Monday, June 24, 2013

What a birth educator wants YOU to know about birth!


I'm a birth junkie, plain and simple. I love learning all about birth and sharing all this knowledge with those around me.

Unfortunately though, my interest in birth has allowed me to witness, both individually and on a population scale, the widespread abuses of women in childbirth. Years of experience as a birth doula, home-based educator for new mothers, and my Master's education in the field of maternal and child health has led me to the firm conclusion that birth in the United States isn't as good for mothers and babies as it can AND should be!

This knowledge and experience has impassioned me to protect and inform women. I want my friends, family members, ALL WOMEN, to understand the options they have for their childbirth. That they don't have to be abused, pressured, or scared. It is my hope that women learn to trust themselves and their bodies and can say "enough" when they are disrespected in their care.

In my experience, many women have an upsetting, dis-empowering, or even abusive first-birth. This is often because they "just trusted" the doctors and the system to care for them - they didn’t research their birth choices, look into their hospital's practices, and ensure they had found a care provider that agreed with their vision of birth. Then, for their second birth they completely change everything and educate themselves so that they can feel more “in control” of their birth and take an active role in decision-making.

Most people will spend more time researching the next car they will buy than researching and preparing for their first birth… don’t be one of those people!!!



 First,  CONGRATULATIONS! 

Whether this pregnancy was planned or unplanned, expected or unexpected, conceiving was easy or difficult... you have likely been through a great many emotions and decisions up to this point, so CONGRATULATIONS on your pregnancy and for making it this far!

This post is being written for a variety of women; I will recommend things, or just briefly mention an option/topic. If you feel something resonates with you, or you would like to know more about a topic, then by all means follow your intuition and look it up! 

That leads me to my first topic, your intuition. Please begin now in nurturing and developing this sixth sense you have. Learn to trust your heart and gut feelings. Often these intuitions, or "gut instincts", are right...learn to listen to them. 

On that same note, sometimes these instincts get confused with a nagging thought, a thought which stems from stress and fear, especially when we are experiencing the unknown; fear of the possibilities can build and build. Living in fear is never healthy and can lead to many life-long consequences. We know that increased stress across the life-span can lead to poor health outcomes... chronic stress during pregnancy can contribute to preterm birth. Fear guides stress into your life, into the corners of your mind. Banish this fear by educating yourself. There is more information available to you than you could ever ask for, educate the fear away. 


 BIRTH WORKS!

Birth works for the majority of women and babies, the majority of the time. The reality is that very few women and babies will have a true complication in birth. These complications are often apparent before active labor begins, birth occurs, and especially before anyone (mother or baby) were to die. There are very few births that ACTUALLY need medical intervention, but, in our medicalized birth model, there is fear of the "risks and complications" and all motherbabies are treated as ticking time bombs.

While this, of course, is not the case for all medical systems, hospitals, and doctors... it is often the case.

The fear and dangers we hear about in birth come from the doctors and hospitals themselves. They operate in a fear-based model that views birth as dysfunctional and in need of medical intervention to save women and babies from their dysfunctional bodies. Many times, a doctor has never witnessed a woman have a natural birth without any medical intervention - they've never witnessed birth actually work.

This can be further exemplified in the fact that the majority of births in the U.S. are attended by a surgeon, the Obstetrician. If we trusted women's ability to give birth, then midwives would attend the majority of women in birth with surgeons as back up. Fear of litigation has led to doctor's practicing offensive/defensive medicine to protect themselves from being sued in the event something does happen - if a doctor monitored the fetus continuously and then did a cesarean section when the monitor showed a little dip, then they feel safe from being sued because they can say "they did everything they could" - when in reality the mother likely ended up with an unnecessary surgery and will suffer from it.

I believe in your ability to give birth and so do MANY others! You, your baby, and your body were made to work perfectly together in unison to birth a baby safely! This being said, question every procedure, whether it is another ultrasound, amniocentesis, induction, labor augmentation, continuous fetal monitoring, laying on your back, episiotomy, etc… none of which are practiced in an evidence-based manner in hospitals across the U.S.

It is my sincerest wish that you and your baby are able to experience a better birth because you were educated about your birth choices and felt empowered to make them... long before the day when you have to refuse the wheelchair as you waddle into the hospital and begin advocating for yourself, (your partner), and your baby to have a happy, safe, and healthy birth!

  CHOOSE A BIRTH LOCATION


Most people will see this headline and be confused because they think the ONLY place and/or the SAFEST place to give birth is the hospital... but this isn't necessarily true. For a healthy woman and baby, home birth can actually be safer than hospital birth due to some of the risks (i.e. hemorrhage) of routine interventions (i.e. Pitocin and Cesarean surgery), frequently overused in the hospital (1). For a healthy woman and baby without any medical indication, a Cesarean surgery carries more risks than a vaginal birth. Always.


