Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
First of all, thanks to all of you for your support, encouragement, birth stories and resources. It is definitely appreciated! I wish that I had time to respond to everyone's comments individually, but there are a few points that came up that I'd like to clarify:
1 - Hospital birth with a midwife is not an option for me. I think there might be one practice in Columbus that still has midwives on their staff, but I'm not willing to change practices at this point. My understanding is that if a midwife is not a part of an OB practice, she does not have hospital privileges. Feel free to correct me if I'm wrong!
2 - "Home birth" =/ "unattended birth." Whether I birth at home or in the hospital, I will be with skilled birth attendants.
3 - It's true; the vast majority of research shows that for 80-90% of women, and out-of-hospital birth with a midwife is a completely safe, if not safer, option than birth in a hospital with an OB. The trouble is, the research is based on "low-risk" births. Although I don't necessarily agree that twins automatically makes a woman "high-risk," the fact is that multiple pregnancies are considered high-risk by the medical community and researchers. Even Marsden Wagner, a HUGE proponent of midwives and out-of-hospital births, puts multiple pregnancies in the "should probably be attended by an OB in the hospital" category.
So where does that leave me? Well, since I last posted, I've had an appointment with Abby and Kelly (the midwives) and an appointment with Dr. Jenkins. I've also continued researching the topic on my own. I currently have a childbirth mini-library on my nightstand! The research has helped me become even more confident in my body's ability to birth two babies, and even more educated on common interventions, the risks and benefits, and the motivation behind them for a typical OB.
I'm lucky - I don't have a typical OB. Here are the birth preferences I gave him at our last appointment:
Birth Team: - Lee and/or Anna are a part of the birth team, and must provide consent for all interventions - The minimal number of staff required for optimal outcome should be included on the birth team
Personal Wishes: - We will photograph and/or record the babies' birth on videotape - Lee and the midwife will stay with Anna at all times - Neither baby will be separated from both Lee and Anna at any time, for any reason
Labor, assuming no complications: - Intermittent, external fetal monitoring only - No artificial rupture of membranes - Unrestricted freedom of movement - Heparin lock insertion only if necessary; attempt forearm insertion first - Unrestricted freedom to eat light foods and sip clear beverages - No pharmaceutical augmentation - Do not offer pharmaceutical pain relief unless specifically requested by Anna
Birth, assuming no complications: - Unrestricted freedom to push and birth in whatever position is comfortable at the time - No episiotomy - Immediate skin-to-skin contact with each baby; Anna will hold Baby A until labor begins for Baby B - Birth Baby B vaginally, even if in less-desirable position (posterior, breech, etc.) - Do not clamp either baby's umbilical cord until her respective placenta is delivered, and cord pulsing has ceased - Spontaneous birth of placentas (no pharmaceuticals, cord traction, etc.)
Emergencies, Complication, and Surgical Birth: - Please respect that this is not a "routine procedure" for our family - Anesthesia to be administered by a certified anesthesiologist - Regional anesthetic preferred, if time allows - Place urinary catheter after anesthesia is established - Do not strap Anna's arms down unless she proves physically unable to control them - If general anesthesia is required, type and dose to regain consciousness as quickly as possible - If baby's conditions allow, Anna or Lee will hold each baby after birth - Post-operative pain medication that allows Anna to remain alert and interact with babies - Healthy babies will accompany Anna to recovery for bonding and breastfeeding
Post-Birth Recovery: - Delay all routine procedures and examinations for at least an hour after birth - Use non-irritating eye ointment (no silver nitrate) - Administer vitamin K drops orally
The ONLY item Dr. Jenkins balked at was our desire to videotape the birth. He said, "I don't mind at all, but the hospital isn't going to allow it." I figure that's a bridge we can just cross if we come to it.
So after all that, you're probably thinking I've opted for a hospital birth, huh? Not so fast. Assuming the babies get back into vertex position (Baby A was breech and Baby B was transverse on Monday), and that I don't go into labor prior to 37 weeks, I intend on birthing at home. I do plan to continue care with both Dr. Jenkins and the midwives until I go into labor. Dr. Jenkins is completely on board with it (or well, as on board as a "conservative" OB can be). Yay!
I will say that I still have some apprehensions about birthing at home. However, I've come to realize that that's ok. If it turns out that, once I'm in labor, I don't feel confident at home, we can always transfer to the hospital. The reverse is also true, but much more difficult to accomplish. I know that sounds a little wishy-washy, but the bottom line is that I need to be where I feel the safest and most confident. Although I trust Abby and Kelly completely, there's really just no way for me to know for sure how I will feel about being at home until I'm in labor. Honestly, though, I have a very strong feeling that everything will be absolutely fine at home, and I'll get to call Dr. Jenkins a few hours later to say, "The babies are here, and everyone is great!"
Now... I just need to convince the little toads to get back into position so that my vision can become a reality!
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
I have never wished harder for the ability to see into the future in all my life. Or yearned more for some sort of guarantee... good or bad. "You will have no complications whatsoever and your babies will be absolutely healthy; go for the home birth," or "There will be trouble; birth in the hospital." Really, either one would be completely fine with me. I just wish there were some way to know, without a doubt, that I am 100% making the right decision either way. Alas, life doesn't come with guarantees.
Why am I considering a home birth? You can read the back-story here, in my personal blog (warning: it's my personal blog, so sometimes I use bad words). The short version is, because there are two in there, I'm automatically "high risk." The fact that I've had three completely healthy, normal, uncomplicated births doesn't figure into the equation. I'm high risk, and therefore there are a whole lot of interventions that are going to be recommended (I use that word lightly) the second I set foot in the hospital.
Quite a few things have happened since I made that post...
First, Lee and I met with Kathy Mitchell, the midwife that was recommended to us by several people. One friend described her perfectly: "She's not crunchy-granola, she's sort of motherly, the kind of person you wish was your mom." That's exactly how I felt as we talked with her. She was very reassuring, and given my health, history, and the fact that both babies are currently head-down, she didn't see any reason that we couldn't try for a home birth. We left feeling really good. Even Lee liked her, and that's saying a lot!
Next up, we had our consultation with the midwives at CHOICE. Lee was supposed to go with me, but Levi altered his nap schedule that day, so we opted for me going on my own, rather than contend with a very crabby boy for the entire appointment. I met with Abby and Kelly, and I adored them both. Abby is older, and very similar to Kathy. I guessed Kelly to be around my age, but she's been practicing since 1987, so she has to be at least a little older. Overall, they were both incredibly realistic. While genuinely supportive of birthing these babies at home, they also carefully outlined the possible risks associated with twins, and how the various scenarios would be handled. At one point Abby said, "I want you to understand that we are NOT 'home birth or bust.' There are times when being in the hospital is the safest option." I found that perspective to be very comforting. While I absolutely believe in my body's ability to birth twins, the bottom line is that there is more potential for risk than with a singleton. If we go with home birth, I would prefer the attendant(s) err on the side of caution. Abby and Kelly felt like a perfect fit. Before I left, I set up the next appointment, where they will do my full history. Lee will come with me to that one, so that he has a chance to get to know them as well.
Finally, I had my appointment with Dr. Jenkins yesterday. Lee was with me, which I think was really good, as we presented a united front. The discussion went... as well as it could, I suppose. I think I offended him a little bit, although I was trying to put things as delicately as possible, while still getting my point across. Going in, what I really wanted was his support of a home birth (even reluctant support would be ok), and his willingness to be a backup should a hospital delivery become necessary. I have a wonderful history with this doctor, and losing him to a home birth would disappoint me greatly.
