Why Gentle, Natural Birth is so darn important to me

We recently sat down with our doula to work on our Birth Plan (or Birth Preferences, call it what you will). Deby, our doula is a very important part of our birth team... we have an entire team of people who support natural birth and have confidence in both my body and our baby, and as I discuss our upcoming birth in more detail with our team, I think of the Nigerian proverb, "It takes a village to raise a child." I believe it takes a village to naturally birth a child!

We will certainly have our own little village at the birth center on BG McD's birthing day... John will be the most involved person supporting me, he took hypnobirthing classes with me and will be in the tub and/or wandering around the birth center. Our doula will come to the house when I am in my early labor and will travel with us to the birth center. She'll be there to support both John and I for the entirety of labor and make sure we get breastfeeding off to a great start. Our midwife and an RN will be at the birth center quietly monitoring my progress, mostly from a distance. Unlike a hospital, there is a 1:1 nurse to patient ratio at the birth center. Our friend, Christine, will be part of our birth team, photographing our birth experience (PG-13 of course!). Our hypnobirth instructor, Kate, may be able to join us as well. This would be pretty neat because listening to a live coach is going to be better than a CD, and we've gotten to know Kate over the past couple months-she's been such a great source of support and encouragement in this pregnancy.  Last but not least, my mom will be coming to the birth center, patiently waiting outside our crunchy birth mud hut [ok, so she'll be in the family room of the birth center-- it's air conditioned, but most people envision me squatting in the mud when I tell them I want an out-of-hospital natural birth]. So here we are, we have our village. The birth center looks like it belongs in a village... or in the countryside. You'd never guess it's across the street from a major hospital.

Hypnobirth. Midwife. Doula. Birth Center. Why all the fuss? Why not just stay with the OB I've been seeing for almost a decade? I live less than 1 mile from a hospital with a maternity ward, why drive an hour away in labor? 

Because I have come to understand just how broken modern American maternity care is. It is broken and needs to be fixed. I will advocate and educate and do what I can as a supporter of better maternity care, but I will not put my baby or myself at unnecessary risk in the process. There are two types of risks here... mortality/morbidity risks, such as medical decisions that impact our well-being, and there is also the risk of both of our experiences in birth. I'm not willing to jeopardize either. The medical risks are the priority so I'll run through a few of those first...

1. Maternal mortality. The US has an EMBARRASSING maternal death rate. PATHETIC. We rank below 38 other industrialized nations. This Guardian article was written to discuss the decline in UK healthcare, which is much better than our poorly managed American situation.

Maternal Mortality: How many women die in childbirth in your country?

Since the advent of obstetricians in the 1800s, OB's have never surpassed midwives in outcomes (both for mother and baby). Obstetricians often trained in medical school without ever seeing a live birth, and few if any performed a live pelvic examination. The books PUSHED and BIRTH: THE SURPRISING HISTORY OF HOW WE ARE BORN are great resources [with statistics and academic references] displaying the ridiculous lack of education preceding the great authority OB's had in the early 1900s.

 

After reading these books and the evolution of medicalized childbirth, the abysmal mortality rates in the US made much more sense... it also made perfect sense to me that I needed a midwife. I must say, there is a time and a place for an obstetrician. There are instances in which surgical birth saves the mom and/or the baby, and there are OB's who are appreciative of a woman's ability to birth. Finding these OB's is easier said than done, and many just don't know otherwise. I will forever remember sitting with my OB/GYN in her office, several weeks before I switched to a midwife. This woman has had four children herself, she's been on maternity leave every other year I've needed to schedule my annual physical. She looked at me like I was nuts  when I said I didn't want to be tethered to a bed to labor. She had no good explanation as to why my local hospital's c-section rate is more than double that of the World Health Organization (WHO)'s 10-15% guidelines. She even went on to tell me that in medical school, she was taught that patient request is an indication for cesarean. All a woman has to do is ask for major surgery! Can you imagine walking into your primary care physician's and asking for an appendectomy!? You'd be committed to a psychiatric facility if you legitimately asked for an unnecessary gallbladder removal or arbitrary tonsillectomy. Women opt for avoidable cesareans daily. Having certain interventions put women at higher risk for c-section, and unfortunately medical complications, some of which can leave a woman infertile.  It seems as though maternity care is the only healthcare specialty in which practitioners often have a carte blanche with regard to their own agendas, where few women are TRULY informed and it's the exception, not the norm to provide patients with the benefits AND risks of each procedure or intervention (hellooooo, informed consent!). Here are a few other facts that many doctors may leave out of their prenatal and maternity care conversations:

