April is Cesarean Awareness month!

Promote Cesarean Awareness and tell a birthing family you love about ICAN and check out their fancy new website!

A friend of mine just had a baby, and the Cesarean rate of the women in her childbirth class was 57%. These were all first time moms who now have the choice between an elective Cesarean and all its attendant risks with their next births, or a VBAC which is increasingly becoming less of an option with many mainstream care providers. Mothers attempting a VBAC face the physical barriers and restrictions in place at many hospitals, as well as the emotional hurdles that come with attempting something widely regarded as "more dangerous" by the medical community and society at large. (for more information on the REAL risk comparison of VBAC vs. repeat Cesarean look here)

This problem is epidemic and it affects us all, whether we are birthing women or not. 57% of women in this class were told they couldn't birth their babies. This is startling, and wrong. It will not stop until we do something to stop it. ACOG is telling us the rising Cesarean rate is due to more overweight and older women getting pregnant and ignoring the other major issues like their own fear of litigation. It's up to us. We cannot know the possible effects that a large Cesarean rate could have on humanity at large. What we do know is that it has the potential to obliterate the confidence and feminine wisdom of an entire generation of women. Women deserve the opportunity to give birth vaginally without fear!

Pregnant women, what can you do to help reduce your risks of Cesarean? This is a short, quick and dirty list. I'll be posting more Cesarean prevention tips throughout April.

• Consider an out of hospital birth if you are healthy and low-risk. Both birth center and homebirth midwives have dramatically lower Cesarean rates than their hospital counterparts.
• Hire a doula. A doula can help you navigate the childbirth system and teach you how to ask the right questions to decide whether intervention is appropriate or not.
• Read EMPOWERING birth stories. Don't watch "A Baby Story" or shows that focus on "baby emergencies". Try both of Ina May Gaskin's books for a start. Focus on what your body is capable of instead of what can go wrong.
• Take a GOOD childbirth class. Consider an independent instructor. These classes often cost more but they are worth it because you're not going to be fed only what the hospital wants you to know. ALACE and Birthing From Within are organizations to consider.
• Turn that breech and try to prevent the odds of back labor with a well-positioned baby. This offers no guarantees against back labor, babies move throughout labor, but it's healthy to try! Do yoga, and check out Spinning Babies for more tricks and techniques for turning both breeches and posterior babies.
• Stay home until you are in ACTIVE LABOR! Simply getting to the hospital too soon skyrockets your chances of Cesarean. More on how to know "it's time" later...
• Choose your care giver wisely. Ask good questions, and expect them to give you open, honest answers. If you feel like they are being evasive, press harder. Don't put your care giver on a pedestal: you are the ULTIMATE expert on your pregnancy and baby, and they work for you. Don't be afraid to look elsewhere for answers or second opinions. TRUST is essential for a good relationship with your care provider. Another note on care providers: if your OB is known as "THE best C-section doc in town"...there is probably a reason for that. And it is more than likely because s/he performs a lot of them. Find out why.

Risk

When I'm talking about choices in birth, I've found the subject consistently turns to risk. What are the risks of home birth? What are the risks of hospital birth? What is the safest possible way to have a baby?

The fact is that risk is an inherent part of life, and birth is no exception to that. There are situations in which being in a hospital is very desirable when you're giving birth. Isn't it wonderful that we have that option, and the benefits of all modern obstetrical technology, available to us when it's needed? On the other hand, the mainstream medical community doesn't seem eager to discuss the risks of giving birth in a hospital. It's painfully ironic to me that midwives are stereotyped as superstitious women who walk around the house burning herbs and chanting, when in fact many -- if not most -- of the procedures in your typical hospital maternity ward are based on fear, ritual, and lack of evidence.

We all have to choose the risks we're comfortable with. Personally, I'll take the risks of birthing at home, over the risks of birthing in a hospital. I feel I'm much more likely to experience the risks of unnecessary interventions in a hospital than I am to face a true emergency at home. I only wish for all women to have the option to make their own choices without bullying, superstition, or manipulation.

This lovely post from Rixa at The True Face of Birth provides a great summary of the risks of VBAC and elective repeat cesarean. What a breath of fresh air! We cannot keep disrespecting women and their babies by refusing to provide them with enough information to make the right decisions for them. If a woman has had a cesarean, her next delivery carries risks -- it's insane to pretend that repeat c-sections are risk-free.

Women are empowered when they can make their own choices, not be pushed into what ACOG would like them to do. If both choices carry risk, we need to make sure that women can choose the risks they're most comfortable with. Is that really so much to ask?



PS A more specific look at some of the risks of home vs hospital birth coming... someday. I promise!

"Epidurals Are For Tolerating the Hospital, Labor Is The Easy Part"

What a great quote, from this blog entry about a mom's recent second birth.

Having a natural birth in the hospital is a huge accomplishment! Women really do deserve a trophy for it. A drug-free labor at home or in an independent birth center is (comparatively) easy.

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.

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?