Ella's Birth Day

Today is Ella's first birthday ~ Happy Birthday to Ella ~ and thanks so much to her mom and dad, Sarah and Ryan for sharing a great birth story!

My Birth Story

When Ryan and I first started trying to expand our family we had two miscarriages and it was during that time I really started thinking about what I wanted in my pregnancy and birth.  When we got pregnant the third time my ideas about birth and what I was looking for had changed drastically from before we were trying.  During my miscarriages I felt a bit looked over, unfortunately my OB went on maternity leave 2 days after my first miscarriage and didn’t return until a few weeks after my second miscarriage.  I felt like I had to press the office for answers and results and really just feeling like I was my only advocate.  It was a hard time made even harder by these feelings.  I reached out to a midwife and seriously contemplated skipping the OB all together, I loved (and still do adore) my doctor, but was hurting and scared at how much a felt like a patient and that I was not being heard.

My sister-in-law had been through the same things I had with miscarriages and had a midwife with hospital privileges for her pregnancy’s and had been singing her praises for several years.  I quickly found that there was only one midwife with hospital privileges here and to me, the hospital was a non-negotiable.  I really wanted to be in the hospital for my own piece of mind.  I think Ryan gave a sigh of relief when I assured him I would like to have our daughter in the hospital; his biggest fear was me giving birth in the canyon!

The third time I got pregnant I wasn’t expecting it and decided to give my doctor’s office one last shot.  My doctor had returned from maternity leave and having her back made all the difference. By this time my ideas for my pregnancy and birth had changed drastically, while I had once said “Give me the drugs” I was now curious about if I could have our baby without drugs.  I had become more cognizant of what I was putting in my body and was more aware of my options.  In my quest to find more information about giving birth naturally I was lucky enough to stumble upon the Bellabirthing website and immediately wanted to enroll in Sasha’s birth class. 

Needless to say once we met Sasha we loved her!  She was everything I had been looking for, she challenged my preconceived notions and allowed us to open up to the many options we had.  I never felt judged by her and she truly opened my mind and heart to choose what I wanted to do rather than what I felt like I should do and what other people wanted or expected from me.  I had not thought much about hiring a doula, it had crossed my mind once or twice after deciding I wanted to try and give birth naturally, but I had feared that having a doula would make Ryan feel left out or that it would somehow make it less between Ryan and I.  On our way home from our hospital tour Ryan asked if Sasha was accepting clients, we decided we wanted a doula, but only if it was Sasha, she was the right fit for us.  Luckily for us Sasha really needed to add a Zamboni driver on her list of clients J

No matter how many times someone told me labor isn’t like the movies I couldn’t quite process what it would be like for me.  So when the doctor told me to think of 5-1-1, contractions 5 minutes apart, 1 minute long for an hour I took it pretty literally.  I woke up the day my due date very early with what felt to me like light period cramps which had happened to me quite a bit during the last two weeks with two back to back bladder infections so I was just thinking to myself that I needed to drink some more water and not miss an antibiotic.  I was still cramping periodically though the day; I kept track a little thinking that I would practice for when I was really in labor.  Who has their baby on their due date anyway? I did think it would be a good idea to carb up that night and made pasta for dinner, just in case, but again, who has their baby on their due date?  

Sure enough I woke up a few hours after going to sleep and was having much more intense cramps.  I didn’t think I was in labor because many people explained contractions as painful and that your stomach would harden with each one.  I wasn’t having that so I just thought I would go stretch out on the ball downstairs and no need to wake up Ryan, that would just be a drag if we were both tired the next day right!?  Well stretching didn’t help me much and I really wanted to sit in the bath, so I got it going and hung out timing what I though was my very early labor contractions for something to do and to pass the time.  I must have been delusional because when I looked back at the log my contractions were on average 45 seconds long and throughout the night went from 7-5 minutes apart.   The bath helped me relax and so I decided to try and fall asleep for a bit longer in the guest room so I wouldn’t wake up Ryan with my tossing and turning.  I fell asleep for a few hours before Ryan woke me up and I went back to our room.  I slept again for about 2 hours and woke up when Ryan was getting ready for work.  It was at that point that I was in a fair bit of pain, I asked Ryan to stay home with me and not to go to work.  He agreed and suggested I eat some breakfast in case today was the day. 

