I'm Not Angry

When I published the recap of my day miscarrying in the emergency room, there was a surprising response from some of my readers. I'm sure everyone who read the story probably felt in some way indignant at my mistreatment and neglect by the emergency room staff that day. Even I, while writing about it, felt some of those feelings myself. Some suggested that I report it to the hospital or even seek retribution or litigation for it. Surely, I should want justice for having to endure such treatment at such a sensitive and difficult time.

I really, truly appreciate every bit of support I've received from my readers and friends regarding my miscarriage. I really needed that support, and probably still do need it. The emotional reactions we all felt to what happened were natural human reactions. Something wasn't done right, and it needs to be fixed. It's an instinctive response.

So here's the deal: nothing can fix what happened. I'm not saying that to be depressive or negative in some way. It's the simple truth. What happened, happened, and I'm actually not upset toward anyone about it. I never felt angry toward the overwhelmed emotionless doctor or the snickering nurses. I didn't feel upset that they basically ignored me while I miscarried right there in the ER bed. It's strange. I guess I should feel some of those things, but I don't.

I understood the circumstances, and I actually empathized for those people who were supposed to be entrusted with my care. I knew they were overwhelmed with a full emergency room that day, even before I was given a bed. I knew from the moment I got in there that the doctor was in the ER for the first time ever, and I didn't expect to be emotionally supported by him when he was essentially on a crash training course. I went there for an ultrasound. I never expected to fully miscarry right there, and I'm sure the hospital staff didn't expect it either.

They offered me the care they knew how to. They suggested treatments which I declined even before I was officially diagnosed, and they probably didn't know what to do with me because I really didn't want or need any medical treatment for a naturally occurring event that just so happened to take place in their territory. They certainly were not OB specialists and didn't know what an obstetrician would do under the circumstances. They referred me to my obstetrician because of this. They made assumptions of what the OB would probably do, but those assumptions were wrong. How were they to know that?

A few weeks after the fact, I spoke with a friend of mine who is a labor and delivery nurse. She told me that they don't routinely do D&C's on women who are miscarrying, and that the emergency department probably wasn't even aware of how the labor and delivery department would handle it. They were acting out of the knowledge and training they'd had, and it was in no way perfect for the situation.

Seeking financial retribution would be pointless and wouldn't fill the emotional pain of having a miscarriage. That pain would be there regardless of where or how it took place, and trying to get revenge on those who happened to be there with me at the time wouldn't serve any purpose to me. Yes, part of me would like to sit down with the group of individuals who interacted with me that day and let them know just how it felt to be in my shoes. Maybe that would help them be more sympathetic to the next woman who comes in with a similar situation.

I also realize that the hospital staff were practicing defensive medicine the entire time I was under their care.

• I came in for an ultrasound and they inserted an IV before anything else was done. They were preparing for the worst, which would have likely been ectopic pregnancy requiring immediate surgery or a miscarriage requiring surgical intervention. All they knew was that I was pregnant and bleeding. Telling me they might need to give me fluids, in my opinion, was a load of bunk. I really don't think that's what they were preparing for. They were assuming the worst, which I suppose is their job. I saw it, I knew what was happening as it happened. I guess that's why I'm not mad. I didn't feel fooled by anything.
• Not letting me have anything to eat or drink. This was the worst part of my treatment, in my opinion. I was bleeding and hadn't had any nourishment for hours. What I really needed was something to keep me stable and healthy, but they wouldn't give it to me because once again they were assuming the worst. What if they had to send me to the OR? What if I had to be put under general anesthesia? They couldn't run the risk of my having anything in my stomach “just in case”. I knew I didn't need any of those things, and I needed to eat. But once again, defensive medicine called the shots.
• Refusing to take out my IV. Now this was just stupid. The same rules apply. They were sending me to my OB for follow-up care. “What if her OB decides to draw more blood or do a D&C?” I guess logically it made sense that the OB's office could just take it out for me, especially since I was only walking next door, but that didn't happen. It was easy enough to remove it myself when I had to.

I guess what my story shows is how defensive medicine can fail. Sure, if my case had been the worst-case scenario the hospital's legal behinds would have been covered by their defensive medicine. But it wasn't. It was a natural miscarriage needing no intervention, in which case the so-called “care” provided was horribly sub-par.

My story resembles so strongly the active management of the labor and birth of an otherwise healthy mother and child in the hospital. Every day expectant women are subjected to unnecessary interventions “just in case” which increase their risks and deprive them of the nurturing loving support they need and deserve. Whether it be induction, epidural, continuous fetal monitoring, restriction to bed, no food or drink, or even cesarean section: all are done routinely for the sake of defensive medicine. Now, that makes me angry!

Birth Humor

I found this through Mom's Tinfoil Hat.  It's got some really great zingers, but be sure to watch it all the way through for the punch line at the end!

Planning and Meditating on Birth - Part 2

If you missed Part 1, click here to read it.


There is no magic recipe for a perfect birth. 

We have ingredients, or options, and each of us is in charge of writing the recipe that's best for us.  Why must we write our own? Why can't we just take an existing recipe and hope for the best? The Feminist Breeder writes on her blog why she won't leave her births up to chance. When you follow someone else's plan without serious consideration you are essentially leaving everything up to chance. I've done it myself, twice. Sometimes this works and things still turn out OK, as it did for me. You survive and your baby survives... oh, but I've gone over this already.

