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!

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.

More Magnesium Mumblings

Some stuff that has been rolling around in my brain thanks to my recent magnesium obsession...

Prenatal Vitamins and Leg Cramps

So... this morning, out of curiosity, I looked at the bottle of prenatal vitamins I took on occasion while pregnant. Lots of folic acid and calcium, for sure. Magnesium... nope. What the?!

Then I remembered something about my sister.  A year or two ago, she told me that she always got bad leg cramps with her pregnancies (I did too). Then she switched to the prenatal vitamins from NuSkin where her husband works, and her leg cramps disappeared. She thought maybe the NuSkin vitamins just absorbed into her body better, and she may be right. After I saw that my bottle of vitamins didn't contain magnesium this morning, I got wondering about NuSkin's prenatals.  So I googled it. And... Yepperdoodle. 39% of the DV of magnesium.  More magnesium, fewer leg cramps.  Just like you'd expect.

Hard Water for Contractions?

My sister also used to get a lot of contractions in the last trimester of her pregnancies (I do too), but she noticed (or her doctor suggested) that if she drank a bunch of water, they would go away. It may have been partly dehydration, but I can't help wondering whether drinking a large amount of the hard, mineral-rich Utah mountain water gave her magnesium stores a boost and helped relax her uterus?  Maybe. Who knows for sure, but I thought it was an interesting connection. 

Hard Water for Cramps and Fetal Hiccups?

Not long before I got married, I was visiting my future-in-laws with my future husband.  While there, my period arrived, and I was hit with some horrendous menstrual cramps.  I literally passed-out in their basement bathroom from the pain, and then spent the next several hours moaning, embarassingly in the arms of my fiance while his mother and sister offered their sweet sympathy.  I remember my mother-in-law saying that she always had excruciating cramps until after her first pregnancy.  So I've been wondering over the past week whether low magnesium was to blame for both of us.

Then a friend recently mentioned that her doula trainer, a midwife, had taught her having that a fetus who hiccups a lot can be a sign of magnesium deficiency.  I told my husband about that, and he remembered his mother talking about how her first baby hiccuped all the time while in utero.  Then the cogs and wheels started going in my brain.

Something changed between her first pregnancy and the rest. She only remembers the first baby hiccuping, and she no longer had bad cramps afterward.  Interestingly enough, she had been living in California for a while before getting married and pregnant.  At some point after her baby was born, the family moved to Utah.  That baby was the only one born in California.

So I found a map showing the relative hardness of the drinking water in the U.S.  on a water science website. I'll throw in a screen shot of it here:  

They were measuring calcium in the water, but I'd venture a guess that water high in calcium would also be high in magnesium.  So if you look at the map, most of California has relatively soft water while Utah's water is completely hard.  I can't guarantee that water hardness was what changed to get rid of my mother-in-law's cramps and baby hiccups, but it's an interesting possibility.

*Edited to add*:  My mother-in-law also grew up in New Zealand which has primarily soft water.  She moved to Porterville, California (a soft water area) as an adult just a few years before marrying.  She was probably already low on magnesium when she arrived in the U.S.  (Fortunately, New Zealand is also surrounded by ocean water, so God provided a simple way for those soft water islanders to get their mg.)

Fluoride + Soft water + Lousy diet = Scoliosis?

The other day I had an epiphany... maybe magnesium will help my scoliosis pain?  So that led me on a google search that turned up some really promising stuff.  There definitely seems to be some connection between scoliosis and low magnesium.  Also, most women who have osteoporosis also have scoliosis and seem to exhibit a cluster of similar symptoms related with magnesium deficiency.  I was thrilled to make this discovery. So I am full of hope that magnesium will tremendously reduce or eliminate my back pain and save me from a future of other possible health problems.  Yay.

