There's a hurricane (and a baby) a comin'

Rock you like a hurricane: Who knew giving birth during
one of the worst storms ever could
be such a normal, natural experience? 

As the nation tenuously waits for Hurricane Irene to make landfall on the east coast, I can't help but think of all the expectant mothers, nervously waiting for their due dates to arrive and praying that it will pass uneventfully: will the baby come during the storm? Will I make it to the hospital in time? Will I be stranded somewhere?

I wouldn't be surprised to hear of a slight increase in the number of cesareans or inductions in the days prior to Irene's arrival, as doctors and patients took a "just in case" approach to avoid any such incidents from happening. It also reminded me of a passage from Jennifer Block's book, "Pushed," regarding Hurricane Charley in Florida - an F-4 storm that was the most powerful they'd seen since Andrew over a decade before. The storm lasted nearly a week, with winds topping out at 150 miles per hour. Pretty scary stuff.

With limited electricity, the hospital was facing measures to treat labor and delivery patients more efficiently given the lack of resources they had. Tracy Lethbridge, a nurse working on the unit during the 2004 storm, was on duty.

"...Hunkering down that evening was a minor interference compared to the week that followed. The hospital's emergency generator kicked in, but, like the rest of the town, the facility lost main power until the following Friday. With only enough generator capacity to run essential functions, there was no air-conditioning and no lab capabilities. That meant that the 13-bed labor and delivery ward wasn't a very comfortable place to either labor or deliver, nor did it have the lab setup required to manage epidural anesthesia safely. Lethbridge and her colleagues had to treat their patients much differently."

With limited power and no access to epidurals, what do you do?

 "We canceled all labor inductions," recalls Lethbridge. Normally, two beds a day would have been reserved for inducing women into labor, an often lengthy process that begins with drugs that "ripen" and dilate the cervix (Cervadil or Cytotec) and contract the uterus (Pitocin). Normally, even women who arrived in early labor – when the cervix is minimally dilated and contractions are several minutes apart – would often be encouraged to stay and would be administered Pitocin to hasten contractions. Lethbridge observed that under normal circumstances, the vast majority of babies were delivered during the day. 

 –––

"We only admitted women who were in active labor – regular contractions and progressive cervical dilation," says Lethbridge. "If they were not in active labor, we'd send them back home." 

Block speaks of this new, relatively unusual situation as an "altered universe" and writes that the nurses on duty during that period started noticing some surprising changes.

"Women were delivering within hours of arriving, even first-time mothers, without any Pitocin," says Lethbridge. ..."We had no cases of fetal distress during labor and no respiratory distress of neonates following delivery..." "We had an incredibly low cesarean rate. Amazingly, the babies were about evenly distributed between day and night shifts."

 "What happened was, women were going into labor all on their own, having good labor courses, and delivering healthy babies. Even the women who were scheduled to be induced that week, three-quarters of them came in and delivered anyway. And basically, they did better than if they had been induced. We thought, wow, this is amazing!"

Block notes that nurses, including Lethbridge, observed during the week period that among the 17 women who gave birth, "one was induced, two had scheduled repeat cesareans, and just one had a cesarean for 'failure to progress.'" Block states, "That works out to a cesarean rate of 17%; excluding the repeat cesareans, it was 6%."

Perhaps this almost informal "study" reveals that yes, birth can be a normal, physiological process if only it's allowed to proceed as such. That, instead of a "94 percent of births are complicated," it's quite the opposite - that 94 percent of births are over-managed, which has completely skewed our idea of what "complicated" means. In other words, that we're treating it as an accident waiting to happen and sometimes creating or precipitating that accident in the process.

As a result of this little experiment, surprised nurses reported their findings back to the charge nurse and hospital officials - who were relatively blase´ about the whole thing. The hospital's lack of action spoke louder than words: "this is not the way we do things because it doesn't make us money." You can't bill a patient for an induction, Pitocin, epidural and cesarean if she doesn't have those things, instead laboring naturally at home and letting her labor unfold by itself, with little to no interventions. Because Mother Nature is completely free - and perhaps not quite as flawed as they want us to believe. Technology can be very useful and life-saving, but only when used appropriately and wisely.

