Birth is beautiful, powerful and full of choices. Parenting is rewarding, challenging and also full of choices. Mother's Nest brings you useful information for pregnancy, birth and while parenting young children.
10-weeks can seem like a lot to commit to, but don't worry - if you need to miss a class, you can make it up online!
3. A well rounded program that stands out!
2. You'll be informed
I LOVE watching people learn! With the Birth Boot Camp curriculum, you'll get up-to-date information to make informed choices for your birth!
1. Birth Boot Camp is AMAZING!
Give me a call or send me an email to find out where the next sip & see will be and come take a peek at the Birth Boot Camp materials and get your questions answered! You're gonna love it!
Hi there readers!! So first, I have to apologize for my hiatus but here I am and looking forward to getting back to sharing more great pregnancy, labor, birth and baby goodness with you again!
For those of you who are local, many of you know I am going to Texas this week to bring Birth Boot Camp to AZ!!! Let me say that again
I am going to TEXAS this week!
BIRTH BOOT CAMP IS COMING TO ARIZONA!!!
I'm not sure which of those I am more excited about!
Birth Boot Camp
is committed to training couples in natural birth and breastfeeding through accessible, contemporary education.
For more info click the link below
So recently, BBC held a contest where moms like you shared why they loved their natural birth.
This is when I discovered Birth Boot Camp had a YouTube channel! How cool is that?!
Check out this mama's video and others (one even raps!) that entered the contest..
In March of 2014, ACOG released a consensus statement:
Safe Prevention of the Primary Cesarean Delivery
In this consensus statement, which was released in effort to lower the United State's Cesarean Rate, ACOG redefined "normal" labor progress. In a stunning realization ACOG announced that dilation from 4 cm to 6 cm could take 4-6 hours longer than Friedman's Curve suggested.
ACOG defined 6 cm as the threshold for the active phase of labor. It's important to understand this new threshold strictly applies to the clinical management of labor and not the timing of admission to hospital or the frequency and intensity of contractions.
cesarean deliveries for failed induction of labor in the latent phase can be avoided by allowing longer durations of the latent phase (up to 24 hours or longer)
Emphasis added: I digress to urge you, all of you, to rethink this concept of "allowing" women in labor.
It means that the average labor and second stage (pushing) may take a lot longer than doctors and hospitals have been anticipating.
It means that
Cesarean delivery for active phase arrest in the first stage of labor should be reserved for women at or beyond 6 cm of dilation with ruptured membranes who fail to progress despite 4 hours of adequate uterine activity, or at least 6 hours of oxytocin administration with inadequate uterine activity and no cervical change.
It requires that care providers have advanced practical skills and suggests that
Amnioinfusion for repetitive variable fetal heart rate decelerations may safely reduce the rate of cesarean delivery.
It means that
Before 41 0/7 weeks of gestation, induction of labor generally should be performed based on maternal and fetal medical indications.
Keep up to date with YC Birth Circle to join us for other great topics and visit my website to find a childbirth preparation course near you for a more in depth understanding of what we covered!
Once again, I'm behind on my blogging and I apologize.
For my local readers - you may not mind so much because I have so many awesome things in store for you!!
Mother's Nest is working on bringing in Ergo & Moby, along with 3 more brands of cloth diapers and lactation cookies!! Ya'll are loving the organicKidz bottles, so we will definitely be keeping those in stock. What will be moving out of the boutique are the resale items. So come and take advantage of 80% off of
retail value while supplies last!!!
Even more awesome news: Two awesome massage therapists have joined the Mother's Nest team and are now offering massage services!! Book yours today. My readers can take advantage of a special introductory offer by printing and bringing in this coupon.
As for the birth services I offer - I have been busy preparing a handful of mini workshops for you working moms who would like to get your hands on evidence based information, labor preparation, birth planning and more, but just don't have the time to take a full series of childbirth classes. Don't forget, Yavapai County Birth Circle is a FREE monthly meet up but I do hope you'll enjoy the upcoming detail rich workshops! You can also take advantage of private childbirth classes, specifically tailored to you - your birth, your desires, your schedule. Check out Guiding Angels Birth Services for more information!
Be well readers. Get ready for the next post: it will include a link to the meta ethnography of RIC in America!
