Monday, June 28, 2010

Thoughts About Labor Support and Unassisted Birth

I've been thinking a lot lately about unassisted childbirth. I must admit that the idea is becoming more appealing to me the more I think about it, and I'm starting to consider this as an option for my next baby's birth.

Don't worry, I'm not pregnant again... yet. We want another baby, but we're not trying to conceive at this time. I'm always thinking and planning for the future.

My childbirth experiences have been a journey. I feel I've been on this road, and I keep growing and learning as I go. My journey from fully medicated birth to unmedicated birth in the hospital, then to birth at home, has been a progression for me. I'm always wanting to find something better and more fulfilling, and possibly more challenging as I go.

I like challenging. It stretches me, helps me grow.

"When you're through changing, you're through." -Bruce Barton

What's the next step? Is it freebirth?

Don't get me wrong. I'm not going to put myself or my baby at risk just because I enjoy a good challenge. I don't make any big decisions without doing my homework and knowing all the ins and outs, exactly what I'm getting myself into.

I also believe in divine personal inspiration, and I'll pray about my options and move forward with what I feel is right and best for my family. I prayed about home birth with my last baby and felt such overwhelming peace that I knew that's what I should do.

Right now I'm researching and considering my options, and I'll pray about them when a decision is needed.

I'm all about labor support. I'm a doula. I DO labor support. I feel it's important to have the right support for birth. But what is the right support? I think it can be different for each birth.

When it comes to unmedicated, natural, spontaneous birth without unnecessary interventions, I've always felt that with the right support and care I can do anything. I love my doula and midwife who each worked with my husband to provide encouragement, comfort measures, and a level head to help me through what's always been for me a somewhat long process of labor and birth.

At one point during active labor with my planned home birth I found myself alone. My midwife was in the other room. She had left my husband and I alone because I was coping well with his support and she was respecting our private space. My husband had to go to the bathroom, and just as he was gone a strong contraction hit.

I had been depending on my husband's support, and it suddenly occurred to me that I was alone! Panic hit, fear set in, and I experienced the worst pain of the entire birth experience. It's the only part of Liam's birth that I consider to have been actually, truly painful. Even transition was nothing compared to the pain I felt at that moment.

I learned two things from that experience:
  1. The Fear-Tension-Pain syndrome is REAL. When we experience fear our muscles invariably get tense, which causes pain. This is definitely true in labor and birth, and I experienced it first-hand in stark contrast to the rest of my otherwise relaxed and peaceful labor.
  2. I have had the belief that I can only handle natural labor if I have support from others. Whether my belief was true or not, it was real and it affected me completely in that moment.
I've reflected on that experience a lot since then. What about women who experience spontaneous precipitous labor and have no support, but still have an amazing and beautiful birth? What about those who plan unassisted birth and handle it just fine without any outside support (other than that of their partner)? Why would I only be able to handle labor well with support, if others could handle it just as well on their own?

If I plan an unassisted birth I would still have my husband's support so I wouldn't be completely alone. Do I actually need the support of a doula and/or midwife or others in order to have a beautiful birth experience?

Friday, June 25, 2010

Freebirth (Unassisted Childbirth)

"Just as a woman's heart knows how and when to pump, her lungs to inhale, and her hand to pull back from fire, so she knows when and how to give birth." - Virginia di Orio

Remember Kasie's story of her unassisted home birth?

That birth story was huge for me. When I first read it, I was 7 months pregnant and planning my own first home birth. Her story gave me great encouragement. I saw a lot of similarities between Kasie and myself, with the exception that I was planning a midwife assisted birth and she had an unassisted birth.

Unassisted birth - or "freebirth", as it's sometimes called - is intriguing to me. I sometimes wonder how my own home birth experience would have been different without the support of my midwives. With a surprise breech, I'm really glad the midwives were there, and everything went smoothly. I like to believe that if I'd given birth without the midwives it all would have gone smoothly, but I suppose I'll never know.

