Once a c-section, always a c-section RIGHT??

The following is an article written by Henci Goer. I found this at: http://parenting.ivillage.com/pregnancy/plabor/0,,bgjt-p,00.html

The facts about VBAC

After years of slowly moving in the direction of establishing VBAC as the norm, prominent obstetricians and the American College of Obstetricians and Gynecologists (ACOG) did an about-face in the mid 1990s and began promoting elective repeat cesarean. As a result, the VBAC rate, which had steadily risen since 1980, fell from a peak of 28 percent in 1996 to 21 percent in 2000, a decline of 27 percent (23). The anti-VBAC campaign has had two prongs: the claim that planned repeat cesarean is as safe or nearly as safe for the mother and safer for the baby and the institution of criteria in the name of safety that act as a barrier to VBACs. (1,16). What changed?

Obstetricians have openly admitted that one reason for the turn around is reducing liability stemming from the scar giving way during labor, a concern that arose from some successful malpractice suits involving VBACs (1,29). This self-confessed incentive provides a powerful motive for bias, conscious or unconscious, against VBAC and a cause for skepticism of statements and policies favoring elective cesareans.

I contend that nothing changed. It remains as true as it ever did that VBAC is as safe as planned cesarean for the baby, safer for the mother, and much safer for any future pregnancies. Here is the research that backs my contention. You decide who’s right.

When is a repeat cesarean not necessary?
Doctors may cite the following as reasons for planned cesarean, but none are true disqualifiers for VBAC. Obstetricians also give rationales that have no basis in the research. These include indications such as mother past her due date, cervix not ready for labor at the due date, baby’s head still high at full term (22):

-Hospital lacks the ability to perform emergency cesarean around the clock: The general hospital population has about the same potential for a labor emergency as the potential for the scar giving way. If the hospital isn’t safe for a VBAC labor, then it isn’t safe for any woman to labor there.
-Prior cesarean for poor progress -- also known as “failure to progress,” “labor dystocia,” “cephalopelvic disproportion”: Eighteen studies report the VBAC rate when the first cesarean was performed for one of these reasons (15). All but two found that half or more of the group gave birth vaginally. Half the studies report rates between 60 and 69 percent, so your odds of vaginal birth with a supportive practitioner should be roughly two out of three.
-Suspected large baby: Ultrasound scans predicting weights over 8 lbs. 13 oz. (4,000 grams) will be wrong one-third to one-half of the time (15). Even when babies weigh more than 4,000 grams, the VBAC rate is about two out of three (30).
-Type of uterine scar not known: Unless the prior cesarean was done in Latin America or certain other countries or for the reasons listed under When would a VBAC be inadvisable?, the odds are 99 to 1 the scar is transverse (10).
-Low vertical uterine scar: Doctors perform a low vertical incision for cesarean deliveries of premature babies because the lower part of the uterus isn’t well enough developed yet for a transverse incision. Data suggest this scar is as strong as a transverse scar (24,33).
-More than one prior cesarean: Two studies reported rates of less than 2 percent and less than 1 percent (3,25),. A third said merely that the rate did not differ from the rate with one uterine scar (9). Overall, the chances of vaginal birth were two out of three.
-Twins: We haven’t much data on twins, but VBAC doesn’t seem to pose excess risk (11,25,27,35).
-Breech: External cephalic version is a procedure in which the doctor turns the baby head down in late pregnancy by manipulating the woman’s belly. What little data we have suggests this procedure is safe in women with prior cesareans (8,19,32).
-Labor induction is indicated: Large studies show that straight oxytocin (Pitocin) induction increases the incidence of symptomatic scar separation only slightly from 4 to 5 per 1,000 to 7 to 8 per 1,000 (21,30). The risk comes when prostaglandins are used. Prostaglandin E2 (dinoprostone), the type found in Prepidil and Cervidil, increases the incidence of the scar giving way to 25 per 1,000 (21). Prostaglandin E1 (misoprostol), the type found in Cytotec, raises it even higher, possibly much higher (12). Some evidence suggests that long, unproductive oxytocin inductions may also be a problem (20).
In any case, induction should be reserved for those situations where the risks of awaiting labor outweigh the risks of inducing it. This occurs far less often than the typical obstetrician thinks it does. One of the common reasons for induction is questionable: induction at 41 weeks. Others aren’t supported by the research at all: convenience inductions, induction for suspected big baby, induction for gestational diabetes, induction before 24 hours in a woman at full term with ruptured membranes, no signs of infection, and who tests negative for Group B strep (15). What are the potential risks of a cesarean?

The risks of planned repeat cesarean fall into three categories:

1. Risks of cesarean, compared with vaginal birth (14):
Cesarean section results in more pain, debility, and a longer recovery period. It substantially increases the risk of infection, injury to other organs, hemorrhage, and blood clots. These complications, in turn, increase the likelihood of prolonged hospitalization, hysterectomy, readmission to the hospital, and maternal death. Babies who were healthy before delivery are more likely to be born in poor condition or have breathing difficulties. In the long term, cesareans can lead to chronic pain or bowel problems, and they increase the risk of infertility, miscarriage, placental abruption (placenta detaching before the birth), and placenta previa (placenta overlaying the cervix).

2. Excess risks of planned cesarean versus labor:
Hysterectomy: In the Swiss study, three times as many women having planned cesareans required hysterectomies as women who labored (45 per 10,000 versus 16 per 10,000) (15,30). Among 29 other studies, comprising 18,500 planned cesareans and 38,700 labors after cesarean, hysterectomy rates were also tripled in the planned cesarean group (21 per 10,000 versus 7 per 10,000) (15).
Blood clot complications: In the Swiss study, planned cesarean doubled the risk of blood clot complications (43 per 10,000 versus 22 per 10,000) (30).

3. Risks that derive from accumulating cesareans. Some complications arise from the build-up of scar-tissue in the pelvic cavity. Some are likely due to accumulating uterine scars leaving bare patches in the uterine lining, the layer in which the placenta implants. Still others may be due to post surgical infection injuring delicate tissues such as the cilia lining the Fallopian tubes that link ovaries to uterus.
-Increased risk of injury to other organs during subsequent cesareans: Scar tissue makes successive cesareans more difficult technically to perform.
-Increased risk of chronic pain and bowel problems.
-Ectopic pregnancy -- embryo implants outside of the uterus: (Potentially life-threatening for mother, invariably fatal for the baby.) A study found no increase in ectopic pregnancy in women with one prior cesarean but half again the risk (3 percent versus 2 percent) in women with a history of more than one cesarean (18).
-Placental abruption -- placenta detaches before the birth: (Potentially life-threatening for mother and baby.) Two to four times the risk compared with an unscarred uterus depending on whether the woman’s first birth was a cesarean, or she has more than one prior birth and at least one cesarean (18).
-Placenta previa -- placenta overlays the cervix: (Potentially life-threatening for mother and baby.) More than four times the risk with one prior cesarean, seven times the risk with two to three, and forty-five times the risk with four (2).
-Placenta accreta or percreta -- placenta grows into or through the muscular wall of the uterus: (Particularly dangerous for mother and baby.) Eleven times the risk with multiple prior cesareans compared with one prior cesarean -- nearly 1 per 100 versus 1 per 1,000 (2). In a study of 109 cases of placenta percreta, 40 percent of women required transfusion of more than ten units of blood, nearly all had hysterectomies, and ten babies and eight mothers died (28).
Both placenta accreta and placenta previa: Eight out of ten women with both had prior cesareans (34). The risk for the combination was 35 times higher for women with a prior cesarean compared to women with unscarred uteruses.

How might care in VBAC labors differ?

VBAC labors shouldn’t be handled any differently from labors with an unscarred uterus with one possible exception. The most reliable symptom that the scar has opened and is causing problems is a sudden drop in the baby’s heart rate. For this reason, Dr. Bruce Flamm, preeminent VBAC researcher, recommends continuous electronic fetal monitoring (EFM). Others have argued that symptomatic scar separations happen no more often than other unpredictable obstetric emergencies (7). If women generally have not been shown to benefit, we should be cautious about subjecting women with prior cesareans to EFM’s disadvantages.

