Trusting birth, trusting our bodies

I met an interesting midwife on Monday who had some very thoughtful things to say about both homebirth and birth in general. Her main feelings on why women should stay home to give birth revolved around the hormone cocktail that is released during labor, and how that hormone cocktail is most effectively released when a woman feels safe. Conversely, when we don't feel safe, our sympathetic nervous system (otherwise known as "fight or flight") kicks in, and coindicentally enough, the hormones that are released under this system directly counteract the hormones necessary for women to relax and let go for labor. Since most of us feel safest and relaxed in our homes, the ideal place for birth is clear.

This is nothing new, these hormonal principles are what Michel Odent and others have used for decades to promote the idea that birth goes best when women are comfortable and either at home or at least in home-like settings. It makes a lot of sense especially when confronted with the staggeringly high statistics of artificially augmented and induced labors (Jennifer Block reports 40% of women answered that their labors were induced in the 2006 Listening to Mothers survey compiled by Childbirth Connection) in hospitals. While the reasons women are given for their induction being "medically necessary" are wide and varied, the message is clear: we don't trust your body to handle this process on its own. We don't trust it to know when your baby is prepared to arrive, we don't trust it to establish the contraction patterns we like (and what we call "normal"), and we don't trust it to expel your baby anywhere near quickly enough.

My thoughts stray to all the birth stories I've heard where the woman tells me that her uterus "conked out" or that her contractions weren't "regular" enough. The messages all imply a failure on the mother and her body. Or the mothers who have grown babies who were "too big" had pelvises that were "too small" (more than likely too small to birth in the lithotomy position"). Or the mothers whose babies overstay their welcome in the womb by a few days or weeks. All of these are candidates for induced or augmented labor.

This same midwife brought up the fact that women who give birth unassisted by anyone but themselves have remarkably good outcomes. In my quest to verify this, I obviously haven't come up with much in the way of randomized controlled trials studying the safety of giving birth unassisted. What I did find was a very much anecdotal and unverified poll from mothering.com, (it's here if you're interested) reporting a 2.1% Cesarean rate (after a transfer to the hospital, of course) compared to the national average hovering 30%, and a .72% rate of stillbirth, which is lower than or comparable to both home and hospital perinatal mortality rates. Fairly impressive considering these are births completely unattended by any medical professional. The midwife chalked this up to trust. Simple trust in the process and the body, that the day of birth is the same as any other day except you are having a baby. Now, I personally don't advocate for unassisted childbirth. My own belief is that birth is safest when quietly observed and unobtrusively monitored by a trained, experienced professional. However, I find the facts absolutely compelling. These women aren't magically growing babies that are just the right size coming on just the right date at exactly the right rate of progress during labor. The only thing that is different about these women is their intuitive trust in their bodies and their babies. I am also considerably awed that they have been able to cultivate this level of trust from within our culture of fear.

I read an article about a year ago about two doctors who delivered a baby unexpectedly on a plane. Neither doctor was a type of doctor that deals with birth on a regular basis, but they both seemed completely shocked that things had gone off without a hitch. One of the quotes that I remember most distinctly was one of the doctors saying "I wasn't sure how we were going to have enough room to deliver this baby. I mean, there wasn't even room for her to lay down!" Little did he realize that her at least semi-upright position was probably working in her favor.

Our culture has become so reliant on technology in birth that we don't even realize that it works without it. Arguably, for low-risk healthy women, it works better without it. Birth actually functions quite beautifully, even if it doesn't conform to pretty charts and graphs.

Nipples Galore

I defy you not to love The Nipple Project!

Be a Part of this Project!

Submit a hand-made artistic interpretation of your nipple or of someone’s nipple you love. Send us a nipple(s) made out any material that can be sewn or attached to another surface. Our goal is to create a large, community based art installation consisting of 3-dimensional media such as knitting, crocheting, beading, sewing, gourd, metal, leather, ceramic, felting and any other media you can imagine. The final piece will include all of the submissions sewn and/or stitched together in a large wall installation.

Deadline is May 1st, 2008. So hurry and send us your nips!

Why are we doing this, you ask?

Initially, we were inspired by the release of the IPEX bra by Victoria Secret. Advertisements for this bra espoused quite blatantly that it provides “maximum nipple coverage!" This bra epitomizes the eradication and androgenization of the nipple. We find this ironic in an era where breast augmentation is done in order to gain a "more feminine look." So we wanted to reclaim our natural femininity and counter this strange phenomenon.

