Women Giving Birth at Home Without Midwives - ABC News

Women Giving Birth at Home Without Midwives - ABC News

I was actually extremely pleased with this one...

The wee hours of August 19, 2004 found me birthing my first daughter into the world and becoming a mother for the first time. As she was pushed earth-side, I was shoved unceremoniously into a world I had no real understanding existed. The Mama World. The Mama world can be a wonderful place. Here you will find people that completely understand how you can dread and love the sound of your baby's cry all at once. Here there are women that KNOW. The droopy eyes, the mismatched socks, the twenty-three interruptions in one telephone conversation- they just get it. The internet has been, for me, the center of my "Mama World" as most of my IRL friends do not yet have children. The internet chapter of this world is always there. I got my first taste of it while pregnant. Any question that I had was immediately answered by at LEAST thirty different women (and in many cases, I received thirty different answers!). Once I was officially initiated into the Mama World I found that there were literally thousands of eyes always available to answer any questions I had. Trouble breastfeeding? Diaper rash? Colic? Not sure which store has the very best price on strollers? Need energy shots? No problem, here's seven-hundred and fifteen opinions with at least forty different links to go with them and while we're at it, here's fourteen phone numbers if you need to talk. With the birth of each of my children, I've been blessed with a HUGE support system for all of my various little Mama Quirks.

Oh we all have them. Some of us simply cannot LIVE without our baby carriers. Others would rather choke on a snake than touch a disposable diaper. Others are more concerned with whether or not everything that their baby ingests is organic. The lists of Mama Quirks go on and on and on and many residual fires can be seen still smoking from flame wars the internet-world over attesting to just how SERIOUS we all are about them.

Flame wars? I know, I said the Mama World can be a wonderful place. It can also be a vicious place. Mothers the world over have a reputation for being fierce and warrior-like when it comes to our children. Unfortunately that Mama-bear instinct can be misplaced into ripping our sisters to shreds for doing or thinking about things differently.

What follows is the first of what I hope will be a series of opinionated posts about these various issues. Today I want to talk about Parenting Labels.

It seems that when I first became a mother I got sucked into the flame wars as quickly as the next mother. I couldn't help but notice, though, that the "more experienced" moms tended to be a bit more careful about picking their battles. As I'm now rounding the first corner into my oldest child's fifth year, I'm beginning to understand WHY. Being a mother is quite possibly THE most challenging occupation I can think of. Deep down inside most mothers want one thing: what is best for their children that doesn't also equal complete insanity for them. Most of the internet moms I settled down with spend a lot of time reading about raising children. And in reading, they've learned that there are some "parenting styles" that have become rather popular. The one I run into the most is, of course, Attachment Parenting (usually referred to as AP parenting or just AP).

In the beginning, this was what I was ALL ABOUT. It just seemed to fit what I wanted for my kids. The base premise is very simple: respond to your baby's needs. And out of that premise we introduce things like baby-wearing and exclusively breastfeeding. But AP parenting has almost become the flag of the "natural" movement. I've not met many women, for example, that home-birth that don't also breastfeed and cloth diaper. I know very few women indeed who cloth-diaper that don't ALSO baby-wear. It's a slippery slope and in general, it's a good thing. All of these things are "good". What's NOT good is the way women seem to become divided over some of these issues.

Honestly, I never gave it much thought until recently. Some women baby-wear, for example, and some don't. But recently, one of the newer moms in a group I belong to wrote in asking a question that really made me realize just how bad this can be. Her question was along the lines of "Do I have to pick up my baby every single time she fusses, no matter what? I want to be AP but I sometimes I'm responding to her needs so often that I literally can't pee!" Ok, so I'm paraphrasing and I don't think her need to tinkle actually made it into her post. Her baby was old enough to be crawling around and getting into things and generally wreaking havoc on Mom's need to wash the dishes. Her question got me thinking: Why is she worried about being AP? It reminded me of my first year of Mom-hood, when I was afraid someone would find out that I let my 12mo old follow me around crying because she wanted to be picked up but I NEEDED a clean house because we were having company. She wasn't hurt, hungry or sick. She just wanted attention and was expressing that to me VERY CLEARLY. And I heard her! I listened, I responded! "I am RIGHT HERE, baby, I can hear you and you can be with me. But right now, I need to wash the dishes so I can make dinner so we can all eat." I felt GUILTY because I wasn't wearing her in a sling on my back so she could be in contact with me during her little moment of insecurity. It didn't help that while I was washing the dishes, she got down on her knees and laid her forehead on my feet and cried herself to sleep. Yes, on my feet. Right there at the sink with me up to my elbows in suds. In case anyone is wondering, she is JUST as dramaful today.

So what's my point? My point is that there seems to be a fine line between advocating "instinctive" parenting and advocating "getting in the line" of a particular label. We need to be encouraging our sisters to parent from the heart and soul, not trying to fit into a particular label. Some of this, of course, comes from the mother herself. I doubt very seriously that anyone would have criticized me for not picking up my whining toddler while I was in the middle of doing the dishes. After all, one of a child's basic needs is to learn how to appropriately interact with their families and sometimes, it is completely necessary that they WAIT on someone else. But I wanted to fit that label, man, I wanted to be an EXAMPLE. I wanted people to think I was the best mom on EARTH and to me, that meant being AP.