1. The first thing to do is become an informed consumer.  I've talked about this many times. It's one of the main reasons I have this blog. I believe every expectant parent should do their research and become an informed consumer. Know your rights and your options, and know that you are the one in charge. As a consumer everyone else serves to please you. Doctors, nurses, midwives, doulas, hospitals, birth centers, clinics... ALL of them are there to serve you. They have training and expertise in their various specialties, and can act as consultants in helping you make choices. Their place is not to dictate what will happen or make choices for you. Uninformed consumers must have choices made for them. It's your choice who will control your baby's birth.

How do you know if your birth will be like mine, better off at home away from medical intervention and unnecessary surgery, or like the other mother I mentioned whose baby needed to be in the hospital where he could get the immediate care he needed?

2.  Assess your feelings and follow where they lead you.  Ultimately you must make a choice, based on both knowledge and your personal feelings. Some people have paralyzing fear of hospitals and doctors and would be most comfortable elsewhere. Others have paralyzing fear of NOT being in the hospital where there is ready access to all the medical technology you could ask for. Whether that's a good thing or a bad thing is really up to you. I have an almost paralyzing fear of surgery, and I would do anything in my power to prevent an unnecessary surgery. That fear definitely plays into the decisions I make for birth, and so far it has served me well. Even if you don't have a paralyzing fear of anything, you will likely have some kind of feeling that will help guide you in the right direction.

3. Honor yourself and tune out the outside noise.  Pregnancy is a time when unsolicited advice seems to come at you from every direction. Whether you want it or not, everyone seems to know what they think is best for you and your baby. Everyone has a story to tell, and they love to tell it. Whether you plan to go to the hospital or have your baby at home or in a birthing center, someone will always have a horror story or opinion to tell you.

I was due to have my fourth baby in January. A very nice lady at church asked me about my due date and I told her that I was focusing on getting through the holidays and then I would feel ready to have my baby. She told me about her daughter who wasn't due until January, but the baby came unexpectedly a month early and she had nothing ready for Christmas. It may have seemed like a harmless story to her, but it stressed me out!

Hypnobabies teaches women to use a "bubble of peace" to help them stay connected with their own feelings and not allow outside advice or stories to upset their emotional balance. Essentially, you imagine a bubble that surrounds your body and keeps in all the happy, good feelings and blocks out all the unwanted stuff that invades you from other people. This is a good way to stay focused on your own feelings, whatever they may be. If there is fear within you then address that fear. Figure out where it's coming from and whether it's valid. Is there anything you can do to allay that fear? Do you have any control over what you're afraid of? If you have control over it, then take care of it. If it's beyond your control then you've done what you can and you can let it go.  Understanding the truth about power and control may help you be able to let go of what you can't control.

4. Continue to check in.  If there's a persistent nagging concern or fear that you just can't shake, then take it seriously and consider changing your plans. Just like the mother I met who never felt comfortable planning a home birth, there could be something you're unaware of that needs you to make a different choice.

In my case, I prayed. I felt I should consider home birth, even though I'd never considered it before. I felt peace about it, and peace as I chose my midwife and moved forward with my plans. I didn't ever feel a need to change my plans, and I never felt the need to prepare for a possible transfer to the hospital. Even as the due date approached, my midwife prayed about who to ask to provide support at the birth, and a specific person came to her mind. That person was a midwife with extensive vaginal breech experience. I feel God knew my baby would be breech, even though none of us did, and He helped me to prepare for it all along the way. I was blessed, I feel, because I knew my options. I had learned as much as I could and then I followed my feelings. I was blessed to avoid surgery which would likely have been traumatic for me. I had the desired experience and the desired outcome, without having to choose between the two.

A Father's Perspective on Doulas

My Experience With a Doula During Childbirth

by Dana H. Glazer

As published on Huffington Post

After writing last week about a father's role in the birthing room, it occurred to me that I would be remiss not to address my own personal experience in the delivery room as you might find it surprising and perhaps even helpful.

Like many dads, I attended birthing class with my wife, watched videos and even read a book or two on the subject of birth. However, studying for the experience and being in the frontlines of a birth are, of course, two different things; and as prepared as I tried to be for the occasion, I thank our lucky stars that we decided to have a doula present with us in the hospital room.

Yes, you're reading this correctly. As a dad, I strongly encourage parents to have a doula present at the birth, especially if it's in the hospital. I realize that for many dads this might be considered some sort of demotion of their role in the birthing process, but I see a doula's job rather differently. Let me explain.

First, when my wife, Deborah, and I initially interviewed doulas, we were looking for someone who could work with both of us and who would be respectful of my role in the delivery process. We ultimately hired a doula, named Sabine, who was very considerate of what our needs were as parents. While it was an additional cost to hire her, we thought it would be worth the extra money. Little did we know how true this would be as I'll soon explain.

When the day came for the baby to arrive, Sabine was there, not just to support Deborah, but myself in the process as well. The nurses seemed a bit taken aback by her presence but we were so glad she was there.