For a number of reasons, including what Lethbridge felt were safety concerns as well as the hospital's lack of support of normal, physiological birth, she quit her job - mostly precipitated by what she saw in women during Hurricane Charley. Within the year, many of the nurses she worked with left their jobs as well, perhaps completely jaded by the system. I don't blame them.

Pushed: The Painful Truth about Childbirth and Modern Maternity Care - Jennifer Block
Why You Need Pitocin in Labor

Ina May's Guide to Childbirth (the *real* girlfriend's guide)

* Now, obviously I am a natural/normal birth advocate, so it's obvious that I'd be more likely to pan some books over others. I'll admit my bias and yet try not to get caught up in too much "woo." Just putting that out there. :)


In light of my last post on pregnancy/birth books, I decided this is the book a true girlfriend would give you if she really loved you. I first discovered this book when I was on the verge of delivering my second child. I was attempting a VBAC, and don't even remember where or how I heard about it - but once I started reading it I was immediately interested. Ina May Gaskin, much like The Navelgazing Midwife, Barbara Herrera, sounds like the kind of midwife you could trust to be open, loving, and more importantly - honest. Infallible and perfect; no - no midwife is. But someone you could trust to completely care for you to the best of her ability, yet call it as she sees it.

Before I even get into the book, take a look at Ina May's website - which has some impressive stats of the births she's attended while at The Farm, her "birth center" in Tennessee. Apparently she is well-esteemed within her local birthing community, even by obstetricians - which for a midwife is saying a lot. (I know there are lots of good doctor-midwife relationships in the medical world, but all things considered, most OB's will look at midwives disparagingly - even excluding them from their practices or at hospitals altogether.)

Ina May's stats - and her book - tell me that she must be doing something right, and has faith in the laboring woman! Among low-risk women over a thirty-year period, her rate of cesareans was ridiculously low. What hospital can say that? Obviously this is a picture that illustrates one thing: normal birth can work. It's clear that Ina May's insights into birth provide a glimpse that few other pregnancy and birth books outside the NCB circle provide - especially one that's not based on fear of birth.


Ina May's Guide has some amazing, empowering birth stories, which are always a fascinating read. Many of the mothers, I feel, give accounts that seem to show how inwardly focused they are, concentrating on their births and the process that is happening within them. It's often said that when a woman gets into the "zone" of labor that she should not be bothered, and yet some books seem to categorize this phase of labor as negative and a sign of the laboring mother losing control. Much like people who have witnessed animal births know that animal mothers don't like to be touched, moved or approached in any way, I think of it in kind of the same way with some laboring women: they need to be left alone, unless they request something else, to just go inside themselves and focus on getting the baby out, a process that ideally shouldn't be met with cries of "Push! Push!" and idle talk and chatter from attendants.

Interestingly enough, in probably every story, the women mention vaginal exams from the midwives. Not excessive ones, but one or two during the course of labor to determine progress. But obviously nothing about it suggests repeat checks every hour on the hour, and no harshness or disrespect that sometimes accompany a hospital birth. Many of the women mention the loving, caring atmosphere from the birth attendants, and being in strong, capable hands of people they knew they could trust implicitly.

Some of Ina May's ideas greatly impressed me when I first read this book, namely how much our fear (or lack thereof) can sometimes dictate our actions in childbirth. I thought back to my first birth, and how I knew I was going to have a cesarean anyway, but was scared something would happen before then (my baby was breech). I was breathing uncontrollably and my husband was busying himself at the monitor by telling me "that was a big one!" when the contractions showed up, which didn't help in the slightest. I was letting the pain and fear take over.

Ina May recounts the story of a woman laboring in a hospital under the care of a resident, who is horrified when her baby presents face-first:

"...[the resident] was not good at hiding his horrified expression when her baby's head parted the lips of her vulva. It seems that the baby was coming face-first, and it was the first time the resident had seen this (usually the top of the baby's head comes first). He imagined that he was seeing some horrible defect. His facial expression terrified the mother, who instantly felt her baby retract inside her body with such force that one of her ribs cracked."

