Rejoicing with a friend

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

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

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

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

All of these discoveries made me giddy with excitement.

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

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

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

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

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

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

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

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

Is water birth safe?

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

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

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

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

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

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

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

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

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

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

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

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

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

A retrospective comparison of water births and conventional vaginal deliveries.

Effects of water birth on maternal and neonatal outcomes.

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

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

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

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

Re-post: Tips for avoiding tearing and episiotomies

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

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

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

Ask Busca: Arizona Birth Activism?

Diane said:

I am getting ready to deliver baby number 3 and this will be my first delivered at home with a midwife. I have been learning and trying to digest everything I can get my hands on regarding midwifery care and home birthing, and I have been absolutely stunned and appalled at what the women in this country have not been told about giving birth. I myself had no idea how things should/can be, and had always assumed that the doctors know best. 

So on to why I am writing to you. My husband and I have been moved by our desire to get the word out to other women, and to also encourage an overhaul of our maternity care in the US. I believe you are in AZ too, and I was wondering if there are activism groups here? Or am I riled up about nothing? I just feel like we should DO something.

Thanks in advance for your time.

 Busca's Babble:

Diane actually sent me this email back in March, so first I'm going to apologize that it has taken me two months to respond.  But I am thrilled that you have had a fire lit under you and want to do something to help other women discover the truth, Diane.  You're definitely not riled up about nothing.

I think the first place I'll direct you is the Arizona Birth Network.  They hold monthly Birth Circle meetings at locations throughout AZ where you can meet with other like-minded women to discuss a variety of topics and brainstorm.  I haven't gone to any of the Birth Circles yet, but I am definitely planning on doing so.  Hopefully soon.

You also might consider attending your local La Leche League meetings.  I have friends who attend the meetings and have formed friendships and support networks through them.  The other women attending those meetings are also likely to either share your desire to share truth and knowledge or be open to further truth and knowledge that you are excited to share.

Another thing you might consider is starting your own group.  One of the fellow doulas-in-training at my doula workshop decided to create West Valley Birth Advocates.  I have attended and hosted meetings for that group.  You might consider hosting viewings of birth films or discussions of birth books in your own home for your friends and other women in your area to learn more.

You can also get involved on a more national level with groups such as Lamaze, Citizens for Midwifery, Childbirth Connection, and others.

I hope that helps, Diane!  Any of my Arizona birth junkie readers, please comment if you have any other ideas or tips.

Rising up

I got married in the summer of 2001. When I was a newlywed, I had only known one woman who had given birth outside of a hospital by choice.  (And I never could have imagined I'd eventually do the same!) 

Nine years later, I can't believe how much has changed.  I can't even count the number of people I know who have given birth at home (or would be open to the possibility).  So many women! That is partly because I have sought friendships and attracted friendships with like-minded people.  But I don't think that's the only explanation.  I think giving birth at home is becoming more and more common.  In fact, I know it is.

Did you see that report back in March from the CDC?  Amy Newman from RH Reality Check summarizes it's findings:

Over the last five years, out-of-hospital births (which includes home birth and birthing at a free-standing birth center) rose 3 percent and home births rose 5 percent after having sharply declined between 1940 and 1969 and then remaining static over the last few decades.

Clearly women aren't abandoning hospitals in droves.  We're talking about a tiny percentage of the total births in the U.S.  But I expect that trend to continue.  Not because hospitals are BAD.  They're not bad.  They serve an essential purpose for women who experience birth complications.  But I expect home births to continue to rise because more and more women are realizing that, being low risk, they can have an equally safe but likely more satisfying birth experience staying home.  And the more women choose that path, the easier it becomes for their friends and family members to choose it... and on and on.

I often wonder what maternity care will be like in the U.S. when my daughters reach their childbearing years. 

Will the cesarean rate have decreased?  Will home birth midwives be able to practice legally in every state?  Will hospitals be more mother-friendly? 

I know my daughters may not choose the same path I have chosen.  I will support them in whatever they choose.  But watching them both scramble to get on my lap whenever they hear the unmistakable sounds of a YouTube birth video, seeing their complete and utter fascination with every detail, their comfort level and curiosity as a baby head emerges from its mother... all of that makes me hopeful that they will at least not enter their childbearing years fearful and uneducated. 

When my oldest daughter does tell me, on occasion, that she doesn't want to have babies because "It will hurt,"  I always smile and respond, "But it's SO COOL!  I love doing it!"  I hope that hearing my love of birth will, with time, ease her fears. I plan to school them all their lives in the beauty of birth and teach them how to help each other and other women through that process.  It makes me so happy to think of them doula-ing each other some day... and their friends... and their daughters... and grand-daughters. 

When I got married in 2001, no one in my family or circle of friends would have ever dreamed of giving birth at home.  Ever.  And now I'm surrounded by home birthing mommas... and looking at the possibility of generations of my own daughters joining those ranks.  What a beautiful sight.

Change is good.