Would you like to weigh in on the survey used for analysis? Follow the link!
Believe it or not, you can actually make a positive impact on your labor prenatally by practicing healthy eating habits and proper posture. There are also a few other things you can do prenatally that promote faster, easier labor!
Regular chiropractic care is beneficial for pregnancy and labor! I recommend at least once in the first and second trimester, and twice during the third trimester; additionally, if you can find a provider skilled in the Webster Technique, chiropractic care can help encourage a breech baby into a vertex presentation.
Acupuncture can also facilitate rotating a breech baby, although you may consider breech a variation of normal! Regular balancing treatments throughout your pregnancy can enhance your health and positively influence the development of your baby. Acupuncture can also help with nausea, fatigue, anxiety, back pain and more!
Along the lines of all this information regarding fetal positioning, you might like to check out The Miles Circuit. Many people falsely believe that fetal positioning can prevent, or rather delay labor from starting and this is simply not true, however, having optimal fetal positioning can certainly facilitate a more comfortable labor!
Don't forget, in labor, your body is working and it's working hard!! To help it out, be sure to rest as much as possible in early labor! The best early labor advice I can give you - is go to sleep. Or if it's the middle of the day or you can't sleep, simply go about your day as normal. Pretend it's not even happening! Nourish your body with healthy foods and drinks and relax.
There was a study done that eating 6 dates a day for the last 4 weeks of your pregnancy can shorten the duration of your labor. Of course dates are also great to ease the symptoms of constipation.
And while we're on the topic of nutrition, throughout the Birth Boot Camp course we'll go over tips to boost your nutrition.
And now... for what you've been waiting for.. Comfort measures for labor.
2) Positioning. Walking and other upright positions help increase the downward compression on your cervix to aid in dilation. Many women find hands and knees to be very comfortable during labor. Birth balls can be wonderful tools to utilize. Lean in to your partner; Bradley classes teach "slow dancing" for labor. Squatting, which is also beneficial prenatally, can relieve back pressure during surges. Lie semi-prone. Generally, lying on your back or being in a reclined sitting position are the most uncomfortable positions for labor.
5) Birth at home! By not transferring, you maintain the highest level of endorphins and other "happy hormones" that have been triggered by an uninterrupted flow of oxytocin. By staying at home you can maintain your privacy, continue laboring in a dark, peaceful and comfortable environment. Staying at home eliminates the first of all birth interventions.
Most women today are expected, even pressured, to have an epidural in labor, because they and the influential people in their lives equate labor pain with suffering. While an epidural eliminates almost all sensation, including pain, it does not address fear, worry, loneliness, helplessness, or other emotions that lead to distress, dissatisfaction, or even suffering. To prevent suffering, women need more than relief of pain; they need to recognize that labor pain is a side effect of a normal process, not a sign of damage or injury. They need a sense of mastery and well-being as they respond to their pain, but they also need humane, caring, confident people giving continuous support throughout labor.
7) Breathe. Rythmic breathing is taught in Lamaze and other childbirth preparation courses.
8) Rythm - find yourself in a pattern. That may be rocking, swaying, groaning, or whatever best suits you.
9) Low, deep sounds. Work with your body and "moan out" your surges.
10) Massage and other touches. I enjoy massaging my clients with a 1% dilution of lavender essential oil in grapeseed or fractionated coconut oil.
11) Hot and cold compresses.
12) Counterpressure and double hip squeeze; especially useful for back labor.
13) Many people find positive mantras and music to be helpful during labor. Guided mediation, as taught by hypnobirthing, is amazing!!
14) Surrender
15) TENS Unit or transcutaneous electrical nerve stimulation, can act as a "gatekeeper" to block pain messages to the brain and cause the body to release natural endorphins.
Understand that there may be times when intervention is very appropriate, such as in a very long labor, or perhaps your body needs some relaxation. At these times, women may consider an epidural or IV narcotics. Hopefully someday a combination of gas and air may be available in the United States.
Below you'll see a video on how an epidural is administered and I encourage you to take the time and read The Big Bad Epidural that has links to risks of the epidural but also talks about when an epidural can be a blessing to the mother! And more information at Childbirth Connection.
As mentioned, IV narcotics are another option. Some women describe these as taking the edge off, others dislike them due to the neurological effects.