But as our project came to life, we realized we had touched something deeper. Women responded to our call for reasons we had not intended. We began receiving submissions breast cancer survivors. Their beautiful creations are an both an artistic and cathartic. Also, women who have lost a family member or friend to breast cancer have taken this opportunity to express their grief and respect to their loved ones. We have also received submissions from women who have recently become mothers and are inspired by the joys and rigors of nursing!

So whether you choose to submit in order to reclaim the expression of your natural femininity or for one of the reasons mentioned above or if you just love nipples - men's and women's!!!...join us and send us your submission.

We love, support and appreciate all of your reasons for submitting and we are honored to be a part of your creative, emotional and artistic expression! Thank you!

I won't be attempting their knitted nipple pattern anytime soon (my knitting time is dominated by a baby blanket for a certain soon-to-be-born little girl at the moment), but I did whip up this little number...

In the News

In Canada, some doctors are claiming a "conscience clause" to refuse women pap smears. Because, you know, only dirty girls get cervical cancer.

Midwife licensure bill passes Missouri senate committee. Yay! Keep up the good work, MO.

Our Bodies Our Blog focuses on teens' dirty vagina diagrams and sex education today.

Avoiding unnecessary labor induction is a good thing.

You know how Henry VIII cast aside his wives when they "failed" to produce male heirs to his throne? (He was hardly the only man blaming his spouse for lack of male offspring.) I see some parallels to that in all the emphasis that is placed on mothers' habits, health, age, diet, etc. in determining the health of her baby. Our wombs are not vacuums, folks! It takes two to tango, and two to make a baby, as it turns out. Some recent research is confirming that dads play a part in making a healthy baby, too. Paternal exposure to toxins can have a real impact on fetal development. So can age. (Hear that, ACOG?)

A Doula's Aromatherapy Kit

Aromatherapy is a powerful but very safe option for providing comfort to a laboring woman. The essential oils used in labor can also be very beneficial in the postpartum period when most women experience at least some measure of the "baby blues." Certain oils can also be used during pregnancy, but you should talk to your care provider about your specific situation and any contraindications with aromatherapy.

I thought I would share what I have personally used both at my own births and for some of my clients. Essential oils in general are fairly inexpensive so it's easy to get started with a handful of oils you love.

It's important to remember and be sensitive to the fact that a laboring woman's senses are heightened, especially her sense of smell. There may be scents she normally enjoys that become repugnant during labor, or, she may even begin to dislike a scent she had asked for in earlier labor. So be sure to use methods that can be "dialed down" fairly quickly. Whereas in day to day life I might scent a bath by putting drops of oil into the bathwater, in labor I typically use a basin of warm water or even the bathroom sink so that if she becomes annoyed by the scent it can be quickly removed. Cotton balls or tissues are an excellent way to give mothers a whiff without scent overpowering the entire room. I carry unscented massage oils and add drops of essential oil only after checking in with the mother and mix it in my palm. It's great if a pregnant woman can experiment with the scents of different oils so that she knows ahead of time which ones she likes. Still, be sure to check in with the laboring mother anytime you are planning on using oils by asking her if that's all right, and maybe giving her a choice between two. Do NOT ask her to tell you which oil she'd like out of seven options or to answer a complicated question about it. This is a surefire way to have aromatherapy harm more than it helps.

Lavender: This one is a favorite of doulas and midwives because it promotes relaxation. It can be used on a cotton ball or electric diffuser if the mom really likes it, or it is wonderful in the tub. Again, use a basin full of warm water or the bathroom sink and add 2-4 drops. Don't add it directly to the bathwater in case the mother suddenly doesn't enjoy the scent, and it's also a good idea not to add anything to bathwater of a woman whose membranes have ruptured. Remember that this is a heady, relaxing scent, so it is best used either in early labor when everyone is trying to get a little rest, or in highly stressful, charged times like transition. Lavender can also be used to help alleviate nausea. It is not a good idea to break out the lavender in the middle of an especially long active stage where everyone is exhausted already when something more energizing might be beneficial. Lavender is an excellent oil for new mothers to have on hand. I have used it in the bathroom when giving my children baths to help wind them (and me!) down for the evening. A few drops on the mother's pillow can help induce relaxation to let a stressed out mother drift off to sleep. Lavender is a key ingredient in the postpartum comfort pads recipe.