While Sabine was supportive of us, she took a backseat to our doctors and nurses; but then, after 19 hours of intense labor, it seemed that our baby was not going to arrive by natural means. The doctor then informed us that surgery would be necessary. At this, Sabine spoke up and asked for a few minutes to try some alternative birthing positions to help along the process. The doctor nervously granted the request and when Sabine instructed my wife to get off her back, the nurses were less than thrilled.

A few minutes later, our first son, Charlie, was born naturally. If not for Sabine, Deborah would easily have had a caesarian birth as were 32 percent of births in this country in 2007 - up 53 percent from 1996. In our home state of New Jersey, 38.3 percent of births in 2007 were caesarian. The reasons for these increased rates are often attributed to hospitals seeing caesarian births as a more controlled, efficient approach as well as having less insurance liability than a vaginal birth. The World Health Organization suggests that the rate should be no more than 15 percent. As a dad, I find the statistics about caesarian [sic] births in our country to be problematic and I feel very grateful that a doula like Sabine was present in both of our son's births.

So, if you're a dad-to-be and you are hesitant to rescind your position as the only advocate for the delivery of your child, consider the percentage of caesarian births in this country and how those statistics might change with an experienced doula by your side, giving you and your partner the support you deserve during one of the most challenging and meaningful days of your life.

(Dana H. Glazer is the award-winning director of the feature length documentary film, The Evolution of Dad. To learn more about the film, please visit www.evolutionofdad.com)

The Home Birth Controversy

Depending on who you talk to, home birth is either the best thing you can do for the safety of your baby, or the worst. Who are we to believe?


Home Birth has been in the news a lot lately. Just one day after legislation was passed in New York allowing midwives to practice independently of physicians, a meta-analysis of home birth studies was publicized by the American Journal of Obstetrics and Gynecology, slamming home birth and claiming that home birth "triples risk of infant death". The Unnecesarean and the Midwife Next Door both chimed in, among others, refuting the meta-analysis and exposing it's faults.

One thing I like to remember is to recognize the source. If a study or analysis is being publicized by AJOG, which is the journal of the American Congress of Obstetrics and Gynecology, then it's going to favor the positions which ACOG has taken on issues. ACOG is a lobbying group, which serves to protect the interests of physicians and hospitals. Groups like the American Medical Association and ACOG have taken strong positions against home birth for a reason. They have financial interest in hospitals and doctors. They lose money when women choose to birth at home. If you read the scathing reviews on the recent meta-analysis you'll see that the analysis contradicts itself. The studies used in the analysis don't support the findings, and the analysis itself contains contradictory information.

You must look closely. Don't take things at first glance, and don't put stock in a catchy headline. Read and do your research. You may find, as I have, that modern obstetrics is not based on evidence. It's based on what's profitable and convenient for the system that's in place.

Learn about your rights as a childbearing woman.

Do your homework. Read books, like "Get Me Out; A History of Childbirth from the Garden of Eden to the Sperm Bank", "Pushed" by Jennifer Block, "The Thinking Woman's Guide to a Better Birth" by Henci Goer. Watch "The Business of Being Born" by Ricki Lake and Abby Epstein. Read any of the books written by Ina May Gaskin.

Jennifer Block wrote a really good piece: The Birth Wars: Who's really winning the home birth debate?

We see so much about hospital birth because 99% of babies are born in the hospital in the US. If you want to learn about the safety of home birth, you have to look for it and find the sources. Here are some you can start with:

• The Home Birth Advantage: The Physical and Emotional Benefits of Birthing at Home
• Midwifery Today: The Home Birth Choice

Ultimately, it is YOU who must decide what's best for you. After you've done your research and educated yourself, search yourself and see what feels best in your heart. I believe that intuition can guide us to make the best choices. Avoid making a choice based on fear. This is where the education comes into play. When you're fully informed, you have no need to fear. If you feel peace about home birth, then you know it's a good choice for you. If you still have doubts or fears about it, keep researching and reconsidering until you come to a decision you feel comfortable with.

Busca on Birth Faith posted a really interesting piece about the irrelevance of the place of birth: The irrelevance of home vs hospital. She states that the place of birth is less important than the support a woman receives through labor and birth. I personally feel that both are equally important, but you must come to your own opinion.

You may decide that home birth isn't for you. You want or need to be in the hospital, but you want it to be a beautiful experience. There is a book called Homebirth in the Hospital, which can help you plan and prepare for a beautiful hospital birth.

Hospital Bans Early Elective Births, Resulting in Fewer Surgeries and Healthier Babies

Hospital cuts C-section rate, leading to healthier babies

As published on fiercehealth.com

June 16 might seem like a great day to give birth, but planning a C-section, or being talked into it for convenience (of either the patient or the physician) may be bad for the baby. Tallahassee Memorial Hospital has decreased the number of preterm births--and thus admissions to neonatal intensive care units and infants with health problems--by cutting elective induction and C-sections over the last three years.

The hospital saw early delivery rates go from 44 percent to less than 37 percent. The statewide rate is 38 percent and has gone up yearly for the last few years; the national rate is 32 percent. The hospital has also reduced first time delivery C-sections from 22 to 15 percent--compared to 25 percent for Florida as a whole. A rate under 20 percent is considered good by childbirth advocates.

