15 Weeks - Prenatal Visit and Plans

Midwife Ina May Gaskin at a prenatal visit.

I keep meaning to blog about my first prenatal visit, and it turns out I have more than that to talk about. Things are coming together, and I'm very excited.

I'll start about prenatal care.

I intentionally waited to schedule my first prenatal visit. Because of my two miscarriages I didn't want to try to find a heart rate at any point when being able to find one would be questionable. For instance, at 10 weeks with a doppler it's possible to get fetal heart tones, but it doesn't always happen. I didn't want to set my hopes up for something that might not work out even if things were still fine. If I hadn't been able to hear a heart beat at that point, it would have only caused more questions and doubts about the viability of my pregnancy, and I couldn't deal with any doubt. I was focusing on the positive and moving forward without fear. There were other factors in choosing to put off my first prenatal visit, but it was mostly that I felt things were OK and I didn't feel a need to have an official visit. I was already consulting with my midwife over the phone, and she had already helped me with some of my needs by offering advice, information, and alternatives I might not have considered myself. That shifted in my 14th week. Out of the blue I felt it was time to call my midwife and schedule a prenatal visit, so I did.

I took all my kids with me to Sherri's house, thinking they'd be happy to play there and that they could all gather around to hear the heart beat when it was time. Not so much. My toddler had just woken from a short nap and was grumpy. The other kids were fine, but the toddler refused to calm down. We didn't know where his pacifier was - I thought we'd left it at home - and he was MAD. Sherri and I were trying to start the prenatal visit and he just screamed at me. About halfway through the visit he found a Spiderman mask, and from that moment on he was Spiderman and he was happy. Phew! I had to laugh when Sherri's 5 year-old (her youngest) who owned the mask kept asking for it back and telling me how "crazy" my toddler was. Yes, welcome to my life.

On to the more important things. My weight was good, and exactly where I knew it was. I had bought a scale when I was thinking I'd have an unassisted pregnancy, so I'd been watching my weight. My blood pressure was nice and low (108/69 - normal for me), and the urinalysis was perfect! When I was pregnant with my youngest I had problems spilling ketones in my urine, meaning I wasn't getting enough nutrition, probably because I was still trying to breastfeed my fourth child at the time and it was such a struggle to meet my body's demands. My midwife counseled me endlessly during that pregnancy about eating more and eating healthier. I was so glad to have avoided that whole conversation this time!

She was able to find the baby's heart rate immediately, and it was 158 beats per minute.

Ina May Gaskin checking FHT with a fetoscope.

I don't remember everything we talked about. She asked if I was taking my nutritional supplements (yes) and how I was feeling. When I told her that I was still fatigued she asked about my sleep schedule and suggested more naps and going to bed earlier. 

Sherri was about to wrap things up and I said "Oh yeah, one more thing!" I told her about how I'd originally wanted to plan an unassisted birth for this baby, and how my husband hadn't felt comfortable about that and we'd decided to hire her again. I explained my reasons for wanting a UC and she listened and promised me that she would be as hands off as I want her to be. At the end of the visit she reminded me of her fees and asked me to talk with my husband and figure out how we would be able to pay her. I told her we would and thanked her, and we scheduled the next visit in 4 weeks. Then I gathered my kids and cleaned up the mess they'd made, and we went home.

I was happy about how the visit had gone, with the exception of the angry toddler. I was grateful for my midwife's support and felt very reassured that all was well with both me and the baby.

And here's where there's more.

About a week after the prenatal visit Sherri called me. She said she'd been thinking about what I told her about wanting an unassisted birth, and about our financial situation. She's a dear friend to us, and she knows our circumstances and has always been willing to work with us. She told me she thought that part of my motivation for wanting a UC was because of finances. She was right, but I had been afraid to admit that to myself until she pointed it out. She agreed that I have a lot of knowledge and understanding about pregnancy and birth and understood that I felt comfortable moving forward without outside support. She also pointed out that at my home birth there was a lot happening behind the scenes that I wasn't aware of. I had thought about that before and realized it was wonderful to just focus and be in labor la la land without worrying about setting up, cleaning up, and all the nitty gritty.

Sherri then offered an alternative plan.

She had talked with one of her midwife assistants and had made arrangements for this assistant to work with her in giving me 5 prenatal visits through my pregnancy, attend the birth, and provide one postpartum visit. They would also provide phone consultation throughout the pregnancy. She offered me this for a significantly lower cost than what my midwife normally charges.

The visits would be at the assistant midwife's home, which is closer to my home and a shorter drive than to Sherri's house. They would expect me to be responsible for my own prenatal care between visits, including tracking my own blood pressure and doing my own urinalysis. I was already comfortable with that, because I'd been considering doing it all myself to begin with. She suggested I get an automatic blood pressure cuff that would take the reading for me, since she wasn't sure if taking my own blood pressure would be accurate. She also told me where I could order the urinalysis strips from, and suggested I could also get my own doppler to use for fetal heart tones. She also asked that I commit to come to her monthly forum throughout the pregnancy, which was something I really enjoyed last time and was already planning on doing.

I'm very happy about this plan. I feel it shows trust in me to tune in to my body's needs and stay healthy and take care of myself, with minimal visits to the midwives themselves. I feel it's a really good compromise between an unassisted pregnancy and one with the full 13 prenatal visits that are typical. I feel very comfortable doing most of my prenatal care myself, and I love the idea of having my midwife and one of her assistants available as consultants. I feel this is a good way of utilizing them as valuable resources but not depending on them for everything. I'm really glad I spoke up and told my midwife about my desire to be unassisted, and that she really listened and seriously considered my wishes and my needs. It also takes some financial strain off by offering us a more affordable alternative.