Here are some unjustified ways that doctors may manage VBAC labors:
-Refusal to allow an epidural: At one time doctors thought an epidural might mask the pain of the scar separating, but pain has been shown not to be a reliable symptom, and experts have long since agreed that epidurals should be permitted (13). That being said, epidurals pose one problem peculiar to VBACs. Some babies will experience an episode of slowed heart rate, and a drop in the fetal heart rate is the most reliable symptom of the scar giving way (15).
-Routine IV: IVs cause pain, decrease mobility and can cause fluid overload. Fluid overload can lead to a host of physiologic problems, some minor, some major, in babies and mothers (15). If you feel uncomfortable refusing an IV, compromise on a heparin lock. With a heparin lock, the IV catheter is inserted, but it is only connected to a short piece of tubing that is taped to your hand or arm. It frees you from the IV pole, but an IV can be plugged in at any time.
-No oral intake: You should at least be allowed to drink clear liquids. Hunger and especially thirst increase discomfort. Dehydration and starvation can diminish contraction strength and may make the baby’s blood more acidic, a symptom of fetal distress (15).
-Intrauterine pressure monitor: The theory is that the scar giving way will decrease uterine contraction pressures. However, an analysis of 76 cases of symptomatic scar separation found that in no case did monitoring contraction pressures internally diagnose the problem (31). Another study simulated scar breakdown in twenty women by recording uterine pressures in laboring women before and after incising the uterus during cesarean section (5). The monitoring device failed to show pressure changes in any of the women. Internal contraction monitoring increases the risk of infection, and in rare cases, the catheter can injure the placenta, pierce the uterus, or become entangled with the umbilical cord.
-Manual exploration of the uterus after the birth: There seems to be little value in identifying symptomless scar windows because they don’t seem to pose a risk in subsequent pregnancies. On the downside, the internal examination is extremely painful. The procedure also could increase the risk of infection or convert a small, harmless gap into a problem. In the sole reported case of maternal death due to bleeding from a scar that gave way, the uterus had been explored after the birth, but the rupture was missed (6).

Will a VBAC affect your postpartum recovery?
If you have a vaginal birth, the days and weeks after the birth are likely to be much easier because you won’t be recovering from major surgery. This will be even more important than it was the first time because you already have another child or children at home. A VBAC that ends in a repeat cesarean can be disappointing, but even so, most women are glad they tried.

When would VBAC be inadvisable?
Doctors agree that planned cesarean is preferred when the mother has a vertical (also called “classical”), T-shaped, or J-shaped uterine incision. However, in most countries, the low transverse incision has been the norm for many years. Reasons for a vertical incision include the placenta is overlaying the cervix (placenta previa), some breech presentations (the baby is buttocks, knees, or feet down), and some emergency cesareans.

What are the potential risks of VBAC?
-Symptomatic scar separation: The main fear with labor after a cesarean is that the scar will open enough to cause bleeding or for the umbilical cord or the baby to pass through the opening. Among thirty studies totaling 56,300 VBACs, the rate of symptomatic scar separation was 4 per 1,000 (15,30). Even so, few instances where this occurs result in harm to the baby, which is the real issue. The perinatal mortality rate (stillbirths and newborn deaths together) from this cause was 3 per 10,000. This did not differ from the perinatal mortality rate of 2 per 10,000 in 29,900 planned cesareans. Nor does planning a cesarean eliminate the risk of the scar giving way. Several large studies reported scar separation rates ranging from 2 to 3 per 1,000 with repeat cesarean, not much less than the 4 to 6 per 1,000 reported in VBAC labors (17,21,30).
-More likelihood of complications if the labor ends in a cesarean: You are somewhat more likely to have complications such as infection with a cesarean after labor compared with a planned cesarean. Nonetheless, planned cesareans have substantially higher complication rates than vaginal births, and most properly managed labors after a cesarean should end in vaginal birth.

In summary, VBAC introduces a slightly greater risk of serious complications relating to the scar, but this is more than counterbalanced by a host of complications that occur more frequently with cesarean section.

What is a reasonable VBAC rate?
Among 34 studies of labor after a prior cesarean, totaling 38, 700 women, all but one reported VBAC rates above 60 percent (15). Half reported rates between 70 and 79 percent. An analysis of 17,600 labors after cesarean in Switzerland reported a 75 percent rate (30). Therefore, with a midwife or doctor committed to VBAC, your overall odds of VBAC should be three out of four, and you would be well advised to seek another practitioner if yours has a rate less than 70 percent.
The odds of VBAC also shift up or down depending on various factors. As you would expect, you are more likely to have a vaginal birth than the overall average if you have had a prior vaginal birth, less likely if your prior cesarean was for poor progress or this baby is big. You are also less likely to have a vaginal birth if you are induced. Nonetheless, the VBAC rates still fall around 66 percent, or two out of three with supportive caregivers (3,9,26,30).

REFERENCES
ACOG. Vaginal birth after previous cesarean delivery. Practice Bulletin 1998, No 2.
Ananth CV, Smulian JC, and Vintzileos AM. The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet Gynecol 1997;177(5):1071-8.
Asakura H and Myers SA. More than one previous cesarean delivery: a 5-year experience with 435 patients. Obstet Gynecol 1995;85(6):924-9.
de Meeus JB, Ellia F, and Magnin G. External cephalic version after previous cesarean section: a series of 38 cases. Eur J Obstet Gynecol Reprod Biol 1998;81(1):65-8.
Devoe LD et al. The prediction of “controlled” uterine rupture by the use of intrauterine pressure catheters. Obstet Gynecol 1992;80(4):626-9.
Farmer RM et al. Uterine rupture during trial of labor after previous cesarean section. Am J Obstet Gynecol 1991;165(4):996-1001.
Flamm B, MacDonald D, Shearer E, Mahan CS. Roundtable discussion: should the electronic fetal monitor always be used for women in labor who are having a vaginal birth after a previous cesarean section? Birth 1992;19(1):31-35.
Flamm BL et al. External cephalic version after previous cesarean section. Am J Obstet Gynecol 1991;165(2):370-2.
Flamm BL et al. Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study. Obstet Gynecol 1990;76(5 Pt 1):750-754.
Flamm BL. Vaginal birth after cesarean section. In Cesarean Section: Guidelines for Appropriate Utilization. Flamm BL and Quilligan EJ, eds. New York: Springer-Verlag, 1995.
Gilbert L, Saunders N, and Sharp F. The management of multiple pregnancy in women with a lower-segment caesarean scar. Is a repeat caesarean section really the “safe” option? Br J Obstet Gynaecol 1988;95:1312-16.
Goer H. Childbirth Forum in press.
Goer H. Obstetric Myths Versus Research Realities. New York: Bergin & Garvey, 1995.
Goer H. The case against elective cesarean section. J Perinat Neonat Nurs in press.
Goer H. The Thinking Woman’s Guide to a Better Birth. New York: Perigee Books, 1999.
Greene MF. Vaginal delivery after cesarean section--is the risk acceptable? N Eng J Med 2001;345:54-5.
Gregory KD et al. Vaginal birth after cesarean and uterine rupture rates in California. Obstet Gynecol 1999;94(6):985-9.
Hemminki E and Merilainen J. Long-term effects of cesarean sections: ectopic pregnancies and placental problems. Am J Obstet Gynecol 1996;174(5):1569-74.
Lau TK, Kit KW, Rogers M. Pregnancy outcome after external cephalic version for breech presentation at term. Am J Obstet Gynecol 1997;176(1 Pt 1):218-23.
Leung AS et al. Risk factors associated with uterine rupture during trial of labor after cesarean delivery: a case-control study. Am J Obstet Gynecol 1993;168(3):1358-63.
Lydon-Rochelle M et al. Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med 2001;345(1):3-8.
Macara LM and Murphy KW. The contribution of dystocia to the cesarean section rate. Am J Obstet Gynecol 1994;171(1):71-7.
Martin JA, Hamilton BE, and Ventura SJ. Births: preliminary data for 2000. Nat Vital Stat Rep 2001;49(5):1-20.
Martin N et al. The case for trial of labor in the patient with a prior low-segment vertical cesarean incision. Am J Obstet Gynecol 1997;177(1):144-8.
Miller DA et al. Vaginal birth after cesarean section in twin gestation. Am J Obstet Gynecol 1996;175(1):194-8.
Miller DA, Diaz FG, and Paul RH. Vaginal birth after cesarean: a 10-year experience. Obstet Gynecol 1994;84(2):255-8.
Myles TD and Miranda R. Vaginal birth after cesarean delivery in the twin gestation. Obstet Gynecol 2000;95(Suppl 1):S65.
O’Brien JM, Barton JR, and Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol 1996;175(6):1632-8.
Phelan JP. Rendering unto Caesar cesarean decisions. OBG Management 1996 Nov:6.
Rageth JC, Juzi C, and Grossenbacher H. Delivery after previous cesarean: a risk evaluation. Swiss Working Group of Obstetric and Gynecologic Institutions. Obstet Gynecol 1999;93(3):332-7.
Rodriguez MH et al. Uterine rupture: are intrauterine pressure catheters useful in the diagnosis? Am J Obstet Gynecol 1989;161(3):666-669.
M, Kogan S, and Blickstein I. External cephalic version after previous cesarean section--a clinical dilemma. Int J Gynaecolog Obstet 1994;45(1):17-20.
Shipp TD et al. Intrapartum uterine rupture and dehiscence in patients with prior lower uterine segment vertical and transverse incisions. Obstet Gynecol 1999;94(5 Pt 1):735-40.
To WW and Leung WC. Placenta previa and previous cesarean section. Int J Gynaecol Obstet 1995;51(1):25-31.
Wax JR et al. Twin birth after cesarean. Conn Med 2000;64(4):205-8.
Zelop CM et al. Uterine rupture during induced or augmented labor in gravid women with one prior cesarean delivery. Am J Obstet Gynecol 1999;181(4):882-6.