As an aspiring midwife, I think about things like this a lot. What motivates us as mothers and how can I facilitate the birth of a new Mom? What, if anything, would be the ONE thing I would say to a mother just starting out? Strive for "this" model of parenting and you can't go wrong? Peh. PEH I SAY. The one and only thing I think every mother on this planet needs to get through her skull is to parent from within. Find something that works for you and nurtures your children, your partner AND YOURSELF and go with it. It's ok if you just can't bring yourself to cloth diaper. I know, I know, it's better for the planet, it's cheaper and can be better for your baby's bum (depends on the kid, lol, I learned that the hard way!). But it's NOT a measure of how much you love your kids or how good of a mother you are. It's a Mama Quirk.


Three months ago I gave birth to my third child, a beautiful son. As I've been breastfeeding for five years (still "snacking" my 2yo daughter) it never even occurred to me that I might not be able to breastfeed my son. I've never had any significant trouble (except for thrush, thrush is my mortal enemy!). My babies have always come out smaller than my breasts but latched on without incident and there ya go, a breastfeeding mama! But my son had a severe tongue tie and was incapable of latching properly. We had his frenulum released at 8days old and all seemed to be well. Except for that niggling sense that something wasn't right, but he seemed to be nursing fine, had a perfect latch and all that. No worries. But he wouldn't grow. Eventually he was hospitalized for failure to thrive and after running every test we could think of it turns out it all came down to breastfeeding. After a long visit with a lactation consultant, we learned that our son has a rear tie (I have never heard of this until now, though apparently, I have one, too) and he literally cannot effectively nurse. It's correctable through major oral surgery. Yay. Not only is it highly invasive and involving general anesthesia, my insurance wouldn't cover it anyway. So...bottle feeding it is! He's getting far more formula than breast milk these days as that's the best I can do. One person very kindly asked me if I was disappointed. No, I'm not. It would certainly be nutritionally better for him if he could nurse but I say NO food is considerably less healthy than formula. I'm grateful we have bottles and the ONLY thing that disappoints me is that I am having trouble pumping enough to feed him. But I'm not upset that I can't breastfeed him. What bothers me is the knowledge, from being on the other side of the fence, that I will be silently judged everywhere I go for not breastfeeding him.

It's not that I don't agree that breast is best, I absolutely do (remember, five years and counting, here). I also extended nurse (my first was weaned at 3.5yrs old). I KNOW where the attitude comes from. But I must admit that now, being on the other side, I've been forced to really THINK about this "judging". Should we stop doing that? Are we hurting more than we're helping? I'm not sure. I will still encourage every mother I meet to breastfeed (or baby wear or whatever) but now I have a different attitude, I guess. The MOST important thing is that she nurtures her children from her heart.

Right?

The Birth of My Son Ethan

Ethan's birth was such a healing, empowering experience for me. It feels odd to put it that way because honestly, most of the time someone says that, they are referring to healing from a previous birth experience. In some ways, I suppose that is true, also, but for the most part, his birth was a balm on a wounded spirit for me.

The year preceding his conception and birth had been one full of the highest hopes and the deepest devastation as all of our dreams came crashing down around us. Along with those dreams, reality crept in and I was dealing with some very painful truths from my childhood and my adulthood. I discovered I was pregnant right in the middle of this and I can't say that I was happy, per se. I was sort of automatically happy the way I always am but I was also feeling rather betrayed, angry and just, confused. My faith had already taken such a beating and here I was, pregnant with a child I was actively trying to avoid! I felt like God or the Universe or SOMEBODY had played a cruel joke on me. It didn't help that my poor husband couldn't take the news well and that both of us were about as stressed out as we could get. To be expecting another baby in the midst of the worst financial crisis (among other things) of our lives together was really a big thing to chew on.

I spent most of my pregnancy trying to consciously NOT make him feel unwanted. I tuned in, I talked to him, I prayed. I felt he was a boy and I felt his name out long before it was chosen (I always wait for my dh to pick a name as kind of a way of confirming my intuition. So far, three times now, it's worked and we've settled on the same name without previously confiding in each other). I was so afraid there would be something wrong with him. My concerns about this came from a feeling of guilt, that he would somehow know he was unexpected and perhaps get from those feelings that he was also unwanted (not true). Also, my 2nd child had been born 4wks early and was so tiny that my recovery time with her was fraught with constant anxiety and worry as I waited for something awful to happen to her. I think, honestly, the recent past had so traumatized me that I was just waiting for the other shoe to drop.

As Ethan grew within me, all sorts of things happened in my life. We uprooted our little family and moved back home (450some miles) after having JUST done that the year before, and moved in with my mother-in-law. QUITE an adjustment for all of us, I assure you. My mother in law is very uncomfortable with homebirth so I spent quite a lot of time grieving what I felt would be a loss of what I needed for a good birth. Oh I cannot thank Heaven often enough for the sisters I've been given as an adult. One of my dearest friends offered me her home to birth in (well actually, three of my friends offered, but I chose this one because it was so close. But really, THREE friends offered?! Who can say they've got their pick of homes to choose from for a birth?). This home is one of my homes away from home anyway. It houses 16 cats, 5 dogs, 2 married couples and 2 single individuals. All of them are some of my closest friends. My children know them all as Aunties and Uncles and it's almost as if my entire "adopted" family lives in one house. It's not a big house, but if there was any more love stuffed in there it would burst at the seams. I was very nervous about birthing in a home that wasn't mine but it certainly wasn't for lack of feeling comfortable there! The idea of actually having to get in a car and travel while in labor, though, UGH. I was not impressed! But again, the gratitude I felt at being so well supported and so well loved spilled over into my ambivalent feelings about my pregnancy and slowly, oh so slowly, I began to heal of the traumas my heart had suffered.

