Distortion of Natural Birth

I was so happy to follow up on Ashley’s Midwife Vs. Medwife post because I really feel as though this will be a little piggy back on the subject. Last night I tuned into ABC’s hit series Private Practice, and during the episode I seriously started to wonder why I continue to watch the show that makes my blood boil.

But what really ate at me was they way they portrayed a mother who was working towards a natural birth. Which made me think about the way that the public views the natural birth community, as well as women who simply want a natural birth for themselves.

They treated this woman in the episode like the butt of all the jokes in the episode until the emotionally charged climax of her birth viewed by perfect strangers that would have been a major HIPAA Violation.  The episode shows this woman with a multi-page birth plan, grinding on the door frame of the birth suite trying to squat to help her labor, joking about how she had been in labor for 3+ days, all of which as a mother who has labored naturally, I found offensive.  The character was essentially the comedy of the episode.

It made me think about the perception the American public is going to get from this message, as well as their views on women who do choose to give birth naturally. Do they think we are all just a bunch of hippies that bite on sticks until we drop a baby out in the middle of a meadow while singing show tunes?  Come on!

The problem is shows like this.
The problem is the myths about who has natural births.
The problem is typical stereotypes.

Where do we start?
How do we start to re-educate and properly educate the public so they don’t think all moms who want to have a natural birth aren’t ding bats like this character was?

I really hope that shows like this, and Grey’s Anatomy, and other medical drama’s take the time to fix the American stereotype of birthing naturally. Women from all walks of life do it!

Just on a side note, the character who was attending this woman’s birth “Dell” a “student midwife” came off as a Student OB/GYN if anything. He had no type of midwife qualities in him what so ever and I think that is another huge slap to the natural birth community. He at best was a “medwife” if that!

Epidurals vs. Unmedicated

I was talking to someone today who was trying to decide if an epidural was right for her in her upcoming labor.  She was well read and still had some concerns on the topic.  But in part of our correspondence she said something that made me realize that she felt it was the epidural or do nothing.  We had a long talk about how women who choose to go without an epidural don’t just sit there writhing in pain until the baby suddenly falls out - they prepare and actively participate.

I explained that if she had any intention of going without an epidural, even a slim chance, that she should find a childbirth class that was designed for women who did NOT want an epidural.  Then she would be prepared, but that if she changed her mind and wanted an epidural she could always have one.  I told her that there were many things that women do to cope with pain in labor including:

• positioning
• movement
• massage
• relaxation
• encouragement
• water
• heat
• cold
• TENS

What would you have told her?

Loyally Devoted to Doctor

I recently read the book The Highly Sensitive Person by Elaine N Aron, Ph.D. In the chapter called Medics, Medication, and Highly Sensitive People, the author states:

“Keep in mind, too, that it is common to feel an attachment to anyone you have been with during an arousing experience, especially if it was a truly painful or emotionally significant ordeal. In the medical realm you hear these sorts of extra feelings when people describe their surgeon or women talk about the person who delivered their child, which is perfectly normal. The solution is simply to know why it happens and compensate for it appropriately.”

In the chapter about relationships, she talks about studies that were done that showed people are far more likely to fall in love under stressful circumstances. She applied this phenomenon to attachment in all relationships, not just romantic relationships. Later when I read the above statement in the medical chapter, so many things started to make sense to me.

