Saffron Doula

My thoughts as I await my third child

2011-05-15T22:17:00.000-06:00

When you're going to give birth, you are doing so with a Divine Being. This person is closer to the Source and knows infinitely more than you do. Trust him/her and trust yourself, for you too are Divine. Release control. You will know what to do and how to do it. Trust yourself and the Being who makes you a Mother.

What birthing has taught me

2008-11-19T13:47:00.004-07:00

In my personal birth experience, I learned that the right education and true support can make the difference between a passive, mainstream I'll-do-whatever-you-say birth and an active, empowering I-am-strong-and-capable-of-deciding-everything-for-myselfbirth. I switched practices when I was 7 1/2 months pregnant because I didn't want to be on the baby-conveyor-belt that the mainstream maternity system puts all of us on. I wanted individual care with a person I knew would be at my birth and who cared about me and wanted to listen to me and really discuss all of my concerns with me. I wanted someone I could trust during my birth so I didn't have to wonder what was going to happen and if a suggestion was really in my best interest or was just because of some medical convenience.

What made this change? I went to a birth meeting in town and was told by a few of the women there (childbirth educators and doulas) that I could do what I wanted, that this was my birth and my body and I could change practitioners if I wanted to. I was on Medicaid and thought I was trapped with the public health department's program, but I wasn't. Medicaid covers a lot of midwives and OBs. I switched and only looked back to see how amazingly different my birth experience would have been if I hadn't done what I did. I also hired a doula and invited my mother and sister to attend my birth (along with my wonderully supportive husband).

I had an unmedicated, active hospital birth with my wonderful midwife and all the other support people I mentioned above and I don't think I could have done it without hearing a few people telling me that I needed to take control and own this experience because it's not something I will experience often and it's something that will change my life forever.

I'm now a labor doula and I'm working on my childbirth educator certification. That's how much my childbirth experience affected me.

As a childbirth professional, I've learned a lot as well. I've learned that the place and people you surround yourself with at birth can be the difference between a natural birth and a cesarean for having a pelvis that's "too small." I've learned that location and attendants can mean the difference between an epidural and a natural birth. I've learned that some hospital childbirth classes are pretty good and some are horribly awful (call and see if the teacher is certified to teach... many haven't even been trained). I've learned that good education and support make for better experiences, even if the events take turns you didn't want or expect. I've learned that hospitals and doctors do not always have our best interests in mind, even if they have them in their hearts, and you might end up with a "problem" that isn't a problem or a procedure that isn't necessary but may affect you for the rest of your life. I've learned that informed decision making only happens when we ask questions until all our doubts and surmises are fully addressed AND the people answering our questions give their answers based on verifiable evidence, not just hear-say or hunches.

I've learned that a lot of women in America feel like they are broken - that their bodies just can't do birth, at least not naturally. I've also learned that this is often because they weren't given enough support, enough time, enough education, enough power, enough freedom of movement and freedom in general, not because their bodies are broken. The World Health Organization states that cesarean section rates should never rise above 10-15% (even for developing nations) because above this number, women and babies suffer more than they do when birthing vaginally, even when they need assistance there. The national cesarean rate is over 30%. It's not because women are broken. It's because women lack support, time, education, power, and freedom in many birth locations and with many medical attendants.

For instance, homebirth midwives have an average cesarean section rate of 2-4%. Now this is for low-risk women, but aren't most of us low-risk women? There are hospitals in the US with 50% cesarean section rates. Isn't there something wrong with this picture? Women who are given 12 hours to birth their babies after their water has broken are at risk because people are doing vaginal exams! Women whose waters break months prior to their due dates are not induced and given 12 hours to have their babies! No, they're put on bedrest and there are no vaginal exams because that increases their risk of infection. Hmmm... Moms who are induced at 39 or 40 weeks for their first babies are being induced a full 1-2 weeks before the average first-time mother would naturally go into labor! To be sure, doctors and hospitals are wonderful to have when women are in high-risk situations or when the rare low-risk birth needs intervention, but with studies showing that low-risk women giving birth are safer in their homes than in a hospital, isn't there something wrong with the way mainstream birth culture addresses birth?

I've learned a lot about myself and about birth in America since I had my first baby two March's ago and I'm still learning. Now I'm starting to plan for baby #2, who is due sometime in late July-early August. I'm planning a homebirth this time, and not because I had a bad experience in the hospital - I didn't - but because it's statistically safer for me and my baby than a hospital birth and my last birth proved to me that I am powerful and capable and intelligent enough to make this decision for myself. Go figure.

My rant about the homebirth vs hospital-birth debates.

2008-11-13T16:02:00.005-07:00

I think it is wonderful that we are living in a time and place when debates like this are happening. We have access to research and opinions, professional and personal ideas, anecdotal and evidence-based practices in our country's medical system.

I would challenge everyone interested in this issue, standing on any part of the spectrum, to read the Johnson and Daviss studies previously mentioned. Dr. Tuteur, as always is comparing apples to bananas by pointing out low-risk hospital-births compared to ALL home births (planned or not, attended by a midwife or unattended, etc). It has been shown time and again, in this an other countries, that homebirth is just as safe, if not a safer alternative to hospital birth for a low-risk mother with a trained midwife. Could hospital births be just as safe as home births? Yes, but they're statistically not.

This debate is all subjective, however. If a woman lives in an area where all the local hospitals have a 50% cesarean rate (a method of obtaining a child which is more than twice as likely to result in death of the mother as a vaginal birth), you can safely bet that a low-risk mother, and perhaps even high-risk mothers, would be better off birthing at home or going to another state to have their babies.

If a woman lives in an area where the closest hospital is 2 hours from their home, she may be in a difficult predicament for choosing her birth place. In the state of Colorado, where I live, a homebirth must occur within 30 minutes travel time from the home to the hospital. This implies an inherent safety of birthing for low-risk women attended by a CPM.

This debate isn't about making all low-risk women birth their babies at home or making all women birth their babies in hospitals. At least, it shouldn't be that way. It should be about finding the options that result in the most satisfying results, including safety to mother and baby. Of course, we are not all the same and we do not all birth the same. Some women have the best outcomes in a hospital, some at home, some in a freestanding birth center, some in other locales altogether. We can't make decisions based purely on other people's experiences, even when those people are doctors.