Pain Free!

Remember the severe low back and pelvic pain I was having? It's gone.

My friend Cherieann recommended that I try taking Cod Liver Oil and she sent me a bottle to try. That was a smart move on her part, because between the exhaustion and the pain I was feeling I might not have put forth the effort to get it myself.

She sent me this bottle of Carlson Cod Liver Oil: 

It comes in softgels so you don't taste the fishy taste. Please forgive me, but I don't remember all the reasons she said it would be helpful, but I trusted her advice and told her I would try it. I'd also read about the wonderful benefits of Cod Liver Oil before, but I'd never tried it, and I wanted to see what it would do for me.

I took 4 softgels each morning when I first woke up, along with a big glass full of water. Occasionally I got little fish burps, but I'm familiar with that from taking omega supplements in the past, and it didn't bother me.

At first I didn't notice anything, but about 4-5 days later I realized my pain was gone. Completely. Not just eased, or a little better, but gone. I can function so much better now!

Some highlights from the supplement facts on the bottle:
Vitamin A
Vitamin D
Vitamin E
Omega 3 fatty acids
EPA
DHA

I guess I was deficient in one or more of these things, and didn't realize it. Thankfully, my friend Cheriann was able to recognize a need and suggest a solution.

Check out Cherieann's facebook page: The Black Sheep Princess. A page about living life off the mainstream and taking charge of your life in various ways: from health, to birthing, to finances, to your attitude, relationships, and more. Cherieann is a genuine person who wants to help people. She has a goal of being a health and nutrition coach and helping people achieve full health.

My Vulnerability

This is something I've been feeling a need to write about. I've hesitated doing it for many reasons. For one thing, it doesn't exactly go with the theme of my blog, and for another it's extremely personal. It's something that's been deeply ingrained as part of my life for over 15 years now.

My husband is chronically ill.

We have five children and we struggle just to get by.

He's been diagnosed with both Chronic Fatigue Syndrome and Fibromyalgia. As far as we know he's had varying degrees of these illnesses for about 20 years now. I've known him for 15 years and we've been married for 12 ½ years.

He was relatively healthy when we were dating. His health goes in waves. He has periods of relatively good health and periods of severe illness. He has depression, pain on a daily basis, struggles to fall asleep and stay asleep, and working full time has become impossible. He was recently awarded disability status with the government after a two-year process of applications, three denials, appeals, and finally a hearing before a judge. He'll start receiving financial compensation for that. We think the disability income will make it possible for us to barely be able to pay our own living expenses, but we won't know for sure until we start receiving it.

We live on very little. The only debt we have are his student loans which are currently in deferment. We own one vehicle which is 18 years old and getting too small for our family, and we don't know how or when we'll be able to get a larger one. We've never owned a home and we get by on assistance programs to help us with rent, food, and medical coverage.

I do a lot of things to help make ends meet. I cook the majority of our meals from scratch. We don't eat out. I make my own laundry detergent. I clean with food items (vinegar, lemons, baking soda, etc.) that we can get through our assistance. We use cloth diapers because we can't afford to buy disposable diapers. I don't use paper products like napkins or paper towels. We use real towels and wash cloths that can be washed and reused. I use a Diva Cup. Our kids' clothes are all hand-me-downs from cousins, and most of our furniture are also hand-me-downs and outdated. If we need to go somewhere that's within walking distance I make an effort to walk with the kids. I'm sure there are other things I do that I can't think of at the moment.

I've found that these things help us save a lot of money, but they also help give me a greater sense of self-sufficiency. It sounds like an oxymoron to say that I'm striving to be self-sufficient when we're in a situation where we depend so much on assistance from government programs and friends and family. I have to do every little thing I can to feel that I'm at least doing something to contribute to our family's well-being, and these things help.

We don't have any credit cards. We don't buy anything we can't afford, and there's very little we can afford. I work doing freelance writing because I can do it from home. It's not enough to support our family, but it helps pay for gasoline and some other necessities. I make enough money each month with my essential oil business to pay for my monthly order, which is a blessing to my family's health.

I've tried to work hourly jobs, but it hasn't worked for us. My husband isn't currently well enough to take care of the kids for me to work outside of the home. We decided early in our marriage that we wouldn't put our kids in day care, and our family that live close by all have their own families and health issues to take care of so we can't rely on them to help take care of our kids. We feel strongly that it's the parents' responsibility to raise the children, and that has been a conscious effort for us.

I still owe money to my midwife for her services during my last baby's birth almost two years ago. Thankfully she's understanding and willing to work with us.

I'm not looking for pity, and I'm not really sure why I'm writing about this. I just feel a need to get it out there. Maybe there are others out there in similar situations who can relate on some level.

I can honestly say that I love my life. While it's extremely difficult, I've come to realize that no matter a person's financial well-being or circumstances, every person on the earth has something that's extremely difficult for them. When I hear about the struggles that other people go through I feel deeply sorry for them, and it helps me appreciate my own life and all the trials that come with it. I wouldn't change anything about the choices I've made and the steps that have brought me to this point in my life.

I have hope for the future. I hope that a full recovery may lie in my husband's future, and if not, that we'll be able to keep moving forward and appreciate each day. That's one thing I've learned: to try to appreciate every little thing. I get depressed at times and really feel sorry for myself, but when I think about the wonderful things in my life I feel happy.

