It's Not About You {Don't Hate, Let's Educate}

Dear mother who had a cesarean,

It's not about you

Dear mother who had a natural birth,

It's not about you

It's not about you and it's not about me; it's bigger than us! It's not about your birth choices or mine, or anyone else's. We each make choices that are best for our own unique situations with the information that is given to us. The information that is given to us is what's so important.

The United State's ranks 60th in Maternal Mortality Rate while flaunting some of the worlds highest World Health Organization's recommended cesarean section rate of no higher than 10-15%, with an astounding rate of 32.8% that can vary greatly even among neighboring hospitals. ACOG has released guideline after guideline after guideline in effort to reduce the climbing cesarean rate and encourage vaginal birth [after cesarean (pg 6)]. What makes all of this a greater challenge, isn't the system, it isn't even the doctors who aren't following ACOG guidelines, it's society, perpetuating lies and fear throughout your community. There are obviously a variety of complex reasons for the high cesarean rate but each woman holds the responsibility to create positive change for our sisters, for our daughters and generations to come by speaking out with facts and encouragement for those around us. Too often I see women perpetuating the fears and the lies that many have come to believe; especially in regards to VBAC. I encourage you to take a class on VBAC and understand the real risks and benefits of a trial of labor vs a planned cesarean delivery. You deserve the facts and evidence based care. An informed decision is not one driven by fear; it is one made from statistics and access to all of the information.

Women deserve access to the safe and appropriate choice of VBAC and banning vaginal births is not in the best interest of babies and families.

Please, join us at this year's 3rd National Rally to Improve birth!!

Introducing the first year of the Improving Birth Fun Run!!

I was recently confronted by a mother who felt attacked by the statistics; a mother who had chosen a RCS for the birth of her second child. I do not know her whole story but she was adamant that vaginal birth was very dangerous! [Perhaps she hadn't know the facts and was second guessing her decision or perhaps she just didn't like that I had personally made a decision that differed from hers or perhaps she was emotionally burdened because she felt that she didn't have a choice.] I don't know, but whatever the reason, this is bigger than her, this is bigger than me, this is bigger than you.

As a doula, I support any birth - I've supported natural births and medicated births, I've supported inductions, I've supported a planned cesarean section and emergency c-sections. I am well aware of the need for facts and evidence based information, especially in the face of our alarmingly high cesarean rate and climbing maternal mortality rate. Women need to be empowered and spreading false information or being denied all the of the information is damaging to society as a whole. The system isn't going to change, women need to be the change.
There is no room for spreading fears and falsehoods.
Each woman is tasked with the responsibility of taking charge of her health; making safe and appropriate choices that are right for their individual circumstances.

Your choice doesn't have to be the same as mine or any one else's. What's important is that your choice is made from fact, not fear; aka making an informed decision.  I further encourage you to give the women surrounding you the same courtesy of informed choice by stopping the wild fire of misinformation and sharing facts.

Had a cesarean? Don't freak. Know the facts.
If you're local to Phoenix of Tucson Give Birth offers a VBAC Workshop
If you're local to Cottonwood, Prescott, Flagstaff or other surrounding areas, yours truly of Guiding Angels Birth Services also presents a VBAC Workshop for Northern AZ. And be sure to check out these helpful links!

6 is the new 4 {A Birth Circle Topic}

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.

Read more:

ACOG Consensus Statement: Safe Prevention of the Primary Cesarean

So, what does that mean for you as a consumer??

It means that 

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.

Birth Monopoly | You're Not Allowed to Not Allow Me

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. 

Read in detail, recommendations for the safe prevention of the primary cesarean delivery.

Want to learn more? Have questions? Schedule your private consultation or contact me via

Guiding Angels Birth Services

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!

Past Birth Circle Topics:

• 6 in the new 4
• Share The Love
• Fertility Awareness
• Meet The Photog
• What's A Birth Circle
• Frequently Un-Asked Questions
• Childbirth In Pop Culture
• Nutrition in Pregnancy
• Essential Oils
• Homeoprophylaxis   
• Birth Stories

'Like' YC Birth Circle on Facebook

Sign up for monthly email reminders of our meet ups

More Than A Scar

       Crisis [krahy-sis]

Noun

1.       A stage in a sequence of events at which the trend of all future events, especially for better or for worse, is determined; turning point.

2.       A condition of instability or danger, as in social, economic, political, or international affairs, leading to a decisive change.

3.       A dramatic emotional or circumstantial upheaval in a person’s life.

I was 37 weeks pregnant, sitting on the white, crunchy paper of a doctor’s office table, when my obstetrician informed me that I was very tiny and the fetus I was carrying was measuring large; “we should just schedule a c-section” he said. Something in me knew that was not the appropriate response and I declined, requesting I be allowed to try and birth my child naturally. Reluctantly, this man I entrusted with my care agreed as long as I “progressed fast enough.”