During my 2nd trimester, I began measuring really far ahead. I went from measuring 3wks ahead to measuring 6wks ahead in 2 wks. In another 2wks I'd "blossomed" to measuring 10wks ahead! A friend was helping me track my prenatal care and I had her double check for me. My friend is an apprentice mw (sort of) and offered to see if her preceptor would be willing to take a look. I was afraid to ask her because I cannot pay, though I know this woman by her reputation. She graciously agreed to take a look, and confirmed that yes, I was measuring very, VERY far ahead. We looked for 2 heartbeats and while we could find it in two places, the beats were not different enough to confirm twins. I felt in my heart it was a singleton, a boy. Nobody but Karen would listen to me. Everyone in my life was convinced it was twins (and in all fairness, I was HUGE). I finally accepted that maybe, just maybe, it could be twins but the truth was that I really felt like it was polyhydramnios and I scheduled an ultrasound. The long and short of that was that I was right: One baby, a boy, and a diagnosis of poly.

I'd like to take a moment to say that I do not do routine ultrasounds. In this instance, though, for peace of mind, I decided to have one because if it was twins, I needed to know (we live in a 2bedroom home with my husband's mother. She sleeps on the couch, my girls share a room and the baby, my husband and I have another. That's six people in a house barely big enough for three! We NEEDED to know). I also felt it was probably polyhydramnios and I am well read enough to understand that poly can be a symptom of serious problems for my baby and I wanted to make sure he was ok. What surprised me was how much confirming his sex allowed me to connect to him during a time when I felt very vulnerable and was having a hard time "connecting". I had already internally been referring to him as "my son" but it was very validating and affirming for me to be able to realize that my instincts were NOT broken. After so much going wrong and so much hurt I had begun to lose faith in myself. That little bit of confirmation was enormously reassuring to me. Even better, as far as the u/s could detect, our little son appeared to be perfectly healthy and growing just fine!

Our last child was born unassisted but my husband and I both felt more comfortable with a MW in attendance this time. We weren't concerned so much with the birthing (I would know if something was wrong) but we wanted someone who could look over the baby with a more experienced eye than us, should he prove to have some problem that explained the poly. The mw graciously agreed to attend, despite our complete inability to pay her. As my pregnancy progressed, I had some very laid back routine prenatal care with this woman. Towards the end, my blood pressure just kept getting higher and higher. We talked about a possible home induction but I wasn't sure it was time yet so we put it off for a week.

Monday morning, August 10th, I was 39wks6days. Karen came over to do a quick check and my bp was through the roof. Not high enough to rush to the hospital (and I didn't have any indication that I currently had pre-e but I was beginning to show some worrisome symptoms) but enough to raise both our eyebrows and confirm to me that perhaps giving a gentle nudge was a good idea. I asked her for a vaginal exam (something I had no intention of doing previously, I hate VE’s). I wasn't even going to try a nudge unless it was physically apparent that labor was very close indeed. I was 3 ½ cm dilated and about 50% effaced. Baby's head was very, very low. She felt a nudge would be effective and simple and my bp wasn't so high that if it didn't work, I'd have to transfer...yet. I felt it was wise to nudge and so gave the go-ahead.

So, at 11:30 and again at noon, I took a tablespoon of castor oil. I also took some labor tincture (2 doses) as I began to have contractions (for the 100th time that month) at around 3:30pm. At 4pm, I called Karen and told her I'd started having contractions that were lasting anywhere from 2-3minutes and were coming anywhere from 2-7minutes apart. Long, sporadic and no, they felt no different to me than the contractions I'd been having on and off for weeks. She asked me if I felt like I was in labor. I told her that IF I was, it was very, very early yet . (To be completely frank, I never actually believed this would work and she teased me about it later.) She advised me to go to my friend’s house as traveling in hard labor is no fun. I said something about not wanting to be over there all up in their space for no reason and Karen said it was up to me but at least if I was there, I’d have a nice time and be in good company. I hung up with her and asked dh to call over at the house and let them know we’d be ready in about an hour. I was in total denial about my labor. Paul told me later that at the time, he thought I was nuts and should just go right over (this is our 3rd baby together, so I guess he knows what to expect) but he was trying to respect my wishes. It’s just that I read all about hypnobirthing and had practiced the relaxation exercises *every day* of the 2nd half of my pregnancy and THEY WORK. I just did not believe that the contractions I was having were any more than prodomal contractions. They just didn’t HURT enough.

So he gets off the phone with Elise (one of the women that lives in the wonderful house) and I make a trip to the bathroom. As soon as my butt hits the toilet seat, I have another contraction….and it’s all downward pressure, all head in the birth canal. OH SHIT. One of my first thoughts (while moaning like a lioness) is “WHAT HAPPENED TO TRANSITION?!?!”

I came out of the bathroom after two more of those and told Paul, “Call Elise back and tell her to come RIGHT NOW.” He said, “I knew it…” and picked the phone back up. Time gets very strange for me after that because the ONLY thing I was concentrating on was NOT pushing the baby OUT. I did not check but I imagine that if I had, I would have been able to touch his head. This is the only time during my labor that I did a lot of yelling. I had to! Birthing is so much energy and I handled the contractions well until I had to fight them. Fighting them SUCKS. I remember standing in the kitchen while dh and Elise were getting the car packed. I had this utterly powerful contraction, the kind that makes your legs shake and your entire body feel like it’s crumpling in on itself. NOT pushing during that contraction was one of the hardest things I will ever do and fighting my body HURT. I kept screaming “hurry up!!!” at them. I totally freaked my 2yo out. She was FINE until I started shrieking. Poor baby, I kept giving her hugs in between contractions, just to let her know I was ok.