Why do women love their maternity care provider, even when they may have done unnecessary procedures on them and not allowed them to make their own choices? Why do many providers use scare tactics? Why do women hold so adamantly to the belief that their provider “saved their life” or “saved their baby” or “was a great doctor” or “really took good care of me”, even when evidence to the contrary is right in front of them? Why do they fail to make important connections, such as that their c-section may have been one of the many unnecessary ones, or that there may not have been a true evidence based need for their induction? Why is childbirth treated like a major emergency with so much fear and anxiety around it? Why aren’t all women who give birth in this system severely traumatized from it, and instead defend and adore their doctors? The answer is simple: the culture of fear that surrounds childbirth actually endears women to their doctors. It cements the relationship between women, their doctors, and the hospitals their doctors practice at. It ensures that the women will keep coming back, and will recommend their providers to all their friends as they speak about them in glowing heroic terms. It is quite brilliant really, providers and hospitals have found the key to running a very successful business, and it has nothing to do with allowing women to make their own choices. They simply have to give the illusion prenatally that the woman can make her own choices for her birth, and then make sure that the actual experience of birth is one filled with fear, anxiety, and of course a healthy baby, and then the narcissistic provider will come out looking like roses to the woman who must endure the “horrors of childbirth”.

Of course, I am not really giving the doctors the benefit of the doubt here. They likely don’t know on a conscious level what they are really doing. They have been trained to act this way, by people who were also trained to act this way, and it is reinforced for them every time a woman profusely thanks her doctor for a job well done, and every time a woman tells her birth horror story where the good doctor makes an appearance as the hero who delivers her baby to her despite all the dangers that presented at the last minute. Both the woman and the doctor seem ignorant of the psychological effects that framing every average birth as a medical emergency creates.

In the statement above, the author states: “it is common to feel an attachment to anyone you have been with during an arousing experience, especially if it was a truly painful or emotionally significant ordeal.” This describes childbirth perfectly. The word “arousing” here is referring to sensory levels. That can mean physically, emotionally, sexually, or any other assault to the senses, good or bad, that can be had. We know childbirth can be described as “arousing” in many ways. It is also inherently “painful” and “emotionally significant”. Even when women use drugs, there is still some level of pain before she took them, and depending on what type of drugs she took, she may still experience pain while she is taking them. So really, all births fit this criteria. Births in a hospital, or at home, or in a birth center all have these same basic elements. It seems women are wired to form an attachment to the people who were with her and helped her through the event. This could be her partner, her doula, her midwife, her doctor, her nurse, or her friend or relative. I think this type of attachment likely had an evolutionary purpose at one time. It would be ideal to attach to an older, wiser woman who assisted with the delivery of babies who would have been there to care for the mom postpartum, and to slowly help her to bond and form an attachment to the baby. This wise woman would then help the mother learn to breastfeed and care for her new infant, while slowly pulling back her own attentions from the situation. This is what we have in homebirth midwives today. How would our ancestors have fared if a man had shown up in the tribe to deliver a baby, and then disappeared immediately afterward? The woman would be left adoring him, yet not having help from him to form an attachment to her infant. Never learning how to breastfeed or other infant care skills. What would have become of humanity? What is becoming of humanity?

Midwives and doulas seem to understand this phenomenon. Doulas usually visit a woman once or twice postpartum and are available if she needs to talk or has questions about the baby, breastfeeding, or the birth. Midwives start seeing a woman more and more as the birth approaches, and then once the baby is born, they start to taper off again, seeing her less and less until she is no longer needed at all. This is a much more natural and appropriate response to caring for a woman during such a pivotal transition in her life. What happens when women see doctors or CNM’s in hospitals though? They are likely seeing a practice, not a specific provider. They will likely not give birth with the same doctor or CNM they saw prenatally. They may never see the same doctor or CNM again after they give birth, or perhaps just once at the six week checkup. How does this affect women emotionally, or in her relationship with her baby, when instead of having a slow winding away from her provider, there is just an abrupt ending to the relationship? Does this interfere with breastfeeding, or affect feelings of trauma related to the birth, or feelings of depression related to her new role as mother? It is ingrained in our psyche to attach to these people who help us through such a major event in our life. How will the people we choose handle this responsibility? Are we choosing someone who will corrupt our experience and force an unnatural attachment to them by creating more anxiety around the experience? Are we choosing someone who will be there for us days, weeks, and months later to answer our questions about the baby or to offer us emotional support? Will the person we choose even be available for the birth, and will we ever see them again afterward?