Now let’s get something straight, I had watched Kourtney Kardashian give birth and she took a shower, blew out her hair and put makeup on before heading to the hospital.  This was my plan, for heaven’s sake if she can do it I should be able to right?!  Well, I asked Ryan to time my contractions so I could get in the shower.  By this time I figured this was labor, however still thought it was pretty early, not so much the case.  After me calling to start and stop the timing of contractions a few times and moving around very slowly I heard a bit of an edge in Ryan’s voice.  My contractions were still 45 seconds long but more like two and half to three minutes apart.  This was not part of my well planned labor plan, I had a one page typed birth plan that I was hoping to follow and I still needed to take a shower!  I didn’t want to go to the hospital too early but Ryan coaxed me into calling the hospital to see what they thought.  The doctor had the same edge to her voice when I told her I lived in Big Sky, that my contractions were about two and a half to three minutes apart… but only 45 seconds long.  She had to explain to me, twice, that the one minute is just a reference, and that I should head in to the hospital.

Well, I texted Sasha, and told her we would call her from the hospital.  Oh by the way, I had no gas in my car, nice move right?  Ryan was not pleased considering the roads were not great, I was not enjoying my contractions and he had to stop to get gas on our hour ride to the hospital.  But seriously, who has their baby on her due date?!  (I had checked and it is something like 5%, I really thought I had time ot get gas)  Once we got that taken care of and made it through the canyon I had a change of heart and decided it was unlikely they were going to send me home and I asked Sasha to meet us there.  The car ride caused my contractions to slow down considerably and when we got to the hospital if I wouldn’t have seen the slightly crazed look in Ryan’s eye I would have suggested we go to breakfast because I thought my labor had stalled.  I wasn’t hungry but figured anywhere would be better than sitting in the hospital.  Once I got out of the car, I changed my tune, the contractions were fast and hard and I moved like a snail.  I was still disappointed that I hadn’t gotten my shower, and done my hair and makeup.

When I arrived in labor and delivery I saw my doctor and completely lost it.  For some reason seeing her made things all real and what I remember through my sobs was her giving me a hug and another doctor, who turned out later to by my daughter’s awesome doctor, said, “Now that looks like a woman in labor.”  I am the type of person that likes to add something to my to-do-list that I have just done only for the satisfaction of crossing it off the list.  So I was all about them checking how far dilated I was.  I like to know my progress, it helps me to prepare and visualize my goals.  So when my doctor said I was 7 centimeters and that she had to go do a C-section but that I would possibly be ready to push by the time she was back I was thrilled with myself for getting to 7 cm before getting to the hospital.  Something I was very adamant about with myself was understanding that while I wanted to have a natural birth if I needed medical intervention I needed to be open to it.  I didn’t want to think of my child’s birth as a failure in any way if it didn’t go as planned.  Originally I had thought about giving birth naturally because I had heard that some women didn’t respond to epidurals and I knew if I planned to have an epidural and for some reason I couldn’t I would freak out.  If I planned for the natural birth and needed an epidural that was fine to me.   I really was hoping to not have a C-section but again reminded myself that if that is what it took to get my daughter into the world that was fine and that sometimes even the best of us need a little help.

So I arrived at the hospital at 9am with Sasha, Ryan and my OB in tow.  I had a great nurse and one of my favorite memories is when I decided I wanted to get in the tub I got undressed to my underwear and bra and wanted to get in.  My nurse looked at me and motioned to my underwear saying, “Sweetie, you know you are going to have to take those off to have this baby right?”  I guess it was her way of saying, “Girl, pretty soon you are going to not care what you look like, sound like and your modestly will go out the window.”  I was not there yet.  I got in the tub, the second to last place I thought I would want to be (last place to come later) with my underwear and bra on.  I think secretly that nurse just giggled at me, I would have too, I must have seemed ridiculous.  Oh well, modesty got thrown out the window later.  The doctor came back around noon, three hours later, and I hadn’t progressed at all.  I didn’t want my water broken and so chose to get out of the tub and try to break my water on my own.  Another one of my funny labor moments was after being checked and deciding to try and get my water to break I asked someone to grab my yoga pants so I could put them back on.  Sasha looked at me with a smile and told me that I was the first mom in labor that had asked to put her pants back on.  She helped me get back in my pants and get on the ball, which was absolutely awful!  The one place I thought I would love turned out to be the worst place ever.  I found my favorite location, much to my dismay, was the toilet.  But once I had a foot stool and pillow behind me it was the best spot in the room, maybe even better than the tub.  By two in the afternoon I still hadn’t really made much progress, I was at 8cm and I decided that breaking my water should be the next step.  By 2:15 my water was broken and I went from 8cm to 10cm by 3pm.  My poor husband was mortified by the noises I was making, I remember one moment where he looked like he was going to shush me, and through better of it and just held my hand instead.  I started pushing on the bed with my upper body draped over the top of the bed.  They did eventually ask me to lie on my back and I agreed as I just didn’t care anymore and wanted my baby out of me.  I am fairly certain I even yelled that a few times.  Again, poor Ryan was just mortified, but kept his mouth shut.  

At 4:01pm February 23^rd my beautiful baby girl was born.  We were so blessed that it went so well, I was able to do immediate skin to skin, waited for the cord to empty before having it cut and work on breastfeeding right away.  

