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.

Thank you, ABC News

For raising awareness about the many problems with our maternity care system in this country and the rising maternal death rate.

Now let's change things.

Happy dispatch

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

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

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

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

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

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

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

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

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. :-)

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. ;-)

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.

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?

The Doula Difference

I wrote this post last month for my personal/family blog, but I wanted to re-post it here for those of you who haven't seen it. :-)

I think every laboring women needs a doula. And here's why...

1) Doulas are nothing new.
A lot of people, when they first hear about doulas, think... oh, that's new. But it's not at all. For thousands and thousands of years women have been supported by other women during childbirth. We watched an awesome film at our training called "The Timeless Way" which showed the history of childbirth starting with ancient artifacts and moving to more modern depictions. I was struck how the very same image was represented through sculpture, wall carvings, pottery, and art over and over and over again. It is the "classic birth triad"--an upright laboring woman supported from behind by another woman, with a midwife in front ready to catch the baby. It has only been in the last century that this "classic birth triad" has all but disappeared. Doulas are not new. Modern obstetric practice is what has strayed (very far, I might add) from the time-tested norm.

2) Women need a "buffer" (i.e. Hospitals and drugs mess with birth).
Don't get me wrong. I am so grateful we have hospitals and drugs to handle birth complications (which do happen!). But, really, when used excessively (as they are) they mess with birth big time. The hospital with its policies (no food or drink, IVs, restriction to bed, bright artificial lighting, time constraints, flat on back or semi-recumbent positions for pushing, etc.) is really the least ideal place to facilitate the birth process. And pretty much any and all of the drugs hospitals introduce into the process screw up birth's carefully orchestrated hormonal responses, often leading to the need for further interventions to counter-act the drugs' side effects. So... here's my point... because 99% of American women give birth in hospitals (80-90% of those with drugs), there is a dire need for a buffer of sorts--something or someone to help women and babies come out of the modern birth machine as unscathed as possible. Doulas can be (and are being) just that buffer. And, I should add, sometimes epidurals just don't work (or only work on one half of a woman's body). Plus you still have to get through early labor (0-4 cm) before most doctors/hospitals will allow you to get an epidural. For some women, even early labor is killer. So it's a good idea to have someone present who is trained to help you cope with labor pain (even if you plan to get an epidural)!

3) Birth is women's work.
We put a lot of pressure on dads (particularly first-time dads) to be the sole support for their wives in labor. The fact of the matter is that it's overwhelming to many of them. They are often at a loss when faced with their own difficulty in seeing their wife's pain while simultaneously trying to help support her through that pain. A study comparing first-time fathers' and experienced doulas' participation in birth showed that males touched their laboring partner only 20% of the time while doulas touched them 95% of the time. They also spent less time with the women and were close to them less than the doulas (Bertsch et al. 1990). I absolutely believe that a husbands' presence can be vital. I would never want to give birth without Ax by my side. But I also believe that the assistance of wise, experienced women is also vital for laboring women. As much as a husband's support is wanted and needed, he is a man and can't ever understand what his wife is experiencing. Experienced women offer a different and much-needed emotional support. Doulas are also trained to assist fathers, giving them suggestions for ways to help their wives when they are unsure how (or are reluctant) to step in and help. My first "doula" did this beautifully.

4) Doulas are proven to improve outcomes for mothers and babies.
Study after study has shown that doulas have a profoundly positive impact on birth outcomes. Check out these numbers (from one of my doula training handouts):

When all the studies are calculated together, the presence of a doula reduces:

* Cesarean sections by 50% (!)
* Length of labor by 25%
* Oxytocin [Pitocin] use by 40%
* Pain medication [opiates] use by 30%
* Forceps deliveries by 40%
* Requests for epidurals by 60%

Other findings:

* Decreased maternal fever
* Decreased newborn admissions to NICU
* Decreased sepsis workups on newborns
* Decreased infant health problems

Long term benefits:

* Increased mother/infant bonding
* Decreased postpartum depression
* Increased success in breastfeeding

Who wouldn't welcome those amazing benefits?! As my doula trainer so aptly pointed out, if a doula were a machine, every hospital would have three of them.

