Wednesday, March 31, 2010

Childbirth and PTSD

Post-Traumatic Stress Disorder (PTSD) Following Childbirth

"Post-Traumatic Stress Disorder (PTSD) after childbirth is an understudied condition. Traditionally, much of the data have been based on case reports, indicating that PTSD can occur following a range of childbirth and child loss situations, including long or complicated labor, severe pain with labor or delivery, cesarean section, and unanticipated pregnancy outcome, such as child loss, miscarriage or infant birth defects. PTSD related to childbirth is frequently overlooked by physicians; the relative newness of the diagnosis and lack of literature on this topic are factors which may hinder recognition of this disorder.

"These studies have reported a wide range of PTSD symptoms, including flashbacks, nightmares, hypervigilance, and avoidance of reminders of the trauma. Women with PTSD also may experience feelings of numbness, anger, depression, social isolation, and chronic sleep problems.

"While earlier reports suggested that PTSD after childbirth appeared to be precipitated by delivery trauma, a recent study by Zaers and colleagues suggests that there are certain predisposing factors which raise the likelihood that a woman will develop PTSD after childbirth.
In this study, 6% of 60 postpartum women reported clinically significant PTSD symptoms at six weeks postpartum. At six months postpartum, 14.9% reported PTSD symptoms. The strongest predictor for post-traumatic stress symptoms was anxiety late in pregnancy. Other predictors included psychiatric symptoms in late pregnancy, stressful life events, and the delivery experience. Nearly one quarter of the women in this study also reported depressive symptoms at 6 weeks and 6 months postpartum.

"The long-term consequences of PTSD after childbirth can be devastating for the mother and/or her family. Women who have experienced PTSD may experience nightmares resulting in conditioned insomnia, difficulties with breastfeeding, impaired bonding with the child, difficult sexual relations with their partner, and poor sense of self-worth. Women with PTSD may avoid childbearing in the future or may opt for an elective Cesarean section in subsequent pregnancies in order to avoid recurrent trauma.

"Careful screening for PTSD symptoms in postpartum women by healthcare professionals is warranted, with special attention being paid to depressive symptoms and anxiety, particularly in cases where the woman presented with anxiety or other psychiatric symptoms during pregnancy or experienced a complicated delivery or an unexpected pregnancy outcome."

For more info:

Monday, March 29, 2010

Infant Massage May Help Prevent SIDS

"Parents have a therapy at their fingertips that may offer their baby protection against Sudden Infant Death Syndrome (SIDS), an Australian pediatrician says."

"Reducing a newborn's SIDS risk could be as simple as massaging them, said Associate Professor Graham Reynolds, as the practice was known to naturally boost a baby's serotonin levels."

"'Scientists have known for a long time that touch and skin-to-skin contact play a major role in the development of serotonin pathways in babies brains,' said Dr Reynolds, who is Director of Paediatric Research at The Canberra Hospital and also patron of the International Association of Infant Massage (IAIM)."

"As well as playing a role in mood and behaviour, serotonin acts as a regulator of the body's basic life-sustaining functions such as heart rate, blood pressure, sleep cycles and respiration."

Saturday, March 27, 2010

2007 US C-Section Rates by State

1 New Jersey 38.3
2 Florida 37.2
3 Mississippi 36.2
4 Louisiana 35.9
5 West Virginia 35.2
6 Arkansas 34.8
7 Connecticut* 34.6
8 Kentucky* 34.6
9 Alabama 33.8
10 New York* 33.7
11 Texas* 33.7
12 Oklahoma 33.6
13 Massachusetts* 33.5
14 Virginia* 33.5
15 South Carolina 33.4
16 Tennessee 33.3
17 Maryland* 33.1
18 Nevada* 33.1
19 Rhode Island 32.2
20 California* 32.1
21 Delaware* 32.1
22 Georgia 32
23 Nebraska 30.9
24 New Hampshire 30.8
25 North Carolina 30.7
26 Michigan 30.4
27 Illinois* 30.3
28 Missouri* 30.3
29 Pennsylvania 30.1
30 Maine 30
31 Kansas* 29.8
32 Ohio* 29.8
33 Indiana* 29.4
34 Iowa* 29.4
35 Montana* 29.4
36 Washington 29
37 North Dakota 28.4
38 Oregon 28.2
39 Wyoming 26.9
40 Vermont 26.8
41 South Dakota 26.6
42 Hawaii 26.4
43 Arizona* 26.2
44 Minnesota* 26.2
45 Colorado 25.8
46 Wisconsin 25
47 Idaho 24
48 New Mexico 23.3
49 Alaska 22.6
50 Utah 22.2
* Tie
SOURCE: National Vital Statistics System, National Vital Statistics Reports, Vol. 57, No. 12.

Friday, March 26, 2010

Preventing Preterm Labor and Birth

Preterm labor and preterm birth are increasing dramatically in the United States, and we don't really know why.

"A preterm baby has a 120 times greater risk of death than a baby born full term, and survivors are at risk of breathing difficulties, bleeding into the brain, and having a significant neurological handicap such as cerebral palsy."