They aren’t lying when they say once the baby is out the pain is gone, I don’t know if it’s because we were just in awe of our little peanut or if really there was just no more pain.  While I wanted as few interventions as possible, I did change my mind about the Pitocin IV after birth.  Having had a friend that had very recently nearly bled out we felt that for us it was the right choice. 

My birth was perfect for me, I went into it with a plan, yet was open to wherever my birth took me and I think that is what has allowed me to embrace the birth of my daughter and cherish the memories of it.  I had people tell me that I wouldn’t win a medal for not having the drugs, that it doesn’t make me a better parent by having a natural birth, but for me that wasn’t what it was about.  I had wrestled with the decision for a long time and had kept that part of my plans as well as my choice to have a doula private for most of my pregnancy.  While I didn’t hide my choice I also wasn’t shouting it from the rooftop.  I didn’t want to hear from people their opinion, whether in my favor or not.  There are always people with opinions, some that will tell you that you are silly to not have the epidural, some will say that you are irresponsible and somehow less of a mother if you have a C-section or don’t have a natural birth.  In the end for me it was really about what felt the best for Ryan and I.  If I had labored for 36 hours I most likely would have gotten an epidural, if for some reason I needed to have a C-section it would still have brought me my perfect little baby girl, it doesn’t make her being in my arms any less valid or real.  It doesn’t make my experience any better or worse than anyone else that I didn’t do something or did do something.  I wanted a hospital birth, I wanted to try and have a natural birth but in the end it was what felt right to me, not what anyone else said or thought I should do.  That to me is what made it amazing and truly the perfect birth.

 Happy Birthday sweet Ella

Judgement

When you care deeply about something (like I do, about birth), it's hard not to have big feelings about it.  I jump up and down with joy when I hear a birth story where a mama gets exactly what she wants, like this morning when I got a text from a doula friend who had her beloved baby boy last night at a birth center and went home a few hours later, feeling like the whole experience was perfect.  How can that not make you happy, right?

And I'm sad, deeply sad when a mother wants something so much, very often just as much for her baby's benefit as for her own, and every single thing goes wrong.  She feels helpless as one intervention is piled upon the other, as every single thing she doesn't want is offered in a last ditch attempt to avoid the seemingly inevitable cesarean at the end of train wreck births like this.  She hasn't done anything wrong, she's not an idiot who bobs her head and does whatever her OB suggests- she's just the mom with the baby that for whatever reason needs to be born another way than the quiet, gentle, non-interventive way that she had planned.

If you are a midwife, or a doula you probably get this - how disappointed and profoundly sad a mother can be when everything goes wrong.  But I notice a lot of other women don't get it.  I hear a lot of "at least your baby is ok," "a healthy baby is all that matters," "the most important thing is getting your baby."  I'm not disputing that a healthy baby is the most important thing to any mother.  I'm definitely arguing that it's not the ONLY thing important to some mothers.

If you are a mother who really doesn't care how her baby came out, fine.  I don't have judgement for that.  If you are a mom who had a traumatic birth but were able to just pick yourself up immediately and never had a single tear over her birth, fine.  Or you had the worst imaginable birth but you could just breathe and let it all go with no disappointment, good for you.  Seriously, good for you.  I think you must have many many gifts to allow you that kind of acceptance and resiliance, and that is a wonderful thing.

But for anyone out there who doesn't get it why a mother would feel sad about her cesarean, or her homebirth transport ending in every drug under the sun, please stop judging.  You don't have to understand how she can be sad and disappointed and over the moon happy in love with her newborn all at the same time.  But please don't judge her, or nudge her to move on, or get over it.  And please don't say any of those statements above dismissing her feelings.

If you really care about her or love her, just listen to her story, without your own judgements and when she says she feels sad or disappointed or angry, tell her it's ok to share her feelings with you and that it's ok for her to have them.  If you really want to help her, let her know that you accept her, that she is a good mom and that you are willing to listen.  When mothers receive empathy instead of judgement they are much more likely to heal from their traumatic experiences, and the painful feelings become less acute over time.

The love that new mothers receive is passed right along to their babies.  When we judge and dismiss, we are missing a beautiful opportunity to fill a mother up with love, to help in her healing and to give her the kind of unconditionally loving acceptance that we all hope she can give to her baby.

A few more hugs and a lot less judgement for the mothers please.

What you can do to make your birth better - RIGHT NOW

One of the toughest aspects of birth is the lack of control.  My opening birth education class often begins with a discussion about what a bunch of control freaks the mothers all are.  The partners laugh and nod in affirmation, but it speaks to a pretty serious issue.  We all seem to be control freaks these days.  