Most of the best things are the intangible, immaterial parts of my life. Living in a beautiful area with varying seasons. The Rocky Mountains, sunshine, and fresh air. Knowing who I am and understanding that the work I do as a mother of raising my children is the most important work I'll do in my entire lifetime. Seeing my children grow each day and watching their developments. Hearing the words they speak, seeing their bright smiles, and all the crazy things they do. The kisses, hugs, and snuggles. Little hands, tiny toes. Watching them learn and excel academically and seeing their personalities continue to unfold. My religion and connection with God and my Savior Jesus Christ.

My husband spends much of his time at home and often can't go places with us. I've heard people comment that I'm like a single mom, because most of the time people only see me and the kids. I firmly disagree. Even if he can't do the physical things to support us, I have his support. He backs me up emotionally, mentally, and spiritually. He encourages me to do the things that are most important to me, and he honors me as his wife and the mother of his children. He gets to spend a lot of time with his kids when other kids' dads are spending countless hours at work.

It's not ideal, but I don't think anyone leads an ideal life. It's MY life, and I'm grateful for it.

My Personal Journey with Vaccinations

I grew up with traditional “western” medicine with doctors and chemicals. I remember getting headaches as a child and my parents simply gave me some Tylenol. We didn't go to the doctor unless there was something seriously wrong, but we didn't have any other treatment options at home. If we were sick we suffered through it or took over the counter medicine and waited it out. We were fully vaccinated on schedule and never had any problems. It was what we and everyone else I knew did.

My husband's family is different, and they really opened my eyes to other forms of treatment and healing. They also choose to vaccinate, but because of their influence I've learned about homeopathic medicine, kinesiology, herbal healing, essential oils, and other things along the way. I've come to embrace these forms of natural healing and I've seen them work in my life. I've also learned about the risks of relying completely on medicine, and I've quietly questioned the safety of vaccinations.

My first four children were fully vaccinated on schedule, according to the recommendations of the American Academy of Pediatrics and the Centers for Disease Control. I never questioned my doctor's suggestions, and I didn't feel a need to challenge them. My kids are all healthy and never had any obvious bad reactions to their shots. I felt the possibility of adverse reactions was obscure, and I didn't personally know anyone who had suffered any injuries from vaccinations.

As I had more children and moved along in my birth journey from medicated in the hospital, to natural birth in the hospital, and then to home birth, I came into contact with some really amazing people. It seems like there are a lot of things that go along with the natural birth movement, and one of those things includes questioning the safety and effectiveness of vaccinations. I started meeting people, for the first time in my life, who had gone against the norm and decided not to vaccinate their children. One of my family members even made the choice to stop vaccinating their children, and it shook the foundations of my upbringing and planted a seed in me.

At first I was hesitant to even learn about it. I didn't want to find out that I'd been making choices that were potentially wrong. I think I knew deep down that if I were to research vaccinations I would find out they weren't the panacea the media and medical community make them out to be. I knew I would find issues and risks, and I wasn't ready to go there. I wanted to stay in ignorance because I didn't want to admit that I might have chosen something that wasn't best. It wasn't something I could go back and change either. I had done it, and there was no undoing.

One my sons suffered from severe recurring bouts of croup. I spent more than one sleepless night in the emergency room seeking treatments to open his airway. In seeking for answers and treatment options other than the routine steroid prescription, we had a biofeedback assessment done on him which found his croup weakness to be linked somehow to the pertussis vaccine he'd received as a toddler. We were able to get some homeopathic drops specifically designed for pertussis, and they helped ease and sometimes prevent his symptoms. I learned how to treat it at home with other things like essential oils, and have since avoided further trips to the hospital. 


My oldest caught Chicken Pox (varicella) when he was 6 years old, despite having been vaccinated for it. Even then I couldn't make myself take a deeper look at vaccinations. I didn't want to face it.

After my youngest child was born at home I went out of my way to schedule an appointment with the pediatrician to get his vaccinations on schedule. I think it was one of the things that helped my pediatrician support me a little bit after a home birth, because I was still being the “responsible parent” and getting my child's shots on time. That continued for about 6 months.

When my baby was almost a year old I started getting reminders in the mail from our insurance company that it was time for a well-child checkup and vaccinations. I had every intention of scheduling the appointment and getting it done, but for some reason every time I thought about it it slipped my mind. For some reason I could not remember to make the call and schedule it. I realized this was out of character for me, and I wondered if there was a reason I kept forgetting.

I had done some research about vaccinations a few years earlier when a family member had given me some information about them and asked me to look into it. I decided it was a good idea to do more research, so I did. I found that everything I needed to know about them I had already heard or learned from my earlier research and through friends who had talked with me about the issue. I realized I didn't need to do any more research on the subject, because I was already familiar enough with it. I felt the next step was to seek spiritual guidance through prayer.

I prayed and asked for some guidance, but I felt nothing. I was confused and upset. I felt that I was being led to delay my child's shots, but I wanted to know why and I wasn't being given that understanding. The periodic reminders kept coming in the mail, and the pediatrician's office even called and asked if I wanted to schedule an appointment. By that time I'd realized I needed to take my feelings seriously and I declined their offer because I felt it was best to wait and figure out the next step before I took any action. The more I thought about it, the more the idea of taking him in for vaccinations felt outright wrong.

I couldn't explain it, and I felt embarrassed that I was changing my mind about something potentially serious based on a hunch. I didn't want to face my pediatrician or my family, who I knew wouldn't understand my choice. I couldn't even give them a solid reason why I was making the choice, and I didn't fully understand myself what that choice was. Was I delaying vaccinations for a while, or was I stopping them from here on out?

A few months passed and I continued to pray and wrestle with the issue in my mind, until one day I had an enlightenment.