Many obstetricians think that deliveries in the 37th or 38th weeks are fine since they don't usually involve serious complications for the infants. They allow both patient and physician more control over their schedules, and inductions can allow physicians to see more patients in a day. But emerging research indicates that any birth before 39 weeks involves potential problems, including respiratory distress. The later the delivery, the fewer admissions of newborns to intensive care, and there is no increase in mortality by waiting until 39 weeks to induce or schedule a C-section.

The Tallahassee Memorial program was the brainchild of a neonatologist who saw a relationship between the sick babies he cared for and how many were delivered by elective inductions or C-sections. Now, physicians can't schedule deliveries before 39 weeks without a medical reason.

The hospital also recommends that physicians not induce until a woman's Bishop's scale score--related to fetal position and cervical dilation--indicates she's ready. Noncompliant physicians get reminders, and the hospital has few outliers among their obstetricians.

Other hospitals should take note: In April, The Joint Commission asked hospitals to start collecting data on prenatal care, including the numbers of near-term deliveries and first-time C-sections in mothers at low risk. It will soon set target rates for hospitals based on their data.

This is a great example of what a huge impact hospital policy can have on the health of its mothers and babies. It's important to ask questions and find out what the policies are at your hospital of choice.

San Diego's Beloved OBGYN Dr. Robert Biter Lost Scripps Encinitas Privileges

Date: Friday, May 14, 2010

Time: 1:30pm - 3:30pm

Location: Scripps Encinitas Hospital

Street: 354 Santa Fe Dr.

City/Town: Encinitas, CA

As of Friday May 7, Dr. Robert Biter's privileges to deliver at Scripps Memorial Hospital Encinitas have been suspended. The hospital refuses to give a reason, and Dr. Biter is legally unable to comment at this time.

Dr. Biter is a Board Certified, capable obstetrician gynecologist, who is famous in the community for his dedication to his patients and commitment to natural childbirth. He does not cut episiotomies or rush his patients off to the operating room for Cesaerean. Dr. Biter is a physician who truly cares about his patients and respects their birth plans.

The suspension of Dr. Biter's privileges has left hundreds of pregnant women without a doctor. It is also part of something bigger. The 'medical' establishment is fighting hard to remove our rights to birth naturally, peacefully and without unnecessary intervention. Midwives have recently been barred in North Carolina, California and Ohio, and the closing of St. Vincent's hospital in New York City left midwives without a hospital backup, as required by law for them to practice.

We must stand up for our rights and act now. We will not be bullied or fearfully forced into birthing according to what the 'medical' establishment deems best. It is our right as women and mothers to choose our birth place and our care providers.

This Friday, May 14, join Ricki Lake, Anna Getty and many others who support choices in childbirth. We will be peacefully rallying in front of Scripps Memorial Hospital in Encinitas in support of Dr. Robert Biter.

Please wear green to represent peace, nature & eco-consciousness, which are all things Dr. Biter supports.

Please bring signs that read:

Bring Dr. Biter Back!

Bring Biter Back!

How is this Mother-Baby Friendly?

This is NOT Mother-Baby Friendly behavior!

Hey Chief of Staff! Bring Biter Back!

Shame on MacCormick-Chief of Staff!

Please bring 5 of your closest friends or family members!

Can't make it? Here's what you can do from home:

Write letters to Dr. Ron MacCormick, demanding that Dr. Biter be reinstated immediately.

Please direct letters to:

Dr. Ronald MacCormick

Chief of Staff

Scripps Memorial Hospital Encinitas

354 Santa Fe Drive

Encinitas, CA 92024

and cc them to:

Mr. Chris Van Gorder

President & CEO Scripps Health

4275 Campus Point Court

San Diego, CA 92121

Please also send a digital copy to:

Carol Yeh-Garner

awelllivedlife@hotmail.com

Sign the online petition at: http://www.ipetitions.com/petition/bringbiterback/

Join Ricki Lake, Anna Getty and Others in Showing Support of Birth Options

Click here to access the facebook event page for this rally

Avoiding The First C-Section

This entry was posted by The Midwife on Monday, 12 April, 2010

In honor of Cesarean Awareness Month, featured in the Courtroom Mama blog, I am continuing the topic of avoiding the first c-section. Why is it so important to avoid the first one?

• It’s major abdominal surgery, and carries increased risks for mother and baby
• It often puts the mother in the position of having repeat c-sections, because she cannot find support for vaginal delivery after a cesarean
• It increases the risk of abnormal implantation of the placenta, which can lead to hemorrhaging or need for hysterectomy
• It increases the risk of unexplained stillbirth in a subsequent child.

No one will argue that c-sections can be lifesaving under certain circumstances. Placental separation, placenta previa, cord prolapse, and certain abnormal presentations of the baby might cause injury or death to mother and child if it were not for the ability to deliver a baby by cesarean. I am thankful we have the ability to perform this surgery in a very safe manner. However, the majority of c-sections are not done for emergent, life-saving reasons. It’s those c-sections I want to focus on preventing.