I don't doubt it. When most of us are trained to see doctors as bastions of calm and collectiveness, it can be unsettling to see through their body language that something might be wrong (even when it isn't).

Ina May's Sphincter Law is a popular theme in the book, explaining how some women can literally clam up when a rough care provider is examining them. Not only are the frequent hospital examinations excessive, but are often done in a less-than-gentle way, especially if mom is already uncomfortable with the idea of a strange doctor delivering her.

She mentions this in relation to directed pushing, when the mother is literally ordered to start bearing down simply because she is dilated. If there is one thing I wish I could change about my VBAC delivery, this would be it: I would push when I was ready to, not when they are.

"Those who have never felt what it is like to give birth while being shouted at can better understand how this can interfere when they try to imagine what it might be like to poop while a stranger stationed a few feet away yells at them how to do it."

Kind of puts that whole thing in perspective: no, pushing out a baby is not like having a bowel movement. You know what's going to happen when you try to go and don't have the urge, right? Why should this be any different?

Ina May also mentions something very important: that a rough exam performed by someone with a less-than-pleasant demeanor (say, an OB who is ready to go home for dinner or is impatient to catch his flight) can actually cause reverse dilation of the cervix. Ina May recounts the story of a patient who was transferred to the hospital because of a bladder infection that was keeping her cervix from dilating past seven centimeters. Upon a rough examination by "an obstetrician who was rather sullen and unfriendly in his manner," he noted that the patient was only four centimeters. Ina May noted that after that encounter, the mother's labor "never reestablished itself after this obstetrician's rude internal examination, so this mother's baby was born by cesarean."

There is a very informative section on pushing positions, as well as illustrations that depict women of various cultures in different positions while birthing. Not surprisingly, few, if any, of the other books I've read so far mention anything about changes in position to either aid in the baby's descent or birth the child. In fact, as far as alternatives to the typical lithotomy position, I don't think they mention it at all. (With one exception: What to Expect does mention changes in positioning, but doesn't really elaborate much on them, that I remember.)

Pushing in the lithotomy position, or flat on your back, has been in fashion for probably a few centuries, at least in Western cultures. While most people think it's necessary, really the only reason it's used is for the convenience of the physician. "By the end of the nineteenth century," Ina May notes, "birth chairs were rarely used any longer." She adds that squatting in labor, which actually helps to open the pelvic outlet, was something considered "low-class."

She includes a passage from physician George Engelmann, written in 1882:

"At every pain she made violent efforts, and would bring her chest forward. I had determined to use the forceps, but just then, in one of the violent pains, she raised herself up in bed and assumed a squatting position, when the most magic effect was produced. It seemed to aid in completing the delivery in the most remarkable manner..."

It sounds like this lady was prompted by sheer instinct. As Ina May says about a patient who flipped to the all-fours position while laboring, "women often make this choice spontaneously." If they're allowed to.

Even Engelmann realized this, in his now-obsolete book Labor Among primitive Peoples. He, too, realized the importance of positioning during a mother's labor:

"If we wish to obtain an idea of the natural position we must look to the woman who is governed by instinct, not by prudery." 

(He does go on to mention women of "savage races," who we can assume are too uneducated or "tribal" to be worried about how their hair looks or if they look "lady-like." While it sounds blatantly discriminatory, I've often thought poorer, less educated laboring women I've read about in birth cultures were luckier than they realized: they were left alone to labor, and often chose medication less often because of physician distrust. Because of their lack of social standing and inadherence to societal customs of the day, they probably had easier labors than their elite counterparts.)

If you're interested in normal birth - not even completely "natural" birth, which can be defined in many, many ways - you need to read this book. Not only to see that yes, it is possible, but that there is definitely something different out there that's worth exploring. So much of the innately beautiful physiological aspects of birth are ignored, covered up with medication and interventions, when they don't even need to be.

What "the other side" is saying about NCB literature

Is NCB literature perhaps more balanced than some would
care to admit?