In response to whether he would be a backup, he said "I won't like it, but I'll certainly do it." I guess I couldn't really ask for more there. We talked about the various things Dr. Ruedrich had said, and he assured me again and again: "This is your picnic... no matter what doctor is on call when you go into labor, no one will do anything to you or the babies that you don't want." He encouraged us to write down the things that are important to us, and bring it to the next appointment. Ultimately, he actually did seem glad that I was open about everything, and that we were having the discussion NOW, as opposed to when we walked into the hospital (or didn't walk into the hospital, because we'd chosen a home birth and didn't tell him). Overall, it appears there is lots of room for negotiation with Dr. Jenkins, and that's encouraging.
So now the questions tumbling around in my brain are...
If I stay with Dr. Jenkins, how much do I trust that our wishes will be honored no matter who is on call that day/night? How much do I trust that we won't have to spend my entire labor warding off interventions?
If we choose a home birth, will I be confident that the midwives will recognize potential problems early enough to transport safely to the hospital?
And the really big ones...
If we birth in the hospital, and something goes horribly wrong, would the the outcome have been different if I were at home?
If we birth at home, and something goes horribly wrong, would the outcome have been different if I were at the hospital?
If I had a guarantee that NO interventions would take place, or even be suggested, unless/until there was specific evidence to warrant it, I would absolutely give birth in the hospital.
If I had a guarantee that I would definitely get to the hospital in time if trouble should arise, I would absolutely opt for a home birth.
Unfortunately, no one is going to give me either guarantee, and I'm back to wishing for a crystal ball.
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
Some of the shots are just amazing. (Especially the wide eyed little girl leaning against her mom's belly and the very close shot of a baby nursing in mom's lap.)
These pictures make me think I need to get a really good posed shot of Emmitt nursing while he's still at it.
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
We knew that World Breastfeeding Week would bring out some folks that are none to happy with the lactivist world. We've already seen it in action this week on shows like The View, where the hosts criticized New York City's new ban on free formula in public hospitals.
If you haven't read anything that ticked you off yet this week, let me point you to a winner of an editorial over at The New York Post.
Columnist Andrea Peyser must be filling like her email inbox has been a little dusty lately. I can't think of any other reason she'd allow her name and email address to be attached to an opinion piece like this.
TAKE it from a mom. The pressure to breast-feed can make a new mother feel as if she lives in a forced-labor camp - where the uniform is half-nude.
It's getting worse.
Now the city has gone beyond propaganda. As The Post reported yesterday, it has banned free formula - the item that nourished an entire generation - from goodie bags sent home with moms at all 11 Health and Hospitals Corp.-run hospitals.
I find her choice of words..."nourished an entire generation" to be interesting.
Anyone out there know the definition of the word nourished?
Anyone?
Bueller?
According to Princeton's Wordnet site...
nourished: being provided with adequate nourishment
Hmm...let's look up a few more words, shall we?
adequate: about average; acceptable
nourish: to feed and cause to grow
So...technically...I could rewrite her statement to say formula is the food that "fed an entire generation enough to grow and be average."
Woo boy. Now there's a ringing endorsement. Call me crazy, but I actually aspire to be ABOVE average and encourage my kids to do the same.
Now, want to read the kicker? Oh, you'll really love this part.
At Metropolitan Hospital in Manhattan yesterday, the staff was giddy about the formula ban.
Breast-feeding "decreases breast and ovarian cancer in the mother. There's less postpartum depression, more bonding and less child abuse," said a pleasant "breast-feeding coordinator" named Dianne Velez.
Then, she said, "They have higher IQs! The IQs of breast-fed babies are 1 to 2 points higher."
Wow. That was enough to make this mother feel guilty for yanking the breast before my kid hit 16. But when I asked Velez for statistics, she did not have them.
"There are studies on this. We're not making things up," said Dr. Sari Kaminsky, the chief of obstetrics.
"The idea is to educate women positively about all the benefits of breast-feeding."
But renegade docs making stuff up is exactly what may be happening.
Leading Manhattan shrink Dr. Shari Lusskin has told me that "some of my colleagues believe the data is made up."
Umm....okaaaaaaaaaaay.
Let's use a shrink to tell us how all those facts and studies and bits of data about improved health due to breastfeeding are all just figments of our imagination.
Some days, I find myself amazed at what the mainstream media will print.
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
If you had your baby in a hospital, chances are pretty darn high that you headed home with a black diaper bag packed with a tiny paper guide to breastfeeding, a ton of flyers for baby stuff and a couple containers of free formula. If you had your baby where I had Elnora, you may have gone home with a garbage bag (literally) of ready-to-feed Enfamil as well.
Lactivist reader Esmerelda points out that if you plan on having your baby in a hospital in New York City, you'll be heading home with something different now...
According to the New York Post, you'll be heading home with:
...a tote bag stuffed with disposable nursing pads, a mini-cooler for breast-milk bottles, and pint-sized T-shirts for the babies that proudly declare "I eat at mom's."
(Oh, how I wish I'd got the contract on the eat at mom's shirt...LOL)
The Ban the Bags movement isn't new, but it is nice to see New York City signing on. In fact, city health officials are going beyond simply banning the free formula hand outs and are working hard to promote breastfeeding.
"Nationally, there has been a push to return to breast-feeding," said Dr. David Garry, director of obstetrics at Jacobi Hospital in The Bronx. "Human milk is still the best for newborn babies."
Jacobi made the push for 100 percent breast milk in 2005 and now says 25 percent of 2,200 babies born at the hospital each year are breast-fed.
"We are pushing to make sure all women know all the benefits of breast-feeding," Garry said.
It's important to note that any mother who requests formula will still receive it.
Not surprisingly, the formula companies aren't happy about the move...
The infant-formula industry said it supports encouraging more breast-feeding, but is opposed to banning distribution of product samples.
Duh. As if they'd dance with joy while shouting "Thank you for limiting our ability to become the brand of choice for a mom who turns to our samples in desperate frustration!"
Personally, I'm thrilled at the move. While I fully support a mother's right to receive formula for her baby the moment she asks for it, I find the act of sending formula home with every mom to be ridiculous.
Yes, you can donate the formula if you don't want to use it. I donated the free formula I accumulated after Elnora was born (I added it up, it would have fed her for more than two months). That said, study after study shows that moms who go home with those free formula samples breastfeed for shorter periods of time. No big surprise there. The formula companies aren't giving out samples to be nice, they're doing it because they have carefully researched the impact on their bottom line.
Formula is a choice that any mom can make, but any mom that chooses formula should do so knowing full well that it is not the BEST option. You wouldn't expect your cardiologist to tell you about the benefits of a diet of fresh fruit and vegetables and then send you home with a coupon for a free Big Mac Extra Value Meal on the premise of "free choice," would you? Why should pediatricians be any different when it comes to the nutritional needs of our babies?
ETA: I'm curious to hear if any readers caught The View this morning. I hear through the grapevine that they discussed the ban this morning and were quite unhappy with it. The hosts claimed that it stifles "free choice" and said the government was going "too far" to push certain ideals.
Can't say it's a huge surprise to me. Barbara Walters isn't exactly synonomous with "breastfeeding advocacy" and Elizabeth Hasslebeck is a paid spokesperson for Ultra Bright Beginnings Infant Formula.
I've checked and no transcript of the show is available yet, so I'd love to hear input from anyone who saw it.
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
There's a great video that's been put together about one of our Ohio midwives that I know many of you would enjoy watching. (Marlene, I can't belive you didn't send this to me!)
Anyway, it's beautiful and it's well worth watching.
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
Pregnant in America examines the betrayal of humanity's greatest gift--birth--by the greed of U.S. corporations. Hospitals, insurance companies and other members of the healthcare industry have all pushed aside the best care of our infants and mothers to play the power game of raking in huge profits.
