Thursday, December 12, 2013

Fetal Personhood Is a Violation of Human Rights

Human embryo at six weeks gestational age
Human embryo at six weeks gestational age (Photo credit: Wikipedia)

Fetal personhood doesn't just affect women who choose abortion. It is a threat to all pregnant women because it puts their bodies at the mercy of medical and legal interpretation. It is based on the overwhelmingly false assumption that a pregnant woman will not make the best decisions for her unborn child. A woman and her fetus are in it together for however long the pregnancy lasts. Putting the rights of a fetus in the hands of anyone other than the pregnant woman can only serve to cause needless pain. To illustrate this point, I will share two very difficult private moments in my life that could have been made far more painful by fetal personhood.

A few years ago, I was treated for hyperthyroidism caused by autoimmunity. I didn't do so well on the medication so I didn't refill the prescription and was still trying to consider my treatment options. Unexpectedly, I turned up pregnant. I had had negative experiences with both the endocrinologist and nurse midwife I had most recently seen so I didn't know who to call for thyroid testing and treatment. I wasn't even ready to tell my husband the news when the gush of blood and tiny barely distinguishable fetus came a few days later. I cried and cried along with my husband. I blamed myself. If only my thyroid levels had been closer to normal, maybe the miscarriage wouldn't have happened (of course there's no way to say for sure that that was the reason for the loss).

 The point is I went against doctor's orders and lost a pregnancy. Under fetal personhood laws that could have easily been construed as a crime resulting in jail time and a criminal record. Think that's a far fetched notion? Just read the news.
Mississippi Could Soon Jail Women for Stillbirths, Miscarriages
Women Jailed for Miscarriages in El Salvador

The other situation was when I was in labor with my third child and having a very ugly argument with the nurse-midwife. My water broke during early labor and progress towards birth was going slow. After having suffered two traumatic (and unnecessary) pitocin augmented labors, I refused to allow pitocin, which would have restricted me to bed with IV and continuous monitor hooked up which meant no way to handle stronger contractions and the calm natural birth I was working so hard for would be gone. The nurse midwife said my baby would be born septic and die. I still refused. (Ultimately I left that hospital, but still didn't have the birth I was going for because I was given cytotec, which is also sometimes used in medical abortions. There never was any hint of infection.)

What if the nurse-midwife and staff obstetrician (who I never saw) could have gotten a legal order to protect my unborn baby by whatever means necessary? Would I have been chained to the bed? Would they have sedated me or simply let me scream in terror? Would they have rushed me to the operating room for needless major surgery? Think that would never happen. Again, read the news.

Woman Ordered by State to Submit to Hospital Confinement, Cesarean
Forced Pregnancy, Forced C-Sections

Still wondering?
Pregnant Woman Suffers. You Won't Believe Who's to Blame.
Your Body, Your Decisions – This Means You, Moms!
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Wednesday, October 2, 2013

What you should never have to expect when you're expecting: Cytotec/ Misoprostal

diclofenac sodium - misoprostol
diclofenac sodium - misoprostol (Photo credit: farlukar)
So your doctor says he's using cytotec to induce labor, or your CNM comes in your hospital room with a jagged pill piece to speed things up after you vehemently refused pitocin. From one mom to another, please don't do it. Here's why:

Cytotec works as a prostiglandin to induce labor contractions and is relatively fast, effective, and inexpensive.
Cytotec is not FDA approved for any purpose other than treatment of ulcers, and is specifically contradicted by the manufacturer for use in pregnant women.

Reality Check:
Popular (My colleagues and I use this drug all the time.) and safe (This drug has scientific studies proving that it does more good than harm.) are two very different things. Cytotec frequently causes uterine hyperstimulation. It can lead to uterine rupture or a rare amniotic fluid embolism or even neonatal brain damage. After lawsuits involving tragedies related to cytotec use, it is generally no longer used in VBAC situations because of the high risk of uterine rupture.

What is the risk of uterine rupture when using cytotec in someone (like me) who has not ever had a c-section? I was shocked to find out that nobody really knows for sure if the risk is that much lower. Just because your care provider has not witnessed a serious complication doesn't mean it couldn't happen to you. The scary reality is that once cytotec is given it can't be stopped. You can be given another medicine to slow down contractions, but this is rarely done.

I was lucky. My baby was born quickly before the cytotec induced nightmarish pain caused a complete uterine rupture, but I did have the warning signs of a small uterine tear starting. It is so absolutely unnecessary to take that chance. If you absolutely cannot avoid induction, consider alternatives such as the foley balloon catheter or even cervadil.
American Journal of Obstetrics & Gynacology: A randomized trial of preinduction cervical ripening: dinoprostone vaginal insert versus double-balloon catheter 
If all else fails, pitocin is still safer so long as you make sure it is turned off at the first sign of uterine hyperstimulation (once again this is defined as more than 5 contractions in 10 minutes or less than 1 minute between contractions).  

Need more evidence?
Consortium for the Evidence-based practice of Obstetrics: Information on the off Label use of ulcer drug Cytotec / misoprostal to induce labor

Need even more evidence? Read Born in the USA
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Monday, September 30, 2013

What You Shouldn't Have to Expect When You're Expecting 1: Pit to Distress

chemical structure of oxytocin with labeled am...
chemical structure of oxytocin with labeled amino acids (Photo credit: Wikipedia)
So you're expecting a baby and for whatever reason your care provider has chosen to give you pitocin/synthetic oxytocin to start or speed up labor.