"Preterm birth costs the United States $26 billion per year. It is one of the most serious and significant challenges to medicine and society and one whose importance is not fully recognized,"

This article discusses findings that genes in mothers and babies can predispose them to preterm labor:

The risk is not completely genetic. "'We have established that one of every three premature babies is born to a mother who has an intra-amniotic infection,' an infection in the normally sterile amniotic fluid that surrounds the developing fetus."

Even expectant mothers who are genetically predisposed to preterm labor can take precautions to stay healthy and low-risk through a healthy lifestyle and diet, including plenty of fresh whole foods and lots of vegetables that contain vital enzymes to aid in proper digestion. This will help ensure that the mother will stay free of infection and reduce her risk of having preterm labor.

Wednesday, March 24, 2010

Scoliosis and Epidurals Don't Mix Well

I don't have scoliosis, so I had never really thought about how it might impact a woman in labor, or the effectiveness of an epidural. This post is really informative about scoliosis and labor:

I also never thought about how scoliosis could affect fundal height (what the doctor measures to see if your baby is growing properly), and how it could cause an inaccurate estimate of the baby's size.

If you have scoliosis, read this blog post and talk with your doctor or midwife about it.

Tuesday, March 23, 2010

Massage Reduces Depression in Pregnant Women

As reported in Massage Magazine

"New research shows massage therapy reduced depression in pregnant women, and also reduced the incidence of massaged women's babies being born prematurely.

"The study was conducted by researchers at the Touch Research Institutes, where pioneering research about massage has been conducted since 1992.

"Pregnant women diagnosed with major depression were given 12 weeks of massage, twice per week, by their significant other. A control group did not receive massage, according to an abstract published on

"The massage-therapy group versus the control group not only had reduced depression by the end of the massage-therapy period, they also had reduced depression and cortisol levels during the postpartum period.

"The massaged women's newborns were also less likely to be born prematurely and low birthweight, pubmed noted, and they had lower cortisol levels and performed better on the Brazelton Neonatal Behavioral Assessment habituation, orientation and motor scales."

Saturday, March 20, 2010

Revealing the Real Risks: Obstetrical Interventions and Maternal Mortality

Dr. Marsden Wagner has written an excellent article about the risks of obstetrical interventions. It's long, but well worth the read. The information can be a bit shocking, but I feel the information he presents is extremely important and should be made known to everyone. You have no options if you don't know what your options are. Please educate yourself on the real risks of obstetrics so that you can make a real informed choice in your own care.

Friday, March 19, 2010

Birth in an Upright Position

I had a "lightbulb" thought recently, as I watched my baby change positions into a squat position as he pooped in his diaper.

That's when it struck me.

An upright position is instinctively better for birth!

We don't lie down on our back to have a bowel movement. Why would we even think to do that? It doesn't make sense. No one told my baby to squat, or had to explain to him that it would be easier and more comfortable for him that way, or help it come out faster. He instinctively knew what to do, and repositioned himself.

If it comes naturally to squat for such a normal bodily function that we do every day, why wouldn't it be just as natural to do so for the much bigger normal bodily function of birthing a baby?

I'm familiar with the concept of birthing in an upright position. I've blogged about it before:

"Lying on the back is convenient for physicians, but 'it's the worst thing for a woman,' Pam says. This position, while common, is more painful for the woman because it collapses the diameter of the pelvis up to an inch, making delivery more difficult. Instead, Pam recommends women stand upright, move around and squat—keeping their hips higher than their knees—until they find the positions that best suit them."

I've also read articles about how an upright birthing position can be optimal for birthing a breech baby.

I birthed 4 babies in the hospital. Each time I was instructed to lie down on my back in the bed, even when I had no medication to numb me or prevent me from being able to stand, sit or squat.
When I later learned about the physiological benefits of pushing in an upright position, I determined that's what I would do. When I told my midwife (at a prenatal visit during my 5th pregnancy) that I wanted to push in a squatting position, she smiled and said "you will birth in whatever position feels right and makes sense to you in that moment".

As it turned out, I pushed my breech baby out while in a semi-upright position in the birthing tub, stretching my body out as I pushed. It felt so right, and no one needed to tell me what to do.

What if hospitals were to stop instructing women to lie down on their backs to push, and instead to assume whatever position felt best? What position would a woman most likely choose?

What do you think?

Thursday, March 18, 2010

State of Florida to Ban VBAC in Birth Centers

"On Wednesday, March 24th, the State of Florida’s Agency for Health Care Administration will move to permanently ban Vaginal Birth after Cesarean (VBAC) in Florida birth centers."

Please click below to read the full story and to sign a petition asking lawmakers to allow VBAC to remain a legal option in Florida birth centers.

Wednesday, March 17, 2010

Midwives in the News

Midwives Empower Women Through Natural Childbirth
by Jessica Eyre

In an unassuming business park, one of the occupied office spaces -- among title companies and insurance agents -- is frequented by pregnant women getting checkups and having babies.

But there are no nurses, obstetricians or anasthesiologists there. Well, there might be a few nurses, but in this case, they are the patients.