HOSPITAL - If you choose to give birth in a hospital be sure to research the hospital and the doctor(s) you will be birthing with. Does the hospital have a high cesarean surgery rate? Do they "allow" Vaginal Births after a Cesarean (which are safer than repeat cesarean section for most women!). If they advertise having "birthing tubs" are they actually used? (more often than not they don't allow women to use them!)
Depending on the answers to these questions you can start to see whether the hospital will provide the kind of atmosphere you need.

If you are wanting a vaginal birth and thinking about trying to labor without medication, but the hospital you are birthing at has a 40% cesarean surgery rate, 85% epidural rate and doesn't allow VBACS... then you may be stacking the deck against yourself and your baby. Find another hospital, another provider, or stay out of the hospital and consider a birth center or staying home.

"High-risk" can be rather subjective at times, with  women over 35 being labeled "high-risk" as well as women with one prior Cesarean section - these cases aren't always high-risk. In some cases a birth center or home birth would be acceptable if the mother desired it, be sure to discuss your choices, risks, and benefits with your maternity care provider!


HOME BIRTH is often the most peaceful, intimate, and empowering for a mother, baby, father, and family. Generally, women and men who choose home birth are well educated about the risks and benefits. They trust the mother, her body, and the baby to work together to complete the birthing process. They believe and trust in birth. Here is a great post from Evidence-Based Birth with more information about home birth. Typically a midwife would assist in a home birth.

Of all the births I've attended, the home births are the ones I personally enjoy the most. I love all births and witnessing the first meeting between parents and baby. But the births that occur at home are so special, so intimate... the experience will keep you feeling whole and loved for weeks and weeks. Many women in developed countries around the world birth their babies at home and ALL those countries have better birth outcomes for mothers and infants than the U.S.



BIRTH CENTERS are a wonderful "middle ground" between hospitals and home birth. They are designed to feel more like home, but have access to much of the same maternity equipment as the hospital. Some birth centers are attached to hospitals and others operate independently, but with a local hospital as a partner in case of emergency. Birth Centers follow a midwifery model of care and as such they are more peaceful, respectful, and family friendly than a hospital birth. Here is an excellent summary of the options and the research from Childbirth Connection.

You also need to choose a care provider (or not, if you are going unassisted!). You can be with a physician such as an Obstetrician or Family Physician in the Hospital, in some hospitals you can also been seen by midwives. If you are delivering in the hospital and they have midwives, go with them! If you are giving birth in a birth center, there will be midwives! If you are delivering at home then you can use a midwife (such as a CNM or CPM). Interview the provider before choosing, to be sure your desires and choices align with their typical practice.

Remember, it is NEVER too late to switch care providers if you feel yours isn't right for you! Trust your gut, your mama instinct, and choose where you birth your baby based off how comfortable and safe you feel. You DO NOT have to give birth in a hospital and for many women the hospital isn't the best and safest place to give birth!

  GET EDUCATED


We can't do something without knowing how it works and what to do... and birth definitely isn't any different! You need to learn HOW the body and the baby work together and what can be expected from the labor and birth process. Far too many women enter pregnancy and childbirth with little to no idea how their body works, such as how the uterus works to expel the baby and how contractions open the cervix in two directions, opening wider and pulling up. Understanding how your body and baby work together will give you more confidence that the sensations you feel during labor are progressive and moving you toward meeting your baby.

READ - There are many, many wonderful books now for pregnancy and birth. Really, my only recommendation here is to avoid the book What to Expect when you are Expecting. This book is poorly written and is disgustingly biased toward intervention ridden birth. It is a dis-empowering birth book and is geared towards preparing a woman for how to willingly submit to the medical system.

I recommend reading lots and lots of positive birth stories and books that prepare you for childbirth while also advocating for your rights as a woman and mother to choose which care you receive or refuse. Some excellent books include: Birthing a Better Way: 12 Secrets to Natural Childbirth by Kalena Cook and Ina May Gaskin's Guide to Childbirth. Visit my Resource Recommendations page where I list a number of books with a short review to help you decide what is right for you!

CLASSES - Take a childbirth education class and a breastfeeding class before you give birth! In a class you will have the opportunity to meet other parents, perhaps some seasoned parents as well as new ones, and ask questions of a birth professional. You will learn about the physiologic process of birth, choices you have during labor and birth (such as pain management and infant procedures), and get to practice positions for labor and pushing, as well as natural pain management techniques such as massage. A childbirth education class offered in the hospital might be a little more geared towards preparing you for hospital interventions - rather than natural childbirth. There are many options for natural childbirth education (that also teach about hospital management and choices!) such as Lamaze and Hypnobirth. Learning about Breastfeeding before giving birth will only help you in the long run and make you more confident when any challenges do arise.