Since most women having a primary (first-time) c-section are also having their first baby, I have five simple precautions that have been invaluable in my practice in helping women to avoid a c-section. I am writing from the perspective of hospital birth, knowing that the majority of women will not choose home birth, although I believe this is the number one way to avoid a c-section:

1. Stay at home in labor as long as possible, and consider giving birth at home. Why?

• Consider an animal in labor. If you’ve ever observed a cat or dog preparing to give birth, you may have noticed that they seek solitude. If they are disturbed during labor, they ahve a natural “fight or flight” reflex that slows or halts labor, allowing them to move to a safer location. While we as human women can intellectually understand the reasons for moving to another location (the hospital) to give birth, our bodies may still respond with a slowing of the labor process.
• It is understood that pain relieving medications can have a slowing effect on the process of labor. Epidurals are associated with a higher rate of vacuum, forceps and cesarean births in some studies. Yet it is difficult for a woman in hard labor to resist the offering of total relief of her pain. When you are at home, you know the pain medication is not available, and so the mind does not focus on it. It is easier to work with the contractions when you aren’t constantly thinking of the epidural available to you in only minutes.
• Staying home in the earlier stages of labor helps you to avoid the urge that hospital staff will feel to “speed things along” if your first part of labor takes many hours. It is common for dilation from zero to four or five centimeters to take many hours, and sometimes more than one day. If you are in the hospital and you are not yet dilated to four centimeters and having contractions three or four minutes apart, you are not in active labor. This part of labor is best spent at home.

2. Hire a doula if you can possibly afford it. If not, seek out an older woman who has had several children naturally herself, or has been present at several natural births, to be with you at home until you decide to go to the hospital.

• A woman who is familiar with the process of a normal birth will be invaluable to you in helping you know when it is time to got to the hospital. She can reassure you that what you are feeling is normal, that you can do it, and that you are stronger than you think.
• Many women are afraid to stay home in labor. A doula or experienced woman will be aware of the normal process of labor and be able to help you feel calm about laboring at home.

3. Find a practitioner who does not put arbitrary time limits on how long you can be in labor. If you are feeling strong, the baby is doing well, and you want to keep going, there should be nor reason to rush to a c-section simply because the labor is taking longer than average.

4. Carry on your usual activities as long as possible. Far too many first-timers make the mistake of doing everything they can to speed labor along. All too often, their efforts succeed at nothing but making them miserable and exhausted. Allow labor to unfold in its own time. Ignore the contractions until you are physically incapable of doing anything else during a contraction as well as in between contractions. This is where many women take their labor too seriously. They think because they have to breathe with a contraction, they are in hard labor. The actions of the mother between contractions are more indicative of the stage of labor. During the latter stages of dilation, the woman is usually quiet, tired, and may even fall asleep between contractions. She does not feel like talking much, or doing anything but resting before the next contraction. If your labor starts in the day, do what you normally would have been doing if you’d not started labor. If your labor starts at night, stay in bed and try to sleep, at least between contractions. If you cannot sleep, at least rest until your normal getting-up time.

5. Stay off the fetal monitor! The American Congress of Obstetricians and Gynecologists has published guidelines for intermittent auscultation of the baby, stating that it is just as safe for low-risk pregnancies as continual monitoring. It has the added benefit of having a lower c-section rate. This suggests that many c-sections are done for “fetal distress” seen on the monitor tracing, when the baby is actually fine. Once you allow someone to connect you to the continual monitor, you most likely won’t be off of it for the rest of your labor. What is intermittent auscultation? It is not being connected tot he monitor for 20 minutes out of every hour, as many hospitals’ protocols require. Rather, it is listening to the baby’s heart rate with a hand-held doppler before, during, and after a couple of contractions every 15-30 minutes during the first stage of labor. A skilled practitioner can determine if the criteria indicating fetal well-being are present, even with a hand-held doppler.

There you have it–my top five precautions to avoid the first c-section. I’d love to hear your ideas for other ways to avoid an unnecessary cesarean.

Directed Pushing vs. Mother Directed Pushing

Have you seen childbirth portrayed in movies and on TV?

"PUSH PUSH PUSH while counting to 10, take a breath and QUICK QUICK START PUSHING AGAIN while counting to 10, and ONE MORE GIVE ME ONE MORE REAAALLY GOOD PUSH counting to 10 and now RELAX RELAX JUST RELAX STOP PUSHING WAIT UNTIL THE NEXT ONE."

Everyone in the room: doctor, nurse, staff and family seems to be yelling at the birthing woman while she strains and tries to push her baby out.

A doula has written a blog post about her feelings on directed pushing:

Doula pet-peeve: directed pushing

She makes some really good points, and while the post is a bit angry it has some excellent information.

First, directed pushing is NOT based on evidence. In fact, it can lead to a greater chance of damage to the perineum and pelvic floor. As long as the baby is doing well, there is no need for doctors, staff and family to try to hurry or direct the pushing stage.

Directed pushing is sometimes referred to as "purple pushing" because many times women are told to hold their breath for the 10-count, resulting in a flushed face and sometimes even popped blood vessels in their eyes.

There is also the issue of how unfriendly directed pushing is, and how contrary it is for a woman who has had a peaceful labor and desires a calm birth experience. Another doula describes the practice in her own blog post:

Is Mother Directed Pushing Possible in the Hospital?

