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Women of Color Can Push for Better Outcomes: What Every Mother-to-Be Should Know About Birth

Mar31

Guest post by Tara Owens-ShulerImage

As an African American Lamaze Certified Childbirth Educator, I have observed over my 18 years of teaching that childbirth education class participants are less likely to be women of color. My desire for more women of color to attend childbirth education classes is rooted deeper than just their presence in a classroom – it is rooted in my desire for more women of color to understand the disparities that exist in maternal and birth outcomes.

In a recent Science and Sensibility blog post by Christine Morton on maternal health disparities, she reviewed the work of several well-known public health researchers – Dr. Eugene Declercq, Dr. Mary Barger and Dr. Judith Weiss. Their findings point to the fact that African American women have higher rates of cesarean births at nearly every age group and across every level of education.

In addition, the U.S. Department of Health and Human Services reports that one of every five non-Hispanic,black births are pre-term, African American mothers experience an infant mortality rate twice that of non-Hispanic, white mothers, and breastfeeding rates among African American mothers are 16 percent lower than white mothers.

Given the disparities that exist in maternal and birth outcomes for women of color, I think April as Minority Health Awareness Month is a great opportunity to talk about a few other factors that minority moms or mothers-to-be can control or influence. It’s a hard reality that mothers face real challenges in getting the childbirth care they want and deserve. Even though medical evidence may tell us certain practices are good for mothers and babies, the “system” is not always geared to deliver that care. Health care providers are rushed, spread thin, or incentivized for practices that are not most beneficial to the mother.

Let’s go back to the fact that African American women have higher rates of cesarean births than non-Hispanic,white women. Is it because African American women are sicker and need to have a cesarean birth? Researchers report that this is untrue. They conclude that higher rates of cesarean births among African American women are a result of a shift in obstetric practices to focus more heavily on use of childbirth interventions. And, when we bring in an induction to the equation, there is a correlation between the increased rates of induction to the increased rates of cesarean births!

Research shows that babies pay a steep price for these early births caused by inductions or a failed induction, which led to a cesarean. Babies have greater difficulties breathing, breastfeeding, and maintaining their temperature, which usually means being separated from moms and spending time in the Intensive Care Unit. While an increasing number of hospitals and health care professionals are shying away from unnecessary cesarean birth and induction, it’s one of many care practices that just aren’t supported by good medical evidence.

So how can women of color push for better care?

  • Become an active partner with your care provider. While doctors or midwives have professional knowledge and skills, they may not know everything about your personal background and preferences. Finding a provider who will also act as your partner can help you push for the care that’s best for you and your baby.
  • Ask questions – lots of them! Labor and birth in particular can be unpredictable. That’s why it’s a smart idea to prepare a list of rolling questions throughout your pregnancy to help you determine if the right care is being recommended during labor, birth and after birth.
  • Do your research. Understand your available care options before, during and after labor at the hospital or birth center. If you know that during labor you’d like the ability to walk around, eat and drink – choose a birth facility that will be more aligned with your birth preferences or wishes.
  • Participate in a childbirth education class. Taking a Lamaze class will help you understand maternity care best practices and be better prepared to navigate your labor and birth. A childbirth educator will help you identify the right questions to ask when making decisions about your care.

I encourage all women – particularly African American women – to learn more about getting the right care in pregnancy and childbirth by attending a childbirth education class. Skipping out on childbirth education is a lost opportunity to stack the deck in your favor and become a well-informed consumer of evidence-based practices! As a consumer, it is your right to be a partner in your health care decisions.

–

Tara Owens Shuler, MEd, LCCE, FACCE is the president of Lamaze International. She has practiced as a childbirth educator since 1995. In 2005, she became the Director of the Duke AHEC Lamaze Childbirth Educator Program. In addition to training individuals to become childbirth educators and preparing expectant women and their partners for a safe and healthy birth experience, Tara provides labor support services. Along with coordinating the Lamaze program in the Duke AHEC office, Tara works with her statewide AHEC partners in developing continuing education programs and/or resources for healthcare providers in North Carolina and assists with the Duke AHEC PATHWAYS Health Careers program for K-12 students. When not working, Tara and her husband enjoy playing with their dog, Gramps, and traveling.

Visit Lamaze International for great resources to help mothers and mothers-to-be learn their options.

Birth Regrets?

Mar8

March 2013 034“I usually talk in my classes about how ‘this’ is the only chance you’re going to get to birth this baby. Sure you may go on to have other babies, but you only get *THIS* chance to birth *THIS* baby. I also share with moms that because of this fact, the significance of this birth is infinitely greater than the significance of this birth is to your nurse, OB, midwife, etc.” – Louise Delaney

As I was writing my post last week about “bragging rights” in birth, I was also considering the role of birth regret. I’ve come to realize that just as each woman has moments of triumph in birth, almost every woman, even those with the most blissful birth stories to share, have birth regrets of some kind of another. And, we may often look at subsequent births as an opportunity to “fix” whatever it was that went “wrong” with the birth that came before it. While it may seem to some that most mother swap “horror stories” more often than tales of exhilaration, I’ve noticed that those who are particularly passionate about birth, may withhold or hurry past their own birth regret moments, perhaps out of a desire not to tarnish the blissful birth image, a desire not to lose crunchy points, or a desire not to contribute to the climate of doubt already potently swirling around pregnant women. I’ve already acknowledged all of my own moments of birth regret, but never all in the same post…so, here they are…

First birth: This birth was great and very empowering, but I also learned a lot of things I’d like to do differently the next time. Maybe “regret” is too strong a word, but there were things I definitely knew I wanted to change for next time. I regretted feeling pushed into several things I wouldn’t have chosen on my own, such as giving birth in a semi-sitting position rather than on hands and knees. I wished I hadn’t had quite so many people around me at the birth and I wished I would have just stayed home, rather than driving to a birth center. I regretting not asking to squat after the placenta to help the “sequestered clots” come out and possibly avoid the manual extraction I experienced which was pretty awful (I swear my uterus actually twinges when writing/thinking about it). I regretted having a pitocin shot after the birth, because I still don’t think I actually needed it and it bothered me for a long time that I couldn’t figure out whether or not I’d really needed it. I was also pretty physically and emotionally traumatized by the labial/clitoral tearing I experienced and desperately wanted to fix that next time! Interestingly, most of these regrets were clearly connected to other people and to events in the immediate postpartum period, rather than anything to do with the labor or birth process itself.