Keep up to date with YC Birth Circle to join us the next time we cover this and other great topics or find a childbirth preparation course near you to practice some of the comfort measures we covered!
And then there's the more subtle words, who's impact is quietly wreaking havoc
like "due date" -two little words that don't really mean what you think they mean.
It used to be that a baby was due, or rather expected, within a certain season or "around Christmas" whereas now, we've come to expect a baby by a certain day! This idea, that a baby should come by a certain day, is enforced by our care providers, by insurance companies, by well meaning friends and family and now, by pregnancy announcements! I recently saw an announcement, beautifully creative with charming colors and cliche phrases referring to a bun in the oven. It was all fine and dandy until that announcement made known that the baby would be cookedby 7/26/14*. STOP!! For real?! Your due date is not an expiration date! Now I'm sure the well meaning designers of this particular announcement and the loving family were not necessarily trying to imply that this is truly what they thought but when we see things like this over and over again, when we repeat "July 26" over and over again and then that date comes and goes... it really has an impact. The wording in this seemingly harmless announcement encourages the idea that a baby is done being in utero precisely when we say so.
Too many women are under the impression that when they pass their "due date" they are "overdue" when in fact ACOG states post dates is past 42 weeks! Thankfully, not all beautiful announcements are quite such precise recipes; just remember, your due date is simply a guesstimate of the time period around when your baby may decide to be born. ACOG's most recent guidelines are
Donna Ryan, author of Banned From Baby Showers presents a great alternative title for "Emergency Childbirth"; as you might remember from another recent post of mine, semantics are incredibly powerful!
My favorite part of her post is her commentary on the response of the OB
that he'd never seen a baby born in "this good of shape born outside of the hospital". He/she must have some magical powers to make babies be in "good shape" when they are born in the hospital! Being born in the hospital does not mean that a baby will be in "better shape" than a baby born outside of the hospital. It's not a magical place.
It's a shame the shock value of this story - a shame that "it's a better news story when it's not planned" because every birth is beautiful whether it be at home, at a hospital, unassisted or attended by a professional. I would not consider an EMT one of those professionals and I cringe at the misinformation they are taught in school. My husband is on his way to becoming a firefighter and happens to be in the paramedics course this semester- let's just say that the "emergency" childbirth chapter of his school book is filled with sticky notes from me! Not only are they taught inappropriate ways to attend to an unplanned unassisted birth outside of the hospital but some of what they are taught can be down right harmful, if not at least traumatizing to the mother and un-beneficial for the baby.
Banned From Baby Showers suggests that this couple, though they esteem this as a positive experience, may venture to opt for an induction for their next baby. I would like to hope they'll opt for a planned home birth.
Where was your baby born? Did you have an unassisted birth? Planned or unplanned?
Youdonothave to be induced. No matter what they say. No matter what you say. Even when medically indicated!
*Gasp* Am I proclaiming that you shouldn't get an induction when medically indicated? No, of course not. But that's you're choice! And that is the point I am making.
I am so tired of hearing women say "I had to get induced because..." You did not HAVE to get induced! You donot HAVE to be induced!
In regards to medically indicated inductions
Please, I implore you, for the sake of birth in our society, consider your words carefully. Because how we speak, how we think, how we view birth matters; it truly, truly makes a difference for women around us and for future generations. What are we teaching our daughters and their future husbands when we say "I had to"? We are teaching them and those around us that it is not their birth, it is that of the institution. Semantics are incredibly powerful. The correct terminology in the case of your suggested medical induction would be, "My care provider recommended induction" And then, do your research or look within or pray, whatever your general go-to method is when between a rock and a hard place. It IS your choice to allow or decline your care provider's suggested induction. Take responsibility for your birth- after all, it's your body, your baby, your birth, your choice.
I urge you, to know and understand what true medical indications for induction are. Take responsibility for your choice.
Did you know:
According to the NNEPQINPost maturity (gestational age <41 weeks) is an elective induction.
ACOG, Mayo Clinic and American Family of Family Physicians all discourage the elective induction or scheduled cesarean for reason of a "big baby." Childbirth Connection and Evidence Based Birth also have a lot to say about inductions. Lamaze International says
When it comes to choosing a birthday, baby knows best.
