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

Everything in moderation - even birth advocacy?

I have always stood firmly in the middle when it comes to birth advocacy. I am not in the "trust birth!" camp, because I feel that birth can still be predictably unpredictable; our bodies, for all their wonderment, can still betray us and so, sometimes, can our births. I am not a person who believes that every doppler and every ultrasound is bad, nor do I believe that birth is "an accident waiting to happen." I also don't agree with the mantra "Just trust your doctor!", because being burned by doing so is probably what leads many women to seek a home birth (or at the very least, an alternative birth experience) in the first place.

Yesterday I read three articles that stuck in my brain - one, about the Australian midwife Lisa Barrett whom the 10 Centimeters blog lambasted for her seemingly reckless midwifery; one written by labor and delivery nurses on how to have a "natural hospital birth," and one from none other than The sOB about The Navelgazing Midwife's transition out of the NCB community. (That one was especially bizarre, most of us agreed.)

If what the writers over at 10 Centimeters are saying is true, Lisa Barrett has had four baby deaths on her hands recently, two of which occurred very close together. I haven't read much on the subject, but I agree that something sounds weird about that. I question those who align themselves with her, simply because overall her attitude sounds very cavalier, almost. The Navelgazing Midwife commented about the situation and further distanced herself from the "NCB crowd," something I can understand - because it seems like The NgM was very judicious in her practice and someone I respected for her cautious approach to bringing babies into the world (something that has drawn both praise and criticism).

As far as Barrett's behavior, I don't know what to say - I wasn't there. If it's true, then I don't know how birth advocates can support her. I get the feeling that it's very easy to blame the mother (for hiring her), in some bizarre way, blame the baby (because, admittedly, some babies die anyway, right?) - instead of blaming a cowboy-type attitude of the birth attendant (which you see in hospitals, too). I've often wondered how women can not intervene and tell the obviously whacked midwife not to get the F out of the way because I'm calling 911 whether you like it or not, but again, I wasn't there. I wasn't inside mom's head to understand what she was thinking, or even if she really had time to think. The words "I trusted her" come to mind, much like they do for many women in hospital births who feel helpless, powerless to question the authority of a doctor who might be behaving in much the same way, only in the opposite direction. I am not saying no cesarean is every unnecessary, but you do have to step back and question for a moment why 1 in 3 babies are born this way.

On the other hand is the article written by two labor and delivery nurses - who give pointers on how to have a great natural birth while in the hospital. Yeah, that's all well and good, but perhaps the realist in me is coming out. The first one on the list is to "plan your birth," whether you write it out officially or not. That's a good idea, in theory, but as most people will tell you, not all births work out the way we want them to. There's a Catch 22 there, though, because for some women having a "plan" doesn't change the outcome - how many times have we heard that having a birth plan is almost a guaranteed cesarean? Is it because mom's plan is too rigid? Or because her physician sees it as an attack on his knowledge and authority?

That's where the idea of "finding a physician you can trust!" comes in. This is true; but for some, it's harder than others. Some go through multiple physicians and still can't find one who doesn't see birth as potentially catastrophic. What if you're living in a remote area and have one doctor to choose from? Then what?

Other points on the list include "asking for the right nurse" and "bringing your own doula." As they put it,

“There are some nurses who cannot stand to hear a woman screaming and it kills the nurse NOT to put in an epidural." 

Oh, I'm sure it "kills her." Perhaps. And then there are those who just want you to STFU and stop your whining already because you're being a royal pain just by allowing yourself to be in pain, like these:

"There is good reason for birthing couples to be wary. Our hospital epidural rates run over 90% and in most hospitals, over 95%. The nurses in general not only do not know how to support a laboring women, but have no desire to do so. They would scramble to take other patients first, leaving the "natural" moms for whoever was "unlucky" enough to not be at the board first. They sabotage natural childbirth at every turn ("There's no need for this suffering you know--they don't give out medals for this," and on and on). I saw moms thwarted at every turn--no help, no support, no suggestions until moms finally begged for the epidural and the nurses responded with comments like "See--now you'll know better than to try this next time." I helped where I could, but couldn't take every mom wanting a natural childbirth. (Read the entire article here.)

As far as the doula part, they say, "...doulas can do the things we'd love to but can't." Well, that may be true, to a point. But there are lots of hospitals and doctors who don't like doulas, don't want them anywhere near the patient, and don't consider them a help but rather a hindrance.