Now I realize why other women feel the way they do about their provider. I did not attach to my provider, I was instead extremely traumatized by her actions. I still wonder why some women are traumatized, and others fall in love with their providers, given the same set of circumstances. I wonder if it is actually more natural, and thus common, to attach to a provider even when (or perhaps especially when) that provider creates an atmosphere of fear. It makes sense then why so few of us are speaking up about the system and the way women are treated. It makes sense that women are extremely loyal to their providers, even when many aspects of their births were disappointing or upsetting to them. It makes sense that many women are reluctant to accept that there is anything wrong with maternity care. It makes sense why the maternity care system is so hard to change and is met with so much resistance from every side.

What can birth activists do to help women form healthy attachments during this transitional time in her life? It may be tempting to try to convince all women to have a homebirth with a midwife since we know that they are probably the best option for healthy attachments and a healthy weaning away as well, however, if a woman has already formed a strong attachment to a certain provider, it may be more realistic to recommend having a doula. A doula will be there prenatally, for the birth, and postpartum, and therefore can provide much of the physical and emotional support that new moms need and deserve. Some moms may hire a doula, yet keep her same provider that she has formed an attachment to, and others may find that a doula is a stepping stone to having a homebirth the next time. One day I hope that maternity care shifts to being centered around the mother again, and not around the provider and his schedule or routine.

Why Our Women are Afraid of Birth

Deliver Me

It is Tuesday, at 10pm while I settle in after getting my little ones to bed. I flip through the channels and settle on discovery healthy which is a personal favorite of mine, but it really has only recently become a favorite because of shows like I didn’t know I was pregnant. It fascinates me that women could make it though a full term pregnancy and not know they were pregnant, but that is just me, and the experiences that I had with my children is what makes me wonder how the heck women could not know they were pregnant.  But that is completely besides my point today.
So as I watch this show, I am noticing a trend. High risk, high risk, high risk, previous cesarean section, scheduled cesarean section, high risk, healthy first time mother, scheduled cesarean, high risk. Well I mean, that is how it is in Los Angeles right?  You would think so!  But apparently because only these crazy, scary, uncommon births make something called ratings, that is all they are going to feature on TV. Because in reality, no one wants to watch a natural birth or a home birth because no one is running around with a scalpel screaming about the emergency that childbirth is. Nor is the mother screaming for her epidural because she just cant deal with the pain of the 3 hours of labor so far.
But what we should be thinking about most importantly is the message this is sending. What is this teaching first time mothers or even young women that may not be planning on having children soon but will some day?  It is teaching them how scary, dangerous, and medical birth is supposed to be. But is that really how birth is? Of course not. Anyone who has taken the time to read the studies, and just not follow what mainstream society thinks is the right way to handle pregnancy will know that birth is not scary or dangerous or a huge emergency. While it can be in some cases, in most cases it can and will be beautiful when just left alone.

When a woman becomes pregnant today, if they do not already have an Obstetrician they have been seeing for well women care since 16, or whatever age their parent decided it was the right them for them, what is the first thing that they do? They ask around their circle of female friends for the best Doctor out there because isn’t that what we all want? We want the one who is the BMW of pre natal care. Little do women know that they are really going to end up with the 1990 Dodge Dynasty when they take this route because hands off is better.
But because our society has told us this is the way things should be, they run off like lemmings right off the cliff of medical interventions landing in the valley of cesarean sections.

Maybe if the television channels like Discovery health followed a dozen home births or even aired The Business of Being Born they could get a popular, and controversial other side to what they are constantly airing. Maybe it will boost their ratings even more, maybe not?  But what it will do is give the other side of the whole issue. Let’s get Marsden Wagner to do a half hour special on Birth in The United States and see how many women run off to the midwives.  Instead they air these disgustingly inaccurate “Freebirthing” shows. They find the one idiot who is going to make women who choose unassisted birth look like a bunch of uneducated yokels.  Which is exactly what they did with their special on Unassisted birth.