But that also led me on a search for other answers.  I was diagnosed with scoliosis around age 14.  At the time, I was living in Massachusetts, in area with fluoridated water.  So yesterday I turned to Google to see if it might be related.  And it turns out that when fluoride meets magnesium in the bloodstream, they bond into magnesium fluoride.  Magnesium fluoride is insoluble, so it "cannot be assimilated by the pituitary, with the consequent failure of the pituitary to function properly that leads to the symptoms of magnesium deficiency" (source). Yikes.

I can also tell you that I had a fairly lousy diet as a teenager.  Most days I skipped multiple meals out of sheer busy-ness or laziness.  Many days all I had for lunch was french fries and a carbonated beverage.  (Oh the things I wish I could go do-over!)  Dinner was the only somewhat nutritious meal I had every day, but we still ate a lot of refined carbs. So... what little magnesium I may have been getting in my diet was probably getting trapped by the fluoride in our water.  Dang.

It gets worse.

If you look on the map, you'll see that MA is an area with very soft water relative to hard water areas. That's three strikes against me: fluoride, poor diet, and soft water.  Ouch.

But I also carried all my heavy text books around in my monstrous backpack, always on my right shoulder... every school day.  I never used my locker in middle school or high school. Strike four!

It's really no surprise that I was diagnosed with scoliosis two years after I moved to MA.  And it's really no surprise that two years later I started having absolutely horrendous menstrual cramps.  Can we say magnesium deficiency?! 

All of this makes me feel like a detective.  It's kind of fun finding possible answers to all these questions after all these years.

*****

The more I learn, the more amazed I am how much impact little things can have.  It's makes me both afraid and hopeful.  Afraid of what little things are impacting my own children right now that will come back to bite them down the road.  But hopeful because I can see that there is almost always a simple solution to our health problems if we can just find all the puzzle pieces and fit them together. 

How's the water where you live? Hard or soft? Is it fluoridated? Is there magnesium in your prenatal vitamins?  I'm totally curious.

Hold your horses (er... scissors)

Cord cutting on the brain because of this and this...


We Can Be Much Kinder - Click here for more free videos

For them I could

Sometimes I feel like it's inevitable. I'll probably end up a midwife, in the end. But most of the time I don't really look forward to it. It terrifies me to imagine holding the lives of women and babies in my fallible human hands. I don't really want to be a midwife. But I've been thinking lately of some facts and figures that just might be enough to propel me forward on the path toward midwifery.

First, my cousin-in-law, Liz, wrote a blogpost discussing the book Half the Sky. She shared a couple of excerpts that have been reverberating through my skull ever since:

In much of the world, women die because they aren't thought to matter. There's a strong correlation between countries where women are marginalized and countries with high maternal mortality. Indeed, in the United States, maternal mortality remained very high throughout the nineteenth century and beginning of the twentieth century, even as incomes rose and access to doctors increased. During World War I, more American women died in childbirth than American men died in war.... 'Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving.' (p. 115-116)

"More women die in childbirth in a few days than terrorism kills people in a year." (Jane Roberts, letter to San Bernadino Sun, qtd. on p. 146)

Then, last night, my brother-in-law watched a PBS segment on maternity care in rural Peru. He thought I'd be interested, so he passed along the link to me. Last year, CNN reported that Peru's pregnant women were "dying at scandalous rates"(source). Yesterday, PBS shared some of the solutions that are being implemented to reduce the mortality rates in Peru's remote areas. The segment starts with this intro:

High in the Andean Mountains of Peru, far from the modern conveniences of a city, generations of indigenous women have given birth at home, their only help from family or a village midwife.

The longstanding tradition of childbirth at home wasn't a problem for most women. But, in that small percentage of cases where complications developed at the end of a pregnancy, in a remote rural area, you could be days away from the nearest medical facility on foot, even multiple-hours' drive.

(Screenshot from the PBS segment)

I've been studying childbirth for the past seven years, but most of my reading and research has revolved around maternity care in the U.S. Although we still have a long way to go here in the U.S., our risk of dying in childbirth is far lower than the risk most women of the world face. I think I could feel content remaining a doula/birth activist if the rest of the world didn't exist. But it does exist.