What I do know for myself is this: If I prayed about planning an unassisted birth and felt the overwhelming peace that I felt after praying about home birth, I would definitely do it.

I'm in a good position for excellent home birth support. Through the process of my doula training and ongoing midwifery training I'm developing a fantastic network of amazing doulas and midwives. Many of them are dear friends. I feel that as long as I live here I will not want for better birth support at home. I may never have a reason to consider freebirth.

But what about the women who live in areas where, for whatever reason, cannot get the support they want for a home birth? While home birth is legal throughout the United States, in many states it's against the law to have a trained midwife attend your baby's birth at home. This means that women wanting a home birth in those areas have two options: go "underground" and try to find a midwife to support them illegally at home, or plan an unassisted birth.

The reasons for choosing freebirth are varied. Some women choose it because of limited options, as I described above. Others choose it because they prefer to give birth to their child without any interference whatsoever, surrounded by loved ones, often just their partner and other children.

We don't really know how many women are giving birth at home without midwives because there are no reliable statistics. Nationwide, 90 percent of births still take place in hospitals with doctors attending. Another 8 to 10 percent are with midwives in hospitals or birthing centers. And 1 to 2 percent are at home.

Regardless of the reasons and circumstances surrounding a planned unassisted birth, the choice should not be taken lightly. If you're interested in or considering a freebirth you should do your homework and educate yourself as much as possible. Check out documentaries (such as The Business of Being Born), find support groups in your area, read up on the natural birth process as much as possible and take classes on it. It's best to avoid classes that are taught at the local hospital or health clinic, because they mostly likely wouldn't give you the information you need for a birth outside of the hospital. The Bradley Method is one class I think would be really informative. Hypnobirthing and Hypnobabies are good as well. Find online groups and other women who have done freebirth. Find out how best to prepare yourself and your home for an unassisted birth.

A word of caution: I personally would not recommend freebirth for a first-time mom, because to her labor and birth are completely uncharted territory. I would suggest having a midwife-supported birth at home or in a good birth center. Then you may consider an unassisted birth with your next baby. You don't always know how your labor will play out and how you will react in certain situations until you've been through it.

Wednesday, June 23, 2010

Vaginal Breech Birth: A Lost Art

Here's a photo of me and my sweet breech baby.


His bottom came out first,

Then one leg came out followed by the other leg,

He kicked his legs in the water,

And the midwife said "Look, he's doing just fine!"

An arm came out next and then the other arm,

And then "he put the hands and the feet on the bum cheeks,

And pushed his head out!"*

*as told to me by my sweet 6 year-old who, along with his 9 year-old brother watched his baby brother's birth.

Tuesday, June 22, 2010

Skin to Skin Contact in the OR: Speaking Up and Making it Happen

I've found more really good information on this subject:

This blog post by a Labor and Delivery nurse gives some excellent advice on how to speak up and ask for skin to skin contact immediately after a cesarean birth. This can be done while the mother's incision is still being closed, and it provides an important bonding time between mom and baby to establish breastfeeding and a healthier, happier newborn.

Here is a wonderful video that shows an example of skin to skin in the operating room:

Monday, June 21, 2010

Breastfeeding and Skin to Skin in the Operating Room

"With a Cesarean birth the baby can be brought to mom's chest and feed even as the incision is being closed."

The routine is generally to whisk the baby away for weighing, drying, and doing newborn checks while the doctors close the incision and the mother lies on the operating table. As long as the newborn is in stable condition, it can be brought to the mother and held skin to skin just as many would after a vaginal birth.

There are other things that can be done differently to make a cesarean section birth more meaningful. A friend of mine had a positive experience with her cesarean birth. Her midwife gave some really good suggestions to them before going in for surgery. One of those suggestions was for the father to hold the baby and not let the nurses have him back. When the nurses wanted to put the baby in the bassinet to take him to the nursery, the father gently refused and told them he would hold his son. Even after they told him he wasn't allowed to do that, he held tight to his newborn and insisted on carrying him to the nursery himself. He stayed with the baby when the mother couldn't be there.