This medication goes through an IV so it can be carefully controlled. The goal is to have 3 moderately strong contractions during a 10 minute period of time. More than 5 contractions in 10 minutes or less than 1 minute of complete uterine relaxation between contractions constitutes a serious adverse reaction and should automatically result in pitocin being stopped. It may be okay to have it restarted at a lower dose if patient and care provider agree to do so.

Now for the very disturbing reality check:
Pit to Distress

An overstimulated uterus is very common with pitocin yet extremely uncommon with natural labor primarily because the body produces natural oxytocin in short bursts and synthetic oxytocin is run through a continuous IV. Just like any other medication, people react differently. Many people (my hand waving furiously) will experience contractions without relaxation and/or contractions that are way too hard and way too fast.

To be absolutely sure the uterus experiences the much needed relaxation phase during labor, simply place a hand on the abdomen and if it remains hard instead of going completely soft after contracting it is an abnormal and very dangerous situation. Equally concerning is if there are more 5 contractions in 10 minutes and/or less than 1 minute between contractions. If this situation goes unchecked, not only will mother be in distress from unimaginable pain not associated with normal childbirth, but the unborn child will be robbed of oxygen and can become quickly distressed. Continuous monitoring may not give an accurate picture of the contraction pattern and might even miss warnings of fetal distress.

Where is the doctor? Probably not even at the hospital. Doctors and even some nurse midwives are only trained in treating the birth of a child as a medical condition, not in how to wait for nature to do its job.
What about the nurses? Don't they have orders to stop the medication in case of adverse reaction? Not necessarily. They have likely not been trained in what to expect in normal childbirth. If they do know this is abnormal, they may still be ordered to continue the pitocin.

It is up to you to demand evidence based care prior to being given any medication, and if things go wrong be prepared to demand that the medication be discontinued if you react abnormally.

Need resources to make an informed decision?
Evidence Based Birth articles for induction and augmentation

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Tuesday, September 3, 2013

Braless Confessons

Barbie Basics
Barbie Basics (Photo credit:
Yes, I did run errands this morning. No, I am not wearing a bra.

One of my earliest memories was of playing dress up with my older sister. She padded her new bra for me and everything and I paraded out of the bedroom. I remember my father's deep voice yelling my sister's full name (middle and all!) "Get your bra off your sister!" People sure get ruffled over who's wearing the "right" underwear.

I've never found bras natural or comfortable. Many people say that any discomfort in a bra just means you are wearing the wrong size, which is most likely true, but only part of the story. Bras may actually be unhealthy (Bra Free!)  .

 Maybe you can't say that bras cause breast cancer (I personally believe it's more complex than that), but there may be enough research to say that they reduce lymphatic flow through the breast tissue, which cannot be good.

Some say that it's impractical for all but the smallest breasts. I think not. I've been through most of the usual spectrum of bra sizes, from the pre-kids A cup to a D cup when breastfeeding my youngest child. My normal settled size is not extremely perky. Because I'm smaller my chest looks bigger than average. 

Yes, without a bra they move around more, and I have less cleavage. I don't have an issue with nipples showing, but I do wear a camisole or tank top. You don't necessarily have to throw all your bras away. Sometimes, you may want the illusion they create. Just don't wear them all day, every day. Go for a weekend day or go out to a movie without one (and notice how nobody notices). Work up to grocery shopping and other public bralessness.

Will bras go the way of the daily corset tied so tight that broken ribs were a real possibility? I don't know, but I hope so!
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Monday, August 26, 2013

Why I don't tell hospital birthers to "go in pushing"

IMGP1260 (Photo credit: Nico Nelson)
Yes, you should try to labor at home as long as possible before going to the hospital. But before trying to use that as your technique to have an intervention free birth (especially for those facing opposition to a VBAC), you need to recognize the inherent variability of the birth process and how hospitals may respond to it.

Good luck calculating exactly when you will be ready to push your baby into the world. If you can do that, be sure to account for traffic, unless you would rather enjoy the first stage of labor in the hospital parking lot. For a fair share of women, the second stage of labor, where they are actually pushing, doesn't last as long as a drive to the hospital. Yes, a fair number of women do get to the hospital just as they are ready to push, but it's not fair to count yourself among them except in hindsight.

Going to the hospital early in labor is just part of our natural instinct to get settled and feel safe before labor is too advanced to move. It's natural to want support and reassurance that the baby is doing well. The problem is when the hospital isn't willing to just let you wait it out. Unfortunately it doesn't matter when you arrive, you can be subject to unwanted and unnecessary intervention without informed consent, up to and including surgery.

The better option is to plan for the birth you want as early in your pregnancy as possible (or even before), and if you meet with hostility change care providers and/or birth location. Keep trying to find what you want and it's never too late to change your mind. You do not need full blown arguments during any part of your labor. In that situation, the person who's not in labor has the upper hand. No matter how it turns out, having to do battle while trying to birth a baby will color the experience. Yes, women who are actively and successfully pushing out a healthy baby can still get wheeled into the operating room against their wishes.
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Monday, August 19, 2013

What not to say to a traumatized mom

Dear friend/family member,

If you're reading this, it means you are an amazing human being who cares. You want the special mom in your life to feel better. It's painful for you to see her reliving her trauma, and like her you just wish it would stop. You've either tried to say something comforting, not known what to say, or both. I wish I could tell you the magic words, but there aren't any. However, I can tell you the two things not to say.