Peppermint: Peppermint can be a very powerful, invigorating oil and is quite versatile. For a woman exhausted by the rigors of labor, a foot and leg massage with a few drops of peppermint oil blended in your favorite unscented oil (I like sweet almond) can be energizing and blissful for tired muscles. Peppermint oil can be used directly on the temples to relieve headaches, but check with your care provider first as using essential oils topically is somewhat controversial. For a woman who is having a difficult time passing urine either during labor or after birth, a few drops of peppermint oil put directly into the toilet bowl can help relax the urethra. Peppermint (and spearmint) are also useful for treating nausea.

Citrus: Some options here include Grapefruit, Orange, Lemon, or Neroli which is wonderful but highly expensive. Grapefruit is fresh and invigorating and perfect for an exhausted labor room. Orange can be combined with peppermint and lavender or used on its own for nausea. Lemon is very refreshing and great for masking any other unpleasant smells.

Florals: I don't personally enjoy many of the floral scents, but lots of people do. The most popular ones for labor include Geranium and Ylang Ylang.

While I have advised using transport methods that can be easily reversed for aromatherapy during labor, there are a couple of exceptions. When first checking into the hospital, if the room smells antiseptic or stale, an aromatherapy mist can be invaluable. Similarly, if a laboring woman (or her partner!) has been vomiting, a mist can help freshen the air. I use a dark blue glass bottle (essential oils are to be kept protected from light) and use 10-15 drops per 6-8 oz. of water.

One of the wonderful things about aromatherapy is the effect it has on everyone in the room, not just the laboring mother. The person giving the scented massage inhales the aroma and benefits from the healing properties just as the person receiving it. One of the most important part of the doula's role is something Pam England (author of Birthing from Within) calls "Holding the Space" which refers to safeguarding the birthing woman's space, keeping it an appropriate atmosphere for giving birth. Instinctively, mammals seek out places that are dark, protected, and overall safe to birth. Nurses and any other caregivers that come into a birth room with dim lights and lovely aromas instantly sense the sanctity of this space and will usually behave in a way that is very respectful. These caregivers also receive the benefit of a little aromatherapy to break up their busy workday, and who wouldn't like that?

If you are interested in learning more about aromatherapy, check out Aromatherapy and Massage for Mother and Baby by Alison England. There are some wonderful labor mist recipes here by Demetria Clark. Be sure to check out the AromaWeb!

If all you have is a hammer, everything looks like a nail

Or, if all you have is a scalpel, everything looks like a surgery.

If you follow the debate about our culture of birth, you may be wondering how two sides can see the same physiological process so differently. OBs say birth is only normal in retrospect; midwives say birth is normal, period, until proven otherwise. Are women who birth at home unusually reckless or wise? Are obstetricians lying about the potential dangers of birth, or do they see scary developments in healthy women every day? Which side is right?

Here's the problem -- both sides are right. Midwives and supporters of natural birth are absolutely correct when they say birth is normal, safe, and healthy. Obstetricians and malpractice lawyers are correct when they say things often go wrong in birth, and that it often requires constant vigilance and management. When American obstetricians and midwives talk about birth, they're talking about completely different processes. In the words of Marsden Wagner,

"[W]e do not have humanized birth in many places today. Why? Because fish can’t see the water they swim in. Birth attendants, be they doctors, midwives or nurses, who have experienced only hospital based, high interventionist, medicalized birth cannot see the profound effect their interventions are having on the birth. These hospital birth attendants have no idea what a birth looks like without all the interventions..."

Recently I came across an interesting New Yorker article. "The Score," by Atul Gawande, seeks to explain the industrialization of birth using the Apgar score as a template by which other outcomes, obstetric and otherwise, can be improved. Sounds great, right? After all, who doesn't want a practitioner who strives to be the best s/he can be?

But in practice, industrialization focuses not on being the best an individual can be, but on producing the best results from as large a group as possible.

"The question facing obstetrics was this: Is medicine a craft or an industry? If medicine is a craft, then you focus on teaching obstetricians to acquire a set of artisanal skills... But if medicine is an industry, responsible for the safest possible delivery of millions of babies each year, then the focus shifts. You seek reliability. You begin to wonder whether forty-two thousand obstetricians in the U.S. could really master all these techniques... Obstetricians decided that they needed a simpler, more predictable way to intervene when a laboring mother ran into trouble. They found it in the Cesarean section."

Basically, it's easier to teach someone to perform cesarean than to manage complications with less interventive techniques, especially since some MDs will not have the aptitude to learn those arts.