WATCH - The Business of Being Born. This documentary is available on Netflix and can be found on the internet. It is very intriguing to watch and provides an excellent overview of the current state of our maternity care system. 

I suggest EVERYONE watch this movie!! You won't be bored, trust me! Additionally, if you are feeling bold and ambitious, watch Orgasmic Birth - you'll be surprised at the secrets the medical community has worked so hard to cover up... that birth can be easy, pleasurable and even Orgasmic!


 Remember how to make those totally normal fears about birth go away? Educate yourself. Read and learn until you understand the things you are afraid of. Read positive birth stories, other people's positive experiences, until you know they are real and possible for you!


 GET A DOULA!

Seriously.  Every woman (and her partner) deserves a doula. In many hospital rooms, if a doula is present she is likely the ONLY evidence-based part of care the birthing woman is receiving. Doulas decrease the need for pain medication and epidurals, negative feelings about childbirth, the need for a cesarean birth or assisted vaginal delivery, and the length of time you are in labor; babies born with a doula assisting also had higher APGAR scores. Here is an excellent article from Evidence-Based Birth about Doulas.

Everyone benefits from the presence of a doula, even the dad! Birth is a laborious event and not just for the mother :) Dads are one incredibly important part of the birth team, but they get tired too! Having a doula makes for a very strong birth team where dad and doula can work together to support the mother, but also provide one another breaks without having to leave mom alone. Doulas can also help with questions about care options and providing all types of physical and emotional support.

You can find a doula in your area that you can afford, I promise! You can search for doulas online through an organization such as DONA International. You can also ask doulas that you call if they have other doulas they can recommend. Be sure to interview your doula and only choose one you feel witll fit well into your birth team and that "jives" well with you and your husband/partner. Some doulas in training will provide their service free or for a very minimal fee - please consider tipping these doulas as they work very hard to provide you the best supportive care!

 CREATE A BIRTH VISION

You can go wherever your heart takes you on this one. If you are a writer, write out your birth story, as you want it to be. If you enjoy drawing, then create a picture, crafting, then make a vision board. 

This activity serves multiple purposes. While imagining, writing, or designing your birth vision, you may encounter some fears or concerns you have - then you can address these. You may decide you want to be able to walk around and squat while you push your baby out (best physiological position for birth!), then realize that this may not be possible in the hospital you are currently scheduled to give birth at - then you could change your provider, perhaps look into a birth center or home birth with a midwife.

You can also use your birth vision to create a birth plan. This should be a positively worded one-page document that explains (simply) what is important to you for your birth. One example might be: I wish to have my baby skin-to-skin after the birth, uninterrupted so we can meet one another and establish breastfeeding. I plan to breastfeed, please do not offer my baby any pacifiers, bottles, water, or formula. 

A birth plan may be the most important in a hospital birth to help the nurses and doctors to understand what is important to you. On the other hand... some hospitals, nurses, and doctors disregard them or see them as annoyances - avoid these places and people, they likely do not believe in your childbirth rights and your ability to give birth and make choices. Find someone who does, you and your baby deserve it!


WHEN LABOR BEGINS

If you have decided to have your baby in the hospital, then stay home as long as possible!! It is often said that the first intervention a woman has in her labor/birth is walking out her front door. The last thing you want is to get to the hospital too early and either 1. Be sent home, or 2. Get trapped at the hospital with their time-constraints and busy hands that may want to intervene. Your labor will likely slow down, even back track, when you leave home for the hospital. So stay home, eat, sleep, rest, shower, drink lots of fluids, BEFORE you go to the hospital and you are on someone else’s turf.

Labor, especially for first time mothers, is going to take quite some time. Having a doula can help you stay home longer by relieving your nerves about being alone without trained support.  Although she will not perform medical tasks, she can help you recognize signs of early labor or labor progress and help you with your decision of when to go to the hospital. If the baby comes when you are at home, don't panic. Many, many babies are born at home throughout time and around the world - birth works very well and it will be successful this time too :)


Bring your own birth gown to the hospital. Remaining in your own clothes gives you more power and confidence... wearing someone else's clothes in their territory makes you more submissive and less likely to feel in control.

Consider walking around outside the hospital for awhile before checking in. Remember how labor likely slowed down when you left home... well, get some progress back before getting locked into the hospital. If it isn't an emergency, and it likely isn't, then take your time :)

Once you are in the hospital - be sure to keep moving as much as possible. They will try to get you into a bed, hook you up to fetal monitors, do vaginal exams, insert an IV (or heplock), and then the intervention snowball begins to pick up speed. Now that you are in the hospital you may be feeling less anxious about the birth (because you feel safe), so try to deflect the interventions as long as possible... they will still be there later if you need them!