Second birth: With this birth, I see very clearly how I deliberately made choices to “fix” the things that nagged at me from my first birth. I gave birth at home, I had very few people present, I gave birth on hands and knees. I was extremely distraught to tear again in the same unfortunate and traumatic way. I’d been totally convinced before the birth that it was all related to positioning and I could fix it, next time. I regretted getting up and showering, etc. so soon after the birth and I wished for more postpartum care (noticing a theme here…). I wished I hadn’t almost fainted several times and still recall the feeling of my head snapping back as I almost went under. That said, I felt the proudest and most exhilarated after this birth.

Third birth: Aside from the obvious of wishing my baby had been born alive, I “fixed” some things from prior births in that I stayed down after the birth to keep myself from fainting. I regretted drinking Emergen-C after the birth. I regretted not being better informed about coping physically with a miscarriage. And, I wished I’d been better able to assess blood loss. I also wished I’d had an attendant of some kind, particularly for immediate postpartum care. I still feel traumatized from the memory of what felt like extreme blood loss during this birth. This was the most physically demanding experience of my life. Not just my birth life, my whole life.

Fourth birth: My biggest regret from this birth was having tried to use a hypnosis for birth program while in labor. I feel as if there were some pre-birth benefits from using the program, but it was not a match for the way I labor and birth and I actually feel as if using it had a negative impact both on my ability to clearly remember and to focus my energy. I did still tear in the same place and in what seems like some new ways as well. I never want to tear like that again. I hate it. I’ve reached my physical and emotional limit with experiencing that type of tearing and I feel like I still have some negative lasting effects. I also think I had some nerve damage that continued until about six months ago. What I “fixed” this time was having a living baby and rediscovering that I could in fact do this and there was nothing wrong with me. I loved that I caught my own baby. (Best. Moment. Ever.) I also had the immediate postpartum care I’ve finally learned I really, really need. I consumed a small piece of placenta postpartum, I drank chlorophyll (and not vitamin C), when I went to the bathroom and did not look down, so I didn’t get all fainty and woozy from seeing the blood, and my doula encapsulated the placenta and I loved it.

It is interesting to me to look at these feelings and situations in the same place. With my last birth, I finally “fixed” the postpartum and blood loss issues that haunted me, but I created new things to fix by experimenting with hypnosis rather than the active birth, birth warrior, Birthing from Within type of experience that truly suits me. I guess I will never fix the tearing situation (I still want to write about that someday!). I also notice how impacted I was and still am by the two births that involved major blood loss. This came up for me very viscerally in reading the current Midwifery Today issue about hemorrhage. While the topic is important and the issue is really informative and useful, I actually had to put it down by page nine because my uterus was hurting/twinging so much (low back too). I really don’t think it was only my imagination either. (This is one reason my work with birth is never going to actually include becoming a midwife!)

I’m curious to know…do you have birth regrets? Or, things that you used subsequent births to fix, overcome, or cope with? Do you see any patterns to your birth experiences like I see in mine?

The other thing this exercise brought up for me is the important of preparing for the birth you want during this birth. This baby is only born once. This birth only happens once. I have clients tell me sometimes while still pregnant with their first baby, “well, next time, I’ll try XYZ…” Don’t wait for next time, do it this time!

The first birth is the pivotal birth. Every birth experience that follows builds on that one. Our choices now are choices for the NEXT birth. The first birth doesn’t have to be either perfect or awful and earth shattering to make us think. We don’t have to choose differently than the first birth; but it’s the first one that gives us a place to begin experiencing not just birth but ourselves as mothers, women, people. We may not all have ground shaking, earth thundering thoughts but we have them. The experience belongs to us. We choose what to do with it. Choosing to do nothing different is still an influenced choice ~ made on that experience…

…What will YOU do to have a first birth that leaves you with few regrets or changes for your NEXT birth? Why not have the birth of your choosing, rooted in truth and your ability to know yourself and your baby now?…

via The Home Birth Experience: The First Birth is HERstory | Real women. Real options. Real birth..

These types of triumphs and regrets produce both birth professionals dedicated to helping others and also mothers who become so hurt and disillusioned with birth that they may actively reject the “natural birth” movement.

March 2013 049

Bits of the (Birth) Net

Oct6

The following is a collection of the bits and pieces that caught my attention and then were shared via my Talk Birth Facebook page during the last two weeks.

Listening

From a good article by the National Association of Mothers’ Centers in Mother Support: When Words Get in the Way…

Words, whether written or voiced, are so very fragile. They can be bent or twisted, even become unrecognizable from their initial intentions. They can have different cultural meanings, regional understandings, and generational perceptions.

There will always be the opportunity for miscommunication…

Such a good reminder. What you say and what people hear are often two different things. What you say and what you mean can be different. How your words are received and interpreted can be very important and intent in many ways doesn’t matter! Communication is transactional process. A two-way process. And, it is symbolic. Meaning can never be fully interpreted and understood completely.

This article also reminded me of one of my own older articles, Listening Well Enough, which came to mind because I’m finishing up with the training of two women. The essay describes my own experience when I was training as a breastfeeding counselor in 2005.

Privacy

The topic of what to risk sharing online came up with friends recently and I enjoyed this article about answering the question of How Much Of Your Private Life Should You Keep Private On Your Blog?

Childbirth Education

“Childbirth education is beginning too late in pregnancy; it needs to begin in the first trimester or even before women become pregnant…“

The above is one of the concluding points from an interesting article from Birth Works International about supporting women without epidurals.

