"Dr." Amy to speak at September ACOG conference

I just heard it through the grapevine that the formidable "Dr. Amy" of homebirth hater fame is on the docket to speak at an ACOG conference in September. And not surprisingly, one of her topics is "Everything an obstetrician needs to know about homebirth."

Of course, I don't know personally, but I'm going to take a wild guess that she's never attended a homebirth before. Yet she is probably considered the "expert" source on them, most likely because she squawks the loudest. Never mind what actually comes out of her mouth.

Here are her "credentials," according to the ACOG PDF handout:

Um, no, not exactly. Although I realize that the title "Dr." is often a courtesy after a physician has left practice or retired, this is incredibly misleading. My father-in-law is a retired physician that most people address as "doctor," but he certainly doesn't go around representing himself as a licensed, practicing physician. I would hope those in attendance actually know better when listening to her blather on for an hour about how much she hates homebirth and the women who choose them.

A Google search of her name produced the obvious results referring to her blog and "advocacy." She shows up on a number of websites like Healthgrades, listing a physical address to what would seem an office, but no reviews from actual patients. And when you search her name on the Massachusetts Board of Registration in Medicine database, you come up with this:

She spends countless hours trolling the internetz for every story ever published about homebirth and basically makes all natural birth advocates everywhere out to be liars. Yet she continues to represent herself as a licensed physician who is still practicing medicine. Hypocrisy much?

Since ACOG is trying to set guidelines that offer women the best care while treating them with dignity and respect, I'm not really sure how she fits into their lineup.

According to ACOG's website, they acknowledge that

"Most women have normal conception, fetal growth, labor and birth and require minimal-to-no intervention in the process. Women and their families have different views about childbearing based on their knowledge, experiences, belief systems, culture, and social and family backgrounds." (Really? They really believe that?! Who knew.)

It goes on to explain their idea of what "patient-centered care" means:

""Patient-centered" means that health care providers, and the system they practice within, accept that the values, culture, choices, and preferences of a woman and her family are relevant within the context of promoting optimal health outcomes." 

They also acknowledge that part of that patient-centered care includes having not only a skilled attendant (which can come in other forms besides an OBGYN), but also "supportive resources."

Based on their description, I don't think Dr. Amy fits into their scheme of things at all. Either that, or they're just very out of touch with the way a majority of births are carried out these days. Phrases like "support" and "education" are all relative, when you consider that many patients often get all their information from their physician and trust no one else in the process.

On the surface, healthcare initiatives and much of the jargon ACOG churns out sound great - but when you actually ask women about their experiences, it seems that there is a major disconnect. ACOG itself argues that they feel the hospital is the safest setting for giving birth, but admits that it "respects the right of a woman to make a medically informed decision about delivery." It's clear that Dr. Amy does not. I am really curious to hear how this one is going to play out.

From The SOb's website: What a caring, compassionate and professional
way to promote your "advocacy." Would you want someone this vulgar and
derisive in charge of your care? 

More reading:
The C in ACOG Stands for Castrated 

Why do women choose "risky" births?

Whenever a tragic birth outcome makes the headlines, especially if it's perceived as "risky," I know women ask themselves, "How can a woman do this? What on earth was she thinking?" It's hard not to, but much of the time, I can totally understand why.

The death of any baby is tragic, and I guess hindsight is 20/20 when you pronounce the death "unavoidable." In the case of this Australian woman, who was attempting a VBAC at home after two cesareans, she was summarily lambasted for not following the advice of her doctor and "internet advisers" were blamed for giving her false information on what she should do. One woman said, "I blame the 'variation of normal' crowd." (The woman's baby was breech.)

Contrast that to this story, of an American woman who died of complications following her sixth cesarean section. No is blaming her for her risky decision to have so many cesareans, as I'm sure she took her doctor's advice - and I highly doubt he/she was pleading with this mother to "please have a VBAC! It's safer!"

What's the difference, really?

Why is accepting one death - that could have also been avoidable - okay, but not the other? Imagine if the Australian woman had decided on that third cesarean, perhaps going on to have more children and more cesareans, and ending up like the woman who died? Are we saying that's just an acceptable risk that you take and "so what?"

I see it as merely shifting the risk. The more you discourage VBAC in women who've only had one prior cesarean, especially in those who desire larger families, the more you end up hearing stories like this. It seems like our medical community, and society at large, is perfectly willing to believe in dangerous paradoxes - namely, that VBAC is dangerous and cesarean section is "perfectly safe." Many commenters were disgusted that she went against the advice of her doctor and attempted a VBAC, which was unfortunate; but for many women who do take that advice, you better believe their doctor can churn out just as much misinformation as that sandal-wearing hippie natural birth advocate you so despise. How is being the opposite side of the same coin any better?

Add the fact that very few hospitals receive an official "Mother-Baby Friendly" designation (not that that matters, I guess) or can seem to be supportive without treating mom like brainless chattel and it should be easy to see why women choose an alternative birth. How many times have you heard that it's damned-near impossible to have a normal, let alone natural (gasp!) birth in a hospital setting? I'm not saying it can't be done, just that it's usually difficult and you have to really work the system (which has quite a learning curve, let me tell you).