Her description is somewhat comical, but still accurate.

The best part of that blog post is the explanation and videos of Mother Directed Pushing. This may also be called spontaneous pushing. The concept is simple. Allow the mother to listen to her body cues and push as she feels the urge, and on her own schedule. This also includes allowing the mother to choose the position she wants to be in to push her baby out. As long as the baby is doing well (normal heart tones) then this approach is more favorable than directed pushing.

Why?

• Less likely to damage the perineum or pelvic floor
• A more peaceful, gradual birth experience, without people yelling and shouting
• Empowering and supportive of the mother in allowing her to decide how to birth her own baby.

This video about mother directed pushing was made by Sheridan, the author of Enjoy Birth Blog:

Please check out the links I posted above. There's also a good one about mother directed pushing at home:

Mother Directed Pushing at Home

Home Birth is Better Than It Was 100 Years Ago

After I had a wonderful home birth experience I was talking with my mom about it. She told me that my grandmother had been really worried that I was planning a home birth, and she was very relieved that all had gone well. I was stunned by this, and felt sad that my grandma had been so worried about my decision that I had felt such peace with.

I thought about the situation. My grandmother was born at home at a time when there was no access to emergency care or hospitals. Sometimes a doctor could make it to the home in time to help "deliver" the baby, but the majority of the time a laboring mother was supported by whichever woman was closest to her and could be there to help. Many times this was her own mother, sister, neighbor, or even daughter. In true emergency situations there was nowhere to go for help, and even the local doctor had huge limitations in what he could do. Birth was a wonderful but potentially dangerous situation, but when there were hard outcomes it was accepted as a part of life.

By the time my grandmother was having babies birth had been moved from home to the hospital. Birth had become even more dangerous due to doctors unwittingly spreading deadly infections because they simply didn't know to wash their hands when going from treating very sick patients and performing surgeries to catching healthy newborn babies. Fear about the pain and dangers of childbirth became even more rampant as doctors and hospitals struggled to find ways of handling childbirth in a new setting. Women were seeking a way to escape the horror of it all, and their doctors were feverishly looking for ways to save the day.

Doctors learned to wash their hands and take safety precautions, and new medications were presented in an effort to "help" women with the process of childbirth. This involved such things as "Twilight Sleep" in which laboring women were medicated during labor, able to feel everything but having no memory of the experience later because of the drugs. Women were tied to their hospital beds and gagged to keep them from wandering the labor ward, thrashing, or screaming out. In other cases women were simply put under with ether or chloroform into a drug-induced sleep during labor, while doctors forcefully extracted their babies using forceps. The mother didn't remember the birth, and would wake alone because her baby had been taken to the nursery while she was still asleep. One can understand why loving partners were not allowed on the labor and delivery ward during this time.

In the years since, there have been huge strides made to improve hospital births. Expectant fathers are now encouraged to be present and supportive while the mother is laboring, and hospital rooms have been made to appear more like a home setting. Other changes include major medical interventions to control and manage the process of birth, such as medications to start labor or make it go faster, and pain medications which numb a woman to the physical experience of childbirth without knocking her out completely or preventing her from remembering the experience. Interventions that can save lives in true emergencies have been developed, but are now being overused to the point that the potential risks outweigh the benefits. It seems that in an effort to improve childbirth it has been taken to the medical extreme in which every step is managed and medicated, and 1 out of 3 newborns in the US is removed surgically.

Those who recognize the extreme medicalization of birth are left wanting for something better. They are returning to "old" ways of birthing without unnecessary interventions, the way my grandmother came into the world. Bringing birth back to the home is a conscious effort to allow women the experience of normal childbirth, as nature is so beautifully designed.

In pursuing a return to old ways women are not simply accepting greater risk than they would face in a hospital setting. Indeed, many feel they are reducing their risks by avoiding the interventions common in the hospital.

So, how is home birth better than it was 100 years ago? Because of the technological and medical advances over the years, we now have access to life-saving interventions which are needed in true birth emergencies. Those interventions which pose greater risk when overused are still valuable and needed in some cases. No woman plans a home birth intending to transfer, but she understands that it is a possibility. For me personally, this was a comfort when I planned my home birth. I knew I would be in a comfortable setting where I could labor and birth my baby in peace, and felt confident in my ability to do so. I felt that all would go smoothly, but I also knew that if for some reason it didn't I had options that my great-grandmother never did.

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.

Motherhood: Revealing the Real Risks: Obstetrical Interventions and Maternal Mortality

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."

My Birth Transformation

I credit my mother for instilling in me a desire to give birth naturally, without pain medication. She was having babies in a time when women were being confined to bed and separated from their husbands, and even being knocked out with ether or chloroform during labor and having their babies delivered by doctors with forceps. Often they would wake with no memory of birth and wonder if they had a boy or a girl. My mom felt strongly that birth is a natural process and she could do this without the medical interventions of the day. She took Lamaze classes with my dad and went on to give birth to 6 healthy babies, each without pain medication other than a paracervical injection to numb the cervix for the pushing stage. She spoke openly about this with me and my sister when we were growing up, and I wanted to have that experience for myself.