It wasn't a light from heaven or big booming voice answering all of my unanswered questions. I was reading an article about a particular vaccine. It was an interesting article, but it wasn't the subject matter that really caught my attention. As I was reading, words came to my mind and told me something. It wasn't about the shots themselves. What was important was that I was following my feelings.

In that moment I felt peace. It was peace I had been seeking for a long time, and suddenly the issue of vaccinations was no longer an issue to me. I knew that as long as I followed my feelings, as guided by God, everything would work out.

I still didn't have all the answers, and I still don't to this day. I don't know if we're delaying or stopping vaccinating our children, but I'm leaning heavily toward stopping. All I know is that as long as I continue to follow my intuition I don't need to worry.

That doesn't mean I never worry. When my toddler caught a cold and developed a bad cough, one of the first thoughts to cross my mind was that he hadn't been vaccinated against pertussis! A moment of panic hit me, and I let it leave as quickly as it had come. I allowed myself to trust my intuition and treat my child at home, and he was fine.

Each time he's gotten sick I've wondered if I would have to take him to a doctor, and then what would happen? Would they hound me about the fact that he wasn't fully vaccinated? Would they run pointless tests and jeopardize his treatment out of fear that he might have something that he could have been vaccinated against? Would they accuse me of being a negligent parent? And what argument could I give? “I have a strong feeling...”

These thoughts have crossed my mind, and I have to remind myself that I'm doing what I feel, and now know in my heart, is best.

The choice to delay or stop vaccinating has impacted other things as well. I realized that there was no point in taking my children to routine well-child checkups if they weren't going to be injected with vaccines. All that was really done at these appointments was checking their height and weight, discussing age-appropriate development and any issues that might come up, and giving shots. I've never had any issues that I needed to discuss with the doctor, and after having five children and raising kids for over 10 years I'm much more confident in my parenting abilities. I'm not concerned about consulting a doctor about my child's development, and if a concern comes up I can always just schedule an appointment for that purpose. So well-child checks are out. I never liked them much anyway.

I also realized I need to find a new doctor. I always liked our pediatrician and never had any complaints, but I've realized that he's extremely pro-vaccinations. When I declined to have my 5 year-old injected with the flu shot, the doctor proclaimed that “there are no draw-backs, only benefits”. That simple statement made me realize that my doctor wouldn't understand my point of view or my reasons for making the choices I have. So, I'm looking for a new doctor that will be more supportive of me making the decisions about the care and well-being of my children.

The United States has a culture that encourages people to blindly trust doctors and medicine, and anyone who chooses not to do so might be labeled "irresponsible", "negligent", etc. I don't believe medicine is bad. It has a place and is needed in certain situations. I just don't think it should be blindly trusted. My position on vaccines is an interesting one. I understand the risks involved and I stand firm in the choices I make for myself and my family, but I also support each person's right to make their own decision. I hope that no one makes anyone feel inferior or stupid for making the choice they feel is best for them, no matter how much it may buck the system.

One thing that I'm gaining through all of this is confidence as a parent. Yes, I have my moments of serious doubt, but I find if I pray and turn those doubts to the Lord I'm able to navigate my options more easily and with peace and confidence.

Influenza, the Vaccine, and Vitamin D

It's flu season!

You've likely noticed the propaganda.  Signs everywhere I go, at pharmacies, grocery stores, supermarkets, warehouse stores, and more!  I see signs on the side of the road, and I hear news stories about how everyone should go get their flu shot!  Some places even offer incentives, such as memberships, gift cards and the like, all for getting a flu shot!  Our pediatrician's office has a sign with a caricature of a man with an ice pack on his head, a red nose, tissue in his hand, covered with a blanket, and a fizzling drink nearby.  It says "Don't let this happen to you!  Get your flu shot today!"  They'll even bill your insurance for you!  No hassle!

One thing all this media coverage makes me question is why?  Where are the funds coming from to pay for all of this?  The advertisements and the incentives?  The pay for the registered nurses who sit at the tables and booths with their syringes ready?  It makes me think that, just maybe, the flu shot is pushed more for monetary reasons than for health.  Just think about that for a minute.

If you live in a place where it gets very cold in the winter, like I do, then the propaganda is likely more prevalent than in warmer climates.  Flu season here can be quite ugly, particularly for infants and babies who can develop potentially deadly RSV, which affects a baby's ability to breathe and get adequate oxygen.  Indeed, parents are cautioned to keep their infants home and avoid public places for fear of contracting the feared flu bug.  When I gave birth to my third baby in October we kept him home for months to avoid any exposure.  We sacrificed holiday parties and family get-togethers out of fear our precious baby might get sick.  He was healthy all season, and I can't say whether or not staying home really made a difference.

I used to get the flu shot, and I even had some of my kids get it more than once.  Our family doesn't get the flu shot anymore.  The decision was simple for me.  I didn't notice our family getting sick less often when we got the vaccine.  The years that we skipped the vaccine we didn't get sick any more often or worse than the years we got it.  I saw no point in subjecting myself and my children to an annoying stick in the shoulder (or thigh) when I never noticed any benefits.

In the years since I stopped getting the flu shot I've done more research on the subject.  This year in particular I've found a lot of resources about the flu vaccine, and they're not favorable.  I didn't intentionally seek out anti-vaccine blog posts and articles, but the research I've found supports my decision to stop getting the annual shot.

Why is flu season during the winter months?  It's quite simple.  The colder weather forces us to stay indoors more.  We exercise less.  We eat more food, and more fatty and sugary foods, particularly during the various holidays that take place during the winter.  Our health overall suffers, and we're more prone to illness.  Flu isn't the only illness that goes around during these times, but it seems to be the one that gets the most attention.  Perhaps it's because of money.  There's a vaccine for that, and lots of companies make money when vaccines are sold and administered.