There are options other than the normal routine, but you must ask for them. You need to know your rights and how to ensure you get them. Do you have any suggestions for expectant parents on what they can do in the event of a cesarean section?

Saturday, June 19, 2010

Breastfed Babies Make Better Teens

As reported on ABC News, Jan 28, 2010

By Gina Marich

Researchers are urging mothers to breastfeed their babies until they are at least six months old after carrying out a study which they say has found a link between breastfeeding and child mental health.

The 14-year study published in the Journal of Paediatrics followed almost 3,000 women in Western Australia and tracked the development of their babies through to early adolescence.

The women who took part in the study breastfed their babies for different lengths of time, with some women not breastfeeding their babies at all.

One of the study's authors, Professor Sven Silburn from the Menzies School of Health Research in Darwin, says it is further evidence of the importance of breastfeeding in a child's development.

"What we found was that for each additional month that a child was breastfed [the] behaviour in teenagers improved," he said.

"We can say clearly that breastfeeding for six months or longer is positively associated with mental health and wellbeing in children and adolescents."

Professor Silburn says it is essential for everyone, especially mothers, to be aware of the importance of breastfeeding.

"Changes in the workplace, the increased casualisation of employment, that is making it very difficult for some mothers to be able to breastfeed as they should," he said.

"Being able to organise work and to have public acceptance of the importance of breastfeeding is something that we want to continually support."

Friday, June 18, 2010

Wonderful Hypnobabies Birth Video

I absolutely love this video of a hospital Hypnobabies birth, published on Enjoy Birth

I observed a Hypnobabies course as part of my doula training, and I'm so impressed by what women can do with it to have a beautiful birth experience.

FYI: in Hypnobabies they use different birth terminology than we normally do. Here are 3 terms that are used in the video:
  • Contraction = Pressure Wave
  • Labor = Birthing Time
  • Transition = Transformation

Wednesday, June 16, 2010

Rising Maternal Mortality Rate Causes Alarm, Calls For Action

"Each day in the U.S., two women die of problems related to pregnancy or childbirth. The numbers have been rising, for reasons that are not entirely clear."

"Nationally, the rate, defined as deaths from obstetrical causes within one year of giving birth, rose from 7.6 per 100,000 to 13.3 per 100,000." (emphasis mine)

This excellent article discusses the rising problem of maternal mortality, and some of the possible causes including: the rising c-section rate, increasing use of medical labor induction, and the changing profile of American mothers (more older women having babies).

The problem is baffling for experts, because high death rates are common in poor countries where women don't have access to adequate prenatal care. The United States, however, spends the most money on health care, yet has one of the highest rates of maternal mortality.

"Though the U.S. spends more per birth than any other nation, maternal mortality is higher here than in 40 other industrialized countries, including Croatia, Hungary and Macedonia, and is double that of Canada and much of Western Europe."

"That the United States is backsliding in this most basic of healthcare measures has triggered attention and alarm in medical circles. In January, the Joint Commission, an independent organization that accredits and certifies healthcare organizations and programs, issued a "sentinel event alert" warning of the rising maternal mortality rates.

"In March, the human rights organization Amnesty International released its own report, 'Deadly Delivery,' calling for sweeping changes in maternal healthcare in the U.S."

"The California Department of Public Health has commissioned a statewide review of medical charts in maternal death cases to identify reasons for the rise and seek ways to improve."

"'Mothers shouldn't die in childbirth,' said Dr. Elliott Main, chief of obstetrics at Sutter Health and director of the ongoing California review. The trend, he said, may signal a much larger problem with U.S. maternal healthcare."

Here are some more articles on the subject:

Monday, June 14, 2010

Celebrating Our Glorious Goddess Bodies

"Studies show that over half of all girls are unhappy with their bodies by the age of thirteen."