We need to be informed consumers and look at the scientific evidence presented to us and listen to our hearts and souls and bodies. If after you have done the research, your heart and soul tells you that the hospital is the place for you, then you're right. Choosing your birth place because everyone else does it that way or because of reasons you haven't researched is asking for trouble. If we find ourselves outright stomping on an alternative we've never looked into, we should challenge ourselves to look into it. We may find that we're right or we may find that we're wrong and our culture has taught us something that is not true or is no longer true.
Yes, mothers and babies in the US suffer from lower mortaliity from birth today than they did in the early 1900s. Why is that? Well, we learned about germs, for one thing, We stopped letting doctors go from cleaning out cadavers to using forceps on birthing women, ungloved and unwashed. When birth went to hospitals, it was more dangerous than homebirth. Read "Brought to Bed" for more on the transition from home to hospital and the numbers associated with this transition. There are plenty of books on the topic and all of them point out that moving births to hospitals was NOT the big change that made birth safer in this country. It was germ theory and penicillin. There were places where birthing in a hospital meant a 50% mortality rate due to infection. It was horrific. No, hospitals are not that bad now, but with 20-50% cesarean rates, you have to wonder.

Speaking of cesarean rates, lets point out that the World Health Organization has proven a cesarean section rate above 10-15%, for industrialized countries, puts women and babies at greater risk of morbidity and mortality than a physiological birth. I already mentioned that mothers are more than twice as likely to die when they have a cesarean as when they have a vaginal birth. And someone said people never die because the doctor is there "in case." Hm... A doctor is trained to see problems and fix them, he or she is not trained to let well-enough alone and see normal variations as normal. An obstetrician is very good at what he/she does, when it is necessary. It is not always necessary, however, and it is certainly not necessary for women to have cesarean sections more than 10% of the time they are just wanting to bring their babies into the world.

Women should not be coerced or forced into having unnecessary interventions in labor and birth, especially when there is evidence to say those interventions are dangerous when used without very careful application. These are the things people should be upset about, not the decisions of some women to birth their babies at home.

First, my definition of safety: your relative chances of suffering physical and psychological damage. This is comparing two cars. They both have 5-star safety ratings under certain circumstances, but they're not the same circumstances.

Is homebirth safe? Yes, but your safety factor depends on some things! Is it safe for a low-risk mother who is attended by a trained midwife with a plan for transfer if mom and midwife decide to go? Yes, this scenario places mom and baby at the same safety level as this same mom in a hospital with a midwife, and if the mother has had babies before, she is safer than at a hospital.

Is it safe for a high-risk mother with the same midwife? Yes, but not as safe as a hospital might be for her and her baby.

Is hospital-birth safe? Again, yes, but it depends! Is it safe for the same low-risk mom as above, who is attended by a hands-off nurse-midwife? Yes, but not as safe as the homebirth would be if she has had babies before. How about the low-risk mom attended by an OB? Hm... this is a tricky one because it greatly depends on the OB's practices. Generally, however, the low-risk mother and her baby, with an OB at a hospital, will be in greater danger of suffering physical and psychological damage than the same mom and baby at home or with a midwife in the hospital. And the high-risk mom in the hospital? Generally safer than at home, still dependent upon her provider, however.

So, it's not all black-and-white. It depends on the mom, the baby, the birth place, and the healthcare provider. That's why it's so important to shop like a consumer when it comes to birth choices. Don't just choose the same car everyone else is going for... sometimes you'll find out that your car isn't worth anything in a few years and you'll need to trade it in. And remember, you can always exchange your car for a better model, sometimes for a lot less money! Plenty of women have changed doctors or switched to a midwife or a homebirth at 8 months pregnant or even later. It's your body and your baby. You should do what feels right for you.

April is Cesarean Awareness Month!

2008-04-03T12:33:00.002-06:00

31.1% of American babies are born by cesarean section, major abdominal surgery. The World Health Organization has been saying for years that rates above 10-15% for ANY nation are high enough that the risks of the surgery outweight any possible benefits. This means that as much as 20% of new mothers and babies are being put at unnecessary risk.

April has been designated as Cesarean Awareness Month. Take the time this month to learn more about the cesarean rates in the United States, in your state, and in your local area. Visit the International Cesarean Awareness Network's web site and get involved.http://www. ican-online. org.

Consider too, getting involved in fighting for VBAC (Vaginal Birth After Cesarean) by writing to your senators and hospitals that do not "allow" VBAC. In Colorado, the majority of Western Slope hospitals now have VBAC "bans" in place, directly interfering with the human rights of women to birth their babies as nature intended, physiologically. Research has proven time and again that VBAC is safer than an automatic repeat cesarean for the vast majority of women. Medical law makes such bans illegal because they remove a woman's right to choose what will be done to her body. It is a fight worth fighting. Again, the ICAN web site is one to visit to read about this issue.

Get involved. Make change. The health of women and babies depend on it.

Am I Too Small to Birth My Baby?

2008-03-17T15:20:00.003-06:00

Unless you had a nutritional deficiency as a child, such that you have physically DEFORMED hips or you had a pelvic break that did not heal properly, there is no reason to think that your hips will not be big enough to birth your baby. Humans wouldn't be around if we grew our babies bigger than we could physically push out.

Trust your body. It knows what it's doing and all you have to do is be an active part of your labor throughout and let your body do what it tells you it needs to do.

Any tests that can be done to "make sure" your baby will fit are flawed to the point of uselessness. Only 18% of estimations that say a baby will be "big" are actually correct, and even when a baby is "big," that doesn't mean that the baby will have ANY trouble being born. Also, taking measurements of your hips and the baby's head do not take into account the drastic changes that occur during labor to both your hips and the baby's head to make sure everything fits. If anyone tells you that your baby will not fit, they are almost gauranteed to be completely and utterly wrong and they deserve no more of your time or attention.

Next, how to avoid a baby getting "stuck" is fairly easy:

1 - Do not lie on your back during labor, EVER. Lying on your back is completely unnatural for a woman to do during labor, especially while she is pushing out the baby. Lying on your back is so unnatural, in fact, that the best way to get a baby "unstuck" if the shoulders DO get stuck in the pelvis is to do this amazing thing... get onto your hands and knees. That's usually all it takes. So avoid the whole ordeal in the first place and push your baby out in a position other than on your back.

2 - labor at home for as long as you feel comfortable doing so. The longer you are at the hospital, the more interventions they will want to do to you and the more likely you are to just lie in bed and wait for the baby. Avoid this by staying home as long as you are comfortable doing so.