In considering whether or not the vaccine is a good choice for you or your family, you should consider the following:

• The latest flu shot has been linked to seizures:  "Australia, just coming out of its flu season, had to suspend flu shots for kids — because little ones were suffering febrile seizures at 10 times the normal rate."  This is the 2010 flu shot.  The one that's being currently promoted.  My kids won't be getting it.
• Six reasons to say NO to vaccination: At first glance I thought this blog post was all about scare tactics, but when I took the time to read past the bold print I realized there's a lot of truth to it.  It's about vaccinations in general, but as you read it think about how it applies to the flu shot in particular.  
• Flu is vitamin D deficiency disease: This post really resonates with me.  It makes sense that during the darkest months of the year we would suffer from vitamin D deficiency, when vitamin D is most available through exposure to sunlight.  Taking a regular dose of cod liver oil or another vitamin D supplement could potentially prevent the flu altogether.  I'm willing to give it a try!
• Vitamin D proven far better than vaccines in preventing influenza infections:  If you're one of those people who needs scientific proof of a theory, here's some evidence to back up the vitamin D link to the flu.
• Food sources for Vitamin D: This site has a list of foods that contain Vitamin D.  The major foods listed are: fish (like salmon and tuna), milk, cheese, and egg yolks, but check the list for more.  It's a good idea to eat as many Vitamin D rich foods as possible through flu season.  An adult should have about 1200 IU's of D3 daily, and a child should have about 400.  You can also get D3 supplements from your local grocery store or health food store.
• Sunlight is the best source of Vitamin D: However, in many very sunny places it's still possible to be deficient because it's dependent on the type of sunlight.  Dietary changes and/or supplementation may still be needed.

I'm not a conspiracy theorist.  I support families making informed choices about their care.  That means knowing what it is you're choosing.  If you choose to get a vaccine, understand the potential risks involved.  If you choose not to vaccinate, understand what you can do to support your family's health more effectively.  Make the choice that makes sense and feels right for you.

I make decisions for myself and my family based on a combination of personal intuition and research.  I go with what feels right, but I also search for evidence and pray about my decision.  This is one vaccine I feel confident about missing.

UPDATE: (10/29/10) Since writing this post, I discovered more information about the 2010 Influenza Vaccine.

Planning and Meditating on Birth - Part 1

I was talking with my sister recently about birth choices, and I started wondering how much the decision of where to labor and give birth has an impact on the experience and the outcome. I told my sister that if I'd been in the hospital with my breech baby I probably still would have had the outcome of a healthy baby, but the experience would've been altogether different. The labor itself would have been different and I wouldn't have been so relaxed and comfortable. And then there's the issue of the surprise breech, which would have led to an emergency cesarean. Instead of recovering from a vaginal birth at home, I would have been recovering from abdominal surgery with 4 small children and a newborn. My fear of c-sections in general would have left me scarred emotionally, and I would've had a lot more to heal from than just the physical trauma from the surgery. I also would have ended up with a uterine scar that could impact future births.

I shared my home breech birth story with a group of my midwife's clients at her home. At the very same meeting another mother shared her hospital birth story, and it was a striking contrast to mine. She had a natural labor without interventions in the hospital and everything went smoothly. However, after the birth she noticed her baby was twitching. The doctors and nurses hadn't noticed it. It took the mother's eye and intuition to see that something was wrong. They determined that the baby had suffered a stroke sometime after the birth. Because they were in the hospital, the infant was able to immediately receive the medical care he needed. What was even more interesting to me was when she told us that she had considered planning a home birth, but whenever she thought about it she felt uneasy. She didn't know why she felt uneasy, but she followed her feelings and planned to have the baby in the hospital. She was exactly where she needed to be, and it was because she followed her feelings. I, on the other hand, had felt nothing but peace when I planned my home birth, and I was exactly where I needed to be.

I believe there are times when no matter which choice we make, we'll still have a positive outcome. Almost all babies would survive whether they were born at home or in the hospital, whether born vaginally or by c-section. Almost all mothers will survive birth regardless of where it takes place or under what circumstances. But the outcome is not the whole picture.

Rixa from Stand and Deliver has a great commentary post on her blog about the way people say that all that matters is a healthy mom and baby. "Health" in this sense usually means "alive".  

We all know that health is all-encompassing, and it doesn't simply imply survival alone. Health is physical, mental and emotional. When a woman has a traumatic birth experience under any circumstances, she is emotionally unhealthy. Trauma can lead to Post Traumatic Stress Disorder, and while it's not commonly associated with postpartum women, if the mother suffered trauma during the birth she is more prone to this state of disease. Trauma is not associated with specific birth events, but rather the woman's interpretation of them and her feelings of either being in control and respected or being out of control and disrespected. By definition the CDC considers cesarean section a "morbidity", which would imply that any woman who's recently had a c-section is physically unhealthy. We can see that there are many different situations under which a mother and baby can survive birth but still be unhealthy afterward.  Heather Armstrong wrote a beautiful, yet heart-wrenching post on The Unnecesarean about her own experiences with emotional and physical trauma regarding birth.

The outcome matters. The experience matters. The emotional, mental and physical well-being of mother and baby matter. How can expectant parents plan for birth with all of these variables in mind? How can they make decisions about their baby's upcoming birth hoping for the best experience and the best outcomes?  


Click here for part 2...