The World Health Organization puts things into persective:

Every minute, at least one woman dies from complications related to pregnancy or childbirth – that means 529 000 women a year. In addition, for every woman who dies in childbirth, around 20 more suffer injury, infection or disease – approximately 10 million women each year.(Source)

Far too many women die simply because they lack "skilled care during pregnancy, childbirth and the first month after delivery," according to WHO.

While I don't feel compelled to become a midwife for my fellow American sisters, I do think I'd be willing to shoulder the risks inherent in midwifery in order to help save the lives of women in places where maternal deaths are excessively common. For them I could do it.

Unfortunately, those who are able to help these women often lack the ability to communicate in indigenous languages. I have a deep love for languages and have always wanted to learn to speak more of them. I've also always wanted to travel to Africa, South America, and other far-off places. I couldn't think of a better reason to fulfill those dreams. Someday down the road... I hope.

Ask Busca: Breaking Water?

Elizabeth asked:

I have a question I'd love you to explore on your blog. In many of the birth stories I've read, Moms mention having their water deliberately broken by their midwife or doctor. Can this ever contradict a woman's internal timetable for the birth? Does water sometimes not break when it should, stalling labor? Is this practice ever considered an unnecessary intervention?

Busca's babble:

Artificial rupture of membranes (AROM, or amniotomy) is very common. Some care providers routinely break the bag of waters in an attempt to speed labor, especially in women who "fail" to follow the standard labor progress curve (at least one centimeter every hour). AROM is also used to induce labor, sometimes accompanied by prostaglandin gel and/or Pitocin. When an internal electronic fetal monitor is needed (to check baby's oxygen levels), AROM is performed to gain access to the fetal scalp. Sometimes AROM helps doctors or midwives determine whether a baby is in distress--as indicated by meconium in the amniotic fluid.

Can AROM ever contradict a woman's internal timetable for the birth? Certainly. Henci Goer, in her book The Thinking Woman's Guide to a Better Birth, explains, "[I]f left alone, two-thirds of laboring women reach full cervical dilation with membranes intact, and there are advantages to this" (p. 101). The amniotic sac and fluid serve a valuable purpose--not just during pregnancy, but during labor as well. Once a woman's bag of waters is ruptured, the chance of infection increases. Because of this, doctors and hospitals generally require that a woman with ruptured membranes give birth within 24 hours. (The chance of infection is much lower if vaginal exams are avoided.) So the membranes protect both mother and baby from infection. The fluid cushions the fetus and umbilical cord. Once the membranes rupture, the risks of cord compression and abnormal fetal heart rate patterns increase.

Early amniotomy also carries the frightening risk of umbilical cord prolapse. When a baby's head has not descended well into the pelvis, the gush of fluid can carry the umbilical cord into the vaginal canal where it will be compressed by the descending fetal head. This is an obstetric emergency requiring an immediate cesarean. My blogfriend, Sarah, recently shared her experience witnessing a doctor perform an unnecessary early amniotomy resulting in a cord prolapse and emergency cesarean. Oh that story made me seethe!

Does it hurt to leave the membranes intact? A recent Cochrane review of research assessing the use of AROM in spontaneous labors came to this conclusion:

Evidence does not support the routine breaking the waters for women in spontaneous labour. . . . Amniotomy has been standard practice in recent years in many countries around the world. In some centres it is advocated and performed routinely in all women, and in many centres it is used for women whose labours have become prolonged. However, there is little evidence that a shorter labour has benefits for the mother or the baby. There are a number of potential important but rare risks associated with amniotomy, including problems with the umbilical cord or the baby's heart rate. . . . The evidence showed no shortening of the length of first stage of labour and a possible increase in caesarean section. Routine amniotomy is not recommended for normally progressing labours or in labours which have become prolonged (Smyth RMD, Alldred SK, Markham C. Amniotomy for shortening spontaneous labour. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006167. DOI: 10.1002/14651858.CD006167.pub2, emphasis added).

