Breastfeeding - From National Breastfeeding Month (Oct)

This is a wonderful article on Breastfeeding - from the perspective of the breasts... In honor of National Breastfeeding month (which I missed, I think it was October which is also Breastcancer awareness month).



http://leakyboob.blogspot.com/2010/11/more-than-fun-bags.html?showComment=1290468201482_AIe9_BHilefYX5-VqUv1A5AgwM7YCJaWujrERWVcpGWu6FkcZJxBFAoY_Umro5FyFRFTeF8wVEJP6LcP-091acFtWTs59RYO3v2HGcaihuGp5SBfWGLNq4E0SxscZhv02leCysvOj-RbEue4J02-PoIHCyUyleQKbtWNYsxkMG9Y9thop8EuNmpNzWUjwmTZpd_XryNXN9Y_Ucz-3hM1NsrPo0UhwutQeK-sUaqsUAaURsDLYRQwqL3m1rIRGZ0CweSQtLQHjsuzZJREy1YmQTsDwNxmVq_QajYwR_sN40m8RcNG2dwKxNXf1Srtm66Xv-y-ni2ONjXEh9w6nI7aB7olVmwXum12FUP8e7-ydqQvS9CDgZfPmrcSx0QLGBiMurX_VkElx-BnAX0jlsThLRBPg-iXC1LGctfBqxNRkJK7aPbCx4f0PrJYociB5yfI2RXM9Ea3vNdv8F0SvAQCyilRrOGTHwLCFbT_zwLQyVXI7l46EP1WtfYArqyjbt3qfvsJoZKr5qREH7i4vykyqgu8ZxXOZtI9pbfNtJGv9GyDmCsG8a7upg9Y--iSmNSXlpCGOp033rPPW8pwiELx2y4yr7LYQ4EtJxwsWVu8UPZOvgHTf-Sg0XeHZjbiz1lDAcfiygEqElD6Oj5P-8RY7ttQQRhWLcD0XMmhD1pJRUj3zPLvQtMY0mhqiEjlcgRujrV7NJyBhcMHJt-4S4r0AV1A_rpESD_XfyxVfx0GSOgVHV8WvsqHfJQzf_Q1gbGM24AHbD4LZwqKqV_vevqugWRmgqBORq1-Wo05G1ZVMTlrn9D7spnVdwOJ220lX6vxg_PQ4aI41HdS#c6798860653188974586

Prodromal labor - start and stop, start and stop...

A friend and very pregnant mommy, just wrote this post. It's really good.

Red Light, Green Light…A Tale of Prodromal Labor
October 30th, 2010 | Author: Ashley Sparks
http://ashley.pieceoftheinter.net/2010/10/red-light-green-light-a-tale-of-prodromal-labor.html#comment-106


I am not a very nice person these days. Just ask my poor husband. I mean, I try to be, but when you feel as though your uterus has declared war on the rest of your body, it’s kinda tough to be Little Miss Sunshine.

There is a term that, unless you have taken natural birth classes (Lamaze doesn’t really count, and we will discuss why another day) or birthed with a midwife, you are probably unfamiliar with. It’s called prodromal labor. Unfortunately, most OB’s and L&D nurses are quick to mislabel this “false labor” or, even worse “failure to progress”. It is neither. First, anyone who has experienced it or seen it will be quick to tell you that there is nothing false about it! Second, progress of some kind is indeed happening, but it just may not be the measurable progress on the timeline that women have somehow been pigeon-holed into as ‘normal’. In reality, ‘normal’ has been narrowed to such a small window that almost no one fits it, which is why we have so many interventions happening. I can show you ten different women with ten entirely different labors and all of them would qualify as normal. We have just forgotten what normal looks like because we no longer give it the opportunity to happen.

Prodromal labor is a funny thing. For some women, this phase of labor may last a day or two. For some particularly lucky women, like me, it may last for weeks.

Basically, your uterus is working hard, and you know it, but the docs may not see the cut-and-dried quantitative results they want to see. During prodromal labor, the types, intensity and regularity of the contractions are widely variable. Some women have what feel like intense Braxton-Hicks contractions with no real pattern for a day or two and then begin “active labor”. Some women have very time-able, regular, labor contractions that will reach regular intervals and then fade apart and die down. This may happen several times over a few days or a few weeks. And, of course, there are many different patterns. Some women will have regular contractions and Braxton-Hicks intermittently between the regular contractions. Some will have one episode lasting several hours and then go into active labor a few days later. Some women will have stop and go episodes for a week or two – or longer. The variations are endless. There are several reasons for this type of labor to happen.

Your baby may not be in great position and your body may be helping baby get into a more favorable position for birth.
Your cervix may be posterior and the contractions may be helping to ease your cervix into a better position.
You may be effacing or “thinning out” which is just as critical as dilation.
You may actually be slowly dilating. I’ve heard of women doing this up to as much as six centimeters!
As you can imagine, this particular type of labor can be very, very draining. It can drain you physically, emotionally, and mentally. Physically, this is the equivalent of lifting a weight every few minutes for hours, days or weeks. After a while, you would get pretty darn tired! Emotionally, you may find yourself getting discouraged, wondering if you will ever really go into labor, and wondering if you will have the stamina to make it through the ‘real thing’. You might feel helpless, frustrated, overwhelmed, angry, impatient, and just generally upset. This is the hardest part for many women. Finally, you may struggle mentally. You may begin over-analyzing every contraction for it’s duration, intensity and frequency. You may begin giving yourself ultimatums, or even doing your best to get labor going by any means necessary. You may start searching the internet for a magical answer to when you will go into labor… I mean, I’ve never done that, but somebody might… ok, I totally have. But the point here is that prodromal labor is very real and very hard to deal with. This is one of the reasons that women often give in to induction, pain relief and even cesareans – because they are just plain exhausted.

Here at the Frazzy house, prodromal labor has kind of been our nemesis of late. My husband has already come home once thinking that this was the real thing and that was two weeks ago! And I’m not even a first time mom! My Bradley teacher has a saying “Labor is a retrospective diagnosis. Once you are holding the baby, you can say ‘yep, that was labor!’” Oh, how true that is!

So, as far as my personal situation, here’s where we are: I am apparently really good at this prodromal labor thing. I have been having the stop and go labor for several weeks now. At one point I was having contractions every 3-4 minutes, over a minute long, for over and hour. Then…it stopped. Just stopped. No slowing down and gradually spacing out. *sigh* Since then I have reached five minutes apart and over a minute long several times, but they keep backing off. Now, I know at one point Baby Bug was decidedly posterior, so I am certain that these episodes have helped her to get into the position she’s in now. I’m sure other things are happening, but since my GBS (Group B Strep) screen came back positive, I am not doing any more exams until I hit active labor. Even then, they will be minimal to reduce the risk of transmission to the baby. (I have another post ready about GBS that I will put up later this week.) So at this point, I am just trusting that my body is doing what it is supposed to be doing and that it’s all for the best. Someone may need to remind me of that if you see a tweet that says something like “I think I might jump off of the roof if I have one more episode of this!” or ”I’m going to choke the next person who asks me if I’ve had the baby!”. Don’t take anything I say personally, I’m just a little on edge. I’ve outlined the reason for that in pretty good detail here. However, I apologize in advance for any ‘tude I throw out there! I promise, it will be over by Thanksgiving at the latest!

Posted in Baby #2, Midwifery, Natural Birth, Pregnancy

Home Birth and Midwifery in the News...

There have been several articles in the news lately regarding Birth, Midwives, and Out of Hospital Birth, specifically Home Births.

http://abcnews.go.com/Health/Wellness/cdc-home-births-rise-us/story?id=9998349

http://www.theunnecesarean.com/blog/2010/5/17/alabama-cesarean-rates-by-hospital-2008.html

http://www.theunnecesarean.com/blog/2010/9/13/read-the-subtext-acogs-position-on-home-birth.html

http://articles.mercola.com/sites/articles/archive/2010/09/28/home-birth-is-safer-than-hospital-birth.aspx?aid=CD945

http://www.facebook.com/l.php?u=http%3A%2F%2Fireport.cnn.com%2Fdocs%2FDOC-478927&h=40f62

http://www.medicalnewstoday.com/articles/202532.php

http://www.seattlemidwifery.org/news.html

This year the CDC released a report on births, and they have seen that Homebirths are on the rise.
http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_11.pdf
http://dl.dropbox.com/u/2847775/Staying%20home%20to%20give%20birth%20JMWH.jpd.pdf
http://www.usatoday.com/news/health/2010-03-04-homebirth04_ST_N.htm
http://www.washingtonmidwives.org/assets/big-push-nvsr-release.pdf
http://www.npr.org/blogs/health/2010/03/home_births_rise.html
"The number of Alabama families giving birth
out of hospital without regulated maternity care providers is
increasing faster than the national average." In AL the rise was 18% compared to 3-5% nationally.

http://www.thedailybeast.com/blogs-and-stories/2010-10-02/home-births-under-fire-amid-outcry-over-wax-paper/
Jennifer Block wrote an article about a study (a very poorly done study), that said HB is 3 times deadlier than hospital birth... This is part of what she had in her article...
*The medical community calls home births unsafe, but recent large studies comparing home to hospital show why women with uncomplicated pregnancies would choose the former: They are much more likely to avoid the complications of surgery or tearing, they are more likely to breastfeed, and they are happier.

...Meanwhile, rival journal The Lancet took the study at face value, publishing an editorial under the headline “Home Birth—Proceed with Caution,” with a stern warning: “Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk.”

“That was really offensive,” said Marjorie Greenfield, M.D., a professor of OB/GYN at Case Western Reserve who submitted a letter to The Lancet along with several other physicians. “But you know, I can understand, because there’s such a deep, deep belief that it is unsafe to have a baby at home. I used to believe that! But when you look at the good studies of home birth, there’s no difference in baby outcomes, and probably improved outcomes for mothers.” Still, she added, “most people I work with think it’s self-indulgent and risky.”