The Secret to a Beautiful Birth

I wanted to share the secret with all of you. It's an amazing concept that few seem to think about. The secret, besides having an AMAZING doula is....

Pick the right provider. Honestly... if you pick a provider that routinely does birth the way you want your birth to be... you are almost guaranteed to get what you want! :o)

Benefits of Continuous Labor Support from lamaze.org

In times past, women learned about childbirth from their mothers and sisters. Birth took place in the familiar comfort of home. Family rituals and traditions ensured that women were confident in their ability to give birth. Throughout labor and birth, family members and wise women surrounded the laboring woman and gave her constant support and encouragement. Community midwives attended almost all births.

As birth moved into the hospital early in the 20th century, women lost the valuable support and encouragement of women from their communities. Nurses gave support, but often they were responsible for several laboring women and could not stay continuously with one woman.

During the 1960s, Lamaze International and other childbirth organizations advocated successfully to allow fathers into the labor room. Fathers provide special emotional support to laboring women and deserve to be present for the birth of their child. This was an important step in preventing women from having to labor alone.

Now, in the 21st century, women are again discovering the value of additional support from women knowledgeable about birth. Women often assume that a nurse, midwife, or doctor will stay with them throughout their labor. In some birth settings, midwives and nurses are able to give continuous support to the laboring woman and her family. However, the reality is that other responsibilities often keep doctors, midwives, and nurses from being with one woman continuously. Even when a midwife is caring for only one woman in labor, it can be helpful for another experienced woman to provide emotional and physical support.

Before your baby’s birth, you should decide who could offer you continuous labor support. You might choose a friend or relative who is experienced with childbirth, or perhaps you will decide to hire a doula, a labor support professional.

Why Is Continuous Support Important? Labor may surprise you (and your partner) with its power. Having a woman experienced with birth there to reassure you and your partner that your labor is progressing normally will help you both to cope. A woman experienced with childbirth will also know how to give comforting touch such as massage and suggest positions that will help the progress and comfort of your labor.

The Role of a Doula According to The Doula Book, a doula is “an experienced labor companion who provides the woman and her husband or partner both emotional and physical support throughout the entire labor and delivery, and to some extent, afterward” (p. 4).3 A doula will remain with you and your partner throughout labor and birth, providing physical, emotional, and informational support. Your doula will never be away from you for more than a few minutes, unless you request time alone with your partner. She will work with you and your partner to help you have the kind of birth you want. She may help you into a warm tub or shower, walk with you and your partner, and massage your back, hands, or feet. She will support you in your decisions about pain medication. If you tell your doula that you want to give birth without medication, she will help you do this. After the birth, a doula usually stays with you for 1 to 2 hours to help you with breastfeeding.

Doulas are not trained to perform any medical or nursing tasks and should never offer medical advice. However, they should help you understand medical events. They also can encourage you to communicate your preferences to the hospital staff. If your labor takes a different path than expected, a doula can help you make clear your feelings and review your options.

One of the most important roles of the doula is to help you to have positive memories of your birth experience. After the birth, you will remember together the positive aspects of the birth, and she will answer any questions you may have. If the birth does not go as you planned, your doula will be there to listen to you and to offer you support.

What Research Tells Us The research regarding the benefits of continuous support by doulas during labor is impressive. A review of the research by the Cochrane Pregnancy and Childbirth Group, a respected international organization that defines best practices based on research, shows that continuous support for women during labor and childbirth is clearly beneficial.2 According to the review, compared with women who do not have continuous labor support, women with continuous, one-to-one support are less likely to:
have a cesarean section;
give birth with vacuum or forceps;
have regional analgesia (e.g., an epidural);
have any analgesia (pain medication); and
report negative feelings about their childbirth experience.2
Two other reviews of the research on continuous support had similar findings.4,5

The authors of all three reviews found that continuous support is more effective when the person providing it is not part of the hospital staff than when it is provided by staff members such as nurses or midwives.2,4,5 In one review, better results were found when the support started earlier in labor.2 Another review showed that support was most helpful for low-income women who would have labored alone if they had not had a doula present.5

The Doula and the Labor Partner Most partners want to participate in the birth of their children and to provide support for their significant others. However, most men and some women have little if any experience with childbirth. As your contractions become more intense and you struggle with pain, your partner may become frightened. Your partner may not have the experience to know whether your labor is proceeding exactly as it should. As labor progresses, it may become more and more difficult for your partner to reassure you. Most partners breathe huge sighs of relief when an experienced childbirth professional is there to assure them that labor is going just fine.

A good doula takes her cues from the labor partner. If your partner is sitting close to you, holding your hand, and providing eye-to-eye contact and supportive words, the doula will not interfere in the intimate relationship between the two of you. Instead, she supports and encourages both you and your partner. However, if you need more support than your partner can give, the doula will work along with your partner. She might give you a back or foot massage while your partner provides the eye-to-eye contact and reassuring words. Or the she may suggest a change of activity, a new position, or a comfort measure you and your partner had not tried. The doula can show your partner how to give effective counter pressure or massage. She can also offer support while your partner takes a much needed bathroom or meal break.

Planning for Continuous Support A friend or family member experienced with childbirth may be able to provide continuous support for you and your partner. These women do not need to have formal training as doulas, as long as they have confidence in your ability to birth your baby and are willing to stay with you continuously during labor.

However, many women find that hiring a doula is the best way to be sure that they have continuous emotional and physical support throughout labor and birth. You can ask for referrals from your childbirth educator, your health-care provider, DONA International, or another doula organization. After you have decided whom you want with you, plan at least one visit with her to talk about the type of birth that you and your partner hope to have. Share with her the comfort measures that are important to you, including medications.

Some hospitals or birth centers may offer free or low-cost doula services. If there is a language barrier between a laboring woman and the doula, both usually find that eye-to-eye contact and gentle touch overcome the lack of a common language. Some hospitals also provide a translator, if needed.

Some health plans will reimburse you for the cost of doula services. You can call in advance to see if services will be paid for, and advocate for doula coverage if they are not. Insurance companies and health plans may not know that, by providing continuous support, doulas decrease health-care costs from interventions such as cesarean surgeries. Doulas charge varying amounts, and some may even offer barter (trade) options or provide free services in order to get their certification.

Recommendations from Lamaze International Lamaze International joins with the World Health Organization in recognizing the value of continuous labor support as a key element in normal birth.1 Lamaze believes that all women should have access to continuous labor support, without financial or cultural barriers. Lamaze encourages you to plan for a supportive birthing environment that includes continuous emotional, physical, and informational support.

A supportive woman experienced with childbirth can make a valuable contribution to your care during labor and birth because of her commitment to staying continuously with you and your family, her knowledge of both physical and emotional comfort measures, and her confidence in your ability to birth your baby.

Doulas and Personal Trainers

I have recently started a fitness study that gives me a FREE personal trainer for 9 visits. (It's a 21-day study). Now a personal trainer is a luxury I would NEVER have thought to give myself because I have a hard time spending money on myself and really could never justify the extra expense. Interestingly enough... my passion for doula work has helped me understand how important a trainer is. Here's my comparison:

As a doula I do not look at my clients and say; "well... I'm not sure if you can do this but we'll try!" I really KNOW that they can succeed, that any obstacles can be dealt with. I give support and encouragement and really good information and believe in the body and it's ability to birth babies. I think this is why having a doula is so effective. Just having someone supporting you that knows that you can do it and reminds you of your goals makes a huge difference.

My trainer looks at me the exact same way I look at my clients. He doesn't look at me and think... "Hmm... there is no way this woman is ever going to run a 5k" he actually KNOWS that I can do it. Now of course he understands that I am the only person standing in my way (short of an injury) and he also understands the importance of having good support. He would never look at me and say... "yup you can't do it... better quit!" or "jeez are you okay, you look like you are dieing!" He pushes me and reminds me of my goals all the while KNOWING that I am capable. He believes in the body and it's ability to be fit!

The moral of the story? Mastering your goals is always easier when you have support from an amazing person who KNOWS how achievable your goals really are... even if you aren't so sure yourself.

Picnic in the Park!!

After the Labor Day Picnic
A gathering of doulas and the families who have used their birth services.

PLACE: Sugarhouse Park-Terrace Central
2100 S. 1300 E.
DATE: Saturday September 13th
TIME: 11 a.m. - 2 p.m.

-Please bring a picnic lunch for your family.