I believe it. I was one of those girls, and it has taken me years to learn to love and accept myself as I am. Interestingly, it was through motherhood that I came to honor and respect my body. It was a gradual process, part of my birth transformation. As I learned to embrace my body's ability to birth a baby without medical intervention, I came to see my body as a beautiful thing, made to create, nurture and love. The soft curves of my body are comforting to my children, who love to nestle in my lap and snuggle.

Having a baby girl has helped too. I look at my beautiful little girl and everything about her is lovely. She's 2 years old and she is all girl and it's a blessed thing, especially with 4 brothers! I look at her and think of the amazing things she will be and do in her life, and many of those things will be her privilege because she is a daughter of God. If she at age 2 is so lovely then I am lovely as well, just for being her mother. I want to be the best example I can be, and I want her to have more understanding of her inner and outer beauty than I did as a child. This helps me embrace myself as a woman and a mother, and it encourages me to strive to be better for her.

I believe every girl has the potential to be a goddess, and part of that is embracing ourselves for who we are and loving our spirits and our bodies.

I like this article in the way it encourages women to appreciate themselves, imperfections and all, and learn to love the goddesses they are.

Friday, June 11, 2010

Postpartum Depression Quiz

I'm a fan of About Pregnancy/Birth on facebook, and I'm always impressed by the really good information posted.

One of the recent posts I found helpful is this Postpartum Depression Quiz.

"Postpartum depression (PPD) has gotten a lot of attention in recent years. While the numbers may appear to be rising, it may also be more likely that it is simply becoming more socially acceptable to admit to needing help and having difficulties in the postpartum period.

"Most women will suffer a mild bout of something called the baby blues which occurs in the first days childbirth. A smaller fraction of women will suffer from an extreme form of depression called postpartum psychosis. Postpartum depression falls in a category on its own.

"In taking this quiz you are looking at some of the most common symptoms for postpartum depression. Certain symptoms, like feeling like you may harm yourself or your baby warrant urgent attention, even if that is the only symptom you experience. The more symtoms you experience, the sooner you need to seek help. Always seek help if you desire help, even if others tell you that you are okay - you are the best judge of how you are feeling."

Monday, June 7, 2010

Baby Birds and Birth

I had a dream in which I had some eggs, and in one of them grew a baby bird. I noticed cracks in the egg and I helped the little bird by opening the cracks and getting it out of the shell. But, since I had opened the egg prematurely the baby bird was weak and unable to even stand on its own feet. It would have to live in captivity its whole life to be cared for. It was a beautiful bird with fluffy bright blue feathers. I wondered if it would ever be able to fly.

After I woke up I couldn't get the image of this helpless baby bird out of my mind. The dream was so vivid, that for hours after waking I could still see the blue baby bird and feel it's soft warm body in my hands. I couldn't help but think how it's the same with human babies.

In modern obstetrics, labor is often induced or augmented artificially, for many reasons. Sometimes the medical intervention is necessary, but many times it's simply for convenience to "help get this baby out" or for scheduling purposes for the parents and/or care givers.

I know first-hand how it feels to be 9 months pregnant and so ready to be done with pregnancy. So ready to get the baby out and be able to hold it in my arms. The longing for the discomfort and awkwardness of pregnancy to end, and to start the next chapter of life with my new little one. The feelings are real, and they help us to be ready for labor when it comes.

The danger comes when labor is forced or coerced before the baby is ready. Many times babies who are induced prior to 40 weeks, even if they're considered "full term" at 36 or 37 weeks will still need assistance with breathing, feeding and basic survival in the neonatal intensive care unit. Should our goal be to get the baby out and support it in the NICU to survive, or should we focus instead on letting the baby come when it's ready and able to breathe and feed successfully without medical support?

"In his classic book Husband-Coached Childbirth, Robert Bradley, MD, compares the arrival of human babies by nature's schedule to fruit ripening on a tree. Some apples ripen early, some late, but most show up right in season. Along with Grantley Dick-Read, the father of what we now call 'natural childbirth,' Bradley advocated relaxation, trusting nature, and allowing babies to show up when nature intended."