I guess in the end, like anything else the television airs, it is biased and we shouldn’t expect much different.

Quote of the Day: Make Yourself Look Important and Busy

“A doctor must do something. He cannot remain a spectator merely, where there are many witnesses, and where interest in what is going on is too deep to allow of his inaction.”

Walter Channing, 1848
Harvard Medical School professor of obstetrics

Read more about Channing’s career and what the Harvard Medical School’s alumni blog calls the Channings “legacy of compassion” and “commitment to social justice.”

The Infamous Cascade Chart

As someone strongly involved in the birth community, this is probably one of my favorite pictures floating around the internet that I run across every once and a while.? One day when I find out the person who actually put these thoughts and cascade of interventions into a physical chart to view, I am going to kiss them!

I have always loved how it starts with induction, because lets face it, so many women today are starting their labors with some kind of artificial labor stimulant. Whether it be pitocin, or the oh so dangerous cytotec. I can personally say I have been the victim of the cascade myself with my first child. Had I seen this before my pregnancy with him, I would have never opted for the induction. Many do not realize that induction in many cases will fail, almost half of the time according to the most recent figures, and when I quote that, I am quoting Robbie Davis Floyd in a 2008 interview, I believe it was in Pregnant in America but my birth/pregnancy movies and interviews all start to blur together when you watch so many of them. These babies are not ready to be born in many cases, especially when we are seeing these inductions before the “due date” or the 40 week gestation mark. Although we know that “due dates” aren’t much to put stock into, many women and providers use them as some type of eviction date, which history has shown to be a pretty bad idea. No one is going to be pregnant forever and many women left alone will go into labor on their own. Now granted, there are cases that induction is medically necessary and for these special cases, I am completely thankful. Without induction these women would be subjected to cesarean sections instead of labor inductions which could in turn be even more hard on their body, and experience over all.
What we do not understand with the induction of labor is, we are creating unnaturally strong contractions in attempt to simulate something similar to natural labor. As someone who has experienced pitocin labor, and natural labor, I would take a million natural contractions over being on the receiving end of pitocin again. The comparison in my opinion is not even in the same ball park. Another issue with these contractions as most know, is the fact that they are more likely to cause fetal distress on the baby because they are not natural contractions or what normal contractions are supposed to be. So in turn we are putting our children under unnecessary stress. Especially if they are not ready to come and join us in “our world” yet. Again something I learned with my first.
Then we have the provider who comes in and looks at the fetal heart monitoring and says, “Oh No! Your baby is in danger!!” So off to the operating room we go for an “emergency” cesarean which in reality was caused by the pitocin to begin with. You would think by this point there would be a bit of common sense in the Obstetric community to say, ya know, I think we are causing these actions instead of blaming the increasing cesarean rate on “patient choice cesareans” which only make up 3% at most of the incredibly high cesarean rate in our country.

But a cesarean is only one path that this induction cascade can lead to. There are still women out there that will have a vaginal delivery when subjected to a labor induction, but in turn these women have greater risks for other procedures including episiotomies which have all in all been proven to really have little to no benefit to women in the long run. While episiotomy rates are starting to decrease, they are still over used in many communities. For example, here in my state of Connecticut, some hospitals have an over 25% episiotomy rate, when science tells us there really shouldn’t be over 10%. Trying to obtain these numbers are like pulling teeth too FYI!

We also have vaccum extraction. I had never really discussed this or spoken with someone who experienced this until I met my Chiropractor in the summer of 2008. He was discussing with me why Chiropractic care in infants is important, and then he described his own daughters birth, they had applied the vaccum to the top of her head, and while “assisting” her out, they pulled so hard the vaccum literally flew right off of her head. My Chiropractor described it so vividly… “I thought her HEAD popped RIGHT OFF! I was horrified to even look!”? My heart broke for him because no parent should have to go through that kind of fright during the birth of their child!