Good article from Lamaze about your breath and how it can help during pregnancy and birthing!

Virtual labor simulator!

Pushing Positions

Very interesting article on What is the Evidence for Pushing Positions?  Apparently there is more blood loss and second degree tears with upright pushing positions. Personally, I CANNOT imagine giving birth in a supine position. But, I’m also really, really, tired of tearing (tired enough that it is one of the factors in our decision not to have “just one more!” baby). For more thoughts about pushing, see previous post on Following Your Body’s Urges to Push…

And speaking of upright birth, Barbie homebirth photos! :)

Informed Consent

Valuable article addressing 10 Responses to Pressure to Consent (remember, it isn’t “informed consent” if you do not have the option of saying NO!)

Posts I’ve written about informed consent:

Prenatal Yoga

Online video prenatal yoga class: Prenatal Yoga – when you feel good, your baby feels good.

And my own prior posts on the subject:

Birthing Room Yoga Handout

“Birth, this elegant, simple, yet intricate process has had unnecessary, complex, expensive technology superimposed onto it, creating a dangerous environment for birthing women.” -Alice Bailes

Loved this article on what really matters for midwives!

Epigenetics

NEW STUDY: Epigenetics: Mother’s Nutrition — Before Pregnancy — May Alter Function of Her Children’s Genes. “As parents, we have to understand better that our responsibilities to our children are not only of a social, economical, or educational nature, but that our own biological status can contribute to the fate of our children, and this effect can be long-lasting,” said Mihai Niculescu, M.D., Ph.D., study author from Nutrition Research Institute at the University of North Carolina at Chapel Hill, in Chapel Hill, N.C.–Epigenetics: Mother’s Nutrition — Before Pregnancy — May Alter Function of Her Children’s Genes

After CAPPA this year, I wrote about epigenetics here: Epigentics, Breastfeeding + Diet, and Prenatal Stress

Call the Midwife

Fun! Ms. Magazine linked to one of my blog posts about midwifery in their post about the PBS show Call the Midwife!  And, after posting to the CfM Facebook page about how I didn’t get to watch the show myself because I have no TV channels, CfM fan Jackie clued me in that Call the Midwife is available online (no TV channels required!) Yay! :)

Older Posts of My Own

Birth Culture: “Birth is cultural, the way eating is cultural. We don’t just eat what our bodies need to sustain us. If we only did that, there would be no reason for birthday cake. Birthday cake is part of our food culture. The place you are giving birth in has a local culture as well. It also partakes of our national birth culture. Not everything doctors do regarding birth makes the birth faster or physically easier for you or the baby. Some things are just cultural.” -–Jan Mallack & Teresa Bailey

Creating Needle Felted Birth Art Sculptures: My first foray into birth art, before I fell in love with using polymer clay!

Centering for Birth: “Centering is a breath awareness strategy that I’ve adapted for use in birth classes based on the ten second centering process described in the short book Ten Zen Seconds…” Free handout available about centering for birth! (I was reminded of this post by Enjoy Birth!

Breastfeeding as an Ecofeminist Issue:“What happens when society and culture pollute the maternal nest? Is that mother and baby’s problem or is it a political and cultural issue that should be of top priority? Unfortunately, many politicians continue to focus on reproductive control of women, rather than on human and planetary health…”

During a week when I didn’t have time to craft delightful new blog posts, it was fun to have a post from a couple of months ago suddenly getting all kinds of hits and Facebook shares. Thanks, internet! ;-D (Around 150 shares on Facebook apparently. I ♥ Facebook!)

On Parenting Books

Mama Birth: Sadly, Parenting Books CAN’T Actually Raise Your Child: Enjoyed this post! (But I recommend NOT reading the comments on the original article she links to about “detachment parenting.” I lost about 30 minutes of my life, felt my blood pressure rising, and only made it to page three!)

“The revolution must have dancing; women know this.
The music will light our hearts with fire,
the stories will bathe our dreams in honey
and fill our bellies
with stars.“
-Nina Simons via Rebecca A Wright, Doula

Woman Centered Pregnancy and Birth

Aug18

“Woman-centered childbirth recognizes the primary role of the mother, and allows labor to progress according to the mother’s natural rhythms.” –ALACE CBE training manual

Several years ago I wrote a popular and somewhat controversial post called What to Expect When You Go to the Hospital for a Natural Childbirth. The article took a look at what women can realistically expect from a “standard” hospital birth and included some thoughts on what they deserve, my conclusion being that what women can expect and what they deserve are often, sadly, very different things. The article was one of my widest-reaching pieces and it was republished on both the Unncesarean and on Navelgazing Midwife. I also converted it into an article that was published in Pathways magazine, laid out so beautifully and professionally I practically cried.

However, my idea for the post didn’t come from me alone, it was sparked by reading a similar list in the 1970′s book Woman-Centered Pregnancy and Birth, co-authored by Carol Downer. So, imagine my delight when I was contacted last month by her assistant, letting me know that they’d read and enjoyed my post and telling me this awesome news:

“We recently published the book in its entirety online at: www.womenshealthinwomenshands.org/BirthingOurBabies.html.“

That’s right, free online! Check it out!

For my conservative readers, do be aware that the book and website both come from a solidly feminist and pro-choice perspective!

“The whole point of woman-centered birth is the knowledge that a woman is the birth power source. She may need, and deserve, help, but in essence, she always had, currently has, and will have the power.” –Heather McCue

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Previous thoughts on Why “Woman-Centered” Childbirth?

The Impact of Birth on Breastfeeding

Jul31

Just in time for the start of World Breastfeeding Week, here is part 3 of my CAPPA re-cap series!

…they want you to believe it’s their power, not yours…They stick needles into you so you won’t hear anything, you might as well be a dead pig, your legs are up in metal frames, they bend over you, technicians, mechanics, butchers, students, clumsy or sniggering, practicing on your body, they take your baby out with a fork like a pickle out of a jar.