Birthing Your Way is an unregulated birthing suite, operated by direct entry midwife Sherri and business partner Heather, a certified professional midwife and licensed direct entry midwife.

What is a birthing suite?

Birthing Your Way has a room set up where women can go to have a baby. It looks like a bed & breakfast room -- bed, fireplace, overstuffed chairs, candles, soft lighting. But instead of knick-knacks and mints on the pillows, there are birthing aids, such as birthing stools [where a woman sits on a low stool, shortening the birth canal and opening the pelvis, to give birth] and tubs [filled with water to deliver the baby or to help relax the woman during labor].

Women typically spend about 24 hours there, with labor, delivery and recovery. The mother and baby need to be stable before going home, which includes eating, going to the bathroom, feeding baby, and stable blood pressure, among other things.

The goal for Sherri and Heather is not only a healthy mother and baby, but to empower the mother with the birthing process, which they believe creates a bond between mother and child that they will carry throughout their lives.

"A healthy mother and baby should be the minimum standard, not the gold standard," Heather said.

Why a birthing suite or home birth?

"When you go to the hospital, you're on their playground," Sherri said. State health regulations are set that the hospital must follow -- procedures that are there for the "just in case." For many women, those regulations interfere with the experience they want.

"Medicine through the ages has been so great, but it has sreally taken over in birth," Sherri said.

Birthing Your Way is an unregulated birthing suite, meaning it isn't subject to state health regulations.

"That's exactly what our patients want," Sherri said. They don't want constant monitoring or an I.V., which restrict movement for the laboring mother.

"Sometimes that woman needs to walk and have that pelvis move," Sherri said. Other physical manifestations of labor include screaming, throwing up, even laughing -- all of which can help labor progress, tightening the abdomen and relaxing the lower part of the body. Sherri said at a certain stage of labor, she'll start telling jokes, getting the mother to have a good laugh.

Both Sherri and Heather do routine prenatal checkups, but they put an emphasis on education. They teach classes on the various stages of labor and techniques to handle the pain, such as subtle position changes and pressure points.

For example, even if you aren't going to deliver your baby in the water, getting into a warm bath during labor is what Sherri calls a "home birth epidural." Just as a bath helps relax you when you have the flu, getting in the tub can help a woman relax and manage the pain of contractions.

"The more relaxed you are the less its going to hurt and the faster it's going to go," Sherri said. And the more you know about the process of labor, the better it's going to go.

"The process is really empowering to women," Sherri said.

Who is a candidate for a midwife?

"We deliver healthy women," Sherri said. The majority of pregnancies are routine. High-risk women, though need to be under the care of a physician.

"There are usually little signs that get you in the right place," Sherri said, noting that most midwives are spiritual in one way or another.

For Heather, she wants the women who come to her to be certain this is the right situation for them.

"I will never talk a woman into a home birth," Heather said, saying that if a woman has reservations, there is probably a reason for it, even if she goes on to have a normal birth in the hospital. "You never ignore those feelings."

Of the 50-plus births Sherri has done in the past two years, she has had to transport three to the hospital, two of which required a cesarian section.

"Ninety-eight percent of the time, you are going to have a normal birth," Sherri said. "In reality, stuff happens.

"The good stories need to be told. The bad stories are usually embellished."

While any malpresentation -- when the baby's head is not the first to come down the birth canal -- is not good, midwives have successfully delivered breech babies.

"Physicians and midwives need to hold hands better," Sherri said.

For both Sherri and Heather, the important thing is that women can decide where they want to give birth, whether it's in a hospital or not.

"Don't take that choice away from women," Heather said.

Monday, March 15, 2010

Home Birth in the News

I was recently interviewed for a newspaper article about home birth. It was part of a full-page spread about out-of-hospital birth, and it turned out really well. It's very exciting to see natural birth getting more publicity, and I'm honored to be part of it.

From Hospital to Home
by Jessica Eyre

For Cherylyn, childbirth has been something of an evolution.

"From the beginning, I wanted to have natural childbirth without medication," Cherylyn said, "but I didn't know how to go about it."

Her first two children were born in a hospital, and Cherylyn got an epidural both times. With only the idea of wanting to do it without pain medication, Cherylyn said both times she didn't have the support or the knowledge on how to successfully do it.

For baby No. 3, Cherylyn found a doula, a trained person who provides emotional and physical support during labor and delivery. Together, they created a birthing plan.

"She worked with me in what I wanted and what I didn't want," Cherylyn said. For example, instead of a standard I.V., Cherylyn wanted a heparin lock. It gives access to a vein but does not require a bottle of I.V. fluid to be running.

"I didn't like being hooked up to wires," Cherylyn said. By having that freedom of movement, she could try different positions and walk around to help the progression of labor.

Another part of Cherylyn's birthing plan was having intermittent monitoring rather than constant monitoring. This, again, allowed Cherylyn to move freely around her hospital room.

She took her birthing plan to her obstetrician, who agreed with everything on it.

Baby No. 3 arrived without any medication.

"That was a wonderful experience, it was really beautiful," Cherylyn said.