These all often lead to epidurals, which especially if you are going to have a cesarean section, you will either have this or a spinal block. All types of anesthesia that will have a direct impact on the baby. Although I have experienced women told there will be no effects on their baby at all.
I am sure most know about the “breast crawl” and I can say after watching a baby who’s mother did have an epidural, as opposed to a mom who had a natural birth, there is no comparing the instincts of the baby. While I had epidurals with both of my children, I didn’t have the opportunity to breastfeed then until they were a little over an hour old. My first was almost 2 hours. For more information on epidural effects on babies, click this link!

The last thing I want to touch on is the separation of mother and baby after a cesarean section which is very common. It is pretty uncommon for an newborn to be allowed to stay in the OR with mom, although it does happen sometimes. I can really related to the lack of bonding, breastfeeding problems, and reduced bonding because of this because I deeply experienced this with the births of both of my children. While I bonded, it was not that “instant motherly love” I am sure most feel. It hurts me to this day to know that my bonding was an almost learned bonding because I knew as a mother it was something I needed to do in order to protect my babies.? While most women who have had cesarean sections are not quick to admit this, I think by discussing this and acknowledging that this is a true problem it will only help to improve it for others in the long run. I also noticed that mothers who do experience this may be ashamed or fearful to admit this because it make portray them in a less than perfect light, or maybe others may look down on them because of this, but they should not be ashamed. It happens and there is nothing we can do about it but help other women to not go through what we did!

Be empowered by your birth, no matter how you birth!
If it is a bad experience, help to educate others so they do not go through what you did, so they can avoid the pain or heartache you have dealt with!

Avoid Giving Birth on the Back and Follow the Body?s Urges to Push

This one just seems like it is out of the Journal Duh.? I mean seriously folks, how can laying on your back NOT be pushing uphill? Can someone cue the song from Wicked: Defying Gravity?? Oh and can you quit screaming at me while I try to give birth to a baby?? This isn’t a football and I don’t need a cheerleader.? I know what to do.? You just be quiet and let ME make all the noise!

Mothers Advocate Video | Mothers Advocate Handout | Lamaze Paper

Bring a Loved One, Friend, or Doula for Continuous Support

When discussion of doula care surfaces on the Internet, it is always surprising how many commenters dismiss continuous labor support by a trained professional as unscientific fluff. Couples who hire a doula are sometimes labeled as selfish, out for “the experience” and elitist.

When a person believes that a pregnant woman (who is not planning a cesarean) checks into a hospital in labor to have a medical procedure performed on her, the idea of labor support seems superfluous. You wouldn’t bring a doula to heart surgery, the naysayers grumble. However, hospital birth should be an opportunity to allow a physiological process to take place in a location in which skilled professionals are readily available to intervene immediately if necessary. A primary goal of maternity care should be determining exactly what is optimal in supporting this physiological process, then ensuring that women in institutional settings have access to whatever best supports the normal process of birth.

Until the 1970’s, most American women labored alone, separated from her loved ones. Advocates, vocal consumers, obstetricians like Robert Bradley and childbirth educators fought hard for the right to labor with a partner. In Birth as an American Rite of Passage, Robbie Davis-Floyd wrote, “Hospitals tolerance of fathers’ presence increased as it was discovered that when fathers are educated and prepared for birth, the support they provide the laboring woman enables her to cope with her labor in more socially acceptable ways (breathing instead of screaming, for example), thus helping her and making it easier for hospital personnel to cope with her.”

While the normalization of epidural anesthesia has filled the role of allowing hospital staff to cope with laboring women, often multiple laboring women at one time, many women would still prefer to optimize support of the physiological process of birth and are not given the chance to do so in hospitals or are discouraged from hiring a doula by those who claim that birth is best left to science.

Fortunately, everyone wins with continuous labor support, the efficacy of which is supported by scientific evidence. According to Childbirth Connection, women who received continuous support were less likely than women who did not to:

• have regional analgesia
• have any analgesia/anesthesia
• give birth with vacuum extraction or forceps
• give birth by cesarean
• report dissatisfaction or a negative rating of their experience.