For those who frequently bitch about how reckless or crazy women are after disastrous home births, what are they doing to make hospital births more hospitable? Oh wait - they're usually the ones that tell you to just "let go of your anger and get over the 'birth experience' - just deal with it." I'm guessing they've never once cracked open a book that details some of the absolutely barbaric birth practices that "modern" obstetrics have put women through* over the generations, and for what? To be treated like a human guinea pig? Or the formidable, unmentionable "physicians" who like to demonize all women for even thinking about a home birth, much less having one - are they making stunning strides and initiatives to support women in a comfortable, accommodating hospital atmosphere? Or just complaining about it and publishing the names and addresses of those women who've lost children in home births?

I'm not sure how I managed it, but I had a VBAC in 2006 and sort of fell into an OB's practice that would actually "let me" do it. I don't think I had any clue how difficult it is for some women to have one. If I hear someone say "just find a supportive OB and hospital with lots of experiences in VBAC" one more time I'm going to scream. Because it's definitely not that easy.

From the ICAN website.

If you look at this list, many are rural hospitals or in smaller towns. And many are hospitals in large cities. I'd like to know how you are just going to up and "find a supportive hospital" when they don't seem to exist. If you live in the boonies, your options for supportive hospitals and OBs or midwives is probably pretty limited, and I'm willing to bet the cesarean and induction rates at those hospitals that serve rural women are through the roof. ACOG Guidelines be damned; they aren't offering up an attorney, birth doula or physician to see you through your VBAC - which means the "guidelines" they issue do little to help the patient if a doctor can just pick and choose which guidelines to follow.

(*And for the record, I'm not intimating for one second that before modern obstetrics, women didn't suffer or go through torturous experiences in order to birth children, sometimes with disastrous results. But I think our glorification of modern medicine might be, at times, misguided and perhaps glosses over  its sordid history and past failings.)

More reading:
The "C" in ACOG stands for "castrated"
Tori Spelling and cesarean complications: why we need to hear about it

Birth as performance art? Why not!

Is that a trophy I see? Why yes, yes it is.
Photo credit: AP. 

It's being talked about all over the birth community: a "performance artist" has just given birth to a baby boy inside an art gallery. Weird, perhaps. Maybe it's the Nyquil haze I'm living in today, but somehow the more I read this story and think about it, the cooler I think it is.

The blogger at Mama Birth and I joked that we'd both like to do posts about it (she beat me to it LOL) and here's her take. I don't want to repeat too much of what she just said, but yeah. What she said.

Something we both noticed were the comments - horrible, as usual. It seems that whenever birth is talked about there's something nasty to say, usually from other women. I don't even remember all of them, but the general feeling I got was How dare you birth somewhere "non-traditional?" How dare you go against the grain and do something that is supposed to be so painful and horrible and make it look ..... easy?! The audacity - to shower, move around normally, get into whatever position you want, no epidural... You are a @(%&&!!!*#^%^@ and deserve to die and have CPS called on you!" 

Okay, the CPS comment came from the comments section about the pregnant marathon runner who gave birth within hours of running a race. I think this birth falls into the same category: that somehow, there are people that think because you birth outside the norm or dare to do anything weird while pregnant, that they have some emotional claim to stake on you, your baby and your birth experience.

What Marni Kotak did was probably weird, but like Mama Birth pointed out in her blog post, not really that different than what they have been doing for years on A Baby Story (hello, since 1998?!). 16 and Pregnant - I've never seen that one, but honestly it sounds like utter tripe. I'm sure we can count the reasonably accurate, normal birth scenes we've seen in TV and movies on one hand.

I'm sure people were even more furious when things went well and the child was actually born. Of course, if things hadn't, they would no doubt declare smugly how "hospitals are where all birthing women belong," and how stupid/selfish/much of a whore she was for deciding to even have children in the first place, or something equally hurtful and bizarre.

For some, this is the closest thing to normal birth that they'd ever see. And it's not like she had an audience, per se - not like birth shows do - because she and her husband allowed no video cameras or photography. If she feels comfortable sharing it with a few people whom she knows care about birth (and her work), then so be it. How is that any different than mom calling so and so's step-sister's aunt's neighbor's daughter into the room (and all her girlfriends and close co-workers) while she's nearing the pushing phase? I don't get that, either, but that's their choice. Just like, I guess, it's Kotak's choice to show others that birth can be normal. That perhaps it's not her that's wrong or weird, but they are, for thinking that a normal birth doesn't exist, can't be done, is dangerous, selfish, blah blah blah. Somehow, though, when people watch birth on reality television they don't spout off about how much these women are trying to grab attention, but when someone like Kotak defies the "rules" they have no shortage of nasty things to say about it.

While my eyes were closed pretty tightly while I gave birth, my husband said there were quite a few people in the room during my VBAC. Not because it was an emergency or things were going badly, but, I'm guessing, because people wanted to see it happen. (Not trying to flatter myself here) but perhaps because they wanted to see a woman come in to the unit in active labor, doing a VBAC and refusing an epidural. Pretty straightforward, over and done within a little over three hours after arriving. While I was busy doing my thing, I couldn't help but notice the almost surprise in the nurse's voice when she did an internal and found that my water was almost ready to break. I thought, What is she used to seeing, then? Good heavens.