UpToDate says
Delivery before the onset of labor is indicated when the maternal/fetal risks associated with continuing the pregnancy are thought to be greater than the maternal/fetal risks associated with early delivery
"I had to be induced because I'm overdue" means "I'm sick of being pregnant so I've decided to force my baby out because I went past my guess date"
As I said before, your due date is not an expiration date. You have options.
Sometimes, women feel - due to family circumstances, such as spouse availability, family being in town to help after baby is born, striving to get all of that maternity leave - that they must induce. In these circumstances, please, please, understand the real hormones involved and the importance of labor. Understand, as said before, you should be choosing the lesser of two evils. It is your choice, I give you that but be responsible for it and responsible for what you say, because semantics are powerful. Did you hear me yet? Semantics are incredibly powerful; we are shaping the way our society views birth, not just now but for future generations. So please, if you've chosen an induction for convenience, stop saying "I need to be induced" because you don't! You are choosing to be induced. Furthermore, you should never feel pressured into an induction. "My care provider says I have to be induced" is not, in and of itself, a valid reason for induction. Your care provider may recommend and induction but in the end it is your choice to accept or decline. You do not have to show up! Make an informed choice that supports your birth, your body, your baby and your desires.
To induce or not to induce. That is the question. And it is just that, a question, a suggestion, an intervention. This is your Journey of Life -own it!
Stop the Mommy Wars is derived from the concept that the only choices we have control over are our own. What another mom chooses is her decision – who are we to judge that? We are each free to make our own decisions and we should support another mother in her own decisions, creating a stronger community. While I fully believe this is an excellent idea to stop the growing trend of pop culture pitting moms against each other, I also feel we have other battles placed in front of us that must be confronted. So should we fight one another, insisting that each person is in the right? No: Don't Hate, Let's Educate.
Birth
Your birth, your way. I firmly believe that and as a doula abide by that; I support whatever kind of birth my client chooses. Here's the catch- I educate my clients. They are making informed choices.
The problem lies, once again, in our misinformed culture. Fear is rampant! Less than half of all expectant mothers will have taken a childbirth preparation course by the time they give birth. A good majority of those who do take a course take one in a hospital setting. In a hospital course you learn how to be a good patient. You learn some basics about the stages of labor but not what you need to know; not evidence based birth. You'll learn what your [medical] pain management options are but most won't tell you all of the risks of an epidural or that a doula helps to relieve your pain naturally and is associated with a more positive birth experience. They'll tell you the process of admitting you to the hospital but not tips to keep your labor from stalling; they have pitocin for that. They don't work to undo the fear that has been bestowed upon us by our pop culture and the collective memory we've built from that culture. It's easy and cost effective when birthing mothers can be put into the system, boxed up and released.
But we are each individual mothers with unique births, bodies and babies- we deserve to be treated as such. Don't Hate the system because it treated you unfairly, Let's Educate and spread the word that this is a human rights issue; autonomy of choice. This is what I'm talking about!
A cause that directly affects the health and well-being of millions of women around the world. That cause is human rights in childbirth.
You, mother who doesn't research and just does as your told in the birthing room, I judge you. I judge you and I apologize for that but if we are to take back birth then there is noroom for mothers who don't care. We need all the support and advocacy we can get because birth matters.
So is this OB vs Midwife? Hospital vs home? Technology vs nature? No! We can all respect one another. I will respect your choice to birth in the hospital with an epidural if you respect my choice to birth at home without drugs. I respect yours because I've researched yours. Have you researched mine? I'm not asking if you believe it, I'm not asking you to achieve it. I'm simply asking you to be informed. Understand that home birth is a safe option for a healthy, low-risk mother. It's OK if it's not the choice for you, I don't judge you; I simply want you to know that pregnancy is not an illness. I want you to know the epidural is not free of risks. Do you know the benefits and joy of natural birth? Or are you overwhelmed by fear of the pain we have been programmed to expect in childbirth?
