbohydrates and balance each meal with protein, fiber, and healthy fats to slow down the body’s insulin response. In a recent study conducted by Harvard researchers, reducing intake of sugar and refined carbs was one of eight lifestyle changes associated with a significant increase in fertility.

4. Maintain a healthy weight. Excess body fat can lead to increased levels of estrogen, throwing off hormonal balances and disrupting a woman’s fertility. The opposite--extremely low body fat--is also not conducive to baby-making. Women who are unhealthily thin can experience amenorrhea (absence of menstrual periods). Take whatever actions necessary to bring your weight into a healthy range. For some women, this step alone is enough to help them conceive.

5. Eat lots of fruits and vegetables. Dr. Randine Lewis outlines the importance of balancing the body’s pH levels to promote conception. In her book, The Infertility Cure: The Ancient Chinese Wellness Program for Getting Pregnant and Having Healthy Babies, she explains, “Acidic cervical mucus may become hostile to sperm, which requires an alkaline environment to survive”(source). Most fruits and vegetables (with a few exceptions) are alkalinizing, so they will promote a pH environment more friendly to sperm. Fruits and vegetables are also loaded with antioxidants which promote overall health and help to protect the reproductive organs from stress. Antioxidants have also been shown to improve male fertility by promoting sperm health.

6. Eat meat, poultry, fish, and full-fat dairy products. Vegetarian and vegan diets tend to be low in vitamin B12 and can lead to vitamin B12 deficiency. Vitamin B12 plays a key role in ovulation and the development of new tissue, so women who are deficient often struggle with infertility and repeated miscarriages (source). The best sources of vitamin B12 are fish, meats, and dairy products (supplements are also an option). When you consume dairy products, be sure you are eating full-fat versions. A study conducted by Harvard researchers revealed that women consuming high-fat dairy products had a lower risk of infertility from ovulatory disorders, and women consuming low-fat dairy products had a significantly increased risk of infertility from ovulatory disorders.

7. Spend time in the beautiful sunshine (or, in other words, increase your vitamin D levels). Vitamin D deficiency can lead to infertility. One study with female rats showed a 75% decrease in fertility among those with vitamin D deficiency. Vitamin D deficiency is the most common vitamin deficiency in the U.S., so you may be deficient without even realizing it. One of the best and easiest ways to increase your vitamin D levels is to simply spend time outdoors in the sunshine (without sunscreen). When sunlight hits your skin, your body produces ample amounts of vitamin D. As always, you’d want to avoid burning. In addition, you can take a vitamin D supplement.

It's my belief that most of our health struggles have logical causes and natural solutions. For many women struggling with fertility, it may be that a few simple lifestyle changes can make all the difference. At the same time, it is likely that some women will be fertile no matter what they eat and drink, and some women will be infertile no matter how healthy their food and lifestyle choices are. Sometimes it's simply out of our hands. Despite those cases, I believe we can take charge of our health and make significant improvements. Even if the tips above don't lead to conception, they will lead to greater health. And that's something we can all benefit from.