I couldn't help but notice in the thumbnail picture of Kotak that she had a trophy next to her bed. That made me laugh. It's like thumbing her nose at all of those women who sneer, "You won't get a medal for giving birth naturally!" I guess in this case, yes, you do.

Related posts:
The pregnant woman as public property

Home birth death: are pieces of the puzzle missing?

I recently read the article about a Missouri baby who died after a troubling home birth in October 2009. I felt that, based on what I read, surely there are pieces of this puzzle that are missing.

I've read two separate articles - one who's tone was anything but unbiased and felt very negative towards midwifery and home birth in general. The other was filled with several inconsistencies, and left me scratching my head at the statements made by doctors: "The doctor told the investigator that the baby likely would have been born safely by cesarean section if the mother had come to the hospital soon after her water broke."

It seems like some form of cord compression happened as a result of the baby's cord being wrapped around his neck, which the doctor described as a "common condition that is easily corrected at hospitals." (emphasis mine)

Wow. Where to even begin here?

The whole issue of nuchal cord and their response to it makes me laugh, because women are often made to think this is always a life-threatening issue that can only be avoided by cesarean. Or that it makes it impossible to birth a baby vaginally. I'd be willing to bet that a good midwife will know how to fix it in a way that doesn't end in surgery more often than an OB would, but that's just a guess. And now suddenly it's "common" and can be fixed only in a hospital? Are you kidding me?

The response about wanting the mother to come in several hours after her water broke seems typical: the general rule is that usually if contractions don't begin within 24 hours, a cesarean is recommended. Some are speculating whether they're really necessary even then, as long as the baby is doing okay and if few vaginal exams are done in order to prevent infection. Some doctors wait less than the typical 24 hours, and a few I've read about give only eight hours. Where's the continuity of care in that?

The comments the doctor made to investigators, though, got me thinking. What, really, does this investigator know about childbirth? About current birth politics? About the reasons women want to avoid a hospital birth? All this comes into play when considering the death of this baby. You can't just take a doctor's admission of the baby "likely" being born safely, because even that is not a given. Since the obstetrical crystal ball technology hasn't really been perfected yet, the best you can do is speculate. Unless the jury is remarkably packed with pro-home birth advocates, or at the very least, people who really know something about birth - and why some women feel boxed into a corner when it comes to hospital birth - what do you really think the jury is going to say? Since most of the country naively perceives all midwives as incompetent, and home birth to always produce disastrous results, why even bother going before a jury? Why not just engage in a massive witch hunt and dispense with the formalities already?

What's to stop any doctor who just happens to be anti-home birth from making this into a situation that clearly damns the midwife, no matter what? How is any investigator going to know the difference?

This raises more questions than answers for me, some of which don't have anything to do with the safety of home birth in and of itself. It's not just a question of poor judgment on the midwife's part; there's so much more going on here.

Apparently, the midwife insisted she had everything under control when the parents were asking about transferring to the hospital. However, "minutes later," she decided to dispatch them to the hospital anyway.

As birth advocates, we preach endlessly about trusting your care provider. Sure, that's very important. But I'm not sure it means that you still don't question them sometimes and do everything they say. I don't know - if the parents are asking to transfer, what do you say? Who's to say you're right, and they're not? Or vice versa?

If I reached a point in a home birth where I thought my instincts were telling me to ignore the advice of my very trusted midwife, I don't know if anyone could hold me back from the doorway and take the keys out of my hand as I prepared to leave for the hospital. It makes me wonder about this thing called "patient compliance," where we as patients find ourselves agreeing with things, doing and saying things while at the same time, in our heads, we're wondering, "Why did I just say that? I don't believe that. I don't want to do it this way, and yet I'm agreeing to it anyway."

I can't really blame the parents, though, because if you don't get that "intuition" that tells you that something might be wrong, then what?

It does make me question, though, how in-depth they researched her qualifications. The midwife apparently produced records after the baby's death that said she was some type of "medicine woman and traditional spiritual leader." Umm.... not exactly sure what that means or how it even remotely makes you appropriately qualified.

Another irony is the criminal investigation of the midwife, and others like her - whether they're trained or not - when a baby dies. Conversely, babies die in hospitals every day. Sure, doctors can be investigated, sued, even. No one denies that. But where is the outrage over that? Given the rise of things like the "Pit to Distress" phenomenon and iatrogenic prematurity, it's amazing more babies don't die. What's even sadder is that people seem completely unaware that this stuff happens, simply because babies don't die more frequently. Depending on the situation and state laws, many times an autopsy is never performed - which grieving parents often, understandably, might not think about or want to deal with at the time, meaning negligence is unlikely to be proven.

Interestingly enough, I do remember during my brief employment at a hospital one OB nurse talking to me at length about a doctor who waited too long to do a cesarean. She said nurses were urging him to do so, but he waited. The baby died. As far as I know, he is still practicing medicine, still delivering babies.