–Margaret Atwood in her novel Surfacing (opening quote of Dr. Jack’s presentation at the 2012 CAPPA conference)

As I mentioned, my favorite part of the CAPPA conference was hearing Dr. Jack Newman speak about controversies in breastfeeding (see next post) and then about the impact of birth on breastfeeding (breakout session). He was an amazing speaker. Very straightforward and almost blunt as well as funny and fast-paced. I really feel glad to have had the chance to see him in person after years of being familiar with his materials.

The notion of the birth-breastfeeding continuum isn’t new to me, having actually published articles about it previously, however Dr. Newman’s phrasing, descriptions, and reminders was just so perfect that it left me feeling even more enthused about the inextricable link between birth and breastfeeding. It is a biologic continuum that nature does not see distinct events—baby is born and goes to breast, it is part of the same event. Drawing on Diane Wiessinger’s work, Dr. Newman explained

With animal births: following a normal birth, infant feeding just…happens. Following an interventionist birth, the mother rejects the baby and there is no nursing at all.

In some hospitals, separation of mother and baby is routine as a way to “prevent” postpartum mood disorders. Dr. Jack’s own theory was that perhaps human mothers turn this “rejection” against themselves and it shows up as a postpartum mood disorder.

Babies NEED and expect to be with their mothers after birth. It is of critical importance. As I shared via Facebook, Dr. Jack explained this:

Know how much an incubator costs now? $50,000. Why don’t we just give half of that money to the mother and put the baby skin to skin on mother’s chest?

And, this gem:

“Our hospital births break every rule in the mammalian list of mother-baby necessities.” –Dr. Newman

He also noted that if baby is put skin-to-skin on mother immediately after birth regardless of original intention, the pair will breastfeed. It is biologically programmed.

Why do hospital births break the rules?

Because, as Dr. Newman explained we have a big, big problem in that HCPs do not recognize the critical importance of breastfeeding. He also repeatedly emphasized (in a very funny way) that there are many people who don’t know squat about breastfeeding and breastmilk and don’t feel like they need to learn anything before they start doing studies and writing papers about it.

Dr. Newman also emphasized the important point that the burden of proof rests upon those who promote an intervention! He was speaking with regard to recommending formula supplementation, but I strongly believe it applies to any birth practice. So simple and yet so profound. One example that he shared that is familiar to birth advocates is that lying down for electronic fetal monitoring is a position of comfort for the care provider, NOT for the mother.

And, he made this excellent point: “All medical interventions, even when necessary, decrease the mother’s sense of control, and increase her sense of her ‘body not being up to the task.” Again, the burden of proof rests on those who promote the intervention, not vice versa.

As I’ve touched on several times before, IV fluids that are commonly administered during labor may increase the baby’s birth weight, leading the baby to be more likely to experience the dreaded 10% weight loss (“totally bogus, by the way”). Also as I’ve noted before, IV fluids lead to significant maternal fluid retention which contributes to edema in the nipples and areolas and then…the dreaded “flat nipples.” The more fluid a mother gets in labor, the more a baby “loses” after birth!

Including the same picture as in my other post, because it is in this picture that Dr. Jack is specifically talking about his next point:

I disagree strongly with this statement:

‘Typically, loss of = or >10% of birth weight in the first few days suggests dehydration and the need to consider supplementation.’

He goes on to note that what is necessary is NOT supplementation but to help the mother and baby breastfeed well. The real question when it comes to newborn weight loss is, “is the mother-baby breastfeeding well?”

Newman also addressed something birth advocates are familiar with, the fact that epidural anesthesia can cause maternal fever. This leads to an infant sepsis workup and antibiotics and usually means separation of mother and baby. Here we again experience the failure of many medical care providers to recognize the importance of breastfeeding as beyond just a feeding method. Breastfeeding protects the baby–this is what most hospitals do not understand.

Of interventions that undermine breastfeeding, Dr. Jack pointed to Demerol (meperidine) as the “worst of the lot,” with newborns experiencing sedation and many of them not sucking at all. He also pointed out that all interventions increase the risk of cesarean section, which leads to increased discomfort for mothers and less willingness to breastfeed and increased likelihood of mother-baby separation.

The importance of skin-to-skin contact

Babies easily find their way to the unwashed nipple. And, given baby’s inborn feeding behaviors and instincts, it seems clear that, “if the baby expresses his or her choice, the baby would choose the breast.” (with regard to breastfeeding as maternal “choice”)

Not putting baby skin to skin with the mother, “increases the risk of hypoglycaemia significantly…Isn’t skin to skin contact a less invasive preventative measure than giving formula?” Newman then points out that most often we see “skin to blankets” which keeps baby from showing they’re ready to feed, doesn’t stimulate milk supply, and leads to engorgement which is not normal.

And, at the end he emphasized that when it comes to birth and breastfeeding, all too often WE MESS IT UP by meddling with the biological processes and rhythms of the mother-baby relationship.

–

For more about controversies in breastfeeding, check out my next post.

Handouts from Dr. Newman are available here. One I’ve used recently is How to Know a Health Professional is not Supportive of Breastfeeding.

I’ve written about the birth-breastfeeding continuum and about some other systemic influences on breastfeeding in breastfeeding as an ecofeminist issue.

CAPPA Re-Cap

Jul24

Yesterday I got home from Kansas City where I’d been attending the annual free birth conference hosted by CAPPA. While there I concluded that Desirre Andrews is officially a superhuman live-tweeter. You can catch up with all of her rapid-fire tweets about the conference at CAPPA’s Twitter account.

I also tried my hand at posting a few things that particularly grabbed my attention to my Talk Birth and Citizens for Midwifery Facebook pages which automatically feed into Twitter. I’m not very good at catching short snippets for live-tweets, but some thoughts that I grabbed to highlight are as follows. If they don’t have quotation marks, they aren’t necessarily direct quotes, just “essence” summaries as I tried to take notes and pay attention!