His wife pregnant, first-time filmmaker Steve Buonaugurio sets out to create a film that will expose the underside of the U.S. childbirth industry and help end its neglectful exploitation of pregnancy and birth.
Pregnant in America is the controversial story of life's greatest miracle in the hands of a nation's most powerful interests.
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
I was thinking this week about my post on the lack of good information for moms that end up exclusively pumping. My biggest frustration with that wasn't just that there was a lack of information but that there seemed to be a lack of information because no one CARED about helping those moms. I could never help but shake the feeling that many people were secretly thinking "well it's nice that you're giving your kid breast milk, but you should have tried harder to make nursing work."
Now I'm well aware that that's MY issue...I'm sure it was the minority that thought that way, but I'm interested in how I see that type of attitude carry over to childbirth issues as well.
I host the Childbirth Choices Debate board over at BabyCenter and I do a lot of reading on natural childbirth, home birth and so on. While I don't know that it's intention, I see a lot of "all or nothing" attitude in that realm as well and it disappoints me.
Here's what I mean by that...
When I see a post by a mom talking about their first birth experience and how disappointing it was or I read a post from a mother that's pregnant and is running into problems with her caregiver, I'm often astounded at the response. Generally, the response boils down to "you should have a home birth, that will solve all of your problems" or "you need a midwife, that will solve all of your problems" or "plan for an unmedicated birth, that will solve all of your problems."
If a mom jumps on any of those three ideas, advice and support literally rains down on them as people share detailed information about how to get the birth they want, what studies support low-intervention birth, where to find a low-cost or even free doula and so on.
This is fantastic! I'm one of the first to ask people if they've ever considered using a midwife or having a baby at home. After all, that's how I "solved" the issues of my first birth when I wanted to make sure that they didn't happen a second time.
However, I also realize that home birth and even unmedicated birth isn't for everyone. Believe it or not, there are moms (and good ones too) that educate themselves on the risks and decide that they would like to have pain relief or that they would like their baby to be born in a hospital. No, they aren't crazy or deluded, they're just exercising their own choices. Homebirthers (myself included) spend a lot of time explaining that mom will progress much more easily in an environment where she feels comfortable. Well, guess what? Some women feel more comfortable having a baby in the hospital than they do at home. Yes, even when they know that home is just as safe.
The issue here is that once we find out a mom is planning a hospital birth and (gasp!) is using an OB instead of a midwife and (bigger gasp) might want to have the option of medical pain relief, we tend to just say "good luck" and leave it at that.
There's very little info from the educated childbirth community about how to have the BEST medicated birth possible. In other words, many childbirth advocates sort of act like if you plan to have a medicated birth, you kind of deserve whatever you get.
This bothers me. The same way that the subtle attitude against exclusively pumping from some breastfeeding moms bothered me.
So, I'd like that address that in this thread. I'd like to share some tips and suggestions for "medical mamas" on how to have the best birth possible and I hope that my readers would kick in their own suggestions. Let's go against the flow and realize that moms that choose to have pain relief during their labors also deserve to know how to avoid the problems that can come with that cascade of interventions.
My tips to medical mamas...
1.) Make sure that your health care provider is on the same page as you. Just because you plan on having an epidural doesn't mean that you want the whole intervention combo platter. Educate yourself about the various interventions and talk honestly with your doctor to find out when they use them and why they use them. Don't be afraid to switch providers to find someone that shares your philosophies of birth.
2.) Check out your hospital before the birth. Find out what their intervention rates are, what their c-section rates are, what their pre-birth and post-partum policies are. Is there an IBCLC on staff? How quickly can you have access to her? Basically, know what you're getting into and if you have a choice between hospitals, pick the one that best shares your philosophies of birth.
3.) If you plan on having medical pain relief, opt for the epidural instead of IV narcotics. While IV narcotics have the benefit of allowing you to be more mobile in labor, they carry greater risks for both you and your baby. If you do choose to have IV narcotics, find out which ones your doctor prefers to use and do your research on the possible side effects to you and the baby.
4.) Consider signing up for a natural childbirth class so that you can learn coping techniques. Even if you plan on having an epidural, the longer you can delay it, the less chance that you'll have the cascade of interventions and the less chance of harm coming to you or your baby. You may even find that the coping techniques work well enough that you don't want pain relief. Also, realize that 25% of epidurals do not give full pain relief...having some backup techniques can make that situation much more bearable.
5.) Refuse an IV until shortly before you get your epidural. Some women will labor for hours before they feel the need to have pain relief. While you do need to have your IV long enough to get some fluids before getting your epidural, you do NOT need to have it in for your entire early labor. In fact, having the IV in place can inhibit your mobility plus the longer it's in, the more fluids that will flood into your system. An overload of IV fluids can cause blood sugar issues for both you and your baby and can also cause edema which can significantly impact your breastfeeding abilities in the early days.
6.) Avoid induction unless there is a medical reason for it. Inductions carry increased risks to both mother and baby and mothers need to be aware of when the risk of baby staying in is greater than of being induced. Suspected big baby, being between 40 and 42 weeks and your doctor going on vacation are NOT medical reasons for induction. ;) If you do get induced, ask for a "long" induction using cervical ripening agents and then the absolute lowest doses of pitocin. Avoid Cytotec inductions like the plague.
7.) Try to push in an upright or side-lying position. Even if you have an epidural, most women can be assisted into upright positions that take the pressure off of their tail bone and that keep them from pushing against gravity. Pushing on your back with your knees shoved into your chest not only closes the pelvic outlet by 30%, it also greatly increases your risk of having a bad tear.
8.) Avoid an episiotomy unless baby is in distress. Episiotomies are not only unnecessary in 99.9% of moms, they also greatly increase your risk of having a third or fourth degree tear. Read up on episiotimies and make sure that your health care provider is on the same page as you and rarely does them.
9.) Get a doula. There's a common misconception that doulas are only for moms that plan to have a natural birth. While it's true that most doulas really enjoy helping a mom achieve the goal of NCB, most doula have the primary concern of helping mom have a good birth. Be honest with your doula upfront about your desire to have medical pain relief and find one that you can work with that has experience supporting medicated mothers. (As a mom that had an epidural with my first after a failed NCB attempt, I can attest that a doula would have been VERY handy.)
There are more, but that's all I've got off the top of my head. I'd also love to hear any advice from c-section moms on how to have the best c-section experience possible. Not everyone can or wants to have a natural birth at home, that doesn't mean that they don't deserve to have the best shot at a good birth.
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
No, not wannabe lactivist you goon, I already AM a lactivist. I'm sort of a wanna be LC, but not really.
So what am I talking about?
I wanna be a midwife. Oh, how I wanna be a midwife. I'm absolutely fascinated by them. I've read most books that I can get my hands on that really delve into their every day life (Peggy Vincent's Baby Catcher is my absolute favorite) and I spend a great deal of my free time hosting the Childbirth Choices board over at Baby Center where I can dig up research, brainstorm with other readers and have great conversation about childbirth with a collection of moms, nurses, childbirth educators and doulas.
Basically, I'm a childbirth nut. (You might be surprised to know that I've way more obsessed with childbirth than I am with breastfeeding...)
Last night I had the chance to go and sit in on a meeting of a few midwives and their apprentices. They asked me to come to speak about milk banking. How could their clients become donors, when might their clients NEED donor milk, how the whole setup works and so on. It was a lot of fun and I could tell they really enjoyed getting the information. I, on the other hand was fascinated by the conversation before and after my little 'talk.' The stories of the latest deliveries, interesting new clients, new research, questions on how to handle complications. Just absolutely fascinated.
If I was living another life, I think I'd go for it.