Shoulder dystocia provides a handy example in the article. He explains what it is, and lists several techniques that can be used for dealing with it, including Woods, McRoberts, Rubin, and breaking the baby's clavicles. But where is the Gaskin maneuver, a simple, extremely effective, and safe technique that simply has the mother flip over onto all fours, and which has a success rate of somewhere between 80% and 100%, depending on the study you're looking at? (For a clear and concise explanation of shoulder dystocia management techniques, see this post on The Lactivist.) Well, if you're attending a typical hospital delivery, the mother has likely had an epidural placed, and she's hooked up to various monitors, IVs, catheters, etc. In other words, even if she were capable of flipping over without serious assistance, nothing in the environment even suggests that as an option to her doctor. Apparently, it makes more sense for an obstetrician to push the baby back inside its mother and deliver it surgically (the Zavanelli maneuver) than it does to execute a simple position change. Midwives, on the other hand, are presented with a woman who may be upright, lying down, in the water, or supported in a squat by her partner, or some other variant of woman-led birthing. When the midwife is presented with shoulder dystocia, the Gaskin maneuver can be the very first thing she tries. Shoulder dystocia is shoulder dystocia... except that it's potentially very different depending on the setting and the attendant.

Gawande's article acknowledges that there is a downside to trying to regulate a human physiological process:

"And yet there’s something disquieting about the fact that childbirth is becoming so readily surgical. Some hospitals are already doing Cesarean sections in more than half of child deliveries. It is not mere nostalgia to find this disturbing. We are losing our connection to yet another natural process of life. And we are seeing the waning of the art of childbirth. The skill required to bring a child in trouble safely through a vaginal delivery, however unevenly distributed, has been nurtured over centuries. In the medical mainstream, it will soon be lost...

Against the [Apgar] score for a newborn child, the mother’s pain and blood loss and length of recovery seem to count for little. We have no score for how the mother does, beyond asking whether she lived or not—no measure to prod us to improve results for her, too."

And there we have it. Variations in the course of labor are approached in such disparate ways by different groups of practitioners that we end up with two versions of birth that barely even resemble each other. An OB who sees technocratic birth every day can't imagine why someone would want to do something so difficult and dangerous at home. She isn't wrong in her assessment that the births she attends are potentially dangerous, but she is made ignorant by her education and training. Unfortunately, mothers and babies suffer the consequences of this ignorance. If only the obstetrical community would stop taking the results of their interventions for granted as normal, and start focusing on how to make birth as normal and safe as possible.

Where does this leave us? Sadly, in our current climate I don't believe we are near reconciling the polarities of our birth culture. In my ideal world, all OBs would spend part of their internship with homebirth midwives seeing what birth can be like. In the real world, activism is vitally important, whether that takes the form of lobbying your state legislature, or simply sharing positive birth stories with every woman you meet. But for practical advice on how to have a good birth, I'll once again quote Dr. Wagner, "The best thing to do if you want a humanized birth is get the hell out of the hospital!"

I suppose we have to address Christina Aguilera

This week, Christina Aguilera told Hello! magazine that she scheduled an elective Cesarean section out of fear of vaginal birth because she'd "heard horror stories about tearing."

Rather than addressing what I consider an impertinent debate that rages on about the validity of a women's "choice" to have an elective Cesarean, I'd like to talk about what's really important here.

Such discussions are inappropriate and useless until we start talking about the fact that little girls in this country are growing up in a culture so rife with fear of normal birth that women are choosing abdominal surgery with all of its attendant risks, a five fold increase in the risk of respiratory distress syndrome for their babies, and a higher risk of placenta accreta in later pregnancies which can result in prematurity, severe hemorrhage and hysterectomy.

Until we are working to change this culture of fear, we are not giving women choices in childbirth. We cannot judge women like Christina Aguilera until we implicate society's contribution to driving choices such as these.

By the way...there are much less invasive ways of avoiding tearing during vaginal birth. Some of the main ones include: choosing a midwife for your care provider, avoiding epidural anesthesia so you have control over your pelvic floor, NOT giving birth on your back but choosing your own comfortable, upright position, and asking your midwife to provide hot compresses on the perineum as the baby is crowning. If you do tear even with these efforts, rest assured that most tears heal far more quickly than Cesarean incisions and become infected way less frequently. With appropriate suturing and care, tearing should not cause any long term issues, which is more than can be said for an elective Cesarean.

Birth plans are no substitute for...

Open and adequate communication about your needs and desires with your caregiver.