I'm not telling you all this to drum-up business for myself. Even if I was looking for clients, I wouldn't be charging anyone. I'm telling you this because I am (excessively) passionate about helping women have wonderful, satisfying birth experiences. Doulas can work wonders, but I don't think most women are aware of just how much difference a skilled doula can make. I just had to spread the word!

As for me... I've got two fabulous births under my belt, and I'm a trained doula myself, but I am still going to have TWO doulas (and two midwives) at my next birth. I am thrilled that we will be surrounded by supportive, experienced women as we bring our first son into this world. I feel confident that their loving presence will make this our best birth yet.

P.S. If you'd like to hire a doula but can't afford one, have no fear! There are always doulas willing to volunteer their services. It's a generally universal doula belief that all women should have access to doulas regardless of ability to pay.

More awfulness

I remembered reading that Pitocin can lead to newborn jaundice, so I was doing a quick bit of internet research and stumbled upon Drugs.com's page about Pitocin's side effects. I already knew they were bad, but I guess I didn't realize they were this bad. Holy moly. Click over and take a look. Be sure to read more than just the "for the consumer" portion for the real juicy details. If that list doesn't scare you away from an unnecessary induction or labor augmentation, I don't know what will.

P.S. If you've been told you "need" to be induced (or your doctor has offered to induce you without a medical reason), be sure to check out "Saying 'No' to Induction," by Judith A. Lothian, PhD, RN, LCCE, FACCE, before you make your final decision.

Sunshine on my shoulders...

...makes me happy!

And even more now that I read about a study conducted by Boston University School of Medicine researchers. It appears that vitamin D can prevent cesarean births! I've fallen in love with vitamin D over the last few years as I've learned more and more about all the ways the "sunshine vitamin" improves our health and well-being, so when I saw this new study's findings, I couldn't believe it! ANOTHER reason to love vitamin D?! Are you kidding me?!

In a news release about the study, Dr. Michael Holick, director of the General Clinical Research Center, a professor of medicine, physiology and biophysics, and an assistant professor of medicine, explains, "In our analysis, pregnant women who were vitamin D-deficient at the time of delivery had almost four time the odds of Caesarean birth than women who were not deficient" (US News and World Report, "Vitamin D Deficit in Pregnancy Tied to Caesarean Risk").

Apparently vitamin D deficiency is tied with decreased muscle performance and strength, so it makes sense that women with low levels would struggle through the taxing muscle-endurance feat of childbirth.

These findings have made me ecstatic, but they've also got me pondering. For so long I've believed that the birth process is perfectly designed... that nearly all complications arise from medical interference in the process. But this study has shed some light (no pun intended) on a percentage of those complicated births. I guess I can't blame the medical establishment for everything... dang it! ;-) The truth is that multiple factors are always involved.

Even so, I still believe that even most vitamin D-deficient women can give birth normally. Chances are it will just take their bodies longer. And that's where the medical establishment steps in. 'Cause they're not typically very patient with those long labors, so interventions are introduced (pitocin, epidurals, instrumental or surgical deliveries). Women with muscle weakness aren't guaranteed a cesarean birth, but their weak muscles will stack the odds against them... at least in the hospital.

All the more reason I'm glad I live in the Valley of the Sun... where even the winters are sunny and pleasant. And all the more reason to get out into that gorgeous weather and exercise. 'Cause anything I can do to strengthen my body is going to improve my odds of a smooth and problem-free delivery!

Two Tidbits Courtesy of Midwifery Today

I subscribe to Midwifery Today's weekly E-News, and found a couple of things in today's email worth mentioning.

