Our Birth Preferences... and why.

I debated posting this but want to share, partly because it's great to have ideas for your own birth plan. and partly because some people look at me like I'm nuts because we're having a natural birth in a birth center (probably a water birth)... feel free to ask questions, feel free to add a link to yours, enjoy!
*My commentary is in blue italic font*

Our Family Birth Preferences

Support Team for Catharine 

Father- John   

Doula- Deby 

Mother’s mother- Debra 

Birth Photographer- Christine 

Hypnobirth Instructor- Kate 

John is my primary support person. He will be at my side at all times unless the baby and I must be separated in a medical emergency. In this case, my mother, Debra will stay by my side while John accompanies the baby.

We are planning a natural hypnobirth. We anticipate laboring at home prior to admitting to the Connecticut Childbirth & Women’s Center. We understand that unexpected complications may arise and will rely on our midwives’ medical opinions and informed consent for any unplanned interventions. In the event that our situation requires a transfer to the hospital, we have educated ourselves about potential interventions and request the following be respected if deemed safe by our providers;

Labor & Delivery

·         We strongly prefer as little medical intervention as possible one often leads to another... many procedures are done "routinely' in hospitals and aren't medically necessary for every woman

·         No artificial rupture of membranes without specific informed consent and medical reason When the baby's lungs are fully matured and she is ready to be born, she'll excrete a chemical that breaks down the waters, when membranes are ruptured before this occurs, the baby isn't ready to come out

·         Regardless of our location, we will be practicing hypnobirthing techniques and request dim lighting and quiet voices in the birthing room. She's been in the dark in water for her entire life, no need to add light and noise to the shock of this big day and the temperature change. I also read once that the first voices a baby hears should be her parents, and I like that.

       We respectfully decline any offers for pain medication, including narcotic drugs and epidurals. Some hospitals repeatedly offer pain medication, this isn't an issue at the birth center but we are preparing for any scenario. Hospitals need an anesthesiologist on staff 24/7 for true emergencies- they are VERY well paid doctors. On hospital maternity floors where less than 80% of women get an epidural, the hospital is losing money having them on duty... sick, isn't it?!

·         Our preference is intermittent Doppler monitoring, Should constant monitoring become necessary, we request external monitoring. We will need to discuss internal fetal monitoring with our midwife prior to the monitor. External fetal monitoring is inaccurate and has more false positives (panic when there isn't reason) than accurate positives ( a real emergency)... they also limit a woman's ability to move as her body wants her to to shimmy the baby down into place. Regular intermittent doppler readings by someone trained to use a doppler (a nurse, midwife, or doc) are more accurate. Internal fetal monitoring involves screwing a needle into the baby's skull and still shows little benefit... there needs to be a VERY good reason for this to occur.

·         We only consent to vaginal exams by Women’s Health Associates. We request minimal internal examinations. Internal exams are a welcome way to introduce infection- your vagina doesn't just GET an infection in labor, they aren't comfortable, either. Each cervix dilates (and can UN-dilate) at it's own pace, there is no purpose in these examinations, so stay out, thank you.

·         We prefer that an instrumental birth is a last resort to avoid a cesarean section and will attempt to assist the baby by changing positions and moving around the room/wing  A laboring woman's body is very smart if unmedicated- it will give her urges to move and bend and flex as the baby bends and flexes- further, the lithotomy position (laying on your back, legs up) is the SMALLEST, TIGHTEST position for your pelvis- not really helpful when trying to allow a small human to pass through. When upright, gravity is on your side, the pelvis is open and loose (it's multiple bones, not one circle, you know!) and baby has an easier time out. Additionally- forceps carry the risk of crushing the baby's skull and vacuum extraction is much more harsh than many doctors let on. A vacuum extractor exerts 50lbs of force (on the head of a 6-10lb newborn)... at 75lbs of force, the extractor can decapitate- sounds barbaric, doesn't it?

·         We do not plan to push on command or have counted pushing. Please do not instruct me to push unless a medical urgency arises Holding breath and counting to ten while pushing (like you see on A Baby Story) cuts off oxygen to mom AND baby (and can put baby in "distress"). Often doctors want a woman to push as soon as she hits 10 cm... when labor is left to it's own, there is most often a period of rest for mom and baby, up to 30 minutes even, where contractions slow- your body wants you to take a break before the home stretch! There's a phenomenon called the "fetus ejection reflex"... when a woman lets her body and the baby do the work, the uterus will slowly contract in downward waves and slowly push the baby out on its own... kind of like a tube of toothpaste! Letting this happen GREATLY reduces risk of tearing.

·         We prefer to avoid the use of routine IV’s, I plan to drink clear fluids during labor to maintain hydration. IV or hep-loc will be for medical necessity only and will be discussed prior to administration  Filling a woman with saline messes with the baby's hydration as well as mom's, messes with blood pressure, and leaves the woman swollen after the birth- I have also read it can mess with mom's milk coming in.

·         I prefer to wear my own clothing for the labor and delivery I'm not sick, I don't need a hospital gown! I think it contributes to the vulnerable patient image and further separates mom from the rest of the people in the room.

·         I prefer natural methods of promoting dilation, we wish to labor as long as necessary provided the baby does not exhibit signs of distress Most hospitals label a woman "failing to progress," if she dilates less than 1cm/hr... the rate of dilation varies dramatically between women and is directly affected by how safe/comfortable/relaxed a woman is. Natural stimulation methods include kissing the partner, nipple or sexual stimulation, and even intercourse (early in labor, if water hasn't broken yet!!)

·         We plan to be physically active in labor, it is important to me that I be supported in moving as my body needs to and utilizing water for pain relief—unless there is a serious medical contraindication, I do not wish to lie in bed As I mentioned above, the pelvis is made up of multiple bones/joints, the hormone Relaxin has been getting these joints ready to move for months now, the worst thing that can be done is laying on your back!! Women in labor get urges to bend over, sway their hips, lean in certain directions, squat, or submerge in water- the body knows what to do!!