"So many North American women have experienced the pain of labor, and then had an epidural, that our collective memory about birth is now full of hurt but is missing the feelings of ecstasy and success that natural birth provides." -Cynthia Gabriel
Our culture has been programmed to fear birth. When birth moved out of the home and into the hospital it became a mystery. Little girls no longer see birth as a normal part of life but as an illness that needs medical care. Everywhere you turn you see complications and pain and no mother wants to be the only woman in the birth circle talking about her blissful or ecstatic birth. Are you getting your information from the media? Are your friends, coworkers and complete strangers bombarding you with horror stories? What would happen if you surrounded yourself with positive birth stories? Have you considered finding a birth circle? Do you have a doula or other caring support persons?
Midwives may provide an excellent source or childbirth education but if you're getting your information from an obstetrician, you must understand that they are trained surgeons; they are trained to manage complications in birth! Don't be ignorant when choosing your care provider. Do you know your care providers birth philosophy? This should be one of the first questions you ask when in search for a care provider. You shouldn't have to settle or compromise. [<--Trigger warning]
Why is it that we get pregnant and call the surgeon!
The United States spends $98 billion annually on hospitalization for pregnancy and childbirth, but the US maternal mortality rate has doubled in the past 25 years. The U.S. ranks 50th in the world for maternal mortality, meaning 49 countries were better at keeping new mothers alive.
So what's different here than in those other countries? Do they have better technology than us? No. What's missing here, in the United States, is the midwifery model of care. Only 8% of mothers are seeking a midwife for their prenatal care and birth. When are we going to catch on? When are we going to realize that birth is a normal life event. Not only does birth matter, mothers matter! It's not enough to merely say "the baby's healthy, that's all that matters."
There's not near enough of a concern for the rising cesarean rate. Can a cesarean save lives? Yes. Are all these cesareans we're having necessary- not even close. The WHO recommends a cesarean rate below 15%; anything above that and our outcomes are not improving alongside of the rise in this major abdominal surgery. We are at a national average of 32%.
Take charge of your birth. Know what interventions increase your likelihood of a cesarean. It is NOT ok that we are using pitocin to elictively induce labor.
Don't Hate, Let's Educate. Surely, a mother who knew the risks of induction to her baby and to herself would not choose this. But as a culture, we have made pitocin far too permissible in birth and ignored the dangers of it. Roberto Caldreyo-Barcia, MD said,
Beyond all of this, it's more than just this moment, this birth; pitocin impacts so much more. Michele Odent, MD first began exploring the desensitization of oxytocin receptors.
A recent ACOG survey found that in 43% of malpractice suits involving neurologically impaired babies, Pitocin was to blame. Is this really a risk you want to take because you're uncomfortable towards the end of your pregnancy? Of course not! But mothers are not being told of the risks and so we are overly seeking convenience. This "convenience" is affecting us as a society. This is what I am so angered by. I don't know your circumstances, I don't judge you; what I judge is ignorance. What I am enraged by is the lack of knowledge and respect for choices made surrounding birth. Why is this risk such an easy option to obtain but to VBAC you have to fight? You'll be told the risks of that and you'll be told in a way that makes you fearful, regardless that a vaginal birth may be a safer choice.
Fear mongering is not ok! Ever!
In conclusion: we must respect each women in the choices she makes for her birth and understand that she made the choice she felt best with the knowledge and support she was given. Don't Hate, Let's Educate. We need to stop bashing one another for the choices the other has already made and start reshaping the way our culture views birth. If we can influence the way we think about birth- trusting mother nature, understanding this normal life process- we can begin rethinking our choices and positively influencing future generations. But with so much negative influence from pop culture and a lack of prevalence in the midwifery model of care, where is a simple consumer to begin improving birth? [<---The answer here.]
The Stir on cafemom came out with this article you can read below and I desperately wanted to leave a comment but what I had to say was too long. I felt this warranted a blog post!
There is a term often used in our society that I have come to question. That term is "Standard of Care"
Initially, I think of my care provider taking this approach to care for me in the best way s/he knows how for my situation. What this term really means is, 'this is the problem, this is the solution' across the board.
Pregnancy and birth are such intimate times and each woman and baby so unique; is this really the kind of care you want to receive. Standard not being what's best for you and yours but what's most commonly used (not necessarily evidence based or the best) throughout America.
I urge you, don't accept merely the "standard of care" but strive to discover what is best for you, as an individual, in your personal life and circumstance, creating the standard for your care.