1. "At least you had a healthy baby."

It is wonderful to see your children grow despite a traumatic birth experience or whatever else happened along the way. I wish that was enough to keep all moms from doubting themselves. All moms who had traumatic births wonder at some point if something they did could cause even minor issues. For me, it was first when I had to fill out papers for speech therapy for my younger children and it actually asked if there were birth complications including labor over 24 hours. It comes into mind at nearly every stressed out mom moment.

A mom who was traumatized often wonders if her birth experience irreparably damaged the parent/child relationship. She almost certainly struggled to survive her child's first few weeks/months. Maybe her child did come out unscathed, but she didn't. She is dealing with mental and often physical scars as well.

Is it entirely unreasonable for her to expect to have been treated better during such a life-altering event? A healthy baby isn't all that matters. If there was not evidence based care, she was put at needless risk of complications, including death. Childbirth should not be like a war zone with mom practically needing a real gun to enforce her right to say what others can and cannot do to her body. It's way too common for moms to experience symptoms like those who have experienced war and gunfire because birth is treated like a battle and the mother is a lowly soldier expected to take orders (even if those orders violate her instincts or deeply held personal beliefs). In truth, birth is a natural process meant to leave the mother physically and mentally strong enough to care for her child and possibly have more in the future.   

Birth is a deeply emotional and even spiritual experience, not just a physical event. When well meaning people remind the traumatized mom to notice her healthy child, all she hears is "Your experience doesn't matter." Acknowledge that her experience obviously matters if it's still affecting her.

Traumatized moms are already very angry at themselves for not being able to deal with it alone. Talking to you about their trauma isn't any easier for them than it is for you. They aren't trying to dump on you nor are they asking you to solve anything. It is a process that they're trying to find their way through. Lack of support contributed to their trauma so every time someone isn't supportive they relive the trauma of going through something as difficult and life changing as childbirth thinking nobody cares. Even if you can't listen at that moment, remind them that you do care.

2. "Some women have more tolerance for pain." (or any other variation of the idea that some women just can't give birth in whatever way allows them to feel good about themselves)

Short of laughing and saying "I knew you couldn't handle it." (Yes, someone actually did that to me after the birth of my first child.) there is nothing worse to say to a traumatized mom. What you're probably trying to say is that everyone is different and we shouldn't all be held to the same standard, but what the traumatized mom hears is "You're a failure at birthing your children. Your mind/body aren't as good as those moms who had a drug-free birth."

It is very true that experiences vary widely. Some women experience a short labor with little pain while others have a long labor with a lot of pain. It's not a crime to prefer medication during childbirth, nor is it a crime to want no interference in a completely natural birth. Many women experience trauma when they expected medical pain relief and didn't get it or it didn't work. Other women wanted to experience natural childbirth but received medications that they feel they should have done without. It's the experience of feeling that a choice was made without you, or the even worse feeling that you had made a firm choice and it wasn't respected or supported.

The issues surrounding birth trauma are complex. For many, it was a preventable c-section or vacuum extraction. For others, it was being stuck in bed and strapped to a monitor and IV line. For me, it was having my natural labor contractions be deemed not good enough and having my body chemically forced to work harder (it felt more like a violent poisoning than birthing a baby) without me being given the option to just wait it out.

Moms need to feel a sense of joy and pride after the birth of a child so that they can give their best to their family and to society. When a mom feels so beaten down by the experience that she wonders if she will ever get up, the whole world is just a little more broken. No one person can fix it, but a single kindness can put one person in the right direction for a moment. That's all that's needed. Other moments may come when that one needs you again, but if you just take this moment and find a way to let it pass without judgement or anger (and not reminding her that she really should just pull herself together because she already knows that and will do it as soon as possible).

 A traumatized mom has this unshakable thought that birth is a right of passage/test and she failed/flunked. Rationally, we all know it's not a contest. Rationally, we all know that our lives must go on after the birth of a child, and no matter how difficult the birth was it's over and we never have to go through that experience again (if we have another child it can be handled differently). Still, there is the shaky sensation, maybe within the very nerve fibers connecting our minds and bodies, that something is very very wrong. Somebody stole something, but it can't be seen so no one can see how valuable it is. We can't find it and take it back, except when we can. When our true stories are acknowledged and retold, we are taking that very special sacred story about how much kinder and gentler birth can be and giving it to the future. Maybe you feel like you aren't doing anything but hearing her angry words and watching the tears fall from her eyes, but really you are making the experience of birth more humane, not just for her, but for all humankind.
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Saturday, August 17, 2013

VBAC is a human right!

Excuse my language but the sh** happening to moms searching for birth options after they have had a c-section is an amazing landslide. Providers say everything from "we'll see" to flat out "no way." Hospitals have flat out bans that lead to moms being wheeled into surgery against their will. Even more disturbing is excess charges for VBAC, frequently an HOURLY fee (let the stressful ugliness of that scenerio sink in), not covered by insurance just so a doctor will actually stick around and wait out your labor at the hospital in case of emergency. How effective is that in discouraging VBAC?

 It has nothing to do with the actual risk of allowing a birth to occur vaginally with a previous uterine scar.  The risk of uterine rupture that is waved in these mom's faces is actually .5-1%.(See VBAC facts). In fact, c-sections carry greater risk, the most common being infection, blood loss, and blood clots in the mother and breathing difficulties in the newborn.Yet, moms are being refused the right to let nature dictate their birth and face forced needless intervention.