Alas, I have two small children, two jobs that I love and not near enough time in my days. Apart from not having the time to pursue midwifery, I must also admit that the idea of that job also terrifies me. While birth nearly always "goes right" there are those instances where it doesn't. The idea of being responsible for two lives and for knowing when and how to react is so daunting to me. I have enormous amounts of respect for the women (and men) that do this.
I also can't even begin to fathom the time commitment. The life of a midwife is unpredictable. You're sitting down to dinner and your phone rings. (Even if it's Christmas dinner.) Your child is about to blow out the candles on their birthday cake and your cell phone goes off. You're on your way out for your first date in months...yep, a mom is in labor. Let's not even talk about the 3am waking and the snowy drives in the middle of the night. I don't know how they do it.
And so, here I sit on the commentator sidelines. Hoping to educate, hoping to spark thought, hoping to lend support. But also staying away from any of the "real" responsibility that comes with that career choice.
So how bout you? Anyone else out there wish they could be an LC or a Midwife or a Doula or some other similar job? Am I the only one that's a wannabe? ;)
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
Lancaster Online is running a story about Diane Goslin, a Pennsylvania lay midwife that serves the Amish and Mennonite community. Goslin appeared before the state Board of Medicine on Friday to face charges for practicing medicine without a license. (Pennsylvania does not license direct entry midwives.)
From the article:
The 15-minute hearing allowed Goslin's attorney and the state to review and agree on the facts of the case. There was no testimony, and a decision is not expected for at least six months.
Goslin admits she holds no license and does not have credentials required by the state to get a midwife license, including a registered-nurse degree and a passing grade on an exam.
But the 49-year-old says she is certified to perform midwifery by North American Registry of Midwives, a certification organization which she said is recognized by 28 states, but not Pennsylvania. She also has 25 years' experience in the ancient tradition of midwifery, most often serving women in local Plain communities.
She also disputes she helped deliver a child in 2005, an event from which the accusations against her stem, saying she was "present for the birth of the child, but did not 'deliver' the child."
Goslin faces $40,000 in fines if charged.
To note, Goslin is licensed by NARM, a certification that is recognized by 28 states. (My own state of Ohio also fails to recognize or issue licenses to NARM midwives.)
The problems here are three fold...
1.) Direct entry midwives are needed within the Amish, Mennonite and even English communities. For those without insurance, the cost of a home birth generally runs less than half that of a standard vaginal hospital birth. Since home birth has been proven to be every bit as safe as hospital birth for low risk women (and to have lower morbidity rates) direct entry midwives provide a safe and cost effective way to handle birth.
From the article:
One speaker, Daniel King, an Amish father of eight from Lancaster County, said lay midwives offer those in Plain communities a less-costly option of home birth — which Goslin said typically costs $800 to $2,000 — compared with a minimum cost of $6,000 for hospital births.
"(Lay midwives) can come to our homes any time of the day or night because we have no transportation," King said. "There are high costs in hospitals, more disease in hospitals. My wife is more comfortable at home. We have no insurances.
"My wife and neighbors are afraid of what will happen to them if Diane Goslin gets shut down."
2.) Direct entry midwives are currently "alegal" in states like Pennsylvania and Ohio. That means that they're not breaking any laws when they attend births (unless they perform a medical procedure like an episiotimy, stitching a tear or administering prescription drugs) but they also risk prosecution any time someone wants to claim that even catching a baby counts as "practicing medicine." In states where lay midwifery is alegal, most midwives DO carry life saving medicines like pitocin or methargine for dealing with hemmorage knowing that if they use them to save a mom's life, their own freedom is at risk.
3.) On the other hand, when direct entry midwives are brought "into the system" by state licensing boards they are usually forced to operate under much stricter guidelines. In most states that recognize DEMs they are unable to attend breech deliveries, multiples deliveries, births before 38 and after 42 weeks and in a variety of other situations. That takes control of birth out of the hands of the mother and places it in the hands of a doctor.
Of course there's also the issue of a small number of midwives going up against the huge ACOG lobby. The last recorded figure I heard put planned, attended home births at about 0.5% of births each year. That makes for a pretty small group of supporters fighting for the right to home birth. That said, there were more than 300 supporters gathered at the courthouse in support of Goslin.
I'd encourage any Pennsylvania readers to consider contacting their local newspapers and representatives to show their support for Goslin.
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
A friend of mine is in the early stages of pregnancy right now and like many of us, finds those first few months wrought with debilitating nausea.
With my first, I has such severe nausea that I lost 15 pounds in the first three months. It wasn't until my sixth month of pregnancy that I finally began to gain weight. I threw up so often that I knew exactly which meals were the "best" both coming and going. (Note: Cheese curls liquify when they reach your stomach...do NOT eat an entire bag just because you crave them because it is more than a little unsettling to throw up florescent orange liquid.) I spoke with my OB about this problem many times and was simply told that it would pass and to try to keep down as much as I could.
Gee. Thanks Mr. MD, you went to school for how many years to learn that?
With my second pregnancy, I switched to midwife care. In my first phone conversation with my midwife (to setup an appointment) she asked how I was feeling. I mentioned the horrific day and night nausea and gave a brief bit of info on my first pregnancy.
"Protein," she replied.
"Huh?" I said.
"Protein."
She explained to me that pregnancy wreaks havoc on not only your hormones, but also on your appetite, which we all know. Since many moms will often feel a little nauseated and then start cutting back food, they start to experience highs and lows in their blood sugar. Anyone that has dealt with hypo or hyperglycemia knows that dramatic blood sugar swings can make you instantly nauseous.
Now, what do we do when we get nauseated? We eat simple carbohydrates, because they are bland. We avoid complex carbohydrates and foods rich in protein because they are "heavy." Unfortunately, simple carbohydrates are quickly turned into blood sugar in your system and cause dramatic spikes (and then drops) in your blood sugar levels. Complex carbohydrates, high fiber foods and proteins process more slowly and help keep blood sugar levels more stable which helps alleviate nausea.
My midwife's suggestion? 100 grams of protein a day.
It's daunting...finding and eating that much protein, especially if you have a pregnancy induced aversion to meat. I tried it though...reading labels, calculating what foods I could eat for the most protein packing punch, and taking small containers of high-protein drinkable yogurts to bed with me for a middle of the night protein boost.
You know...it works. At least it did for me and it's working right now for my friend. It's also worth nothing that there's speculation and some studies that imply that high protein diets can make Pre-E, HEELP syndrom and some other pregnacy problems less common.
I found that on the days I hit at least 80 grams of protein I had almost no nausea. On the days that I slacked off, I felt like dying.
So what are some high protein foods that make a good fit for this pregnancy diet?
Chicken or Turkey (about 40 grams in one cup) Fish (30-35 grams per fillet for most types of fish) Pork and Beef (25-27 grams per 3 oz serving) Cottage Cheese (30 grams per cup) Soybeans (28 grams per cup) Couscous (22 grams per cup) Baked beans (17 grams per cup) Long grain white rice (13 grams per cup) Lima Beans (12 grams per cup) Yogurt (8-12 grams per cup) Trail Mix (10 grams per half cup) Cow's Milk (8 grams per cup)
There's obviously a ton of other stuff, but if you get creative, it's pretty easy to hit. I'd often have a hard boiled egg or a drinkable yogurt in the middle of the night. For breakfast I might have eggs, toast and fruit. Lunch? A PBJ sandwich on high protein bread, a glass of milk and some veggies. Dinner? Meat, a high protein veggie, and a complex carbohydrate.
I'd keep trail mix, granola, almonds, peanuts and such around as snacks. It was amazing to see that if some nausea started to creep up on me and I'd simply eat a handful of nuts or drink a glass of milk that things would seem to level back out. I did try those high protein "candy" bars a few times but found them almost impossible to eat. I suppose you could also mix protein powder into a fruit smoothie or something else as well, but I was aiming to get my protein from 'whole foods' whenever possible.