Finally the damn car was ready. I fight off another contraction and then rush from the front door to the car-only to realize that the front seat (MY seat) is covered in junk. Damnit! I really did not want to be fighting contractions out where the entire world could see me. OH WELL. So I have one standing up by the car, while Elise is clearing the seat off. I say, “OMG it’s FUCKING hot out here!” And it was. It was the hottest day we’d seen that year (we found that out later). The contraction and gravity were working so well together that I had no choice but to get down on my hands and knees (yes right there in public!!!) and howl and holler, trying to keep my son IN. Finally! The seat is clean, I can get in the car. I’m talking to myself in my head, at this point: “You will NOT have this baby here in the grass. You will wait this contraction out and then, ok, here we go, UP, GET IN THE CAR, quick, before the next one!”

The car ride was a special level of hell. For one thing, I was literally sitting on my son’s head. I could FEEL it right there. I was trying not to shriek in the car because for some reason, I was very aware of how loud it would be to everyone in the car (particularly Abby, who was so upset by it). It occurred to me, though, as we were traveling, that dh needed to call Karen back and tell her that she needed to leave NOW to come meet us at Ruby’s. Right as he begins to do that…we turn up this little street only to be made to stop because of construction. The guy was trying to make us wait for an entire line of cars coming the other way! OH NO HE DIDN’T!! Elise starts shrieking out the one side of the car, My husband (who is still on the phone with the midwife) is leaning out his side of the car, banging on the door shouting, and I’m yelling NO NO NO NO NO!!!! As much as it sucked in the moment, it makes me laugh to remember it. He let us past, thank God.
At one point, during the drive, I said something like “do NOT have the baby in the car!” and Elise reassured me that hey, if the baby was born in the car, at least labor would be over!
Thankfully, the baby was not born in the car but I felt like I might need to poo. And as I’d had castor oil, I was highly conscious of just what that might look like and so I desperately wanted to get to the bathroom. This was at the forefront of my mind when we arrived at the back of Ruby’s house. Naturally, I’m having a contraction when Nick opens my door to help me out so I have to wait through that one and then it’s UP AND GET ACROSS THE YARD AND UP THE…OH NO, HERE’S ANOTHER ONE! I knew that if I stood up during a contraction, the baby was going to come sooner rather than later and damnit, I needed to go potty first! NO POOPING IN PUBLIC. So I backed off the steps I had started up and got down on my hands and knees, again, where everyone could see me. Why on earth it bothered me I cannot tell you but getting inside the house was SO important to me.

Finally contraction over and as I go up the steps into the house, I have this quick panic that I’d get in there and the pool would not be set up and I would cry. But no, there it was, in all of it’s glory! Clean, set up and half-full of wonderful, delightful water! But NO, I have to poo! Contraction by the door, walk to middle of living room, down to my knees for another contraction. I think Molly was helping me to the bathroom and I’m pretty sure I made it up the steps before the next one. I sat on the potty with Molly outside the potty and had 2 more contractions on the toilet. I managed to poo such a tiny little bit that I almost had to laugh at myself for wasting all that energy getting to the bathroom! So, back down the stairs.

I was beginning to calm down. Everything can unfold now, I don’t have to fight my body anymore, I can go back to relaxing and breathing and enjoying the amazing dance of life that is birthing a child. My husband had taken the opportunity to have a celebratory smoke with Nick, in the basement. Ruby had taken the girls out to the front porch. Molly and Elise were like my personal hand-maidens. I remember, upon first stepping into the pool, telling Elise the water was too warm, but not by a lot. I felt like a queen! It was…I don’t know how to explain it, it was just so calm and peaceful and I was cared for so much and I could FEEL it in the air! I sat down and immediately all the pain in my lower back just stopped. OH IT WAS HEAVEN. Elise switched the water to cool and I was so hot I put the hose right in my face and got my hair wet. Sweet relief! I just kept my feet in front of the cool water coming out after that, it felt fabulous. I had a contraction and was able to just stretch out and breath and no more fighting! Damn, his head is really right here, huh?

Ruby appeared and I don’t remember exactly what we said to each other but I do remember saying she could bring the girls in if she wanted to (Elizabeth really, really wanted to see her brother come out). Right then, Paul came upstairs. He was smoking a cigarette and on his way out to the front porch with Nick, who, having completed his task of setting up the pool, was leaving. Nick heads out to the porch and dh stops by the pool and says, “Wow, I didn’t even know you were down here, I thought you were still in the bathroom! You’re so quiet!”
“The baby is coming out” I said. With a look of affection and sympathy he says, “I know, babe”. Another contraction begins and I manage to grit out “No, he’s coming out RIGHT NOW” as I get my hand down to my vulva and cover the top of his head with my hand. Watching my husband consciously decide NOT to throw his smoke over his shoulder while he races around the pool to get by my side was priceless and I will never forget it. As he gets around, to where I was, my son’s head is born. “Head’s born” or “head’s out” (I can’t remember which I said). I switch to half crab-squat, half recline as he rotates and my body expels him in one big contraction. Paul gets his hands in the water just in time to keep the baby’s head from hitting the bottom of the pool. I have this snapshot image of him floating there, just for a second, before I reach down and scoop him up. I could NOT stop smiling this huge, elated smile. HI BABY!! HI LITTLE SON! I heard someone say “Becky, the look on your face!”. I don’t even know who it was. I just could not get over my beautiful son! He was here! And so quickly! It was only 5:15pm! AND THE HAIR OH MY GOD! My girls didn’t have a bunch of hair, but this boy looked like the dream-baby I had…Dark hair! And he was long and perfect and squishy and beautiful and I couldn’t take it all in, I was just telling my mw I was only, MAYBE in early labor and here I am, with a naked, vernixy boy in my arms and she wasn’t even THERE yet! Paul poked his head out the front door to tell Ruby and Nick and the girls that the baby was born. Nick hadn’t even gotten halfway through his smoke!