I have two overused and unnecessary pregnancy procedures to add to this list by Michelle Zipp- vaginal exams and IV fluids. Most importantly vaginal exams. They are not necessary in pregnancy or labor and can lead to the overused, and often inappropriate, diagnosis of "failure to progress" in labor. In pregnancy, many women think they need to know if "they're getting close" by vaginal exams as they near their due date. Getting a vaginal exam does not predict when you'll go in to labor. As a birth doula, I've had clients be at 2cm for weeks before labor starts and clients who weren't "showing any progress" go into labor the next day. I put "showing progress" in parenthesis because there is so much more going on in labor than a cervix is telling and the cervix dilation is the last thing to happen. In labor, not only is your body preparing to open and birth your baby, but the baby is preparing as well; it's an delicate dance, best left undisturbed. Maryn Lyster describes birth as "being, not doing." Now along those lines of the position of baby- I've read a lot of comments in the original article of fetal monitoring and fear!!! We don't have to have the electronic fetal monitors and not having them should not create fear. A hand help doppler or fetoscope works just as well. For years and into this day and age, women safely deliver babies at home without these efm's. Not only can electronic fetal monitors can be read wrong but they also restrict your mobility. Did you know that your position can also affect baby's heart rate? For example, if you're lying on your back, which you are doing quite often when on the monitors, you can be compressing the baby's cord which can cause a dip in the heart rate. Too often, unnecessary panic and cesareans are caused by these monitors. Before panicking, try changing positions. Also consider and internal monitor if you're being faced with a cesarean. Also consider, are you being directed to push and doing so on your back? This brings me back to the vaginal exams. Pushing should be left to the experts- the laboring mother. If you have the urge to push, you're care provider or nurse may want to make sure you're fully dilated- whether you allow this or not is up to you, but if you have the urge, you have the urge and if you don't, you don't! Quite often while attending births as a doula, I see [too] frequent vaginal exams during labor and then mother reaches 10cm and she's given "permission" or sometimes directed to push before she has the urge. As I said earlier, there is so much more going on than cervical dilation, including the position of the baby. Perhaps, though mom may be fully dilated, the baby is not in the most optimal positioning for pushing or perhaps she's lucky enough that her body is allowing a break before the 2nd stage. Going ahead and pushing on command could have a negative affect on baby and make it harder for mom, when she could be enjoying this nice break or using this time to re-position herself or work with her doula or partner, trying rebozo sifting or other methods of encouraging the baby to get into position. IV's - when and why? IV fluids are needed if you plan on or need an epidural. The hospital will administer fluids, via and IV, to help reduce the likelihood of your blood pressure dropping too low upon administration of the epidural or spinal block. IV's are also used to administer medications such as pitocin or narcotics. If you don't plan on any of these interventions and are low risk, you don't need the IV. The hospital will encourage you to have a heplock, "just in case" but think about it- Getting the heplock is not going to administer the fluids, that you probably don't want any way, it's just there. So, it doesn't have a head start on much "just in case" and if you're trusting the hospital to be a safe place for the birth of your baby, I hope you trust the skill of the personnel enough to place an IV should the medical need arise. Use your best judgement; do what's right for your body and your baby, know your options, be prepared for your birth- don't skimp on the childbirth education. The conclusion of all of this is to trust birth and to trust your body. Too often these "standard of care" medical procedures cause the very problem you'd like to avoid. If you are low risk, a low intervention birth is probably in your best interest. How will you be empowered on this Journey of Life?
A Birth Circle is a place for expectant and newly postpartum mothers to connect with birth professionals and other families in the community. We provide a safe, non-judgmental place to share your stories and explore the desires you have for your birth experience. Our goal is to provide you with information to make informed decisions regarding your maternity care and newborn. We know that every birth is beautiful and hope to enhance your bonding and breastfeeding experiences. The journey into parenthood and growing your family is one filled with decisions
-- we are there to support you on this beautiful Journey of Life.
Our topics change each month and will include trouble shooting in breastfeeding and the benefits of extended nursing, choices involving newborn procedures, GBS, babywearing and attachment parenting, questions for your health care provider and pediatrician, pain management in labor (natural, medicated and alternative options), positive/negative thought and how it affects your labor, natural family planning, infant massage, prenatal fitness and nutrition, tantrum tamers and parenting with love, benefits of placenta, choices for your birth place, childbirth in pop culture, meet the doula, meet the photographer and much, much more! We hope to see you there!
