Seeking your input

I'm doing a daddy-doula "boot camp" for two couples soon to embark on their first drug-free hospital births. If you had less than two hours to teach dads how to help their wives through labor, what would you say are the best things I could teach them?

I know I'm starting to sound like a broken record

I'm amazed that magnesium is the real answer to so many problems, but even many scientists and researchers seem unaware of its importance.  This Reuters article talks about the rise in kidney stones among children in South Carolina and points to excessive antibiotic use as a possible cause.  Antibiotics deplete magnesium!  And the "stone belt" (from Virginia down to Florida and over to Texas) mentioned in the article is an area of the country with primarily very soft water--low mineral content.  Hard water and healthy gut bacteria help raise our bodies' magnesium levels.  They don't mention it in the article, but low magnesium can lead to kidney stones. Magnesium is the missing puzzle piece no one (well, almost no one) is talking about.

Get yer magnesium, my friends!

Hear me roar

After a few weeks of caring for her precious first-born baby, my friend Fig declared, "Motherhood is blood, sweat, and tears. Rinse and repeat." Are you nodding and chuckling at the same time? Fig's good at inducing the chuckle-nod. She's so witty. And right on.

So I've been thinking, of late, about how I focus so much on the intense physical challenge of labor (some, including me, call it "pain") that I have sort of neglected to give attention to other physical "pains" associated with bearing and nurturing children. For example...

* The cramping associated with ovulation and/or menstruation is painful for some women.
* PMS can cause painful bloating, headaches, etc.
* Love-making is painful for some women.
* Some women experience round-ligament twinges and/or cramping in early pregnancy.
* Morning sickness can range from mildly bothersome to excruciatingly miserable.
* Some pregnant women suffer with back pain, sciatic nerve pain, joint pain, etc.
* Preterm labor pains keep some women on bed rest for weeks or months.
* Then there are the after-pains (I think they get worse with each birth... wowza!).
* Some women endure general perineal tenderness, pain from perineal tears/episiotomies, or cesarean section wounds.
* Breastfeeding hurts like the (toe-curling) dickens in the beginning, being compounded initially by painful breast engorgement, painful milk let-down, and more intense after-pains due to the uterine contractions produced by suckling.
* The muscle strain from carrying around a 5 to 10 lb newborn can lead to sore arms and/or sore backs, especially with a first child.
* Once an infant has teeth that introduces a whole new kind of potential pain during breastfeeding.
* Back pain can continue and intensify from carrying increasingly hefty babies and toddlers.
* Rinse and repeat.

(And that's not even getting into the emotional pains we endure.)

The other day a first-time pregnant woman I love told me she's pretty sure she'll get an epidural 'cause she's (and these were her exact words) "such a pansy." I couldn't help myself... I rushed toward her, grasped her face in my hands, and said, "No! You're not!" This woman has endured excruciating menstrual cramps every month for over a decade followed by miserable morning sickness for the last couple of months... and she thinks she's a "pansy!"

Look at the list above, ladies. Take a good, long look at it. Do you really think God would entrust those challenges to a bunch of pansies?



Nope.

We are women. We are strong. We can push ourselves to our absolute limit and somehow find the strength to push some more. And then rinse and repeat.

Don't you dare call yourself a pansy. 

 (Photo by Fife Photography, Fall 2005)

Re-post: To the women of the world

I've been reminiscing about two years ago when I started this blog and thought it might be fun to do a re-post of my very first post ever... which also happened to be one of my first publications ever--an opinion piece in the newspaper. It was a long-time goal of mine to have something I had written published. And it was all the more satisfying and fulfilling because I was able to educate people about something I was passionate about in the process. Here it is...

After two years of reviewing 15 years of medical literature, a team of national experts has come forward with this reality: Many of the routine medical interventions used in births in the United States do not improve outcomes for mothers and babies. Some even cause harm.

Their findings demonstrate increased risks and problems with many prevalent interventions including labor induction, cesarean section, continuous electronic fetal monitoring, routine use of IVs, amniotomy (artificial breaking of water) and withholding of food and liquids. Though these interventions have become commonplace and viewed as part of "advanced" and even "superior" medical care, this study indicates these practices are not improving outcomes in most cases. In fact, they often create more problems than they eliminate. These findings will appear in the winter 2007 supplement to "The Journal of Perinatal Education" in a summary report entitled "Evidence Basis for the Ten Steps to Mother-Friendly Care."

This is not the first time these facts have been brought to the nation's awareness. Time and again researchers, activists and organizations, such as the Coalition for Improving Maternity Services, have tried to create change by raising awareness about the problems with maternity care in the the United States. Generations of women have recounted their birth horror stories over and over to each other. Scores of women wear the physical and emotional scars of unnecessary medical interventions.