So, AROM carries known risks and apparently few benefits, at least when used routinely as it so often is.

When left alone, sometimes the amniotic sac never ruptures--births "in the caul." I sometimes wonder whether my second daughter would have been born in the caul since my sac remained intact until my CNM broke it at 9 centimeters. Navelgazing Midwife says this about AROM and births in the caul:

I'd heard about an OB that was so disgusted with AROM that he offered a $50 bounty for every caul birth and shelled out thousands before calling the game... proving that it is possible and isn't dangerous and not AROMing did not slow labors down, but, in fact, helped women cope better.

She also shares some of her fascinating experiences witnessing births in the caul. When handled correctly, there is no harm to being born in the caul. Navelgazing Midwife's conclusion? "I find, as time goes by, that I touch membranes less and less. I believe they are there for a reason... will break when ready... and serve a purpose we might never know" (source).

For two out of my three births, my membranes ruptured before the onset of labor. In the future, should my sac remain intact (as with my second birth), I think I'll request that it be left alone.

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.

In praise of good birth attendants

I brought these mini rose bushes, thank you cards, and copies of my birth slideshow to my midwives today. It was my 10 week postpartum appointment. I was thrilled to see their new, gorgeous, and much larger office. Their practice is growing, and that makes me so happy.

This is the first time I've ever wanted to give a thank you gift to my birth attendant. And I'm feeling even more grateful today than I was a few weeks ago. Some scary complications following my sister-in-law's home birth have shaken me up over the last couple of weeks. And they have shown me more clearly than ever how valuable an experienced midwife is. I love midwives. I think more women should be attended by midwives. I think we need more midwives in this world. But I now know that I will never feel comfortable putting my or my future babies' lives in the hands of just any midwife.

I sat and talked with Mary today at my appointment. She held and admired my beautiful Bubby, of course. And we chatted for a bit about my birth and my sister-in-law's birth. Every midwife is so different. Not all midwives will handle a situation the same way. But I think one of the reasons Mary's outcomes have been so consistently good is that she can sense when something is going to happen... before it happens. She told me that most midwives develop that ability after they've practiced for more than 15 years. Mary's been a midwife for over 30 years, so her sense is especially in tune. And I'm so grateful for her gift. Because it kept my Bubby safe when she sensed he needed to be born quickly. I also think her years of experience have exposed her to nearly every possible complication, so she has witnessed and learned the best ways to handle those problems.

I had a really hard time keeping my "birth faith" during and immediately after my sister-in-law's brush with catastrophe. I even contemplated quitting this blog altogether. But then I cooled down and got my head in order and realized that her experience didn't change what I already knew deep down. The birth process was beautifully designed, but that doesn't mean complications don't ever happen. No one ever said bad things don't happen in home births. What we do know is that home birth is just as safe for low-risk women as hospital birth, but there is always the "with a skilled attendant" to qualify that safety. Midwives have varying degrees of experience, skills, and credentials. So what exactly qualifies someone as a "skilled attendant"? I'm not really sure what the answer to that is. But I am grateful and fortunate that I chose Mary--without a doubt one of the most skilled attendants there is.

Fortunately, my sister-in-law is doing much better now. Thank heaven for doctors and hospitals when we need them! No doubt about it... we are so fortunate to have modern medical intervention at our service when we need it. And, fortunately, my sister-in-law's birth experience itself was wonderful and beautiful. In fact, to this day she can't remember feeling any labor pain. Now that's incredible! I guess I need to look into that hypnobirthing stuff!

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.