His cord was so much shorter than I’d had before, I could only hold him around my belly button area. The girls came in to see him then and Elizabeth was so precious. “Oh he’s so cute! Can I hold him?!” “Baby! Baby! Baby!” from Abigail. At some point Karen arrived and said something about how I make such pretty babies (that woman knows how to make a freshly birthed Mama burst with pride). Paul was there by my side the whole time. I loved how Karen made no moves to do anything at all. She just commented on my beautiful baby, my beautiful girls and began to fix me some tea. I loved that. I was worried, a bit, that she wouldn’t really be hands off but she WAS. I mean, lol, you can’t get much more hands off than missing the birth, but at no point in the 3rd stage did I ever feel like she “took over” . Nope. She was helpful and confident but not intrusive.

Ethan’s cord was short enough I asked her to cut it for me so that I could get out of the pool. I remember he had the kind I’ve always thought looked so cool: fat and really twisty. She cut it and I think I passed him off to Paul. The afterbirth high makes it hard to remember anything very clearly. I know that I took off my shirt so I could skin to skin with Ethan. I remember that before doing that, I birthed the placenta and in so doing discovered some minor little tears (skin deep, all of them) in some awkward places. I know Karen took a quick look at my girly bits (as I asked her to) just to make sure the tears were minor. The girls made sure I was snuggled in on the couch with my new little son and somewhere in there Ethan was weighed and measured (5lbs15oz and 20 ¾”). I couldn’t stop smiling! Karen instructed Ruby in how to make me a lovely cup of tea with some AfterEase tincture in it. That stuff is heaven! Meanwhile, the pool was broken down and washed and afterwards, I passed Ethan off and had a nice soak in an herbal bath while Ruby kept me company. Molly was the perfect nurse for me as she got me what I needed and helped me into Ruby’s bed for some more alone time with my baby. Karen left right around the time I was getting ready for my bath.
Again, I don’t remember the timelines so clearly but at some point I decided to join my family and friends downstairs on Ruby’s couch again. The girls had all had a chance to hold their little brother, my MIL and Aunt Debbie had brought some things we’d forgotten in the mad dash out of the house along with some gifts! After I got settled onto the couch, a bunch of our friends arrived. Lee, Jansen and Alex showed up. Lee and Jansen had gotten Ruby and I bottles of wine (and yes, I had a small glass to celebrate!). Lee decided he was going to cook everyone dinner and damn, they threw a party!

Honestly, I can’t say enough positive things about Ethan’s birth. I feel as if in many ways I’ve lost my family over the last ten years but these women have become my sisters (Uh…yeah, Jansen and Lee count as “girls” in our circle, lol, Lee was even at my Blessingway). How precious a thing, in this day and age and in our society, to have a circle of women that are so open to caring for one another? There aren’t words to express my gratitude and how humbled I was by their gift. I don’t know how many women can say they’ve had a birth experience like this one and I know I will cherish it in my heart until the day I die.

A post with a little substance?

So I made this blog to write about things that were important to me. You know, to exercise my brain and my need to sound like I know a thing or two. I then promptly neglected it. :( I was reading Jill over at Revolutionary Keyboard and it hit me, yes, she's right: I don't have time for anything anymore. It's crazy!

We had our 3rd baby 7wks ago yesterday (and honestly, wth, he was JUST BORN a few days ago, I swear!) and ever since then it's like someone pressed the fast-forward button and I can barely catch my breath. I'm loosing my mind, lol.

No time for anything. Well that's not entirely true. I have time to do lots of "nothing" (you know what I mean, when you get to the end of a day and you're utterly exhausted and you have NO IDEA what you have been doing that wiped you out?). I have time to nurse my son. Time to clean up my youngest daughter (as she is forever finding new ways to decorate herself with food, snot, markers, various creams, shampoos and lotions she can reach NO MATTER WHERE I HIDE THEM!!!). Time to plan and cook nummy meals (crappity crap crap, I just realized I need to pull something out for dinner tonight!), time to potty and change my son, time to help my oldest with her homework and listen to her endlessly and excitedly ramble about how Juan pooped his pants at kindergarten and of course, the finer details of how to play Miss Fox in Gym class. There's the cleaning, the booboo-kissing, the OMG did you just dump half a carton of milk on the carpet?!, the rescuing the baby from the clutches of his adoring 2yo sister and the nearly endless (and mostly silent) battle with my mother in law over the right to mother my children as I see fit. I haven't touched on laundry, husbands that are full-time students, grocery-shopping, sick kids, cleaning the rabbit cage and the feeling that it just goes on and on in a great infinite spiral, forever and ever. You don't even want to know how many times a week I get to actually wash my body. And at the end of the week, ask me what I've been doing with myself and I draw a BLANK. Oh you're busy? What have you been up to? Um...ummm...I DON'T EVEN KNOW.