First I attended Laurel Wilson’s talk about Bridging the Nutrition Gap and next, I listened to Tracy Wilson-Peters speak passionately about the “accidental parent.”

Essence tweets from Laurel and Tracy’s talks:

Babies don’t need to be in nurseries–they need to be with their mothers. This MATTERS!

Science can do a lot, can do wonderful things. Mother’s body can do even more…

Prenatal diets high in hydrogenated oils predispose mamas to postpartum moods disorders.

And, then I attended a breakout session from Darla Burns about postpartum rituals and snagged this interesting tidbit:

In Holland, all pregnant women are required to buy a homebirth kit, “just in case.”

The second day, I found myself entranced by the most awesome Dr. Jack Newman. His presentations were the highlight of the conference for me. I loved him! I attended two–his general session on Controversies in Breastfeeding and then his breakout sessions, Impact of Birth Practice on Breastfeeding:

20120724-174258.jpg

If you ever get a chance to see this man, don’t miss it!

We have a big, big problem in that HCPs do not recognize the critical importance of breastfeeding.

There are many people who don’t know squat about breastfeeding and breastmilk and don’t feel like they need to learn anything before they start doing studies and writing papers about it. –Dr. Jack Newman

There is no such thing as “standard” breastmilk. It is a physiological fluid and varies from person to person. We DO NOT have to prove that breastfeeding is better than formula. Those comparison studies are unnecessary.

The burden of proof rests upon those who promote an intervention! –Dr. Newman

With animal births: following a normal birth, infant feeding just…happens. Following an interventionist birth, the mother rejects the baby and there is no nursing at all.

“Our hospital births break every rule in the mammalian list of mother-baby necessities.” –Dr. Newman

Lying down for electronic fetal monitoring is a position of comfort for the care provider, NOT for the mother.

Know how much an incubator costs now? $50,000. Why don’t we just give half of that money to the mother and put the baby skin to skin on mother’s chest? –Dr. Newman

Seriously, Dr. Newman’s talks were amazing. Be prepared to hear more about them soon!

The final day I heard Polly Perez speak about Building Bridges with an emphasis on communication and fear:

Luke: I don’t believe it. Yoda: that is why you fail.

“Use language that lets you share your heart openly.” –Polly Perez

Listening is *active*, not a passive activity. Listen with empathy, openness, and awareness.

We have taken the hearts and minds out of much of our work because we’re frightened of getting too close. But, close is where we need to be.

“We must give people the opportunity to challenge their fears. Not only will this change each person, it will change the political and medical climate in which they make these choices.” –Connie Pike, via Polly Perez

Polly shared the first home birth she attended – made her fear of it “melt away like butter in a pan.”

You do not have to be an OB to be knowledgeable about birth. –doctor working with Polly Perez

Follow up from same doc: “if you tell me a baby is going to come out, I’m a gonna believe you!”

Changing sick systems is not about subterfuge but bringing light to situations that need to be altered.

Since micro-blogging is simply not my gift and is unlikely ever to become so, I am also planning longer posts based on several of the conference sessions. They will be (links will be updated as the posts become live):

At the CAPPA conference I also made a large custom order of great gifts from Joy Belle jewelry.

And, I ate tons of sample honey sticks from Glorybee–yummy! (see prior post: Why Honey Sticks During Labor?)

Other treats involved getting to spend some quality visiting time with a Friends of Missouri Midwives friend from St. Louis. We spent a lot of time talking over the FoMM newsletter (of which I am editor) and I feel very enthused about our ideas for its future.

I also got to meet a Facebook friend who started out originally two years ago as a Talk Birth fan on FB (after finding my site via my all-time most viewed post: In-Utero Practice Breathing). We spent some good time together visiting and laughing and it was fun to make the friendship connection with someone who was previously only an internet friend!

The Rest and Be Thankful Stage

Feb26

During my first labor, I experienced what Sheila Kitzinger calls the “rest and be thankful stage” after reaching full dilation and before I pushed out my baby. The “rest and be thankful stage” is the lull in labor that some women experience after full dilation and before feeling the physiological urge to push. While commonly described in Kitzinger’s writings and in some other sources, mention of this stage is absent from many birth resources and many women have not heard of it. After writing recently about the spontaneous birth reflex, I received a comment stating the following: “I was particularly interested in the idea of resting after full dilation before pushing. This makes sense if you are only following your body’s urges to push, but never something I had seen (or remember seeing?) spelled out before.“

I always make sure to tell my birth class clients about the possibility of experiencing a lull like this, because it is during this resting phase that labor is sometimes described as having “stalled” or as requiring Pitocin to “kick it off again” or as requiring directed or coached pushing. Also, think of the frequency of remarks from mothers such as, “I just never felt the urge to push.” When exploring further, it is often revealed that what the mother actually experienced was no immediate pushing urge instantly following assessment of full dilation. Depending on the baby’s position, this can be extremely normal. The way I explain it to my clients is that the lull represents the conclusion of the physiological shift happening in the uterus—the transition between contractions that open the cervix and the contractions that push the baby down and out.

As I wrote in a previous post from several years ago:

Your uterus is a powerful muscle and will actually push your baby out without conscious or forced effort from you–-at some point following complete dilation your body will begin involuntarily pushing the baby out. Many women experience the unmistakable urge to push as an “uncontrollable urge”–-but, in order to feel that uncontrollable urge, you often have to wait a little while! Though some care providers and nurses encourage you to begin pushing as soon as you are fully dilated there is often a natural lull in labor before your body’s own pushing urge begins. Some people refer to this lull as the “rest and be thankful” stage. It gives your body a chance to relax and prepare to do a different type of work (in labor the muscles of your uterus are working to draw your cervix up and open. During pushing, the muscles of your uterus change functions and begin to push down instead of pull up). If you wait to push until you really need to, you will often find that your pushing stage is shorter and progresses more smoothly that pushing before you feel the urge.