Her doula was there with her, helping her focus and manage what she was going through.

Her fourth pregnancy went the same way, and she decided then that she wanted to become a doula herself.

While going through the training process of becoming a doula, she started reading course materials, and came across "The Business of Being Born," a documentary film about childbirth. It was this film that introduced Cherylyn to home birth as a safe, viable option.

"I realized I had more choices than I ever knew I had. So with her 5th pregnancy, "I knew that's what I needed to do," she said, referring to delivering at home.

Cherylyn found a midwife, who was a client of her husband, a massage therapist. Cherylyn said it is important when choosing a midwife, that you are comfortable with their credentials, experience and personality -- just as you would with a doctor.

There were similarities, but some big differences, between Cherylyn's prenatal care with her midwife and obstetritian.

The first prenatal visit was at Cherylyn's home, and subsequent visits were at her midwife's house. The prenatal schedule was virtually the same as her OB.

She did urinalysis and other tests, although Cherylyn chose to have an ultrasound and Group B Strep test at her doctor's office so it could be paid for by insurance.

A big difference for Cherylyn, however, was the approach her midwife took toward her health. Cherylyn has problems with anemia during pregnancy. Her iron levels were always low, even with a supplement.

"With my midwife, she talked to me about nutrition to help," Cherylyn said. While she still took an iron supplement, "for the first time ever, I didn't have an iron deficiency."

Another difference Cherylyn pointed out was the time she got to spend with the midwife at each appointment.

The midwife spent about 45 minutes with her each time, talking about good nutrition and her emotional well-being.

"She really connected with me on an emotional level, while still staying on top of my physical well-being," Cherylyn said.

When it came time for delivery, Cherylyn chose to deliver in a birthing pool, provided by her midwife, in her home.

During labor, midwives monitor the mother, they can administer oxygen if needed, they can break the mother's water.

"There are lots of things they can do at home," Cherylyn said.

But mostly, a midwife is there to make sure nature takes its course and the mother and baby are healthy on the other side of delivery.

When Cherylyn was delivering her baby, it was discovered that he was breech, meaning he was coming out feet first. While her midwife wanted to move her to the bed so she can turn the baby. But a second midwife who was there to help had a lot of experience with breech babies, and said Cherylyn could stay in the water and continue to deliver, and he was out within 10 minutes.

Cherylyn said the most interesting part of this experience was how the baby really worked with her body during delivery. Once his legs came out, he was kicking in the water. When his body came out, he was able to move his body around.

"He used his hands and his feet to push off to get his head out," Cherylyn said.

Certainly a delivery of this nature could have gone in a very different direction.

"If I would have had him in the hospital, I would have had surgery," Cherylyn said.

Cherylyn is now training to be a midwife, too, which she anticipates will take about five years.

Friday, March 12, 2010

Healthy Baby Bounty Bag Winners

And the winners of a Healthy Baby Bounty Bag are:



Sara B.


I'm contacting the winners to get their physical address. If I don't hear back within 5 days (by Thursday, March 18), I'll draw more names until we have 2 winners.

Midwifery Resources and Web Links

Midwives Alliance of North America - "In 1982, the Midwives Alliance of North America (MANA) was established as a professional organization for all midwives, recognizing the diversity of educational backgrounds and practice styles within the profession. Its goal is to unify and strengthen the profession of midwifery, thereby improving the quality of health care for women, babies, and communities."

Citizens for Midwifery - "Citizens for Midwifery is a non-profit, volunteer, grassroots organization. Founded by several mothers in 1996, it is the only national consumer-based group promoting the Midwives Model of Care."

Coalition for Improved Maternity Services - "The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and well-being of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based mother-, baby-, and family-friendly model focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs."

Foundation for the Advancement of Midwifery - "The Foundation for the Advancement of Midwifery (FAM) is a 501(c)(3) non-profit organization dedicated to increasing access to midwifery in North America through education, research and public policy. Consistent independent research shows that expanding the midwives model of care in North America improves maternal and infant health outcomes, reduces unnecessary and costly medical interventions, and increases patient satisfaction. FAM receives its support from foundations, midwives, and those individuals who embrace the midwives model of care."

Mothers Naturally - "Mothers Naturally is a public education program from the Midwives Alliance of North America. The goal of Mothers Naturally is to increase the number of safe and positive births by educating and informing the public about natural birth options and empowering women to make pregnancy and birth choices appropriate for their lives."

The North American Registry of Midwives - "The North American Registry of Midwives (NARM) is an international certification agency whose mission is to establish and administer certification for the credential "Certified Professional Midwife" (CPM). CPM certification validates entry-level knowledge, skills, and experience vital to responsible midwifery practice. This international certification process encompasses multiple educational routes of entry including apprenticeship, self-study, private midwifery schools, college- and university- based midwifery programs, and nurse-midwifery. Created in 1987 by the Midwives' Alliance of North America (MANA), NARM is committed to identifying standards and practices that reflect the excellence and diversity of the independent midwifery community in order to set the standard for North American midwifery."