Who is listening?

Does anyone care?

Let me use the words of Thomas Paine from his fiery call to arms, "Common Sense," with just a few of my own insertions: "Every quiet method for [change] hath been ineffectual. Our [appeals] have been rejected with disdain; and only tended to convince us, that nothing flatters vanity, or confirms obstinacy in [an old, broken system] more than repeated petitioning." The methods we have used thus far have been passionate and have brought about small victories, but the changes most needed have yet to be recognized or addressed by the mainstream medical community. We need a new approach.

Buckminster Fuller said, "You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete."

Women and mothers of the world, I call on you to "build a new model." The time for complaining, pleading and persuading is over. Those methods have been tried, and they have done little. It is time to say, "Enough!"

Let us no longer accept mediocrity and "go along blindly" with any procedure. Let us no longer tolerate practices that have been shown to cause us or our babies harm. Let us stop playing the victims and start creating the reality that we all deserve — the absolute best maternity care possible. Let us demand the best of the best for ourselves and our babies.

We cannot underestimate the power of women united in behalf of themselves and their children. "There is a woman at the beginning of all great things," said Alphonse de Lamartine. Imagine what we can accomplish if we unite our efforts. Imagine what we can create.

Can you spare a few for midwifery?

I just got this forwarded email from a friend and midwife in UT:

Supporters of midwives! We have an amazing opportunity to advance the availability of midwives not only in our state, but nationally.

Holly Richardson has been asked by the National Association of Certified Professional Midwives (NACPM) to go to Washington, DC this Wednesday, Thursday, and Friday to lobby Senator Hatch and Congressman Matheson to get Certified Professional Midwives (CPMs) on the national Medicaid provider list. These two leaders hold important positions on the committees that will make the decision to add CPMs or not, and therefore we as Utahns can play a particularly influential role on this issue.

What does this mean?

If Holly and the NACPM are successful and CPMs are added to the national Medicaid provider list, CPMs would become eligible Medicaid providers in all states, and all states would have to reimburse CPMs for their services under Medicaid. This would make midwives and out-of-hospital birth much more accessible to women who currently can't afford it, or who won't even look at it because they feel forced by Medicaid to "go hospital." Midwives would be free to choose whether of not to participate in Medicaid, of course, but at least this way it would be a choice instead of an impossibility.

If President Obama is successful in implementing some form of national/universal health care, the national Medicaid provider list will likely become the de facto list of providers under that plan also. Anyone not on that list will have great difficulty playing in the health care game. Whether you love the idea of national health care or hate it, it's passage might be the death knell of midwifery if midwives aren't included on the list of eligible providers.

If CPMs are included in the national Medicaid provider list, other private insurers are more likely to reimburse for services. They don't have to, but it does become more likely.

Even if the effort is unsuccessful in securing CPMs a spot on the provider list, there is still great benefit to sending Holly on this mission. At the very least, she can raise the awareness of our senator and congressman to the issue of midwifery, and pave the way for lobbying on any midwifery issues that may come up in the future.

Why send Holly?

Holly is in a unique position to succeed in this mission. Since she first started working on legislation here in Utah she has been working her way into other Utah politics and been unbelievably successful. She has run successful campaigns, joined organizations, started a very influential blog, become a recognized player statewide. She now has the kind of clout to ask for a meeting and GET HEARD. We can't guarantee the senator and congressman will do what she's asking, or that the committees they sit on will listen to them after she's convinced them, but she has a better shot than anyone at making it happen.

This is an amazing opportunity. We need to send her, but she doesn't have the money. The NACPM that has asked her to do this doesn't have the money to send her. We estimate that it will take $1150. That's a doable amount if we all share! Can we do it? Can we raise that in three days? I believe we can.

Here is what we need:

1. Send a check TODAY to Holly Richardson, 882 W 2800 N, Pleasant Grove, UT 84062.

We would love a large check, of course. But we'd love small checks, too. We know times are difficult, so if $5 is all you can give, we'll accept it with gratitude. It will make a difference!

Even better, WE HAVE AN ANONYMOUS DONOR who is willing to MATCH all donations up to $500. This will double your contribution! $5 will become $10, $100 will become $200. It won't take much to reach our goal if you'll all help.