Induction and Meconium Aspiration Syndrome

Part of this issue of E-News contained an excerpt from a Midwifery Today article entitled, "The Problem Is Induction, Not Meconium," by Gail Hart. Meconium is the fetus's thick, dark-colored first bowel movement, and, when found in the amniotic fluid, it is a sign of fetal distress. Meconium itself is not generally a problem unless it gets into the fetus's lungs--meconium aspiration syndrome (MAS). It is generally accepted that meconium is more common the longer the pregnancy goes, but that may be simply because those pregnancies are most likely to be induced. Gail Hart shares the findings of a study indicating that the factor most strongly associated with MAS was induction, not being postdates. This makes sense when you remember that drug-induced contractions can be abnormally intense and long, restricting oxygen supply to the fetus. It follows that fetuses being born by induction would experience more distress. Just one more strike against pitocin/induction in my book, as if I needed any more. Check out the actual excerpt from Gail Hart's article here.

Infant Formula and DHA/ARA

The other tidbit I wanted to share was especially disturbing. I have for the past few years been a big proponent of everyone making sure they get their omega-3 fatty acids, especially DHA, but this issue of E-News shared the dark side of the omega-3 craze as it applies to infant formula.

Based on a report presented by the Cornucopia Institute (a corporate watch-dog group), the DHA/ARA added to many infant formulas is created from fermented algae and fungus and is structurally different than the DHA/ARA found in breast milk. The FDA isn't even convinced of the safety of these algal and fungal DHA/ARA additives! Apparently some infants fed DHA/ARA formula have even suffered from severe diarrhea, vomiting, dehydration, and seizures until being switched to a non-DHA/ARA-supplemented formula. Some infants even suffered death. Despite the FDA's reservations, these additives were somehow still approved for infant/human consumption.

Formulas supplemented with DHA/ARA are marketed as being "more like breastmilk," suggesting to consumers that they are somehow healthier than other formulas. In fact, scientific studies are inconclusive regarding the benefits of these DHA/ARA additives. Martek Biosciences Corporation, a manufacturer of these additives even acknowledges: "Even if [DHA/ARA] has no benefit, we think it would be widely incorporated into formulas, as a marketing tool and to allow companies to promote their formula as 'closest to human milk'"(source). Here's what the Cornucopia Institute concludes about the motives of infant formula manufacturers: "Given the safety concerns and doubts within the scientific community, it is clear that the infant formula manufacturers’ claims are marketing tools designed to sell more formula, and sell it at a higher price"(source). So what it really comes down to is money. Are we really surprised? Of course not. They're corporations and it's their job to make money. Adding DHA/ARA sells more formula, regardless of the fact that it's very different from the DHA/ARA in breastmilk and may actually be dangerous.

Unfortunately, parents are too busy or too trusting to ask any questions about it. I know for a fact that, if I had needed to feed my infants formula, I would have gone with the DHA/ARA version because I would have believed it was better. Get this... just yesterday I bought some Yoplait drinkable yogurt. Which kind did I pick? The one that said "with DHA" on it, of course! I looked at the label this morning, and, sure enough, it has "omega-3 DHA algal oil"--the very stuff implicated the Cornucopia Institute's report! Marketers certainly aren't stupid. They know omega-3 DHA is all the rage. I'm especially prone to buy into the notion that anything with DHA is better, regardless of where that DHA came from. Oops.

Included in the Cornucopia Institute's report is the following disturbing tidbit (evidence that infant formula marketers have done their job very well): "According to the National Alliance for Breastfeeding Advocacy, mothers have contacted health care providers asking the following: 'I want the breast milk formula,' or 'I want the formula with breast milk in it,' and asking questions such as 'whose breast milk is in the formula?'"(source). Oh my.