-The Utah Doulas association will be providing drinks and dessert.

This is a fun time for doulas to get together with previous clients. It's also an opportune time for anyone interested in doula work or the services provided by doulas to meet a great group of women who believe in the beauty of birth. Can't wait to see you all there. :o)

Your provider- The key to a beautiful birth.

One of my favorite CNM's Danielle Demeter said.... "I don't care where you choose to birth but with WHOM you choose to birth." This statement could not be more true.

It seems that many women fall into the "oh he is so nice!" trap. I admit being lured to such a trap but somehow managed to switch providers before my birth became a repeat of my recommending friend. (Who after telling me about the pitocin, episitomy and forcep delivery won me over by telling me how incredibly kind her doc was throughout the procedure.)

My first official doula client chose her provider based on the "niceness" factor. As it turned out... her very kind Dr. turned out to be nicknamed "the vacuum doc" (as he vacuum extracts all first babies) and was NOT nice once told "NO!" In fact, he resorted to name calling and threats when my client begged him to just let her tear and not cut an episiotomy and his tantrum worked. She walked away with a HORRIBLE birth story and realized that he wasn't so nice after all.
I am bringing this up because in my experience as a doula I have found many potential clients who don't seem to realize how important the provider really is. These care providers are creatures of habit. Some routinely cut episiotomies. Some insist all women birth with epidurals. Some even discourage women from taking childbirth classes or having doulas so they can be their clients ONLY source of information.

If you choose a provider her is a creature of such habits you are very likely to be subjected to these things regardless of what your birth plan states, or what you have previously discussed, so how do you know when you have chosen such a provider? ASK QUESTIONS and don't be afraid to switch providers.

First of all, when looking for a provider lean to people who support or have experienced the type of birth you are seeking. If you are seeking a non intervened unmedicated birth start with natural birth friendly people. Doula's are a great source of information regarding providers who are supportive (or unsupportive) of such births and you can find many local doulas who are willing to just chat and let you know @ www.utahdoulas.org. (If you are not in Utah you can start with www.dona.org (Doulas of North America).)

If you have already picked a provider and want to make sure they are on board with natural birth ask them questions such as: "How often do you feel it is necessary to cut an episiotomy on a first time mom?" or "How many of the mom's who tell you they want to birth without an epidural actually achieve their goal?" If you provider is unable (or unwilling) to give you a direct answer... RUN. If his answer to the first question is a high number, you are incredibly likely to have an episiotomy.
Two doulas I LOVE have both been heard numerous times saying: "YOU CAN'T GET PIZZA AT A CHINESE RESTAURANT!!" If you choose a provider who loves to cure women of their pregnancies he will most certainly cure you! But pregnant women are NOT SICK and we certainly don't need to be cured, or treated like every other pregnant woman. Our needs are unique and our own birthing desires CAN BE unique as well.

Another trap we fall into is the "it's too late to switch" trap. This is never the case! Please don't ever settle or sacrifice your birth experience because you are nervous about switching providers. If you don't get an answer you like from your chosen provider, find someone who gives you the correct answer. I promise your baby has no emotional attachment to the first person you chose. Switching to the right provider at 38 weeks is better than staying with the wrong one and getting a less than ideal birth experience because of unnecessary interventions.

Birth at..... HOME?!!?!?!

I have been asked by a few people to post by birth story. I am thrilled to announce that my 4th son was born on Wednesday June 4th in my home. It was an AMAZING experience and I will try to do it justice here. Before I begin I want to point out that it was my desire to have a better birth experience that led me to the world of doulas and I did not begin to get involved in anything doula until this pregnancy was already established! ;o)

Last summer I knew that I was going to be taking out my IUD very soon. I was not sure what I would do for a provider/hospital. I have had 3 VERY different birth experiences with the providers I have used in the past. With the first 2 I used the same group of midwives. They are an incredible group but I really HATED the hospital where they attended births. I knew that I didn't want to have my baby there so I picked a different midwife practice based on the hospital they delivered at (which has a good reputation). It also was NOT a good experience as the midwives themselves proved to be very interventional and impersonal... not what I expected at all. I also realized that no matter what hospital you are at they are all similar in the way they handle infants, which is my biggest erk with the hospital system. I hate that they TAKE your baby. They "DELIVER" your baby (as if you didn't do all the work), they PERMIT you to LOOK at him/her, and then they take them away to stare at them under the light. No one asks permission to hand your baby back and forth or stick their finger in your little guys mouth. They take them for a "quick test" and bring them back when I'm finally calling out because I'm having an anxiety attack. Needless to say, I hate when they take my baby away from me for any period of time and I've always thought that there has got to be a better alternative but I've never found it.

I had heard about "crazy" women who dared to have their babies at home. I thought they were all insane and irresponsible. I'm not sure what prompted me to research it. Maybe it was the feeling that there was no better alternative. I went into my research very skeptical; wondering just how many women and infants were dieing from their own stupidity. What I found was incredible. It was exactly what I was looking for. Proof that birth is beautiful, natural and unflawed. Statistically, home birth is incredibly safe. For someone like me (who's history of child bearing is very simple) it actually looked like home birth was a safer alternative then birthing in the hospital. Home birth takes out the interventional aspect of birth that has become routine in the United States and gives birth back to nature. The statistics were proof enough to me that my body really does know how to have babies and that birth, when left to it's own accord, will happen smoothly and without complication. And so began my quest to attain my ideal birth.



I admit I was becoming increasingly frustrated as my due date came and went. I have never been "overdue" before and I became more and more nervous with each day that passed. What if my body DIDN'T know what to do? Maybe this whole "letting nature happen" thing was a bad idea. My midwife had complete faith in my body even though I was skeptical and at 12:05 a.m. on June 4th (the dawn of my 41st week) I woke to some very intense contractions and just enough blood to let me know that my body was serious. I have a history of fairly fast labors but have never been left to labor without my water being broken. I was excited to labor without intervention but nervous that with my membranes intact, labor would be long. Luckily for me, that was not the case.



My sister (AKA my doula) arrived around 12:30 and knew instantly that we were rockin' and rollin'. I had called my midwife (who lives 35 minutes away) shortly after I woke up and she arrived around 1:20. Labor was very intense from the time my sister arrived and when my midwife arrived I had already been in and out of the birthing tub.

The water had felt so good at first but I had begun to overheat as the contractions got more intense. It was her suggestion that we add cold water that allowed me to get back into the tub, where I remained until little Colton was born at 3:20 into the hands of his daddy.

The labor itself was incredibly intense from start to finish. My midwife, her apprentice, my sister and my husband were my constant support. They took turns pushing on my hips and applying sacral pressure. They also encouraged me and reminded me of the incredible miracle that is labor and birth. No one told me when to push or rushed to check dilation before pushing was "permitted" nor did anyone insist that I push on "their" time or in a position that was most convenient for them. It was amazing to feel the "urge" to push and to go with my body as I knelt in the water. The midwife was frequently checking fetal heart tones and it was when the baby was all the way to the perineum, waiting to be pushed free that I heard the heart tones and knew that the baby needed to come then. As the midwife calmly and quickly moved to get oxygen for me, I made the decision to push past all the burning and pressure that crowning presents for me and his head emerged into the water along with a small loop of chord (which explains the low heart tones as his chord was being compressed). Shortly after, I pushed his little shoulders free and he was lifted out of the water by his dad. It was so incredible.

The fact that he didn't cry right away was not terrifying and did not bring any panic to the environment. My midwife very peacefully lifted his little face to hers and puffed into his tiny mouth/nose. A small exhale/grunt was heard and she repeated the process until about 5 breaths later, when a loud cry echoed through the house. This entire process took about 20 seconds. I was at ease the entire time. And with that cry, the baby was handed to me and we were left to bond in the tub as hot water was added and the midwife poured warm water over his tiny body.

The birth and everything to follow was exactly what I wanted, what I knew birth should be. I was thrilled to avoid the audience of strangers staring at my bulging bottom as I pushed. (At my third birth which was intended for just me and my husband, there were at least 5 other "health care workers" besides my midwife in the room while I pushed.) I was also so excited to have my baby with me and my family. I loved being the one who provided my son with all that he needed and also that I was in control of who touched him, who held him, when they last washed their hands, whether or not they were sticking their fingers in his mouth and that NO ONE was going to take him away from me. I also was happy to avoid the interventions the hospital does without any form of consent and without your knowledge like erythromycin ointment (intended to avoid the transfer of gonorrhea and chlamydia from mom to babies eyes) and vitamin K injection. Really truly, it was perfect and beautiful. I had been seeking this, I just had no idea that I would find exactly what I was looking for right here in my own home.

Now I don't want anyone to assume that I believe that having a home birth is something that every woman should do. I truly believe that women should birth their babies in the environment where they feel safest. It would be impossible to enjoy your birth in any environment if you are uncomfortable or feel unsafe in that place. As a doula my goal is to help women achieve a birthing experience that is as close to their ideal as possible. Just wanted to share with all of you my beautiful birth.