3 - hire a doula. Doulas are your constant support during labor, helping you get into active positions, reminding you of things you said you wanted to do during labor when you might not be thinking of such things, helping you ask the right questions to make informed decisions, and helping your partner be of the best help possible. Doulas have been found to reduce the chances of a cesarean by 50% (and shorten labor)!

4 - do not be induced unless you have a clear medical reason that makes waiting more dangerous than being induced. Induction has a slew of risks, one of the biggest being c-section. If the induction fails, c-section. If the induction is too painful (and inductions are considerably more painful than natural labor), you'll probably need pain medications, which increase your chance of a c-section. Induction tethers you to the bed because induction makes you high-risk... being tethered to the bed, as I said before, means you're more likely to have baby get stuck, and more likely to have a c-section.

5 - plan on using natural methods of pain relief and if you do want an epidural, waiting until AT LEAST 5 cm dilation. Better yet, plan on not having any pain medication unless your labor is extremely long (longer than 24 hours) or unnaturally painful. Epidurals cause you to stop moving, making it a lot more likely for baby to get stuck. Epidurals make it more likely for you to have a c-section in general. Epidurals make baby more likely to get stuck because your body cannot respond as it normally would to the cues that arise when baby needs you to move or take action. You can't feel, so you can't act.

All of these things are true, regardless of your size and your baby's size.

I also wanted to mention that only about a third of c-sections are necessary, let alone "emergencies." With over 30% of live births being delivered by c-section, it is important for ALL expectant mothers to take an active role in their care and their births. If you have a doctor or midwife with a low c-section rate, you are already in good hands. If your doctor's or midwife's rate is high (more than 25%), then you know you're already setting up for a cesarean section, regardless of your size, and you might want to think about changing to a provider who believes in the female body's ability to birth babies.

Studies have shown that planning a c-section because the baby is suspected to be "too big" is dangerous for mother and baby and does not improve outcomes versus allowing things to go on their natural course.

Trust your body and your baby. They know what they're doing. If you allow your body and your baby to do what they need to do without interfering unnecessarily, you will be amazed at what they can do.

Source(s):
Gonen Ron, Bader David, Ajami Maha. Effects of a policy of elective cesarean delivery in cases of suspected fetal macrosomia on the incidence of brachial plexus injury and the rate of cesarean delivery. American Journal of Obstetrics & Gynecology. 183(5):1296-1300, November 2000.Klaus, Kennel, and Klaus. Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier, Healthier Birth. 1993.International Cesarean Awareness Network - http://www.ican-online.org

(My quick response to a woman on Yahoo Answers asking when her doctor would be able to tell if she would need a c-section because of her size.)

ACOG Anti-Home Birth Response

2008-02-08T13:06:00.000-07:00

The American College of Obstetricians and Gynecologists, ACOG, released a press statement on Wednesday, February 6th, about it's stance on home birth (ACOG 2008). Their statement epitomizes the position of ACOG as representors of their members, not the rights or needs of the women their members provide care for. The statement is riddled with propaganda, including sentences like, "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre," and "Choosing to deliver a baby at home is to place the process of giving birth over the goal of having a healthy baby." Allow me to paraphrase and address each paragraph in the statement.

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The first paragraph states that ACOG is opposed to home births, that childbirth is a normal process, that monitoring in a hospital or certified birth center is necessary due to the potential for quickly arising complications.

This seems like a reasonable enough set of statements, except that if a hospital is really the safest place for complications to be addressed, why is it that many hospitals across the country are not equipped to respond to an emergency in the 30 minutes commonly expressed as necessary for an emergency cesarean? Why are VBACs banned in many rural hospitals because of lack of adequate staff for an emergency cesarean when the chances of any other laboring woman needing an emergency cesarean are at similar rates? Why did the 2005 study of outcomes for planned, appropriately attended home births yield similar or better results for maternal and perinatal mortality than did hospital births in the same period (Johnson 2005)? Home births are just as safe or safer for low-risk women who are planning an attended home birth because an adequately trained home birth midwife is able to handle common health needs of childbirth and serves as a first-responder in true emergencies. Home birth midwives with adequate training can recognize the need for hospital transfer, usually long before any true emergency arises.

In Colorado, home births are required to occur within 30 minutes of a hospital. This would negate the worry of adequate access to hospital personnel and equipment, considering that in the event of an emergency transfer, an ambulance would be used and the hospital medical team would be informed of the incoming patient's needs. Hospitals typically take this long to prepare for an emergency anyhow. Considering this Colorado regulation, I fail to see the additional dangers associated with home births attended by trained midwives.

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ACOG "acknowledges" the rights of women to choose their health care providers, but does not support home birth providers or home birth advocates. ACOG also states that they only support midwives certified by ACNM or AMCB.

ACOG is blatently claiming that women should have limited rights to birth attendants and environments! What right have they to dictate what a woman can choose for the "normal physiological process that most women experience," as they state in their first paragraph? This statement should be drastically fought, considering its implied removal of a woman's rights to her body and to informed decisions. This statement might as well say, "Birth is only okay when We are in ultimate control of you. Don't listen to those crazy old granny-midwives. Only We know what is best for you."

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The next statement expresses ACOG's beliefs that home birth is a trend made popular by celebrities, that life-threatening complications can arise during birth, especially for VBACs, and that a woman puts herself and her child at unnecessary risk by giving birth anywhere except a hospital or accredited free-standing birth center. This paragraph contains the amazingly expressive sentence, "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre."

Considering that only 1% of U.S. births are at home, how could one call this a "trend" at all? What this statement is referring to is Ricki Lake's recent film The Business of Being Born. Ricki Lake has brought home birth to the public eye unlike anything in the past decades, showing America and the world that home birth is not only an option, but a safe and desireable option. This is threatening to ACOG because it may be a cornerstone to a shift in birth philosophies of many Americans. To speak fairly, the movie also increases the likelihood of people choosing home birth when it may not be a good option for them. Instead of better educating the public and expressing the means of making home birth safe for appropriate people, ACOG chooses to blast home birth altogether, implying they are more interested in representing their members than the public good.

Another issue to take up with this statement is that ACOG doesn't put out damning press releases when celebrities glorify elective primary cesareans, even though they are drastically more dangerous (three times the neonatal mortality rate) than home births, when applied to the same low-risk category of women (McDorman et. al. 2006). A low-risk first-time mother electing for an unnecessary primary cesarean versus a low-risk first-time mother electing for a CPM-attended home birth within 30 minutes of a hospital: which would you say is more deserving of a press release of condemnation? It seems the health of mothers and babies is not the only thing of concern to ACOG.