Obviously, we aren't going to have enough time if everyone mails checks today to get the money in Holly's account before she leaves. But she's willing to put everything on her credit cards as long as she knows the money is coming to pay the expenses off afterwards. So,

2. Post either to the list or to me privately at suzanne@betterbirth.com and let me know how much you are sending.

This way we'll know whether we'll have enough to send her or not. If we can't get enough commitments by Wednesday June 17 for her to feel comfortable that the money will be there, she won't go and the money will be returned. DON'T LET THAT HAPPEN! This is a huge opportunity, way too important to waste. I'll be posting as the commitments come in so you can see how we're doing.

If we get more than the amount needed to finance this trip, we will turn the extra back over to Utah Friends Of Midwives for the further advancement of midwifery in the state.

Come on! We can do this. Ask everyone you know who supports midwifery to send what they can. Send what you can. Make a difference. Please, please, please, send a check right now. If we fail to act, the consequences could be terrible, and the opportunity if we succeed is amazing. I believe in you guys.

Suzanne Smith, CPM LDEM

Baby killers?

Every so often I like to plug "home birth" into a google news search and see what's out there. This morning I found something that has consumed my thoughts all day: "New study indicates hospital delivery safer for babies than home birth." What?! I hadn't heard anything about this study, so I checked it out.

Here's an excerpt describing the study's findings:

"The risk of neonatal death (dying during or shortly after birth) with a hospital delivery for a baby at term (between 37 and 42 weeks) was approximately 0.06%. The risk with a home delivery with a certified nurse midwife was almost double at 0.1% and with a non-certified midwife at home that number jumped to 0.18%. Low Apgar scores, a reflection of oxygen levels at birth, were also more common with home deliveries than in the hospital"(source).

Those are some disturbing numbers. Especially considering that they conflict with the growing body of evidence already published in peer-reviewed journals about the safety of home birth for low-risk women. Obviously I wanted to know more. So I poked around the internet off and on all day trying to find an original source for this study. All I could find were a few articles reporting about it. For example...

"Safety of midwife-attended home births questioned," from Canada.com
"Analysis Finds Risks With Midwife-Attended Home Births," from redOrbit.com

There were several other similar links. They all seem to be regurgitating the same words, but none of them directs me to more information. (It appears that this study has not yet been published in a peer-reviewed journal.) I want to know details!

Based on their findings, the researchers concluded that "the safest setting for the delivery of babies is in a hospital attended by a certified nurse midwife"(source). While the media grasped onto the home birth headline, they could just as easily have written: "New Study Shows Nurse-Midwives Safer Birth-attendants than Doctors." Except, while the press release willingly shared the neonatal death rates of the midwife-attended births, the only information we get about the doctor-attended neonatal death rate is: "Malloy hypothesized that in-hospital deliveries attended by certified nurse midwives had lower mortality risks in his study than in-hospital physician deliveries because the physicians were delivering babies at higher risk"(source). Wait a second... only a few paragraphs earlier, we're told that they limited the analysis to "low risk" births, which they define as full-term vaginal deliveries. If the only births included were "low risk," how could "high risk" babies explain why doctors were less safe?

Other questions I have about this study...

Were babies born with conditions or defects incompatible with life included?
Where did they find the records for these births?
What was the death rate for the babies delivered by doctors?
What about the birth center rate?
When was the "recent 5-year time period" they pulled data from?

I also have a hard time with their limiting the study to full-term vaginal deliveries. It seems sort of ridiculous to imagine including cesareans in such a comparison, but think about it... One of the reasons mothers choose home birth midwives is to avoid unnecessary interventions--for example, unnecessary cesareans. How many women began labor as "low risk," but ended up having their babies surgically removed because their labors were derailed by the bright lighting, immobility, strangers, or drug side effects? What about neonatal deaths preceded by cesareans that were brought about through iatrogenic complications? Excluding those neonatal deaths by removing cesareans from the study analysis removes one of the largest strikes against hospital birth in the minds of home birth proponents--the "cascade of interventions" leading to cesareans and increased risks for both mother and baby.

Clearly it's difficult to compare home birth and hospital birth. They're two completely different species. And there's no perfect way to structure a study's cohort to make home and hospital birth comparable.

But here's what we do know... at present, the published body of peer-reviewed research indicates that home birth is just as safe for low-risk women as hospital birth. We also know that home birth would be even safer than it is if hospitals and doctors would collaborate more fully with midwives in creating a better system for handling those rare emergency transfers (as we see in many European countries). Home birth would also be safer if practicing midwifery weren't illegal in some areas of the U.S.

Couldn't we focus on making all births safer instead of bickering about who's better? Couldn't we collaborate with each other in working to provide women and babies with the absolute best care possible? Couldn't we incorporate practices that facilitate healthy births in all settings? When will we demand that our care be evidence-based?