So I'm curious...did anyone else's doctor or midwife stress the 100 grams of protein a day to them? I seem to hear it a lot from women who used midwives but not so much from people who used OBs.
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
Micky over at MochaMilk has a must-read post on her site about Depo Provera. Now I'm not a fan of hormonal birth control (in fact, I blame it for my own fertility problems) but her blog post made me even more upset at the ways these products are being promoted.
Micky's post covers a pretty broad spectrum. From the impact of Depo on a mother's milk supply to the use of it on inner city single mothers without their knowledge, you'll likely find yourself more than a little ticked off after you've read it.
Here's a sample of what she has to say:
Lactation consultants will tell you story after story of mothers who struggle to bring in any milk supply at all after receiving an injection of Depo Provera. Even worse, how many mothers now think this is one more way that their body doesn't work; they could not produce milk for their baby. Yet, it didn't have to be that way.
Do doctors know they are sabotaging their patients? Do they care?
It gets worse...
I have heard time and time again of it being given with and without consent to black mothers (some young, some low income, some not) in the hospital. Apparently some doctors are so concerned that these potentially "non-compliant" patients will either skip the 6 weeks appointment or come back pregnant that they are willing to trample on their right to make an informed decision (especially one they may not agree with).
Anyone else as incensed about this as I am? Now long-time Lactivist readers already know my opinion of obstetrics as a whole (if not, just read the childbirth related posts here on the blog) but this just....arg...it just ticks me off. It's one thing to coerce a mother into a bad birth experience for the convenience of the doctor, it's a whole other thing to take away a mother's fertility without her knowledge and to put her ability to breastfeed at risk. It reeks of the days when moms were given shots in the hospital to "dry up their milk" because doctors believed that formula was so much better than breastmilk.
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
I'm back from Thanksgiving and will be up and posting again later today. (Down with a cold right now though, so we'll see how I'm feeling.)
Lots of content coming up this week...a roundup of news on the Delta Nurse-in, two product reviews and some insight on how important it is to normalize breastfeeding in your own little niches...
For now, just had to stop for a quick post with a link to a shirt that I just bought for Emmitt on CafePress.
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
I never knew how it came about or why, but it's kind of a neat story and the article has some interesting commentary...
Throughout her career, the work she loved most was providing anesthesia for child deliveries. But she was appalled by the poor care that many newborns received. Babies who were born malformed or too small or just blue and not breathing well were listed as stillborn, placed out of sight, and left to die. They were believed to be too sick to live. Apgar believed otherwise, but she had no authority to challenge the conventions. She was not an obstetrician, and she was a female in a male world. So she took a less direct, but ultimately more powerful, approach: she devised a score.
The score was published in 1953, and it transformed child delivery. It turned an intangible and impressionistic clinical concept—the condition of a newly born baby—into a number that people could collect and compare. Using it required observation and documentation of the true condition of every baby. Moreover, even if only because doctors are competitive, it drove them to want to produce better scores—and therefore better outcomes—for the newborns they delivered.
It also has some sharp criticism of the Obstetrics model...
Ask most research physicians how a profession can advance, and they will talk about the model of “evidence-based medicine”—the idea that nothing ought to be introduced into practice unless it has been properly tested and proved effective by research centers, preferably through a double-blind, randomized controlled trial. But, in a 1978 ranking of medical specialties according to their use of hard evidence from randomized clinical trials, obstetrics came in last. Obstetricians did few randomized trials, and when they did they ignored the results.
And shares why the Apgar Score, which originally helped improve results, eventually led to a common problem with the profession...way too many c-sections...
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—the Woods corkscrew maneuver for the baby with a shoulder stuck, the Lovset maneuver for the breech baby, the feel of a forceps for a baby whose head is too big. You do research to find new techniques. You accept that things will not always work out in everyone’s hands.
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. You notice the steady reports of terrible forceps injuries to babies and mothers, despite the training that clinicians have received. After Apgar, 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.
This procedure, once a rarity, is now commonplace. Whereas before obstetricians learned one technique for a foot dangling out, another for a breech with its arms above its head, yet another for a baby with its head jammed inside the pelvis, all tricky in their own individual ways, now the solution is the same almost regardless of the problem: the C-section. Every obstetrician today is comfortable doing a C-section. The procedure is performed with impressive consistency.
Finally, a few other interesting and sometimes scary passages...
A measure of how safe Cesareans have become is that there is ferocious but genuine debate about whether a mother in the thirty-ninth week of pregnancy with no special risks should be offered a Cesarean delivery as an alternative to waiting for labor. The idea seems the worst kind of hubris. How could a Cesarean delivery be considered without even trying a natural one? Surgeons don’t suggest that healthy people should get their appendixes taken out or that artificial hips might be stronger than the standard-issue ones. Our complication rates for even simple procedures remain distressingly high. Yet in the next decade or so the industrial revolution in obstetrics could make Cesarean delivery consistently safer than the birth process that evolution gave us.
and
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.
and
In a sense, there is a tyranny to the score. Against the 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. Yet this imbalance, at least, can surely be righted. If the child’s well-being can be measured, why not the mother’s, too? Indeed, we need an Apgar score for everyone who encounters medicine: the psychiatry patient, the patient on the hospital ward, the person going through an operation, and the mother in childbirth.
Interesting...all very interesting. I think the main thing that I took away from this though was the concept of vaginal birth becoming a lost art. I guess in part, I never really thought about the skill it takes to allow a vaginal delivery to progress. After all, if you don't know what's normal, you can't identify what's wrong either. The point about c-sections becoming the answer to all problems also shows the danger that we're in of being able to handle even MINOR complications of vaginal birth. How long before the medical community loses even MORE skills and the c-section rate skyrockets even further?
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
Although my official “guess date” was October 1st, we’d figured all along that this baby would show up several days late like his sister did. (In fact, I’d told most everyone that I expected him to arrive on October 4th, simply because we really wanted to see the season premier of Lost.) Apparently Emmitt had other plans though as he decided to show up a little bit early. That said, he managed to fulfill just about everyone’s wishes and requests for birth timing, so we’ll forgive him.
Wednesday evening after getting Elnora to bed and watching a few hours of TV out on the porch, I noticed that Greg had fallen asleep on the futon. He looked comfy enough, so I left him be, let the dog out and headed to bed. I crawled into bed about 11:30 and set my iPod to play through my Hypnobabies scripts like I do most nights, before too long, I was sound asleep.
Around 1:30 I woke up having to go to the bathroom. I went in and sat down and immediately noticed that my back was REALLY sore. I also felt a little crampy and I remember wondering if maybe I was going to end up with a bought of diarrhea to clear my system out before the birth. I played Tetris for about five minutes on the GameBoy then headed back to bed. I put my headphones back on and went back to sleep. About 2:00 I woke up and headed to the bathroom again, a little annoyed to be woken up by my bladder again that soon. Once again, as soon as I sat down on the toilet, I started getting really crampy. At this point I was getting a little frustrated since I just wanted to get it done with and go back to sleep. So, I headed back to bed again.
This went on with me waking up every 15-20 minutes having to head to the bathroom. By about 4:30am I noticed that within a few minutes of laying down, I’d start to feel pretty crampy and really had to pee. I spent about 30 minutes in the bathroom at that point wondering if maybe the back pain was back labor and if maybe this wasn’t just diarrhea, but was actually the start of early labor. I realized that I wasn’t getting much in the way of sleep anyway, so I grabbed my iPod and headed out to the porch to sit in the recliner. I listened to the Hypnobabies for about an hour but didn’t pay much attention as it was now 5am and I could feel contractions coming on long and strong. So, I spent an hour timing them. Turns out they were a good 45-60 seconds long and about 5 minutes apart. I timed them that way for about an hour and decided at 5:45 that I wasn’t going to be able to wait until 6am to call the midwife (I was trying to let her sleep).