While I do find all of this disturbing, I also recognize and accept that infant formula is a life-saver for infants who are unable to breastfeed. And, given this fact, I do believe that formula manufacturers should do everything they can to create a product as close as possible to breastmilk. Unfortunately, in the end, it's just a sort of lost cause because breastmilk is something technology, no matter how advanced, cannot duplicate. While formula saves some lives, it will never be ideal. I'll end with this quotation from the International Baby Feeding Action Network:

"While researchers fiddle with the balance of fatty acids in infant formula, and deal with the additional uncertainties of the complex cascade of interactions that each adjustment provokes within the omega families, breast milk will always be the simple, perfectly balanced source of each essential nutrient."(source)

For more info, see...
Midwifery Today, Volume 10, Issue 11
"Replacing Mother — Imitating Human Breast Milk in the Laboratory"
"C-sections, breastfeeding, and bugs for your baby," by Jeff Leach

Posterior Ponderings

My second baby came into this world upside down, or "sunny side up" as some people say. She was posterior (facing my front side) rather than the normal anterior position (facing my back). Her posteriority (I think I just invented a word!) brought with it some surprises. I had fully expected my second birth to happen very quickly. My sister's labors were each roughly half as long as the previous. My first daughter's birth lasted less than six hours, so I was expecting my second to come in less than three! I suspected she might be posterior, however, when that supposed-to-be-fast labor turned into an on-again-off-again roughly 28-hour labor.

Fortunately, for me and my baby, the planets aligned to make our birth experience smooth and uncomplicated. My labor started and stopped every few hours, eventually kicking into full gear after about 26 hours. I arrived at the hospital nearly 6 centimeters dilated and delivered my baby about two hours later. There was no need for forceps or vacuum to get her out, I pushed for less than 20 minutes (it wasn't until then that my midwife said the p-word and confirmed my suspicions about my baby's position), and I suffered only a minor tear. My recovery was terrific compared to my previous birth. My first baby was not born posterior, but I suffered extensive tearing followed by a very painful recovery. Ultimately, I succeeded in having a very satisfying unmedicated labor and delivery despite having a posterior baby.

I feel fortunate, because, for many women, a posterior position is a recipe for disaster. A 2005 article, "Digital/manual rotation reduces need for C-section," in OB/GYN News explains: "Previous epidemiologic studies have estimated the prevalence of the occipitoposterior position to be about 5%. Among such pregnancies, there is a high incidence of cesarean section, instrumental delivery, third- and fourth-degree perineal tear, postpartum hemorrhage, and puerperal infection" (source).

I shudder to think what my experience could have been like. If I had gone to the hospital earlier when my labor was periodically stalling, it is likely I would have been given Pitocin. The contractions produced by the Pitocin would likely have been too painful for me to handle without medication, so I would have likely asked for an epidural. Epidurals make the pushing stage more challenging for many mothers, particularly those with posterior babies, so it's highly likely I would have ended up with an instrumental or cesarean delivery. I feel so fortunate to have evaded those outcomes!

I will be forever grateful that I trusted my baby and my body enough to wait things out and let labor kick into full gear on its own. I spent most of my labor upright, moving, walking, rocking my pelvis, getting on my hands and knees--outdoors and in my own and family members' homes until the last couple of hours. Sometimes these measures will help a baby to turn. Sometimes babies just stay put. And that's okay. Don't let the "p-word" scare you. Having a posterior baby doesn't have to mean a horrible birth experience. For me it was smooth and satisfying. I believe it can be smooth and satisfying for most women when labor is allowed to progress without interference.

Love this!

I love this excellent parody/response to the ACOG anti-homebirth press release posted by Tienchinho on the MotheringDotCommune Forum. Here are my favorite excerpts:

"As a home birth after cesarean mom (HBACM), I reiterate my support of home births. While complications can arise with little or no warning even among women with low-risk pregnancies, childbirth is a normal physiologic process that most women experience without problems. Continuous monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center has not improved maternal or fetal outcomes."

"Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by hospital birth advocates, a highly medicalized labor and delivery can physically and emotionally scar both the mother and baby. . . . Unless a woman is in a supportive birth environment that allows the birth process to unfold on its own schedule, she puts herself and her baby's health and life at unnecessary risk."