More Midwifery Links

Wednesday, March 10, 2010

A Midwife's Care Under Special Circumstances

by Kendra

"Brian and I decided to have more kids about a year ago. We didn't want to get pregnant again while in school, and I'd already tried to get on medicaid and had been denied so financially it didn't seem like a good idea. But the feeling wouldn't go away, it was time.

"I looked into the costs at a traditional hospital, but really I wanted to give birth naturally at home or a birthing center. I'd always wanted a midwife. I'd loved my doctor in Texas, but I wanted someone who sat with me, who knew what was going on every minute of my laboring process, who listened to all my concerns and didn't try to force anything medical on me. I wanted someone who looked at birth as a natural process, not a medical one.

"One problem, my husband REALLY liked hospitals, and really didn't like the idea of having a baby outside of one. I did some research, crunched the numbers, and like all smart women, I convinced him by making him think it was his idea (Ok, not really, but I did get him on my side). First, I got him to agree with me that it was indeed time to have another child, then I showed him the cost of different types of labor and delivery, and last I had him meet with a midwife at a birthing home. She was amazing, the birthing home was beautiful. She answered all our questions and was exactly what I wanted. Brian (after really looking at our finances) agreed!

"I got pregnant very quickly- especially after having dealt with infertility with the first two pregnancies. But I was able to get on Medicaid and my midwife didn't accept Medicaid. I was devastated. Financially I couldn't pay for something that I could get for free. Luckily, I found out about an office that had midwives and accepted Medicaid. I was very excited. I was back on course for finally having the natural birth I'd always wanted. I would only have to give in on one thing, the baby would be born in the hospital. I could deal with that.

"Enter heart problems... I'd always known that something wasn't quite right with my heart. But with each pregnancy I could tell the problem was getting worse. I mentioned this to my midwife and she recommended I see a cardiologist. I did, and I was shocked at the laundry list of problems I was presented with. Once again I thought I was going to loose my chance at a natural birth. But since there are OB's and midwives at the office I was going to, I was able to stay with my midwife as long as the doctors reviewed my charts. The doctors said I also needed to see a perinatologist. I went to see them, and I've decided that they are the worse pregnancy fear-mongers around. I went home from my first appointment thinking I was going to die (seriously.) They had misread my heart charts and thought one of the conditions I had (pulmonary hypertension) was much worse than it actually was. When this is the case, the mortality rate is 56%.

"Fortunately, a few days later I got a call from their office telling me they had talked to my cardiologist and I was not, in fact, dying. Oh, gee, thanks for getting back to me so quickly! Unfortunately, they were recommending I get weekly ultrasounds and non-stress tests. The midwives weren't allowed to go against the recommendations. As time went on I felt like nothing was going like I planned. At this point I made a very serious decision. After much thought and prayer, I decided that I wasn't going to have any more children. I'd always wanted at least four children, but I'd also always wanted to be the one raising my children. So I decided that after I had my son I was going to get a tubal ligation.

"I knew I wasn't going to go full-term, both my other children were born two weeks early. I tend to dilate and have contractions for about 3 months. So it was getting close to when I thought I was going to deliver. Some nights the contractions were so bad I thought for sure I was going into labor, but I'd wait it out and they'd go away. Once I went to the hospital to make sure, and the contractions stopped. A week later, I knew it was the real deal. Right on schedule, exactly two weeks early.

"We headed to the hospital at about 4 am and we were all checked in and hooked up at about 5 am. The thing I hate the most was the IV, but at the hospital they require all women delivering to have one. My midwife came and checked on me, I really did love her! She would come in and unhook things the nurses had done that I didn't want (too bad she couldn't take out the IV). Also, because I was getting a tubal after I delivered, I had an epidural. By this time nothing had really gone how I'd planned, so I had prepared myself to not be disappointed when I didn't deliver without drugs. Then, they decided to give me pitocin! I was not happy about this. I told them it wasn't a good idea because my babies come very fast. But they insisted because after I got the epidural my contraction pretty much stopped. They started the pitocin and then my baby's heart rate started dipping every three minutes- which confused the nurses since I wasn't having contractions... Then I checked the monitors on my stomach, and sure enough the one measuring my contractions was upside down! I fixed it and then the nurses saw that I was indeed having very hard and close together contractions.

"My midwife was with another woman during this (who was pushing). So after she was done with that delivery, she came in and took me off the pitocin. Then she stayed with me. I loved that. She pulled up a chair and talked with me, for about an hour. My dad called and while I was on the phone with him I was taking deep breaths. When I hung up I noticed my midwife getting her gear on and calling in the nurses. She said, "It's time!". I asked her if she was going to check me and she said she didn't need to, that she knew I was ready. When they put me at the end of the bed and lifted the robe, there was a little head, ready to come out. My midwife asked me if I wanted any of the equipment on me, and I said no, so she took off all the monitors. It was very quiet and peaceful. Very different from my other labors. After pushing for about 10 minutes, my sweet little boy was born. He was a bit bruised from coming out so fast, but to me he was perfect. Wesley Owen was born Nov 15th at 9:09am 6lbs 13oz. And even though so many things didn't go the way I'd originally wanted them to, I realized that I didn't care because I was holding my son and he was healthy and safe. That's what mattered."