Last week here in Alabama we had families from all over the state gather in 7 cities and we Walked for Midwives, in an effort to help bring awareness to the issue, and to garner support. The Alabama Birth Coalition is trying to help get legislation passed to allow and License Certified Professional Midwives.
Here in our fair city... we caused a stir!
http://www.facebook.com/l.php?u=http%3A%2F%2Fblog.al.com%2Fbreaking%2F2010%2F09%2Fmidwife_advocates_march_throug.html&h=65d6b

In response to this -
The President of the Alabama Chapter of the American Academy of Pediatrics wrote an article
http://www.facebook.com/l.php?u=http%3A%2F%2Fblog.al.com%2Fpress-register-commentary%2F2010%2F10%2Fyour_word_lay_midwifery_an_unn.html&h=65d6b

This was then written in response to the article:
*The president of the Alabama Chapter of the American Academy of Pediatrics displayed his woeful ignorance of birth, midwifery and the current proposed legislation to provide Alabama women with birth options.
I urge people to learn the facts and then educate him on the topic. http://www.facebook.com/l.php?u=http%3A%2F%2Fwww.frazzalicious.com%2F&h=65d6b
This is the official response from the Alabama Birth Coalition to the specific article written by Dr James C. Wiley.
http://blog.al.com/press-register-commentary/2010/10/your_word_a_wonderful_option.html
They make sure to explain that ABC is not trying to get licensure for untrained 'lay' midwives, but are seeking recognition and licensure for Highly Trained and skilled Certified Professional Midwives.

Things have certainly been heating up... Now if we can just get the law passed here in Alabama, so many mom's would be so happy, and planning for their births would be so much nicer as well!

A Metaphor for Breastfeeding...

A friend on facebook posted this link.
It is a wonderful 'description' of breastfeeding. In it this mom breaks it up into phases to describe it. I will say that I think she describes the potential pain as lasting a bit too long, but I know that some mom's do have various issues that cause it to be a little rougher than others. I do encourae mom's to 'get help' so that they can correct whatever may be a bit off (I'm NOT saying you are dong something wrong, it can even be a physical issue of your baby's mouth, or whatever, but it helps to get that issue 'fixed') so that you can move on with confidence and comfort to the next phase. Even then... it's is so worth it.

Her description of the nursing relationship and then the time of weaning almost made me cry. Very nice writing.

I do think back to those days sometimes; it's been 2 years since my 'baby' weaned, at 2 1/2 yrs... and I miss them. It is sad when you know that a very big part of your life, is over forever... It was time to move on, but oh... this message reminded me of all those memories, from each of my 6 babies, and I miss it a little bit.

Enjoy -


http://dumbmommy.wordpress.com/2010/07/09/searching-for-the-metaphor/

A pregnant friend called last week. We talked about co-sleepers, and pants with expandable waistlines, and what types of excretions to expect during labor. As we said goodbye we made plans to speak again soon. “Next time,” she declared, “I want you to tell me what nursing is like.”

I hung up the phone with a mission. I was going to come up with the ultimate breastfeeding metaphor. This was a friend who had been with me throughout every step of my pregnancy, she listened to my freak-outs, brought me crackers when I felt nauseous and offered feedback on my endless lists of three-syllable baby names.

But then I moved, and now we live in two different cities, we don’t have the daily contact that we used to. We’ve lost touch. I wanted to give her something spectacular to make up for the distance; something that would paint a perfectly perfect vision of the bonding, and the sensations, and the mechanics of it all. Like the way Shakespeare summed up the journey of human existence simply by saying” All the world’s a stage, and all the men and women merely players.”

Like that…but with boobs

Try as I might every attempt turned into a horrendously epic run-on sentence. I could not distill the experience into a concise statement. There was no metaphor that would capture the many phases I went through as a first time nursing mom. I decided I’d make a list- sort of like the “ages and phases” stuff that baby center offers the expecting parent.
It would be my Eriksonian attempt at capturing the mammary glands in all their glory.


The first three days - were like puberty. I was massively sweaty and my shirts were way too tight. My breasts felt suddenly powerful yet completely overwhelming. I cried all the time.

Days 4-6 – were like assembling a bookshelf from IKEA. I knew if I could just get the DANG positioning right it would all come together. I looked at diagram after diagram and it appeared so easy in the pictures. But each new attempt left me bruised, demoralized, and frustrated.

Days 7-18 -were like S&M. The pain was so bad I wanted to puke but I went back for more every two hours. Many people told me that my experiences did not sound normal; they speculated that perhaps there was something very wrong with what I was doing. They suggested I seek professional help.

Days 19-50 – were like learning the guitar chords to your very favorite song. It was hard, there were blisters, but they weren’t too bad; certainly nothing that would stop me. Each day it got easier. Eventually the blisters were gone, my hands moved with ease, I just knew what to do. I could finally experience it, like a song. I felt so proud, I felt like telling everyone, “Do you see this! Check me out. I’m going to do this everywhere. I’m going to do this right in your face! I’m a total rock star!”

Fifty-one days to two years – were like one amazing conversation. Like the kind of chat that leaves you knowing everything about someone. The kind that ends with you staring into someone’s eyes and feeling like the entire world is being held somewhere in-between your gaze.
Two years to two years, four months- were like the last two hundred pages of a very good book. I slowed down, I paid very close attention, I did not want it to end. I was not sure what would happen after I finished. I sensed that I would feel a little bit empty.

The other night was like saying goodbye to a very close friend who suddenly has to move.

After stressing over whether or not to finally wean my daughter, she announced while nursing, “Mommy, your boobies aren’t working any more.”

And just like that, the entire experience shifted

Somewhere

Into

The distance.

edited for language

Perineal Massage, Episiotomy, Perineal Support...

http://prepforbirth.com/2009/08/25/new-episiotomy/
This link is to a story lied further down my rambling post and the purpose of this post. Please check it out.

When I had my first baby I was so unprepared in so many areas. I remember reading about episiotomy and thinking I did NOT want that.
So, there I was in labor, and in the overseas hospital I was at, they did a partial shave, which I thought odd, then all of the sudden I noticed the OB coming at me with a large pair of scissors! I remember screaming -in my head- STOP! No! Don't cut me! and more specifically, "Can you just give me a minute! I'm in the middle of a contraction!"

Being the 'good little patient', I said nothing, and the cut was made. Granted, I didn't particularly feel it at the time (he did what is called a pressure episiotomy - when the pressure of the baby's head is there during crowning, the tissues have a sense of numbing, and so you don't actually feel the episiotomy, and you don't need to have a local anesthetic, until they stitch you up). After the birth however I had very bad swelling, pain and tenderness. I learned that they had done a Mediolateral episiotomy, which in fact do cause more swelling and pain than a midline episiotomy. Mediolateral Episiotomy is common in Europe, where the cut is made at an angle into the labia, rather than straight down into the perineum. The theory is that if the mediolateral cut tears further, it will not end up in the anal sphincter, like a midline episiotomy can have a tendency to do.

With my second baby, I did not have an episiotomy, and would have been fine, if I'd been allowed to listen to my own body as I pushed. However, this Dr. -a tall man- tilted the bed, up and back, so that I was literally pushing up hill, and then I was being yelled at, with counting and pushing, and counting. I had a minor labial skidmark/tear, probably only because of the small size of that baby... but I had a lot of bruising and postpartum pain from the way the birth was 'managed'.

The most helpful things that I personally have had that helped to stretch the perineum, was the use of Warm compresses during pushing with two of my babies. The moist warmth helped soften and stretch the tissues and helped me to feel my body to be able to push slowly and ease the head out, and caused less stress and trauma to the tissues of the perineum. The other thing that was a helpful thing as well was having waterbirths. My level of postpartum discomfort/pain from birth was dramatically different and lessened after the use of warmth and moisture.

As a labor doula I have witnessed many births where the OB or even the nurses employed the use of 'perineal massage, or more often I've heard it called 'Ironing out' the Perineum. I have watched as this very vigorous, intense 'massage' is done during the pushing stage of labor. I have watched the tissues swell and subsequently tear during the birth of the baby's head or shoulders, and in one case, before the head was even crowned, just due to the ironing out of the tissues. Some Dr's have commented when I have had clients/patients ask about this procedure/process that the Dr. had for a period of time stopped performing this 'perineal massage' and reported that they had an increased incidence of perineal tearing, so they had gone back to the massage/ironing out of the perineal tissues during pushing. What I have have witnessed is that nearly EVERY single mother that has had this done, has torn and needed stitches after the birth.

**********************************************************************************The link tells detail about what this is like. http://prepforbirth.com/2009/08/25/new-episiotomy/
**********************************************************************************

There are directions for perineal massage, it is to be done prenatally, and can potentially help the tissues stretch during birth. http://www.childbirth.org/articles/massage.html
http://www.birthingnaturally.net/cn/technique/perineal.html
Then at the birth the mother can massage and help ease the tissues as the baby is born. Some people swear by it. I tried it for one birth, where my caregiver performed the massage, NOPE, that was not for me! However during my waterbirth, I instinctively reached down and eased the tissues around my baby' head. No tearing or cutting and no need for stitches.

I have witnessed a few hosp births without a mother tearing, one even that the Dr. was pushing very hard to perform an episiotomy, "because the mother was going to tear horribly", and the mother refused the cut and birthed her baby, amazingly, over an intact perineum! I have only witnessed one or two episiotomies. I have seen many a mother however birth in an out of hospital environment, and when she is supported, births in an upright or hands and knees position, listens to her body, pushes when she feels the need, not because she is being yelled at to push to a count of ten... mother after mother birth their babies, over intact perineums! The average is 8 lbs or over. I've seen mothers birth 10 and even one 12 pound baby, without even a skid mark, let alone a tear! Yes, I've seen a few tears at OOH births as well, but the way the birth is watched, supported and guided is so different from the managed way of birth in hosp. it wasn't for lack of trying, and few OOH have been as severe as the one's that I believe are caused by the way of birth and perineal massage/ironing, that is used.