When I was pregnant with my first baby my husband and I took a childbirth class at the local county health department and they taught us some basic breathing techniques and comfort measures. However, the majority of the class was dedicated to educating us about the actual function of birth, complete with diagrams and charts and explanations of the stages of labor and when to go to the hospital. I joined online birthing websites and read books and tried to educate myself as much as possible about birth. I felt if I could be well-informed then there was no need to be afraid. Unfortunately, I was still not prepared for what I would experience.

My water broke spontaneously and I had no noticeable contractions. Of course, I had been told to immediately go to the hospital if my water broke, so I did as I had been told to do. The hospital staff immediately started me on pitocin to get my labor going. It was a long, hard battle. The pitocin did indeed get my labor going, but it also made the labor so intense and difficult that I didn't know how to handle it. I forgot everything I had learned in our childbirth class about breathing and working with the contractions. I had told myself that I wanted to birth naturally, but if it got too hard then I would get the epidural, and that's exactly what happened. The epidural slowed my labor, and then the baby's heartbeat was erratic. The doctor explained that they would stop the pitocin to give the baby a break from the onslaught of contractions and give him some time to recover. They would then start the pitocin again and see if my labor would progress after that. He used the dreaded c-word and explained that if my labor did not progress at that point, they would do surgery. My greatest fear was materializing and I was terrified. I cried, and my family comforted me.

Thankfully, the plan worked and a c-section was not necessary. My epidural wore off just in time to start pushing, and I went from feeling completely numb to feeling absolutely EVERYTHING. I was not prepared for that kind of pain, and I endured it for 90 minutes while I pushed my baby out. It was traumatic. He was born in the middle of the night, healthy, after a full day of hard labor, and we were both exhausted. The nurses told me they would take the baby to the nursery so that I could rest, and I complied because I thought they knew best. I slept fitfully, and then woke up around 6am in a panic without my baby! I paged the nurses and had them bring him in immediately, and I did not calm down until he was with me. Breastfeeding was a challenge because he was so sleepy. I hadn't had the chance to establish breastfeeding immediately after birth and the baby was tired and sluggish, and I didn't know what I was doing! The lactation consultant was not helpful, but thankfully we figured it out and I went on to breastfeed my son for over a year.

Three years later I was pregnant with my second child, and I had decided that childbirth was just too much for me to handle without an epidural. When my doctor told me we could schedule an induction, I thought it was wonderful that we could plan it out and know when the baby would be born! I didn't know anything other than induction and epidural, and this was my way of taking control of the situation. It was a wonderful experience, and I remember chatting and laughing with my husband and the obstetrician while I was pushing. It was 4 ½ hours from the time they started the pitocin until my beautiful baby boy was born, compared to over 14 hours with my first. I was in a smaller community hospital this time, and the atmosphere was calmer and I felt I got more attention from the staff. I was able to hold my baby very soon after he was born, after the staff had checked him out and weighed and measured him. I had him latched on and breastfeeding before the doctor even left the room. I didn't like how long it took for my epidural to wear off after he was born. I wanted to be able to move around and enjoy my baby and the birth being over, and that was an annoyance.

Two years passed and I was expecting our third baby. My husband, Matthew was in massage therapy school and he worked at the front desk of a massage clinic. He told me that one of the therapists there was a doula and she wanted to work with me and provide support for me at the baby's birth. I didn't know what a doula was, but I wanted to talk with her because I had many questions and I thought maybe she could help me. Mandy and I immediately bonded. I told her I had always wanted to give birth without medication but I didn't know how to do it! She told me she would help, and she answered all of my questions and helped me feel at ease about approaching birth in a new way. She helped me write a birth plan, outlining my wishes for childbirth. I realized that I had choices and could let the doctor and hospital staff know how I wanted to handle things rather than let them take the lead and tell me what to do. My obstetrician was very open to my wishes and willing to work with me, and I checked with hospital policies to ensure that my desires were feasible within their limitations.

I didn't know what to expect because I had never experienced my body starting labor on its own. I was sent home from the hospital three times because I wasn't progressing enough to be admitted, but I was determined not to be induced. I had early labor for about two days, and Mandy taught me how to breathe with the contractions and work with my body. The third time I was sent home from the hospital I decided to go home and sleep. My labor stopped for about a day, and I rested as much as I could. The next morning, my water broke while I was in bed, and Mandy met up with us at the hospital. It was beautiful! Because of the practice I'd had with my early labor, I knew how to breathe and focus.

Mandy and Matt worked together to provide comfort measures for me, including acupressure points and counter pressure on my hips, knees and lower back. I wasn't hooked up to an IV pole or monitors, and I could move around as I wanted to, leaning on the birth ball or walking around. I even got into the tub in my room for a little while, but it was too shallow to give me much comfort. I focused through the contractions and enjoyed the company of my husband and my doula between them. Only once during transition did I feel I couldn't do it, and Mandy told me “You ARE doing it!” She kept me focused and helped me through it all, and the hard part was relatively short. My healthy baby boy was born within a few hours of arriving at the hospital, and I felt like a super hero! I was energetic and happy, and I had never before experienced such euphoria after giving birth. I was able to breastfeed my baby immediately after his birth, and we spend some quiet time with him in our room without any interruptions from hospital staff. The nurses were very curious and asked me which birth method I preferred (epidural or no medication) and I told them I would do natural birth again without a doubt!