One hospital prohibited elective inductions prior to 38 weeks. As a result, there was a drop of over 40% in newborns being admitted to the NICU. There was also a drop in the number of c-sections being done.

The concept of nature knowing best also applies to c-sections. When a baby endures labor contractions, the compression from the contractions press on the baby's lungs, preparing them for breathing on its own. Newborns delivered by c-section are more likely to have respiratory problems and require breathing support and admission to the NICU. Babies born by elective c-section may also be at an increased risk for SIDS because of the associated problems with breathing and sleep apnea.

Elective inductions and scheduled cesarean sections have become commonplace in our modern society. This poses greater risk to both mothers and babies.

You would never break open a chick's egg to get it out faster knowing that as a result it would be too weak to survive. Why would you do the same thing to your own baby?

"Attending births is like growing roses. You have to marvel at the ones that just open up and bloom at the first kiss of the sun but you wouldn't dream of pulling open the petals of the tightly closed buds and forcing them to blossom to your time line."
- Gloria Lemay

Here are some other posts about labor induction:

Saturday, June 5, 2010

Great Post Defining "Natural Birth"

I came across a really great blog post about the definition of the term "natural birth"

"Sometimes “natural birth” refers to a vaginal birth, as opposed to a cesarean section.

"Sometimes “natural birth” is used to describe a birth where the mother doesn’t opt for medicinal pain relief.

"Sometimes when referring to “natural birth,” people mean birth in comfortable surroundings. A birth where you can play music, dim the lights, and have your loved ones nearby—all things that help the body to naturally progress through labor and birth."

In the post, the author Melissa describes various perceptions of natural birth, and explains the concepts of physiological birth and pathological birth. I find it extremely interesting, and very helpful. I feel it's very important for expectant parents to educate themselves as much as possible about childbirth options. One of the main objectives of this blog is to provide information to help educate people about birth, and thus empower them to make their own decisions.

Friday, June 4, 2010

Dangers of Disposable Diapers

Disposable diapers are filled with chemicals that help keep the diapers drier and enable manufacturers to make them thinner and lighter. Pampers new Dry Max diapers are thinner and lighter than any other Pampers diapers, but they are possibly causing chemical burns on infants. Ouch!

Incidentally, it's because of these chemicals that it takes 500 years for a single disposable diaper to decompose. Ew!

Yet another reason I'm glad I use cloth diapers.

Wednesday, June 2, 2010

Nitrous Oxide for Labor Relief?

Why haven't I heard of this before?

Consider the Source: An Interview about Nitrous Oxide with Judith Rooks

European countries use nitrous oxide regularly and safely as a form of labor relief, but it's a practically unknown as a labor option in the US. This is possibly because only two hospitals in the United States currently offer nitrous oxide to laboring women. There is a shortage of equipment as more hospitals are trying to acquire them and be able to offer it.

When you read the article you may be as stunned as I was to find:
  • Nitrous oxide is safe to both mother and baby with none of the ill side effects associated with other forms of pain relief.
  • It can be self-administered by the laboring woman, which allows her to use it as-needed and also avoids over exposure.
  • The gas is expelled quickly from the mother's and the baby's bodies. A newborn infant expels the gas from its body with its first few breaths and is completely free of it within 5 minutes. This means no NICU admissions from adverse reactions to medication.
  • For women who want to avoid an epidural, the use of nitrous oxide can take the edge off in the moment she feels she needs it. Because it's self-administered, she can start it or discontinue it at any time.
  • Women wanting an epidural can use nitrous oxide in the early stages of labor and while waiting for the epidural, and avoid the use of opoids (which carry a risk to the baby).
For much more in-depth information, along with scientific evidence, please read the full article linked to above.

For demonstration purposes, please check this video of a woman using nitrous oxide while pushing her baby out. Please ignore the cheesy commentary from the producer.

What do you think?