I was 40 weeks pregnant, sitting on the white, crunchy paper of a doctor’s office table, when my obstetrician reminded me that I was very tiny and the fetus I was carrying was measuring large. At this point, I scheduled my induction. Little did I know, ACOG does not support induction or routine cesarean section for a suspected big baby.

I was 40+3 weeks pregnant in a hospital bed, receiving Cervadil. A few hours later it was apparent that either my child was ready for his birthday or the Cervadil was all I was going to need. It was around 2am, Feb 6, 2007 and my labor had begun. I slept through most of early labor and a nurse came in at 7am because “it was time” for the Pitocin drip to begin. I didn’t want it, I was beginning labor on my own but “I had to” have it. It was started and then quickly stopped due to decels in fetal heart tones. I labored naturally on my own, frequently interrupted by “required” vaginal exams to ensure I was “progressing fast enough.”

It was Feb 6, 2007 at 2 o’clock in the afternoon, I was 7 centimeters dilated, my water had spontaneously ruptured about an hour ago, fetal heart tones were reading great, maternal blood pressure was spot on but twelve hours was long enough according to the obstetrician I had entrusted with my care. A cesarean section was ordered for “failure to progress” and approximately 1.5 hours later, my child was cut out of my body. I gave my child a kiss and we were separated, the rest of the operation details don’t matter much. He was 7lbs, 2oz, 20 in long and his head was 14 ¾ in diameter.  At my late ultrasounds, the doctor had estimated my baby to be around ten pounds but “Wow, what a big head. He wouldn’t have fit anyway,” was the explanation without apology from my obstetrician.

A mother seeking a TOLAC, (trial of labor after cesarean), in a rural town is very limited. At the hhosptal in my town an RCS, or routine cesarean section, is scheduled for mothers with prior cesareans. For my second birth I sought care from a group of midwives in the city and planned my birth place to be a hospital; not my first choice but one of the few options I had because of my prior cesarean. I was 37 weeks pregnant, moderately dissatisfied with my choice of care providers, sitting on the white, crunchy paper of a doctor’s office table. My midwife informed me my fetus was breech, I would “have to” have a cesarean. I found a new care provider. My crisis taught me that this is my body, my baby and my birth.

My crisis taught me that I shouldn’t trust another with my care; I had to be responsible for the decisions made. My crisis taught me to follow my heart. My crisis taught me that what one person says is not always correct. Little did I know how profound that statement was to become.

I was 41+6 weeks pregnant, it was a little after midnight and fear overwhelmed me; fear that if I didn’t “push fast enough” this opportunity, this right, and this birth, would be taken away from me. Three pushes later, my son was born, measuring in at 8lbs, 6oz, 19 in long with a head that was 14 ¾ in diameter. My prenatal challenges shaped who I was becoming as a mother but these numbers impacted the realization of my crisis on a deeply emotional level; realizing how much I had been lied to during my first pregnancy. The cut of my first birth may have been the actual event of a crisis but it was at this moment that it became such.  It was at this moment my life changed.

As the weeks unfolded I bonded with my VBAC baby like I have never done with my first child. It was during these moments I began to feel the emotional impact and realize my first birth experience was a crisis. It had always angered me, it had been a frustration during my second pregnancy but now, it hurt me. The cut of my cesarean cut more than just my body, it cut my soul.

-- Anonymous  

The cesarean rate in America is 32%. The World Health Organization recommends less than 15% to be appropriate.  With these numbers in mind, it's no surprise that so many mothers have suffered from birth trauma from a cesarean. If this is you, I encourage you to process your past birth experience(s). Find a local ICAN Chapter, take a birth after cesarean workshop, attend a group counseling session where you can share your experience(s), hopes and fears, and be showered with love, compassion and support. Some mothers may benefit from seeking a therapist trained in EMDR, (eye movement desensitization and reprocessing). All mothers will likely benefit from a doula.

Not all mothers feel traumatized by their cesarean but most view it as a crisis that challenges them to this day. Use this challenge to support those around you; use it to improve birth. Because when you know better, you do better. Find evidence based information; know and understand your options and make informed decisions, encouraging those around you to do the same. 

If a mother feels empowered in her birth experience, no matter the type of birth it is, she is less likely to suffer emotionally. Birth shapes the type of mothers we become, the relationships we have with our partners, our children and those around us.  A cesarean affects a mother emotionally, physically and medically for the rest of her life.