Here are just a handful of links that detail the evidence supporting continuous support of laboring women. And, really, is support of laboring women something that needs scientific evidence to justify its normalization?

Cochrane Review on Effects of Continuous Labor Support (Childbirth Connection)

Best Evidence: Labor Support (Childbirth Connection)

Healthy Birth Practice #3: Bring a Loved One, Friend, or Doula for Continuous Support (Lamaze)

A Doula at Your Birth (VBAC.com)

CAPPA Position Paper: Evidence-based Labor Doula Care (pdf)

OBs denying doula access: Where’s the SCIENCE!!!1!? (Hoyden About Town)

Why Did I Move During Labor?

I never knew the importance of moving around during labor until I was actually in labor with my second child. With my first I was strapped to a bed, a fetal monitor, and pitocin, so I never really had the option of moving around.

My second time around I realized why it was so important. When I would have a contraction, if I moved, rocked, walked, it would help the pain. Sitting in one spot, tensing up, screaming, or clenching onto something all made the contraction itself a million times worse. As my labor progressed, I realized this. Which helped me to “ride the wave” which is how I looked at getting over my contractions. I pictured them as a giant wave that I must surf over in order to get closer to my baby. As the time went on, and boy what a long labor I had, I realized the more movement the less pain.

The modern form of maternity care, which keeps women in one position, place, or hooked up to machines is what is causing the fear of pain in society today. Because woman’s friends, and family members are routinely going through this kind of system, it is becoming the tell tale so much more.

Until there is a change in how hospitals deal with birth, women are going to continue to think birth is the end of the world because they are not being allowed to move or be active while in labor, when in the end, it does way more good, than it does harm.

Move, Walk Around & Change Positions Throughout Labor

Moving in labor is something that we don’t often think about these days.? After all, if you give birth in a US hospital, you walk in and see a bed.? If you were following the live birth on the Internet the other night, we were all amazed at the size of the room (it was small) and it was the VIP room!? What did you see prominently featured in the center?? he bed, of course.? Unfortunately freedom of movement in labor has come to mean, you can lay on your right or your left side.

I’m here to tell you that moving around in labor helps a lot.? When my leg hurts, I shake it out, I stand up and move, changing how I put pressure on it.? When my back hurts, I stretch, bend and fold until the pain subsides.? Labor pain is no different.? And yet by restricting movement we take away a woman’s freedom to alleviate that pain without medications.

Now, some hospitals will claim that they are not actively restricting movement of their laboring patients.? And while we do not hand cuff women to their beds very often anymore, we do tether them with physical items like IV poles and fetal monitoring equipment.? Then add the psychological aspects of the bed and being a good patient and throw in a poorly designed hospital gown that shows your buns at every turn and you’ve got a woman who is more likely to stay in bed.

So here are my tips for freedom of movement:

• Begin this discussion early and often with your practitioner. Ask lots of questions that can only be answered with open responses.? “Can I move?”? elicits the answer: “Sure!”? But you’re thinking hands and knees, squatting and roaming the halls and? your practitioner is thinking, on your back and sitting up. Try something like, “What positions have you seen women give birth or labor in?”? You might also try, “What positions do you recommend for pain relief in labor?”

• Tour the hospital or birth center. Other than a bed, what can they provide you to help you move?? Do they have birth balls?? Do they offer an early labor garden or path? These hospital tours are given in groups or in private.? Try both if you can.

• Exercise and practice. Just as with anything, if your body isn’t ready to use muscles that are required to squat, you’re not going to be very successful at doing so. It will also help you and your partner feel more comfortable as the movements become familiar to you and your body.

• What tips would you add?

For more information on this healthy birth practice, you can see:

Lamaze’s Handout | Mothers Advocate Handout | Mothers Advocate Video