Think of weddings - the most important day of many women's lives - planned right down to the minute, every single detail scheduled out and prepped to be absolutely perfect.  We'd like to think we can do this with birth - that other "most important day" of women's lives.  But deep down (most of us I hope) know we can't plan birth.  Birth happens the way it wants to, often due to circumstances far beyond our control - our family's genetic tendencies toward gestation, labor and birthing, for example.  Babies come when they are ready.  Birth often happens in the wee hours of the morning or the middle of the night.  It might involve screaming or vomit.  And transition - what a beautiful exercise in lack of control.  Often the births women are happiest about later involve a complete surrender of control at some point.  The thing we cling to most (control) is the thing birth demands we give up.

I created this list several years ago to restore a little control.  (Don't get me wrong - I think birth knows exactly what it's doing - letting go of control during labor is key in the process of becoming a mother, but some control, especially before labor begins can help women feel safe.   And safety is VERY important for birthing.)  I hope it can help you have a better birth (and enjoy your pregnancy too.)

The Top Ten List

What you can do (today!!) to have the best birth possible for you (in order of importance)

• Practice relaxation, hypnosis, meditation or visualization 20-30 minutes daily, preferably with your partner.  Your mind is your most powerful ally in birth.
• Eat well.  Eat protein with every snack and meal.  Eat smaller meals and frequent snacks to stabilize blood sugar.  Eat at least 100 grams of protein daily.  Eat whole foods (especially leafy greens).  The single best way to protect your health and your babies health.
• Talk to your partner about your fears, needs and desires for your birth.  Let them know what they can do to help you.
• Hire a doula.  She can help comfort you physically and emotionally, provide you with information and support your birthing decisions, while working along side your partner to help you have the best birth possible for you and your baby.
• Talk to your birth provider about your choices, make sure they understand and respect your wishes.  Check out Childbirth Connection for help with this.
• Find a counselor or therapist - if you have anxiety or depression, are a survivor of abuse or simply need someone to talk to about your choices.
• Care for your sleep and rest.  Nap whenever you can.  Limit screen time one hour before bed, and go to bed and wake at the same time each day.
• Walk daily.  Fresh air and sunshine are good for you.  Walking helps position your baby well and strengthens your birthing muscles.
• Insulate yourself from negative influences (people, TV, books, online), especially about birth.  Limit your contact with people who don't support your birth choices (don't allow them to be with you in labor).  Create positive affirmations about your ability to birth.
• Learn how to assess your baby's position and utilize movements to help your baby find the best position for labor and birth.  Check out Spinning Babies for information about an easier birth.

While there is much we can't control about birth, and the unexpectedness of this happy event is certainly part of its joy, these ideas are sure to help you have a calmer pregnancy and face your labor with confidence that you did every thing you could to ensure the best outcome for you and your baby.

To find out more about my birth classes, please visit Bellabirthing.com.

Are you gonna eat that?

Nurse (smiling): "You can't eat that."

Laboring mother (smiling): "It's a cracker."

Nurse (not smiling):  "You don't want to hurt your baby."

Laboring mother (smiling even bigger): "A cracker can hurt my baby?"

Nurse (actually frowning):  "Well, you can't eat that."

Ok then.  What's a laboring mother to do?  She's hungry, been in labor for hours, now at the hospital and she wants a cracker (or an apple, a burger, a piece of toast, a candy bar, you name it - she's still pregnant, remember?).

But if her hospital is like thousands of other hospitals in America she has an extremely restricted diet while in active labor (in some hospitals, any labor at all).  She can have artificial flavor, food coloring, artificial sweeteners, sugar, salt, some fruit juices, gelatin (and we all know where that comes from, boiled hooves are ok I guess), water and ice.  She can have it in the form of popsicles, juice (may actually be sugar water), diet soda, Jell-o or broth.  YUM!!  (Actually popsicles can be tasty in labor, but maybe something else sounds good after, say, 36 hours of "orange or grape?").  Did you notice the complete lack of protein in this diet?  Or any other nutrients at all?  What each item on this menu has in common is that you can see through it.  (Actually, you can't.  But hospital officials will say that if you boiled it down or melted it, you could see through it.  Are you following all this?  No protein and you can see through it.  I guess we could add snow to the list.)  

Would you feed this to your baby?  Or how about if you were running a marathon, would this sustain you?   I've had a few marathoners in my birth class or as doula clients.  Do you know what they say? Birth is WAY harder than running a marathon.  And marathoners eat whatever they want, including a lot of protein, simple and complex carbs, etc.  They have to in order to race well and not just lay down and die out there.

So what is going on?   Long long ago a doctor decided that because women in labor were at risk of a cesarean, which under rare conditions might be performed under general anesthesia, they should be treated as surgical patients.  Each and every one.  Even though the vast majority would not be having surgery (especially back then - today 1/3 of women will be having surgery, but we'll come back to that).