The Importance of Baby Friendly Hospitals

What makes a hospital baby friendly?
Essentially, it understands, promotes and educates moms on the importance of breastfeeding.

The 10 steps are

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.
7. Practice “rooming in”– allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

 Get the details here. A baby friendly hospital strives to provide moms and babies with the best start possible. The hospital near to you may not be the best choice for your birth. Ideally, the new family will have immediate and uninterrupted skin-to-skin contact for at least an hour, if not two, after birth and be coached in breastfeeding.

Sounds simple right? So why aren't more hospitals in Arizona involved? And why is this so important? And scroll down to "because it does matter" in this post. Successful breastfeeding is found most easily in support; that support should begin at birth, if not before!

Don't have a baby-friendly hospital near you?
Don't fret! Just remember the rap ;-)

• skin-to-skin is best
• hold off visitors (especially well meaning family) until after The Magical Hour
• delay or forgo newborn procedures
• Is Erythromycin Eye Ointment always necessary?
• 10 Decisions for Parents of Newborns: Part 1 | Part 2
• delay or forgo the baby bath
• Why the newborn bath should wait
• resist artificial nipples
• room in and feed on demand
• join a local La Leche League 

This is the earth-side beginning of the Journey of Life. Why not give babies and moms the best start?  

What was your immediate postpartum experience like?

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 ?

Standard of {Your} Care

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.

Be empowered with informed choice and refusal. 

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?

Birth of our Society

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. 

Why the wait? {Delayed Cord Clamping}

Delayed cord clamping is all the rage - but why?

Skin to Skin

Along with immediate skin to skin contact, the blood baby receives from the cord aids in stabilizing her temperature.  Furthermore, if baby is still attached to you, the chance of a nurse whisking her away to a warmer for typical newborn procedures is minimized.  Besides her blood, you may also want to let baby keep her vernix; avoid/delay the baby bath.  Like blood, vernix also can help regulate body temperature and has antibacterial properties, as well as being natures best moisturizer so it is best to rub this slimy cheese-like substance into the skin rather than wash it away.

Blood Flow

At 1 minute after birth approximately 80mL of blood is transferred from the placenta into baby.
At 3  minutes after birth that becomes approximately 100mL of blood according to the WHO.

Delayed cord clamping is defined by waiting about 3-5 minutes after birth or until the cord stops pulsating.

 Cord just after birth- still pulsating with blood.








Limp cord- blood fully delivered to baby.
Photo courtesy of Perfect Chance Photography

So why is this important?

Baby gets much needed iron supply.  According to Michelle Roberts, a BBC Health Reporter, iron deficient anemia is "a significant health problem because it can harm a child's brain development."  Allowing a child to receive the full potential of blood and iron stores meant for him ensures a good start; "babies with delayed cord clamping had better iron levels at four months of age." (Roberts, 2011)  This iron supply is especially important in premies who may have not had those last 8 weeks in utero to store up iron.

The brain is afforded some extra protection with this blood flow.  In babies with complicated births, especially a lack of oxygen, this layer of protection is crucial to the brain.  Oxygenated blood travels through the cord to the baby helping to prevent hypoxic injury and associated long term problems due to lack of oxygen.  
Elizabeth Perry describes a birth in which 

the baby was resuscitated physiologically through the intact, unclamped cord.

Perry, E. (2012). Redefining Normal. In N. Halseide (Ed.), Second Stage: The Pushing Phase of Labor, Midwifery Today, Inc. 
 -A highly recommended read from this Collection of  Articles from Midwifery Today Magazine.

The Count

A full-term newborn has an average of 120 ml of blood per kilogram of body weight, or an average of a total fetal-placental blood volume of about 480 ml (16.9 oz.) At any given time about 70 % of his blood is in his body and 30 % is in the placental/cord unit.

- Frye, A. (2004). Holistic midwifery. (Vol. 2). Portland: Labrys Press.

In premature babies and babies born to mothers with gestational diabetes these are very significant numbers. By receiving his full quota of blood, your baby is less likely to have low blood sugar and an increased count of white blood cells means better ability to fight off infection.

Q- Even in uncomplicated births and healthy babies, why not allow the baby the blood belonging to them? 
Jaundice is a commonly heard response, however studies show "no evidence of adverse affects from this."  Studies have shown that jaundice and polycythemia are not curbed by immediate cord clamping as there are other factors involved in their derivation.
A- Cord banking may be the only accurate answer to that question. More on this here.  The chances of a low-risk baby needing his stored stem cells is 1 in 20,000. 

To clamp or to delay clamp? That is the question.  One of the many decisions you'll make for your newborn on the Journey of Life.  What will you do?

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.