I feel your pain. It is your body and it should be your choice which risks to take, and you should be able to go to any hospital and have evidence-based care and that includes VBAC. Unfortunately, in today's climate you might need to consider a joyful and safe homebirth with a trained attendant even if that would be your last choice (It is possible, even if that trained attendant cannot yet attain legal status where you live). It once seemed crazy to me too, but I'm also a mom not eligible for a natural hospital birth due to misinformation and hospital protocols. Now, I'm becoming a midwife to give women out-of-hospital birth options.

Friday, July 26, 2013

The Beautiful Moments of Birth

birth (Photo credit: j.cliss)

Even within the most traumatic of birth experiences, there are joyful moments. I write this list for everyone who, like me, came out of a birth experience feeling less than, and as a reminder that childbirth is not all bad. This is dedicated to my children who made me who I am.

1st birth

Rocking in my grandfather's rocking chair in dark silence moving with the natural rhythm of my body's labor.

Pacing in my grandparent's front yard. Taking in openness. My grandmother's calm reminder that everything was okay after a little admonishment about being outside in the middle of the night (she didn't make me come inside).

Not once did anyone ever mention epidural. (I had meds but nothing that actually took away the pain. It was bad, but also good.)

Lying in the hospital bed in the dark, pain suddenly became bliss as my my body gently nudged my baby out of my body. For once, I was free of all thoughts, including any realization of what was happening. I felt powerful and animal-like with no concept of time or emotion. (The nurse that unfortunately walked in on the scene may have thought I was asleep until she saw my baby's head or maybe I was making noise that caused her to turn on the light. I really wouldn't know:)

My newborn daughter was sat on a pillow on my lap (I was too shaky to hold her). She had been shrieking frantically, but then she latched onto my breast all by herself and was quiet.

A few hours later, I was able to hold her and talk to her.

2nd birth

Alternating between pacing and lying on the floor in an overheated little apartment.

Sitting in the hospital bed drinking grape juice with my toddler daughter at my feet (waiting for a relative to pick her up).

Laughing when my son peed on the nurse attempting to put his first diaper on him.

Finally being left alone to hold my son.

3rd birth

Making love with my husband for closeness and pleasure (Knowing he'd probably have said no if I had told him that I had had contractions all afternoon.)

Pacing the floor by myself all night. (I thought about my husband needing to rest, but really wasn't concerned about the marathon I was running in my living room.) I ate yogurt and popsicles. With nobody bothering me or giving me reasons to be concerned, I wasn't feeling bothered or concerned.

Drinking tea and my husband feeding me a few bites of chocolate silk pie even though the nurse-midwife said I shouldn't have it.

In the hospital, on hands and knees on the bed while leaning on my husband. I felt my baby moving a lot so I knew she was doing just fine. (She was probably trying to get into a better position for birth, but not much luck.)

Being asked if I wanted an epidural, and honestly being able to say no. I didn't need labor to be faster or painless. I trusted my body even when the nurse-midwife didn't.

Finally, curled up behind my husband, napping between contractions a few minutes at a time. (Unfortunately, this only happened after leaving the hospital against medical advice and the cytotec induced contractions were abnormal and dangerous, but naps are absolutely essential during a long labor. After two nights with labor pain and no sleep, staying awake just to be harassed in the hospital was not an option.)

My husband laying our new little daughter beside me so I could cuddle and nurse her.


Notice that not all of these moments were without pain, but the joy far exceeded any pain.

Many women, like me, don't want constant attention during labor. Gentle support and a few reminders are sometimes all that is necessary.

With my last baby, I drank a lot of fluids and ate a little during labor, and vehemently refused pitocin and pain meds until the last hour (had I known I was that close I could have continued to refuse, but nobody knew or they probably would have said it was too late for an epidural). This was the only birth experience where I didn't vomit and dry heave violently.

I was seriously hoping for that urge to clean house some women speak of having before a baby is born. No such luck. The pacing was far different than the normal walk I might take for nervousness or to think. It was very mindless. (Because I was worn out, the hospital should have insisted I nap (even if it took a small amount of meds) rather than trying to speed things up with meds. Common sense.)

Being out of one's mind is by far the easiest way to cope with the intensity of childbirth.

Everyone is different. Everyone has different preferences and ways of being, which might change as we grow and learn.
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Tuesday, July 23, 2013

“Don't be a hero” or Why Natural Childbirth Is Not Masochistic

Tip of 16G Portex Tuohy needle and epidural ca...
Tip of 16G Portex Tuohy needle and epidural catheter tip (Photo credit: Wikipedia)

How many times do you hear the sales pitch for the epidural? “Why be in pain if you don't have to?” “Don't be a hero.”

I'm totally not into pain. I've been known to try to hide under the covers from menstrual cramps and headaches. When I was in elementary school, spanking was still common, and I assure you the fear the paddle inspired was enough to keep me from being purposefully disobedient. No piercings or tattoos for me. By all accounts, I should have been the first one in line for drugs when it came to childbirth. If birth were only physical, I would totally agree that pain medication should be standard, but the reality is that birth is also emotional and even spiritual (or at least a deeply meaningful life event).

Nobody around me cared in the least how my babies were born so long as they were healthy. Still, I just had this sense that childbirth was sacred. My mother, and billions of mothers since humanity began, experienced childbirth without pain medication. My assumption was that unless labor was very long and/or complicated I wouldn't need medication to control the pain. Had I been encouraged to rest in the middle of labor instead of given labor augmenting drugs, I would have almost certainly had three drug-free births even with long labors and two babies in a posterior position.