Breastfeeding - Breastfeeding gets off to the best start when mother and baby are skin-to-skin after birth and allowed to bond for the first 30min to 1 hour. Breastfeeding is a beautiful, natural way to feed and nourish your rapidly growing baby. Breast milk is the most optimal nutrition you can provide.

Many babies still receive formula or water supplements in the hospital, EVEN when the mother expressed a wish to exclusively breastfeed (some studies say up to 30%). Research shows that just one bottle of formula can alter the baby's gut bacteria (which may have serious consequences in some babies). Formula is not "second best" to breastfeeding, as many of us have been told, another woman's breastmilk is. If you do decide to use infant formula, look into goat milk derived formulas as these are healthier for the infant's system than cow's milk formulas. Cow derived formulas are associated with increased risk of infant illnesses, SIDS, childhood obesity, allergies, asthma, and more.

Even if you aren't sure you want to breast feed, your baby will want to nurse on you for comfort and love after they are born. Perhaps give breastfeeding a try a few times and see how you feel about it after you and your baby get a chance to experience it, together. You can always decide later if it isn't right for you or your baby, but it is harder to go back and try again later. I have personally supported many women who said they did not want to breastfeed, then after the baby was born and rooting around for their nipple, the mothers crumbled with love when their baby latched on. Many of these women ended up breastfeeding for many months :)

If you haven't seen or heard of the "newborn breast crawl" then you MUST watch the amazing process of a baby crawling themselves to their mother's breast and latching - all by themselves! No one needs to force baby to latch, let them find it on their own while you fall in love with your little one and watch the magic happen! Here is one short video of a newborn breast crawl:






A FEW MORE THINGS

If the mother and baby are healthy and there is no medical indication, the pregnancy should continue for AT LEAST 39 weeks. 
The March of Dimes has info about birth before 39 weeks and AWHONN has a 40 week campaign – in case you need some scientific, research-based support to not be induced early! The natural birth advocates around the world say that if mom and baby are healthy, there is no need to induce before 42 weeks. You are not “over-due” until 42 weeks (some would argue as far as 44 weeks because your estimated delivery date may be off by 2 whole weeks!!). In any case, if there is no medical reason to do so, do not induce labor or schedule a cesarean surgery before 39-40 weeks of gestation. Of course, for most women, letting pregnancy begin on its own is the safest choice.

Limit your ultrasounds - there isn’t enough research to PROVE they aren’t causing harm… there are many people (Doctors and researchers included) that are worried about how frequently ultrasounds are done on developing babies and the potential consequences of this. Many women receive more than 3 ultrasounds during their pregnancy without strong medical reasons and there is some evidence to suggest physical changes in the baby when more than 3 are performed... so limit your ultrasounds until we know more! See my post about Ultrasound Safety.

Infant Care - Delay cord clamping and cutting! There is plenty of research to demonstrate this is the best for the baby. Your baby doesn’t need a bath, shots, eye ointment, or anything else for the first hour or two –  protect this time for you, your partner, and the baby - and to establish breastfeeding. This is the first time you are meeting this new life that has grown within you for 10 months and worked with you for so long to get Earthside. Inform hospital staff that you would like some quiet family time - you will never get this moment in time back. The first time you meet your baby is important, make sure to remind the hospital staff to respect this precious moment as such! A doula can help protect this time, help you with initial breastfeeding, and take some pictures of you as a new family.

Prenatal and Perinatal Psychology -  This is a fascinating new field about your developing child and the things they experience and already know. I recommend the book Windows to the Womb by David Chamberlain and Pre-Parenting: Nurturing Your Child from Conception by Thomas Verny. You can read more about my thoughts and discoveries with PPN here.

Diapers and formula -plan now for saving money later... breastfeeding for as long as possible to save on health costs and formula. Consider cloth diapers, even if just sometimes at home, to cut down on expensive diapers. More info here.


In the end, it is ultimately about how informed and prepared you and your partner are, along with how supported you and your partner feel, that makes your birth experience memorable! 

Even mothers who planned all natural birth at home and then needed an emergency cesarean can be happy or content with their birth experience if they felt informed and knowledgeable enough to make choices and if they felt supported, heard, and loved during their birth!!


Trust the Mother inside you and have faith in your baby and your body
YOU are an incredible creation and you have the power to birth your baby! 
You, your baby, and your birth matter!


Congratulations and Happy Birthing!
~Wisdom and Birth


1. de Jonge A, Mesman JA, ManniĆ«n J, Zwart JJ, van Dillen J, & van Roosmalen J. Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study. BMJ 2013;346:f3263 


1 comment:

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