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ACOG applauds themselves for issuing a task force to analyze cesarean rates of physicians and hospitals and to assist said institutions in lowering their rates, if they deem it necessary. They go on to cite obesity, gestational diabetes, and maternal choice as important factors in the rising cesarean section rate, and state that it is impossible to determine a goal for cesarean rates.

I want to point out the irony of this: ACOG supports maternal choice in the cesarean epidemic, but not in home birth, which, as was previously mentioned, is safer than elective cesarean. The reasoning for this discrepancy is obvious: cesareans support ACOG's members, home birth does not. It is also appalling that ACOG would point blame at these groups of women for the cesarean rate, avoiding any statements inplying that their own practices might contrbute to said problems.

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ACOG next states that OB/GYN's may save lives and lower the chances of "bad outcomes" in emergency situations. They also say that they believe the safest place for labor, delivery, and postpartum are hospitals, accredited free-standing birth centers, or birth centers in hospital complexes.

All statements in this paragraph have previously been addressed in this essay.

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The next paragraph states, "studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous." Then ACOG states that midwives cannot perform cesareans or other procedures that would be best for mother and child.

As is obvious from my essay thus far, adequate studies have indeed occurred and have certainly been rigorous enough for change to be made and informed opinions to form. Home birth is at least as safe, if not safer, than hospital birth for low-risk women attended by adequately trained midwives.

It is obvious that midwives, as well as family practitioners and other non-OB attendants, are not able to perform cesareans, but this statement also implies that such medical procedures, which only obstetricians can perform, are necessarily the best for mother and baby. One need only spend a few days on the ICAN email forum to realize that an inexcusable number of women and infants are the victims of unnecessary obstetrical procedures, performed for the "safeguarding" of obstetricians, not of mothers and children. Stories abound of women who were sectioned because their obstetricians had a social obligation, because nobody told them they could try something different, because a cesarean was presented as their only option, because they had a cesarean with the last baby, because the baby was getting "too big," because labor was taking "too long." This list goes on.

If this second statement were to be taken seriously, all hospitals without in-house obstetricians and anesthesiologists available 24-hours a day would have to shut down their maternity wards. This statement basically says that such hospitals are unsafe for labor, childbirth, and postpartum.

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ACOG summarizes their statement by supporting prenatal care and birth plans, hospital or birth center births, and CNMs working with physicians. They also state, "Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby."

This statement, which implies that women do not care for the health of their babies if they choose to birth at home, is ludicrous and false. It also explicitly shows that ACOG does not care at all about the mother, the mother's health, the mother's desires, or what is best for mother and child. Even if the health of the baby were the only goal of ACOG, home births would be the method of choice for many babies.

ACOG is not interested in the health of mothers or babies, however. ACOG is interested in "representing over 52,000 members who provide health care for women." ACOG represents it's members by lying to the public, by attempting to bully people into choosing the more dangerous options, by putting mothers and babies at risk who would not otherwise be there, by allowing their members to perform unnecessary primary cesareans thus endangering the lives of mothers and babies, and by pushing propaganda instead of informing the public of scientifically based risks and benefits. ACOG is obviously not interested in providing health care for women, ACOG is interested in providing under-educated patients for their members to make money from.

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References

ACOG (2008) "ACOG Statement on Home Births" February 6, 2008. Washington, DC. <http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm>.

Johnson, Kenneth C and Betty-Anne Daviss (2005) "Outcomes of planned home births with certified professional midwives: large prospective study in North America" British Medical Journal. 18 June 2005 330:1416. <http://www.bmj.com/cgi/content/abstract/330/7505/1416>.

McDorman, Marian F. PhD, Eugene Declercq PhD, Fay Menacker DrPHCPNP, Michael H. Malloy MDMS (2006) "Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with 'No Indicated Risk,'" United States, 1998-2001 Birth Cohorts. Birth 33 (3), 175–182. <http://www.blackwell-synergy.com/doi/full/10.1111/j.1523-536X.2006.00102.x>.

Quick Reply - Avoiding Labor Induction

2008-02-05T18:06:00.000-07:00

There are plenty of ways of avoiding induction.

1st - don't go in for the appointment. I know this seems flippant, but you really should keep in mind that all decisions are YOURS to make, with your doctor's advice. They are not your doctor's decisions, your doctor's body, your doctor's baby, etc.

Next, consider the reasons your doctor is recommending induction. If you have not yet reached 42 weeks and everything looks normal and healthy, there may be no medical reason to induce, in which case, inducing may be more dangerous than waiting. Even if you have passed 42 weeks, you still have the option of monitoring the baby and placenta to make sure things are doing well as you wait. If you are not interested in inducing except for when medically indicated, then let your doctor know this and work from there.

There are a number of natural induction methods that are not usually dangerous for you or the baby (consulting medical professional, of course), and certainly not as dangerous as chemical induction. Acupuncture can work (see link below) as can nipple stimulation.

I have only heard of nipple stimulation being dangerous if you continue doing it after a contraction has started... it's much safer than chemical induction though because when you stop stimulating the nipples, the contraction goes it's course and stops. This is unlike chemical induction methods, which can hyperstimulate the uterus to the point of distressing the baby and causing very bad things for the mother. "Hyperstimulation" is also possible with nipple stimulation, of course, but is not nearly as likely as with chemical induction and it is also avoidable simply be stopping the stimulation when a contraction starts. Nipple stimulation is also not as "efficient" as medical inducing agents, meaning that it could take longer to work (good, in my opinion). The other thing is that nipple stimulation isn't done with hospital monitoring, usually, so docs worry about that.

A good question to ask yourself and your doctor when thinking about induction (natural or unnatural) is how likely it is to succeed. If your cervix is not favorable (i.e. closed, hard, posterior), medical induction is more likely to fail and result in a cesarean and "natural" induction may succeed but will probably take a long time.

So the things to do to get your body ready for labor now are to have sex (to start effacing the cervix), walk (to get baby into a good position), and possibly take measures to start contractions (acupressure, nipple stimulation, etc).