I've been mulling this one over all week, trying to pinpoint what exactly makes me so uncomfortable about ACOG stating that they encourage women to write birth plans instead of having homebirths (there are actually MANY reasons I'm uncomfortable about it...see my letter to ACOG below.)

The natural childbirth movement has raised up the Birth Plan like a revolutionary torch to reform birth in America, when in reality, Birth Plans mean quite little to birth professionals all over the country. Every childbirth author from Kitzinger to Simkin will tell expectant mothers to write one. But in all honesty, the words "birth" and "plan" really shouldn't have ever gotten mixed up with each other. Anyone who has been around birth realizes that it rarely goes as planned. Don't get me wrong, I'm not upholding the rallying cry of the "birth is an emergency" movement and saying that things often change dramatically, rapidly and drastically for the worse, rather, merely that birth is the unfolding of a process, and there are myriad different twists and turns that process can take, much of it dependent on how much unfolding is permitted to happen. Expecting the unexpected is a large part of working with birth.

My issue with Birth Plans are this: it seems that too many women put off actually discussing (or evendeciding on) their desires for birth until the time comes to present their Birth Plan. They hope to avoid verbal confrontation or resistance by showing up with a piece of paper that outlines their wishes, assuming it will be easier for the care provider to just agree to what's in writing instead of having to ask difficult questions of someone in a perceived position of authority. I know that for me personally, this is exactly what I did. I had asked questions of my care provider throughtout pregnancy and up to that point been presented with what should have been unsatisfactory, vague answers. When said care provider saw my Birth Plan, the response was less than stellar. In fact it was dismissive and sarcastic, and what inspired me to change providers and birth location at 37 weeks.

The problem with Birth Plans is that in a lot of cases, they mean virtually nothing if hospital policy is in conflict with the requested care. Too many women are writing "I want the freedom to eat and drink during labor" and "No IV unless medically necessary" without actually finding out if their hospitals even permit these practices. It's important to note here that there is practically nothing you absolutely have to consent to in the hospital, but if it is their policy, they will do what they can to get you to comply. Do you really want a fight over every item on your Birth Plan? If you are against every single policy and practice at the hospital, perhaps you should reconsider giving birth there. Just as if you are asking a homebirth midwife to perform tasks beyond her normal scope of practice, perhaps home is not the appropriate location for your birth.

Another issue that is up for interpretation is "medically necessary". Most Birth Plans start out with a paragraph that states the birthing mother will deviate from this plan if the health of her baby is in jeopardy and thus medically necessary. The mere fact that women include this paragraph illuminates clearly just how little faith our culture has in birthing women. Where exactly are these women who are putting the health and lives of their babies at risk in order to stick to the Plan? It should be assumed that women will obviously do what needs to be done in the case of a true emergency. However, instead of writing "No episiotomy unless medically necessary" or "I prefer to go into labor and avoid an induction unless medically indicated" on a Birth Plan, simply asking your care provider in what instances they perform an episiotomy or an induction yields a better and more open response. Rather than telling them how to do their job, you give them an opportunity to tell you how they practice. And regardless of what is written on your Birth Plan, that is the kind of care you are going to receive too. You owe it to yourself, and to them, to find someone whose philosophy is aligned with yours, rather than trying to change and battle for the kind of care you want from someone who doesn't offer it. Asking a highly technological OB who is quick to perform Cesareans for a non-interventive birth is no different than going to a homebirth midwife and asking to have your water broken and be induced at 39 weeks with an automatic episiotomy culminating your birth experience.

It bears repeating from a different source. Diana Korte writes in The VBAC Companion that women need to find out how their care providers generally practice because "the care you receive will be similar to what your doctor does routinely with other pregnant women in her care." Again, rather than simply coming in with a list of preferences, ask how your provider prefers to practice. This is a much more effective, open, and honest form of dialogue. Beware of anyone who says they "never" do this or that. Even the best providers use interventions, no matter how rarely, in certain circumstances. It's wonderful if your provider will agree to use intermittent vs. continous electronic fetal monitoring, but you should find out in which instances your provider feels continuous monitoring is safer and more beneficial.

What worries me about ACOG's endorsement of Birth Plans is that they could be counting on women to be taking cozy comfort in having their wishes in writing but not necessarily ever questioning their doctors in person. I hate to sound like a conspiracy theorist, but considering how condescending and paternalistic the rest of ACOG's statement on homebirths was, I'm not sure it's so far-fetched. Much of what is commonly requested on a Birth Plan has very little to do with the doctor since it often occurs long before the doctor shows up to catch the baby. A Birth Plan is not legally binding in any way. Without these important discussions with your care provider, a Birth Plan has little more value than a letter to Santa. And perhaps ACOG is banking on that.