I got into an interesting conversation with some readers of an infamous anti-natural childbirth blogger (and that's all I'm going to say about that, since I will not link to her site and run up her traffic meter from my blog). We were discussing childbirth books, and what's currently out there on the shelves.

It was also a refreshing change of the normal pace of that blog, where most people are just as into their "woo" as they think we are. In light of the series I'm doing on pregnancy books, this conversation really piqued my curiosity.

I really haven't found any good literature on birth outside of the natural childbirth movement. And I've seriously tried. The natural childbirth people have their problems, but they've reflected on the subject far more, and in far more profound ways, than anyone I've ever found who *doesn't* think that an unmedicated birth is the ideal. I've learned some things by reading real medical journals (the popular websites run by places like Mayo and John Hopkins really don't have enough information to be helpful), but even leaving aside questions of trustworthiness, they just aren't responsive to many of the questions people have about birth. There are no arguments, just claims. They're not actually engaging the natural childbirth people at all.

This blog (the anti-natural birth blog) is about the closest thing I've found to a "popular" medium for opposing the ideals of the natural childbirth movement. That's why I come here sometimes, but frankly, it's not impressive. Even from a scientific standpoint, it doesn't treat a lot of the most pressing questions. For example, one of the biggest obstetric controversies of the last 10-15 years is on misoprostol (Cytotec) induction. Put it in the search bar. I found only one very brief reference to the issue. Useless.

The reason most birth-interested people ultimately favor natural birth is because that's the only viewpoint that's seriously represented in the literature. There are no compelling spokespersons for any other point of view.

My eyes were widening. What? Are we willing to admit that perhaps the out-of-the-mainstream pregnancy books might be offering more useful information to women? *gasp!*

Here's another interesting, slightly puzzling, take from another commenter:

No actual experts are writing for lay people on childbirth- at least, not outside of the trite, middle school level stuff in baby books. NCB, on the other hand, has a wealth of accessible, appealing information; it ranges from outright incense burning woo to Henci Goer type psuedoscientific research...  

I think the imbalance in available reading material is a problem. It doesn't signify much if all the correct info is in scientific journals for experts, when the people pushing out the babies are flooded with NCB dogma before they even get to the OB's office.

(Incense burning woo? Seriously?)

In reference to studies, books and hot-button topics like Cytotec inductions, the first commenter adds this:

It's something the natural childbirth people talk about a *lot*. Maybe that's just them being crazy, but if part of your purpose is to answer the claims of that general camp of people, it's definitely something that should be discussed. When people in those communities discuss it constantly, and people on the other side say nothing, it starts to look like a cover-up, whether or not that's the case.  

You don't say. *sigh*

She does go on to say that often mainstream books and agendas fail to adequately draw on the psychological and social aspects of birth, and I agree. I find that is often the driving force among women who seek a "birth outside the box." And, in a surprising twist, she offers up this tidbit:

Finally, it's not been my experience that natural birth supporters are uneducated losers with no grip on scientific literature. 

Thank you! Finally! If only the rest of the world could admit this.

And either this person is delusional, lying or lives in an alternate universe, she thinks natural childbirth books "dominate" the discussion:

I agree that the NCB crowd is dominating the discussion. There are tons of books and websites dedicated to NCB beliefs. These sources are easy to access for laypeople and often compile many issues together (so you don't have to hunt down different sources for epidurals and for c-sections, etc.). I agree that if all you can find is NCB literature you are more inclined to think that the NCB viewpoint has a lot of support.

I wish that were the case. Although I do think, as someone else pointed out, that it could be based on geographical area. I pointed out that in my searching the stacks to see what was really out there, I surely never came across more than two or three copies of well-known pro-NCB books, and that was total inventory between two major booksellers.

If "we" have a corner on the discussion, I'm surely not seeing it. Perhaps blogs are getting traction and making waves among the birthing community, which is understandable considering the Internet in all its glory is a big medium for information-gathering. But I'm still not seeing it when I walk into my bookstore, nor when I talk to any of my friends or the public-at-large, who really have no idea what true natural childbirth even means.