"Elective" Cesarean

My heart has been aching the last couple of days for my blogfriend, Sarah. She recently shared the intimate details leading up to, during, and following her daughter's birth. It is a heart-breaking story. After educating herself, working hard to find the right provider, and hoping and praying, Sarah ultimately ended up losing her dream of a VBAC with an "elective" cesarean. I put elective in quotation marks because, like so many other women reaching for VBAC, the odds were stacked against her. And Sarah's heartbreak only intensified when her daughter suffered life-threatening complications as a result of her cesarean. Though her story is painful, I encourage you to read it. The truth needs to be shared so that the future of birth can be brighter. Thank you for being willing and courageous enough to put it out there, Sarah.

It was sadly fitting that I read a news report about the risks of repeat cesareans the same day I read Sarah's birth story. US News and World Report explains:

"Babies delivered by elective, repeat cesarean section delivery are nearly twice as likely to be admitted to the neonatal intensive care unit (NICU) than those born vaginally after the mother has previously had a c-section, a new study finds.

"These c-section babies are also more likely to have breathing problems requiring supplemental oxygen, the researchers say" (source).

Sarah's story is a sad testament to these facts. I ache for her and all women like her.

It makes me wonder... why did I get to have such good experiences? It's not fair, really. I didn't do anything to deserve smooth births. Sarah couldn't have prevented her first cesarean--twins in transverse position. Why was she dealt such difficult circumstances and I such uncomplicated ones? I suppose none of us avoids difficulty in this life. We'll all encounter struggles in some aspect of our lives. But today I'm feeling especially grateful for my wonderful births... because I realize today, more than ever, what a blessing they were. Oh how grateful I am!

Ask Busca: Turning a breech baby?

Tiffany asked:

I am 36 weeks and currently my baby is breech. The doc said if he doesn't move by next week I need to either schedule an external reposition of the baby or a c-section. This is my first and I was going to try to have a natural vaginal delivery but it might not be possible now. I was wondering if you had done any research or pro and cons of repositioning the baby. Thanks!

Busca's babble:

Great to "meet" you, Tiffany! I hadn't actually done much research into handling breech babies, but I'm always thrilled to learn something new. First of all, I think it's worth your while to try anything and everything (within reason) to try to encourage your baby to turn. While not all turning methods have high success rates, most of them are not harmful.

1) External Version
Based on what I've read, external version is safe for most women. There are some risks, but they are reported to be very minimal. These include: premature labor, premature rupture of the membranes, bleeding, and fetal distress leading to an emergency cesarean delivery (source). The procedure is also apparently quite uncomfortable (one woman described it as the worst pain she's felt besides childbirth). You could approach it as a warm-up for childbirth. :-) Practice your pain-coping techniques, work on relaxing all your muscles, and visualize your baby turning. External versions are successful about 60% of the time.

2) The Webster Breech Technique
You may also want to consider visiting a chiropractor skilled in the Webster Breech Technique. This technique is designed to release stress in your pelvis and relax the uterus and surrounding ligaments, making it easier for your baby to turn. This technique has been reported to have a very high success rate--82% according to one study. Excellent odds! And it'd probably ease some of the late-pregnancy discomforts too. :-)

3) At-home techniques
I think it's also worth trying at-home techniques. These include the breech tilt position, using music (at the lower abdomen) and/or ice (at the top of the uterus) to coax baby to turn, etc. The website Spinning Babies is a great resource. I also found another site that listed 17 ways to turn a breech baby.

I hope some of this was helpful. Good luck! Let me know how things turn out. ;-)

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?

Front page news

I was thrilled when my doula told me about the article on the front page of the Arizona Republic newspaper today: "C-sections linked to future birth risks." Not thrilled about the sad facts in the article, but thrilled that the truth about cesareans is finally becoming front page news. It is my hope that articles like this one will lead to a reduction in unnecessary surgeries.

I was amazed to hear just how much each cesarean increases a woman's risk of placenta accreta. Here's an excerpt:

"Studies and textbooks suggest that the risk of developing an accreta is as high as 4 percent in women who have had two previous Cesareans; that jumps to 60 percent with three C-sections, their physicians said."