Greg woke up just as I was picking up the phone (he was still asleep on the futon on the porch) and asked what was up. “Having contractions” I said…”time to call the midwife.” LOL…that woke him up.
So, I talked to Becky and told her that I must have hit early labor around 1:30, but contractions didn’t get regular until about 5am. I let her know they were coming about 5 minutes apart and how long they were and that they felt pretty strong, but they didn’t hurt. (Just like waves of very light menstrual cramps at that point) Since she was about 45 minutes away, she said she’d head down shortly to check me out to see how things were going.
Greg decided at that point that it might be a good idea to start filling the pool, but wouldn’t you know it, we’d stripped the threads out on the hose adaptor when we did our test fill earlier in the week. Ugh! We debated having him head down to Meijer to buy another one, but I figured I’d just ask my friend Judy to stop on her way up instead since she was coming to keep an eye on Elnora. So, we putzed around for a bit, me listening to Hypnobabies on the iPod, Greg doing some dishes and straightening things up.
Becky arrived about 6:45 and carried her supplies in through the rain. (as an aside, I love rain, I even said to Greg on Wednesday that I’d love to have the baby on a rainy morning.) She asked how I was doing and I said that I was just getting to the point where the Hypnobabies scripts were annoying the crap out of me. She laughed and made some comment about me maybe not feeling like my cervix was a beautiful gold ring. ;) (That was the last of the Hypnobabies…never did pull the iPod out again, her voice just suddenly sounded so saccrine and annoying, I couldn’t take it.) She then asked if I wanted her to check me to see how I was progressing.
That left me wondering and I told her that my concern was that we’d find I was hardly dialated at all. That was my experience with my first birth and it was pretty demoralizing. Basically, I said if I was 2cm, I didn’t want to know, but if I was a 5 or something, that’d be great. “Well then I’ll lie!” she responded and we laughed. So, off we went to check with me hoping that a cervical check wouldn’t be as painful as it was the last time.
It was.
Good gravy, I will stand by my prior birth experience of saying that for me, a cervical check is like letting someone drive a truck through my vagina. I think it really tops the list of the most painful things I’ve ever experienced, up there with breaking bones and such.
When she finished checking, I asked if I wanted to hear the results and she laughed. “You’re about an 8 or a 9 and your bag of waters is totally bulging. If I’d break it, this baby would be here in a flash.”
“8 or 9?! You’re lying to me, aren’t you?”
“No, seriously, you really are an 8 or a 9.”
I was floored. Suddenly Hypnobabies was back on my “wow, that rocks” list. There’s not a doubt in my mind that all that prep work really did get my brain and body ready to roll and that had me experiencing what I *thought* was early labor when in reality, I was rocketing my way to complete.
At this point, I made some quick calls to my best friend (labor support), my friend Judy (Elnora support) and my in-laws (who I’d said could come up for the birth, though they were an hour away.) Everyone said they’d head out shortly…it was about 7:30am.
Feeling pretty darn confident at this point, I headed back in the kitchen to find Greg trying to setup a siphon system out of the kitchen sink to fill the pool. Becky laughed and said “I don’t know if you’re gonna have time to get it filled.” I told her I had a feeling it was still going to be a little while because I knew I hadn’t hit transition yet and we both figured if it kept Greg happy to try and solve the pool problem then it was fine with us. Besides, I figured I could always crawl in afterwards to relax. ;) I hadn’t eaten yet, so I had a bowl of Life cereal, knowing that it would probably revisit me a bit later…
Since I was close to complete, but my cervix was still very high and tilted backwards, Becky suggested that I try to spend my contractions with one leg up on a chair, leaning my weight over onto my leg. She said this often helps turn the cervix and move the baby down. So I spent about an hour doing that during contractions and we chatted and laughed in between. I remember commenting on how surreal it was to be that far in labor and to be feeling that fantastic.
By 8:30, Judy and Rachel had shown up and both were shocked to find out I was as far along as I was. (Especially Rachel who remembered me never making it past 5 in the hospital.) We put the plastic sheet on the futon, then found another old sheet to cover it with, got towels ready to go in the oven and generally organized things for the birth. Not long after, Greg had managed to get enough water into the pool that Becky suggested I try climbing in. Contractions were starting to move closer together (every 2 minutes or so) at that point and were now strong enough that I really had to concentrate through them, though they still weren’t painful.
I climbed in and immediately felt a TON of relief. That pool was just heaven! No wonder all you women love them! For the next hour, I spent time sitting in the pool, leaning back against the side while Becky and Rachel rubbed my shoulders during contractions. At one point, I got on all fours and leaned over the side of the tub. I asked Rachel to snag me a trash can and she did. I was pretty nauseated, but the puke just wouldn’t come. I asked Becky if it would be “wrong of me” to make myself hurl and she laughed and said “no, go for it.” A finger down my throat later and bam, back came the Life cereal and then some. I puked my guts out for about five minutes, but immediately felt much better. Totally worth it. ;)
By that point it was a little after ten and I really felt like I should get out of the pool. Becky had suggested that I give a gentle push with the last few contractions in the pool to see how they felt and it seemed to “fit” so I got out, dried off and moved to the futon. Immediately upon getting there I realized that I was exhausted, so I pretty much collapsed into a side lying position and thought I’d try pushing that way so that I could “sleep” between pushes. The contractions were REALLY rough lying down, to the point of hurting for the first time since I went into labor. During one of them, Becky tried lifting my leg up to set it on her shoulder and I yelled that it hurt like crazy and to let go. I honestly think I would have kicked her if she hadn’t. She told me she needed to check me on the next contraction to make sure I was complete and I said “whatever” then about cried in pain when she did check. I was complete and she said again that she could break my water if I wanted her to. I was pretty worried that it would quickly move to being horribly painful if I let her, so I said no, hoping they’d break on their own.
After about ten minutes of “pushing” while laying sidways I tried all fours. That felt better, but pushing hurt…a LOT. It was sort of like hitting late transition and was the first time I started saying “I cannot do this, I’m done…no way…etc.” After ten minutes of pushing that way, I collapsed back onto my side again saying that I needed a break. Once again, Becky tried to lift my leg up and I kicked at her and shouted no. I made it halfway through a contraction on my side and SPRANG up onto all fours in what felt like about 1/10th of a second. Suddenly pushing that way felt effective.
I told Becky that if she thought it would make baby come quickly, she could break my water because I was feeling pretty exhausted and I was HATING pushing. With the next contraction, she reached in and pinched the bag and BAM…absolutely flooded the bed. I remember feeling more than an inch of warm water pooling around each of my knees. I looked down to make sure it was clear and it was. When the next contraction hit, I suddenly realized what women meant when they said they couldn’t NOT push. It felt like my body was trying to crawl forward out of my skin, though oddly, I felt all the pushing pressure in my rear. It really did feel like I was trying to squeeze out a bowling ball.
By this point, I’d been pushing for about 30 minutes and I was quite literally shaking so hard I thought I was going to vibrate the futon to pieces. I also was having trouble holding myself up. So, Greg crawled onto the futon and got on all fours in front of me so that I could rest my head and arms on his back. The next ten minutes I sort of went along for the ride as my body just did it’s thing…with lots of me thinking “holy crap, this hurts/this is hard/why am I doing this” in between contractions. Basically, I held on for dear life and hoped I wouldn’t break Greg. Finally, I felt the baby start to really move down and on the next push, I tucked in my hips, raised my shoulders so I was more upright and pushed for all I was worth. That got Emmitt down far enough that I could reach back and feel his squishy head. I felt the ring of fire and started blowing and panting and sort of tried to push from the top of my head (think exhaling through your nose instead of your mouth) instead of from my gut.