What will happen if that poor hungry mom I quoted above actually has to have a cesarean?  Not that unlikely since maternal exhaustion leads to fetal exhaustion, a common cause of cesarean (and I don't know about you, but I get tired when I'm running mile after mile on an empty stomach, especially when someone is jogging right along with me telling me "You can't eat that!").  So mom has to have surgery.  95% of cases will NOT require general.  She has a 5% chance of general.

If she's in the 5%, her anesthesiologist will intubate her (putting a tube down her throat to keep her airway open) JUST IN CASE.  In case of what, you ask?  The very thing that this doctor long long ago was so afraid of - that she would vomit, while out, and breathe the vomit into her lungs, possibly dying.  Death by cracker.  They didn't have intubation back then.  BUT WE DO NOW.  ( I just had surgery (knee) under general, I starved for more than 12 hours before, and guess what they did anyway, that's right - intubate me).

There is a huge problem with the logic that starving a mom in active labor will keep her safe from aspiration anyway (that's the complication).  I was in active labor all of 3 hours with my first baby. No way was the pizza I had for dinner was out of my stomach by the time I went to the hospital. General?  I would have needed intubated anyway.  And no anesthesiologist on the planet is going to risk taking a mother's word for it that she hasn't eaten in 12 hours.  ( I wouldn't - I see moms lie about eating all the time).  So they just intubate everyone who gets general to be safe (and remember it's only 5% of the 30% who even get general).

So why still no food for mom?  I don't have a clue.  It makes no sense.  It's like a triple, double, super, extra fail-safe.  Except that it's not a "safe" at all because starving mom has risks.

Now I'm going to get serious.  Very serious.  Have you ever spent time with a laboring mother who is being starved?  They are cranky. The don't like being out of control.  Sometimes they are downright angry.  Their blood sugar is a mess.  They vomit more.  They cry and scream more.  They need way more pain management (either natural measures or drugs).  Their babies are exposed to more drugs, to more stress, to longer labors.  Mothers and babies get depressed.  They are more likely to have that surgery, just from starving.  They suffer.  I am not a fan of suffering, just to give birth to your baby. Suffering is really obnoxious when there is a perfectly good cracker sitting right there, and there is NO GOOD REASON WHATSOEVER why she can't eat it.  (You might think all of the unpleasantness above is just what labor looks like - I have seen women eat, and women starve - the starving suffer far more, both physically and psychologically).

So, if you are a mom about to have a baby, or someone who is helping a woman do that hard work, what can you do?  

1. Don't have your baby in a hospital.  Birth centers and homebirths have no restrictions whatsoever on what you eat.  They have a much lower cesarean rate and among their cesarean transfers, there is no higher risk of aspiration (obviously women who've been eating through labor).
2. Tell your doctors or nurses you are going to eat whatever you darn well want, and show them the evidence to support your choice.  A doctor or hospital's policy is not the LAW ladies.  If the doctor or nurse tries to pass the buck to the anesthesiologist, ask to speak to her and show her the evidence.  Ask for proof to back their refusal to let you eat.  And if you are not convinced, eat.
3. Eat whatever you want whenever no one's looking.
4. Or starve yourself and hope for the best.

The mom I quoted above did #3.  She ate that cracker as soon as the nurse left, and several more.  She also ate a couple bananas later on and some homemade cookies, with peanut butter, oats and nuts. She had a long labor, first time mom, and she had been vomiting in early labor.  But she stopped as she found her groove, ate something she wanted, and she went on to have a completely natural labor, all on her own power.  Her baby was great throughout the whole labor.

I encourage you to read the evidence and decide for yourself.  Take responsibility for your birth, your baby and your body.

Blog post comparing your risk of aspiration to dying in a plane crash or from complications from an elective cesarean.  (Eating can prevent cesareans).  8X more like to die in plane crash, 900 X more likely to die from a cesarean, than from aspiration from general anesthesia during a cesarean.

WebMD - Researchers Say Eating And Drinking Don't Pose Risk for Delivery

Unnecesarean on British Medical Journal's reassessment of eating during labor

Citizens for Midwifery - great review of the Cochrane Review on eating during labor

Favorite labor foods:

• whole grain cookies
• nut butter
• apples
• grapes
• pears
• yogurt
• smoothies - yogurt, banana, nut butter
• real fruit juice
• turkey
• bananas
• Luna bars
• cheese
• crackers (with or without a frowning nurse)
• and yes, popsicles.  I like orange best.

"Natural Cesareans"

This post is being re-purposed by MCC member, Kimmelin Hull, who initially published the article on Lamaze International’s Science & Sensibility blog site (May 18, 2011).  