60%?! Holy cow.

And another:

"'In the 1950s, the incidence was something like 1 in 30,000 women,' Mills said, adding that newer studies, conducted within the last decade, suggest that the rate has climbed to as high as 1 in 2,500 or even 1 in 500.

"'So there is definitely an increase in occurrence,' he said. 'And in women with C-sections, that's where we've really seen an explosion.'"

This gave me hope:

"Hospitals also are encouraging more pre-natal counseling of C-section risks, particularly if a woman is interested in having multiple children. They say it is possible for a woman who has delivered her first baby via Cesarean to give birth vaginally the second time."

So often I feel discouraged as I hear about record cesarean rates every year. But maybe the trend is coming to an end? I really hope so.

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.

Awesomeness and Awfulness

I'll start with the awfulness, so we can end on a good note...

Remember this post? The one where I mentioned that baby lotions and soaps are basically totally unnecessary and possibly harmful? Well, last Friday's Washington Post warned: "Probable Carcinogens Found in Baby Toiletries." Though the manufacturers of these products claim the levels are very low and within government regulations, health and consumer advocates argue that repeated exposure could have a cumulative damaging effect. In any case, there are more natural alternatives out there, and warm water alone does the trick just fine for newborns. Remember... dirt is good for babies.

Now the awesomeness...

I met another home birthing momma at church yesterday. We had a fun chat and she gave me some helpful tips. But... get this... she pushed out a 12 lb baby in ten minutes with no episiotomy or tearing! My response: "That is AWESOME." I love hearing those stories. Don't let anyone tell you, "Your baby is too big." Mommy hips and baby heads are flexible for a reason.

Where do they come up with this stuff?

After watching BoBB the other night, my friends and I were talking. One told us about a discussion she had had with an OB resident. She mentioned to him that she was looking into her options for her next child's birth and considering choosing a midwife (for a hospital birth). Apparently he tried to talk her out of it, saying midwives were much less safe. It almost made me wish I had been there... so I could have asked him, "Based on what? Show me your research." I don't know if I would have had the guts to actually say those words (being non-confrontational by nature). But I can't stop thinking about it. And it's got me on the defensive and all riled-up 'cause, clearly, I'm a huge fan of midwives. So I'll just refute him here . Since my friend is only considering midwives who can deliver at a hospital, I'm going to focus my proof on certified nurse-midwives (since they're the only kind of midwives who can deliver in hospitals).

1) Mortality Rates
There are many levels of "safety" when it comes to birth. When doctors use the word, I think they're generally referring to the most basic level of safety--a mother and baby who are alive. So what does the research say about CNM vs doctor mortality rates? Here are a few excerpts...

"After controlling for social and medical risk factors, the risk of experiencing an infant death was 19% lower for certified nurse midwife attended than for physician attended births, the risk of neonatal mortality was 33% lower" (MacDorman, M.F., Singh, G.K. (1998). Midwifery care, social and medical risk factors, and birth outcomes in the USA. J Epidemiology & Community Health, 52).

Regarding the above study: "Certified nurse midwives attended a greater proportion of women who are at higher risk for poor birth outcome: African Americans, American Indians, teenagers, unmarried women, and those with less than a high school education. Physicians attended a slightly higher proportion of births with medical complications. However, birth outcomes for certified nurse midwives were better even after sociodemographic and medical risk factors were controlled for statistical analyses" ("Infants Delivered by Certified Nurse Midwives have Lower Mortality Rates," National Center for Health Statistics Press Office, May 19, 1998).

"A nurse-midwifery program providing for the education of nurse midwives and integrating them into the existing health team helped reduce dramatically the infant mortality rate in a Mississippi delta county from 39.1 to 21.3/1000 live births in less than 3 years" (Meglen MC; Burst HV, Nurse-midwives make a difference. Nursing Outlook. 1974 June;22(6):386-389).