One must wonder if perhaps the midwife's obvious reluctance to head to the hospital sooner meant that she would be met with scrutiny and a couple of policemen on each arm. I would hope the mother, when hiring this woman in the first place, would understand that - as well as midwifery laws and their tumultuous history in her home state of Missouri. The often (well-documented) harsh, judgmental behavior of both doctors and nurses during a home birth transfer is, sadly, probably enough to make many only want to head there as a last resort, which could possibly have dire consequences. Couple that with the all-too-common naive assumption that any home birth transfer is likely because of impending disaster, and it's a recipe that leaves a very bad taste in one's mouth.

Edit: Reader Lauren has recently posted this link about the death of a labor and delivery nurse's baby and her hospital transfer when things went wrong. Apparently, you can never get to the hospital soon enough, so it's always your fault, right?

Risked Out

A few months ago I posted the home birth story of my friend, R. She is now weeks away from the birth of her third child and was planning a home birth. The birth kit had been ordered; arrangements were being made. But in the background, other things were happening.

Before R got pregnant, she had been diagnosed with an infection of some kind, which meant her platelets were low and she developed thrombocytopenia. Despite this, her doctor gave her the all-clear to become pregnant. This bleeding disorder means that if R had problems during labor, she could essentially bleed out. She has tried everything, to little avail. She finally emailed me and said her midwife, who sounds very caring and supportive, has officially risked her out of a home birth.

I told her I thought it was the best decision, under the circumstances, to have a hospital birth. In her situation, it was best to know ahead of time and not be faced with it for the first time while in labor. Her care so far, from her description, under both her OB and her midwife, has sounded thorough and excellent (contrary to the belief that midwives can't provide more than adequate care during pregnancy). Her midwife has agreed to also act as her doula and accompany her to the hospital.

While it's a tremendously emotional, difficult decision to make, I think R and her midwife were very wise to do so. I remember being faced with similar decisions in my last two pregnancies: attempt a VBAC or go with a repeat c-section? Proceed with the hopes for a vaginal birth even though the baby had turned and my blood pressure was up? It's a gamble we often have to take, and it does hurt when things are obviously not going to work out as planned.

I told R I wanted to highlight her situation on my blog if only to say, "Home birth mothers are not reckless; they do care about their babies!" Of course, we know that. But many people - including doctors - seem to think that people who desire home birth have an agenda; that they place the actual experience of giving birth over the importance of having a healthy baby. I think R, and many home birthing mothers, agree that you can achieve both. R has dealt with medical issues during her entire pregnancy, and none of what she decided to do was taken lightly. I get so irritated with people who have a certain stereotype of mothers who home birth - and chances are they, and the doctors who hold similar ideas, have never even attended a home birth to even know remotely what they're talking about.

Home birth has recently been a hot topic of debate in the media in the last few months, whether it's the snide, sneering comments about Gisele Bundchen's home waterbirth or the somewhat patronizing headline, "Should American women learn to give birth at home? " (When you click on the link, the headline is different on the page, almost like someone went back and changed it.) Learn? It almost sounds like society is asking itself, "Should we allow women in our culture to behave so stupidly?" not realizing that their own perceptions about care for the average, normal pregnancy and birth are defined by many outdated practices and ideas, shaping their thinking and creating a false idea that everything is inherently right, good and necessary because it comes from a doctor or hospital's standpoint.

What doctors, hospitals, the media and other critics of home birth fail to look at almost every time is why women are choosing to have one. Many like to just scratch the surface with things like unnecessary cesareans, Pitocin inductions and the basic idea that pregnant women are often treated like they're terminally ill instead of just having a baby. Many critics treat home birth and natural birth advocates as if they all disagree with interventions of any kind, when in fact, that's not true. (I haven't met anyone, ever, like this yet.) The idea of a pregnant woman being treated like a medical experiment or as if they are completely incapable of making decisions for themselves - and their unborn children - is nothing new and probably spans more than an entire century.

Therefore, when we understand that the roots of our maternity care system come from this standard of care, we will understand why many women choose home birth. We will understand why things like birth trauma matter, and why some women are even forced into a corner in order to avoid more trauma, which can lead them to make dangerous decisions in childbirth. Instead of demonizing them, however, we need to understand why they felt compelled to make the decision they did - and that sometimes, even though it's perceived as reckless, selfish or stupid it can still work out.

A Journey to Homebirth: Part 2

The Story of My Second Birth

When I went for my 6 week post-partum check-up after the birth of my son, I learned that my midwife had been fired by the doctor that she worked for because of “business reasons.”  This is code for she was taking too many of his patients and he was having to pay her too much money (per her contract, she got a bonus for each delivery she did.)

About 15 months later, when I found out that I was pregnant again, I knew that I wanted to have a  home birth.  While my hospital birth experience wasn't bad (I actually enjoyed the actual experience, aside from a few incidences with Nurse Crusty, who the next morning was very kind and patient with us), I didn't want to have my next baby in the hospital.  After all, I wasn't sick.  I had began to view birth as a natural process, not a medical one.