Monday, March 8, 2010

Beth's Story

"When pregnant with my 1st daughter, I was already seeing an OB because of previous miscarriages, I never thought to use a midwife, nor had I given much thought to what I wanted in labour, I just knew I was anxious for a baby. I often felt rushed through my appointments and given very little time to ask questions, and my concerns were brushed aside. After taking prenatal classes, I decided I wanted a natural birth, and made this very clear on the birth plan I submitted to the hospital. My water broke before contractions started, and the hospital wanted me in there right away. Labour quickly started on its own, and although [I was] admitted at 8 am, I never met the OB on call until 7 pm that evening. While I was coping with the pain, I was quickly getting overwhelmed, and after repeated offers of medication and an epidural, I soon broke down while my nurse kept insisting I had hours and hours to go. Three hours later my baby girl was born after 40 minutes of pushing, narrowly avoiding an episiotomy, with a small tear, only needing a single stitch. An okay birth, but not what I wanted, I felt really disappointed that while the hospital asked what I wanted in my birth, they seemed to have little intention of helping me get it.

"My 2nd baby girl was born 22 months later. Silly me, I went back to the same OB, and felt even more rushed, and brushed aside during appts. A cesarean was scheduled at 38 weeks because my baby went into the transverse position. My OB refused to try to turn the baby, citing an 'inferior pelvis'. I was told it was impossible for the baby to turn on its own, and an immediate cesarean was necessary. The next day I reported for my cesarean, and was experiencing mild contractions, causing my OB to point out why this was so necessary. The resident asked to do an ultrasound to see the baby's positioning as she had never seen one in transverse before. My OB got really annoyed when she mentioned the baby appeared to be head down, until he checked for himself. Oops, those mild contractions were my little monkey baby changing position and going head down. I hopped off that bed, and went 2 more weeks before going into labour on my own, 1 day past my EDD. Labour was fast and hard. I had mild contractions that quickly got stronger. I was admitted to the hospital at 6 cm, my OB was on call, and decided he wanted my water broken right away to speed things up. He insisted I was silly to insist I didn't want it. I quickly found the contractions too strong to bear, and asked for an epidural. The anesthesiologist and my nurse got into a fight over my back while doing this and bickered among themselves for quite some time. Ten minutes after the epidural was done, my baby girl was born, in 2 pushes. No stitches, and no OB in the room. He was sleeping.

"Baby #3 was born 2 1/2 years later, and yep, silly girl I went back to the same OB. I was determined this time to do things the way I wanted, and had lots of questions of my OB, so I could be prepared. He told me that he didn't have time for my questions, as this was my 3rd baby, and I knew what to expect. I tried to switch to a midwife, but the practices near me were all filled up. I went into labour on my own early in the morning, mild contractions, but I felt I needed to get to the hospital quickly. I got the hospital early in the morning. [It was] very quiet on the floor, actually two nurses were asleep next to the admitting desk. I was 6 cms when I checked in. Twenty minutes later I insisted I needed to push, and was told it wasn't possible, but it was. I was fully dilated, but had to wait for the OB on call to wake up. She rolled her eyes, and asked what was taking so long for my next contraction to start, so I could push. Baby girl was born in 2 pushes, no stitches thankfully, and I finally got my natural birth. I was thrilled and felt great right afterwards. During my hospital stay, I noticed that I was pretty much left to my own, rarely having a nurse check on me and my baby. I figured it was because this was my 3rd baby, and I knew what I was doing, until I wondered why no one came in to release me. After asking at the desk several times when I was going to be able to go home. I found out they didn't know who I was. They had forgotten I was there, and then after doing a quick check, told me I couldn't be released because my blood pressure was too high.

"Two years later, baby #4, the day I found out I was pregnant I called my closest midwife practice hoping to get in. My family Dr. strongly encouraged it. I got in, and loved it from my very 1st appointment. I wasn't questioned about why I didn't want to have the triple screening done, and very few ultrasounds. My appointments were an hour long, and I could ask any question I wanted. I was asked questions and given choices about things I didn't even know I had choices about. A dating ultrasound revealed placenta previa, and my midwife phoned me at home and went over this with me, and what it could mean, when a later ultrasound revealed that it had corrected itself, she phoned me right away to tell me this too. Because I was Group b Strep positive with 2 previous pregnancies, I started taking a homeopathic regime in hopes to avoid it again. My midwife phoned me at home as soon as the test results came in to tell me that I did it, I was negative. At 35 weeks, my baby was still breech. I was given a homeopathic recommendation that worked immediately .We chose to have a home birth, with my 3 older daughters in attendance. This was strongly encouraged, however at 39 weeks it was felt that it would be better for me to be induced, which would mean a hospital birth. I did choose to go a different hospital than where my older daughters were born. My water was very low, and baby appeared to be in distress. My midwife spent over an hour on the phone with me explaining the induction process and phoned the hospital to see if they would make an exception and allow my daughters in to watch the birth. Their policy was no one under the age of 11 and my daughters were 6,4 and 2. The hospital bent the rules for us. Some complications arose during labour, and the attending OB had to be brought in. She told me that she respected my desire for a natural vaginal birth, and she was going to have the OR prepped just in case. She wanted me to try my hardest to push my baby out quickly, and that she too was going to do everything she could to get me the birth I wanted. I was only 6 cm, but she stretched my cervix the remaining 4 cms, and we got her out 5 minutes later, a healthy baby girl was born. I very narrowly escaped a cesarean again. I left the hospital 2 hours later with my midwives and went home to rest.