While these are ultimately your choices to make, it is not advisable to do anything behind your doctor's back. Letting him/her know what you are thinking or doing is of utmost importance in helping them adequately do their job as your care provider. There may be medical reasons for you NOT to do something that a lay person suggests, and you may only know about these if you talk with your doctor about them. There are always risks to every intervention, and naturally inducing your labor is still an intervention.

You shouldn't necessarily be afraid of doing anything, but you should know the risks involved in all choices before you move forward.

Also... find out what your doctor would do to induce you. What drugs would s/he use. Learn about those drugs. I wouldn't wish a Cytotec/misoprostol induction on anyone in the world. Look into that drug and make your own choices.

http://acupuncture.rhizome.net.nz/Defaul... - acupuncture for pregnancy, childbirth, etc.

Hospital Corp. of America bans VBAC once again

2008-01-15T11:47:00.000-07:00

Another HCA hospital has "banned" VBAC (Vaginal Birth After Cesarean). Bans of this sort force women into unnecessary major surgery, putting themselves at greater risk from surgical complications and complications in future pregnancies. Such bans also go against their legal right to choose and refuse care. It is a basic right upheld by every tenet of related legislation.

The only reason such bans exist is to avoid legal liability of the hospital if something happens during a VBAC and the hospital cannot respond quickly enough. Sounds like a problem with the hospital, not the woman, doesn't it?

What do we do about this? Complain, refuse, know our rights and act on them. Write government representatives and grassroots organizations like MomsRising. Join ICAN (International Cesarean Awareness Network) and get involved. File a grievance with the Chief Compliance Officer at the offending hospital(s).

Refusing to consent to a cesarean can be done on any consent form at the hospital. Simply cross out any wording on the generic consent form, initialing the change, and add that you refuse a cesarean section. You are not required by law to sign a consent form if you are in labor. EMTALA states that labor is an emergency situation in which they must treat you until you have stabalized (birth is complete), and they cannot order you to have an unnecessary cesarean without a court order. A court order would require proving that a cesarean is medically necessary.

Heinous violations of our rights such as these will not change until people take action against them.

For more on hospital VBAC bans, visit the ICAN of Portland website (although not in my state, still has thorough info).

Waterbirth International and alternative birth choices need help!

2008-01-08T16:52:00.000-07:00

I'm trying to get the word out about the needs of Waterbirth International. Hopefully we can find a way to make a difference. The organization helps women and communities and countries open the doors to safe alternatives in childbirth, particularly waterbirths. They are currently in dire need of enough finances to keep going.

Barbara Harper said,
"How can you help us stay open to take the next phone call? - to convince the next
obstetrician to incorporate waterbirth into his/her practice - to work with the nurse
midwives to install pools in their facilities? To educate an entire hospital on the benefits of
allowing women freedom of movement in the water. How much is it worth to see waterbirth
become the norm in the US, like it is in the UK? I think we only need a few more years to
make that happen. Do women really want waterbirth to be an available choice in every
hospital? I think so. "

They need help by getting the word out, by getting the information on lists and blogs and forums. They need to be on YouTube and in the general public. They also need money. Although I didn't see this, they could probably use donations for speakers and events. They could use volunteers.

Let's help keep Waterbirth International alive!

Here's what the website says:

For twenty plus years WBI and Barbara Harper have been here guiding mothers and their providers, providing education and birth pools all over the world. We are facing the hard truth that the Gentle Birth World Congress - a fabulous success in every way for international , as well as local attendees - drained all of our resources. We may have to close the doors permanent by January 31st.

We need to raise $200,000 in donations to cover the debts from the Congress and move on to keeping waterbirth alive as an available option.
Can you help us stay open to take the next phone call?
- to convince the next obstetrician to incorporate waterbirth into his/her practice
- to work with the nurse midwives to install pools in their facilities
- to educate an entire hospital on the benefits of allowing women freedom of movement in the water
How much is it worth to see waterbirth become the norm in the US, like it is in the UK? I think we only need a few more years to make that happen. Women really do want waterbirth to be an available choice in every hospital. They need choices now, more than ever.
If we need to call every single waterbirth parent personally, we will. We don't want 25 years of pioneering work to end and the vision of safe and beautiful waterbirth to go away.

Please do the following:
~DONATE any amount you can ~Become a member of Waterbirth International
~Buy a birth pool for your local midwives ~Buy a birth pool for yourself
~Buy a birth video and donate Post this message on other sites and blogs
http://www.waterbirth.org

My letter to Dr. Laura

2008-01-04T15:26:00.000-07:00

I'm a labor doula, a non-medical childbirth assistant. Today you had a caller ask about her desires to birth her baby in a free-standing birth center and I have some issues with your responses.

I find it appalling that such an influential woman such as yourself would commend cesareans so nonchalantly when the procedure is at epidemic levels. In the U.S. 31.1% of live births are delivered by cesarean, which is more than three times the safe level for a developed country. Cesareans are causing more harm in this country than good, and nonchalantly commending them for non-medical reasons is only going to compound the problem. Women won't realize that childbirth is a consumer activity until the media personalities make it clear. Women shouldn't be given false security in the safety of cesareans. The surgery is much more dangerous than a vaginal birth unless there is a true emergency or good medical reason for it. If you look into the research and the experiences had by women who have had cesareans, it's apparent that change needs to be made.

Second, out-of-hospital births are actually SAFER than hospital births for low-risk women. The majority of women have low-risk pregnancies. It is actually safer to have a baby at home, if you are low risk, than to have your baby in the hospital. Suggesting that all women give birth in hospitals "just in case" is preaching a distrust in women's bodies and God's design. Hospitals have higher infection rates and higher intervention rates for low-risk women than do home births. Also, infections obtained because of the hospital environment are more likely to be antibiotic-resistant and more problematic. Hospitals oftentimes CAUSE problems for low-risk women that wouldn't have been present in a midwife-attended homebirth or at a free-standing birth center.

Women in this country have more choices regarding pregnancy and childbirth than they ever have had in the past. It is imperitive to the continuation of our rights and safety during childbirth that we educate ourselves and others about the facts of our alternatives. Blindly following the propaganda of the last two hundred years' medical professionals' touting their expertise and knowledge over OUR bodies and babies is scientifically and socially unfounded.
Women/consumers need to understand where science and medicine really can help them and where it is all just bells and whistles and self-preservation. High cesarean rates are not safe for women, high intervention rates are not safe for women, all women having hospital births are not safe for women. We can see all of this by looking at other countries and at the medical and scientific research on the subject.