Advocating For Evidence-Based Health Care

I found this on Science and Sensibility: Understanding Evidence-Based Healthcare: A Foundation for Action

This includes maternity care, but it's much bigger than that.  The Consumers United for Evidence-Based Healthcare (CUE) is a group that helps educate and advocate for improve healthcare in the US.

‎"We’re only going to get evidence-based healthcare in this country through consumer activism." 

-Kay Dickerson, director of Consumers United for Evidence-Based Healthcare.

Prescription Human Milk: In Honor of World Breastfeeding Week

World Breastfeeding Week ends tomorrow.  What have you done to show your support?

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)

Rising maternal mortality rate causes alarm, calls for action

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:

It's Now More Dangerous to Give Birth in California Than It Is in Kuwait or Bosnia

Revealing the Real Risks: Obstetrical Interventions and Maternal Mortality

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."

Click here to take the quiz and assess whether you may have PPD

Articles About Breastfeeding

The American College of Obstetricians and Gynecologists (ACOG) recommends 6 months of exclusive breastfeeding for all infants. The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) similarly recommend exclusive breastfeeding for the first 6 months of life, continuing at least through the infant’s first birthday, and as long thereafter as is mutually desired. The World Health Organization (WHO) recommends at least 2 years of breastfeeding for all infants.

The Risks of Not Breastfeeding for Mothers and Infants

"Health outcomes differ substantially for mothers and infants who formula feed compared with those who breastfeed, even in developed countries such as the United States. A recent meta-analysis by the Agency for Healthcare Research and Quality reviewed this evidence in detail:

• For infants, not being breastfed is associated with an increased incidence of infectious morbidity, including otitis media, gastroenteritis, and pneumonia, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome (SIDS).
• Among premature infants, not receiving breast milk is associated with an increased risk of necrotizing enterocolitis (NEC).
• For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, and the metabolic syndrome."

Low Breastfeeding Rates and Public Health in the United States - This is an excellent article which provides an overview of the history of breastfeeding as a public health issue in the last century. It's chock full of information and explains very effectively the need for more mothers to initiate breastfeeding and continue breastfeeding as long as possible. It opened my eyes to some of the real issues in the ongoing debate of breast milk versus formula.

Substance Found in Breast Milk Kills 40 Types of Cancer Cells

As published on FoxNews.com

"Swedish researchers have discovered that a substance found in human breast milk has the ability to kill cancer cells, according to a study published in the PLoS One Journal.

"The substance known as HAMLET (Human Alpha-lactalbumin Made Lethal to Tumor cells), was discovered years ago, but has just recently been tested on humans.

"In the trial conducted at Lund University in Sweden, patients suffering from bladder cancer were treated with HAMLET. After each treatment, the patients excreted dead cancer cells in their urine, healthy cells remaining intact.

"Previous laboratory experiments showed that HAMLET has the ability to kill 40 different types of cancer cells, but this was the first test conducted on humans. The next step will be to test the substance on skin cancer and brain tumors.

"The trial breakthrough increases the hopes that HAMLET will be developed into a cancer treatment medication in the future."

Menstrual Cups - Alternative to Tampons and Pads

This isn't related to pregnancy or childbirth, but it's a product that benefits women, and I think it's worth sharing:

The Diva Cup - Menstrual Solution

“With all the state-of-the-art conveniences Western society has developed, it baffles us why outdated feminine products are still being used. We believe that reusable menstrual cups are the next generation of feminine hygiene because they are the most environmentally responsible choice. They are also the most convenient and reliable option available and are not linked to Toxic Shock Syndrome.” Francine Chambers

"The DivaCup ends hassles with unreliable disposables in endless absorbencies, shapes and styles. It is perfect for all activities – giving women true freedom without the worry, guessing and unreliability that disposable feminine hygiene products pose."

I personally know women who have used the Diva Cup and love it. I'm considering getting one for myself.

As I've done some research, I've learned that there are many menstrual cups out there besides the Diva Cup. These include The Keeper, Mooncup, Lunette, Miacup, Instead, and more! If you're interested in learning more about menstrual cups, please check out this livejournal community for menstrual cup users. They have tons of how-to and product information, as well as product comparisons and where you can purchase one.

Click here if you're interested in eco-friendly cloth menstrual pads.

The Perineum's Vital Role in Female Health and Birth

"You know that thong of tissue that keeps your tongue anchored to the floor of your mouth? It’s your frenum. And the translucent cartilage between your nostrils is your septum. And the flesh that stretches like a hammock between your vagina and your rectum is your perineum, and you and it are going to have a special relationship in the childbearing year.

"You will want to be on good terms with this most tender of tissues. You will want to get to know it well. You will want to become, in fact, your perineum’s pal."

My Perineum, My Pal

This is an informative article which explains the function and importance of the perineum in female health and childbirth, as well as detailed ways you can strengthen your perineum, prepare yourself for birth and take care of yourself postpartum. This is information I believe every woman should know.

I also found a video all about incontinence (bladder control) problems during pregnancy. It's really interesting, and it explains why it happens and what you can do to minimize such problems:

Habi-it Pelvic Floor Video

Honoring Our Cycles: Using Fertility Awareness to Achieve or Avoid Pregnancy

"Like the earth's surface, a woman of childbearing age moves through cycles of heating and cooling, which in turn create moistening and drying, which in turn provide a fertile environment for life to evolve. Rocks, glaciers, plants, and animals (including humans) all evolve in concert with these processes. Just as a meteorologist can observe and measure cycles in the earth's surface to determine weather patterns, a woman can observe her daily waking temperature, cervical fluid, and the cervix's changes to gauge her gynecological health and to determine when she can and cannot conceive. According to Leah Morton, an MD with a family practice in Santa Fe, New Mexico, 'The first step in being healthy is knowing about yourself and respecting nature. Fertility Awareness provides a way to learn these things.'"