We had the support from the ones that mattered most, our families.  We had found a wonderful, caring midwife.  She had worked in L&D for many years, before becoming a home birth midwife, so I was confident in her ability.  I knew that if there was any indication that there may be a problem, we would be off to the hospital.  After all, that's why they are there, right? 

We did not have the support of all of our friends, though.  One couple, in particular (she is a L&D nurse in a local hospital known for its interventions and high C-section rates) was out-outspokenly opposed to our decision.  She would often tell me stories of how many babies they saved that day from certain death.  I would ask how many of those babies were in distress because of their own medical interventions and “messing” with the natural process of labor.  I never received a reply to that.  They even told us that they would send us on a vacation to Hawaii if we would agree to have our baby at a hospital.

One Wednesday morning in late June, I woke up feeling different.  I couldn't tell you what was different exactly, but I felt like the baby had moved, not dropped, just moved, and I just felt different.

Later in the evening, I took our son for a walk in the stroller.  I felt like I could walk forever.  I was restless, but so was the weather.  Thunderstorms had already rolled through and more rain was on the way.  He and I walked around the little block and continued to just walk up and down the driveway and then played on the front porch.

That night, when I nursed my son as he fell asleep, I could tell that the contractions that I had during nursing felt different than the ones that I had been having during nursing, but they didn't feel like labor contractions.  I hurried up the nursing session and spent some time in front of the TV with my husband.  (Yes, I nursed all through my pregnancy and went on to tandem nurse my baby and my toddler for about nine months.  Pretty radical for a mom who was only planning on nursing her first babe for six months... But that's another story.)

At 11:00 PM, I was having a lot of pressure way down low and it was very uncomfortable to sit.  Being on my knees and leaning on the couch felt really comfortable.  I told my husband that I was pretty sure he wouldn't be going to work on Thursday.  I didn't feel like I was in labor, but I felt different.  I told him that I was going to bed because I was sure that it would be a long night.

Since about the middle of my pregnancy, my Braxton-Hicks contractions would be triggered when my bladder was full.  I spent from about 11:15 until 11:45 PM on the toilet.  I was more comfortable there and could empty my bladder easily.  What I thought was Braxton-Hicks contractions was actually my true labor.  By 11:45 PM, I couldn't tell the difference between one contraction and another.  I wasn't sure if they were coming right after another or if they were double-peaking.  My midwives had told me that I could probably expect a couple nights of labor starting and then stalling a few hours later.  I was expecting this to happen.   I decided to lay down in bed.  It was storming outside and I heard the tornado sirens go off.  I woke up my husband and he checked the radar on TV and the worst of the storms seemed to be to the east of us, near where my midwife lived.

My contractions, and the storm, continued through the early hours of the morning.  I finally agreed to let my husband call my midwife and my parents around 1:30 AM.  He wanted to call sooner, but I wanted to wait to make sure this was the real thing.  My husband was trained and knew the emotional and physical sign posts of labor.  He should have just ignored me and called! 

Shortly after my husband called my midwife, I was back in the bathroom.  I felt my stomach gurgle and thought “I am hungry!”  I know that hunger is an early labor sign.  I felt so discouraged because my labor was so intense.  I felt like that if this is just the beginning, how am I going to make it through the “hard part?”  About 2 seconds later, I yelled to my husband, “I'm going to throw up!  I'm going to throw up!”  I remember that one of the nurses at our son's birth called this the “seven centimeter pukes.”  I was relieved to think that maybe I was actually seven centimeters.

The apprentice midwife that was training with my midwife arrived around 2:30 AM.  It is normally a 20 minute drive, but with the weather it took her about 45 minutes.  She asked how I was doing and I told her that I had already puked.  She checked me and found that I was already about nine and a half centimeters and had a bulgy bag of waters.  She called the head midwife right away.

I was having horrible back labor that wouldn't go away.  All I had learned said that back labor moves down your back as the baby moves lower in your pelvis.  My back labor never moved; it stayed high in the middle of my back.  It would fade a little as the contraction changed and the tightness would increase across my abdomen.  I labored the whole time that I was in bed on my right side.  I tried to move to my hands and knees, but couldn't force myself to move.  The contractions were so intense that I had a hard time relaxing through them.  I had my husband talk me through them several times and also guide my breathing to slow it down.  He  and the apprentice midwife took turns guiding my relaxation and putting counter pressure on my back.  They told me that they could feel the baby move through my back as they applied the counter pressure.  I could feel the baby move in my uterus and could feel its feet pushing back against the contractions.  It was marvelous!  This baby was working so hard to be born!  The apprentice midwife would check the baby periodically with the Doppler and every time the heartbeat was strong and reassuring.  Later in my labor it was noticeably slower; she told me that the heartbeat slows normally as the baby moves lower in the birth canal and all sounded great.  It was nice to be informed about the progress of my labor and to know the natural processes that occur.  The storm outside was powerful and seemed to echo the power of my contractions.  The lights flickered several times and I know at some point my husband went to get the Coleman lantern and an extra flashlight in case the power went out.