In the book, Our Bodies, Ourselves: Pregnancy and Birth they share the following important point:

“Research suggests that the length of time before the baby is born is the same if you allow one hour of ‘passive descent’ of the baby (when you relax and don’t consciously try to push) or you start pushing immediately after you are fully dilated.”

via Waiting before pushing… « Talk Birth.

That’s right, the length of time between full dilation and baby’s birth is the same, whether the mother waited one hour before pushing, or started pushing without the urge immediately following full dilation. I know which one sounds easier and more peaceful to me!

In my own experience with my first baby, I found that I felt like I should be pushing after full dilation and thus began to do so before feeling the full urge. I ended up pushing for about an hour and fifteen minutes. I suspect if I’d just continued hanging out for 45 minutes to an hour, he may have flown out in 15 minutes. Prior to pushing though, I did experience a rest and be thankful stage of about 30 minutes in which I sat in a rocking chair, joked about feeling “trippy,” and talked about being an A++ birthing woman. I describe it in my son’s birth story:

After finding out that I was fully dilated, I started to feel very odd and I really think I had to go through a sort of emotional/psychological transition to adjust myself to the fact that I had “missed” the physical transition point…I sat in the rocking chair for a while and kept saying things like, “am I dreaming? Is this real?” I also made a joke about feeling “trippy” like in Spiritual Midwifery. We also joked about what an A+ + + laboring woman I was (a family joke–I was a 4.0 student throughout college and grad school and so we always say that I like to get an A+ + + on everything I do). Those pressure feelings I had been having for a while, got a little more intense and I started pushing kind of experimentally. I was on my knees with my head on the bed on my pillow again and during one of the little pushes my water broke with a giant, startling POP and sprayed across the room including all over my friend. At this point, the midwife left saying, “I think I should call the doctor.” via My First Birth « Talk Birth.

The blog Birth and Baby Wise has some great thoughts to share on resting and being thankful (note the blog is from an educator in London, thus the use of the term Syntocinon, rather than the U.S. based brand Pitocin):

… it seems that there is little appreciation for this well documented pause amongst health professionals working in the consultant-led units of hospitals. Any stop in action once the magic ’10 cm dilatation’ is reached is met with almost instant medical intervention to get the contractions back up and running, ie a syntocinon drip. Women experiencing this are already on a consultant-led unit, where a higher level of medical intervention can be anticipated, but it is strange that there seems to be such a rush to use a syntocinon drip to get the contractions going again, providing mother and baby are both coping well.

One reason the contractions may ease temporarily is in order to allow the baby’s head to get into a better position. If this is the case, then artificially speeding contractions up is hardly likely to have the benefit of a faster birth for the woman – if anything, a slower and more complicated birth as she tries to push out a baby that is not quite in the right position. In addition, she has to cope with stronger contractions that she might find difficult to deal with, necessitating further medical help in the shape of an epidural – which in turn makes pushing the baby out even harder…

…At this stage, the woman and her partner are incredibly vulnerable to this well meant ‘help’ from midwives and obstetricians and are unlikely to question the requirement for additional medical help. It is also unlikely that the calm and relaxed environment so important for a peaceful birth can survive the worries of the health professionals, which will affect most women and their partners. via Rest and be thankful – or panic and have a drip shoved in? | Birth and Baby Wise.

I agree. In my own personal experience with my first birth, I was very vulnerable to just the perceived expectation of it being “time to push.” With later babies, it was intensely important to me that I have very few people present at the birth, knowing how sensitive I am to the expectations of those around me. It is truly only my husband and my mother than I trust to not disrupt my “birth brain” and the freedom of my birth space.

I’d love to hear more from readers about their experiences with the rest and be thankful stage.

Did you experience this lull between full dilation and pushing out your baby?

Was the lull recognized and respected by your birth attendants?

If you pushed without feeling the urge, was the pushing stage fairly long?

With subsequent babies, I had no internal checks during labor, so I never really knew if I experienced the rest and be thankful stage with them. I just pushed when my body started pushing—I have no idea how long after full dilation that was. So, I also am curious to know if women find they experience this stage with all babies, with only the first one, or with only some of their babies?

I suspect I did experience it with Alaina, because I remembering feeling concerned that contractions were suddenly “far apart.” I started talking more and analyzing myself and the labor and this was probably part of a lull in the intensity of the contraction action while my body prepared for a powerful spontaneous birth reflex.

Birth Plan Item #1: Leave My Cervix Inside My Body!

Feb11

Some time ago I read several articles in Midwifery Today about birth in the Ukraine. Apparently, it is a routine practice immediately postpartum to use two “shoe horn” shaped devices to pull the cervix out of the woman’s body to examine. Yes, I think that warrants repeating–manually pulling out the cervix to look at! (no pain medications). This is so patently horrible and unnecessary that I had a visceral response to reading about it–my uterus hurt.

U.S. maternity care routines

However, as I reflected on my reaction, I began to wonder if the practice is any more strange or disturbing that some U.S. maternity care routines? I still feel like cervix-pulling-out ranks pretty high on the horrible factor, but I also recognize that it is filtered through my cultural lens of what I’m used to—”normal” (i.e. culturally acceptable) birth practices in the U.S. (such as Pitocin injection immediately following most normal births regardless of indication and so on and so forth). We have any number of questionable medical care practices in this country too, but because I’m used to them they register as “normal.” Of course, this doesn’t mean I approve of them or fail to notice that they are not evidence-based, but I accept them as possible occurrences and I’m certainly not surprised to read about them over and over again, or shocked when my clients experience them during their births.

One of the articles was about birth in a Ukrainian “birth house” and the other was a composite of observations about birth in the Ukraine in general. Sometimes there is a tendency amongst midwifery supporters to romanticize birth and midwifery care in other countries and to vilify the U.S.—if you are a Ukrainian woman, this is clearly misplaced!