"With Fertility Awareness, a woman can be in sync with her own cycles, and couples often experience enhanced communication and intimacy."

Honoring Our Cycles: Using Fertility Awareness to Achieve or Avoid Pregnancy

This article gives an introduction to Fertility Awareness and how it can be a benefit to couples. For more information about Fertility Awareness, please read the book Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, by Toni Weschler.

Advice regarding breastfeeding for mothers with possible H1N1 infection

"Advice regarding breastfeeding for mothers with possible H1N1 infection
Ruth A. Lawrence, M.D., FAAP and John S. Bradley, M.D., FAAP

As published in AAP News - Official Magazine of the American Academy of Pediatrics

"Neonates and infants younger than 6 months of age are at risk for complications from seasonal influenza and presumably 2009 H1N1 influenza (swine flu), although the morbidity and mortality from this new virus have not yet been described.

"While the advantages of breastfeeding are well-known, this close interaction of mother and newborn also can facilitate transmission of influenza virus. The benefits and the risks of close contact must be considered carefully.

"To protect the infant from possible serious infection while allowing essential and encouraged mother-infant bonding to occur, a compromise is required until more data are available. The following precautions are suggested to minimize the risk of infection to the infant, particularly while still in the hospital and while the mother is symptomatic with fever and coryza:

"Pay careful attention to handwashing prior to any contact. Prior to breastfeeding, wash the breast with mild soap and water; rinse well The mother should wear a surgical mask to prevent nasal secretions and the spontaneous cough or sneeze from inoculating the infant. Use clean blankets and burp cloths for each contact. Monitor the maternal-infant interaction on perinatal floors for compliance with the above precautions. These precautions are designed to minimize the risk of transmission until mother’s immune response to H1N1 influenza is established, and increased, specific immune protection may be provided by breast milk. Note that influenza virus does not pass through breast milk.

"Although the most effective way to prevent influenza transmission is complete separation from her infant when a mother is receiving antiviral treatment, separation may create more long-term problems in breastfeeding success and mother-infant bonding than any potential benefit achieved from avoiding infection in the newborn infant.

"For any mother with H1N1 influenza infection who presents in labor to a health care institution, testing and empirically starting therapy for influenza with an antiviral is suggested. Oseltamivir (Tamiflu) or zanamivir (Relenza) will hasten resolution of symptoms and infectivity, particularly if treatment is started within 48 hours of onset of illness. Neonatal exposure to oseltamivir (Tamiflu) excreted in breast milk is extremely low.

"Immediately following delivery, the precautions listed above should be instituted as the newborn infant is first placed into mother’s arms. These precautions should be followed until mother’s illness is resolved, i.e., no fever, as measured without antipyretics, for 24 hours.

"While no data exist to support these suggestions, it is believed that these represent an appropriate balance between the benefits of mother-infant interaction and the risks of serious neonatal infection. Institutions may wish to modify of these suggestions to address their needs and medical practices.

"Dr. Lawrence is chair of the AAP Section on Breastfeeding executive committee. Dr. Bradley is a member of the AAP Committee on Infectious Diseases."

Study on Health of Mothers and Newborns Throughout H1N1 and Cold/Flu Season

My friend Rachel, author of The Beginning of Motherhood blog and Labor and Delivery Nurse, is conducting a survey about the outcomes resulting from current CDC recommendations regarding H1N1 and new mothers and babies. She needs study participants from three groups of women:

1. Those who have symptoms and have been isolated from their baby but continue to feed breast milk,
   
2. Those who have had no symptoms, were given baby within 2 hours after birth and breastfed,
   
3. Those who have no symptoms, but were not with baby within 2 hours after birth and breastfed or expressed milk for infants.
   

All of these should be full terms infants (37-42 weeks) . They can be born at the hospital, or alternative birthing area. She is hoping to follow these babies for six months to see who is getting sick.

For more information, please see Rachel's blog: The Beginning of Motherhood

How Do You Feel About Hospital Policies Regarding H1N1 (Swine Flu)?

The policy at some hospitals right now is to take the baby away from mom after they are born if the mom is showing symptoms of H1N1 (swine flu). They get the baby back if they have been on Tamiflu for 48 hours or if they get test results back that they are negative. They are allowing quarantined breastfeeding mothers to pump colostrum for the hospital staff to feed to the baby. I want to know what you think. Would you be mad, understanding, frustrated?

I would love to see what people think about this policy. I've posted a poll on the right side of this page where you can cast your vote anonymously, or please feel free to post your opinion in a comment on this post.

Thanks!

How the United States Ranks

There are precious few situations in life where the cheaper alternative is also the better alternative – and maternity care is one. If we eradicated the unjustified obstetric monopoly in the United States, with its extreme medicalization of birth, and replace it with a humanized maternity care, we can vastly improve the care of women and babies, lower death rates for both women and babies, and save vast sums of money at the same time. A few facts:

• Percentage of gross national product spent on health care:
  

1966: 6 percent
1992: 12 percent

• Percentage by which U.S. health care expenditures exceed those of:
  