The quality and outcome of childbirth in our society is in need of reform. This is a life changing event for a family and should be recognized as such. Throughout time our statistics in health outcomes have declined along with the quality of care a woman receives. Options have been stripped, the compassion and art of birth is being lost in the rush of our culture. Today it is common to find birth rushed and controlled and being born of those demands we continue to live those demands. [This is no way to live!] We need to recognize this as a problem and begin remember the midwifery model of care and give birth back to the mother.
The birth of her baby will impact a woman for the rest of her life; this occasion will affect what kind of mother she will be, the kind of lover she is and ultimately determine how she perceives herself. If her birth experience left her feeling strong and able she will be empowered and confident; birth matters. Ask any woman her birth story and you’ll see the flood of emotions come back to her. ACOG defines delivery as the extraction of a fetus.
The state of maternity care in the United States renders us third highest of developed nations for maternal mortality rate. In a nation where we flaunt our technology this statistic is shameful. Our cesarean rate is 32% when the World Health Organization recommends no higher than 15%. Hospitals emphasize standardized care across the board for this personal life event. Putting a woman in a hospital, treating her as if she has an illness, completely undervaluing her power and ability to birth her own baby is not the appropriate approach to birth. Maternity care should protect mothers from complications rather than creating them. Far too often care providers are managing birthing women in the most time efficient, convenient manner; cost being a huge influence of how they provide care and further influence coming from insurance companies and new technology that is released before its full impact can be determined. Indeed, we are seeing today the effects of the epidural and still seeing more negative outcomes than positives as a result of standardized continuous fetal monitoring. These fetal monitors interfere with the ability to labor comfortably; whatever happened to women being attended individually and monitored by their personal birth attendant? This can’t be done in a hospital when the demand is for more patients, nurses stop by for scheduled readings and care providers step in to “deliver” the baby or if the machines determine a problem. In other developed nations such as Holland, home is the place of choice for birth, yet here the first thing we do is call a trained surgeon and pick a hospital. At home we can’t control labor and birth like we can in a hospital but that’s just the thing—like Mother Nature, birth is not meant to be controlled. In a hospital, a woman must be firm in her request for staff to ‘sit and wait’ because it’s so common for them to speed things along, manage her pain “the easy way” and turn the bed for the next patient. Those who are aware of their options have to exert great effort for what they want, negotiate to prevent what they don’t want and constantly repeat their desires. If health care providers were to protect the mother’s space, being there when needed to assist as she birthed, patiently sitting on their hands when not needed, birth could become the sacred, peaceful event it was meant to be.
Today, the media has
instilled into women fear surrounding birth. From the introduction of
hospitals, came a veil, separating fathers for a time, and stripping
birth from its normal role within the family when girls once saw birth
many times prior to their own experience. In this harsh environment
complications were born where we sought to make things easier. Doulas
are said to create a buffer for this harsh environment as well as
provide continuous emotional and physical support for the mother
and even for the father allowing him to participate at a level that he
feels comfortable. Prepared childbirth aims to give women understanding
of the physiological process of birth, understanding the hormones,
emotions, variations of 'normal' and their options. There are various
methods of prepared childbirth that equip women with means of coping and
accepting their labor in a positive, relaxing way. The goal of
prepared childbirth is to take away fear and instill confidence; doulas
facilitate this preparation. Unfortunately only 36% of women will take a childbirth education course and only 3% will use a doula. Fear of birth results in negative outcomes,
while acceptance is attributed to positive birth outcomes.
In most cultures midwives provide the primary care for expectant mothers and obstetricians are there in case of complications. This is not to say that all ob’s are medicalized but that is their training—in managing complications prenatally and in labor & delivery. In the 1920’s when birth moved into the hospital, doctors slandered midwives to gain more patients and attract attention to their “nice, shiny facilities”; there became a rift between these two birth professionals. Across the United States midwives face animosity from obstetricians and hospitals when in fact, their goals should be the same—a healthy mother & baby and a satisfying birth experience. The birth experience will influence bonding between mother and baby as well as overall maternal health, therefore, this aspect cannot be ignored. The problem remains in the great divide between obstetricians in midwives. It is immensely important that we bridge that divide as well as heed to the “do no harm” creed in obstetrics care. It would be prudent of us to follow suit of those cultures where birth is attended by a midwife and medical interventions and ob’s come in play as necessary. Birth is a natural life event, an important part of the Journey of Life, and should be treated as such; it’s not a money-making endeavor.