"It should be emphasized that childbirth comes with inherent risks. Implying any guarantee otherwise is misleading and unjust to a birthing mother and her family. Although able to perform live-saving [sic] emergency cesarean deliveries and other surgical and medical procedures, board-certified obstetricians have been cornered into practice styles that perpetuate the need for these same measures. They have lost skills such as detecting and adjusting a baby in the occiput posterior position. Untreated, this condition can result in prolonged labors mislabeled as 'dystocia' and in cesarean sections. They minimize the profound impact of a woman’s birth experience on her future relationship with her children as well as her own view of herself. Since suicide and substance abuse are leading causes of maternal mortality, disregard for a mother’s emotional health can lead to tragic consequences for her and her baby."

Click here to check it out!

"The Birth of a Breastfeeding Baby and Mother"

Check out this column by Judith A. Lothian (PhD, RN, LCCE, FACCE) in the Journal of Perinatal Education. Here's the abstract:

"In this column, the author describes the way in which the normal, natural process of labor and birth prepares both mother and baby for breastfeeding. Birth practices including induced labor, routine interventions, epidural analgesia, and separation of mother and baby disrupt the process of early breastfeeding for mother and baby. Normal, natural birth sets the stage for uncomplicated breastfeeding."

Five Ways Pitocin is Different than Oxytocin

I have been doing some research about oxytocin and stumbled upon this great overview of the ways Pitocin and oxytocin differ in the process of labor. If you're considering an induction with Pitocin or are just curious, check it out!

Back in the saddle again

No, I'm not pregnant. :-) But I jumped back in the saddle of being a "natural childbirth advocate" last weekend. I suppose when I put all my birth books on our new bookshelves in the living room, I also sort of "shelved" that passion for a while. Plus, having moved to a new place, I suppose I've been busy with other things--one of them being making new friends. And I guess I haven't felt ready to expose myself as a birth nazi and lose all those newfound friends just yet. ;-)

But, as most people who know me well are aware, if you bring up the subject of birth (and not in a "OMG! Give me the epidural!" sort of way) and seem interested or open to my views, you will find that I have a way of going on and on and on and a very difficult time shutting up. One of my favorite things in the world is to talk birth with others who are willing and eager. If you don't want an earful, well, don't bring it up.

Well, we were at a Halloween party last Saturday and we ended up sitting by some neighbors. We hadn't had the opportunity to really sit and talk with them before (partly because the wife has been awfully sick with her pregnancy), but we did get a chance to talk at the party. I don't even remember how the subject came up, but my new pregnant friend asked me if I had given birth without drugs. My radar detector started beeping like crazy, and I said, "Yes." Then she did what would make any natural childbirther salivate--she started asking me questions! And she seemed genuinely interested as she listened to me tell my birth stories! Oh my... I had forgotten how much I love talking about this stuff.

My new friend is pregnant with her second child. She had Pitocin with her first labor because her water broke and then her contractions didn't start. The Pitocin-induced contractions came one on top of the other without any breaks. She started screaming at the nurses to give her an epidural but they told her they couldn't until she dilated more. They reassured her that she would be able to get the epidural soon, but she yelled at them more: "You're lying!" She was in so much pain that she was out of control. Needless to say, she isn't a huge fan of Pitocin. She said, "Pitocin is evil." An now I have one more story to add to my list of reasons why I get irate and start foaming at the mouth when I hear the nasty word.

I can't recall now why, but she has a feeling that the labor with her second child is going to go very quickly and that she may not have time for an epidural. And she said that the booklet her doctor gave her has very general and fairly unhelpful information about how to cope with labor pain (surprise, surprise). I gleefully offered my collection of birth books for her to check out. Then we arranged that I would give her my copy of The Birth Partner, by Penny Simkin, the next day. I put a scrap of paper into the chapter on coping measures so she could find it easily. Oh how I love sharing this stuff!

