Don't Hate, Let's Educate {Birth}

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 no room 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.

Daily Med Plus

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,

Pitocin is the most abused drug in the world today.

We are disregarding the importance of mother nature and creating detrimental affects.

Infographic courtesy of Plumtree Baby

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.

Oxytocin is the hormone of love and bonding and human connection. If the oxytocin system is damaged, or a child’s oxytocin receptors become desensitized, the ramifications are huge. Click here to read more about how pitocin impacts can be life-long. 

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.]

Previously in Don't Hate, Let's Educate: Vaccinations and Baby Feeding

For more in evidence based birth to help you make informed choices, follow the Journey of Life.

What's important for your birth ?

Informed Consent

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!

Technology in Childbirth

Each new year brings new knowledge and new technologies.
From stethascopes to continuous fetal monitoring, we've come a long way in childbirth but are all these advancements helping or hurting us.  With the introduction of continuous fetal monitoring came an increase in the c-section rate but no benefit to the health of baby.  From 2D ultrasounds to 3D ultrasounds; we can see so much more detail today but at what cost?  With these advancements we are losing the art of birth.  Experienced midwives on The Farm will tell you that they can guesstimate a baby's weight by palpation alone with just as much if not more accuracy than the technology.  If you consider pain management a technology, this is another change women face; their expectations changed all together.  What many women don't realize is that we are still learning the effects of epidurals and certain narcotics.

I challenge you- with everything offered to pregnant women today it's hard to filter through it all and know what's best for you and your baby, but this is your body, you birth!  Take charge of it- do your research.  Today, women will spend more time planning for their wedding than the birth of their baby and that shouldn't be.  Some things to consider while planning your birth-  Where you will birth, who you will have there, what procedures you will have done prenatally, how you will best embrace labor, birthing positions, newborn procedures and your postnatal care plan.  All of this to come in future blogs!  This is the start to a very important someone's Journey of Life, this is very important part of your very own journey.  Birth is one of the most transformative times in the lives of at the very least two people!

Doula Without Guilt

This blog is in response to a book published in 2011 Epidural Without Guilt.
Below the author addresses "epidural myths" and attempts to dispute them.  Quite often he avoids the real truth and topic at hand, so I've taken each issue and readdressed it.

"* Epidurals will slow down my labor

This is a commonly believed myth, but in fact is not true. Since 2005, there have been four scientific studies published on this issue. Three of the studies found that instead of slowing down labor, pregnancy epidurals and spinal epidurals actually speed labor up – especially when pregnancy epidurals are given before the cervix is 4 cm dilated. The fourth (and largest) of the studies showed no difference in how long labor lasted, whether or not a pregnancy epidural was used. So pregnancy epidurals do not slow labor down – they may even speed it up."

If a woman has been in labor for a long time (whatever she deems as long) an epidural can indeed relax her enough and provide her with much needed rest to continue and even speed up her labor.  Until you get it, you don’t know how you’ll respond to it, therefore a better option may be to hire a doula and take childbirth education classes that teach you natural coping methods.  There are plenty of natural techniques and tools for relaxation; water and breathing to name a couple.  Ina May’s sphincter law explains why relaxation is so essential. 

The problem with receiving an epidural before 4 cm dilated lies in the increased risk for baby going to NICU.    Quite commonly when a woman has had an epidural she will develop a fever; medical personnel have no way to determine whether or not this is due to an infection and therefore baby will be sent to NICU “just in case.”  The longer a woman has an epidural the higher her temperature may be.

An epidural comes with an I.V., a blood pressure cuff, continuous fetal monitoring (which since began has not shown a decrease in infant mortality but an increase in cesarean rates) and the inability to move.  This limit to mobility is what results in a slower labor and increased risk for a cesarean.  A better option would be to keep your mobility.  Use your doula to help you find a rhythm.  Trust your body to birth and you’ll naturally find the positions best suited to work with your labor.  Doula’s are experienced in labor and can help with suggestions for comfort and assist in helping baby into the best position resulting in a more efficient labor.

"* Epidurals will increase the chance that I will need a cesarean

This is an old myth will not go away, even though many studies from different parts of the world have found that pregnancy epidurals do NOT increase the chance of needing a cesarean. So why all the confusion despite solid scientific evidence? It’s because pregnancy epidurals are associated with cesareans, but they don’t cause cesareans. What do I mean by this? Well, women who have difficult, painful labors are more likely to need a cesarean. And these are the SAME women who are more likely to ask for a labor epidural – so there is an association between labor epidurals and cesareans. But the labor epidural does NOT make a cesarean more likely."

On the side of medical interventions, what an epidural does negatively interfere with is pushing; resulting in the increased use of vacuum or forceps extraction and an increased risk for tearing. 