"I am currently expecting my 5th baby. This was surprise, and I was 3 months along before I knew I was pregnant, I was petrified that I wouldn't get into a midwifery practice. Fortunately, I did. I ask tons of questions at every visit, and I'm never rushed. They encourage me to bring my younger children to every appt. I am planning a home water birth again, with my daughters there to watch, and am very eager for my next experience :)"

Saturday, March 6, 2010

More Midwifery Experiences From Real Women

From Lynn,

"My first pregnancy, I started in a group of 5 OBGYNs. When I told them that I was leaving to birth naturally in a birth center, I was told "Good luck. I wouldn't wish that pain on my most hated enemy." They also tried to scare me into rethinking birthing out of hospital. I'm glad I did not listen, because I went on to birth my daughter in a birth center, naturally with a midwife. I had my second baby at home with a midwife. Both experiences were wonderful!"

From Andrea,

"I am currently 30 weeks along with my first and using a midwife for a homebirth. When I compare the experiences my friends with doctors have versus my care the number one thing that stands out is the level of attention and pure just bonding I have with my midwife. Almost every visit is 2 hours long because we chat and get to know each other. My husband is with us every visit because she works around BOTH of our schedules. I have truly created a relationship with my midwife that is more than just routine medical care with a little standard chit chat. The other thing I love is I never feel I am bothering my midwife and I can call her about any little freak out or concern at literally any time. I don't have to wait till the morning if I have a concern at 8:00pm. Overall every meeting with my midwife just ensures even further that I have made the correct choice for my family."

Friday, March 5, 2010

A Doula's Perspective on Midwives

by Samantha

"I have not personally given birth, but am a DONA birth doula and working on becoming a CBE (Child Birth Educator). Where I grew up (southwest NH) midwifery and natural birth is the norm and it is what made what to get on this path. I grew up thinking childbirth was a normal event. Not one that needed to be induced or numbed. There was a free standing birth center at the end of my street and my favorite thing was to go on walks and see if the "new baby" sign was up and the info on it. All gynecological care I ever received as a teen and young adult was by a CNM, and she made me want to be proactive in my own health, instead of fearful. When I was 17, I went to a DONA training to become a doula and fell in love with birth.

"I moved to Chicago to get my Bachelors in Nursing and to attend midwifery school. Since being in IL I have worked with mostly OB's and it has been very disappointing with one exception. There is one OB I have worked with multiple times who is part of a group with four midwives. The way he practices compared to other OB's is night and day. He allows pushing in any position, he does not rush mom and lets her do things at her own pace. He allows dad to catch the baby all by himself if he wants, he is anti-circumcision and applauds parents for opting not to cut. C-sections are only for women and babies who are in true distress and he doesn't believe in pushing pain meds or time tables. When I asked him if this was his normal practice or only the practice when he is a CNM backup, he said that the CNMs showed him what birth should look like and he never looked back."

Wednesday, March 3, 2010

Experiences With Both Doctor and Midwife

by Nicole

"When my husband a I got pregnant with our first child we already had plans to use a midwife. It was something I had wanted to do for years because I don't like the hustle and bustle of hospitals with the possibility of going through several different nursing staff during shift changes and I also had a horrible experience with a spinal tap. When I was getting my tap done the doctor said don't worry its like an epidural (which I had never had one, so at the time it didn't mean anything to me). Well after the tap I ended up with a spinal migraine that left me incapacitated for about a week. The words of the doctor stuck with me... If the tap has similar side effects as an epidural and I was in my room in complete darkness for a week what would I do if I had an epidural for labor and I experienced the same thing? What about my baby and the bonding? It knew that an epidural was out of the question for me. So that is how I ended up wanting to use a midwife.

"I found my midwife through the place we took the Bradley birth classes. I see my midwife for all my prenatal care and I see a doctor for some of my prenatal visits as well. The reasons why I see both is one, being that if things don't go as planned for my home birth I would somewhat know who would be helping deliver my baby and two, is pretty much because it seems to make everyone I know feel better about my decision even though it shouldn't matter. The funny thing is that when you tell people that you see a doctor as a back up it makes them feel at ease even though my doctor really doesn't know me at all.

"From my experience seeing both my midwife and my doctor are 2 totally different things. With my midwife she gave me the time and patience and respect I was looking for. Every prenatal appointment we had was at least an hour long. She really cared about what was happening to my body physically and emotionally. She even wanted to make sure my husband was doing well during my pregnancy. She cared about us as a whole. Even though I felt very educated on pregnancy and child birth my midwife had so much information and real experiences to share that it was better than any reading I could have done. I learned so much from her.