I also hosted a baby shower for a new friend this past weekend. She is due to have her baby any day. And, just before she got into her car to head home after the shower, she happened to mention that she would really like to avoid drugs while she's in labor. I tried to restrain myself, though that inner radar detector started beeping like mad. I did my best in those few minutes to encourage her and give her a positive take-home message that might (just maybe, I really hope) help her make it through labor. But it's hard to make a huge difference in three minutes. I told her she could do it, that I love giving birth, that I'm practically addicted to it, and that I wouldn't do it any other way than au naturale.

I'll never forget the conversation I had that was the spark for my interest in natural childbirth. An acquaintance was pregnant with her first child and had some books from the library. I asked her about the books. I don't even remember what the books were. But she ended up mentioning that she would be giving birth without drugs. It floored me. What?! People still do that?! I couldn't believe it! But she explained that her mom had all her children that way and she planned to as well. She said there were lots of benefits, but didn't go into them much 'cause there wasn't time. But that little exchange is what started it all for me. It got me thinking and wondering and intrigued. So when I entered my first pregnancy, I went to the library and checked out some books and I was never the same.

So I guess I hope that even if my two pregnant friends don't have wonderful birth experiences THIS time, maybe our conversations will have been the spark that will intrigue them and inspire them to check out some books and prepare themselves in the future to have the kind of birth experiences their bodies were intended to have. I really do hope so.

In the meantime, I'll enjoy the natural buzz/high that follows a few good conversations about birth.

Think you're better off with an epidural? Think again...

• Epidurals cause women’s bodies to stop or slow the release of oxytocin—slowing labor and removing the feel-good effects of the hormone. The first stage of labor tends to be about 26 minutes longer and the pushing stage 15 minutes longer in women with epidurals. Epidurals also eliminate the natural peak of oxytocin intended to occur at the time of birth to facilitate the delivery and bonding processes.

• Women with epidurals are nearly three times more likely to have Pitocin—to speed up labor—than those without epidurals.

• When the pelvic floor muscles have been numbed by an epidural, a woman’s body cannot guide the baby’s head to the ideal birth position as effectively. Babies are four times more likely to be posterior (facing up—a more difficult position for birth) in the final moments of labor when their mothers have epidurals. As a result of these complications, some women with epidurals experience difficulty pushing their babies out—doubling their risk of forceps or vacuum extractor deliveries.

• Other epidural side effects for mothers include: drop in blood pressure, difficulty passing urine, itchiness, shivering, sedation, nausea and vomiting, fever, breathing difficulty, inadequate pain relief, slurred speech, drowsiness, convulsions, postpartum weakness and/or numbness, postpartum back pain, mild to severe postpartum headache (sometimes lasting six weeks), temporary or permanent paralysis, cardiac arrest, respiratory arrest, and death. A woman’s risk of dying from childbirth complications triples when she has an epidural. (For a recent news story on the rise in epidural-related maternal deaths, see here.)

• When mother develops an epidural-induced fever, her infant tends to have poorer condition at birth, has an increased risk of having signs of brain damage, and will likely undergo an invasive sepsis evaluation to check for infection.

• Epidurals can lead to worrisome fetal heart rate changes also. This is in part because women with epidurals tend to lie down in one position for extended periods of time which can restrict blood flow to the fetus. Change of position will often improve the fetal heart rate abnormalities. When an epidural is coupled with Pitocin, the signs of fetal distress can be more prolonged and severe.

• Some data also indicate that babies born to women who had epidurals show increased risk of poor brain function at one month of age.

• As many as 85% of women in some U.S. hospitals receive epidurals.

Little known facts about Pitocin and induction

"Pitocin is the most abused drug in the world today." ~Roberto Caldreyo-Barcia, MD, former president of the International Federation of Obstetricians and Gynecologists

• Pitocin is not approved by the FDA for elective (patient or provider convenience) inductions or stimulation of labor (moving things along).

• Pitocin generally produces contractions that are much longer, more intense, and more painful than normal contractions....

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