Kimmelin Hull was originally trained as a Physician’s Assistant and worked in clinical medicine for 5+ years before turning her attention toward community health education.  She began teaching childbirth preparation classes as a Lamaze instructor in 2005 and took on the role of Lamaze International’s Science & Sensibility blog Community Manager in 2010.  Kimmelin is now pursuing her Master of Public Health~ Maternal & Child Health from University of Minnesota.  Following her program completion, she hopes to work on promotion of family health and well-being by targeting women and mothers.

Introducing….the concept of the “natural” cesarean… I have struggled with whether or not to post on this YouTube video for some time. The title, in and of itself, is aggravating. And I don’t mean from a judgmental standpoint, but simply from a realistic standpoint: cesarean birth—whether positively, clinically indicated or not—is not “natural.” It is an alternative method to birth compared to how nature originally designed it.

I have heard many others refer to the practices described in the video as “gentle cesarean.” This, at least, seems to be a bit more accurate—except for the cutting, pushing, tugging, pulling, suctioning, cauterizing, and externalizing of the uterus that goes on. (In a former career life, I used to surgically assist on cesareans, so I’m pretty familiar with what the procedure looks like.)

A list serve I’m a member of has recently spent a lot of time debating practices that surround cesarean births: should hospital policy allow for placement of baby skin-to-skin with mother directly following birth? Should breastfeeding be allowed in the OR while mom is still being sewn up? Should separation of mom and baby in the minutes and hours be avoided following a C-section in the same way this practice has taken hold in the vaginal birth setting?

Other questions about cesarean birth discussed frequently in my own local birth network include: Should birth plan elements such as low lighting, quiet music and delayed cord clamping be integrated into the C-section setting? Should doulas be allowed into the operating room to provide the emotional support the mother/parents hired her for? (An aside here: the most common argument against allowing doulas into the OR at my local hospital is that, “the OR is too small to have an extra person in there.” Every time I hear this I nearly explode: the OR seems to be large enough to admit medical and nursing students at-will, along with the various OR staff coming and going from the room throughout the procedure. And yet the presence of a doula sitting quietly and still beside the birthing woman/couple seems to take up WAY too much space!)

The “Natural C-Section” video encourages many of the issues discussed above. It follows a second-time-mama into the OR for her second cesarean birth and features obstetrician, anesthesiologist and midwife talking heads who all describe this version of a cesarean birth in a universally positive light. In fact, mood lighting does seem to be implemented. The sterile drape separating mom’s head and the rest of her body is dropped in time for her to see her baby being pulled from the incision in her belly. The doctor holds the baby up, legs spread, so mom and partner can “discover” the baby’s sex on their own, as the OB narrates, “…it’s one of them.” Baby is placed right away, vernix, fluid, blood and all, on mom’s chest. Dad cuts the cord following a delayed cord clamping. In this video, the midwife’s job following the baby’s birth is explained as being focused on facilitating bonding measures like skin-to-skin contact and early breastfeeding, while also assessing baby’s well-being.

Interestingly, the anesthesiologist included in the video describes the birthing woman as ‘awake and participating in her baby’s birth.’ I have a hard time agreeing with his sentiment. While it is certainly preferable for the mother to be awake and aware the moment her baby exits the womb, I’m not sure how much ‘participating’ she is doing when strapped down with 2/3 of her body numb and immobile.

For women who must deliver via cesarean—I can definitely see the appeal in this version of a surgical delivery. It attempts to come up to speed in so many ways. There is no hour-long separation between mom and baby. When mom goes to the PACU (Post Anesthesia Care Unit), so does baby. The midwife in the video even acknowledges the associations between postpartum depression and cesarean rates as well as decreased breastfeeding initiation rates amongst women who have undergone a cesarean birth.  She then goes on to imply that this gentler approach to the C-section might just ameliorate some of this association.

Criticism Against the “Natural Cesarean”
Here is the cause of my hesitation: does this promotional video of the “Natural C-Section” run the risk of making surgical birth look so enticing that the risks of C-section get pushed under the table?

Dr. Andrew Kotaska, an obstetrician in Yellowknife, NT, Canada describes his concern over the “Gentle Cesarean” this way:

“It is admirable to minimize the necessary disruption of normal early maternal- neonatal contact associated with NECESSARY cesarean section. The gentle measures employed will not, however, reduce the maternal risk of amniotic fluid embolism, pulmonary embolism, operative injury, infection, severe hemorrhage, and death - all several times higher with C/S than vaginal birth. They also will not help achieve the neonate's normal immune system activation during labour, perhaps leaving it more vulnerable to autoimmune disease later in life.