The first commenter adds this:

I think the thing...is that the very superficial books are sometimes "mainstream", and most of the practice is basically according to the medical model, but if you want to dig a little deeper and think about the issues more it's all NCB, and there aren't many compelling, intelligent *replies* to the NCB arguments. It mostly seems like the medical establishment is just hoping that the majority of people won't investigate NCB enough to care.

Ding! Someone hit the nail on the head. Of course, a delusional response was quick to follow:

I don't think the medical establishment really thinks about NCB much at all. They aren't putting out information to counter NCB rhetoric because such rhetoric is barely on their radar. They put out accurate information. 

If that were the case, we wouldn't need books like Ina May's. Because doctors and hospitals would be giving much more accurate information through their childbirth classes, or promoting it more heavily during the birth process. I wonder, do the people who really think this way actually talk to real live people who have just given birth to find out what their experiences are?

If the natural childbirth movement really is perceived as more informative in its realistic coverage of birth issues, then that's a definite plus, especially if the "other side" is willing to admit it. I hope that means we're doing something right.

Do you need a doula?

When most people think of labor support, they conjure up images from movies and sitcoms: the idea of nervous dads and meddling mothers-in-law, in a scenario of total chaos where everyone freaks out so much they pay little attention to the laboring mother. I've talked to a few people who, if they even know what a doula is, think they're a waste of money and would never hire one, because they have their husband, after all. This is really quite unfortunate.

I'm not downplaying or underestimating dad's role as labor coach. Some dads are terrific - rocks of strength and support for their laboring partner. Some are not - quivering, uneasy blobs of jelly who hit the floor the moment the first real contraction hits. And some are on the fence - they want to support their partner in labor, but often fall prey to the hospital staff who sometimes use fear and scare tactics to get mom to comply.

This is where a good doula comes in. Perhaps not just to support mom, but both parents in labor.

A few days ago a most disturbing blog entry was posted on My OB Said What?!?. A mom was going over her birth plan with the OB, and requested no pain medication. The OB responded, "That's okay, we'll just get your husband to sign the release and give you an epidural anyway."

I can't think of anything more repulsive.

I'm not even going to join the "at least they were honest" crowd, because regardless of whether it's a bad joke or not, it's downright despicable. And clearly it's obvious that this doctor willingly uses dad as a pawn to manipulate the mother into things that she doesn't want and might not even need.

Some OB's, in discussing birth plans or other details with the female patient, will completely overlook mom and make eye contact with dad instead. As if he's her overseer; her boss, her daddy, if you will. This is why it's so important for both parents to be on the same page about birth wishes. And if they're not - if dad is on the fence - I strongly recommend a doula, who will help both mom and dad in the process.

This is another reason why it might not be a good idea to have dad, or another family member, as labor coach: they love you, they don't want you to suffer or be in pain. If dad, or mother-in-law, or whoever, is quavering even a little bit, that fear comes out and someone will tap into it: whether it's an overbearing nurse or a doctor who just wants to get it over with and move on to someone else. Having a neutral third party there, if doctors and nurses are unsupportive or blase about mom's birth plans, is essential.

I also recommend hiring a doula if you you have no labor support. Mothers whose partners are deployed, or where family is far away, could greatly benefit from having a doula. Think of all the inductions that take place simply because mom is waiting for parents, grandparents, sisters, etc. to roll into town. Just because of this perceived lack of support, mom now puts herself at greater risk of cesarean section and a whole host of other potential complications, and for what? I often think that if women and their loved ones knew what an induction entails, and the complications that could - and often do - arise from them, they would never want you to go through all that just for their sake.

If you desire a natural, normal birth like the woman mentioned above - with no induction unless absolutely necessary, no Pitocin and no epidural - then hiring a doula is probably the best thing you can do. While there's definitely no shame in asking for drugs if you need them, you should not buy into the illogical farce that you absolutely need drugs to get through labor, because you might not. It's the doula's job to remind you of that, much to the chagrin of the OB. While some hospitals are completely supportive of natural birth, many are not, and those women who truly want that experience might find it hard to combat aggressive nursing staff or the idea that they are stupid, uneducated or ill-informed because they recognize the risks of pain meds and want to forego it if they can.