I love to have a warm pot of water filled with a bag of healing herbs that I can put cloths into and then use for perineal support. I think it helps the mother.

I have desired to start a dialog about this practice of the 'new episiotomy',for a long time. I'm glad that someone has written about this. Lets get more dialog going, and try to let birth be a more gentle process, no matter your location.

GETTING WHAT YOU WANT FOR YOUR BIRTH EXPERIENCE

At www.aims.org Alliance for the Imporvement of Maternity Services (AIMS) you can find this great resource to help you with

GETTING WHAT YOU WANT FOR YOUR
BIRTH EXPERIENCE

Prepared by Doris Haire, President

American Foundation for Maternal and Child Health

Below is a wonderful article on how to get what you want, with lists of things to be aware of and to ask for to get the birth you want.
(I have added bold or italics some of the things in the list that I think are really important).

A good childbirth experience should be happy and gratifying, as well as safe. You are much more likely to have a good experience if you establish early a good communication with your physician or midwife. Sometimes it is the expectant parents who must take the lead in establishing a rapport, but don't let that hold you back. It's your childbirth experience. It's up to you to let the doctor or midwife know what you want. If he or she is not in agreement with your wishes, it is far better to find that out while you still have time to shop around for a doctor or midwife who does agree with you.
Most of the common practice patterns employed in the obstetric care of an essentially healthy pregnant woman and her baby have not been shown to be in the best interests of the woman or her baby. Unless there is a medical indication for the procedure there is no scientific support for routinely:
a. confining the mother to bed during labor and birth,
b. placing an IV or saline lock,
c. shaving the mother's pelvic area or administering an enema,
d. chemically "ripening" her cervix or inducing labor,
e. artificially rupturing the amniotic sac,
f. administering analgesia or regional anesthesia (epidural, spinal, pudendal, etc),
g. prohibiting the mother from eating lightly and drinking fluids during labor,
h. placing the mother's legs in stirrups for delivery,
i. performing an episiotomy or proctoepisiotomy,
j. directing the mother to bear down longer than 5-6 seconds,
k. applying fundal pressure,
l. extracting the baby by forceps or vacuum extractor,
m. clamping the umbilical cord before pulsation stops,
n. putting the baby in a baby warmer, rather than putting the baby with the mother, inside a prewarmed blanket, and
o. prohibiting the baby from breast feeding in the delivery room.
Since all of the practices listed above pose a risk to the mother and/or her baby it is important that the mother discuss these risks with her doctor or midwife.
WHEN YOU GO FOR YOUR FIRST PRENATAL VISIT:
• Ask the office nurse about the fee for vaginal delivery, and also for cesarean section, in case one should become necessary. If you have health insurance, ask if it will fully cover the fee for vaginal delivery or cesarean section.
• To make sure that your doctor or midwife is sympathetic with your wishes ask, "How do you usually conduct labor and delivery?"
• If you are planning a home birth make sure that your provider has sufficient skill and backup to take care of an emergency.
• Ask other mothers who have had that doctor or midwife about their experiences. Find out if he or she honored the mothers' requests they made during their office visits. Did they find their requests denied once they got into labor/delivery? If so, which requests were denied and why?
• If you have any doubt that the doctor or midwife is the right one for you, you may wish to keep your options open to find someone more compatible. Think twice if the doctor or midwife insists that you must pay the full fee early in your prenatal care. This locks you in to an arrangement that you might later regret. After all, you might want to move before your due date. By paying at the end of each visit you preserve your flexibility. This also gives you the freedom to walk out of the office without paying for the visit if you are kept waiting for an hour or more in the office.
• If the doctor or midwife does seem right for you, ask about his or her "call schedule". Ask if it is possible, or likely, that another person will actually attend your delivery. If yes, ask about that person's philosophy regarding labor and delivery. Request a visit with the alternative doctor or midwife on one of your prenatal visits.
• Some doctors and midwives are very sensitive, and some are even annoyed when expectant parents ask questions about obstetric procedures and drugs. Therefore, TACT is very important. For example, to question a procedure you might say, "I realize that you are interested in my welfare, but I'm concerned about................................
TAKE ALONG A "SUPPORT PERSON" FOR YOUR PRENATAL VISITS. It is often very helpful to have a "support person" along on prenatal visits. If the physician or midwife seems defensive about your companion's presence, explain:
"I've brought along my (friend, mother, etc.) because I may not always remember everything you tell me."
If you want to question the safety of a procedure or drug, ask:
• "What is the scientific documentation for using this procedure (or drug)? Please let me read some literature which guarantees that there are no harmful effects to me or my baby from .......... "
If you are questioning the safety of a proposed drug, ask to see the FDA package insert for the drug.
OTHER IMPORTANT QUESTIONS TO ASK YOUR PHYSICIAN OR MIDWIFE INCLUDE:• "What % of your patients ambulate during labor?"
• "I do not want to be fed intravenously during labor since it will interfere with my ambulation and may result in hypoglycemia in my newborn baby. Will I be allowed to drink liquids and eat lightly during labor in order to keep up my stamina?"
• "What % of your patients have no drugs at all during labor and birth?
• "What drugs do you commonly give women during labor?
• "What are the risks of those drugs to me and my baby?
• "Could I read the manufacturers' package inserts (information sheets) of those drugs?"
• "Has the FDA specifically approved of these drugs as safe for my unborn baby?" (Many drugs, including terbutaline, used in obstetric care have not been so approved.)
• "When you listen to the fetal heart rate during pregnancy and labor, do you use a fetoscope or ultrasound?"
• "Since the FDA has acknowleged that no one knows the delayed, long term affects of ultrasound on human development when it is used in obstetric care, I would like to be monitored by a fetoscope. Will you please check with the hospital labor/delivery unit to be sure they have a fetoscope, rather than an ultrasound doppler?"
• "What % of your patients have no episiotomy?"
• "What % of your patients have cesarean sections?"
RESISTING THE INSISTENT PROVIDER
If you do not want a sonogram, ask the following questions:
• "Why do you consider this procedure necessary? What are you looking for? Is the sonogram being carried out solely to establish fetal age or multiple fetuses?"
• "How would you alter the course of my treatment if the sonogram discloses the condition you are looking for?"
• "If I am sure of the dates of my last menstrual period, what advantage is there in performing the sonogram at this stage in my pregnancy?"
• "Will one sonogram give you the information you need, or do you expect to do additional sonograms later in my pregnancy?"
• Since the FDA has recently acknowledged that no one knows the delayed, long-term effects of diagnostic ultrasound on the subsequent development of the exposed offspring, shouldn't we wait until my baby is bigger?"
COMMON RESPONSES TO INQUIRIES ABOUT ULTRASOUND
• Expressions of concern regarding the safety of ultrasound are often met with assurances such as "Sonograms are not x-rays", or "Sonograms are just bouncing sound waves".
If the doctor or midwife continues to insist on a sonogram then ask:
• "Can you give me information from the company which will guarantee that the ultrasound will have no adverse effects on my child's subsequent physical and neurologic development?"
(The doctor or midwife will be unable to provide you with such a guarantee because there have been no properly controlled, long-term studies to evaluate the effects of diagnostic ultrasound on subsequent human development - but the mental exercise will make him or her stop and think carefully before exposing your baby to ultrasound via a sonogram or electronic fetal monitoring.)

MAKE SURE THE DOCTOR OR MIDWIFE AND THE OBSTETRIC STAFF KNOW WHAT YOU WANT
Make a list of your preferences. Begin the list by writing: "If there are no medical contraindications, I would like the following:
1 ........................
2 ............................
3 ........................ , etc."
Make three copies. Keep one for yourself to take with you to the hospital. Give two copies to your doctor or your midwife, one to remain in his/her files. Ask that the second copy of your requests and preferences be attached to the copy of your prenatal records which are sent to the hospital prior to your due date.


HOSPITAL CONSENT FORM
During the latter part of your pregnancy write to the hospital's Public Relations Office and ask for a copy of the consent form used for obstetric patients. On admission to the hospital, write in above your signature on the consent form, "Subject to my informed consent at the time." Keep in mind, if you don't give your informed consent, you have not consented.
If you are refused admission unless you sign the consent form "as is", go ahead and sign the form. Once you are in the obstetric unit give your nurse a copy of your previously written instructions which reads:
• "I hereby withdraw my consent to all non-emergency drugs or procedures unless you obtain my informed consent at the time. Neither I nor my baby shall be used as a teaching or research subject without my informed consent at the time..".
HOW TO REFUSE AN INSISTENT RESIDENT OR NURSE
• "I realize that you feel I should have the .............. "or "would like to make me more comfortable, but I will wait until my doctor or midwife arrives so I can talk it over with him/her personally. I want to discuss the alternatives with him/her."
• "If you insist on monitoring me, give me some literature from the manufacturer which guarantees that the procedure will not jeopardize my baby."
To make the provider think about what he or she is offering you, ask:
• "Why do you suggest that? Has something gone wrong?"
Remember, directions have legal connotations; requests can be ignored.
• Example: Don't say, "I'd rather not be shaved." Say, "Do not shave me.""Do not put my legs in stirrups."
"Do not send my husband out of the room."
"Do not take my baby out of my room."
"Do not feed my baby water or formula in the nursery"
"Bring my baby to breast feed when he or she is hungry", etc.
THE DOCTOR CALLS THE SHOTS!
If you are being made miserable by a nurse or doctor who insists that
"Hospital rules require that .............",
Tell the caregiver that you will sign a waiver to release the hospital from responsibility for your refusal.
If the caregiver continues to hassel you ask to see a copy of the hospital regulation or protocol that deals with the issue in question. It's doubtful that the regulation actually exists.