One that really stuck out was "Be prepared to follow hospital procedure." Then that basically means, be prepared to surrender your rights in some cases, and have a far less chance of getting the birth you want. I guess this is one of the parts that makes me a moderate - while I know you're there for help should you need it, I also realize that much of the hospital's crap policies and procedures make that desired natural hospital birth next to impossible.

The article asks, "What keeps women from having a great birth experience?" The nurses say it's the idea that women are not accepting enough of themselves, and often blame themselves when things don't turn out perfectly.

“We tend to be pretty controlling beings. Having a baby is a rare situation for us [as individuals] because we’re not used to the lack control. For most women, this is their first experience in a hospital or in any real pain.”

That idea of control sticks with me, somehow. I do think that women should be permitted to exercise control during their labors - to a point. You should be able to control some aspects, but if the true need for cesarean arises, you have to surrender some of that control to the physician, unless you plan on doing one on yourself.

It's when sometimes over-the-top advocates over-analyze the experiences of others and tell them what could have been different, what you should have done, this that and the other that I start to be glad I'm sort of sitting on the outside of the advocacy circle, sort of like watching the debacle unfold while sitting on the curb. I think we've all done it, and sometimes it's quite clear what happened and where things went downhill. Sometimes it isn't, though. I've had at least three people feel the need to almost justify their experiences - prefaced with a "I know it's basically everything you disapprove of" - and this makes me bristle. Disapprove? As if I am somehow the Final Judge of All That Is Holy and Right concerning your birth. Not. Although, in explaining the situation, I've realized there is often a lot more going on behind the scenes than I know, and can often understand their position. And sometimes I don't agree (like my neighbor who likely had two births unnecessarily over-managed simply because it was a holiday) but crap, I'm not going to say anything. What business is it of mine? Not my body, not my baby, not my doctor, not my anything. And likewise, I will use my somewhat crazy birth experiences to inform others that yes, there is an alternative. You can still think I'm nuts, but that's your problem.

It's important to be very careful when questioning the experiences of others. There's a fine line between coming off as a know-it-all and basically telling them they're dumb for doing it by the book and simply, respectfully, informing them of their various choices when it comes to birth. I know after having my VBAC and second cesarean that things could have been different - it was after this last birth that I read that "breech and nuchal cord are not necessarily cause for cesarean." Yeah, that doesn't really help me after the fact, though. And who the hell am I to force my doctor to deliver a baby in a manner that he hasn't been skilled in since I was probably a child? No thanks.

One thing I simply cannot stand is the idea that all natural birth advocates are the same: the group at 10 Centimeters does this, as does The sOB. Surprisingly, she had a change of heart about The Navelgazing Midwife after hearing that Barb was leaving the midwifery community because of her disagreement over their somewhat radical views. Strangely, she is now almost aligning herself with Barb.

I was once lambasted in the comments section of The sOB for a post I did on gullibility and the "Trust your doctor!" ideology.  Someone questioned my idea that because it comes from a doctor's mouth, it must be right and true, and asked "How can we stop this?"

I guess this is just another way in which I am a moderate: blindly, completely trusting your doctor is often not a fool-proof way to have a great birth. Neither is throwing all caution and reason three sheets to the wind. There has to be middle ground. I try to be realistic but not scary and ridiculous; I find that some like to practice "fear-based obstetrics" in both directions: there has to be more to the argument than "all birth is dangerous" or "home birth/unassisted birth is the only true option." Many women have been betrayed by their bodies during the birth process; just as many have been betrayed by overzealous midwives who want them to have a natural, intervention-free birth seemingly at any cost; by nurses who sabotage their efforts to have a "safe," natural birth in a hospital; by doctors who knowingly put them at increased risk to either get it over with already or teach them a lesson. By lumping all natural birth advocates together, by shunning those who disagree, or by aligning ourselves on the extreme ends of either spectrum, we are ignoring - and doing a great disservice to - all of those who land somewhere in the middle.

Related posts:
What the "other side" is saying about NCB literature
A bitter birth nerd
He's your doctor...you have to listen to him
My doctor will tell me everything! Part 1
The myth of the emergency c-section
Birth faith

The pregnant woman as public property

Marathon runner Amber Miller gave birth within hours of
finishing the Chicago Marathon. The way people criticize
her, you'd think she gave birth along the way and kept
running with the baby still attached or something.
Photo credit: Griska Niewiadomski.