Mothers who are attempting a VBAC or twin vaginal delivery would likely benefit from having a doula as well, mainly because women in these situations are finding increased pressure to perform a cesarean because the medical establishment sees these scenarios are increasingly seen by the medical establishment as "dangerous" or impossible

Another group of women who could benefit tremendously from a having a doula are teen mothers. There is already so much negativity and bias towards young mothers while they're pregnant that it often makes it very difficult for them to find support while in labor. Their youth, coupled with the possibility of being completely uninformed about the birth process, as well as their rights and choices in childbirth, can make it a disastrous situation that no doubt ends with more primary c-sections. Not to mention it further embeds a very abnormal view of birth in their minds, which is hard to erase or change.

Yesterday I had a wonderful conversation with a friend whom I am going to lobby hard for this year to become a doula. She has been the labor support person at almost all the births of her grandchildren, and attended nearly two dozen births while working as a crisis teen pregnancy counselor. She told me one interesting story of a young mother who was in active labor, and the nurse wanted to give her Pitocin.

ML showed up at the birth and the nurse demanded to know who she was. Nurse Ratched then told her that the patient needed to be put on Pitocin, and ML demanded to know why. "What do you know about Pitocin?" the nurse asked defensively. In other words, How much can I get away with telling you before you'll realize I'm giving you a load of crap?


The nurse explained that they needed to free up more beds on the L&D floor, to which ML replied, "This girl is already in active labor. Go speed up somebody else's contractions."

As far as ML is concerned, I think she'd make a great doula. She is compassionate, caring, and yet outspoken. Even if you don't know the ins and outs of something like a doctor or nurse would, just asking questions - "Why do I need to do this?" - makes a world of difference. And if they can't give you a good answer, chances are you don't need whatever they're selling.

ML affirmed my opinion that teen mothers - who are already in a position of vulnerability - are often the scapegoat of frustrated care providers who are out to "teach them a lesson" because they got pregnant so young. No one needs that care and support more than someone who is not that far out of childhood herself.

Studies have shown that doulas can actually decrease the rate of epidural use and cesareans (although they most certainly can attend you if you do have a cesarean). Although I kept an open mind about pain relief when I had my VBAC, my doula was - literally - a focal point for me while in labor. She talked me through it, was supportive and focused on me, and I focused on her. It was literally like having an extra person there to guide my husband in his support for me, too, so that the care and attention he paid me was more productive and meaningful. (In other words, he didn't look at the monitor and say, "Looks like another contraction is coming!" like he did during my first labor, God bless him.) Following the doula's lead can encourage other family members who might be present not to contribute to the general freak-out factor when they see how things can progress normally, without such a sense of urgency.

Unfortunately, some doctor practices forbid the use of a doula, which in a strange way I find sort of comforting. Not only does it tell you that perhaps your control-freak doctor might not be the right fit for you, but it effectively admits that the doula can be a symbol of peace and calm, yet power all at the same time. Because of her neutral advocacy, she is there to remind you that yes, you can do this! and provide mother-focused care that the OB might not, which means you just might get the birth you want and deserve.

More recommended reading:
Doulas of North America (DONA)
Statistics on doulas and how they can help in labor
He Ain't Creepy: He's My Doula

Before you get that epidural ...

In many US hospitals, it's
reported that as many as
90 percent of women choose
an epidural when giving birth. 

Many people think that babies - especially newborns - are just floppy, drooling blobs that sit there and do nothing, completely unable to move under their own volition. This incredibly awesome video shows us how they can move up to their mother's breast - many within less than an hour of being born.

There are two groups: those who were the product of a natural, non-medicated birth, and those whose mothers had epidurals. Their behavior is markedly different, and yet most people think that medicated labors do not produce any effects in the newborn.

I don't know how that's possible. We know that babies can be effected by things in utero that we ingest; even taking Sudafed while nursing, for instance, can produce a jittery baby. There is some debate as to whether the medication crosses the placenta, and I think we can see in this video that there is definitely something going on, to say the least.