"[A] search of the scientific literature fails to uncover a single study demonstrating poorer outcomes with midwives than with physicians for low-risk women. An advantage to midwifery care is that evidence shows primary care by midwives to be as safe or safer than care by physicians" (Marsden Wagner, MD, MSPH, "Midwifery in the industrialized world").

2) Other Measures of Safety
Coming out of birth alive isn't the only thing that matters (a fact that many medical professionals seem to forget). How do certified nurse-midwives compare in other measures of safety? Let's take a look...

"Significant differences . . . between the obstetrician and nurse-midwife groups were found for seven clinically important outcomes: . . . infant remaining with mother for the entire hospital stay (15 versus 27%), third- or fourth-degree perineal laceration (23 versus 7%), number of complications (0.7 versus 0.4), satisfaction with care [higher with CNMs]" (Oakley D; Murray ME; Murtland T; Hayashi R; Andersen HF; Mayes F; Rooks J. (1996). Comparisons of outcomes of maternity care by obstetricians and certified nurse-midwives. Obstetrics & Gynecology, 88).

"The obstetric outcomes of a primary-care clinic for low-income women staffed by certified nurse-midwives is compared with the obstetric outcomes of a group of four obstetricians’ private practice patients. The birth outcomes were comparable with a significant reduction in cesarean sections (13.1% to 26.4%) for CNMs’ patients" (Source [Blanchette H. (1995). Comparison of obstetric outcome of a primary-care access clinic staffed by certified nurse-midwives and a private practice group of obstetricians in the same community. American Journal of Obstetrics & Gynecology, 172, 1864-1868]).

"The Medical University of South California Twin Clinic study demonstrated a lower rate of very early pre-term births, very low birthweight infants, Neonatal intensive care admissions, and perinatal mortality in a CNM directed Clinic where CNM care is given when compared to a MD directed team where MD care is given. This demonstrated that the contributions of CNMs to high-risk prenatal care can be considerable" (Source [Ellings & Janna, et al. (1993). Certified-nurse midwife directed twin clinic reduces very low birthweight delivery & perinatal mortality. Journal of Obstetrics and Gynecology ]).

"The risk of delivering a low birthweight infant was 31% lower. Mean birthweight was 37 grams heavier for CNM attended than for physician attended births. The authors, from the Centers for Disease Control and Prevention, National Center for Health Statistics, conclude that national data support findings of previous local studies that certified nurse midwives have excellent birth outcomes, and CNMs provide a safe and viable alternative to maternity care in the United States, particularly for low to moderate risk women" (MacDorman, M.F., Singh, G.K. (1998). Midwifery care, social and medical risk factors, and birth outcomes in the USA. J Epidemiology & Community Health, 52).

I could keep cutting and pasting, but this post is getting rather long. Is there really anything unclear about the research?

So... where do they come up with this completely false notion that midwives are less safe?! When will medical schools, the media, and popular opinion reflect the actual truth about midwives?? When, oh when??

Horror story of the day

One in 1,000 c-sections ends in "catastrophic bleeding." Did you know that? I sure didn't. That seems like a LOT. Here's a really, really sad news story. Coincidentally, the whole ordeal started with preeclampsia (subject of my last post and all the more reason to do everything we can to avoid it). Preeclampsia leads to a failed induction leads to c-section leads to catastrophic bleeding leads to death. So, so sad.

Stories like this really put articles like this one into perspective. (See here for some facts about the demand for elective cesareans).

Roughage

Got fiber? Well, you will if you want to decrease your chances of developing preeclampsia by 70%! Check THIS out!

As promised

Why I'm planning a home birth...