That's my opinion. I chose to become a doula because I want to help women make informed choices. I don't want to choose what is best for any one person. I only want to help women be smart consumers and to have safe, empowering births.

Thank you,

Christina Rochette

Some books I've read recently

2007-12-29T16:48:00.000-07:00

I found Val Clarke's Instinctive Birthing at my local library and picked it up not knowing it was a book from the UK. I'm very glad I read it. It is written by a British midwife in an effort to encourage and teach pregnant women how to birth instinctively, as the title suggests. It bemoans the loss of instictive birthing from the general British culture and talks about how to listen to your body and use medical resources as your particular circumstances deem necessary.

One thing I am very glad I read in this book is Clarke's suggestion for a membrane leak late in pregnancy. Although I have heard people talk about staying home and monitoring yourself for signs of infection if a slow leak occurrs (instead of going to the hospital and being put on a timer for when you are "allowed" to have your baby naturally), this is the first medical professional source I have actually seen that supports this action.

It was also very interesting to read about British maternity practices, just because I love to read things like that.

I also read Doreen Nagle's But I Don't Feel Too Old to be a Mommy recently as well. I have a client who is going to be a midlife new mother and thought I would read it to see if there's anything I should think about or look into particularly having to do with older moms. It was an interesting read because of the information on fertilization treatments and some of the feelings that a midlife mom can feel. Basically, however, there's nothing different about a midlife first-time mom and a younger one. Sure, there is a slightly higher chance of having a baby with Down's Syndrome and medical personnel may treat you slightly differently because your "old," the basics are all the same (no surprise, really).

I thought the book was interesting from a fertilitry treatment perspective, but I really didn't learn anything pertinent to my line of service except that I was right in thinking that the basic worries and issues and support methods are the same, taking individual personality and needs into account, of course.

Now I'm reading Mothering the New Mother and The Happiest Baby on the Block. I'm really enjoying Mothering, but Happiest Baby isn't helping me as much as I had hoped. My babe is now 9 1/2 months old and I'd like to get him to sleep in his own bed at night without screaming irrately every time we try to lie him down without a breast in his mouth. The book I got is really aimed strictly at newborns, not touching much on issues of attachment and changing habits. If my babe would fall asleep without nursing and would sleep through the night without nursing, that would solve the problems my husband has when I go to births. That's the real issue. At this point, it doesn't matter so much that he's sleeping with us, but needing a milk snack to get there is a big issue right now. I think I'll have to start actually asking for some pointers.

Leboyer's "Birth Without Violence"

2007-12-23T20:45:00.000-07:00

I checked this book out at the library and finished reading it in an afternoon about a week ago. It was a very good book and quick to induce emotion. Some things mentioned are older complaints about how birth is orchestrated, like holding a newborn by the ankles and giving him/her a sharp spank to get some good crying. Birth attendants still want the baby to give a lusty cry, but the whole upside-down-by-the-ankles gig isn't done here anymore. Most babies are also put directly on a mother's abdomen at birth, like Birth Without Violence suggests.

It was nice to see what a "Leboyer bath" is. I had come across the term a few times and didn't really understand what exactly was meant by it. A Leboyer bath is done soon after birth by immersing the baby in a body-temperature bath (except the face, of course). The baby is immersed slowly to help him/her get used to the bath, and the point of the bath is to help the baby with the transition to dry land from his/her previous watery home. Apparently babies who experience the bath are very happy about it.

The Leboyer method of birthing without violence does have a number of other concepts which, when used together, are supposed to help babies have a peaceful entrance into the world. Leboyer did make it sound like the event of childbirth was a very traumatic one for the babies, which I agree with to some extent. The only thing I disagreed with was that he made it sound as though it were worse than I believe it to be. In my opinion, birth cannot be quite as horrible as he makes it sound simply because it is a natural thing for life to begin with. It's not a piece of cake, and it certainly can be as difficult and traumatic for a baby as it can be for a mother, of course, but babies are designed to withstand it. Some births can certainly be more traumatic or difficult than others, but that doesn't mean they are inherently horrible for the baby.

In Leboyer-style births, the babies do not cry very much, as Leboyer says that traumatized, terrified crying is not a normal aspect of birth. The baby is taken directly to the mother's abdomen at birth and the mother massages the baby rhythmically, imitating the contractions of labor. After the cord has stopped pulsing, somewhere between one and five minutes after the birth of the baby, the cord is cut and the baby is left with the mother for a little while, then given the bath. The baby is supposed to cry a few lusty cries, then will stop crying and simply take in his/her new world. It was nice to read this because that is what my son did at his birth. Reading something saying that his behavior was normal for a peaceful birth made me feel good about the birth (I already did) and made me a little sad that the baby nurses did a deep suction on him because "he wasn't crying enough" at the time. Ah, interventionist medical personnel are lovely.

Thrift Store Treasures

2007-12-01T16:03:00.000-07:00

On a recent excursion to the local ARC, I found two little treasures of someone else's trash. On of my treasures is a 1940 baby book written by a pediatrician. It's very funny and interesting to see what kinds of things were done or recommended at the time. The second treasure is an inversion table! Talk about awesome equipment at the thrift store!

The inversion table is the perfect height for moms with breech babies. It will be so much better to offer that to moms whose doctors approve of it than to have them prop up their ironing boards against couches or chairs. I'm very happy that my husband saw the inversion table. I just need to clean it up a bit. The vinyl is pretty gross, but the mechanics work just fine. What I'll probably do is mention to mothers with breech babies that I have it and make sure they discuss it with their doctor before they try it. I don't want to be liable for anyone who falls off of the thing because I recommended it. If the doctor recommends or condones it, however, that's a different story.

The book is really interesting. After spending two weeks in the hospital, the mother and baby go home. It's written like a story from the baby's perspective. The baby goes "talks" with the doctor and his mother during well-baby visits. I've gotten up to 9 months old so far. It's really funny and amazing to see what kinds of things were recommended in 1940. The baby doesn't get any shots until he's about 9 months old, and then only gets shots for about five things. I'll write a more detailed blog about the book when I've finished it.

Chalk up two more for my used bargains list!

Finished reading The Birth Book by the Sears'

2007-12-01T15:42:00.000-07:00

I finished another book yesterday! It was, as the title of this blog suggests, The Birth Book by Robert & Martha Sears. It was a great book. I highly recommend it. The only problem I saw was that it is in need of revision to make it up-to-date. I think it would be good to use in conjunction with other books.