Hooray for empowered women!

I attended an incredible birth yesterday (technically this A.M.) with an amazing couple. I will have to get permission to post the birth story but I wanted to say: "I LOVE WOMEN WHO BELIEVE IN THEIR BODY'S ABILITY TO BIRTH BABIES!!!" I love that affirmation that birth works and this mom was truly amazing. Congrats to the new Mommy and Daddy. Happy Easter and way to make a BEAUTIFUL baby!

Cute little comic...

Cyanide & Happiness @ Explosm.net

Free showing of Business of Being Born!!!

Date: February 28th at 7:00pm
Location: Salt Lake Community College Larry H Miller Campus
9750 S 300 W Sandy, UT 84070
Cost: Free, registration required as seats are limited
To register contact our office at (801) 565-3755

Dr. Joseph Humpherys
Medical Director
Healing Solutions Pediatric Center
Phone: (801) 565-3755 Fax: (801) 565-7171
www.healingpediatrics.com

Silly little birth story!

I just thought this was too cute to not share!

The "Middle Wife" by an Anonymous 2nd grade teacher

I've been teaching now for about fifteen years. I have two kids myself, but the best birth story I know is the one I saw in my own second grade classroom a few years back.When I was a kid, I loved show-and-tell. So I always have a few sessions with my students. It helps them get over shyness and usually, show-and-tell is pretty tame. Kids bring in pet turtles, model airplanes, pictures of fish they catch, stuff like that. And I never, ever place any boundaries or limitations on them. If they want to lug it in to school and talk about it,they're welcome.

Well, one day this little girl, Erica, a very bright, very outgoing kid, takes her turn and waddles up to the front of the class with a pillow stuffed under her sweater.She holds up a snapshot of an infant. "This is Luke, my baby brother, andI'm going to tell you about his birthday.""First, Mom and Dad made him as a symbol of their love, and then Dad put a seed in my Mom's stomach, and Luke grew in there. He ate for nine months through an umbrella cord."She's standing there with her hands on the pillow, and I'm trying not to laugh and wishing I had my camcorder with me. The kids are watching her in amazement.

"Then, about two Saturdays ago, my Mom starts saying and going, 'Oh, Oh,Oh, Oh!' Erica puts a hand behind her back and groans. "She walked around the house for, like an hour, 'Oh, oh, oh!' (Now this kid is doing a hysterical duck walk and groaning.)"My Dad called the middle wife. She delivers babies, but she doesn't have a sign on the car like the Domino 's man. They got my Mom to lie down in bed like this." (Then Erica lies down with her back against the wall.)"And then, pop! My Mom had this bag of water she kept in there in case he got thirsty, and it just blew up and spilled all over the bed, like psshhheew!" (This kid has her legs spread with her little hands mimingwater flowing away. It was too much!) "Then the middle wife starts saying 'push, push,' and 'breathe, breathe. They started counting, but never even got past ten. Then, all of a sudden, out comes my brother. He was covered in yucky stuff that they all said it was from Mom's play-center, so there must be a lot of toys inside there."Then Erica stood up, took a big theatrical bow and returned to her seat.I'm sure I applauded the loudest.

Ever since then, when it's show-and-tell day, I bring my camcorder, just in case another "Middle Wife" comes along. Now you have two choices...laugh and close this page or pass this along to some one else to spread the laughs. I know what I did!!!

Hypnobabies

I have recently had the priveledge of attending a Hypnobabies class taught by Laura Lund in Provo. It has been an amazing experience for me. I actually attended and used hypnobirthing with my last child and found it to be effective but lacking somehow.

As I have attended Hypnobabies I have found what that missing link is! Hypnobabies not only teaches deep relaxation, but also hypno anesthesia and talks directly about interventions and their necessities (or lack there of). Had I taken hypnobabies with my last child I KNOW that I would have had a completely different birthing experience. While hypnobirthing worked for me to an extent, it did not prepare me for the interventions I was faced with and even chose for my last birth.

I am very excited to attend births with hypno mommies. I know that the class they are taken gives them the tools to choose the birth that is ideal for them.

Why I chose to birth unmedicated!

I thought that it might be fun to let others know how I came to have babies without epidurals. When I became pregnant with my first son, my husband and I approached birth completely unprepared. We attended a short class at the hospital and learned about the process of birth, but we had no clues about interventions, or what to ACTUALLY expect from the labor process. When I woke up one bright May morning and realized that my "water had broke" I paced around the house completely dismayed, I honestly had no idea what I was supposed to do. After cleaning and packing I woke up my husband and told him that we might need to go to the hospital.

We arrived at the hospital around 7:30 in the morning and it was determined that my water had indeed broke! We were quickly admitted to a labor room and left alone. We remained in that room for 4 hours with not so much as a peak from a nurse or my CNM. Eventually the contractions became very intense and not knowing what was to come, I pushed on the call light and said "Uh... this hurts." They sent in the anesthesiologist to administer my epidural. I would love to thank that anesthesiologist for doing such a HORRIBLE job! The placement was very not typical and after 45 minutes of his prodding I was left with an epidural, however, I had accidentally been given a spinal as well. I was completely limp from the waste down. When he was finally finished it was determined that I was complete! So there I sat... waiting to have enough feeling to push out my son. The staff suggested I take a nap! 2 hours passed and they finally decided that I should try to push. About an hour and a half later I had my son. Completely pain free, and completely empty. It was so strange. Here was this beautiful baby who had apparently come from my own body, but I felt nothing.

In October of that year, just 5 months after my son was born, I realized that I was pregnant AGAIN!! I decided to go to the same midwife practice where I mentioned that I wasn't sure if I wanted an epidural this time. My pregnancy was a fun emotional roller coaster for us all and when it was finally time to deliver my son an angel walked through the doors to attend us. She looked in my chart and read that somewhere along the way I had said that I wanted to try and go "unmedicated". That was all she needed and the birthing began. She was like a doula, never left my side! She helped me change positions, use the birth ball, get in the tub, breath, dance, whatever was comfortable. I never asked for medication and SHE NEVER OFFERED THEM!! I knew that if I asked she would be HAPPY to get anesthesia there immediately... but I also KNEW that she knew I could do it! It was an amazing and exhilarating experience. When my second son was born it was the most surreal moment of my life. I had birthed my baby all by myself. No IV, not strapped to the bed, it was as natural as I could imagine birth ever being! It was beautiful!

I have since given birth another beautiful son... 5 years after my second son was born. The thought of an epidural never crossed my mind. I had gained great faith in my body and the birthing process (and so had my husband) from experiencing it in all it's glory. I also chose to take a hypnobirthing course for this birth. The class taught me so much about relaxation and I delivered my third son after a 3.5 hour labor which was augmented by pitocin due to an impatient care provider. The experience was very exilerating however, I missed the support I had recieved from my previous midwife. Her belief in me and determination to help me achieve my goal is what got me through the previous labor, and it gave me the strength to know that I could do it the 3rd time around.

I believe in birth! I know that woman are strong. Birth can be hard, there's no question about that, but a lot of things we do in life are hard. It is the hardest challenges that reap the greatest rewards, and hey, I'm always up for a challenge!

Midwifery vs obstetrics.. how the models differ!

This is an excerpt from Ina May's Guide to Childbirth. (It talks about the difference between the midwifery and obstetrical models. I found it to be very informative and absolutely truthful!):

Sociologist Barbara Katz Rothman was the first to name and describe the differences between the models. She pointed out that the midwifery model of care is female-centered. Within it, birth is something that women do- not something that happens to them. The birth-giving woman is the central agent in the ancient drama of life bringing forth new life. The midwifery model of care recognizes the essential oneness of mind and body and the power of women in the creation of new life. The midwifery model of care conceives of pregnancy and birth as inherently healthy processes and of each mother and baby as an inseparable unit. According to this model, the emotions of the woman have a very real impact upon the well-being of the baby. When the woman's emotional needs are filled, there is less risk for the baby. The reality is that the baby has no choice but to feel what the mother feels. Prenatal visits within the midwifery model tend to be much longer, allowing for more questions to be answered than in prenatal visits in the medical model. The midwifery model of care recognizes the importance of good nutrition as the best way to prevent the most common complications of pregnancy. It emphasizes the importance of companionship and encouragement during labor as a way to minimize techno-logical intervention in the birth process. It does not impose arbitrary time limits in physiological processes.