Postpartum Comfort Pads

These soothing pads do wonders for soreness and swelling after vaginal birth! Prepare 18-24 ahead of time; this is a great early labor project!

Supplies:
Overnight/Jumbo maxi pads
Witch hazel
Lavender oil
Aloe Vera gel (this is an edible liquid, not a topical ointment, and can be found in health food stores)
Aluminum foil

Unfold each pad, and pour a little witch hazel, aloe gel and 2-3 drops of lavender onto the surface. The pad should be damp, but not soaked. Wrap each pad in foil and store them in the freezer. Witch hazel and lavender are natural astringents, so they'll help reduce swelling, and the aloe and the cold are very soothing.

In the News

Amongst its many other magical properties, breast milk contains stem cells. Try reproducing that in your factory, Similac. (Actually, just... don't.)

Another study saying that acupuncture can improve the odds of achieving pregnancy with IVF.

Men in the UK believe that contraception is the joint responsibility of both partners. Just so long as it's not inside their bodies.

Elizabeth's Anti-Eclampsia Salad

Pre-eclampsia (aka pre-eclamptic toxemia, toxemia, or pregnancy-induced hypertension) is a disorder of the liver and kidneys that affects around 5% of pregnant women. Signs include elevated blood pressure plus protein in the urine and fluid retention. (Elevated blood pressure by itself does not mean you have pre-eclampsia, and is actually normal at the end of pregnancy, along with swollen feet and ankles -- talk to your midwife if you're concerned.)

Left untreated, pre-eclampsia can cause severe headaches, problems with your kidneys and liver, and it can interfere with placental function. In extreme cases, it can lead to seizures, changing the diagnosis to eclampsia.

Causes and Risk Factors
The exact cause is unknown, but:

• Thinner-than-normal blood vessels in the placenta caused by an inappropriate reaction of the uterus to the placenta may be a factor.
• Pre-existing conditions such as diabetes, kidney disease, high blood pressure, being in your teens or over the age of 40 may also increase risk.
• The risk of pre-eclampsia is highest in a woman's first pregnancy, but if she is pregnant with a new partner, her chances are about the same as if it were her first pregnancy.

While its cause is up for debate, many midwives believe there is a very strong link between nutrition, especially adequate protein intake, and pre-eclampsia. The work of Dr. Tom Brewer focused on this link, and he recommended 80-100 grams of protein each day. And so, dear friends, here's a little something I started making during my first pregnancy. Salads are inherently flexible, and the ingredients listed below can load you up with as much as 40 grams of protein in a single meal -- good for you and your baby regardless of your feelings on the link between pre-eclampsia and protein.

Bon appetit!

Elizabeth's Anti-Eclampsia Salad
Mixed dark greens (mustard + Romaine is a good combo)
One hard-boiled egg, sliced or chopped
Cold chicken (preferred) or Quorn/Bocca chicken, sliced
1/3 cup low-fat cottage cheese
Dried cranberries (unsweetened)
Whichever fruits and veggies you like, such as carrots, bell peppers, tomatoes, avocado
Unsalted sunflower seeds
Walnuts
Dressing (I highly recommend walnut oil and a tasty vinegar)

Variations/Optional:
Leftover cooked quinoa, cous cous, or lentils
Orange slices (great for boosting iron absorption!)

More information, research and theories on pre-eclampsia.

My Baby Ate My Brain!

A new report on studies of memory function during pregnancy (and beyond) states that pregnant women were,

"significantly impaired on some, but not all, measures of memory, and, specifically, memory measures that place relatively high demands on executive cognitive control may be selectively disrupted. The same specific deficits associated with pregnancy are also observed postpartum."

Menfolk, before you start getting smug, there's more to this story. While I think every mother I know has attributed some mental lapse to "baby brain," remember that overall, motherhood makes us smarter.

Dear ACOG,

(I'm going to have to post my response to ACOG's latest statement on homebirths in several parts, because there's just so much to say. My first will be in letter format, thanking ACOG for all the good works they do.)

I am writing to thank you for your news release providing a statement on homebirths. Your honesty and complete willingness to come out and make a public assault on women's rights is refreshing. Most organizations who conduct business that undermines women do so quietly and with subtlety, whereas you put your complete inability to trust that women might actually know what's best for their body and their baby right out in the open. Bravo!