It is possible for most women to actually enjoy the experience of labor. It's nearly shameful to admit that anything other than actually holding your baby was enjoyable. I'm not ashamed. I enjoyed natural labor (not medically augmented labor) so much more than the numbing epidural. The epidural made me so numb that I couldn't feel my legs for several hours after or even take a deep breath. Granted, when I requested not to be numb with my last child they were able to do that, but it was still bad for me. It calmed both the physical and emotional pain I was experiencing, but it took all positive physical and emotional feeling away too.

Birth is emotional. If you take nothing else away from my musings here, remember that. A woman in labor is often not pleasant to deal with. Doctors and nurses tend to appreciate the epidural because it makes a laboring woman much easier to examine and preform routine procedures on.

If we really care so much about “unnecessary pain” why should needles be standard in childbirth? During my third labor, I complained about the huge needle they stuck in my arm for IV antibiotics. The nurse couldn't believe I was worried about a needle rather than labor. The epidural needle (which I regretfully had twice because of unnatural drug induced pain) was like an electrical shock to my spine.

Hospital birth doctors and midwives are almost always way too quick to recommend induction or augmentation of labor, but don't talk about the pain it will cause because they can always call for an epidural to alleviate the pain, then more pitocin because the epidural slows down labor.

Pain and pleasure are separated by a very fine line. It is a delicate balance. (If this makes no sense to you, ask someone experienced in the kink community, but please don't read 50 Shades of Grey.)

Very very few moms who had a drug-free birth regret the experience, even it wasn't planned that way. A whole lot of moms who experienced medicated births do regret it, even some who planned it that way.
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Friday, July 19, 2013

Breastfeeding Is Worth the Work!

English: A baby breastfeeding
English: A baby breastfeeding (Photo credit: Wikipedia)

Sore nipples. Leaky boobs. Breast pumps, pillows, and creams. Days when feeding your baby is all you get done. Hoping that the whole world isn't staring at your chest, especially when you're breastfeeding in public (or among friends and family who aren't used to nursing babies).

So why bother? You've heard that breast is best, but is it just nutritional balance?

It's life balance. You are setting up your baby's whole body for a healthy life. Your body makes exactly what your baby needs and it comes in a nice warm container! It's your time with your baby.

If you have problems or are told by a professional that you can't breastfeed, seek a second opinion. Very few medications and medical conditions actually make breastfeeding unsafe . See Find a Le Leche League leader. Breastfeeding is natural, but it doesn't always come naturally.

A natural birth experience sets you up for breastfeeding success, but many many moms breastfeed just as successfully after surgical or medicated births. Start as soon as possible after birth. If you can hold your baby immediately and postpone routines (immediate assessments can be done with your baby on you or next to you) all the better.

If things go wrong with breastfeeding, you can still keep trying. Even moms who have adopted a baby and not given birth can produce milk so anything is possible if you want to continue.

Don't let anyone tell you to stop sooner than you want to. I personally breastfed my youngest child for two years and have known other moms to nurse longer than that.

For those moms of older kids who didn't get to breastfeed, you did not fail. You are still the mom and can encourage healthy eating habits at any point in your child's life.

Always be supportive of breastfeeding moms. No giving unwanted bottles or pacifiers. No unsupportive advice, and for heavens sake no staring like it's something strange.
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Tuesday, July 16, 2013

Your Body Is Beautiful

After Baby Belly
After Baby Belly (Photo credit: tanya_little)

Your Body Is Beautiful

I can't tell you this enough to make sure you believe it. It's up to you to do that. Set aside everything you've seen and look in amazement at your individual body.

The female body is absolutely amazing! Before we are even born ourselves, our bodies are made for creation and the welcoming of new things. Babies are only part of what our bodies are made for. Those who have not had children are no less amazing. There is a constant stream of new ideas and ways of being for us to incubate and give birth to. (Men do this too, but the creative and nurturing energy is primarily feminine. But that is a more spiritual discussion than I'm going for here.)

Our bodies change, usually in fits and starts. Growing up is change enough, but puberty for girls feels really unfair. (What? Bleeding every month? Oh, you gotta be kidding.) A girl's breasts seem to come in only two sizes: “Too noticeable” or “Not noticeable enough.” Sometimes the cycles ebb and flow like a gentle tide, and sometimes it's a tsunami. Eventually, the cycles stop, as they should. The changes continue. We have subtle or less subtle weight gains and/or losses throughout our entire lives. We have a healthy sex life with someone else, or not. We have a healthy sex life with ourself, or not.

Then, there is the body that has gone through childbirth. Some are scarred from a surgical birth. Some have a little stretching. Some vaginas have a straight scar from a cut. Some have a jagged scar from a tear (as strange as this may sound, these tend to actually heal better). The stomach may be striped with stretch marks. The muscles may be stretched apart. It's hard not to be jealous of the rare body that seems to fall right back together, but you can love the body you're in. It's a gift for a short time, and there is no reason to give it anything other than love.