“In no way can the "gentle cesarean" be construed as making C/S safer. In the best quality prospective data set on elective C/S, 1/2300 women died. Soft, family-centered window dressing does not change the cold, hard risks; it is important practitioners and women keep this in mind.” (Landon; NEJM 2004)

In the United States, we are struggling against an ever-increasing cesarean rate. Readers of this blog are well-aware of the ~ 33% C-section rate that doesn’t seem to be decreasing any time soon. In an age when we should be working to reduce the C-section rate to somewhere at least close to that which the WHO recommends, the promise of a gentler, naturalish surgical birth could threaten the work many maternity care professionals and normal birth advocates, alike, are doing to properly inform women (and some providers) of the true risks associated with cesarean birth.

On the same list serve I mentioned above, another related thread developed: should we “allow” post-cesarean moms to initiate breastfeeding while still in recovery? The meat of the debate was whether or not women with anesthesia levels up to the nipple line will suffer nipple damage from incorrect infant latches, if they cannot feel the latch. Hospitals apparently have policies on this: when a mother is and is not allowed to nurse her baby, depending on the type of birth they have experienced (and the resultant side effects—such as prolonged numbness). Since when did it become reasonable for maternity care facilities to dictate when a woman is and is not “allowed” to feed her own child? 

This is exactly the type of down-stream effect of surgical birth that
1) likely does not get discussed prior to consenting for a cesarean and
2) is not erased by a gentler approach to the procedure and
3) involves the institution of policies that certainly are not evidence-based.

A Wolf in Sheep’s Clothing
I will never become the person who denies the importance of C-section as an option in a few, particular cases: umbilical cord prolapse, placenta previa, abruptia or accreta to name a few. The cesarean
method of birth was, after all, developed to be a life-saving measure and, to this day, continues to be just that in a handful of circumstances. And when a C-section is truly indicated (but not emergent) then, YES, incorporating gentle, respectful, best-practices elements into the cesarean experience should be done. To me, this should quickly cease to be a point of debate at all. But for the remainder of women who find themselves in the position of contemplating the type of birth they’d like to experience—those who might be considering an elective C-section; those who have had a previous cesarean and are toying with whether or not to go for a VBAC—the promise of a “Natural C-Section” may turn out to be a wolf in sheep’s clothing.

As one participant on the list serve summarized:

“Can we work to make cesareans less common and also kinder--

at the same time?”

Kimmelin can be reached at kimmelin@adozeninvisiblepieces.com

Freedom for Birth

Birth as a Human Right?

On September 20th, Improving Birth National Rally for Change, ICAN of Bozeman, MT and the Montana Childbirth Collective hosted a showing of Freedom for Birth, "a new 60 minute campaigning film that re-frames Human Rights as the most pressing issue in childbirth today."  This film shows how choosing the way in which she births is a fundamental human right for all women, and how this right is routinely violated, all across the world.  The film is amazing and we highly recommend you view it, and show it to others, especially women.  We had a lively and thought-provoking discussion afterward, about birth as a human right (something many of us had not pondered before), about the violations in the film and about birth in our own community.

This got me thinking about what we are doing right - and what still needs improvement - in our own community.  One of MCC's members at the film premiere said "We are so lucky to live here - we have so many choices other women do not have."  Absolutely.  In Bozeman (and surrounding towns) you might choose a homebirth midwife - we have several with great reputations and many many years of experience.  They will attend you in your own home with kindness and compassion and a high level of care.  We have two beautiful birth centers, The Bozeman Birth Center and The Birth Place, each staffed by highly trained, experienced and well-regarded midwives.  Both offer a lovely facility as well as compassionate and safe care.  These are all excellent choices for VBAC moms, or other moms who've had traumatic previous births.  About 10% of families choose either home or center births, the highest in the state, and Montana has the highest rate of out of hospital birth in the country.

Home or center choices here give women the choice of a low to no intervention birth, a family centered birth, a birth where the mother is firmly in control of her experience.  And we know from years of research studies that these are safe choices, the most recent from the Cochrane Review, concluding "Observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications."  Less interventions and fewer complications mean fewer cesareans, less separation of mother and baby, fewer problems with nursing, less tearing of the perineum, less induction, less pain medications and much happier birthing experiences for families.

What are the problems?  Some insurers still won't pay for these choices, or will pay for only some.  Women deserve for their insurance to cover all the choices.  And this makes good sense for society too, as these choices are tremendously cheaper than even natural hospital births (and since they result in so many fewer interventions and complications, they are obviously cheaper than highly interventive births).

Not enough women know that home or birth center births are safe.  Not enough women know that they probably wouldn't need pain medications (like epidurals, which are not available outside of a hospital) if they didn't birth in a hospital.  And not enough women have trust in the birth process to take total responsibility for their births, which one must do to birth out of hospital.