"As for my doctor it is exactly what I try to avoid. It's chaotic and busy and I spend most of my time waiting. I usually end up waiting for at least 15 to 20 minutes before I get to go in a room. Then the nurse sees me first. She weighs me, takes my B.P. and a urine sample. The nurse asks me the usual questions. What meds are you on? Do you have any cramping, bleeding or abnormal discharge? Then she leaves and I wait in the room some more to see my doctor. When my doctor comes in she asks the same cramping, bleeding, discharge question that the nurse already asked me and she asks me how I'm feeling and if I have any questions. Then she measures my uterus and we listen the the baby's heart beat. Then that's it. I get about 5 to 7 minutes with my doctor and I'm on my way.

"I feel somewhat satisfied how the appointments go because I get everything else I want and need from my midwife. I do feel the sense of being rushed while I'm there and feel there is such a lack of personal touch. I also feel like the only information I would get from my doctor is if I brought in a list of questions. (which they wouldn't have that much time to answer anyway) I cant imagine not having a midwife who spends the time to help me learn and prepare as much as possible. I feel like there is so much information women don't get from their doctors unless the woman pursues it.

"I'm not against doctors or hospital births because I feel its important for a woman to do what's comfortable for her. From my experience I think too many women just trust their doctors and do whatever they say and that is not always the best way to go through pregnancy, labor, and delivery. I feel so many women may not being getting the opportunity to learn about birth and pregnancy and what their rights or choices or options actually are.

"I have an amazing relationship with my midwife. I consider my midwife to be a part of my family. She was there for me in all aspects of the most important time of our lives, not only for the pregnancy, labor and delivery but even for questions after the baby was born. I remember calling her a 12am in tears because I was having trouble nursing. I don't know anyone that can call their doctor at that time for that kind of question let alone even calling their doc at all. I tried calling my doctor once before for a question about my child. My daughter had a diaper rash we couldn't clear up. I just wanted to know if there were other creams or natural ways to help other than what we were already doing. Well when I called the nurse took my call and said "I can't give you suggestions without seeing it you need to make an appointment". So I called my midwife, she gave me two suggestions, I tried one and in 2 days the rash was gone.

"Everything I had imagined on how I would want my midwife to be and how I pictured my labor and delivery came true. It was the best experience I have ever had. I am pregnant with my second child right now and due February 7th. Again I see my wonderful midwife and I see the same doctor as well for the prenatals. I love seeing my midwife and love the interaction she has with my first daughter that she helped bring into this world. I am really looking forward to having another home birth with her again."

Monday, March 1, 2010

Home Birth Transfer Under a Midwife's Care - Emily's story

by Emily

"With my first son, I was twenty weeks pregnant before I found a homebirth midwife, an LM (Licensed Midwife) educated in Washington State. Previously, I had been seeing a group of midwives and OB's who were affiliated with my local hospitals birth center. Every time I went there, I was weighed, measured, and told my BP was too high. It would take several checks before it would come down. The first time I had an appointment with my MW, she had me weigh myself in the bathroom down the hall, then trusted me to tell her, and my BP was lower than it had been my whole pregnancy. I knew I'd found "the one."

"She was great during my labor. I had several family members there, but she didn't mind at all. When my water broke at 10 cm it was stained with meconium and my boys heart rate dropped significantly. We ended up transferring to the hospital. Her assistant rode in the back of her subaru with me, assuring me it would be fine.

"My MW ended up seamlessly taking over the role of doula once we got to the room. She would give suggestions for positions to push, and thought that having me push with every other contraction would help with the baby's HB. It helped immensely. She even whispered in my ear that the OB was looking at using the vacuum and to make my pushes really count. I can't imagine pushing for 2 1/2 hours without her there. After my Samuel was born, she stayed and helped me breastfeed. She and her assistants went back to my house with my mom and sisters and cleaned up my house.

"With my second son, we were able to rent a birth tub through her, though we didn't use it much. She had some great herbal remedies for when my blood pressure began to creep up a bit. She was fabulous during my labor when I had a OP(occiput posterior) baby, and my labor dragged on and on. I felt like I had put my whole self in her hands. And she took wonderful care of me. Sometimes people talk about not relying on anything but their own bodies during labor, but I never feel like that, I feel like I need some one with me who knows what they are doing, because I'm 22 and don't know anything but what I've read in books!

"When Matthew was born, I was standing up against the headboard of my bed and birthed his big body over an intact perineum. He came out and was floppy and white. My MW was amazing, immediately called 911 and began administering oxygen. His heart rate was strong and steady but he was reluctant to come around. I'd almost say it was like he passed out as he was born. He perked up just as they arrived. She had it under control, even when the EMT's arrived and completely ignored her authority and essentially "stole" my perfectly healthy son and transported him to the ER for an hour. The next day she went and gave them a lecture on home birth and her role versus theirs. She was awesome.

"She was a great mixture of professional and warm. She was like a doctor, in the way that she was full of information and had such a direct and strong way about her, but she was a midwife at heart, warm and willing to be leaned on."