Time to write? I think that might count as an "anything". Well, I'm going to air the Stay At Home Mom dirty little secret: Sometimes it's absolutely MIND NUMBING. So while all the little "nothings" that fill my life DO bring me joy, fulfillment (and exhaustion) my poor little thinker is shriveling up and I just need MY SPACE. Which happens to be a bog or three. :) Got to love the internet: every poor SAHM's place to blow off steam!

So...I'm back and promising myself a little time for "anything" here and there because I need it.

My next post is going to be the birth story of my son, my 3rd child, 2nd uc/homebirh. I put my last one on here with some names changed and so, for the sake of consistency, the names I changed last time are changed here, also, with the same replacements.

Shout it from the rooftops, Woman!

There has been a lot of buzz lately about various shows and articles coming out about homebirth. I had a huuuuuge, disjointed rant in my head but thankfully, you are spared having to read that because Keyboard Revolutionary has done a MUCH better job than I could of saying all of the the things that need to be said.

http://keyboardrevolutionary.blogspot.com/2009/09/iridescent-tile-makes-all-difference.html

Check her out! Well said, Jill, seriously.

Stop and Smell the Baby: Prepared for Life

Welcome to August's Carnival of Breastfeeding! This month our posts are on the World Breastfeeding Week themes "Prepared for Life" and "Breastfeeding in Emergencies." Be sure to check out the posts from our other Carnival participants linked at the end of this one.


I'm not entirely sure I'm doing this right but I've come across so many posts in response to this that I was inspired to write, too. So,here goes!






By the time my first was a few weeks old I could make a great case for breastfeeding based on the benefits to the baby alone. I was completely unprepared, though, for how it would change my life. There is something almost magical about the way nursing a baby makes a mother feel. The very first time I looked into my daughter's eyes, it took my breath away. She was so...sentient, so aware and so uniquely HER, right from the beginning. The first time she latched on and took sustenance from me, the hormonal rushes combined with intense pride about knocked me out of the bed! I chose to breastfeed before knowing anything about nursing, though. I chose it because it was FREE and natural. Therefore, it made loads more sense to me than the alternatives. I was to discover, though, that it is so, SO much more than just a free meal. I learned SO much in the first year about the benefits of breastfeeding for my baby but I was completely innocent of how much breastfeeding would change ME and prepare me for life.
You see, breastfeeding is natural, yes. For some of us, it's even easy (has always been for me, though I realize that for many, it's most definitely NOT). But it comes at great personal sacrifice. I know, I know, that's not trendy. Trendy moms juggle a career and a family and find a way to make it work: and my hat's off to them. But breastfeeding requires a great deal of personal investment. It's TIME CONSUMING. Yes, much easier than lugging bottles and checking water temperatures and measuring and sterilizing, to be sure. But you can't take your boob off, prop it up with a pillow for the baby and go back to doing dishes. Nope. You cant take your breasts off and hand them and the baby to a friend and finish cooking dinner, either. Nope. If the baby is hungry, everything stops so she can eat. If the baby hurts herself and needs comfort, you sit down, wip it out and give comfort! If the baby is sick you thank God, the universe or whomever you thank that breastmilk, at least, stays down when nothing else will...and so do you, on the couch, for the entire day/night until bub feels better. Nursing our babies forces us to literally give of ourselves. It's as if nature has built in a platform for forming that connection from day one. I'm not suggesting that women who bottle feed do not give of themselves. I've known plenty of fantastic, selfless, bottlefeeding mothers. I just have to wonder, though, if it was harder for them. I suppose this is the sort of thing that varies from woman to woman anyway, we are all so different. But for me, at least, breastfeeding my babies has underlined everything else. It's like a srpingboard that vaults me into other areas of self-giving that help prepare my children for life.

Nursing my children has taught me patience (trust me, when you've been interrupted during a growth spurt for what feels like the 400th time that hour for a quick nibble, you learn patience). It's taught me humility (I mean, come on, when one is wearing a 40G you learn humility when the baby isn't particularly interested in who you are flashing when nursing at Walmart).
Out of all the things I've learned, though, I think one of the most profound is to STOP...and smell the baby. This has been particularly true since my 2nd daughter was born, as I'm sure any mother of more than one can attest to. I just get SO busy, so stressed about this and that which needs to be done. Then, that call, those eyes and that forced rest. So, sure, the laundry is only half folded and taking over my kitchen table and perhaps child #1 is over there "helping" in an entirely unhelpful way while I'm nursing the baby but STILL, I'm forced to sit down, take a few deep breaths and look my little one in the face and spend just a few minutes with JUST her. If nothing else, I've learned to let go a little and relax. RELAX.

If I'm able to relax, to let rigidity give way to routine, to allow my children to impose upon MY plans a bit, I'm a better mother. I'm also far less stressed out. This not only prepares my children for a life that's actually happy (you know, without a stressed out, spastic headcase for a mom) it molds and shapes me into a better persn in general. Breastfeeding my children has been a door that has opened up onto a new outlook of life for me. I have learned (and continue to learn) how to truly serve. I've learned how to love with my whole being. I've learned that it's OK if the priority is my children and not having the Better Homes and Gardens thing DOWN. I've learned to stop and smell the baby. And really, what could possibly be more wonderful?















Check out the other participants in this month's Carnival.