It was very good at showing how a good relationship can be fostered between "natural" childbirth and "technical" childbirth. Though informed decision-making, one should never feel regret for using technology in childbirth. There are always risks and benefits to medical interventions, which should be considered, but one should be open to utilize what is necessary to have a good birth experience with good outcomes.

It was nice to see a childbirth book written by a nurse and pediatrician who had both hospital and home births. Their opinions seemed to be very moderate and well-thought-out.

Michael Moore's "Sicko"

2007-11-21T21:32:00.000-07:00

Hubby and I watched Michael Moore's Sicko a few days ago. Wow. Now, I've not seen any other Michael Moore films, so I don't have anything to compare it to. This film was fantastic. He points out the biggest problems with our healthcare system using real examples of people who have dealt with the worse and the standard. He also goes to a number of countries with socialized medicine to debunk the popular arguments used against such systems. After watching a film like that, one cannot see our healthcare system as successful in the least.

I found it very interesting for the birth aspect. Moore goes to France and visits a maternity room at a hospital, where mothers receive excellent care (and have lower mortality/morbidity than in the U.S.). He also touches on the fact that new French families receive state-funded postpartum doulas. How fantastic is that?

The film made me angry about our healthcare system (as though I wasn't already angry about it). It pointed out many of the problems I already saw in the system and pointed out ones that are horrifying. I know that there are often ways of getting around many aspects of the high prices and poor care we receive, but it doesn't work so well if you have a long-term problem or if the insurance companies are very much against you or if your premiums and co-pays add up.

I think that all emergency services should be completely free of charge, that all children's healthcare should be completely free of charge, that all elderly healthcare should be free of charge, that prenatal and pregnancy-related care should be free of charge, and that all other services should be affordable for everyone. I think that higher taxes should be implemented to make this possible. I do not think that medical personell would experience a lowering in pay for such care.

Birth This Week

2007-11-21T20:56:00.000-07:00

I went to another birth with Candace this week. It was fantastic. I was called in the morning and done in time for lunch with Candace! Hah! Not that long births aren't great too, it was just a treat. It was also au naturale and the mom was ecstatic to have done it without meds.

The nurse was totally awesome. She gave excellent recommendations and even let the mom start pushing at about 8 cm because she was already fully effaced and "floppy." It worked wonderfully, and she birthed her baby with ease. Baby was over 9 lbs and the mom barely had a scratch. She was a super-woman for certain.

That's all I have to say about that. It was great.

Brought to Bed - book reflections

2007-11-17T21:56:00.000-07:00

Today I finished reading Brought to Bed by Judith Walzer Leavitt. I am very glad I read it. Although written in the 1980's, the fact that it is a historical view of childbirth in the United States means that the information in it has remained pertinent. I have no interest in giving a book report, but I will say that it is definitely worth the read. I do want to get out some of what the book has made me think about.

I find it amazing that early hospitals did not make childbirth safer, even though that was the only reason women were going to the hospitals in the first place. It wasn't until the 1930's that it became safer to birth in hospitals than in homes, on average, and that was because of the availability of bood transfusions for hemmorhage and antibiotics for infection, for the most part. This means that the major changing factors for safety in childbirth did not come from obstetrics, but from medicine outside of maternity wards and schools.

Forceps deliveries, while better for situations in which babies and/or mothers would have died previously, were overused to the point of increasing maternal morbidity for the whole of women. Of course, women will choose a life of debility over a dead child, but when the debility was unnecessary to begin with, it is obvious that the "improvement" was not all that great.

I was amazed to realize that I have more knowledge and experience than most doctors had when they left medical school in the late 1800's.

I also found it very interesting to make general comparisons between the U.S. and Norway. In the U.S., it is incredibly rare (1%?) to have a homebirth, but in Norway, I think upwards of 30% of births are at home. The clencher is that Norway has lower maternal morbidity and mortality rates and lower neonatal morbidity and mortality rates than the U.S. It makes sense when you consider that Norway continued to utilize traditional midwifery models of maternity care, while adding science and medicine where it could help and maintaining the sense of normalcy in birth. The U.S., on the other hand, clung to "progress" and "science" to a destructive and dangerous extent, outlawing midwives and turning normal births into technological, doctor-driven anomalies.

I keep thinking that it's not obstetricians who have made birth safer, it's medicine outside of obstetrics, it's access to clean water, it's access to prenatal care regardless of financial ability, it's lower disease rates for rickets and tuberculosis, etc.

Of course, I need a disclaimer. Obstetrics has done some amazing things in the last hundred years. I do think that obstetricians are absolutely necessary under certain circumstances, and it is obstetrics which has helped determine what those circumstances are. Obstetricians are specialists, however, and it's unwise to see a specialist when you don't need one. If you don't want surgery, don't see a surgeon.

The book also made it clear that doctors really have always been pressed to take action, not to wait and allow things to happen naturally. Doctors were originally pressed by other arrangements and other women and families to care to, leaving them desiring to speed things along, to interfere, to make the women fit their schedules. This is still true, of course.

It also made it more apparent to me the position of nurses. So many people expect a nurse to be a support person during labor, but that's not their job. It has never been their job. When hospitals first began institutionalizing childbirth within their walls, most women were so drugged up that support for the woman wouldn't have been received. Not to mention that the environment was supposed to be "sterile" to the point that a nurse probably wouldn't have touched you unless necessary, let alone told you that you were doing a good job. Women were strapped down during normal deliveries through the 1950's. Who would think that a nurse would be supportive in such an environment? A nurse isn't support for the woman, a nurse is support for the doctor.

I feel like my blog entries are very anti-doctor/hospital/nurse and I keep feeling the need to back up and express the other end of the spectrum of my feelings. Perhaps I just need to clarify. I think that women should have homebirths or births at free-standing birth centers unless their health or the baby's health necessitates hospital birth. I think that women should be referred to midwives when they tell their gynecologists that they are pregnant and should only see an obstetrician if medically necessary. I think that the place held by each member of the birth support team should be explicit, with no false perceptions remaining at the birth. I think that women who want hospital births when they don't need them should be allowed to choose their birth environment, but should be given the risks involved, just like they would be for other choices in birth. I think the evidence and information should be freely given, regardless of who benefits from her choices.

I support women's choices. I just think that we all need to have a better idea of what meets our needs and expectations. I don't have all of the answers yet, of course. I hope, one day, to have enough information gathered that I can really wrap my head around a lot of this.