To prove a point, I will tell you about my body. First, there is no reason to be sorry for what I've gone through because my body is amazing. My stomach is flabby and stretch marked. The muscles are separated so that the stomach can never be flat without being cut and sewn back together, and sit-ups can in fact do more damage (I didn't know that either, but it is fact for about 15% of women). My vaginal opening was cut, torn, and stitched. Then, when my youngest child was born, the spot that was cut tore open again. At the time, I couldn't handle the thought of stitches because I had just been through way too much. So years later, a small part of my perineum (the area from the vagina to the rectum) is still open. It can cause discomfort with excess pressure. I have, usually minor, stress incontinence. I could be surgically repaired (even laser resurface the stomach), but even if I had thousands of dollars would I really want to be “fixed” in that way?

I am not broken! I am still whole. I can still make love. My body is still beautiful. Yours is too!

Some days, we feel like the door mat, but let us be the bright welcome sign in the window of life.

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Friday, July 12, 2013

Rhythm and Birth

Batuku rhythm model
Batuku rhythm model (Photo credit: Wikipedia)

Rhythm is inherent in the feminine cycle. Some women claim they could set a clock by their period. To them I can only give an envious laugh. I have done much to work with my body using herbs and am more in touch with my body every day, but I still am not in love with my feminine body. I'm hoping to get it figured out before menopause and be able to make that transition as gently as possible.

These body rhythms are essential to a normal birth. Some women's bodies go through labor with a perfect rhythm. They give birth relatively quickly. Again, all I can share with them is an envious laugh. My body went through uncoordinated but painful contractions. Labor was long and exhausting.

Birth is a complex and beautifully orchestrated process. The exact mechanisms that begin labor aren't well known. We know that the baby's placenta as well as the mother's brain release hormones that cause rhythmic uterine contractions.

It's not currently medically possible to give even a remote approximation of natural labor hormones. All that can be done is a continuous IV of synthetic oxytocin (pitocin) which is nothing like the short bursts of oxytocin a laboring woman would naturally produce.

Singing and dancing (or writing or listening to music) are known to contribute to a positive labor experience so I would have to guess that such things encourage healthy rhythm. Also, going outdoors (even birthing outdoors or near an open window) gets you more in touch with natural rhythms.
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Tuesday, July 9, 2013

How to Deal With Long Labors

Past Childbirth Scene
Past Childbirth Scene (Photo credit: nep)

First and foremost, any form of labor augmentation (medical, herbal...) is cruel punishment for an exhausted mom. If mom is exhausted, activities that stimulate labor, such as walking or nipple stimulation (or sexual activity other than gentle touching), are also inappropriate. Having been in that situation three times, I have an excess of authority to declare that. Add to that adequate medical evidence to prove that speeding up a slow labor is not the best standard of care.

A long labor is defined differently in different contexts. Generally 24 hours of labor is considered very normal for a first time mom. Progress is frequently defined by how much cervical dilation occurs in a given amount of time. It's accepted that future babies “should” come faster. Given a calm, patient birth attendant and adequate support, laboring longer isn't a problem. It becomes an issue when a nurse, doctor, or midwife insists that it is an issue. If the amniotic sac is broken the risk of infection is greater (a good reason to not break it artificially), but that situation doesn't usually become life-threatening unless mom is running a fever. Medical problems occur when the mom is not allowed to rest, becomes dehydrated, and ultimately will spill protein in the urine and suffer acidosis. Labor could stop altogether at a late stage, and that can be serious.

Long labors have a lot of causes. Sometimes it is a malpositioned baby. Many times it is stress filled emotions. Sometimes it is a combination of factors. It is rare to have an actual case of obstructed labor where the baby physiologically cannot descend and a trained midwife can rule this out.

So what should be done? Ensure the mother's comfort. Hydration and nutrition are essential. Anybody will crash if they try to run a marathon without eating and drinking lots of fluids. Emotional issues may need to be let go of. Encourage mom not to fight contractions.

Now the biggest key: Rest! Mom should have private time by herself or with her partner. No harsh lighting. No noise unless mom wants soothing music.

Sleep is like a reset button for an uncoordinated labor that isn't progressing well. Hops tincture is a recommended midwifery remedy, but anything gentle that helps mom sleep without leaving her groggy later is good (a shot of wine is okay). In hospitals, an old medical standard of care was to give a small amount of morphine through the IV to ensure complete relaxation (This would have to be safer and less traumatic than hours of hard pitocin induced contractions and an epidural). When mom wakes up, her labor pattern will almost always be normal and she can go on to birth without complication.

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Friday, July 5, 2013

Pitocin and the Evils of “Speeding Things Up” During Labor

Baby boy after birth
Baby boy after birth (Photo credit: Wikipedia)

First, I must add this caveat: Pitocin (synthetic oxytocin) can be life-saving if a woman is hemorrhaging after birth. An induction of labor can allow a healthy vaginal birth where complications make it dangerous or deadly to wait for labor to begin naturally.

Within the framework of my personal experiences, there is no room at all within my personal body for drugs to speed up childbirth. For myself, I would rather have a c-section in case of complications. I absolutely understand and respect moms who would make a different choice, but I feel that as part of informed consent there should be an offered choice between a c-section and induction. Why?

Any drugs to induce or augment labor throw everything out the window in terms of natural childbirth. They not only intensify contractions, but can totally obliterate that all important space inbetween contractions. With an unnatural forced labor there is no way for the body to keep up production of natural pain killers or any other natural reaction (and we don't know everything that the body produces in reaction to labor).