I've heard many people say this, including a labor and delivery nurse with supposed years of experience. I'm guessing she hasn't seen many unmedicated births in a while - and she holds the notion that painful childbirth is unnecessary and "why bother?" when you can get pain meds. One mom I talked to said she had an unmedicated birth and that hospital staff were "amazed" at how alert her baby was. No kidding!

In this PregnancyToday question and answer forum, a nurse who teaches childbirth classes asked if epidurals cross the placenta, mainly because a Bradley instructor was telling her clients that they do. The concerned nurse said that it was "her experience" that they didn't. I'm wondering how many natural births she's attended to know what to compare it to - it's a sad reality that many doctors and nurses have never, or very rarely, ever attended a non-medicated birth to know the difference in newborn behavior.

The response (it doesn't say from whom, by the way) immediately slams the Bradley instructor as having an 'extreme' view, and I'm not even sure the answer they gave makes any sense, really:

"As with every extreme position, there is a string of truth. Here are the facts: Local anesthetics cross the placenta. Local anesthetics are used in epidurals. Some local anesthetics placed into the epidural space will be absorbed into the bloodstream and cross the placenta. The small amount of local anesthetic from a properly placed epidural that is absorbed into the bloodstream and crosses the placenta should not affect the mentation of the baby. The lack of affect on the mentation on that baby is an advantage that regional techniques, such as spinals/epidurals, have over intravenous medications."

I'm not sure this really answers the question, and assumes way too much before suggesting that it doesn't ever affect the baby. In one breath, they say the drugs will go into the bloodstream and cross the placenta. Then they turn around and say they should not affect the "mentation" of the baby, but we can see, and some women experience, that it does in fact. Does that mean there are lots of bad anesthesiologists running around, giving bad epidurals? And does this mean they should really admit that the Bradley instructor is right?

I had two cesareans, so obviously I had a spinal for both. In my vaginal birth, I had Nubain but no epidural. I noticed a huge difference in behavior between my babies after birth. Coupled with my inexperience at breastfeeding the first time around, it was difficult to get my oldest to latch on and we spent days - literally - working at it before we were successful. With my second, she took to the breast as soon as I offered it (which, unfortunately due to mother/baby separation that is so typical in American hospitals, was probably at least an hour or two after her birth) and behaved much differently than her brothers did. I don't remember my third being that particularly alert or interested in the breast after birth (again, after being separated from me for several hours).

It could be said that in some babies, the epidural or similar anesthesia can diminish or totally destroy a successful breastfeeding relationship between mom and baby, or at the very least, create a more difficult start to breastfeeding than need be. An inexperienced breastfeeding mom may take this as a sign that baby is totally uninterested in her, and will decide before she even leaves the hospital that breastfeeding is not for her.

It's important to realize that epidurals can be great tools for allowing the mother to relax and labor to progress. But in some cases, they can slow down labor. This is another point of contention among some, but just the other day I heard the amazing birth story of a first-time mother who said that her labor was going pretty fast, and she noticed how the epi slowed it down. For her, this was a good thing because she felt that it allowed her to get her thoughts together. For others, it can be a nightmare that leads to more (and more) interventions, that can sometimes lead to a cesarean - or at the very least, a rather traumatic, difficult vaginal birth.

Studies have shown that epidural use can increase the need for tools such as vacuum suction and forceps - mostly no doubt because some women can't feel what's going on, nor can they get up and change positions when an epidural is in place. Many talk about "light epidurals" (even an anesthesiologist told me about these) but still lots of women say they were completely unable to move due to having one. Again, the jury is out as to whether this is really widespread and may depend on a number of factors, including mother's position and doctor/anesthesiologist preference.

Lastly, we must look at the standard procedure for birth in many hospitals: the mother is likely allowed no food or drink in labor, is encouraged to lie down frequently for cervix checks, is hooked up to a monitor for continuous fetal monitoring, and as a result, is not allowed to move around or really change positions. When it comes to pushing, she is often told she must assume the lithotomy position (flat on her back). When you add all that up, it's not a wonder so many women ask for epidurals and it's amazing a woman can even birth a baby at all.