1) Safety
First of all, medical research demonstrates that planned home births with skilled attendants are as safe as hospital births for low-risk women. My first two pregnancies were smooth and problem-free. This pregnancy has also been smooth and problem-free. There are no guarantees in childbirth—no matter where you are. Sometimes the worst case scenario arises. Fortunately, it is very rare (1-3% of births among midwives I've interviewed) that home birth midwives have to transfer to hospitals for true emergencies. Should an emergency arise, the hospital would be immediately notified of our situation, and we are well within the American obstetric standard of “30 minutes from decision-to-incision.” So, as long as no problems arise and I remain “low-risk,” home birth will remain a viable option for me.

In fact, I am in much better health nutritionally and fitness-wise than I was in my previous pregnancies. I plan to continue exercising throughout my pregnancy because of its amazing benefits for both myself and my baby. Women who exercise throughout their pregnancies have far fewer birth complications and need much less intervention (see here). I see exercise as a way to make myself even more “low-risk” than I already am and increase my chances of an even safer labor and delivery.

Midwife-attended home births also provide many advantages—much lower rates of complications and intervention (c-sections, etc.) and more constant and personal support and attention. Most women laboring in hospitals spend very little time actually attended by nurses or doctors. Instead, they are strapped to a machine and checked-on only occasionally by actual people. A midwife is constantly assessing both mother and baby’s condition throughout labor and watching for indications of arising problems. A skilled attendant is a much safer, more accurate, and more reliable “monitor” than a machine. Many midwives are simultaneously trained doulas or have assistants who are trained doulas. The presence of a doula has been shown to significantly reduce childbirth risks, complications, and interventions. So, being constantly attended by a supportive professional will also further increase my chances of a safe labor and delivery.

You can read more about research on the safety of home birth here, here, here, here, and here. If you’d like to read more, I’m happy to direct you to further resources and research.

2) Cost-effectiveness
Home birth is significantly less expensive than hospital birth. One study indicates: “The average uncomplicated vaginal birth costs 68% less in a home than in a hospital, and births initiated in the home offer a lower combined rate of intrapartum and neonatal mortality and a lower incidence of cesarean delivery” (“The cost-effectiveness of home birth”). Cost is a major issue for us this pregnancy because our maternity insurance only covers complications, so (barring any major crisis) we will be paying out-of-pocket for everything. It just makes economic sense to only go to the hospital if it becomes necessary rather than paying several thousands of dollars more than we likely need to.

3) The Experience
Of course a healthy and safe mother and baby is the most important goal in childbirth, but I believe the experience itself is also important. And I also believe that God intended the birth experience to be a wonderful event. I have frequently felt the impression that it breaks God’s heart to see the way some women are mistreated in childbirth. It breaks my heart, too. I’ve had two wonderful hospital births, and I probably could have had another. But I look forward to being at home and unencumbered by outdated hospital policies which have little or no evidence supporting their use—electronic fetal monitoring, lying on the bed for delivery, no food or drink, intravenous fluids, etc. I look forward to moving as I please, eating or drinking as I please, pushing as I please, and hopefully coming away from the birth without needing any stitches!

4) God’s Guidance
None of the previous reasons (even combined) would have been enough without this last one. I knew that I would not be able to take on the real, though minimal, risks of a home birth without God’s own support. Initially, when I prayed about the question back in early August, I felt a subtle impression that going with a certified nurse-midwife in the hospital was the best choice. For a time, this felt right. And I think God had some excellent reasons (I won’t go into) for suggesting I start out the pregnancy this way. Slowly, however, I began to feel uneasy about that path. So, once again, I began exploring the home birth option. I agonized over it, again. And I took it to the Lord again. This time, the answer wasn’t subtle. It was an overwhelming and profound YES. And accompanying that yes were some beautiful glimpses of why and how my taking this path will fulfill His purposes for me and those around me. I had wanted so badly to know without a shadow of a doubt that I was making the right decision, and God, in his tender, loving mercy, gave me that wonderful gift of complete assurance.

So, now, without doubt or hesitation, we are moving forward with this home birth plan. And I am thrilled about the blessings that are in store for us.

Stay tuned for details about the midwives I've chosen! They're incredible! :-)