GETTING YOUR OBSTETRIC RECORDS
Your obstetric records are an important part of both your and your baby's health histories. Well before your due date, during one of your prenatal visits, tell the doctor or midwife that you want a copy of your and your baby's hospital medical records including nursing notes. Nursing notes are important because many notations in your records are made by staff members who are not nurses.
The following statements and questions are examples:
• "I would like a copy of my and my baby's prenatal and hospital medical records, including nursing notes, monitor strip, etc., to keep for my own records. May I have them?"
• "How much will it cost me to obtain a copy of these records?" (Copies should cost approximately 50c a page.) If the cost seems too high, ask what they charge when another authorized physician requests a copy of your records.
• "What do I do now to clear this request with the hospital?"
• "I don't want to wait until the last minute to find out that...."
If you are offered a summary or abstract of your records, rather than the complete records, keep in mind that a summary can OMIT information which you may later find desirable to have. If your doctor or midwife refuses your request for a copy of your and your baby's hospital/medical records you are justified in refusing the hospital's request for your authorization to allow your health insurance company to review your records for payment. To make sure the hospital complies, write in above your signature,
"My and my baby's records may be reviewed by my health insurance company only after my personal inspection of those records and I have received a copy of our records."

We hope that the above suggestions will help to eliminate any misunderstanding that might mar your birth experience. We wish you a happy, healthy birth and baby.
Prepared by Doris Haire, President
American Foundation for Maternal and Child Health

© 2000, Doris Haire http://ht.ly/2BN53

Birth Trauma... not an easy topic, but it is real and it happens to too many women

Women deserve respect and compasion. Birthing Women, as strong as they may be personally, when it comes to the time of labor and birth are at a most vulnerable place. It's hard to stand up for yourself and FIGHT while in labor and the biggest thing is, you shouldn't HAVE to!!!

Below are several links to posts that have been discussing this. How do women feel about their births? Too often, women are feeling traumatized, victimized, assalted, or even so violated in person and spirit that they feel as though their experience was akin to rape.

http://grabapple.net/entry/102
A difficult story to read... one woman's story of her traumatic birth, how the restrictions placed upon her took away her dignity, her plans and her birth.

http://www.theunnecesarean.com/blog/2010/9/9/so-about-this-birth-rape-thing.html
Women's exeriences are REAL, it is how they feel! Noone else should be able to tell a person that they aren't allowed, or aren't supposed to 'FEEL' how they feel.

http://jezebel.com/5632689/what-is-birth-rape

Pre-labour rupture of membranes: impatience and risk

Pre-labour rupture of membranes: impatience and risk

http://midwifethinking.com/2010/09/10/pre-labour-rupture-of-membranes-impatience-and-risk/

When my water broke with my first baby and I had not had the first contraction yet, I remember being so upset, since I knew the Dr's would want me to come into the Hospital right away! I had read a 'vast' library (all 7 that I could get my hands on) of books on pregnancy and childbirth. I knew that what I wanted was to stay at home and labor for as long as I could before going to the hospital. Now, with my waters broken, that was not going to be a possibility, under todays medical management of labor.

Lucky for me, my contractions started up 30 minutes after the rupture of membranes, and then I was off. I am among the small number of women(abt 10%), whose membranes rupture spontaneously, prior to labor actually beginning. Most women if left alone, will begin labor within about 24 hrs. In this article it states that jsut a few short years ago they would wait for 72 hours, then the timeline became shorter and shorter. Now days, you are advised by your OB Dr. that if your membranes should spontaneously rupture, you are to call them and rush right in to the hospital.

In many cases it will mean that your labor is artificially stimulated by a pitocin drip in the i.v. in your arm, you will also very likely have to have i.v. antibiotics, "just in case" you might get an infection, which is unlikely if you aren't putting anything up into the vagina, but at the hospital you will be submitted to numerous vaginal exams to 'check' for dilation. You may even be pressured to have an internal contraction and fetal monitor attached, which then add to the 'stuff' going up into your vagina while you have ruptured membranes and increases your risk of uterine infection.

Early, prelabor, rupture of membranes does not however increase the risk of your baby getting an infection, as the article states so nicely, but that is NOT what the medical team will tell you. In fact if you begin to get an infection, with an elevated temperature, (or if you get an epidural fever, where your body gets a slight fever trying to, I suppose, fight off the epidural line, medicine, etc being introduced into your body, but does not mean that you are in fact 'sick' or have an infection), your baby will be taken from you after the birth for observation in the nursery or NICU, and often subjectred to a battery of invasive testing, (ie: a spinal tap for meningitis), then given a course of antibiotics "just in case" your baby has an infection. This 'routine' separation of mother and baby and delay in the breastfeeding relationship, often is for a minimum of 24 hours.

Another thing that will most likely happen to you if you go directly to the hospital, is that because of your rupture of membranes, and the unrealistic (my theory is, there are a lot more prolapsed cords with induced labors. The baby - often 38 weeks or before it is 'due' - isn't really setteled down into the pelvis well, and as part of the inductin they artificially rupture your membranes, then since the baby is still floating, with the rupture of membranes, the cord gets washed down and out with the big gush of fluid that was just released) fear of a prolapsed umbilical cord, you will then be restricted to bed, often forced to use a bed pan, instead of being allowed up to go to the bathroom, and all of that being stuck in the bed, instead of being up to move around and have the effects of gravity, do not help your body kick itself into labor and encourage you to labor on your own.

Doesn't all of this sound like a lovely way to start labor? (dripping with sarcasm)
The sad part if, that inducing a labor to start just because of spontaneou rupture of membranes, is not justified, or backed up by research.

Read this blog post. It has all the links to the Cochrane Review's with the research and facts to back this up.

Please educate yourselves on the issues dealing with pregnancy and birth.

Early Cord Clamping

I have not done any real, indepth study of the topic, but early cord clamping and cord blood banking seem like a scary thing for a baby. Perhaps it's a very simplistic thought process for me to have on such a complex issue, but it just seems to me that if God designed the process of birth to include the cord continuing to pulse with umbilical blood that is going to the baby, there is probably a pretty good reason for it to be that way, and the baby probably NEEDS that additional blood volume. I have seen cord blood banking done a couple of times, and it seems like quite a lot of blood that goes into the kit to send away. I asked someone involved in Cord blood banking about the amount of blood that is used/needed for the testing and banking process. She told me about 1/4C. Perhaps she was just throwing out a number, because I had asked for one esentially, but, 1/4 CUP seems like an awful lot!

If you think about the relative size of a newborn infant, and it's total blood volume, and you take 1/4 cup of the intended blood volume and remove it... Wow, what does that do to the poor newborn baby who is attempting to transition from intrauterine life, to extrauterine life. All while having his cord clamped and cut early so he is forced to breathe, filling his/her little lungs and all the other complex things that go on after the birth, and now, you are taking away the extra blood volume as well. When we as adults go in to give blood, they take a pint, it takes a month or more for our blood volume to rebuild itself back up. in the mean time, we mght be a bit weak, and have a difficult time adusting to the loss of blood. How much less is 1 (one) pint of blood compared to our total blood volume, then you think about a baby losing that much blood. In any other circumstance we would be extremely concerned about a baby losing that much blood.

I suppose if you just didn't know there was a different option that is one thing, of course I encourage mom's to educate themselves on all the issues surrounding their pregnancy, labor and births. But the dr's have heard the possible different theories on this, and many (dare I say, most) Dr's don't worry about the new studies and information available on the subject. They continue to cut and clamp the cord imediately after birth, for no better reason than it takes less time for them to complete the birth and be done and on their way. Not many Dr's are accustomed to waiting the average 5-7 minutes for the cord to stop pulsating before cutting the cord. Lets also not forget that once the baby is delivered, and free from the confines of the womb and free from the cord by which he/she has been attached and nourished by his mother, the Dr can pass the baby off to the nursery nurses, and his responsibility at that point is no longer to both the mother AND baby, but the mother only, and the baby is now in the care of the nurses and the pediatricians, Neonatologists, etc.

Perhaps this is a harsh opinion and I have given you nothing concrete to back up my point of view, but these are the thoughts I've had going around and around in my mind lately...

Below is a link to another message and this lady gives greate research and study information on this topic. Enjoy reading...


http://www.givingbirthnaturally.com/restricted-umbilical-cord-problems.html

Post Dates: Separating fact from fiction

This was on the Unnecesarean blog. http://www.theunnecesarean.com/blog/2009/10/3/postdates-separating-fact-from-fiction.html

It is from a guest blog post - by: Birthkeeper (Christine Fiscer)
excellent information about what should or shouldn't be called post dates and reasearching the facts before being pushed into an unneeded induction, which too often ends in an unnecesary c-section.

Postdates: Separating Fact from Fiction
Saturday, October 3, 2009 at 7:53AM
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A guest post by Birthkeeper (Christine Fiscer)