My head midwife arrived  just before 3:30 AM.  The storm was still raging outside and my contractions weren't letting up, either.  She later said that it was the worst drive she had ever had to any birth.  After she checked me, my midwife kept telling me to listen to my body, so I knew that I was complete and could push whenever I felt the urge.  Finally, I had what seemed like a one or two second break between contractions (the first complete break that I had) and I knew that my pushing contractions were beginning.  Like my first birth, I didn't get the overwhelming urge to push, but I knew that my body was telling me it was time.  It was a relief to push and be an active participant in my labor, rather than to strive to remain relaxed.  My husband didn't know that I was pushing; he was still trying to coach me through contractions when he told me not to hold my breath.  My midwife told him that I was pushing.  I started pushing at 3:55 AM.  At 4:03 AM, my water broke.  It was strange sensation; a relief in a way.  As I was pushing the baby out, my contraction stopped as it was half-way out.  It was almost confusing having the baby's body half in and half out.  I know I said “Get it out!!”  The baby was born at 4:05 AM.  As the baby was being born into this world, I heard my midwife say, “Hi, Baby! Jesus loves you.”  What glorious first words for my child to hear!  My husband saw part of the cord and her genitals were swollen from the hormones and cried out “It's a boy!”  The midwives had to look again because they were sure that they had seen girl parts.  She is indeed a girl!  All of our “girl feelings” were correct.

My daughter was quiet and calm after birth.  And, as soon as she was born, the thunderstorms stopped.  It was as if God had provided the storms as a cover noise for my son to sleep through my labor.  Her APGAR scores were 9 and 10.  I was amazed at how great I felt as soon as she was born.  The contractions were over and I felt normal.

My baby weighed eight pounds and eight ounces and was 20.5 inches long.  I had no tears.

I called my mom after my daughter was born; my parents were still making the long drive to our house.  My mom could tell that all was quiet and that I was calm and relaxed.  She said “You aren't in labor any more, are you?”  I am pretty sure she thought my labor had stalled out.  I told her that if she

hurried (they were actually only about two minutes from our house) that she could still cut the cord.

It took a while for the placenta to detach and be born.  My baby's cord was short and I wasn't able to nurse her until after it was cut.  (I am not sure why I didn't let them cut the cord.  I know nursing her would have helped me deliver the placenta.  I am not sure where my mind was when I kept insisting to wait until I delivered the placenta to cut the cord.)

After delivering the placenta, and the cutting of the cord, my daughter and I got into a warm bath filled with soothing herbs.  It was a wonderful time to bond and gaze into each other's eyes and get to know each other.  It was amazing birthing her at home.  It seemed so natural.

My labor was just over four and a half hours.  It was so different than my eighteen and half hour labor with my son.  My second labor started right away in active labor, where as my first labor started slowly and gently.  I told my husband several times during my second pregnancy that I thought I was going to have a very different labor.  I think God was preparing me for it. 

After our herb bath, and baby getting measured and weighed, my husband took our new baby girl, all swaddled in a blanket, into our son's room later that morning when he woke up.  Our son saw the baby in his daddy's arms, pointed, and said, “What's that?  A sister?”  God must have been preparing him, too, because we did not know the gender of our baby until she was born, and our son didn't even know I had been in labor.

For me, having a home birth was a beautiful, peaceful experience.  It seemed natural and comfortable.  It was so nice to cuddle in my own bed with my new baby and then later as a whole family.  I hardly have words to describe it.  But, as much as I loved having my baby at home, home birth is not for everyone.  You have to be willing to accept full responsibility for your birth experience.

Many people wonder about newborn and post-partum care when you have a home birth.  The midwives stay for several hours after your birth to check your bleeding, the monitor the baby and to make sure that nursing gets off to a good start.  They also do a 24 hour check, as well as coming back three days and two weeks after your birth to check you and baby.

And, as much as I endorse natural, medicine-free, intervention-free births, I know that the ONLY thing that is important is having a healthy baby and a healthy mom.  To me, this also includes the mother's mental health... her being an active participant in her labor and delivery and her and her husband being allowed to make the choices necessary.  The medical field serves a very important role in the birth of our children; they DO save countless lives every day.

When I have another baby, will I have it a home?  Absolutely.  If something indicated that I should have a hospital birth, would I hesitate to go? Absolutely not.

And you wonder why women don't want to give birth in hospitals ...

'Birth is inherently dangerous,' cries Dr. Amy, an outspoken 'skeptical OB' who seemingly roams the internet, looking for 'birth gone bad' stories in order to fan the flames of panic and worry. Skeptical of what? I wonder. That women can actually give birth without fear, worry and all the other trappings that come with it?

I've been pondering a couple of things lately: namely, again, the death of my great-grandmother, precipitated by my reading Tina Cassidy's book, and a recent visit from my mother. We talked about the physician who delivered my grandmother and again of his disgusting medical practices, even though the word about proper infection control was no doubt spreading faster than a colony of germs. She told me how classmates of hers remembered going to this same doctor for routine shots, and he would use the same needle on both kids.

Gack. No wonder my grandmother died, I thought. I'm partly tempted to use the 'they didn't know any better' defense for some of these a-holes, but yet I'm not sure that's entirely true. I mean, you wouldn't eat dinner with those filthy hands, would you? So why would you deliver some woman's babies with them?!