Finally, we have a small choice of hospitals, Bozeman Deaconess, St. Peter's Hospital in Helena (about 1 1/2 hours away), Livingston Community Hospital (1/2 hour away) and St. Vincent's or Billings Clinic, (Billings, 2 hours away).  Most women in Bozeman choose our local hospital.

What are they doing right?  Moving in the right direction - toward a gentler and more patient centered kind of birth.  Bozeman is becoming Baby Friendly, which means a huge step toward better breastfeeding rates and help for mothers who want to breastfeed.  Some mothers are now able to keep their babies with them when they have cesareans and nurse right away, rather than have the newborn and partner whisked off to the nursery for hours.  Mothers who want low intervention births are more likely to be met with encouragement and support.  Doulas are warmly welcomed.  Two nurse midwives are now on staff at Billings Clinic's Bozeman OB practice, offering a level of care more based in midwifery.  Women choosing them would have one of two midwives attend them (instead of one of very many doctors, whomever is on call).  This makes a big difference to many women.  The maternity care nurses are well-trained to help mothers who want a low intervention birth and happy to support that with compassion.  VBACs (although called TOLACs - trial of labor after cesarean) are now "allowed," at least for some mothers.  Women transported from out of hospital births are generally treated kindly and with respect.  There are a number of doctors who are patient and support natural birth and who refrain from intervention.  This is all cause for celebration.

What still needs to be done?

• All mothers who have cesareans need to keep their babies (except the very rare baby who needs intensive neonatal care) for the duration of their surgery and have help latching on right away.  Separation needs to be as close to zero as possible.
• The cesarean rate is too high - the hospital reports a rate at the national average - about 30%.  This is at least 15% too high.
• VBACs need to be openly celebrated and encouraged, not treated as train wreck waiting to happen.  The research just doesn't support this panicked mentality.  VBACs are very safe.
• Far fewer inductions.
• A doctor/patient system that puts the patient first.  Birthing women need to birth with the caregiver they've seen for 9 months, not the stranger who happens to be on call.
• A return of breech births for the majority of those cases.  Again the research supports this as a safe practice (and can help lower the cesarean rate).

Our community can continue to support women's choices about birth, as a human right.  We can all respect the value of mothers by letting them choose what they know is best for their families.  And we can encourage our community hospital to continue taking steps toward improving its care of mothers and babies.

Sasha, Lucy and happy mama Winston

Welcome!

This blog is MCC's newest adventure:  a way for us to share, connect and inform women and families about birth.  MCC is a group of birth workers (doulas, yoga teachers, birth educators, hypnotherapists, chiropractors and others) based in southwest Montana (Bozeman, Livingston and Belgrade) who joined to support one another and help the birthing women in our communities.

This first post is a welcome and an invitation to participate in discussions and share your thoughts.  I'm Sasha, one of the founding members of our group, a birth doula and birth educator, and passionate birth junkie.  You'll meet other members in future posts!

Jen, Sasha and Laura at a birth and baby fair.

As a birth doula I've been blessed in so many ways, and connecting with other women as mothers is at the top of my list.  There are few opportunities in our busy world to truly connect hearts with another human in a deep way.  We have so many layers covering our inner spirits, so many ways we hide ourselves from the outside world, so many faces we put on to be socially acceptable.

The emotional challenges and physical hardships of labor and birth are like a razor blade that cuts through those layers, sometimes brutally.  I don't think most of us would choose to show our deep, unprotected, unembellished selves to those around us, although that part of us is always seeking to be heard and accepted.  We protect it with distance.  Labor erases that distance and like the layers of onion peel, one by one labor removes the protective barriers.  What is left is raw, but beautiful, the true person.  

When I am with a women in labor most often I witness this process, often culminating with transition.  What appeared to be a very controlled, reserved woman may now be a bit like a wild animal, crying, needing reassurance, needing acceptance.  It's a bit scary.  It's the thing women hear about and worry about happening to them in labor.  "I don't want to lose control," I've heard from pregnant women over and over again.  But truly, it's an opportunity.  An opportunity for those around this woman to show her love, compassion and ultimate acceptance.  Loving her (and sticking with her, and believing in her abilities) when she's a sweaty, smelly, vomiting, crying and screaming mess is an act of unconditional love.  Or sometimes she is so quiet and calm, but there will be a moment when she peeks out from her meditation and needs her caregivers to acknowledge her beauty and humanity, her hard work, her love for her child.  These are gifts she will carry forever, and hopefully share with her child.  

This is my favorite blessing of doula-hood - seeing the truth of a woman, in her power, in her most vulnerable state, seeing who she really is.  I've never been disappointed.  I stand in awe of her.  And I often leave feeling very in love with someone I hardly know, but know so deeply I feel like I have seen her soul.

I leave you with my favorite blessing, one which conveys everything I've tried to say, so much more beautifully.  

Namaste

~Sasha