Cesareans (10/12/07)

2007-11-17T15:58:00.000-07:00

The cesarean section rate in the U.S. is 30.1%. W.H.O. guidelines state they should never rise above 10% for developed countries. This means that 2/3 of all U.S. cesareans are unnecessary. W.H.O.'s guidelines are based on when the risks begin to outweigh the benefits of this major abdominal surgery. This means that babies and especially women are actually being unnecessarily harmed by this cultural practice.

Why no outcry? Why no laws being made against unnecessary cesareans? Why no required guidelines for hospitals and maternity healthcare providers to follow to reduce their cesarean rates?

I joined the ICAN (International Cesarean Awareness Network) Yahoo group and read experience after experience of women who felt robbed, raped, devastated, devalued, lied to, and more because they had a cesarean that they later found was unnecessary. I read stories of doctors and nurses presenting vulnerable, laboring women and their spouses with the "option" of cesarean, or worse yet, tossing the "dead baby" card on the table when there was no reason to believe the baby was in danger. After months of physical recovery and years of emotional anguish, postpartum depression, and cases of post-traumatic stress disorder, these women go over their medical reports, talk with other medical professionals, talk with other women, and learn that their cesareans weren't necessary. They learn, three children later, that the repeat cesareans they were "offered" during pregnancy were not also not necessary, but because their doctors presented it like the first option, they took it. Doctors say, "You can have another cesarean," and refer to a VBAC as a "trial of labor," instead of telling women, "There is good reason to have a VBAC, in your case." When a woman wants to have a "trial of labor," they're not only given the consent form, but they're also given the lecture of all the risks of the "trial," whereas mothers who choose to schedule a repeat cesarean are not usually told of the risks of thier second (or third or fourth) cesarean when they sign the consent form. It's not until they've had three or four cesareans that their doctors get a little worried and tell them that they shouldn't get pregnant again because another cesarean would be risky, and they won't attend a VBAC after a woman has had that many cesareans because it would be risky... so a woman is told not to have any more children. TOLD. Who is this person who plays God over you as a woman? Who thinks you should just get a hysterectomy with your next cesarean? What angers me the most this is that these women wouldn't be "at risk" with subsequent cesareans or VBACs if their doctors hadn't suggested they take the second cesarean, and better yet, if they hadn't had an unnecessary cesarean in the first place.

Yes, I'm getting carried away on a scenario where women have bad doctors or simply feel under-educated. Yes, cesarean sections are necessary and life-saving in some circumstances. It is utterly horrifying to me that the cesarean rate is what it is in the U.S. I cannot express the horror I feel at the idea that one in three live births delivered in the United States of America are removed from their mother's splayed abdomens while they lie behind sterile shields with their arms tied down and their spouses nowhere to be seen. It's the thing of horror novels to imagine women with their babies ripped from their bellies, and yet we do it. To me, it is equally horrifying when the surgery does not save lives and livelihoods. No, not all obstetricians are evil surgery-mongers who want to cut open every woman who comes through their practices. I've never been one to think it's okay being satisfied and passive because things are "okay" or because it's good more than it is bad.

The big questions are why are so many unnecessary cesareans being performed and how do we stop it?

The Healthy People 2000 objective of reducing the cesarean rate to no more than 12% for primary cesareans, no more than 65% for women with previous cesareans, and no more than 15% overall not only failed, but failed miserably. The rate didn't go down, but went up and continues to do so. So, making objectives to make people healthier doesn't work.
The Coalition for Improving Maternity Services created the Mother-Friendly Childbirth Initiative, which states that mother-friendly maternity services will have a cesarean rate of less than 10% for low risk and 15% for high risk women (http://www.motherfriendly.org) was established in 1996 and hasn't worked in reducing the cesarean rate overall.

This is just the beginning of my thoughts.

Christina

Welcome to Saffron Doula's Blog!

2007-11-17T13:38:00.000-07:00

I have decided, after much inner-dialogue, that I should put my thoughts concerning pregnancy, childbirth, local and national birthing culture, statistics, cesareans, trends, and the like into writing. What better way than to create a blog and link to it from my web site and MySpace?

In case you are wondering, I am a doula. A doula is a non-medical childbirth assistant. For more on doulas or my business, visit my web site, http://www.saffrondoula.com/.

I feel passionate about women's choices before, during, and after childbirth. I feel passionate about VBAC (vaginal birth after cesarean) as a safe option for the vast majority of women who have had cesareans (I'll go into that in another entry). I also feel passionate about cesarean sections and the continued need to make change in the maternity field. These passions do not detract from my passion for women's ability to choose whatever is best for them personally.

I do not believe that there is any "right" way to give birth, nor that the things I want and need during childbirth are necessarily the same as things anyone else will want and need during childbirth. Birthing is an inherently personal, spiritual, life-changing event with unpredictable variables throughout its process. It is imperitive that women regain their status as the owners and doers of childbirth, refusing the trend of the last 70-odd years where medical professionals are considered the owners of birth and birthing women, the determiners of what will be done to a woman's body.

Medical professionals are necessary in some cases. Don't get me wrong there. Prenatal care and medical advances like antibiotics for infection, blood transfusions, and necessary cesarean sections do save lives. However, what should be an open dialogue between care providers and women and other support people is too often an unhealthy dichotomy where the medical professionals take the power and the women are left with the consequences of unfair control held over them. We have been taught in this culture to trust doctors to a flaw. We expect them to be perfect when they're only human. We place our lives and our bodies into their hands and feel angry, betrayed, violated when something goes wrong, when the inherent unpredictability of life, birth, and death rears its ugly head and thwarts us all. Or we later discover that we had options not revealed to us at a pivotal moment, that we didn't need the surgery after all, that our bodies aren't broken, that we could have said "no."

I think we need to make some changes to our medical system across the board, but certainly in maternity. We as women and mothers need to be smart consumers, demand what we want and need, refuse what we see as unnecessary, and get real, detailed, thorough answers along the way. That's why I'm a doula - because women need to know what their options are, because I need to know what is going on behind those "secure" and "sterile" doors. I am a doula because women need support in their most vulnerable hours, and not just physical and emotional, but informational as well. Women need to have someone there for them who will say, "here are your options," "here are the risks they're not telling you about," and "remember, you're in charge here." I want to make some changes, and I think this is a good way to start.

Christina