Some books I've read recently

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"

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

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'

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"

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

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

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)

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!

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