My first thought when reading the essays was, “Wow! The U.S. system isn’t so terrible after all!” But then, I tried to imagine the U.S. birth culture seen through completely fresh eyes, as I had just viewed the cervix-pulling technique. How would facets of hospital birth care in the U.S. appear to me if I was just hearing about them for the first time? As gross human rights violations?

Though I cannot make it have the same raw emotional and physical shock to me as cervix-pulling-out, I can only imagine how an episiotomy might sound to my imaginary fresh eyes: “then the doctor took some scissors and cut through the skin and muscles at the base of the woman’s vagina.” Or, the same with the not uncommon addition of, “as she begged ‘please don’t cut me! No!’”

I also read with sadness and dismay about the emotional maltreatment of Ukrainian women in labor and how (in hospitals) they are frequently denied the companionship of their husbands. Is this really more awful than women being coerced into unnecessary cesareans or even more basic, being denied food and drink throughout their labors? No, not really, just less familiar.

What do all women deserve?

While it is nice to recognize that there are things that women birthing in U.S. hospitals can be very grateful for, there is not an official continuum or hierarchy of “better” bad things to happen to birthing women regardless of country of residence. Humanized care is humanized care. Women worldwide deserve a safe environment, a respectful caregiver, continuous emotional support, physically responsive care, evidence-based medicine, and to have their cervixes and uteruses left inside their bodies.

—

(P.S. In case anyone is interested, “cervices” or “cervixes” and “uteri” or “uteruses” are both acceptable plurals)

All That Matters is a Healthy Husband (or: why giving birth matters)

Feb10

It is your wedding day. You have been planning this day since you got engaged nine months ago. You are happy, excited, and a little nervous. When you get to the church, you are told that it is necessary to switch your wedding to the courthouse instead—it is disappointing, but the minister’s assistant reminds you that the courthouse is probably a safer location for your wedding because there are more people on staff there to handle any problems that might arise. When you arrive, you are told that your minister isn’t going to be there for the ceremony after all, but there is a perfectly good justice of the peace available instead.

You ask when the ceremony can begin and the clerk tells you not until your fiancé’s heart rate has been monitored for twenty minutes—“We need a baseline strip on him, hon. After all, you do want a healthy husband out of all this, don’t you?!” she says.

You are asked to change out of your wedding gown and into a blue robe. When you express your dismay, you are reminded that your dress could get messy during the wedding and also, “Why does it really matter what you’re wearing? In the end you’ll have your husband and you’ll be married and that’s really what counts.”

Next, the clerk starts an IV in your hand because, as she explains, you might get dehydrated while you wait for your fiancé.

“I have my favorite juice here, I’ll drink that instead,” you reply.

“No, no dear. No juice. You could aspirate it and die if you end up needing surgery.”

“SURGERY!” you exclaim, “Why would I need surgery? I’m just getting married!”

The clerk gives you a knowing glance, “Honey, about forty percent of women who get married here need surgery before their marriages are finalized. This is an excellent courthouse! We do everything possible to make sure you have a healthy husband when you leave here. Isn’t that what you want?”

“Yes,” you reply weakly.

Finally, the other clerk signals that your fiancé is ready. You turn to look at him and see that he has a monitor strapped to his chest to monitor his heart rate and that he has an electrode on his scalp. You smile at him and prepare to say your vows—you’ve waited for this moment for so long! But, as you begin to speak, the clerk tells you to stop making so much noise. You start to cry in confusion and embarrassment and she tells you that you really need to get control over yourself.

She calls over several other clerks who stand near you and they all begin chanting loudly, “Say I DO! Say I DO!”

“Wait,” you protest, “What about our vows?”

“No time for that—you’ve got to get married as quickly as possible. Husbands can only bear to stand at the altar for a short time before they start showing signs of distress—you wouldn’t want anything to happen to your husband would you? Now, say ‘I DO,’ say ‘I DO’!!”

So, you say the words, feeling a sense of dismay at it not being like you had planned, but excited to finally be married to your beloved. You turn to your new husband and reach out for him eager for your first married kiss, but the clerk grabs his arm and tugs him away after her.

“Wait!” you call, “I want to see my husband!”

“Sorry,” is the reply, “He needs to be taken to the new husbands’ lounge for observation.”

“Observation of what?”

“Weddings are stressful for husbands; we need to make sure he is all right. Now wait here, while the other clerk brings you a wheelchair to take you to your waiting room.”

Instead of leaving for your honeymoon, you end up staying at the courthouse for three days. You keep asking to see your husband, but the clerk tells you he needs to gain some weight before he can leave and that he also needs some more blood drawn. She also lets you know that he has finally stopped complaining about his spinal tap.

Spinal tap?! Your dismay shows on your face and she tells you, “Come on! You’ll be married for the rest of your life! A few hours of separation isn’t going to hurt either one of you. You’ll have plenty of time with him after you get home and will probably just get fed up with him then! What really matters now is that your husband is healthy.”

“Yes, of course…”

Finally, you get to go home, but you feel distant and sad. Your wedding was nothing like you’d dreamed of and you feel disappointed and betrayed. You enjoy being married and snuggling with your new husband, but you keep thinking about your wedding day and all of your ruined plans to make it special. When you try to tell your mother how you feel, she tells you that you should be grateful, at least your husband is nice and healthy.

When you tell your best friend about your disappointment, she tells you it is time to get over it—“Your wedding is just one day of your entire life. It is the marriage that really matters in the end. You only get married once, but in the end, you’re married and you’ve got a healthy husband and that’s really what counts, not how you get there!”

You tell another friend about your ruined plans and she reminds you that you are lucky your husband is healthy and that it is selfish of you to keep thinking about your wedding. It is over and you’ve got your nice healthy husband to keep you busy now.

“Yes, but I feel like I missed out,” you venture.

“On what? Weddings are SO overrated. It isn’t like you get a medal for having a beautiful wedding or anything. People have weddings every day.”