• Having an elective c-section increases risk of maternal death three-fold compared to vaginal delivery
• There is an increased risk of hemorrhage and/or sepsis in c-section, the doctor can knowingly or unknowingly knick an artery, organ, or tissue, which can leave a woman open to internal bleeding and/or serious infection
• In 2-6% of c-sections, the doctor cuts the baby with the scalpel
• 20% of women who have c-sections experience hospital or doctor-caused infection, with antibiotic-resistant bacteria increasing at all US hospitals, this can be particularly dangerous
• Even if the c-section occurs without incident, subsequent pregnancies have risks- embryos will not attach to scar tissue so there is an increased risk for out-of-uterine pregnancy (ectopic or otherwise), the placenta will not attach effectively to scar tissue so placenta previa risk increases (as does the risk of the placenta detaching), the uterus is at higher risk of rupturing in a subsequent birth, this risk multiplies with each c-section, further weakening the uterine muscles--having induction drugs after c-section further increases THIS risk, as your body is not nearly as likely to push the uterus beyond it's capabilities as inducing drugs (cervidil, prepidil, pitocin, etc) would be.
• Having an epidural significantly increases likelihood of instrumental vaginal delivery and c-section

Epidural anesthesia carries notable risks as well:

• 1 in 4 women receiving an epidural will experience some sort of complication
• low blood pressure, fever, nausea, vomiting, heaedaches, shivering, and prolonged labor are common
• Babies can experience significant, dangerous side effects- low blood pressure, toxicity, oxygen deprivation, malposition/inability to maneuver down the birth canal
• Paralysis (1 in 500 temporary, 1 in 500,000 permanent)
• 4 times greater risk of forceps or vacuum assisted delivery
• 30-40% of women experience back pain after birth, 20% still have the pain 1 year later
• Urinary retention is experienced by 15-35% of women who receive an epidural
• 15-20% increased risk of fever during labor which means baby and mom both get antibiotics, baby will likely require a spinal tap in the first day of life
• 10% of epidurals fail to work, so the woman has the risks listed above with no pain relief

Don't get me wrong, I'm not anti-surgery, there is a great value in c-sections when used with discretion. The problem is, 5-10% of labors result in urgent medical need for c-section... in CT the lowest rate at a hospital (as of 2007) is 28%. There are some hospitals in CT with nearly 50% c-section rate, and 2% or less VBAC rate. The WHO states that anything over 10% for healthy populations and 15% for high-risk populations increases risk of injury or death to mom and baby. A few examples of necessary cesareans might include:

- fetal distress (with second opinion), not just assessment of one strip of monitor tape

-placenta previa (placenta is completely covering the cervix)

-abrupted placenta (placenta detaches before baby is born)

-transverse lie (baby is positioned horizontally instead of vertically and cannot be turned)

-prolapsed cord (the cord is compressed between baby and birth canal and cannot be freed)

-hyperstimulated uterus (caused by inducing drugs, contractions that are too intense and cannot be medically managed can cut off oxygen to baby and put mom at risk for hemorrhage)

-uterine rupture *true emergency!*

-preeclampsia (high blood pressure in pregnancy, second opinion should be obtained before c-section)

-active herpes outbreak (can be passed to baby)

-HIV positive status (surgical birth can reduce baby's likelihood of contracting HIV)