When I got pregnant with my fourth baby, I knew what I wanted. I had been permanently converted to unmedicated birth. My husband had a client who was a home birth midwife, and she offered her services if I wanted to have my baby at home. I politely declined, explaining that I had my OB, my doula, and my birth plan and I knew what I wanted. This time I was determined not to be sent home from the hospital, and I intentionally labored as long as possible at home. Again I had two days of early labor, and the labor stopped for a few hours while I attended my baby shower and then started up again later that night. My husband and I were watching TV, and when I got up to use the bathroom I felt a leak. I told him that either I had wet myself or my water had broken.

We called Mandy and made arrangements to meet her at the hospital. I was admitted in the middle of the night and labored for a few hours, using focused breathing and trying to rest between contractions. The doctor arrived in the morning and suggested that he could break my water to get labor going faster. It turned out the leaking I had was a fore-bag and not the actual bag of waters. I was ready to have a baby, so I agreed and he ruptured the bag. After that things went quickly and our beautiful baby girl was born within a few hours. Once again my husband and my doula worked together to give me the support I needed, and it was a wonderful, empowering experience. The baby latched on immediately and we bonded. My baby was beautiful, and I was thrilled to finally have a little girl, but there was a subtle nagging feeling in the back of my mind. I felt like something was missing.

When my daughter was still a newborn I decided to become a birth doula. I wanted to help other women as my doula had helped me. I felt she was indispensable in my achieving the beautiful natural birth experience I had always wanted. I started reading all the required books and took the doula training. I couldn't get enough information about birth! I watched The Business of Being Born, and learned that some women still safely give birth at home rather than at a hospital. Within a year I found I was pregnant, expecting my fifth child. I felt that I had some different choices to make, and I started thinking about planning a home birth. I researched it and thought about it and prayed about it. I felt peace, and it was a wonderful overwhelming peace. I knew I wanted to have this baby at home.

I called the midwife whose services I had declined for my daughter's birth, and started going to regular prenatal visits with her. I went to my obstetrician's office a few times during the pregnancy for certain things like an ultrasound, blood work and screenings, but the rest of my prenatal care was provided by my midwife. I trusted her and her 15 years of experience with home birth. I also met her birth attendants who were all doulas and midwives.

I had early labor, on and off, for over a week. I was anxious to meet my baby, but I had to practice more patience than ever before. I used the time to prepare things in our home for the birth. Four days past the due date, my midwife brought the birthing tub to our house and did a brief check for the baby's heartbeat, with my four children watching. Later that evening, my contractions were coming closer together and stronger. My midwife came over and set things up and we settled in to have a baby. I was focusing and breathing through the contractions and leaning on my birth ball. I labored in the bed and rested between contractions, and in the birth tub immersed in water up to my neck. The water dissolved the discomfort of the contractions and my husband pressed acupressure points while I breathed through them. We chatted with the midwife and enjoyed the quiet and peaceful atmosphere. I have never experienced such peace in the hospital.

As things progressed, a second midwife came to assist, and she cleaned my kitchen and helped get the kids settled when they started waking up in the morning. At one point while I was resting in bed, my water broke in a small leak and my midwife ruptured the bag the rest of the way. The kids went to play at grandma's house and things really picked up! We called the two oldest boys to come home and as I was pushing we realized the baby was coming out breech! His bottom was coming out first. I was in the birth tub, and it felt really good to stretch my body out as I pushed. His bottom came out, then one leg, and then the other leg. Then his torso was delivered, followed by an arm, and then the other arm. And then, as my 6 year-old described it, “he put the hands and the feet on the bum cheeks, and he pushed his head out!” I only pushed for a few minutes, and my beautiful baby boy was here! He was healthy and perfect. I held him in the tub with me for a couple of minutes before the midwives helped me out to deliver the placenta, and then into bed. We cuddled and bonded as a family, and our oldest son cut the umbilical cord.

I've realized since my home birth that if I had planned a hospital birth for my breech baby, it would have ended in a cesarean section. If that was the only benefit of having him at home, it was definitely worth it, but there were many other blessings of having our baby at home as well.

I don't consider my home birth to have been a painful birth. I felt intense pain with my hospital births, and there were moments of discomfort during my home birth but never what I would describe as pain. I think it had to do with the peace I felt and the confidence I had gained from my previous birth experiences. I am no longer the meek woman willing to submit to whatever the doctor tells me I should do. I know exactly what I want and how to achieve my goals. I know what I am capable of, and I feel stronger than I ever have in my life.

I used to regret my earlier birth experiences, wishing I had experienced unmedicated birth from the first rather than the traumatic experience it was. Now I'm grateful for those earlier experiences for the way they've shaped me as a person and as a mother. My first birth experience was an important catalyst in motivating me to find a better way for me to give birth. I don't feel that there is one birth choice that is best for every woman, but I hope that each woman can know that birth is beautiful and empowering, and if you don't experience it that way then find out how you can.