Dr. Amy wants us to believe that 'birth is inherently dangerous' because we never know what can happen around the corner. Yes, I suppose there is some truth to that. I can't account for every birth disaster or bad outcome, but neither can you compare it to the births of yesteryear (which I think she wants us to do). She relates that women routinely died in childbirth, but makes it sound (maybe not even intentionally) like it was a product of their own doing, a result of their body being 'defective,' rather than admit that many, many bad outcomes were a direct result of improper and inept physician care. (Cassidy cites this in her book, using the example of a well-qualified late 18th century midwife who had very positive outcomes, until a young, inexperienced doctor delivered one of her client's breech babies with fatal results.) She wants us to believe that being in a hospital is the safest place for us to birth our babies, even though we're treated like robots, or processed faster than a new Chevy on an assembly line in Detroit. (Never mind that, with modern obstetrics and interventions, the rate of neonatal death continues to rise in the United States.)

And anymore, it just seems like you can't put all your faith and trust in that guy in the white coat. Just because he has a diploma hanging on the wall doesn't mean he has common sense. In comparing my grandmother's death to medical practices of today, I found the curious 2005 case of Dr. Harvey Finkelstein , a Long Island anesthesiologist who was found guilty of reusing syringes in multi-dose vials, which put thousands of patients at risk for contracting blood-borne illnesses such as hepatitis and AIDS. So, do you want him giving you your epidural? Sadly, it is known that he is not the only doctor to have done this.

Even my dad, who attended my brother's birth in 1982, noticed the doctor arrived basically 'covered in blood' from another delivery and noted that he looked a mess. (Ironically, my brother suffered from severe group B strep after birth.)

But, if you are a health professional who happens to call your doctor on his/her mistakes, you just might get sent to prison for it. Anne Mitchell , a whistleblowing nurse from Texas, wrote an anonymous letter to  her boss, Dr. Rolando Arafiles, Jr. because of what she considered 'unsafe practices.' He promptly fired her. (At her trial, she was acquitted.) (More on the case here , where patients also stood up for the good doctor because 'he saved their lives,' including the town sheriff. It seems like poor Anne had the cards stacked against her from the beginning, maybe.)

Maybe this is why so many OB (and other) nurses don't complain about patient treatment when they work with a doctor notorious for being harassing or aggressive towards pregnant patients. Or, perhaps it's a case of 'if you can't beat 'em, you might as well join 'em.'

We know better now about infection control and safe medical practices, and have countless studies that prove some of the interventions and procedures performed on women might have the opposite effect on them. Yet doctors still blatantly disregard these common sense practices and throw all caution to the wind, often putting countless mothers and babies at risk for no reason.  Is it any wonder why women don't want to give birth in hospitals?

"Ricki Lake, please stop lying about homebirth."

This is the message on the May 3, 2009 blog posting of Amy Tuteur , whom I've mentioned here on this blog before. She is a mother of four herself, former clinical instructor at Harvard (I think we're supposed to be impressed and bow down, maybe?) and is hugely against home births. At least from her negative, biting, somewhat unprofessional criticism of it.

As I await a copy of "The Business of Being Born" on loan from the library, I think of how women have to fight every day to have home births in this country, and I bet Ricki Lake was like a shining ray of light in the darkness to them. A voice that said, 'Yes, you can do this!' Depending on where you live, it's very difficult, if not impossible, to get good support from the medical community when making this decision. And it's definitely a decision you don't make lightly. Whenever I'm in conversation with someone about the 'dangers of home birth,' I basically say, 'It's not like this person woke up this morning - the eve of their due date - and decided to do a home birth.'

It's interesting, though - if you do a Google search on 'celebrity home births' you'll get some fascinating hits. Celebs who have birthed at home include Meryl Streep, Pamela Anderson, Cindy Crawford, Christy Turlington, Demi Moore and Kelly Preston (some of them more than once). Maybe they wanted to avoid unnecessary interventions, avoid the paparazzi, or whatever - but who really cares? They did it. So how come I don't hear Dr. Amy blogging to Cindy, Pamela or Christy - all of whom have probably birthed less than a decade ago - to 'stop lying' about home births?  Did they either have just really supportive doctors and midwives or were they 'too beautiful, rich and powerful' to be told "no"? What the heck?

Another Google search will reveal tons of criticism about Ricki Lake, though. Included among the headlines are "Ricki Lake's home birth film upsets the AMA," "AMA to Ricki Lake:  No more babies in bathtubs, please" (as if), "Doctors unhappy about Ricki Lake's home birth movie," "Ricki Lake irresponsible to promote home birth," and of course the good doctor's blog headline. Curiously there is no criticism of the countless other celebrities who have also home birthed, maybe because they didn't have the guts to make a movie about it.