What is one of the first things that a pregnant woman hears once she reaches 40 weeks?
“When will your doctor induce you?”
Is there evidence behind this practice to support the routine induction of pregnancies that go beyond 40-41 weeks? What are the usual assumptions and beliefs surrounding this?
• There is a higher risk of the baby being born still• The placenta will stop functioning• There will be a decrease in amniotic fluid• The baby will grow too large
We are going to take a look at the validity of these claims and beliefs, and compare them with what the research has to say. After all, your doctor would never do anything that wasn’t in your or your baby’s best interest, correct?
The first things to really look at are the definitions of the two key words with the pregnancy that goes past 40 weeks. Postdates, and Postmaturity. But is it accurate to start with these terms at 40 weeks?
• Postdates – Defined as a pregnancy that goes beyond 42 weeks, based on LMP. The problem with this is that it’s not the same for every woman. Due dates are calculated depending on LMP, but does not usually take into accounta woman who has shorter or longer than 28 day cycles. The pregnancy wheel that is commonly used by doctors and midwives, is based on 28 day cycles. If you have a longer cycle, days will need to be added to your EDD ( Estimated Due Date ). This is rarely done however, and women who have longer cycles are held to the same due date estimation as women with shorter cycles. So on paper, you might be 42 weeks according to the estimated due date, when in actuality you would only be 41 weeks. A more accurate way of dating pregnancy is by solidly known conception dates.
• Postmaturity – Postmaturity, or Postmaturity Syndrome (PMS) can only be diagnosed after delivery and is defined as a postdates pregnancy accompanied with a combination of the following newborn assessments:
a) No lanugo ( fine body hair )b) Long nailsc) Abundant hair on headd) Calcified fetal skulle) Hanging or wrinkled skin, with the appearance of weight lossf) Dehydratedg) Peeling skin
Postmaturity Syndrome also only affects less than 10% of pregnancies that go beyond 43 weeks. The vast majority of pregnant women do not go beyond 42 weeks with correct dates. Some studies show that less than 3% of women go beyond 43 weeks. So if the risk of postmaturity is less than 10% of pregnancies that go beyond 43 weeks, and the percentage of women who go beyond 43 weeks is less than 3% - how big of a risk is it really?
The problem with assessing risk for postmaturity is that modern Obstetrics, and even modern Midwifery, tends to treat all women as equal in pregnancy. Seldom is personal or familial gestation history taken into account, or abnormal cycle and ovulation schedules. These things are important to consider! How healthy would a midwife’s policy of inducing at 41 weeks , be for a woman who has a personal or familial history of going to 44 weeks? We are talking about potentially trying to induce a baby who will be 3 weeks “early” according to their own biological gestation clock. And if the induction “fails”? It will likely result in stress for both mother and baby and lead to more invasive intervention, and possibly a cesarean.
The condition of a baby and placenta all depends on the health and personal history of the mother, as well as the health of the baby – at any gestation. A placenta does not begin to deteriorate automatically beyond 42 or 43 weeks. A placenta can begin to deteriorate at 36 weeks, once again, depending on the health and over all well being of the mother and baby. I have often heard the fear in women of “placental deterioration” after 40 weeks. But as it has been seen, this has nearly nothing to do with length of gestation, as much as it has to do with overall health and maturity of the individual pregnancy and baby. I personally have seen a baby born at 43 weeks, solid dates, absolutely covered in vernix and attached to a very healthy placenta. In contrast, I attended the birth of a 37 week baby who had dry, wrinkly skin, and a calcified and very old looking placenta.
Other important factors include unhealthy habits and complications such as:
• Smoking• Alcohol• Drugs• Diabetes ( Mellitus, NOT Gestational )• Hypertension

When did 40 weeks become the magical number?
The interesting part in the discussion of postdates, postmaturity, and all that it involves, is the thought that 40 weeks is some sort of magical number. In the past, there was a general “due month”. Women were given an estimation of when they would deliver, based on the known fact that normal gestation is anywhere from 37 to 42 weeks. So when did 40 weeks become this magical number that women fret over and worry once they go beyond it? It has always been that 40 weeks is the general time frame when babies were “due”. But it wasn’t until a study by McClure-Brown came out with date collected from 1958, that showed the perinatal mortality rate doubled from 40 weeks to 42 weeks – from 10/1000 to 20/1000. So it might be logical to assume that inducing labor before 42 weeks would cut back the risk of stillbirth, correct?
The problem is, this study is inaccurate and too old to continue to be of use. Modern obstetrics contradicts the findings in the study published in 1963. And yet, the findings continue to be cited. If we accepted the outcomes in the McClure study, we would also have to accept a 10/1000 mortality rate at 40 weeks! And we know that is not correct. We know that in the 1950s, the majority of women were put under general anesthesia, or twilight sleep, and forceps were commonly used.
Modern obstetric research actually shows there to be not much of a difference in perinatal mortality rates between 38 and 42 weeks, with a decline in between.
An identically set-up chart to the 1963 study, published in 1982 ( Williams, Creasy ) reads:
• 7/1000 at 38 weeks• 6/1000 at 40 weeks• 8/1000 at 41 weeks• 9/1000 at 42 weeks• 10/1000 at 43 weeks• 11/1000 at 44 weeks
A graph from 1987 statistics ( Eden, Sefert ) shows:
• 6/1000 at 38 weeks• 2/1000 at 40 weeks• 2.3/1000 at 41 weeks• 3/1000 at 42 weeks• 4/1000 at 43 weeks• 7/1000 at 44 weeks
So according to the second set of statistics gathered above, women were at higher risk of stillbirth at 38 weeks, than they were at 42. Interesting! In the first set, there was only a steady increase, resulting in a very small risk increase. Is the slightly increased risk worth the myriad risks that come with labor induction?
A large study done by Weinstein, et al. , compared nearly 1,800 reliably dated post-term pregnancies with a matched group of on-time deliveries ( between 37 and 41 weeks ). The outcomes were surprising. Perinatal mortality was similar in both groups ( 0.56 / 1000 in the post-term and 0.75 / 1000 in the on-time group ). The rates of meconium, shoulder dystocia, and cesarean were almost identical. What was most interesting, however, was that the rates of fetal distress, instrumental delivery and low Apgar scores were actually lower in the post-term group than in the on-time group.

What about the Amniotic Fluid?
There is a flawed belief that the amniotic fluid will somehow begin to “run out” beyond 40 weeks. There is a belief that women will have a “dry” birth. Let’s start with some basics.What is amniotic fluid?
• Beyond 36 weeks, amniotic fluid is comprised of mostly fetal urine. When the baby’s kidneys are functioning properly, the baby will continuously produce and process amniotic fluid. The fluid is swallowed by the baby, and then urinated out, once processed by the kidneys.
As long as the mother is adequately hydrated, and there are no congenital abnormalities in the baby, the baby will continue to create amniotic fluid until birth. Whether this be at 37 weeks, or 44. If decreased amniotic fluid is suspected through palpation, an ultrasound can be done to measure the volume found. However, this is not an exact science, as the volume found can – and usually will – vary from ultrasound technician to ultrasound technician, and can also sometimes be dependent on baby’s position. If the levels are found to be on the low side, evidence based protocols suggest having mom orally re-hydrate and return within 24 hours for another AFI ( Amniotic Fluid Index ), preferably by a different technician. This has shown repeatedly to have improved outcomes, versus immediate induction for low AFI levels.
A study published in the Journal of Reproductive Medicine found a significant increase in amniotic fluid after maternal oral rehydration, as well as intravenous hydration, with neither one better than the other. In all, 62.5% and 44.0% demonstrated improved AFI levels.

What if the baby grows too large?
First, who defines “too large”? What is “too large” for one woman, might be the next woman’s smallest baby size. The most important thing to remember is that there is no fool proof way of knowing whether or not your body can naturally birth a baby of whatever size, until you have tried. Ultrasound has a 20% error rate in either direction, and many women have allowed an induction after being told that their baby would be nearly 10 pounds, only to give birth to an 8 pound baby. And, there is no reason for a woman to doubt her ability to birth a 10 pound baby unless she tries. I, for one, never would have believed that I could have birthed my nearly 11 pound baby, especially because I was told that I could not safely birth my 8 ½ pound baby that I was scared into a cesarean with. You never know until you give it a full chance.
Women are often told that a baby will gain approximately a ½ pound per week in the end of pregnancy. However, this is simply an approximation. Once again, this is NOT the same for every woman, or for every baby.
According to a fetal growth rate chart comprised by four studies , a baby will only put on approximately 0.56 pounds – that’s just over half of a pound – between 40 weeks and 43 weeks. And since we’ve shown that most women go into labor before 43 weeks, it can be assumed that it is even less than that. Babies hit a plateau with weight gain around 40 weeks. So really, is there a huge concern to be had over a baby being birthable at 40 weeks, but not at 42 if we’re talking about less than half of a pound? And, does less than half of a pound change the shoulder width or head size of a baby? Hardly. It may give baby chubbier cheeks, or chubbier buns, but will not change the overall structure of the baby, making baby automatically “too large” to birth between those two weeks.

When Should Monitoring a “Post Dates” Pregnancy Begin?
This may be different for each individual pregnancy, each individual woman, which makes cookie cutter policies surrounding post dates, arbitrary. To begin, we have now shown that according to research, doctors, and all basic “rules” that a pregnancy is not even considered postdates until after 42 weeks. Not 40. So if the pregnancy is not postdates until 40 weeks, why do doctors often begin Non-Stress Tests ( NSTs ), Biophysical Profiles ( BPPs ), and Amniotic Fluid Index ( AFI ) at 40 weeks? It goes back to the very flawed study from 1963.
It is up to each individual woman to decide if she is comfortable waiting on monitoring, but if a woman understands that there is virtually no risk difference from 38 weeks to 42 weeks, it should clarify that testing before 42 weeks is mainly unnecessary unless other pregnancy complications are present (i.e. Hypertension, Diabetes Mellitus, IUGR suspicion, Congenital Abnormalities ).
So, let’s take a look at what type of monitoring is available, and how effective they are in finding possible problems.
• Biophysical Profile ( BPP ) – A BPP checks fetal body tone, fetal movement, amniotic fluid volume, and fetal “breathing” practices. Each of these are given a score, and then it is added up to give an overall score. A high score of 8-10 usually shows a baby in good health, while a baby who scores 0-4 indicates a baby who needs to be more closely monitored, or needs to be outside of the womb. Scores in between will usually come with more monitoring, including another BPP within 24 hours.
According to Enkin et al., in A Guide to Effective Care in Pregnancy:There is some evidence that these tests can detect pregnancies in which there is ‘something wrong,’ but less evidence that their use improves outcome, or can eliminate the additional risk of post-term pregnancy. The only controlled trial shows no advantages of complex fetal monitoring with computerized cardiotocography, amniotic fluid index, assessment of fetal breathing tone, and gross body movements over simple monitoring with standard cardiotocography and ultrasound measurement using maximum amniotic fluid pool depth.
So as you can see, even the detailed testing may not prevent issues that may arise.According to several studies that researched the accuracy of the BPP, the false positive rates were quite high, resulting in unnecessary induction or further monitoring.
One in particular showed a 21.3% false positive rate for the BPP, and a 39.3% false positive rate for the Non-Stress Test ( NST ). More studies have shown much higher false positive rates for the Non-Stress Test, which is the most common for women who go beyond 40 weeks in care under an Obstetrician.
• Amniotic Fluid Index ( AFI ) – An AFI is basically a mini Biophysical Profile. It measures the maximum amniotic fluid pool depth in the uterus. However, as was shown in the beginning of this article, the AFI in a pregnancy can be contingent on several factors. Being dehydrated can lessen the AFI found. The baby’s position can affect how much amniotic fluid is seen. The skill of an ultrasonographer can make a difference in the AFI level found.It was also shown that AFI levels can be improved with maternal oral rehydration. Often in modern obstetrics, this protocol is ignored, and induction is recommended very much against proven evidence.
• Non-Stress Test ( NST ) – The NST is the most commonly used test with women who go beyond 40/41 weeks pregnant, under the average Obstetric care. An NST is electronic fetal monitoring for contractions, fetal heart rate variability, and overall heart rate strength. If a baby is found to be sleeping, stimulation is often used in the form of vibration, a cold drink with sugar ( such as orange juice or soda ), or palpation stimulation.
The NST comes with the highest false positive rates of all of the tests, which is why it has become a controversial test amongst some groups.Studies have been done that conclude anywhere from a 50%-75% false positive rate on average, sometimes reaching as high as 80-90%. False positives will lead to more testing, more stress, and possibly unnecessary intervention in the pregnancy.Conclusion
Facts:• A pregnancy is NOT “Postdates” until after 42 weeks.• The risk of stillbirth is nearly a flat line between 38 weeks and 43.• Amniotic fluid is dependent on maternal hydration, in the absence of congenital abnormalities.• A baby’s weight virtually plateaus after 40 weeks.
Some things to think about :• If I am not “overdue” until after 42 weeks, should I allow testing or intervention before this point?• If NSTs come with very high false-positive rates, is it a test worth submitting to?• If my baby will not put on much weight within a 3 week period, is it logical to worry about my baby being “too large” within a probable 2 week period?