Motherwear Breastfeeding Blog: Breastfeeding in Emergencies
Hobo Mama: Prepared for Life: Breastfeeding in local and global crises
Zen Mommy: How breastfeeding has shaped my toddler's view of breasts
Pure Mothers: Marketing away real milk
Chronicles of a Nursing Mom: Tips for consistent & long-term breastfeeding success
Cave Mother: Three moments that make me thankful I breastfeed
Blactating: Breastfeeding news and views from a mom of color: Infant feeding and disasters

So fantastic, I had to pass it along!

http://jeremyscorner-grifter.blogspot.com/


I just copied and pasted what she wrote....no credit for this whatsoever. I will say this is one of the most concise, clear breakdowns of this particular debate that I've read in a long time.

Tuesday, June 30, 2009

Cesarean section is NOT the reason the maternal mortality rate has gone down

It has been a while since I posted another OB myth. Today's myth comes to us courtesy of Dr. Amy. Another Amy, Amy Romano, wrote a blog post in which she questions the lack of attention to the maternity care situation in an article written by Dr. Atul Gawande. In her blog post, she says,

Gawande saw a fall over time in perinatal and maternal mortality and attributed it to advances in hospital-based obstetrics. But he knows as well as anyone that correlation is not the same as causation. While a few medical advances — oxytocics and ergot derivatives to control hemorrhages, antibiotics to treat infection, and surfactant to treat respiratory distress in premature infants — have certainly prevented deaths, much of the fall in mortality likely comes from basic improvements in public health and hygiene. By looking through the bifocal lenses of medicine and history, Gawande makes an erroneous assumption that, when it comes to giving birth, more technology is inherently better. What he fails to ask is the very question at the heart of The Cost Conundrum: could we get the same or even better outcomes with fewer risky and costly procedures?

Of course, leave it to Dr. Amy to come around and champion the cause of medical technology. In the comments section, she says,

Basic improvements in public health and hygeine occured in the late 19th and early 20th Century. The spectacular drop in maternal mortality (99%) and neonatal mortality (90%) occurred between 1940-1980, long after basic advances in public health.

One of the advances most closely associated with the drop in maternal and neonatal mortality is the development and improvement of epidural anesthesia, making Cesarean section far less risky and far more common.

But Dr. Amy makes the same mistake that Amy Romano pointed out Dr. Atul Gawande made, and that most hospital birth advocates make: correlation is not the same as causation.

Dr. Amy mentions that the "spectacular drop" in maternal mortality, which occurred between 1940-1980, can be largely attributed to the use of the epidural, and therefore the relative safety of the cesarean section. This is an inherently illogical conclusion, as it assumes that cesarean sections were previously risky due to the method of anesthesia. In fact, the two biggest risks of cesarean section were (and still are) blood loss and infection, neither of which have anything to do with the method of anesthesia.

One of the main causes of blood loss during cesarean section prior to the end of the 19th century was the fact that physicians did not suture the uterus closed, fearing infection from the internal sutures. In 1882, Max Saumlnger, of Leipzig began arguing in favor of uterine sutures, and together with the development of silver wire sutures, physicians began using internal sutures, which necessarily reduced the rate of severe hemorrhage. From the late 1800s to the 1920s, physicians continued to improve the procedure itself, including performing the surgery earlier in labor, before the mother was on the verge of death, and using a transverse incision. (Please view this publication for more on the history of the cesarean section.) The first spinal block was not used until 1943 (ref), so while the epidural certainly contributed to overall improvements in the surgery, advances that directly eliminated or reduced factors that contributed to maternal mortality were already in place.

So what were women dying in or after childbirth dying from? The most feared complications of childbirth pre-1950s were hemorrhage, obstructed labor, and infection.


Hemorrhage

Blood loss is one of the most feared complications in childbirth. It is a reasonable fear! When the placenta separates from the uterus, several minor and major blood vessels are left exposed, and continue to pump blood until the uterus clamps down and closes them off. In some cases, the uterus does not do this adequately, or fast enough, which can result in blood loss, shock, and eventually death for the mother. Prior to the 1930s, there was not much modern medicine could do for blood loss. Midwives had traditionally used herbal remedies, such as ergot, to treat hemorrhage, but it was slow-acting and had serious side effects, including the potential to cause death. In 1909, the hormone oxytocin was discovered, but was not widely available. In 1935, the specific oxytocic agent in ergot was isolated, and preparations were made available. But the real discovery came in 1953, when the biochemist Vincent du Vigneaud discovered a way to create a manufacture-able, synthetic version of oxytocin (now known as pitocin). (ref)

No one can argue that the discovery of oxytocics was a significant step in advancing women's health, but equally significant was the improvement in women's lifestyles and nutrition. A study was done in Maryland which looked at a certain population of women's diets, which diet was considered to be comparable to that of women in the late 19th century, and found that 70% these women were severely anemic, and many had contracted pelvises (more on that in a minute). (ref) According to this publication, anemia in pregnant women reduces a woman’s ability to survive bleeding during and after childbirth, and is associated with 22% of mother's deaths (as of 2006). While oxytocics can slow a postpartum hemorrhage and prevent many immediate deaths, a reduction of severe anemia in pregnant women helps ensure they will survive in the days and weeks following a major hemorrhage. With increased proper nutrition among childbearing women over the years, it's no wonder that the maternal mortality rate has continued to decline. It is interesting to note that severe anemia due to poor nutrition still accounts for a significant portion of maternal deaths today in developing countries and poorer populations.