While I'm sure the AMA's fear about Ricki's movie is partly due to safety issues surrounding the baby and mother, it's also sending a very strong message to the mothers who want to avoid a hospital birth: not only do they not want masses of women 'jumping ship' and doing it 'their own way,' but that they don't trust you, or your care providers, to make good decisions regarding your care. Blogs like Dr. Amy's - "The Skeptical OB" - seem to reflect the feelings of the "industry" in general: that OB's are increasingly skeptical not only of women who deliver without interventions or pain meds, but also that women can make choices and decisions about their bodies and their unborn babies. Ironically, a woman's rights are more respected when she decides to abort her baby, but when she wants to keep it, it's as if she's merely a vessel and nothing more.

If anything, the movie should serve as a wake-up call to doctors and hospitals that perhaps there is a very good reason why these women chose to birth at home - and send a message to the "OB industry": that when YOU stop lying about c-sections, VBACs, and unnecessary interventions and get over your God Complex, Ricki will stop "lying" about home birth.

Home Delivery is for Pizzas

I was already in a bad mood yesterday. When I got to the grocery store, I happened to park next to a car with a bumper sticker that read, "Home delivery is for pizzas," with an image of a stork next to it. 

I wanted to blow a gasket. I searched female faces once I got in the store, wondering, "Was it her? Is it her car?", which is ridiculous, but still: I wanted to know who could possibly espouse such narrow-minded ideas. Surely, as a result of the great abortion debate, the mantra is, "Our bodies, our choice!", right? I guess only in certain situations. If you want to keep your baby, suddenly it's not your choice anymore what happens to your body or where and how you give birth. It's as if you've handed over all your rights to someone who suddenly knows your body better than you do. Lots of doctors (although not all, let's not lump everyone into that group, I suppose) use your baby as a weapon to coerce and pressure you.

While I've never had a homebirth, I was pretty darned close to the idea of one during my last pregnancy. I realize now it wouldn't have been the right choice for me (yay, two points for Dr. Congeniality and mom has to admit she is wrong!) but, had my child been in the birthing position, I was seriously considering going into labor on my own and having my friends at the local fire station attend their very first HVBAC. 

There are lots of reasons why someone might choose a homebirth: a terrible hospital experience, fear of being pushed into numerous unnecessary interventions, or wanting to birth in a natural place that was most comfortable to them. One look at the crazy ridiculous c-section rate in this country and I can totally understand, especially after having had two sections myself. I haven't met a doctor yet who doesn't see pregnancy and birth as a medical condition, a clinical process that has nothing to do with your mind and spirit as much as it has to do with your body being an amazing machine, really. They offer little support in the process and do more to tear you down than build you up. They could have witnessed thousands of successful births, but the minute you mention the words 'homebirth' or VBAC, they immediately start pulling out the horror stories to dissuade you from making a decision about your own body. Yes, it's important to know the risks - but more importantly, it's key to have support in your decision. 

I got online to read the statistics on the safety of homebirth, and once again was directed to the blog of Dr. Amy Tuteur, an OBGYN. While not discounting any of Dr. Tuteur's experiences, I couldn't believe the sheer arrogance expressed in her blog. She claims her site, homebirthdebate.blogspot.com, is for both supporters and opponents of homebirth. But it reads more like a bash session against homebirth and midwives than anything else, and supporters are probably few and far between. At one point, Dr. Tuteur actually says, in the comments section of her post "and they wonder why no one takes them seriously," that "midwives lack basic knowledge, and don't like what they find out when they do acquire basic knowledge." She goes on to say, "Midwives aren't knowledgeable, they don't like what knowledge shows them, and they place inordinate value on their own emotions."

Midwives aren't knowledgeable? What? Isn't that a bit of an overgeneralization? The certified nurse midwife who delivered my second child certainly seemed to know what she was doing. No woman, or midwife, should approach homebirth without a lack of knowledge. I also don't know many women who wake up at 39 weeks pregnant and say, "Oh, I think I'll have a homebirth!" Nor can I imagine a midwife who says, "Sure, let's do a homebirth! How hard can it possibly be?" You cannot approach a homebirth or VBAC without knowing the risks, and the facts - not the trumped up worries of a handful of people who think you're being selfish or dangerous. Tutuer is trying to separate the emotional from the clinical aspect of birth, and in my experience, you can't do it. You can't deny that birth is a very emotional, spiritual process, something that many cold, scientific doctors are unwilling to admit or lend credence to. If midwifery is not to be trusted, and midwives like Ina May Gaskin are so 'unknowledgeable,' then how do you explain her success rate? 

Whatever the case, yes, there are risks. But there are risks to doing everything: riding in your car, going for a walk outside, even having a fatal accident within the four walls of your own home. It's important to put this into perspective, rather than fall victim to scare tactics like the ones Dr. Tuteur has firmly seeded in the brains of women everywhere. The what if's that might never be suddenly take on a life of their own and completely overshadow everything else, and ultimately, there are risks involved that might be unavoidable, even in a controlled hospital setting. Because that's what it's ultimately all about: control, and how countless American obstetricians suffer from a God complex and are trying to control a process that is still not up to them. What she fails to mention is that women still do die during hospital births and after c-sections, even despite our wealth of knowledge and superior facilities. She also fails to mention that the intrusive and often unnecessary practices of her very cohorts are what drives many women to seek out a homebirth in the first place.