2. So those are my primary medical concerns for hospital birth... but what about the quality of our birthing day? What about our birth experience? If a woman and baby get to go home safely from a hospital, the family is expanded by one (or multiple) people, isn't that a success? Well, not really. Research in birth trauma for both mom and baby is increasing in popularity in the fields of psychology and public health. As we learn more about babies' awareness in utero and during/after birth, we must consider THEIR experience as well. There's an exceptional blog post I read a while back that takes us on a journey through the baby's experience in birth: 

What Natural Birth Means to Your Baby  

This blog brought up several points I hadn't considered- I though dim lighting was part of natural birth because it's calming to us, must be calming to babies, right? Well it didn't occur to silly me that the baby has never been exposed to light beyond potentially seeing a small difference in dark vs. really dark in the womb. We often have multiple overhead flourescent lights, if a doctor has a woman spread-eagle on a table there are huge bright exam lights as well... this has to be unpleasant and uncomfortable for baby. Similarly, people are excited, they yell, "PUSH!" and encourage the mother loudly, "One more! You're almost there!" or "Here he/she comes!" ... this baby's ear canals have been fluid-filled until a few minutes ago, and even then baby was inside their mother- what a sensory overload! Remember, the baby has only existed in liquid up to this point- commonly they are roughly toweled off, handled by multiple gloved strangers, and handled gruffly by these strangers who are all to accustomed to quickly maneuvering tiny infants- what an unpleasant way to meet Mr. Gravity.

For these reasons we will have a doula in our "birth village," we have educated ourselves about what kind of birth we hope for, we have selected medical professionals who judiciously use intervention in the least invasive way possible only when medically necessary, those who value and honor baby's experience, acknowledging her as a tiny, vulnerable person. You only get to be born into this world once, you only meet your parents for the first time once, shouldn't it be a safe, comforting, loving experience?

Reflections... and rants

I am 17 weeks pregnant. I've been contemplating starting a blog for a while now, about as much as I've contemplated diligently completing the baby journal I eagerly purchased at 6 weeks pregnant!  I've kept some strong opinions to myself on this journey thus far and I have shared some to others, but I want to record it all, so here we are!

Our journey TO pregnancy was 15 months of anxiety, waiting, frustration, and disappointment (in the little pink lines, not each other!). I had an interest in natural birth long before it became relevant and the year and few months we were trying I learned more and more about the world of modern maternity care in America, what women were allowing to happen without question, and the consequences of this herd mentality. There is no shortage of internet resources about women who felt traumatized by their birth experiences, some of whom likened their birth to medicalized rape, just awful pain they live with long after their body has healed-- I don't want any part of that! --During one my unpleasantly regular visits to the OB/GYN's office I ran into my OB, whom I've been seeing since I left my pediatrician (it's been a while!). When I went to college I scheduled my annual exam around breaks so I could keep this doctor, I had never questioned that she would be the person to "deliver my child," (it never occurred to me that I am a WOMAN, I was MADE to make babies) so thinking of these horror stories women had, I started feeling out my doctor for her thoughts- by this point I had researched hospitals in the area and the hospital where she delivers is known as one of the most restrictive hospitals in the state- their idea of a "family birth place" is letting you bring in a photograph, gee thanks- what did you let Kodak sponsor the purchase of your EFM's??? Let me get this straight, you get strapped to a bed as soon as you get in, have a high episiotomy rate and a ridiculous c-section rate, but good thing I have my photograph to focus on...it'll all work out, right? Hmmm. So all the terrible reflections of births gone bad started with a doctor giving vague or evasive answers about hospital policies, their general practices, and wouldn't give the women direct answers about when they c-section and when they don't. Surely my OB wouldn't be like this! She'd have great, concrete answers! Right? 