(It is also worth noting that while postpartum hemorrhage is typically associated with vaginal birth, the average blood loss from a c-section is twice that of an average vaginal birth. (ref) In addition, since 1998, the rate of blood transfusions in the US among all delivering women has increased by 90%. (ref))


Obstructed Labor

Obstructed labor, for various reasons, was a common cause of death previous to the improvements made in the safety of the cesarean section. If a baby was transverse, or stuck in the pelvis, or for whatever reason could not be delivered, it resulted in the mother's death. Prior to the improvements made to the overall safety of the cesarean section, if a woman did not die from the obstructed labor, she would certainly die from any surgical attempt made to save the baby. In that respect, one could argue that cesarean sections are the one of the main reasons for the reduction of maternal deaths due to obstructed labor. However, at the same time as improvements in obstetric care were developing, the number of obstructed labors were decreasing.

Obstructed labor is usually due to three main causes: malpositioned fetus (as in transverse lie), malpresentation (as in brow first), and cephalopelvic disproportion (CPD). One of the main causes of CPD is an inadequate bone or skeletal structure, directly related to poor nutrition. (See this article for a more detailed discussion of nutrition and obstructed labor). In the late 19th century, this often meant rickets. Women and children in urban areas, working in factories where they were largely not exposed to sunlight, and eating poorly, suffered this condition which often resulted in pelvic deformities.

In the book, Women's Bodies: A Social History of Women's Encounter with Health, Ill-Health, and Medicine, the author estimates that in some areas at this time, one out of every four women suffered from some degree of pelvic contraction. The percentage of women with contracted pelvises who died as a result of obstructed labor varied, from 20% of mildly contracted pelvises to almost 50% of severely contracted pelvises. With the total percentage of women presenting with a malpresentation or or malposition averaging around only 4% of total births, the reduction in the number of women with some degree of pelvic contraction, who accounted for perhaps 25% of all births in some areas, would have a particularly important effect on the overall maternal mortality rate.

How was this achieved? By the 1920s, researchers had learned what was causing rickets and other similar bone-deformity diseases, and successfully patented a method of irradiating food, and began a campaign to irradiate commonly eaten foods in an attempt to lower the incidence of rickets. (ref) By the 1940s, Vitamin D-fortified milk was ubiquitous, and the incidence of death of children due to rickets had been reduced to less than 75 cases a year. (ref)

So while the improved safety of c-sections certainly positively impacted the maternal mortality rate among women with malpresentations or malpositions, the largest reduction in maternal morality rate from obstructed labor has quite clearly come from better nutrition and lifestyle, which prevents contracted pelvises in the first place.


Infection

In the early days of hospital birth, another common cause of maternal death was "childbed fever," or puerperal sepsis. Puerperal fever is an infection caused by transmission of bacteria (most often Group A Streptococcus) to a woman, resulting in sepsis, and if untreated, death. Prior to the advent of antibiotics, puerperal fever was one of the leading causes of death among women in hospitals. Puerperal fever was known to kill postpartum women before the advent of hospital birth, but the incidence of it was apparently uncommon. When birth moved into the hospitals, doctors themselves caused outbreaks of the infection by going from patient to patient and performing vaginal exams without gloves, clean clothes, or washing their hands. In some cases, doctors would go from an autopsy to an exam of a pregnant or recently-delivered woman. (Read this article for more discussion on the history of childbed fever.)

In the mid- to late 19th century, several doctors put forth the idea of bacteria transmission as the cause of puerperal fever, but were dismissed. By the turn of the century, the theory of bacteria transmission was widely accepted, but aseptic routine was still not widely practiced. According to the article referenced above, the maternal mortality rate continued to stay the same until the 1930s, the United States continuing to have the worst maternal mortality rate among industrialized nations.

In 1935, a German doctor introduced the use of prontosil, a sulfonamide dye, the precursor to the use of penicillin and modern antibiotics, as a treatment for puerperal fever. It worked remarkably well, and by the end of WWII, penicillin was widely available and used to combat all types of infections, puerperal fever included. The result was that by 1949, the maternal mortality rate in the United States dropped by more than 700%. (ref)


What does all this mean? It means that the time period which Dr. Amy was referring to - the 1940s - might have seen the advent of the epidural, but that was almost certainly not the reason why our maternal mortality rate declined. The 1940s saw a reduction in bone deformity diseases, a reduction in anemia, a reduction in transmission of bacteria, and a successful way to treat bacterial infections. These advances were by and large brought about by cleaner conditions, better health, and better nutrition. The cesarean section has certainly had its place in the preservation of women's lives, but was not the first or the last word in maternal mortality, as proponents would like to argue.

But even if the c-section were the saving grace of modern women, surely we should be seeing an even more dramatic drop in maternal mortality today? Not so. In 2003, the maternal mortality in the United States ROSE to 12.1 deaths per 100,000 live births, to a rate higher than it had ever been since 1976. (see more numbers here.) The United States ranks 41st, continuing to rank last among industrialized nations as we did before all these new advances, for maternal mortality. Women are still dying in or after childbirth! Study after study continue to come out that show the risks of cesarean section relative to vaginal birth, and show the benefit of low-intervention births. It is obvious that the cesarean section, while essential to many women in high-risk situations, is NOT the primary reason maternal mortality rates fell in our country.

And I would like to ask the Dr. Amys and Atul Gawandes of the world what Amy Romano is asking: could we get the same or even better outcomes with fewer risky and costly procedures?