To put this in human terms, for me it was the difference between feeling like moving around and generally being an active participant in the birth process and curling up in a ball of pain too horrible for any sort of screaming or thrashing. I vomited and dry heaved violently and had to be given medication to stop it, leaving me sedated and even less capable of coping. Not everyone reacts so badly, but these are all known risks.

What I didn't really know then was that I was put at risk of hemorrhaging and other horrific deaths. Even worse, my babies were being put at risk of dying or being brain damaged.

ACOG: Study Finds Adverse Effects of Pitocin in Newborns

With my last baby I absolutely refused pitocin, but I had PROM (water broke before an active labor pattern) and the CNM (a hospital midwife who was not adhering to the midwifery standard of care) kept insisting that progress needed to be faster. After epic arguments, I, defeated and exhausted, took two doses of a drug called cytotec. I was given no info on the risks. When it finally worked, contractions were shooting pains from my scalp to my toes. I thought my back was going to break apart (posterior baby) and eventually I felt odd ripping/cutting and stinging sensations inside my lower abdomen. This was a possible small uterine tear (only a rupture with blood loss or fetal distress would be detectable).

Finally, here's what you won't hear from a doctor or pharmacist. There are emotional side effects. For me, natural labor was a balance between “sh** this f******* hurts” and “my body is amazing.” Once pitocin or cytotec took over, there was no amazement. I no longer connected what I was experiencing to the fact that I was about to meet my child. When it was finally over, I couldn't feel joy. I could care for my babies, but I wasn't excited or happy. I was angry at everyone (except my children). Something was just dead wrong inside. I felt like something inside me was missing, but there was nothing I could do except focus on my baby. The first few days of breastfeeding were difficult. It was like the colostrum (premilk) wasn't flowing (an affect of hormones unbalanced).

Granted, most women won't have quite as bad an experience, but please be aware of the physical and emotional risks of this form of tampering with labor.

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Monday, July 1, 2013

Healing Birth Trauma

The Genil river, near its birth, Sierra Nevada...
The Genil river, near its birth, Sierra Nevada, Granada Province, Spain (Photo credit: Wikipedia)

Part of my journey in becoming a midwife is healing from my own traumatic birth experiences. I have come to accept the deep anger and sadness that come with what many people are calling “birth rape.” Some people feel that calling any birth experience, no matter how violent, “rape” diminishes victims of a violent sexual crime. I think that there just isn't a word to adequately describe the crime of forcing unwanted interference on a woman during childbirth. I was coerced with lies, touched with hands and needles, and even cut (into my vagina) against my wishes. Make no mistake, it should be criminal.

I believe we have incredible creative power in life. We are not mere victims of chance. My experiences were part what my society has created collectively and part what I had created. I had a very negative attitude towards birth, especially hospital birth. I had irrational thoughts about the intentions of the hospital staff. I didn't welcome the support that was available to me (My mom wanted to be there, but I didn't want her help. I irrationally and incorrectly assumed she would only encourage me to be obedient to hospital routines.)

If you too have been disappointed or traumatized by a birth experience, your feelings are valid. Anger, guilt, and sadness are normal. It's okay to feel like you lost or missed out on something special. Acknowledging those feelings is an important part of healing. Know too that you are not alone. Other women have been there.

Find the support you weren't given during childbirth. Be as gentle with yourself as possible. You are in charge of every moment from now on. It's important that you don't let the negativity cloud your life, but that doesn't mean you forget or stop talking about what went wrong. It's important that we hear about what happened so it doesn't keep happening. There is much to learn from positive stories, but there is something to be learned from negative stories too. Some people may not want to listen, but others will hear you.

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Friday, June 28, 2013

Is Homebirth Brave?

English: Ágnes Geréb, Hungarian midwife and do...
English: Ágnes Geréb, Hungarian midwife and doctor checks the heartbeat of the fetus during labour at a homebirth. (Photo credit: Wikipedia)

Every act of motherhood is brave. Taking charge of one's own life experience is brave. We all have the ability to create our circumstances. Sometimes we just forget and let things happen to us.

Do you want to be an active participant in your baby's birth? The reality of hospital birth is that it involves a routine that may not suit you.

Some people feel that it is brave to have a homebirth because pharmaceutical pain control isn't available. For some having medication at the ready is a comfort, but it is not the only way to have a comfortable labor and birth. Pain medications commonly used during childbirth are not always effective and they do carry serious risks. Most people won't tell you how painful it is to receive an epidural or how dizzy, sick, and tired you may feel after receiving pain medications. What if you are one of those women who would actually enjoy a natural birth? What's brave about preserving your right to the birth that makes you happy?

Are you taking a big risk by having a homebirth where life-saving technology is not right at hand?
Technology commonly used in birth is a double edge sword. It lowers risks when applied to high-risk situations, but in everyday, low-risk births all of the risks inherent in the technology are there but then there are no benefits.

Pregnancy is a very good time to take charge. You are in charge of a fragile new life and your life is in a state of change. What happens to you happens to your baby. Your stress is theirs.

When all is said and done, you have to be comfortable with your birth experience.

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Tuesday, June 25, 2013

Pain in Childbirth

ThreeFigures (Photo credit: Wikipedia)

If I believed that achieving a natural childbirth without pain medication was a simple matter of pain tolerance, I wouldn't be studying to become a midwife. Why tout the physical, emotional, and spiritual benefits of natural childbirth if it's something only some women can achieve? It would be just plain mean to imply that some women are strong enough and others are not.