Please, please always do your own research. Question what you are told - and go study the subject – regardless of whether your OB, midwife, family member or friends are the ones giving you the information. Make informed decisions, and take charge of your prenatal care!

Christine Fiscer is a Traditional Midwife who blogs at http://www.midwiferyramblings.blogspot.com/ and also http://www.joyfulbirthservices.blogspot.com/. She enjoys all things birth, sewing, and spending time with her family.
_______________________________________________________________________________________
McClure-Browne, J.C. 1963. Comparison of perinatal mortality rates versus gestational age through the past three decades. Postmaturity, Am J Obstet Gynecol 85: 573–82.Journal of Fetal Medicine 1996 Sep-Oct. 5(5): 293-97. Expectant Management of Post-Term Patients: Observations and Outcome. Weinstein D. et al.Journal of Reproductive Medicine 2000 volume 4 pp 337-340. Effect of Oral and intravenous hydration on oligohydramnios. CHANDRA P. C.; SCHIAVELLO H. J. ; LEWANDOWSKI M. A. ;(1)Doublet PM, Benson CB, Nadel AS, et al: “Improved birth weight table for neonates developed from gestations dated by early ultrasonography.” Journal of Ultrasound Medicine. 16:241, 1997.(2)Hadlock FP, Shah YP, Kanon DJ, et al. “Fetal crown rump length: Reevaluation of relation to menstrual age with high resolution real-time US Radiology.” 182:501, 1992.(3)Usher R, McLean F. “Intrauterine growth of live-born Caucasian infants at sea level: Standards obtained from measurements in 7 dimensions of infants born between 25 and 44 weeks of gestation.” Pediatrics. v.74, 1969.(4)Wigglesworth JS. Perinatal Pathology, Second Edition. W.B. Saunders Company. 1996. page 24.Hassan S. Kamel, Ahmed M. Makhlouf, Alaaeldin A. Youssef. Gynecol Obstet Invest 1999; 47: 223-228Evertson LR, Gauuthier RJ, Schifrin BS, et al., Antepartum fetal heart rate testing. I. Evolution of the non-stress test. Am J Obstet Gynecol 1979;133:29-33Miller, David A MD; Rabello, Yolanda A MSEd; Paul, Richard H. MD. Americal Journal of Obstet and Gynec. 174(3):812-817, March 1996.
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MM 550x120

Post Partum Depression...

When I was pregnant with my first child, I was happy, though miserable - I had a rough pregnancy. Through it all, I also had deep fears... I worried that about my ability to be a good mother. I worried about being able to keep my children safe; safe from the crazies of the world, from abuse, and trauma. I also worried about falling into a pit of despair known as Post Partum Depression. I had already felt that deep pit and with the help of medication and counseling I had begun to climb out of it. When I spoke to my Dr. about my desire to become pregnant, he suggested I wait, and stay on the medication for at least a full year. Back in those days not as many medications were available, and the medication I was taking was not great for pregnancy.

When I realized a week later that I was in fact, already pregnant, I went off of my medication cold turkey! Perhaps the joy of anticipation of the new life growing inside me helped me to not fall back into depression during the pregnancy. I worried a lot however, having read about the possibility of PPD, that after the birth I might fall into what had formerly been an abyss for me.

Then, events that had seemed a world away from me became up close and personal! Saddam Husein invaded a small country I had previously never even heard of called Kuwait. As the military started building up for War, I spent more time worrying, about bigger things than just myself, but when word came that my husband too would be joining the fray, life became somewhat of a blur... My husbands unit left for Saudi Arabia the first part of December 1990, when I was about 7 months pregnant. Here I was a young Army wife, and the Company Commanders wife decided since they had already been on orders to go home before the war broke out, she decided to go ahead and move back home to the US. None of the other Officers were married, so I became the Head of our Family Support Group and I had to try to help comfort and support all of the other wives and families in our Unit; Most of which had been married and part of the Military far longer than I had!

I was asked/or invited to attend the meetings on Post with all the Rear Detachment Commanders of the Post. They often had weekly or monthly meetings. This kept me busy, and again, perhaps unable to focus so much just on me, and my personal loneliness, etc.

I did however, have plenty of lonely times. Both of my parents had passed away before I had ever married. I spent much of my pregnancy wishing I had the support and encouragement that all young mothers probably want. I wished I had a mother I could call and ask questions of: Did you feel like this when you were pregnant? Did you get this ill? How did your births go?

After Christmas, my dear friend flew to Germany to spend time with me until my baby arrived. (She stayed for nearly 3 months). I was and continue to be so very grateful for her friendship and support. She became my secretary, my constant companion and confidant. She attended all the meetings with me. She attended my appointments with me, and was with me for every part of my birth.

Even though I had this wonderful friend helping me, I was still very alone; No Mother, No husband (for the time being), and about to have my first baby, far away from anything familiar - living over seas, in a foreign country. I worried about everything! I worried even more that I would have PPD. I certainly had plenty of reasons to expect trouble with it, from previous issues of depression, and going off of my medications, to having my husband deployed to a War Zone, and having a baby alone... My best girlfriend stayed with me until my baby was around a month old. I'm sure that her company, and all of her help was immensely important in my post partum ability to cope with things. Then she had to return home (to get married), and I was left on my own.

My baby was not as easy as I had imagined and hoped. She was probably as close to colicky as a baby could be without actually having colick. She cried and fussed a lot and spit up untold volumes. I think I still managed to hang on to reality for the most part, and again I'm sure the meetings I had to continue to attend and helping the other wives and mothers in our Unit, kept me going. But I do remember that I would often go days without saying a word. I would meet the physical needs of my baby, but she wasn't much of a conversationalist. When the phone would finally ring, I remember my voice croaking as I answered, being the first time I'd spoken in days! Then I would feel guilty about not talking to and interacting with my baby.

My husband came home from the war when our daughter was 3 months old. I had survived somehow, but only barely. Why I didn't suffer from full blown PPD, is still somewhat of a mystery to me as I certainly had plenty of 'reasons' to have suffered from it. I have compassion for those mothers who through no fault of their own, struggle and suffer from the often debilitating effects of Post Partum Depression.

I like the analogy of it taking a village to raise a family. A new mother and father, needs a village to help support and sustain her in the days and weeks (and years) after the birth of a new baby. Motherhood with a new baby while you are sleep deprived and often worse is hard. Again, I am ever so thankful that my dear friend Jessica was able to come and be with me for that first month. Without her help I am sure I would have swirled right down into the pits of despair.

For some mom's it takes even more, medication, counseling, etc. The link below has some really terrific information, stories and book suggestions to help. Check it out.

http://goop.com/newsletter/93/

Gwyneth Paltrow shares her experience of Postpartum Depression on her Goop Blog.

When my son, Moses, came into the world in 2006, I expected to have another period of euphoria following his birth, much the way I had when my daughter was born two years earlier. Instead I was confronted with one of the darkest and most painfully debilitating chapters of my life. For about five months I had, what I can see in hindsight as postnatal depression, and since that time, I have wanted to know more about it.

She has Dr's sharing information.
Dr. Laura Schiller - a New York city based OB/GYN and advice from psychologist and frequent GOOP contributor (and mother of two) Dr. Karen Binder-Brynes.

Also, her friend Bryce Dallas Howard - fellow actress, (Victoria on Twilight-Eclipse)

I recently saw an interview I did on TV while promoting a film. In it, I was asked about my experience with post-partum depression and as I watched, I cringed. I said things like “It was a nightmare,” or “I felt like I was in a black hole.” But I couldn’t even begin to express my true feelings. On screen, I had seemed so together, so okay, as if I had everything under control. As I watched, it dawned on me. If I had been able to truthfully convey my ordeal with post-partum depression under the glare of those lights, I most likely would have said no words at all. I simply would have stared at the interviewer with an expression of deep, deep loss.

a couple of book suggestions:
Brooke Shields “Down Came the Rain.”
Heather B. Armstrong “It Sucked and then I Cried,”

Bellies and Babies: Induction Increases the Risk of C-Section and C-Section increases Newborn Infection

Bellies and Babies: Induction Increases the Risk of C-Section and C-Section increases Newborn Infection

Induction Increases the Risk of C-Section and C-Section increases Newborn Infection

Induction Increases the Risk of C-Section and C-Section increases Newborn Infection
Posted by Nicole D. over at Wonderfully Made Bellies and Babies
http://wonderfullymadebelliesandbabies.blogspot.com/

Labor Induction and the Risk of a Cesarean Delivery Among Nulliparous Women at Term, a recent study published with the American College of Obstetrics & Gynecology (July 2010 - Volume 116 - Issue 1 - pp 35-42) gave the following conclusion:

Labor induction is significantly associated with a cesarean delivery among nulliparous women at term for those with and without medical or obstetric complications. Reducing the use of elective labor induction may lead to decreased rates of cesarean delivery for a population.
This makes for even more worrisome fodder, as the study also includes this information:

Labor induction was used in 43.6% of cases, 39.9% of which were elective.
Inductions for 43.6% of cases?! How many inductions are too many?? And, based on the information given just previously, how many of those resulted in maternal or newborn risk?