Good research shows that when the midwifery model of care is applied, between eighty-five and ninety-five percent of healthy women will safely give birth without surgery or instruments such as forceps and vacuum extractors. Within the midwifery model, medical intervention is inappropriate unless it is truly necessary. Labor has its own rhythms, so it is not expected to conclude within any rigid time limit. It can start and then stop, speed up or slow down and still be normal. A laboring woman may move around freely, drink, eat, and be sexually playful with her partner within this model (if that is what best stimulates her labor). All of these activities help labor to progress. The midwifery model of maternity care, of course, recognizes that medical intervention is sometimes necessary and that it should be applied in these particular cases. At the same time, it maintains that medical intervention may be harmful when it is used purely for convenience or profit.

The techno-medical model of maternity care, unlike the midwifery model, is comparatively new on the world scene, having existed for barely two centuries. This male-derived framework for care is a product of the industrial revolution. As anthropologist Robbie Davis-Floyd has described in detail, underlying the technocratic mode of care of our own time is an assumption that the human body is a machine and that the female body in particular is a machine full of shortcomings and defects. Pregnancy and labor are seen as illnesses, which, in order not to be harmful to mother or baby, must be treated with drugs and medical equipment. Within the techno-medical model of birth, some medical intervention is considered necessary for every birth, and birth is safe only in retrospect. According to this model, once labor starts, birth must take place within twenty-four hours.

Mind and body are considered to be separate within the techno-medical model of birth. Because of this, emotional ambiance is of importance only when it comes to marketing the service. Where the techno-medical model of birth reigns, women who give birth vaginally generally labor in bed hooked up to electronic fetal monitors, intravenous tubes, and pressure-reading devices. Eating and drinking in labor are usually not permitted. Labor pain within this model is seen as unacceptable, so analgesia and anesthesia are encouraged. Episiotomies (the surgical cut to enlarge the vaginal opening) are routinely performed, out of a belief that birth over an intact perineum would be impossible or that, if possible, it might be harmful to mother or baby. Instead of being the central actor of the birth drama, the woman becomes a passive, almost inert object-representing a barrier to the baby's eventual passage to the outside world. Women are treated as a homogenous group within the medical model, with individual variations receding in importance.

The techno-medical model of care has been dominant for a century in North America. By the 1920's the United States and Canada had become the first societies in human history to do away with midwifery only to find out some decades later that women still wanted midwives and that some (like my partners and me) would reinvent midwifery if they had to. Many people share the goal of reclaiming midwifery and ensuring that in the not-too-distant future there will be enough midwives in Canada and the United States that every women who wants one can have one. Even though midwifery is legal in the United States and Canada, midwives still attend fewer than ten percent of all births in each country. These percentages are far below those of the nations of western Europe and the rest of the world, where midwives attend the vast majority of all births. More than seventy percent of babies born in the countries with the lowest rates of maternal and newborn deaths are born with only midwives-no physicians-in the birth room. In Germany, a federal law ensures that a midwife must be in attendance at every birth-even in cases when an obstetrician must perform a cesarean section or an instrumental delivery.

Hypnobirthing!

Last Sunday early morning I had the honor of attending the birth of an adorable little boy who couldn't have had more loving parents. His mother is a 3rd time mom who had epidurals with her previous deliveries, but who had decided for various reasons to go unmedicated with this 3rd birth. To assist her in accomplishing this, she chose to attend Hypnobirthing . I can not say how AMAZING this birth was.

Before I tell the short labor story, (YAY for 3.5 hours of labor!) let me briefly explain the philosophies of hypnobirthing. Hypnobirthing focuses on relaxation and relieving tension during birth. The idea is that if a woman can relieve tension and let go of fear during birth, she will experience less pain and will actually HELP her body through the birth process by trusting that her body is doing it's job. It is a truly amazing thing to watch a woman be so focused with each contraction.

When I first met with this beautiful couple, I was told that the dad wanted to be VERY involved... basically, coached. My role was to help mom stay focused and comfortable but mainly to do those things through her husbands hands. (To make suggestions on position changes or show him pressure points that would elevate the intensity of her contractions.) I was really excited for this birth, I've never met a dad so loving and involved in the birthing process.
So I got the call at 4:27 in the morning and raced to answer the phone. I was certain that the only person who would be calling at this hour was a woman in labor. I answered the phone and could tell by her voice that she was ready! I got to the hospital about 15 minutes after the couple arrived to find her looking very calm. Her husband whispered to me that she was at a 7. WOW!! It was actually impossible to tell when she was having a contraction. Her relaxation music was playing, the lights were very dim and she sat in the bed as the nurse started a Hep lock IV. She was very comfortable and I was a little worried that I would be no help at all as she definitely had this under control. We chatted, joked, and I refilled her water for about an hour and a half before the midwife came in to check her.

It was right around 6:30 in the morning when the midwife pronounced that the mom was still about a 7 and offered to break her water (which we had discussed before hand). The mom was confident in answering that she would be fine with that and soon the membranes were ruptured. It took a few minutes before the contractions started up again but when they did, they came on with a new intensity. It was with the onset of this intensity that I became useful, although the mom was still VERY much in control. Pressure points and position changes were necessary to help keep the mom focused and dad was up for anything I suggested. The birth ball was a fantastic place for her to be for quite a while but eventually we found a very comfortable position for her sitting in the good ' ol hospital bed. Hospital beds are REALLY amazing. They do incredible things and with this particular bed we were able to sit her up in a perfect upright position with knees at about a 90 degree angle resting beautifully on the bottom of the bed... kind of like a wheel chair, for lack of a better explanation. She found that she very much enjoyed the "knee press" which was quite easy to apply in this position in the bed. It was really fun as she hopped out of the bed and paced around the room to bring the contraction on and then raced over to sit in the bed so her husband could apply that pressure to her knees. After only a few contractions she started to skip the hopping in and out part and resolved to stay sitting in the bed. It was very evident that the contractions were very intense based on small changes she had made in her focusing technique, but she never faltered from her focus. I don't recall her so much as grimacing her face. Through every contraction her body looked relaxed.

When the midwife came in and let her know she could push mom was not quite feeling the urge. It was at this point that everything just sort of happened. It's a blur for me, I can only imagine how blurry it is for her. The midwife offered to allow her to push in a couple of different positions and the mom chose the one she thought she would be most comfortable in. She pushed through 3 contractions and her beautiful son was born at 8:07 a.m. It was incredible.

The most inspiring/memorable moment for me was a few minutes after the birth. It seemed like mom had finally realized what had just happened! (Unmedicated birth is very surreal. You feel it all, but when it's over, you can't really believe what just happened!) At this moment of realization she kind of laughed and cried out loud, and her expression was unforgettable. So empowered, so thrilled, and so proud! If I could do that birth all over again I would! Over and over. (But I understand that the mom probably wouldn't be so thrilled about this idea.) It was perfect. This mother with so much determination to trust her body. A dad who never for a moment looked doubtful. He always believed in her, as I always believe in all of my mom's as they embark on this amazing/challenging/rewarding time in their lives! WOMAN ARE STRONG!! It's so fun to find other woman who believe it! :o)

Woman believe in their own bodies ability to ovulate, implant, nurture and grow their children. My goal is to help woman also trust equally their bodies ability to birth those little ones. Birth is part of the process, as instinctual as a newborn who takes right to the breast. It's BEAUTIFUL!!!

UCAN BIRTH!!!

Unmedicated Childbirth Advocacy Network
UCAN Birth Support Group
Are you tired of people looking at you like you're crazy because you want or have had an unmedicated/natural childbirth experience?
Are you discouraged by comments such as "oh, I wanted a natural birth, too, but I couldn't do it (and neither can you)"?
Do you want to learn more or share what you know about unmedicated, natural childbirth options?
Would you like support for your decision to give birth normally and naturally as well as information on how to achieve your goal?
Would you like to learn about or gain support for "alternative" childbirth options such as midwifery care, home birth, waterbirth, doula support, vaginal birth after cesarean (VBAC), hypnosis for childbirth and other childbirth techniques?
Come to a free UCAN Birth support group meeting because you can birth in the way you desire!

The next meeting will be Thursday, Dec. 13th from 7-9pm. We will be sharing inspiring natural birth stories. Bring your birth videos or birth stories along with a food item to share! We will also be watching the birth video Psalm & Zoya, which shows the unassisted home birth of twins.

Please R.S.V.P. and get directions for these UCAN Birth support group meetings through the contact info listed here: http://www.birthnaturally.org/aboutme.htm#contact

I am really excited about attending this! I've heard wonderful things about Laura and her birth support group! I've also heard that the video is amazing! So anyone out there interested in attending! I hope to see you there!