Wrong. She couldn't give me a single answer about the benefit of these hospital policies that directly conflict with the World Health Organization's recommendations for optimal maternal and fetal outcomes. When I inquired about the c-section rate at this hospital she assured me that she is "more patient than some other doctors," but couldn't explain the near 40% statistics at this hospital-- So 4 in 10 women cannot birth their children without surgery? If that was the truth, would our society have made it this far? Again- she had no answer. I want to walk and move during labor- doc just looks down and away- Red flags, anyone? I politely ended our conversation, took my records for the fertility clinic, and never went back.

Fast forward to November, we're 5 weeks pregnant and need a new caregiver. If I want to be honest I am feeling a little anti-obstetrician at this point, and I know I want a midwife. Our options in our state are slim, we can see a midwife in an OB practice and hope we get her when we're in labor (still in a hospital), there's a birth center an hour away, and there is ONE home birth midwifery practice in the state. The home birth midwives didn't call us back and the birth center could see us for a tour right away, so off we went. 

We immediately fell in love with the birth center and the midwife we met with, so we scheduled our first visit. The birth center (BC) is everything we could want, it looks like a bed and breakfast, each birth room has a 2-person shower and jacuzzi, a queen size bed, a birthing rocker, and a birthing ball. Bring on the natural birth!!! 

The next week we had a great first ultrasound at the fertility center and were ready to grow a baby to birth naturally! Awesome! We did our homework, I know just about every statistic related to every birth intervention and relaxation technique, I'm ready to give birth! Now off to get some organic produce to grow my organic baby.

I had this silly misconception that if people asked about our birth plans, they'd find it cool that we were going to do this the way nature intended (hence the natur-al). WRONG again! So here's my rant-here are the things I've heard and why I have beef with them:

*Judgement*It's dangerous to have a baby out of a hospital.

     *FACT* In a healthy pregnancy, there are less interventions and risks OUT of a hospital

*Judgement* You need a doctor.

     *FACT* Midwives have better outcomes internationally than OB/GYN's, the first OB's were trained BY midwives, but their outcomes have never been as good as midwives.

*Judgement* If the baby has the cord wrapped around it's neck it could die.

     *FACT* Tons of babies have cords around their neck, it's rarely dangerous and if it is, it can be cut really quickly. In actuality, when doctors break a woman's water, it's more likely to coil the cord because a flushing effect (think of a toilet) occurs and the amniotic fluid swirls out quickly... doctors can CREATE the "dangerous" situation that they "rescue" babies from. 

*Judgement* You'll want an epidural.

     *FACT* I fear an epidural and possible subsequent interventions more than I fear any pain that labor could give me. I know what it entails, I know what risks it comes with, I don't want anything to do with it.

*Judgement* There could be an emergency

   *FACT* Good thing I have great midwives... they'll watch me in person rather than interpreting a monitor down the hall so they'll know if something is becoming less than ideal long before it's urgent... if anything is urgent, there's a hospital across the street. 

*Favorite Judgement* Why would you go through labor when you don't have to? If you have a c-section you don't have to go through that!

 *FACTS* Labor will probably hurt, but as Ina May likes to say, it's "honest pain," once the baby arrives, it's done... why opt to unnecessarily cut through layers of skin, muscle, and organs to be in pain for weeks after?!

Here's a judgment of my own- women who eagerly sign up for multiple c-sections probably haven't educated themselves about the serious risks each subsequent cesearan poses. They probably aren't aware that a placenta doesn't want to attach to scar tissue, each time there is a cesarean, there is more scar tissue, making the next pregnancy more risky. C-sections are major surgery, they have a 3x higher risk of death than vaginal delivery. I get it, c-sections can save lives, when done properly in the right situation to avoid death or injury- but when they're done electively, they CAUSE injury. They can complicate future pregnancies and births... I feel like it's so American to be so self-absorbed that people are blissfully unaware that in the rest of the world,  c-sections aren't treated this way and these countries operate less often and lose less mothers and babies. Ignorant America ! Ugh!

That's enough of an intro I suppose... next blog maybe I'll reflect on this thing called pregnancy!