Canada: 40 percent
Germany: 90 percent
Japan: 100 percent

• The twenty-two countries with lower infant mortality rates than the U.S.: Japan, Sweden, Canada, Singapore, Hong Kong, Netherlands, France, Ireland, Germany, Denmark, Norway, Scotland, Australia, Northern Ireland, Spain, England and Wales, Belgium, Austria, Italy.
• Percentage of countries with lower infant mortality rates than the US that provide universal prenatal care: 100 percent
• Percentage of US women who receive little or no prenatal care: 25 percent
• Chances that a woman with little or no prenatal care will give birth to a low-weight baby(less than 5.5lbs) or premature baby(less than 37wks): 1 in 2
• Factor most closely associated with infant death: low birth weight
• Percentage of infant deaths link to low birth weight: 60 percent
• Average cost of long-term care(through age 35) for a low-birth-weight baby: $50,5588
• Average cost of long-term care (through age 35) for a baby of average birth weight: $20,003
• Cost of newborn intensive care for one infant: $20,00 to $100,00
• Cost of prenatal care for thirty women: $20,000 to $100,000
• Percentage of births attended principally by midwives (CNM’s and CPM’s): United States: 10 percent; European Nations: 75 percent
• Percentage of countries with lower infant mortality rates than the US in which midwives are principal birth attendants: 100 percent
• Average cost of a midwife-attendant birth in the US: $1,200
• Average cost of a physician-attended vaginal birth in the US: $4,200
• Health care cost savings obtainable by using midwifery care for 75 percent of pregnancies in the US: $8.5 BILLION per year
• Cost per year of using routine electronic fetal monitoring during every childbirth: $750 million
• Number of well-constructed scientific studies in which routine electronic fetal monitoring (EFM) during every birth has been proven more effective than the simple stethoscope to monitor the fetal heart: zero
• Health care cost savings obtainable by eliminating the routine use of electronic fetal monitoring in every birth: $675 per year
• US C-section rate: 1965: 5 percent, 2004: 29.1 percent, 2007: 33.3 percent
• Cesarean section rate targeted by the World Health Organization (WHO) and the US Department of Health and Human Services (HHS): 12 percent
• The eighteen industrialized nations and states with lower C-section rates than the US: Czech Republic, Japan, Hungary, Netherlands, England and Wales, New Zealand, Switzerland, Norway, Spain, Sweden, Greece, Portugal, Italy, Denmark, Scotland, Bavaria, Australia, Canada.
• Percentage of women in the US with C-sections who undergo repeat c-sections today: 91 percent
• Ratio of women dying from C-section to women dying from vaginal birth: 4 to 1
• Average cost of a C-section birth: $7,826
• Health care cost savings obtainable by bringing the US C-section rare into compliance with recommendation from WHO and the federal Department of Health and Human Services: $1.5 billion a year
  

Source: Born in the USA by Marsden Wagner,M.D. , 2006

C-Section Not Best For Breech Birth

The Society of Obstetricians and Gynecologists of Canada will launch program to teach physicians breech vaginal delivery

from Globe Life Health and Fitness

by Carla Wintersgill

"Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.

"Released yesterday, the guidelines are a response to new evidence that shows many women are safely able to vaginally deliver babies who enter the birth canal with the buttocks or feet first. Normally, the infant descends head first.

“Our primary purpose is to offer choice to women,” said André Lalonde, executive vice-president of the SOGC.

“More women are feeling disappointed when there is no one who is trained to assist in breech vaginal delivery,” he adds.

"Since 2000, C-sections have been the preferred method of delivery in breech births. Studies suggested that breached births were associated with an increased rate of complication when performed vaginally.

"As a result, many medical schools have stopped training their physicians in breech vaginal delivery.

"The problem now, according to Dr. Lalonde, is that there is a serious shortage of doctors to teach and perform these deliveries.

"With the release of the new guidelines, the SOGC will launch a nationwide training program to ensure that doctors will be adequately prepared to offer vaginal breech births .

"The new approach was prompted by a reassessment of earlier trials. It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.

"News of the change is a boon for the Ottawa-based Coalition for Breech Birth.

“We're really, really pleased,” said Robin Guy, co-founder of the coalition.

"Ms. Guy started the group after the birth of her second child in the fall of 2006. Although she had given birth to her first child at home with a midwife, Ms. Guy delivered her daughter in the hospital because of the baby's breech position.

“I was cornered into an unneeded and unwanted C-section because the obstetrician that I had didn't have the experience to catch her,” said Ms. Guy.

"The aim of the coalition is to ensure that women know what their options are when it comes to breech birth. Ms. Guy believes that many women don't realize that vaginal breech births are even possible.

“Educating women is our primary goal because it takes more than just a guideline change,” she said.

"The SOGC stresses that because of complications that may arise, many breech deliveries will still require a cesarean section.

"Breech presentations occur in 3-4 per cent of pregnant women who reach term. That translates to approximately 11,000 to 14,500 breech deliveries a year in Canada.

"The new decision to offer vaginal breech birth aligns with the SOGC promotion of normal childbirth – spontaneous labour, followed by a delivery that is not assisted by forceps, vacuum or cesarean section. In December of 2008, the society release a policy statement that included its recommendation for a development of national practice guidelines on normal childbirth.

“The safest way to deliver has always been the natural way,” said Dr. Lalonde.

“Vaginal birth is the preferred method of having a baby because a C-section in itself has complications.”

"Cesarean sections, in which incisions are made through a mother's abdomen and uterus to deliver the baby, can lead to increased chance of bleeding and infections and can cause further complications for pregnancies later on.

“There's the idea out there in the public sometimes that having a C-section today with modern anesthesia and modern hospitals is as safe as having a normal childbirth, but we don't think so,” said Dr. Lalonde.

“It is the general principle in medicine to not make having a cesarean section trivial.”

"The SOGC believes that if a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally.

"The national average for babies delivered via cesarean section in Canada is 25 per cent."