The bad news is that you can't talk yourself out of the pain of childbirth. It can be sharp and incredibly intense. There may be times when you can't handle it. Even if you don't scream, you will probably feel like it at some point. And no, you probably won't forget all pain the moment you see your baby.

Some natural birth advocates try to say that labor isn't painful. Contractions are just pressure waves. Painless birth is just another technique to be learned. Sorry, I'm not buying it. Self hypnosis and rhythmic breathing can be useful tools in coping, but I wouldn't trust my entire birth experience to that alone.

Now for the good news: You can do it! Seriously, your body was made to give birth. You will have breaks after every contraction. People go on and on about the pain, but they don't tell you how great you can feel during the breaks. You can talk, eat, sleep, or even be intimate with your partner if you want.

Natural childbirth may not be easy, but it is empowering. You can cope. It starts within you and with the choices you make ahead of time. The first choice you make is where you will give birth. Where would you feel most comfortable birthing? If you know you won't feel comfortable in a hospital, don't birth there. Focus on alternatives and plan to go to the hospital only in an emergency.

If you decide that the hospital is best, consider which routine interventions are most likely to cause you the most stress. If you hate needles, an IV will probably upset you during labor (duh!). It can be confining and is almost always unnecessary, and if it is necessary it can be disconnected or even removed if need be after you receive necessary antibiotics or other medicine. If your labor isn't short, you will need to have brought your own food and drink. With newer anesthetic techniques, even if you end up in surgery you won't aspirate (which is the unfounded reasoning behind starving laboring moms). Believe me, I can say from experience that if you do vomit during labor, it will be less painful if you have had light food and liquids. You need to move so being strapped to a monitor is unacceptable. Demand periodic monitoring, preferably with a handheld device. Most importantly, if you don't like pain, avoid pitocin or any other drug to induce or speed things up.
Your second consideration for making pain manageable is to decide who will support you. Don't expect your husband to be your sole support, he may become overwhelmed too. A female family member or friend who has experienced birth is ideal. If you can find a doula you are comfortable with you should add her to your support team. Don't be afraid to ask for support. Most of the moms who had a terrible natural birth experience due to pain (not because of interference) were unsupported and not encouraged to move, eat, drink, vocalize, and express emotion.

Water is a very effective means of making labor easier. Those who have had a waterbirth are overwhelmingly happy with the experience so it is worth whatever you need to do to allow that.

Learn to relax. Practice meditation.

Overall, consider your needs and make sure you are set up to have them met. Keep a positive attitude. Look at birth as a joyful transition.
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Friday, June 21, 2013

Why Birth Matters

"Birth of the Messenger" by Viktor
"Birth of the Messenger" by Viktor (Photo credit: Tony Fischer Photography)

Why Birth Matters

As long as mother and baby are healthy in the end what does it matter? That induction, c-section, episiotomy, vacuum delivery, IV, epidural, narcotic pain medicine, continuous monitor, confinement to bed, forced pushing, lying flat with feet in stirrups.... may or may not have been necessary, but it's no big deal. Why are some women getting so bent out of shape? Why are some people fighting so hard to have legal professional midwives attend them at home or in a home-like birth center? Isn't it “crazy” that some women would rather have an illegal birth attendant or no trained attendant at all rather than go to the hospital? Can't they just ask for they want in a hospital and be “safe”?

It's time for a different line of thinking. What if the whole idea that pregnancy/birth is a medical condition is wrong? What if the hospital isn't inherently a “safe” place for birth? I (along with many other midwifery students and professionals) believe that pregnancy is a normal state of being and birth is a sacred event. Birth is rarely complicated so we should work on the assumption that it will not be problematic until something tells us otherwise.

Hospitals do wonderful, life-saving things for those with serious medical problems. If a pregnant mom has a serious medical problem or an unborn baby is in distress, the hospital is the right place to be. However, there are many many things a hospital can do but usually don't to make birth as gentle as possible for those moms who need medical intervention (like the mother centered cesarean). Many people have good hospital experiences. Some people are comfortable with routines and medications. That's okay, but the rest of us need options too.
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Tuesday, June 18, 2013

I Want To Be a Midwife

A midwife measures the height of the mother's ...
A midwife measures the height of the mother's fundus at about 26 weeks to determine the probable gestational age of the fetus. (Photo credit: Wikipedia)

I Want to Be a Midwife

Why? Why now?

I have a passion for well-being. I believe in joy.

Every woman should have pregnancy, birth, and well woman care that empowers them.

Every woman's journey is different. I want to be there to preserve the sacredness of birth for individuals and society as a whole. The medical model of care is still there when wanted or needed. A big part of midwifery training is to recognize when a situation is potentially dangerous.

I didn't have empowering care. I had fear mongering. No one deserves that. Everyone should have the right to a choice. To have to choose between hospital or unassisted birth (or even a birth with an illegal attendant) is not a fair choice. I want to see the options in women's healthcare change (birth centers and legal home birth midwives) so I need to be the change I want to see.

Non-nurse midwives weren't legal in my area until very recently so it was off my radar in terms of professional options. I deeply admire those who risk their freedom to give women the option of compassionate care, but I couldn't be part of it. I was raising children and not able, ready, or confident. Now it's time for me to get the training and be not just the midwife I wish I had had, but the midwife who can adapt to any situation and be there when needed and make myself nearly invisible when not needed. It's a tall order, but I'm believing in myself. Far more importantly, I believe in women and their ability to heal themselves and to birth without routine intervention.

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