·         We prefer to use perineal massage to an episiotomy if at all possible. Episiotomy incisions permanently damage muscle, if massage doesn't work (which can be very effective!), natural tears are natural injuries, less scar tissue is create and nerve endings are less likely to be severed... quicker recovery time and less permanent damage.

Newborn care

·         We plan to delay cord clamping at least until it stops pulsating and preferably until the placenta is delivered Mom's blood isn't pumping through the placenta like a hose, what's in the placenta is the baby's blood and has great benefits if she can receive it, lower likelihood of jaundice and anemia, important infection-fighting/immunity-boosting blood cells.

·         Unless there is an urgent medical concern, we wish to allow the placenta to deliver naturally Allowing the placenta to break away on it's own continues the ideal labor cocktail of hormones for decreasing risk of hemorrhage and encouraging mom's breastmilk to come in.

·         John plans to cut the umbilical cord  Typical dad thing, worth mentioning though!

·         We wish for the baby to be placed immediately upon my chest. As long as she is breathing on her own, we would like her to be able to crawl to breast on her time  The best way to regulate a newborn's temperature (more effective than a newborn incubator box!) is skin-to-skin contact with mom. This also helps regulate baby's heartrate and breathing quite effectively

·         Please do not roughly towel the baby, we wish to leave the vernix intact We will wait to bathe the baby at home The vernix, the cheesy coating a baby is born with, has antibacterial, antiviral, and antimicrobial properties... it also has vitamin K in it, which is helpful in clotting. This is especially important in a hospital where many staff may handle the baby and she would be exposed to strangers' germs.

·         Please wait to weight and measure baby and  administer Vitamin K until after breastfeeding has occurred The first breastfeeding and how uninterrupted it is can set the stage for great breastfeeding or breastfeeding difficulties, if you google "breast crawl," you will see videos of babies left to find the breast on their own- in the first hour or so of life, a baby on mom's chest has the ability to crawl to the breast, unmedicated babies will find the breast and latch on instinctively... interrupting this and the first moments of bonding for weight and length measurements seems trivial! She won't grow in an hour.

·         We respectfully decline/waive Erythromycin eye ointment administration. We will sign any necessary waivers  This antibiotic eye ointment is given routinely to all babies in CT, I'm unsure about other states, but many women aren't told WHY it's given, so I'll tell you- if a woman has gonorrhea or chlamydia at the time of delivery, the baby can get those bacteria in his/her eyes in the birth canal- they can lead to blindness/infection. If you don't have either of those, the baby doesn't need antibiotics in their eyes at birth. Additionally, c-section babies don't need it either- as they never came into contact with the birth canal! Gooping up baby's eyes interferes with his/her ability to see mom and dad clearly, can create anxiety because they can't see clearly, and can be irritating (the baby is moments old, we don't know if they're allergic!)

·         We respectfully decline the hepatitis B vaccine at this time, our daughter will receive this under the care of her pediatrician at a later date Unless mom or dad are IV drug users that could have bloodborne contact with the baby and open wounds, it isn't urgent to give this vaccine... again- why are we exposing baby to man-made chemicals in the first moments after birth!? We discussed vaccines (that's another blog) and she won't step on any IV needles between birth and coming home... once she's mobile and could in some crazy universe step on a needle at a park or playground, then we'll give her the Hep B series... babies were meant to have colostrum and skin to skin contact in their first day of life, not shots and antibiotics.

Surgical Birth

It is my strong wish that I give birth vaginally. In the event that my midwife and consulting obstetrician feel a cesarean section is absolutely necessary for the safety of my life and that of our baby, we request the following to make the surgery as family-friendly and natural as possible:

·         My husband will accompany me and my doula or mother will be available as a backup support person should John need to leave my side to follow the baby I don't know that my mom want to be in my OR, my doula has attended c-sections...one of them would be with me.

·         ALL IV medications are to be discussed with us prior to administration. Informed consent isn't too much to ask for, right? Sometimes women are given sedatives or other drugs in their anesthesia and not told, not ok.

·         I do not consent to insertion of a urinary catheter until after anesthesia is in place Ouch. A simple courtesy I believe...

·         I would like to request one arm be left free so that after the birth I may hold my baby with assistance  You can still have skin to skin contact in a surgical birth, I feel if I had to have a cesarean it would be that much more important!

·         If the baby is breathing on her own, I would like her placed on my chest immediately with my husband supporting her while my incision is being closed. same idea as the last bullet point

·         If a cesarean section is necessary, I request a surgeon able to complete a double-layer stitch as I plan to have subsequent deliveries vaginally.  Please ensure someone proficient in a double-layer suture is part of our medical team. The uterus is made up of multiple layers of muscle... some contract vertically and others horizontally, it makes sense to sew them up separately so they can work in harmony next pregnancy. Additionally, this double-layer reduces the risk of uterine rupture in subsequent pregnancies

·         I do not consent to the administration of sedatives after delivery. Some women are given a sedative after surgery, I would want to be awake and alert to feed baby as soon as possible.

·         We prefer all routine procedures be delayed until after I have been taken to recovery. Again, no urgent need to weigh or measure the baby, especially if we both went through major surgery.

·         I do not consent to baby being removed from our presence at any time. Taking the baby away for routine testing is not okay with us- one of us will be with her at all times to ensure our wishes are respected and she's appropriately cared for.

·         I would like the IV and catheter removed as soon as possible so I may get out of bed and move around

·         I wish to eat as soon as possible after delivery

Soooooo that's our birth plan thus far!! Anything I forgot? 

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!