I'd also like to thank you for clearing up some misconceptions I've clearly had about the reason for the skyrocketing Cesarean rate. I thought maybe it was because most breech babies are now born by Cesarean because your members no longer have the skills necessary to assist a vaginal breech delivery, or because at least 300 hospitals in the U.S. have banned VBACs, and women who have had previous Cesarean deliveries are often being forced into another one. Or gosh, even maybe due to the fact that the vast majority of labors in the country are being either induced or augmented with Pitocin requiring continuous fetal monitoring which is notorious for raising the odds of a surgical delivery. But thanks to your statement, that the Cesarean rate is due to the "rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes", I now realize women are being surgically delivered because we're just too fat and old to do it the old fashioned way!

Thank you also for realizing that women are so brainless and negligent for their welfare and that of their baby that they will choose homebirth because it is "trendy". To me it appears the epidural seems to be more "fashionable" since 80% of women now opt for such pain relief while less than 1% of women are choosing homebirth, but I'm so glad you cleared up that silly theory! I'm sure you're equally concerned about women choosing elective Cesareans because of Britney Spears and Posh Spice. You know, especially since babies born via planned repeat Cesarean have a 4 times greater risk of respiratory distress. Especially since even women having their first Cesarean double their chances of having a peripartum hysterectomy, while women on their second or third have an 18 times greater risk. But I'm sure you're on top of that, and what can you do if women are just choosing to have them, right? And it's not like you can just make your OB's perform VBACs, right?

I'm glad you've clarified your position on Birth Plans. I'm sure now your members will start taking them seriously. Because you know, before this statement, a lot of OB's were reacting to Birth Plans with reactions from ridicule to outright rage. I'm sure the news will also trickle down to those OB's who pressure hospital childbirth educators not to teach pregnant couples about Birth Plans.

Lastly, I want to thank you for being so clear and open on just how important you think "the birth process" is. Selfish is the woman who dares not to let the birth process unfold just how her OB actively manages it. Ignorant is the woman who expects something out of it besides a scar and a healthy baby. The homebirth movement must include all the women who don't have that incredibly powerful instinct to protect their unborn baby the second they find out they are pregnant.

Thank you, ACOG, for exposing yourself and women for what they are. I hope you can continue to undermine women's rights in an open forum, because trust me, more women need to realize what ACOG is all about.

Fondly,
Amie

Anger Towards ACOG

I'm trying not to be angry about ACOG's (The American College of Obstetricians and Gynecologists) latest statement on home birth. I'm hoping Amie will weigh in here with some of her eloquence and humor, but in the meantime, a few quick excerpts and responses...

The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies.

This reminds me of the OB in The Business of Being Born who said her problem with home birth was, "What about monitoring? Do they do fetal monitoring?" In other words, ignorance of what midwives actually do at a home birth. And which complications are they concerned with, exactly? The medical community tends to use that ominous word without delving into what they mean by it. (They also like to say, "If you'd seen what I've seen...") Midwives are highly trained professionals who know how to deal with (rare) emergencies, and who will, if necessary, transport care to a hospital setting.

ACOG acknowledges a woman's right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births.

So, basically ACOG doesn't support women's rights to make informed decisions regarding her delivery and choice of provider.

Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre.

Because .5% of birth represents a fashionable trend. But I think really this is a dig at Rikki Lake.

Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it...Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice...

If ACOG is so interested in reducing the number of cesareans, then WHY do they keep harping on cesarean by "maternal request"? (See this great pdf from the Lamaze Institute for an excellent summary of the issue and references.) Especially when you consider the fact that most women aren't actually requesting them?

It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.

And the BMJ study is what, chopped liver? I love how they use the term "lay midwife," to imply someone with little or no training. It takes time to prep an OR, even if you're in the hospital. Cesarean doesn't just happen by magic. Often a homebirth transport patient can have a cesarean as quickly as a patient in the hospital, since her midwife (a highly trained, competent professional) can alert the hospital to their impending arrival and need.

ACOG encourages all pregnant women to get prenatal care and to make a birth plan.

No one in the hospital will read your birthplan, but it's nice to know ACOG supports us having them! Oh, and midwives provide excellent prenatal (and postpartum!) care.

The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.

Wait, homebirthers don't care about healthy babies?! I chose a home delivery the second time around largely because I felt it was safer than the hospital. But the second line is what I really want to address. The "process" is important. The "process" can be magical, empowering, and beautiful. The "process" can give birth to a stronger woman, can lead to a more satisfying breastfeeding relationship, and can make bonding so instant and intense that the mother won't hesitate to advocate for her child for the rest of its life. The "process" can also belittle, abuse, and devastate both mother and baby. If ACOG doesn't see the value in birth itself, then all the rest of this is beside the point. ACOG just doesn't get it.