The midwife commented that he was almost there and I honestly thought she meant he’d crowned. Then she paused and said something about me moving positions and I thought “oh crap! His shoulders are stuck!!” I knew I couldn’t possibly move so I shouted “give me one more push” and went to town on the next contraction. Apparently, he had only been out to his nose when I said that, but I shot the rest of him out in one big gush on the next contraction.
Never in my life have I felt the “relief” that comes from feeling all of baby actually shoot out. Even with my first, since I had the epi, there was no comparison. It was like the biggest sigh in the entire world left my body. There wasn’t any sound at all and I remember saying “what is it?! What is it?! Greg, what is it!?” (He was looking between my legs at this point since he was still acting as my headrest, lol…) “It’s a boy!” he said. Just then, he let out a tiny little cry. Becky and Rachel got him wrapped in warm towels in a flash and I rolled over to a side that wasn’t all yucky and lay down with him on my chest. Just breathing him in and praising God that it was all done.
Absolutely beautiful, the most amazing thing I’ve ever done in my life.
About five minutes after he was born I called my mom to let her know she had a grandson, then Emmitt and I just kinda curled up for a bit while Greg went in to tell his parents. After about 20 minutes, the cord finally stopped pulsing, so Greg came to cut it and then he took Emmitt to show everyone while I sat up and took some deep breaths. Another 5 or ten minutes went by and I gave a tiny push to deliver the placenta. Becky showed us all the parts and how they examine it and how it works. (pretty cool!)
Since the pool was still warm and I hadn’t given birth in it, Becky went ahead and added her herbal bath mixture to the water and I climbed in there to relax for another 15 minutes or so. It felt fantastic, plus it helped wash away some birth gunk. ;) I climbed out, put on some old PJs and headed over to the recliner where I nursed Emmitt for the first time.
Since then, it’s pretty much been nurse Emmitt, try to eat some food and occasionally catch a few Zzzzs. I’ve only slept maybe 3 or 4 hours total, but I can’t even believe how awesome I feel. I have no hemorrhoids, no tears (just a TINY skidmark) and basically, feel absolutely fantastic. By this morning, I’d gotten up, taken a shower, washed my hair and feel like a normal person again. Emmitt nurses like a champ and I’m realizing what women mean when they say they do nothing but nurse, nurse, nurse. If he keeps at this when my milk comes in, he’ll outweigh Elnora in a month! (At 9 pounds, 7 oz, he already weighs half of what she does and she’s nearly 2)
Overall, with the exception of pushing being harder than anything I imagined (and really, pretty much sucking royally) I couldn’t have scripted a better birth. Baby came on Rachel’s day off, while it was raining, so FIL didn’t have to be in the fields farming, and when Greg was in between projects at work. I’m still floored that I basically made it to 8cm without even thinking I was in “real” labor.
I really did get the birth of my dreams. I have no complains, no regrets and I’m so thankful that we found an amazing midwife and that I had the support of so many people in taking this route. Greg and Rachel both commented after the fact that they couldn’t even believe how different (and better) this birth was than my hospital birth. The two can’t even compare.
So, one more shot of Emmitt and I taken this morning after I managed to snag a shower. ;)
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
So I'm a skeptic...a big time skeptic. I don't believe that DiDi7 is going to magically lift every stain from my wardrobe, nor do I believe that after a one hour seminar I can go home and start buying investment properties with no money down. ;) In general, I live by the adage "if it's too good to be true, it probably is."
That's why it took me a good couple of months after I first heard about Hypnobabies to go from "yeah, uh huh, pain free, whatever" to "well, it certainly couldn't hurt!"
I'd studied the Bradley method for my first birth, though only at home with a few books. We weren't able to find any Bradley classes in our area. (Ended up taking some pretty useless Lamaze classes, though it did reinforce much of what I'd told my husband about the intervention side of things...) The Bradley methods were mostly useless to me as I simply was not able to lie down at all during my labor. That said, the educational aspect of the glasses was invaluable. This time around, I already knew pretty much whatever I needed to in regards to interventions and the process itself, plus I'm having a home birth, so I don't need to worry about much of that.
Thus, it was the actual process of dealing with labor itself that I figured made Hypnobabies worth trying.
Now, to note, I never really experienced any pain in my first labor. I had back labor for about 18 or 19 hours before I eventually ended up with pitocin and an epidural, but I'd never describe my labor as painful. It was simply hard work. Kind of like pushing yourself through that "I'm gonna die" spot when you're working out. Nonetheless, I also never made it past 5cm dialation, so who knows if I ever really hit "real" labor that time.
So I ordered the home study course of Hypnobabies when I was around 20 weeks pregnant and started it at 24 weeks pregnant. Went through the course by 30 weeks, including all my practicing and everything. Then I sort of slacked off. ;) At around 33 weeks, I picked it back up again though I'm far from doing it as I'm supposed to. Basically, I burned all the scripts to my iPod and I fall asleep every night listening to them. I might remember to practice my "finger drop technique" once a week or so...and my husband has never practiced the partner scripts with me.
That means I'm hardly the test case for "will it work."
I will say that I have, on many occasions, used it to create anethesia for my heartburn and it did work amazingly well. I also find that I have an amazing peace about this birth and absolute zero fear about how it will go. I credit that to the Hypnobabies suggestions.
I bought an FM transmitter for my iPod so that I'll be able to listen to it through the stereo without having to change CDs all the time. I figure I'll give it a go and we'll see what happens. In reality, if I have a pain free birth, that's going to absolutely rock. If I don't, I'm certainly not going to be any worse off than I would have been if I didn't take the class. ;)
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
Work...have to schedule the people that are filling in for me during my maternity leave...it takes time to get 8 people scheduled. Yep...that's right, it takes 8 people to fill my shoes! (Ok, ok, so they are each filling in for one week for a total of 8 weeks leave...)
Home...my mom's headed this way on Thursday to help me actually setup a nursery, pull out baby clothes, etc... Hopefully by this weekend the baby will stand a chance at having more than just a dresser drawer and a bag of diapers to greet it.
Birth stuff...gathering up my supplies for the home birth. Planning a test run of filling up the labor pool this weekend so that we can see how long it takes, whether we can actually get the water hot and so on. I've got a fawcett adaptor, but I still need to track down a hose that I can use. Also stopped and picked up things like a fitted waterproof sheet for the futon and some waterproof pillow cases. Add in the package of Serenity pads that I bought in case my water breaks at the onset of labor again and I'm sure the checkout clerk was feeling really bad for the poor pregnant woman that must wet her bed a lot these days...
I am seeing a bit of nesting coming into play...actually cleaned today and I never do that. I just have this feeling like I have to get the bathroom and kitchen clean by early next week. The idea of birthing in a house that has a messy kitchen and bathroom just icks me out. Also had a burst of energy that led me to bake a peach pie and a peach crumble with the 1/2 peck of fresh peaches that I picked up at the farmer's market this weekend.
Having contractions pretty much all the time these days. Never had that with my first, so I'm seeing what all the "fun" is when people complain about prodomal labor or really strong Braxton-Hicks. The good news is that Hypnobabies may be working because they don't hurt in the slightest. In fact, sometimes they feel kinda good. (Like when you go over a hill and your stomach "drops" only lasting for 40 seconds or so...)
Anyway, I'm still here, just not having time to stay on top of the news. Figured I'd better post though or folks like K were going to start wondering where I was and if the baby had shown up already. ;)
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
So I know there are quite a few NCB moms that read this blog and I'd be curious to hear from the ones that either labored or delivered in water. TheSmockLady seems to be with me on the desire to labor in water, but not actually deliver in it.