More info:

What is UCAN Birth?
UCAN Birth is a volunteer organization of women interested in advocating for normal, natural, unmedicated childbirth. Think of it as a La Leche League for birth. UCAN Birth headquarters are located in Provo, UT in Utah County and women along the Wasatch front are invited to attend.
Who is invited?
Women who desire to give or receive support and information regarding unmedicated, natural childbirth options are invited to attend UCAN Birth support group meetings. Occasionally we may hold meetings to include male birth partners. Those meetings will be specified as such. Please make arrangements for older children. Nursing babies are always welcome.
What are meetings like?
UCAN Birth meetings are informal gatherings at which all women are encouraged to share information and/or ask questions. Each meeting will have a general topic related to natural, unmedicated childbirth that will be the focus for discussion. We may occasionally have guest speakers, but the majority of the time spent at UCAN Birth meetings is spent in relaxed, friendly discussion.
Where are meetings held?
UCAN Birth meetings are held in Provo. Please contact me to R.S.V.P. and get directions.
What are our goals?
To promote researched, fact-based maternity care.
To promote gentle birth options that protect and respect mother and baby.
To inspire women to trust themselves, their bodies, and their babies to give birth safely and normally.
To provide information on natural childbirth options and share suggestions and experiences on preparing for unmedicated birth.
To facilitate learning and foster a nurturing, fun environment in which this can take place.
To share positive, empowering natural childbirth stories that uplift and inspire other women who are about to give birth.
To be a safe harbor in this world of epidurals, inductions, and elective cesareans where women can be truly supported in choosing natural childbirth.

Faith in Birth

So I had the honor of attending the birth of a beautiful baby boy last Friday. Not only did it strengthen my faith in birth and the birthing process, it made me grateful for that faith. I was invited to attend this birth by a wonderful women anticipating the birth of her 3rd child. I totally believe that I had a huge advantage in this matter for several reasons!

#1- She is a very close personal friend of mine!! She trusts me, I trust her!

#2- She has had 2 previous un-medicated birth experiences, so she already believed in herself!

#3- Because I have had children un-medicated I personally KNOW that women's bodies can birth babies!! I understand the sheer strength that comes with being a woman!



This was a scheduled induction at 37 weeks because the mother has a history of preterm labor and is also a gestational diabetic. I have to admit I do have reservations regarding induction, but she agreed with her Doctor that it was really necessary in order for her to have an optimal outcome. So I arrived at the hospital shortly after she did. I was anxious and excited because I knew that she would be successful in reaching her goal of having another un-medicated birth. It is a beautiful feeling to feel so connected to another woman in such a personal way.



The birth was much longer than the mother had anticipated lasting about 8 hours. The nurse had read through her birth plan upon admission and had asked her several questions regarding her desires and let us know in advance that if she did something contrary to the birth plan that she would like a reminder from us so that she could give her the birth that she wanted. (The nurse seemed to be afraid that she might count while pushing, or take the baby away when he was born due to habit!) The process went as smooth as anticipated, (kind of like driving on a dirt road) and the mother was very flexible with what she was willing to do in order to have as much her way as possible. This meant that she really had to compromise a lot from how she had hoped things would be. She was prepared for this however, and because she felt in control of the situation, none of the little dips seemed to phase her. She was a trooper!

So for the first several hours I spent a lot of time "comforting" a very calm woman! Seriously, she breathed through every contraction without so much as an ounce of tension. I was shocked that on 20 of pitocin she was dealing with contractions with ease and control. It wasn't until the contractions finally started dilating her cervix that I really started to be a major part in her getting through every contraction and staying on top of them as they came. When it finally came time for her to push, the Dr. was called into the room! (This is not the standard of practice, but because she had such quick previous births the Dr. came in for the entire pushing process.) It was discovered by the Dr. at this point that the baby was posterior, or "face-up." A posterior baby is not the ideal position to push a baby out in, it also explained a lot about the intensity of the contractions, and the pressure that she could not find the words to describe. Either way, the Dr. allowed her to push her baby in a semi-sitting position with her legs where they were comfortable (even though the nurse desperately wanted to pull her legs back towards her head!) We all watched patiently and silently as she pushed her little guy out! No cues from the nursing staff, no one counting or telling her to "push, push, push" or hold her breath. It might be shocking to people, but the desire to push is not something that can be avoided and it is actually instinctual to push! So after about 20 minutes of pushing, the little guy entered the world "face-up" and perfect.

So even though the birth didn't go exactly how the mother would have pictured it, it followed the plan as closely as possible. The interventions that she had hoped to avoid were avoided, and she had total control over every decision made during the birth process. She didn't go to the hospital to "have them help her have the baby" she went there to let them have the pleasure of watching her birth her baby all on her own, and that's just what she did!

Birth!

So I attended the birth of my niece on the 8th of October. She is beautiful! My sister and her husband are amazing! The birth reminded me over and over again of Laura Lund's article. Picking your provider is key to having the experience that you want/deserve. I have come to the conclusion that there are 2 attitudes you may want to stay away from in choosing a provider.

#1-"All that matters is that the baby is healthy." While the health of the baby is very important, most healthy babies are born that way because their parents made a healthy baby and the mom avoided using substances that could damage the health of the baby while she was pregnant. A healthy baby is OF COURSE the outcome that all women want but remember: YOUR HEALTH AND SATISFACTION WITH YOUR ROLE IN THE BIRTH MATTERS TOO!!!! Some providers may go against all of your wishes and tell you after all is said and done that at least the baby is healthy... as if they made him/her that way! Don't let anyone tell you that you don't matter! You do!!!!!

#2- You can't plan birth. Everyone knows that we can not calculate exactly how a birth can go but with the right provider you can plan to avoid certain interventions regardless of the twists and turns of the birthing process. This means if you do not want an episiotomy you don't have to get one! If you don't want continuous fetal monitoring but must have it, you can be hooked up to a telemetary unit and not be strapped to your bed! If you want to walk, use a birth ball, or have hydrotherapy (bath or shower) in the hospital, all of these things are possible even if you MUST be monitored continuously, provided you have talked to your caregiver ahead of time. A birth plan is not an outline of how you plan the birthing process to go. It is a guideline of what interventions you do and DO NOT want done to you during the process and a reminder of your ideal birth. I recommend that you research a lot and come up with a birth plan that outlines your desires and take it to your provider even on your first appointment. If the Dr. smirks at something, or tries to convince you that certain things are ridiculous and you've done the research... find another provider. Because in the end, what matters most is that you feel accomplished by your role in the birth of your creation.

I recently watched a video on U-tube, a clip from Monty Pythons the meaning of life. It is actually a funny little sketch about the birth of a child. There are two things that the "Dr." says to the patient that I find to be appalling, but have seen in the birth of my niece. "Don't worry dear, we'll soon have you cured!" Some providers approach labor as the onset of a disease and seem to completely believe that they are there to cure you, rescue you, save you from your own body. In another part the patient asks the Dr. "What do I do?" He replies, "Nothing dear you're not qualified!" When you are visiting with your Dr. and asking him questions about interventions and birth, ask yourself if you hear either of these things in his answers. My sister heard them, and disregarded them. In the end, her provider proved to have no intentions of following her birth plan. Instead he CURED her and SAVED her baby and left her feeling empty, and abused!

Love this quote!

"We have a secret in our culture and it's not that birth is painful, it's that woman are strong!"
-Laura Stavoe Harm

Great article by Laura Lund HCHI

Burger King and Birth: Have it Your Way!

by Laura Lund, HCHI

www.BirthNaturally.org Copyright 2007. All rights reserved.
.pdf version is here.

Let’s say you’ve decided to go out to eat. As you’re driving around you see a few different options and you choose to go to Burger King. You wait in line and when it’s your turn you say:

“I’ll have whatever she had” (pointing to the woman who just ordered);
“I’d like a number 3 meal”;
Or maybe you want to customize it a bit and you say “I’d like a number 3 with

no mayonnaise, no pickles, heavy tomato, and cheese.”

No problem, right? They should be able to handle those variations (although you’ll probably have to repeat your instructions at least once).

What would happen if instead of ordering something on the menu you said, “Hi, I’d like a fillet mignon steak, cooked medium-well, a baked potato, steamed asparagus with hollandaise sauce, and garlic bread. I’d like that served on fine china and I’d like to sit at a private table for two with candlelight and a white linen tablecloth.” Would the Burger King employee say, “No problem, ma’am, we like you to ‘have it your way1’?” Unlikely, since that isn’t the type of service or food that Burger King normally provides. They don’t even stock that kind of food and probably don’t have the equipment or knowledge how to prepare it, either.

The Burger King employee would more likely say, “I’m sorry, ma’am, we don’t have those things here.” Or maybe he’d say, “Um, I’m sorry, ma’am, but this is Burger King. We only serve fast food, not gourmet food. If you want gourmet food you should go to the sit-down gourmet restaurant across the street. Otherwise, please order something on the menu.”

Now, at this point, you could decide to go with one of the first three options and stay at Burger King. Or, if you decide that you really want that gourmet meal, you’ll find a restaurant that caters to delivering that type of meal as a normal matter of course.