Another study printed with the National Academy of Sciences researched what microbiota habitat a newborn at birth... depending on their mode of birth. The small study found that:

those born vaginally tended to get colonized by bacteria such as Lactobacillus from the mother's vaginal canal. C-section babies, however, got more Staphylococcus, a type of microbe usually found on the skin and one that sometimes causes nasty infections. - "Babies' First Germs Depend On Type Of Birth", Chao Deng, NPR

So, in conclusion, to lower cesarean rates and increased risk of newborn strep infections, we should stop inducing for mundane reasons. To lower strep infections, lower the risk for newborn death, respiratory distress, incidences of autism and other SENs, and modestly lowered IQ scores, we need to stop inducing so much.

This is only the tip of the iceberg, people. Oh, the tangled web we weave.

Fantstic post Nicole D.
I love how you put the two new studies together to make them make even more sense! If only people would listen... Wendy - Mother, Doula, Childbirth Educator, Student Midwife, concerned citizen...

Why you shouldn't just 'TRY" to have an unmedicated birth!

I found this FANTASTIC post on the net at Birth Resource Network. This is so well said!

http://www.birthresourcenetwork.org/blog/why-you-shouldnt-try-to-have-an-unmedicated-birth/comment-page-1/#comment-759

Why you shouldn’t “try” to have an unmedicated birth.
by Doula

You will hear many women say they are going to “try” to have an unmedicated birth. To me, “trying” connotes sheer effort and endurance. What I hear women say when they say “try” is that they are just going to see how long they can stand the pain. My dictionary defines “to try” as “to make an attempt or effort”. What happens when you try something? Either you can succeed or fail.



There’s a lot of derisive talk out there about birth plans and women who “plan” an unmedicated birth – or really plan anything about their birth at all. There is a lot of fingerwaving about how birth is unpredictable and you can’t PLAN anything. After seeing a lot of births, I have to say I agree. My dictionary says to plan is to “decide on and arrange in advance” – you can’t really do that with your birth. What happens when you plan something? Maybe your plans work out, and maybe they don’t.



What I wish more women would say, and take ownership of, is that they are preparing for an unmedicated birth. My dictionary says ” to prepare” is “to make ready or able to do or deal with something”.This sounds just about right! Someone who is prepared does not fail or have plans not work out – they meet what comes with their goal in mind. They have made themselves ready to handle birth and any twists and turns they might meet on the way.



I encourage women to think of birth as a marathon – it is long, challenging, sometimes painful, sometimes exciting, and can be very rewarding. Many people regard having run a marathon as difficult, but very rewarding and a huge achievement. However, if you knew someone who told you that on Saturday they were going to “try” to run a marathon, you’d probably look at them a little askance. You’d start asking questions: “Have you practiced? Did you read up about marathoning and long-distance running? Do you know anything about the route?”



What would you think if they said, “I’m just going to start running and see how long I can stand it. There will be people along the way to tell me where to go.” You might have some more questions for them. “Don’t you think that at some point you’re going to get exhausted and want to quit? If you haven’t prepared, how will you have the resources to keep going? Wouldn’t you like to know something about the course – where the steep hills are, where to save your energy, where to expect things will be tough?”



If this person then tried to run a marathon, and dropped out at mile 10, or had a miserable time, and then told their friends how horrible marathons were and how stupid someone would have to be to go through that awful experience just to prove they were “tough”…wouldn’t you be skeptical about their opinion? And yet that’s where we’re at in a lot of ways. Many women see unmedicated birth as some kind of test that you pass via sheer endurance and “feminist masochism”, as one doctor in “The Business of Being Born” puts it. There’s often a vague, generalized perception that drug-free is “better”, but without much clear understanding of the actual risks of drugs. If you “try” to have the unmedicated birth and “fail”, then you have a lot invested in trying to convince people that this “test” is silly and has no bearing on your strength, motherhood, or womanhood (a position I agree with completely). I think many of the birth horror stories and dismissive “just take the epidural, honey, you’re gonna need it” comments that pregnant women here come from that place.



On the other hand, if you approach natural birth with the mindset that this is a rare and challenging event that you would like to fully experience, with interventions available whose risks you’d prefer to avoid, you can prepare for it. You can take classes, read, and find good coaches and support systems. You can remain flexible and open to changes in the situation. Let’s ditch this whole “trying” thing and switch to “preparing”.

author unknown

http://www.birthresourcenetwork.org/blog/why-you-shouldnt-try-to-have-an-unmedicated-birth/comment-page-1/#comment-759

"Madre De Muchos" - "Mother Of Many", by Emma Lazenby

Mother of Many - a short award winning annimated film

http://www.youtube.com/watch?v=Zbx3ECKvt60


http://www.youtube.com/watch?v=-QJpm00sCYo
February 21, 2010 — Sally Arthur and Emma Lazenby win Best Short Animation at the Orange British Academy Film Awards in 2010.

Emma Lazenby's mother recently retired from a 30 year career as a Midwife. A day in the life of a midwife was theinspiration for this film.

Vernix - it's amazing stuff for your newborn!

http://roseysrelaxingremedies.co.uk/AmazingVernixandamnioticfluid.aspx


Why not to wash your new baby straight away...
Why to avoid artificial rupture of your membrances...

It turns out that vernix (the white stuff some babies are born with) and amniotic fluid have similar immune enhancing properties to breast milk... artificial rupturing of membranes can take away the amniotic fluid's protective capability. Cleaning your baby straight away can take away the immune protecting properties of vernix....




Source: Pubmed central.



http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1595247




ANTIMICROBIAL PROPERTIES OF AMNIOTIC FLUID AND VERNIX CASEOSA ARE SIMILAR TO THOSE FOUND IN BREAST MILK




Akinbi, H. T., Narendran, V., Pass, A. K., Markart, P., & Hoath, S. B. (2004). Host defense proteins in vernix caseosa and amniotic fluid. American Journal of Obstetrics and Gynecology, 191(6), 2090–2096.
Summary

In this study, researchers analyzed samples of amniotic fluid and vernix caseosa (vernix) from healthy, term gestations to determine the immune properties of these substances. Participants were pregnant women admitted for elective cesarean section after 37 weeks gestation with no prior labor and no signs of chorioamnionitis (intrauterine infection). Women with a history of prenatal fever or premature rupture of membranes, or who received steroids prenatally or antibiotics while giving birth were excluded, as were women whose babies passed meconium in utero, had congenital malformations, or required prolonged resuscitation after birth. Amniotic fluid was obtained by amniocentesis to determine fetal lung maturity prior to elective birth. Vernix was gently scraped from the newborn's skin with a sterile implement immediately following birth. The researchers obtained 10 samples of amniotic fluid and 25 samples of vernix.

Tests (Western analysis and immunochemistry) revealed that lysozyme, lactoferrin, human neutrophil peptides 1–3, and secretory leukocyte protease inhibitor were present in the amniotic fluid samples and in organized granules embedded in the vernix samples. These immune substances were tested using antimicrobial growth inhibition assays and found to be effective in inhibiting the growth of common perinatal pathogens, including group B. Streptococcus, K. pneumoniae, L. monocytogenes, C. albicans, and E. coli.




The authors point out that the innate immune proteins found in vernix and amniotic fluid are similar to those found in breast milk. As the baby prepares for extrauterine life, pulmonary surfactant (a substance produced by the maturing fetal lungs) increases in the amniotic fluid, resulting in the detachment of vernix from the skin. The vernix mixes with the amniotic fluid and is swallowed by the growing fetus. Given the antimicrobial properties of this mixture, the authors conclude that there is “considerable functional and structural synergism between the prenatal biology of vernix caseosa and the postnatal biology of breast milk” (p. 2095). They also suggest that better understanding of these innate host defenses may prove useful in preventing and treating intrauterine infection.




Significance for Normal Birth




Routine artificial rupture of membranes increases the likelihood of intrauterine infection because it eliminates the physical barrier (the amniotic sac) between the baby and the mother's vaginal flora. This study suggests an additional mechanism for the prevention of infection when the membranes remain intact: A baby bathed in amniotic fluid benefits from antimicrobial proteins that are found in the fluid and in vernix caseosa.




The results of this study also call into question the routine use of some newborn procedures. Early bathing of the baby removes vernix, which contains antimicrobial proteins that are active against group B. streptococcus and E. coli. Delaying the bath and keeping the newborn together with his or her mother until breastfeeding is established may prevent some cases of devastating infections caused by these bacteria. The fact that preterm babies tend to have more vernix than babies born at or after 40 weeks might mean that healthy, stable preterm babies derive even greater benefit from staying with their mothers during the immediate newborn period.




Finally, this study illustrates how the normal physiology of pregnancy and fetal development is part of a continuum that extends beyond birth to the newborn period. The immunologic similarities between amniotic fluid, vernix, and breast milk provide further evidence that successful initiation of breastfeeding is a critical part of the process of normal birth.

What Not To Read - when you are expecting (and what TO Read)...