Really, I hadn't thought much about a labor pool up until a week or so ago. I figured I had my shower and I could always use that if I wanted some water relief.
Then I got to thinking one day about how nice it feels to submerge in a warm tub. (Not a hot tub, I hate those, way too hot...just a warm tub.) So, I asked my midwife what she thought of the benefits of laboring in water. She said she's had clients swear by it and that she thinks it's a great idea. Most of the moms she's caught for simply used kiddie pools though, very few rented "birthing tubs."
My main issue was the heat thing. It just seemed/seems like so much work to keep a tub warm. Boiling water, running hoses from the sink, using up the hot water tank, etc... When you rent a birthing pool (like an Aqua Doula) they come with heaters so that they maintain a constant temperature. That left me thinking that I would spend the $250 to rent one.
I asked around, including on a debate board that I belong to and pretty much everyone said that with the right kiddie pool, they had NO problem keeping the water warm and they liked the pool just as much, or more, than the "birthing tub." They also pointed out that with something like an Aqua Doula, the sides are thin and hard and not so great for leaning against. With a good inflatable pool, you can hang over the side and your midwife won't lose the circulation in her arms if she's leaning in to check you. ;)
So...it was suggested that I buy this pool as it's what many of the moms had used. They say it's super comfy, deep enough and wide enough for mom or for mom and hubby.
Now I'll note, I have no desire to give birth in the water. Placenta soup and all that...ick. I see why some women like the idea, but it's just not my cup of tea. I picture giving birth, then rolling over, cuddling up with baby, letting baby latch on and falling asleep. ;) No where in that "picture" is there "wiping all the red water off of me and baby before putting on some clothes.
Feedback? Did you use a labor tub or a kiddie pool? How did you keep the water warm? Did you have problems keeping it warm? Did you want to birth in the tub and change your mind, or maybe you just wanted to labor in the tub and decided to stay put for the birth... Would love to hear from anyone else that has either labored or birthed in the water.
Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
The government is at it again…trying to achieve a worthy goal, but going about it in entirely the wrong way.
The Washington Post reports that the CDC along with the backing of groups like ACOG, March of Dimes, and the National Center on Birth Defects and Development Disabilities have decided that the best way to lower the U.S. infant mortality rate is to treat all women as “pre-pregnant.”
From the article…
Among other things, this means all women between first menstrual period and menopause should take folic acid supplements, refrain from smoking, maintain a healthy weight and keep chronic conditions such as asthma and diabetes under control. Women should also make sure all vaccinations are up-to-date and avoid contact with lead-based paints and cat feces, Biermann said. The report recommends that women stop smoking and discuss with their doctor the danger alcohol poses to a developing fetus. The article goes on to explain that since half of all pregnancies in the United States are “unplanned” and since such grave and great danger awaits the children of the women that don’t find out they are pregnant instantaneously, that we must get all women to act as if they could be pregnant at all times. The idea is that this will help lower our infant mortality rates.
Let’s look at this issue a little closer though…
The U.S. currently ranks 24th among industrialized nations when it comes to infant mortality rates. Our current rate (7/1000) is roughly three times the rate in Japan and 2.5 times higher than most of the Nordic countries. That’s obviously pitiful, especially for a country that is supposedly as medically advanced as we are. However, there are several things factoring in to play here…
1.) In the United States, there is a vast variant in the infant mortality rate between white mothers (5.7/1000) and black mothers (13.5/1000). While it may be easy to write that off as “the U.S. has a higher black population than those other countries” most studies have shown that the socio-economic factors and a lack of insurance and access to prenatal care plays a significant role in the difference between those two numbers.
2.) While Japan is a highly medicalized society (like our own), the Japanese people are, on the whole, MUCH healthier than Americans. They have lower rates of obesity, lower rates of diabetes and lower rates of many other problems that can cause moms to be high-risk and can make outcomes worse for babies.
3.) In nearly every country that is ahead of the United States in terms of infant mortality, there are two very important factors at play. (And neither one of them is “don’t clean out the litter pan.”)
a. Socialized Medicine. Now, I’m the last person to advocate giving the government more control over medical care and I’m NOT a fan of socialized medicine as it is practiced in most countries. With that in mind, it’s important to realize that in countries with socialized medicine, good pre-natal care is more readily available and good pre-natal care has a significant impact on the outcome of births. Socialized medicine also leads to my next point… b. In nearly all of these countries, birth is still treated as a natural function rather than a sickness, which means that the midwifery model of care leads the way. OBs are used only for high-risk patients. Medical interventions (like epidurals, ERCS, and pitocin) are no where near as common and home births are very common. Even among hospital studies that pit midwife attended high-risk patients against OB attended high-risk patients, midwives have significantly lower mortality and morbidity outcomes than OBs.
So what’s the solution here? Well, that’s a tough one.
Obviously I’m not going to argue that it would be a good idea to encourage women to quit smoking, to regulate alcohol consumption and to generally life a more healthy lifestyle. I mean that’s just good sense overall, not something that’s necessary just for “pre-pregnant” women.
It’s also true that this type of encouragement from health care professionals is hardly going to destroy the world or cost more money.
It’s more that this is like trying to use a bandaid to fix a severed finger. The problem needs far more response than the lip service that it’s being given.
So here’s what I’d like to see…
1.) Unique solutions to the lack of insurance for pregnant moms. There are plenty of groups out there that are setting up free medical clinics in order to provide free pre-natal care to uninsured moms. These types of clinics are often run by churches and community groups. They also provide an ideal environment for midwife apprentices and OB residents to gain experience treating women from a diverse socio-economic background. I would love to see more public and private funding for these types of centers and more encouragement for HCPs to volunteer their time in this manner.
2.) A return to evidence-based obstetrics. Unfortunately, anytime that you have apprenticeship style teaching like you do in the medical world, you have people learning from others based on habit. That means that it will take generations for new research to filter into the mainstream of medicine. So many doctors still perform episiotomies simply because that’s the way it’s always been done. This, despite new guidelines from ACOG stating that episiotomies should be reserved for emergency situations where seconds count. This also holds true for policies like NPO, routine IVs, CFM, etc…
3.) Gaining control of the med-mal environment for obstetrical practice. George Bush said it best…the malpractice insurance rates for OBs are skyrocketing out of control. This has a two-fold effect. First, it drives OBs out of practice leaving less choice for women. Second, it forces OBs to practice defensive medicine…defensive as in “will this hold up in court” rather than “is this the best decision for mom.” When malpractice insurance companies are dictating the standard of care based on what will play in court, everyone loses. Even OBs themselves are faced with the frustration of dealing with this.
4.) Education of society and insurance companies on the safety of midwife care and on the safety of home births. Study after study both in North American and abroad have shown home birth with a skilled attendant is every bit as safe for low-risk moms as hospital birth with an OB. In fact, the morbidity rates are actually LOWER for home birth. The costs are also significantly lower. A non-complicated vaginal birth in a hospital with an OB will run, on average $6000-$10000. (Add in another $1500-$2000 for an epidural) A home birth with a midwife will run anywhere from $1000-$4000, depending on the provider and the area of the country. Yet insurance companies that are more than happy to pick up the majority of the cost of a hospital birth will balk at the idea of paying for a home birth. I will be paying roughly $1800 out of pocket for my prenatal care and homebirth with a lay midwife. That’s the total cost of care. For my daughter, I paid roughly $1000 and my insurance company picked up another $7000 or so. You do the math…(from the insurance company’s point of view…)
We’ve got a long way to go folks…and simply talking all women of childbearing age into taking folic acid and avoiding the litter box isn’t going to do it.