You stop sharing your feelings, but you can’t shake the memories. What you expected to be a beautiful day filled with love and celebration was not and you feel a real sense of grief at the loss of your dreams. You know you shouldn’t feel this way. You know that what really matters is your healthy, happy husband, but you keep wondering if your wedding really had to be that way. Yes, you love your husband and you are so happy that he is healthy, but you also wonder if that really is all that matters. Don’t you matter too? Doesn’t your relationship matter? What about respect, dignity, love, and self worth? Don’t those matter too? Wasn’t this a special life transition for your family? Wasn’t it the beginning of a special relationship together and couldn’t that relationship have been celebrated, honored, and treated as worthy of care and respect?

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Notes: I originally wrote this essay in 2007. It was retained for publication by Mothering magazine, but did not end up making it in before the print publication ceased. It was then retained for publication by Midwifery Today, but has not yet appeared. I decided it is FINALLY time for it to see the light of day!

I was inspired to write this essay after reflecting upon the similarities between weddings and births—both mark the beginning of a new form of relationship and a change to the family structure and to individual roles in society. Yet, in our culture, one of these transitions is celebrated as a milestone of adult life and the value of honoring the first steps in life as new partners in a relationship is a given. The other is institutionalized and mechanized and the partners’ individuality is minimized or ignored. Much preparation, energy, time, and finances are invested in planning a lavish wedding and you are expected to expect things to go beautifully, perfectly, and as planned. If they didn’t and your wedding was ruined, most people would say, “It is awful that your wedding was ruined! Wow!” and not call into question your love of your husband or your commitment to your new role as his wife. The wedding ceremony is respected as having value in its own right. This is not true of birth, which is widely viewed as unimportant in terms of how it happens, as long as the result is a “healthy baby.”

Molly Remer, MSW, ICCE is a certified birth educator, writer, and activist. She is a breastfeeding counselor, editor of the Friends of Missouri Midwives newsletter, and a professor of Human Services. Molly has two wonderful sons and one delightful daughter and lives in central Missouri. She blogs about birth, motherhood, and women’s issues at http://talkbirth.me and is the author of the miscarriage memoir Footprints on My Heart.

Alaina’s Birth Story–Baba Style!

Jan28

On Alaina’s birthday I received a special treat—her birth story written by my mom (called Baba in our family). I asked her if I could post it here and here it is!

Alaina’s Birth Story

Baba’s version

Waiting for a baby to be born can be exciting and stressful at the same time – but waiting for baby Alaina was especially poignant because of Molly’s previous loss of little Noah. I was worried. I knew she had a specific vision of how this – her last – birth would be, and I was concerned that my presence would somehow ruin things for her, or not live up to her expectations. I was also actually afraid. I was afraid something would go wrong, either with the birth process or with the baby herself.  I was afraid I’d have to be the one who was called upon to act in some heroic manner and would fail. I was afraid I wouldn’t measure up to Molly’s birth expectations. I wanted to do it all right, perfectly, and was afraid I couldn’t. I felt that voicing these fears would somehow manifest them, and I didn’t want to carry the fear into the sacred birth space. I felt prepared – I had been trained in neonatal resuscitation, knew where all the tinctures, supplements, and supplies were located, had a little bag packed for myself – but I was still emotionally and mentally concerned.

However, a few days before the birth, Molly and I had a talk, and it really cleared the air! When the “stand by” call came from Mark, I knew I was ready to be of service to my daughter and arriving granddaughter. The first request was for us to collect the big brothers, who had awakened early and were impacting Molly’s birth environment. I picked them up and brought them to home with me. At that time, Molly was very clear and focused, doing her work on the birth ball. When Mark called me to come back to the house at about 9:00, I scrambled into the car and tore over there, as if there might not be enough time! Molly has a history of precipitous births…….

There was definitely some birthy energy going on! Molly was on the ball with Mark rubbing her back. I knew she wanted to be left alone and have a peaceful environment, so I spoke as little as possible. At some point, I slipped over to her futon nest and tucked my little cheat sheet list underneath. I didn’t want to forget any of the resuscitation steps or what supplements to give her.  I tried to remind her to eat, drink and use the bathroom, without being obtrusive about it. She was obviously making progress, and I could hear in her voice that the contractions were growing in intensity. She worried about being too much “in her head” and analyzing things. I tried to reassure her that this is always how she approaches the world, and that it was fine to be that way. She was up and moving around, talking and considering, and also worried that she might not be progressing. This made me think transition might be near, but I didn’t say that to her. She felt some rectal pressure and decided to sit on the toilet for a while. It seemed to me that things were progressing apace, when she reached down and felt something squishy. She said she thought she was pushing, and I decided it was time to abandon my “silence” (really hard for me, by the way!) and comment that she should probably get to her nest if she wanted to avoid having the baby on the toilet.  She agreed, but didn’t really seem to want to move. No wonder. She barely made it! Meanwhile, I had called Summer, the doula, and midwife E.

Baba meets Alaina!

Molly dropped to her knees on her futon nest, and had an obviously intense contraction. We helped her get her clothes off. She was upright on her knees, intent upon finding heart tones, when the phone started ringing incessantly. It was SO annoying that I ran over to, picked it up and slammed it down to make it stop. That’s when I heard some garbled crying and Molly had baby Alaina in her arms! In my mad dash to the phone, I had missed the actual moment of birth :( . We all burst into tears and Molly was repeating, “You’re alive! You’re alive! I did it! There’s nothing wrong with me!” The baby was crying lustily, so we got Molly into a prone position (she was still kneeling) with the baby on her chest and covered up. My job was to pop things into Molly’s mouth – supplements, vitamins, chlorophyll, etc., so I got ready to do that. Summer arrived, midwife E arrived, and all was right with the world. Baby Alaina was safe and in her mother’s arms! And in mine, as soon as I could get my hands on her…..

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Molly’s version of Alaina’s full birth story.