Remaining upright in early labor can actually make the first stage of labor go faster, and being mobile during labor can help mothers cope with the pain better. Being flat on your back , confined to bed, does not.

It's important to realize that studies have been done, some of which produce completely counterintuitive results. Like, it would seem perfectly plausible that epidurals - especially ones that are "heavy" and allow the mother no sensation whatsoever - would slow down labor. Studies have shown, apparently, that this is not the case. But it's not just as simple as that: it's a multi-faceted issue with lots of pieces to the puzzle that need to be put together before you can draw any conclusion. Since many hospitals and doctors have little idea what normal birth is like, we base the results of many studies - and thus our conclusions about birth - on a completely skewed model of care. Therefore it's important to remember that some studies, however official-sounding, are inaccurate and inherently flawed, especially if they do not take into account those differences.

As I wrote about in this old post , if you choose to get an epidural, that's your decision. It should not be one that's taken lightly, but rather with as much information as possible, so that you have made an informed decision, not one that's based on someone else's perception of pain.

Do epidurals cross the placenta?
Facts on Epidural Anesthesia

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.

Bring back Dr. Wonderful

At a rally outside Scripps Encinitas Hospital in San Diego, CA. 

Posted by a fan on the FaceBook group "I Love Dr. Biter! "

If you want a natural birth, you might find it's getting harder and harder to come by. Your friends will probably laugh at you, call you brave or crazy, and your doctor might sneer and mock you for your decision. It seems like few doctors will support you in your quest to have a healthy, normal birth - and this guy - Dr. Robert Biter - is one of them!

His patients call him 'Dr. Wonderful.' If he's so wonderful, then why has he lost his privileges at Scripps Encinitas Hospital in southern California?

Because he isn't doing enough c-sections. And because he's supporting mothers, giving them and their bodies a chance when few others will.

That's what I heard this morning when I logged onto FaceBook. I'd never even heard of this guy until this morning, and after I read this, my blood boiled for most of the day. I thought, You have got to be kidding me. But hey - look at the figures: a vaginal birth with no Pitocin, no epidural, and no interventions is probably cheap. Too cheap. Especially compared to a c-section.

I can see why his patients call him "Dr. Wonderful." In the photos posted over at The Navelgazing Midwife he looks like the baby's father, right in there with mom holding her hand or wiping her brow. Dressed in regular street clothes, not much identifies him as the doctor except the pair of sterile gloves. Dude, that rocks. There is nothing more psychologically and emotionally strengthening than a care provider who is right there with you, fighting the good fight to bring this baby into the world: not leaning over you, saying "You're not progressing fast enough - you're lousy at pushing!" and other nonsensical crap.

When women want a natural, normal birth, they head to Dr. Wonderful's office - in droves, apparently. He gets nothing but glowing reviews from patients when you Google his name:

"Dr. Biter is a fantastic doctor for delivering your baby! While most will show up at the last second to pull your child out while they're crowning - he will be there through the entire pushing process ..."

 "If you have a birth plan, this man will honor it..." (from a dad)

"Many of my friends have also delivered with him and each of us have had great birth experiences with him."

"I wanted an all-natural birth experience and he was totally on board. He really helped relax me and had that baby out in 30 minutes." (first-time mom)

There are lots more. Apparently if there are any negative reviews, it's because of the horrendous wait time. Of course it's bad - he's probably one of the most sought-after guys in the area. If I could birth with this guy, I'd probably camp out in his office for a week, if need be!

Scripps Encitas Maternity Center boasts of "high-tech equipment, medical care and comfort to offer you the world-class care that Scripps is known for." Apparently they haven't learned that high-tech isn't even necessary sometimes, and isn't always better. If they're so concerned about your care, then why are they trying to take away the one person who could help facilitate a happier, healthier birth experience? Now that's world-class care. But that doesn't make them any money. Sure, their patients are over the moon with their experiences and they and their babies do better for it, but the hospital's bankroll doesn't reflect that. In fact, what it says to the outside world is, "We are willing to force someone to put you and your baby at increased uncessary risk in order to fund our facility." That is definitely low class, not world-class.