The reality of hospital births is that hospitals are not generally set up to cater to the individual desires of each woman that comes in to give birth there. Certain requests can usually be accommodated without a lot of fuss or bother, like requesting Burger King to hold the pickles and the lettuce. If a woman comes in wanting to wear her own clothes or listen to CDs or turn off the lights, no one usually cares about that.

Other requests come closer to requesting fine dining in a fast food joint. If a woman comes in declining a routine IV, choosing to eat and drink as she desires, opting for monitoring 10-15 minutes per hour instead of all the time, declining pain medication, avoiding pitocin or other interventions to “speed things up”, getting into the tub or shower even after her water has broken, and pushing in an alternative position such as a squat, some doctors, nurses, or midwives are going to have a difficult time feeling comfortable with those requests. A few of those choices are against typical hospital policy and the rest of them are likely to be very different from the types of births most hospital care providers and nurses usually attend. They may not be prepared to support that type of birth and they may not feel comfortable with those sorts of requests.

Now, it’s not really your problem if your requests make anybody else uncomfortable. The birthing mom is the boss, period. However, as you make choices regarding your baby’s birth, including what you would ideally like to have be a part of that birth experience, you need to make sure that you are wisely choosing a care provider and birth location that are conducive to the type of birth you’d like to have. Hospital birthing moms may find that they need to exert more effort in communicating their ideal birth preferences and they may find that they need to make concessions regarding certain aspects of those birth preferences. A hospital birthing mom may find a compromise that is still ok or good enough for her while also allowing her doctor or nurses to feel more comfortable. For example, a woman who may not have wanted any vaginal exams may find that she’ll agree to having one upon admission and one prior to pushing since her doctor feels very uncomfortable about not doing any. If she feels ok about that compromise after considering the benefits and/or risks of that course of action, that’s fine. It’s her birth experience.

Moms who choose to give birth outside of a hospital typically find that they have many more automatic birthing options—like having a caterer or personal chef come to your house and deliver a meal that is customized for your tastes and desires. A woman who desires to give birth without any routine interventions (no IV, no continuous monitoring, no vaginal exams, no episiotomy, etc.) and wants the freedom to do pretty much whatever she likes during her birthing time without anyone batting an eye (walk, use the tub during labor and/or birth, eat, drink, adopt whatever positions suit her, wear her own clothes or even no clothes, etc.) would do well to consider birthing outside of a hospital, where that type of birth is pretty much the norm. A woman who wants the postpartum period to be more relaxed and low-key (no routine procedures for the baby, no separation from the baby, etc.) may also prefer out-of-hospital birth. Planned home and birth center births have been proven to be at least as safe as hospital births for most women and babies.2 There is a very large body of research available documenting the safety of out of hospital births.3, 4

The bottom line is that you can, for the most part, have it your way. You need to decide for yourself what “your way” is, exactly, and where and with whom you’re most likely to be supported to give birth in the manner that best suits you. Are you more likely to have your ideal birth in a high tech hospital with a surgeon (OB/GYN) attending? Are you more likely to have your ideal birth in a smaller community hospital with a family practice doctor or CNM attending? Are you more likely to have your ideal birth at an alternative birth center or at home with a midwife attending? These choices are aspects of your baby’s birth that you directly control that have an enormous impact on what kind of birth experience you ultimately have. It’s really very important that you carefully research and consider all of your options and choose the option that you feel most comfortable with, whatever that may be.

If a woman decides that an OB/hospital birth is her best option does it follow that she should just choose any old random OB that happens to be on her insurance list? Are all OBs the same?
I’ve attended births with OBs that respect a woman’s wishes and strive to meet those wishes even if they don’t personally agree with all of her choices. These OBs offer their opinion and the facts and then leave it to the woman to decide.

I’ve attended births with OBs who use fear, misinformation, and anecdotes to manipulate a woman into complying with his wishes and desires. After all, he’s the expert. He’s the one that went to medical school. This type of OB typically feels strongly that the only birth plan a woman should have is “Go to hospital. Have baby.” He believes birth is dangerous and needs to be carefully monitored and manipulated in order to be “safe”. I’ve heard this type of OB say to a mom whose progress has stalled for a few hours that she’d better start dilating again or else she’d have to have a c-section. After waiting an hour I heard this OB say “this is just Mother Nature’s way of telling us that it ain’t gonna happen this way.” He then proceeded to inform the mom (who was in tears) that c-sections are actually better and safer than vaginal birth anyway (not true!)5, 6, so she shouldn’t be upset.

Which type of OB more rightly deserves the trust of his patients? Which OB would you rather have? How can you tell which type you have right now?

Well, for starters you can ask lots of questions. Find out what s/he thinks about natural birth (birth without interventions or medication). How many of his/her patients give birth without IVs? How many need, in that OBs opinion, to be induced? How many need, in that OBs opinion, c-sections or episiotomies? How many give birth in “traditional” positions such as semi-sitting vs. “alternative” positions like squatting? How does s/he feel about a birth in an alternative position? How does s/he feel about intermittent vs. continuous monitoring?

As you have this discussion with your care provider, watch his/her body language and be careful with your own wording. You want to ask the questions in such a way that you aren’t leading his/her response (you want your care provider to be honest rather than just tell you what you want to hear, which doesn’t help you). You want to ask open-ended questions “how do you feel” instead of yes/no questions. Of course you will want to avoid asking questions like “How often do you cut episiotomies?” Because s/he’s likely to respond with “only when they are necessary” which, again, tells you nothing. Instead you might ask “About what percentage of first-time moms do you think end up needing episiotomies?” (or c-sections or continuous monitoring or IVs, etc.).

Henci Goer has some excellent ideas for questions to ask and how to interpret a care provider’s responses in her book The Thinking Woman’s Guide to a Better Birth.

If a doctor says that 80% of first-time moms need episiotomies and you are a first-time mom, what are your chances of “needing” (and receiving!) an episiotomy if you choose to use this doctor? Are you comfortable with those odds? Can you trust that doctor’s judgment on whether or not that episiotomy is truly necessary? Do you want to be in a position where you have to wonder whether or not an offered intervention is needed? Choose your care provider carefully! Obviously there are questions that can and should be asked if an intervention is offered, but it is much easier to avoid unnecessary and unwanted interventions if you do some legwork before the birth and choose a care provider that doesn’t routinely offer or perform them!

Every woman is individual in what would make a good birth experience just as every person has their own individual tastes and preferences for what they want to eat for dinner. There’s no one right kind of birth just as there’s no one dish that will satisfy everyone’s unique appetites. The bottom line is that you, the consumer, need to make sure your birth choices (all of which impact your ultimate experience) are likely to result in the birth you desire. You can’t go to Burger King to get a gourmet meal, but maybe what you wanted was a hamburger, anyway. Just make sure that what you order is satisfying.

Laura Lund is a Hypnobabies childbirth educator, founder of UCAN Birth support group, and doula in Provo, UT where she lives with her husband and four children.
Copyright 2007 by Laura Lund. All rights reserved. Laura gives permission to print and distribute this article freely.

Notes
Have it Your Way” is copyrighted by Burger King Corporation.
Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005 Jun 18;330(7505):1416. PMID: 15961814 [PubMed - indexed for MEDLINE]

CONCLUSIONS: Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.
Anderson RE, Murphy PA. Outcomes of 11,788 planned home births attended by certified nurse-midwives. A retrospective descriptive study. J Nurse Midwifery. 1995 Nov-Dec;40(6):483-92. PMID: 8568573 [PubMed - indexed for MEDLINE]

This study supports previous research indicating that planned home birth with qualified care providers can be a safe alternative for healthy lower risk women.

Olsen, O. Meta-analysis of the safety of home birth. Birth. 1997 Mar;24(1):4-13; discussion 14-6. PMID: 9271961 [PubMed - indexed for MEDLINE]
CONCLUSION: Home birth is an acceptable alternative to hospital confinement for selected pregnant women, and leads to reduced medical interventions.

Kolas T, Saugstad OD, Daltveit AK, Nilsen ST, Oian P. Planned cesarean versus planned vaginal delivery at term: comparison of newborn infant outcomes. Am J Obstet Gynecol. 2006 Dec;195(6):1538-43. Epub 2006 Jul 17. PMID: 16846577 [PubMed - indexed for MEDLINE]

CONCLUSION: A planned cesarean delivery doubled both the rate of transfer to the neonatal intensive care unit and the risk for pulmonary disorders, compared with a planned vaginal delivery.

Wax JR. Maternal request cesarean versus planned spontaneous vaginal delivery: maternal morbidity and short term outcomes. Semin Perinatol. 2006 Oct;30(5):247-52. Review. PMID: 17011394 [PubMed - indexed for MEDLINE]

INTERPRETATION: Although the absolute difference is small, the risks of severe maternal morbidity associated with planned cesarean delivery are higher than those associated with planned vaginal delivery. These risks should be considered by women contemplating an elective cesarean delivery and by their physicians.