Celebrity Homebirth

The wife of John McGinley, one of the actors from Scrubs, just gave birth to their baby girl at home. It's nice that the coverage of the happy news has been matter-of-fact and positive. In a celebrity-obsessed culture, we need some good folks like this to balance out the scheduled c-sections.

While waiting for a haircut appointment a few years ago, I came across an article written by Thandie Newton about her wonderful home birth in the Oprah magazine. I can't find the full text online, but here's a snippet:

"It just seemed obvious: I didn't want the conventional picture of a woman on her back with doctors urging her to push. In fact, I didn't want my experience to be controlled by anyone other than me... I knew I needed to be in a place that I identified with trust and safety, and in my home I could be whatever I wanted to be, whenever I wanted... [W]ith a healthy pregnancy, I knew who the expert was: me."

Who else is birthing at home? Can they make this the latest cool thing to do? Dior birth tubs, anyone?

How to Make a Placenta Print

When your placenta has finished the work of nourishing and protecting a baby, this multi-talented organ can also make some lovely art! Placenta prints make a wonderful keepsake for the baby book, or you can frame it and have fun watching your friends wonder just how that pretty tree-like art was made. This is a really nice project to do with a friend/doula/midwife in the first couple of days after birth, and is a natural opportunity to reflect on your birth experience. Try not to wait more than about three days, though -- print quality will suffer as the placenta starts to deteriorate.

What you'll need:

• Any decent acid-free art paper will do. Watercolor paper can be especially nice.
• Ink -- acid-free stamp pads are perfect for this kind of project. Buy several colors; some will "take" or look better than others. Green and purple are my personal favorites.
• A fresh placenta, obviously. Ask your midwife to wrap it up and put it in the fridge after the birth.
• Latex gloves (optional). Otherwise, towels to wipe those messy hands!

Step One: Lay the placenta out on a flat surface (cord-side up) and cover it with ink:


Step Two: Press your paper down on top of the inky placenta:


Step Three: Carefully pull up your paper and admire your pretty work!


Tips & Tricks for placenta print success:

• For your first print, try using the blood that's already on the placenta (below, left).
• If your paper is big enough, you don't have to limit yourself to just one print per page. In fact, you can do one print from the maternal side, and one from the fetal side.
• And if you're artsy, consider putting down a background color first, as seen below, right.
• Expect to make at least a dozen prints to get one that you love.
  

On a quest for birthy clip art?

I suggest not starting with Microsoft. When you search "birth" on the Office clip art page, what do you think are the first 3 images that come up?


The first two are of baby Jesus in his manger. And the third?

All hail the almighty bottle, which still reigns supreme as the ultimate iconic image of all things baby.


Let it be clear that I was not expecting photos of a baby crowning, or a really groovy cartoon placenta. But a bottle? What does that have to do with giving birth, really? The bottle imagery that is so pervasive in this cultures flies in the face of everything the AAP, WHO, and UNICEF attempt to promote about breastfeeding. Here are selected quotes from each organization:


"Human milk is uniquely superior for infant feeding and is species-specific; all substitute feeding options differ markedly from it. The breastfed infant is the reference or normative model against which all alternative feeding methods must be measured with regard to growth, health, development, and all other short- and long-term outcomes."


"Breastfeeding is the ideal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family and the health care system...recommended by WHO as the perfect food for the newborn, and feeding should be initiated within the first hour after birth."


"The aim is to create an environment globally that empowers women to breastfeed exclusively for the first six months and continue to breastfeed for two years or more. This is optimal infant and young child feeding."


[emphasis mine]


It appears that the birth of a baby and the bottle should not ideally be so mixed up with each other. You can't blame Microsoft...the bottles are everywhere. On baby jammies, on nurse's scrubs, on baby cards, gift bags, decorations, children's books and everywhere in between. Both of my daughters barely even knew how to drink from a bottle as infants, and yet, they both look for bottles when it's time to feed their baby dolls. In our culture baby=bottle, despite all of the world's major health organizations striving to push breastfeeding rates higher over the years.


For Mothering magazine's take on why we need a breastfeeding culture, check out the July/August 2006 issue for a great article and discussion. Here is just a taste.


In the meantime, I propose some new clip art that makes sense.