Here is another fabulous post from Wonderfully Made - she blogs about some of the popular Pregnancy and Birth books and tells why she might not recommend them and what books she would recommend instead.

http://wonderfullymadebelliesandbabies.blogspot.com/2009/09/what-not-to-read_4036.html

Enjoy!

Some of my favorite books include-
Your Best Birth by: Ricki Lake.
I spoke with her writing team several times and gave some of the insights I have learned about birth in our modern times...

Gentle Birth Choices by: Barbara Harper
This book gives a different perspective to birth than what is often out there in our society. It gives a sense that Birth is NORMAL and that you can do it!

my favorite book on Breastfeeding is -
So That's What They're For! by: Janet Tamaro
A humorous realistic guide on Breastfeeding information

YouTube - The Big Push for Midwives Campaign 2009

YouTube - The Big Push for Midwives Campaign 2009

Social Media and Birth Change...

Another good article/post on how social media; possitive birth films on Face Book, etc... may be what it takes to effect change in our birth culture.

http://www.drgreene.com/perspectives/2009/11/04/could-youtube-change-our-birth-culture?page=2#comments

Along with being a good blog post, she posted a great video of a mother being supported in labor -by doulas. (and I personally feel some of these images depict midwivery care as well).
http://www.youtube.com/watch?v=16uFf02NYb4

You tube does it again with promoting a video that compares Mass Media Childbirth vs. the Real Thing!
http://www.youtube.com/watch?v=V9Gd7pqeESE&feature=related

Letting Go...

So, This past year I sent my first baby off to college many miles and many states away... The same year my 'baby' started pre-school. It's hard moving on to new stages of life sometimes. It's difficult to know what is ahead, and hard to look back at what you are leaving behind you.

This birth story is really amazing and speaks to this 'letting go' concept.

http://florencedotcom.blogspot.com/2009/08/happy-21st-birthday-margaret.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+FlorenceDotCom+%28Florence+dot+com%29&utm_content=Google+Reader

Take courage! You can do it. you will be able to handle the challenges ahead, so go on, Let Go!

Study shows that it is currently more dangerous to give birth in California than in Kuwait or Bosnia...

Although the number of deaths is relatively small — and pregnancy and birth are safe for the vast majority of women – it’s more dangerous to give birth in California than it is in Kuwait or Bosnia.

http://www.ourbodiesourblog.org/blog/2010/02/maternal-mortality-on-the-rise-in-california

The California task force isn't waiting to determine the ultimate cause of these deaths. It has started pilot projects to improve the way hospitals respond to hemorrhages, to better track women's medical conditions and to reduce inductions.

Dr. David Lagrew, meanwhile, thinks he may have arrived at an answer. In 2002, Lagrew, the medical director of the Women's Hospital at Saddleback Memorial Medical Center in Orange County, noticed that many women were having their labor induced before term without a medical reason. He knew that having an induction doubled the chances of a C-section.

So he set a rule: no elective inductions before 41 weeks of pregnancy, with only a few exceptions. As a result, Lagrew said, the operating room schedules opened up, and the hospital saw fewer babies admitted to the neonatal intensive care unit, fewer hemorrhages and fewer hysterectomies.

All this, however, came at a cost: The hospital had to take a cut in revenue for reducing the procedures it performed. Lagrew doubts that any hospital has increased its C-section rate in pursuit of profit, but he adds that the first hospitals to adopt controls on early elective inductions have been nonprofits.

On average, a C-section brings in twice the revenue of a vaginal birth. Today, the C-section is the single most common surgical procedure performed in the United States.

Although the state hasn't released the task force's report, the researchers and doctors involved forwarded data to the national Joint Commission, which issued incentives for hospitals to reduce inductions and fight what it called "the cesarean section epidemic."

"You don't have to be a public health whiz to know that we are facing a big problem here," said Bingham, the executive director of the task force.

Online resources: To read more about maternal mortality rates and pregnancy-related deaths, go to http://www.californiawatch.org/

Other related links: http://www.time.com/time/health/article/0,8599,1971633,00.html
http://www.time.com/time/magazine/article/0,9171,1880665,00.html

Not Among Strangers...

I met Valerie El Halta many years ago... before she became a midwife. I attended Church with her younger daughters from the time I was 5 yrs old. She and my mother were friends. My mother taught her youngest child in pre-school. I suppose he's a grown man now... I babysat for some of her clients while they attended her childbirth class once...
I wish I had any 'idea'about midwifery and Home Birth way back then. Oh, to have learned at her feet... It might have immpacted my life and the births of my first two children. However, I suppose, we become who we are, partly because of our experiences, and I chose to become involved in birth because of those first two births.
I 'found' Valerie El Halta several year back through the magic of technology and the internet... I considered having her attend my 2nd home birth, but we lived so many miles (and States) away from one another. I've thought of her often over the years. Time and life moved on, I lost contact with her, and then today 'found' her again through the technology of the internet. I happened to read this article she wrote, and just loved the thoughts of birthing among 'friends', 'family' and "not among strangers". I hope it's alright that I reposted it here. It's lovely.

http://www.midwiferytoday.com/articles/notamong.asp

Not Among Strangers

by Valerie El Halta, CPM

© 2003 Midwifery Today, Inc. All rights reserved.
[Editor's note: This article first appeared in Midwifery Today Issue 50, Summer 1999.]
How important is the impact of the birth environment upon achieving an optimal outcome of the birth process?

The environment in which birth takes place has an enormous impact upon birth outcome. Labor progress, pain tolerance, necessity for medical intervention, fetal well-being and satisfaction with the birth experience may all be directly related to the mother's sense of "safe place" in which she brings forth her baby.

"Safe place" has little to do with physical surroundings alone. Yet for many a woman, the home in which she resides, feels loved and secure, has prepared for her baby and "nested" most clearly defines that place. "Safe place" also has to do with the people with whom the woman feels most secure and comfortable. The interaction of the several personalities, which may be involved during labor and birth, may either positively or adversely affect the laboring woman's sense of "safe place." As we come to understand the importance of how these personalities impact the birth environment, we, as caregivers, become more sensitive to the needs of the mother as she approaches the time of labor and birth.

Traditionally, birth has been a very private affair in which only the most intimate of a woman's relations would attend the laboring woman. Grandmothers, aunts and wise women of the village whom the woman most trusted were the ones to be called. In today's society, women have been taught to place their trust in the medical model of childbirth and in medical professionals rather than in persons with whom they are most familiar. They are taught to accept the place of birth that the medical professional chooses (because it is the medical professional's "safe place"?). For many women this is a difficult and sometimes impossible transition, one which so impacts the sense of the familiar that patterns of labor are changed and the sensation of birth pain intensified. Outcome is made less predictable, and birth comes to be regarded as a difficult and painful ordeal, fraught with danger. Moreover, if the woman is confronted with an unfamiliar and therefore "not safe place," a survival mechanism will kick in. She will protect her baby by preventing it from being born by ceasing to contract, keeping her cervix closed and in general "failing to progress."

Those of us who are certain that a woman's home is the most suitable environment for her to give birth in must be particularly aware of the influence we may have on the woman's sense of safety. The most well meaning midwife may nonetheless be a "stranger" to the mother and a threat to her need for privacy if she has not become at one in trust with the woman well before labor ensues.

It is important for all midwives to develop the skills necessary to facilitate the best possible communication with their clients. Learning to establish a relationship of trust with the woman will do more to ensure an optimal outcome than taking classes in anatomy and physiology!
The successful midwife is the caring person who has learned to listen with both her mind and her heart, she who has mastered "the chameleon effect" of being able to integrate into the woman's environment without prejudice toward her lifestyle, race, religion or personal idiosyncrasies.
It is this empathetic midwife to whom the woman may turn in her hour of greatest need, who will be there for her whether that need be physiological or psychological. When the midwife is able to establish this level of trust between herself and her client, her presence at the time of labor will not conflict with the woman's privacy needs and will often have a dramatic influence on the progress and time lines of labor as well as on the woman's perception of labor pain.
If we could ask babies where they would like to be born, I wonder how many would answer: "Oh, in a hospital, of course! I want to be sure that I will be born amidst all modern technology has to offer in the event that an emergency should occur." Or, might they answer: "I want to be born in an environment of peace, security and joy and be received into the loving arms of my mother."

I wish that instead of a written article this were a video I could share with you as I remember one of many special homebirths. My friend Melinda was about to give birth to her ninth baby. This was to be her seventh that I was privileged to attend. I am her sister and her friend, and "Auntie Val" to all the kids. We had spent the day canning salsa and making my sour cream chicken enchiladas. Melinda was in the shower when she called out to me that the baby was coming!

Picture a woman at rest on a big waterbed, reclining in her husband's arms while eight brothers and sisters reverently encircle her, awaiting the moment of birth (Silent Night). As my hands and warm compresses soothe the mother's stretching tissues and the head begins to show, the youngest child, two-year-old Emily, says, "Oh! I can see the baby's head!" Then a deep giggle and, "I want to see my baby's head again!" The baby comes forth, looks all around, breathes quietly, and rests on his mommy's breast. Melinda sighs and says, "It is always so worth it." Dad gently touches the baby's head (Holy Night). The children all begin to sing a special family hymn to the baby as he continues to gaze at his mommy (All is Calm). Does he recognize the voices? Oh, I know he does, he has heard them all for months. Emily says, "There is a snake on the baby's tummy," and giggles again (All is Bright). There is plenty of time for cord cutting, weighing and measuring. Now is the time for being—he is home, he is safe, he is much loved. He has not been born among strangers.

It has been my experience that when the mother is able to labor in an environment of her choice, with persons surrounding her who make her feel respected, loved and safe, that she is free to "give birth to" rather than "be delivered of" her baby. Where else than in her own home, laboring with those she has chosen, should this most important event take place?
Never—no never—among strangers.

Valerie El Halta Valerie El Halta, CPM, has been practicing midwifery for twenty-four years. She co-directed The Birth Center in Dearborn, Michigan with Rahima Baldwin Dancy for nine years. She now enjoys a busy homebirth practice and continues to write and teach. -->

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