According to the American Medical Association, informed consent
is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.
In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with your patient:
The patient's diagnosis, if known;
The nature and purpose of a proposed treatment or procedure;
The risks and benefits of a proposed treatment or procedure;
Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);
The risks and benefits of the alternative treatment or procedure; and
The risks and benefits of not receiving or undergoing a treatment or procedure.
In turn, your patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention.
A key factor in the case of labor and birth would be timing. Be sure to ask if the situation is urgent or if the procedure can wait. Consider what is being used to indicate timing. For example, does an electronic fetal monitor indicate baby's heart rate is dipping? Note your position. Are you lying on your back? This position cuts off oxygen to the baby which results in a stressed fetal response, Try lying on your left side and see if this fixes the problem.
Continuous monitoring became a standard obstetrical procedure before studies could show if the benefits outweighed the risks, and without clear-cut guidelines on how doctors should interpret the findings. (Brody, 2009)
Evidence shows intermittent auscultation is the best way to monitor baby during labor. Were you told this or of the risks of cEFM, including increased vacuum extraction, increased incidence of cesarean section without a reduced risk in perinatal mortality? I have seen all too often women whose doctors told them they'd have the freedom to move during labor only to find once in the situation they were restricted far more than they would have liked and had been led to believe by the monitors. In the examples above and below, restriction to the bed could be the cause of the 'problem.'
Perhaps your labor seems to not be progressing. Before you sign the consent for a cesarean , consider dilation is not the sole purpose for contractions. Labor is a delicate dance, according to an article in Midwifery Today,
What a contraction is doing is always ahead of what a cervix is telling.
There is purpose for pauses in labor, yet some medical professionals tend to jump the gun and assume labor has stalled, opt for a c-section and jot down "failure to progress" on your medical record. Easy, safe, fast fix. Though it's not always safe. Let me remind you, to be informed you must be aware of the risks and benefits of accepting the intervention as well as declining it. Informed consent should not be fear based, yet the laboring woman is told you're not progressing, something is wrong. This creates fear & anxiety, which are not conducive to labor and birth, and also puts the pressure on the laboring mother to "hurry up and dilate" -a bodily process she cannot directly control.
Labour in a clinical environment may undermine women's feelings of competence, perceptions of labour, confidence in adapting to parenthood and initiation of successful breastfeeding. (Hofmeyr, Nikodem et al. 1991)
This referenced study exhibits some of the risks of laboring at a hospital. A hospital 'requires' at least one cervical exam and the risks explored here include unnecessary surgery, postpartum depression and more. Were you informed of this? Were you informed of the risks and benefits of cervical examines? Did you know you have the option to say no. Remember, it's your body, your birth experience. Keep calm and birth on!
A person must be "in a reasonable state of mind" in order to give informed consent. A woman in a non-medicated labor is in a primal state- this is not of reasonable mind. When in this state, being coerced with fear does not equal informed choice. It is essential to educate yourself on labor and birth, create a birth plan, get to know your care provider and hire a doula- this person can advocate for you and help you remember your options and assist you in making informed choices when emergencies arise. Labor and birth are unique to each woman and each birth yet too frequently women are treated on the same basic template. When something arises that an intervention is suggested, a woman in labor is not necessarily of a "reasonable state of mind" and her partner may become intimidated, stressed and concerned for her well being and that of the baby. A doula comes equipped with a clear mind in the time of need and knowledge of the physiology of labor and birth, of various medical interventions and of hospital protocols. Using a doula facilitates informed consent. She is not there to make choices for you but to inform you of your choices.
Evidence shows that using a doula decreases the request for epidurals. When a woman asks her doctor about pain relief it isn't very often they recommend a doula, most frequently they'll mention narcotics and epidurals. Ask about the risks and benefits! And don't accept the answer that there aren't any risks- it's simply not true.
Empower yourself on this Journey of Life with education to understand all of your options for labor and birth. Be informed when you consent!