As for me, I knew giving birth to my son at home was the right choice for us regardless of the research. God trumps research... even studies of 12 million births.

If you have any more details about this recent home birth study, please let me know.

Here's the question

I stayed up way too late tonight finally writing my birth story. It took me four and a half pages in a word document. So here's the question... do you want it all? Or should I condense it? Cast your vote in a comment. :-)

And... for fun... here's a picture of my girls enjoying their favorite new toy (the birth pool)...

My new toy

I got a birth ball, baby! I think my husband was even more excited than I was to blow it up last night and try it out. He's a runner and general fitness-lover, so he was trying out push-ups and sit-ups and various moves on it. Then he laughed at me while I bounced on it, smiling from ear to ear like a little kid. :-)

In other good news, we also bought most of the supplies for the birth last night! You can see some of them piled in the background of the picture... lots of plastic drop cloths and shower curtains to protect the floor and furniture, loads of cheap towels and wash cloths, diapers, batteries for the camera, nursing pads, etc. I feel so much less anxiety now that we're stocked with what we need! Yay!

And, speaking of getting prepared, I'd love your help creating my "birthing playlist." I'm looking for soothing and inspiring music. So far I have a lot of Enya and Sarah McLachlan on my list. Any ideas??

2009--The Year of Birth Trauma Awareness!

I love this idea and this photo at Joyous Birth!They urge us:

Kick off Birth Trauma Awareness Year 2009 by standing proudly with your sisters.

We are all in this together.

What is done to one woman, is done to us all...

Enough is enough.

We will no longer stand by while our sisters, partners, friends and babies are mutilated and traumatised.

The silence ends now.

YES! Let's do this, girls!

Seeking birth stories

Do you have an uplifting birth story? If so, I would love to get my hands on it, or my eyes, rather. I would like to put together a collection of uplifting birth stories for publication. My working title for the compilation is: Birth as Intended. Even if you aren't sure your birth story fits the title, I'd still love for you to send it my way. It may be that the title gets adapted to fit the stories I receive. Or it may be that I don't ultimately choose to include your story, but I'd still love to check it out. If you want to participate, send your story to me at laniaxman at gmail dot com. I'm looking forward to hearing from you!

To the women of the world

After two years of reviewing 15 years of medical literature, a team of national experts has come forward with this reality: Many of the routine medical interventions used in births in the United States do not improve outcomes for mothers and babies. Some even cause harm.

Their findings demonstrate increased risks and problems with many prevalent interventions including labor induction, cesarean section, continuous electronic fetal monitoring, routine use of IVs, amniotomy (artificial breaking of water) and withholding of food and liquids. Though these interventions have become commonplace and viewed as part of "advanced" and even "superior" medical care, this study indicates these practices are not improving outcomes in most cases. In fact, they often create more problems than they eliminate. These findings will appear in the winter 2007 supplement to "The Journal of Perinatal Education" in a summary report entitled "Evidence Basis for the Ten Steps to Mother-Friendly Care."

This is not the first time these facts have been brought to the nation's awareness. Time and again researchers, activists and organizations, such as the Coalition for Improving Maternity Services, have tried to create change by raising awareness about the problems with maternity care in the the United States. Generations of women have recounted their birth horror stories over and over to each other. Scores of women wear the physical and emotional scars of unnecessary medical interventions.

Who is listening?

Does anyone care?

Let me use the words of Thomas Paine from his fiery call to arms, "Common Sense," with just a few of my own insertions: "Every quiet method for [change] hath been ineffectual. Our [appeals] have been rejected with disdain; and only tended to convince us, that nothing flatters vanity, or confirms obstinacy in [an old, broken system] more than repeated petitioning." The methods we have used thus far have been passionate and have brought about small victories, but the changes most needed have yet to be recognized or addressed by the mainstream medical community. We need a new approach.

Buckminster Fuller said, "You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete."

Women and mothers of the world, I call on you to "build a new model." The time for complaining, pleading and persuading is over. Those methods have been tried, and they have done little. It is time to say, "Enough!"

Let us no longer accept mediocrity and "go along blindly" with any procedure. Let us no longer tolerate practices that have been shown to cause us or our babies harm. Let us stop playing the victims and start creating the reality that we all deserve — the absolute best maternity care possible. Let us demand the best of the best for ourselves and our babies.

We cannot underestimate the power of women united in behalf of themselves and their children. "There is a woman at the beginning of all great things," said Alphonse de Lamartine. Imagine what we can accomplish if we unite our efforts. Imagine what we can create.

(Opinion piece I wrote for The Deseret News.)