Cesarean rates are increased for women receiving an epidural accompanied with induction or augmentation.  When Pitocin is administered contractions are more erratic and forceful, due to this most of those women receive an epidural.  Pitocin will gradually be increased throughout labor based on physician direction and other medical protocol.  Once the epidural is administered, the woman no longer feels the pain of the contractions and therefore will not direct stopping the drip.  The epidural has cut off this(pain) necessary means of communication.  Meanwhile, though contractions weren’t feeling stronger for mom, they were becoming increasingly stressful on baby.  The only way baby communicates stress is a drop in the heart rate.  Once this happens, even if Pitocin is turned off its affects can still be felt for an hour, which is far too long for a decreased heart rate in baby, resulting in a c-section.  Pitocin and Epidural do a dance together, as they each have opposite effect.  One relaxes and one stresses and therefore as you give one you necessitate the other.  The real problem of the two being pitocin.

Doulas are beneficial no matter what type of birth you plan on having.  Studies show that using a doula decreases the incidence of cesarean!

"* Epidurals will cause backache

It turns out that backache is very common during pregnancy and after pregnancy. In fact many women experience backaches after they deliver that can last for many months. Scientific studies of backache after delivery have found that the chance of having a long-lasting backache is the same whether or not the mom got a labor epidural."

Backache is the least of your worries if you are faced with PDPH, better known as Postdural puncture headache.  When signing the informed consent form, most women are not told that it is a blind procedure and that every woman is different!  Due to this and the precise location the medication needs to be administered into, it is not uncommon that the needle goes a bit too far causing a leak in spinal fluid.  What happens then is your brain is compressed heavily against your skull and no longer cushioned by the fluid resulting in an extreme headache when in any position besides lying flat.  The best fix for this problem being the epidural blood patch.

Due to not being able to feel when pushing, it is not uncommon that women overstrain themselves, therefore resulting in more of a backache than they may have had.  Pushing with an epidural can take longer because the woman may not be pushing as effectively as she could be.  Women pushing with epidurals are generally pushing as directed.  There are numerous benefits to pushing on instinct that are hindered by epidurals.  You’ll never know, so why not take the more natural approach and use a doula to help with coping during labor.  If you don’t have an epidural you can (ideally) push in any position you’d like.  More optimum pushing positions result in more effective pushing and less strain.  Listen to your body and trust birth!

"*Epidurals are dangerous for my baby

This is a particularly wicked myth, because it makes women feel guilty for wanting to their pain relieved. Although there are certain problems with labor epidurals that could be bad for babies, for example, a significant lowering of the woman’s blood pressure – most effects of labor epidurals are actually helpful for the baby. An example of this is the labor epidural lowering the woman’s stress level and thus getting more blood flow and oxygen to the baby during labor and delivery."

I feel this completely is avoiding the topic at hand- that epidurals are derived of cocaine.  No matter how you spell it, drugs cross the placental barrier and baby is receiving the drug as well.  The bonding between mom and baby is threatened from an epidural in that it reduces the suckling desire, causes baby to be drowsy and increases the risk of baby being sent to NICU resulting in a loss of that precious bonding time.  The safest bet for baby and bonding is a natural labor allowing the amazing hormones of pregnancy to do their thing.  Epidurals interfere with the natural flow of hormones that are so important for bonding.

Using a doula reduces the likelihood of requesting an epidural.  Doulas can help you relax and manage the sensations of labor without drugs.  A doula is there to help you have your ideal birth; if you plan on using pain medication and doula can most definitely support you in that as well. 

"*Epidurals will prevent me from breastfeeding my baby

I hear this myth repeated all the time, but the scientific evidence is scanty, at best. Modern pregnancy epidurals and spinal epidurals use such low doses of medication that it’s hard to imagine a negative effect on breast-feeding the newborn. In fact, pain after delivery can be bad for breast-feeding. Pain reduces the amount of milk a new mother produces. And a new mom in pain may be less likely to want to interact with her new baby. So I suggest something that isn’t usually considered: think about using a very low-dose labor epidural after a difficult vaginal delivery, and certainly after cesarean. It’s the best way we have to make the mom comfortable without being drowsy."

It has been proven that women who receive epidurals are more likely to have pain once it has worn off because they have not received the necessary hormones that flow in a natural labor and they have possibly strained more than necessary while pushing.  When a woman uses natural coping methods and allows the natural flow of hormones she experiences elation after the birth of her baby, experiencing the unsurpassed “birth high.”  She is able to get up and walk around, without pain and bond with her baby as nature intended.  A doula can help a new mother begin breastfeeding.  A baby who has not received epidural drugs will root for the nipple and latch on its own.   

After birth, a woman feels “after-pains” which is the uterus contracting to return to its original size and place.  This is a necessary part of birth that does become more intense after each child.  These after-pains can be felt for days after birth; it took nine months for your uterus to expand, it needs sometime to return to its original shape and size!  Oxytocin is the hormone that stimulates the uterus to contract and is released while breastfeeding.  Your milk, which won’t come in until a few days postpartum, will not be hindered by this as the paragraph in the book seems to be suggesting! 

Whether you have the epidural or not, your doula will be there to help you start breastfeeding; lean on her again to relax and breathe through the after-pains.  However you do it, do it without guilt; this amazing part of the Journey of Life.