I was all set to finish my series of posts on vaccines when this story grabbed my attention: marathon runner Amber Miller gave birth to her second child within hours of finishing the Chicago Marathon. Pardon my ADD postings, but reading about this amazing lady was just awesome! Until I got to the comments section, that is.

Of course - whenever there's a story in the news about a pregnant woman doing something, there are sure to be a plethora of stupid ass comments to follow. Remember when a pregnant lady walked into a bar?... almost sounds like a bad joke. Unfortunately, it wasn't: back in January, a story hit the news about a woman who was eight months pregnant walking into a bar with friends. She had flown into town for her baby shower, and her friends convinced her to go out for a few hours with them.

But her effort at late-night fun lasted a whopping 15 minutes. No sooner than Lee had arrived, a bouncer at the the Coach House Restaurant told her she had to leave; no pregnant women allowed.

Too bad she wasn't drinking anything stronger than water. She was seen at the bar with a friend who was doing shots. Perhaps she was keeping track for her, who knows. Whatever the case, even though law enforcement said there is "no reason" she should have been asked to leave the bar, the bouncer escorted her out.

I'm sure the bar is concerned about rowdy patrons and bar fights like you see in the movies. However, one can easily surmise that they would do the same thing they did to this woman: ask the offending patrons to leave the restaurant. And no where in the article does it mention anything about a scuffle, flying beer mugs or overturned tables. Really, though - if that kind of thing were going on while this woman was inside, don't you think she'd do what most reasonable pregnant women would? She'd leave the area. It's not like she's going to body slam someone and join in.

The woman did not partake of any alcoholic beverages, and it can be assumed that just like everywhere else, there is no public smoking in restaurants in the state of Illinois, where this took place. And even if she had a glass of wine - which is, according to some, okay for a pregnant woman - who are they to decide for her whether she is using good judgment or not? Since when does that give strangers the right to police our actions once it's obvious we are pregnant? What are you going to do - give every woman of childbearing age a pregnancy test before she enters the bar area, just in case?

Just like in Amber Miller's case, there is a familiar pattern here: treating the pregnant woman like public property, as if she is incapable of making decisions for herself and her unborn child.

It seems like once you are visibly pregnant, people feel the need to comment endlessly on your condition, touch your belly, and step in and make decisions on your behalf. I'm not sure what it is about pregnancy that makes perfect strangers feel the need to treat us like helpless idiots who have no brains, feelings or an original thought of our own.

Several years ago (before the days of officially no smoking inside public buildings) I worked in a pharmacy with a pregnant woman. Our boss would sit behind a partition during his breaks and smoke. Somehow I don't remember the smoke being that bad, but at least one customer felt the need to comment curtly on how she didn't think pregnant women should smoke. While now I think our boss should have had the courtesy to go outside and do it, Tara didn't seem to mind and just gave that customer a sweet "Go screw yourself" smile and moved on. (Tara also worked her last shift before maternity leave all while having contractions, and when her shift ended she calmly proclaimed, "Okay, I'm going to the hospital now to have the baby. See you in a few weeks." Wow, that's my kind of woman. I think she had the baby less than an hour after getting there, with no epidural.)

Amber was, according to several articles, in excellent physical condition - she'd have to be, in order to run a marathon only ten months after her first child was born. People called her stupid and selfish, and some suggested that her baby should be taken away by child protective services! Many questioned the authority of her doctor for even giving her permission to run it in the first place.  Of course, if she had done it without his permission, they would have raked her over the coals just the same. Amber walked and ran the race, so I'm sure she realized her obvious limitations and didn't try to push herself. It's not like she was in a dead sprint the entire time. Some use foul language and call her names - you'd think she was doing crystal meth on the sidelines or something.

The pervasive myths about pregnancy continue, as usual: that a woman is in a "delicate condition" and must be treated like a piece of glass about to shatter. I'd love to talk to Amber and see how her labor went - she apparently gave birth little more than two hours after getting to the hospital (before stopping on her way to get a sandwich, though). I don't know what her philosophy on birth is, but I'd say she did everything right: kept herself in great physical shape, remained upright and moving and ate while in labor - all of which can help speed up labor and make delivery easier. The comments that demonize her are based in the ignorance that a laboring woman needs to be shackled to the bed with continuous monitoring, tubes and wires - not have the audacity to keep moving, and even (gasp!) eat a sandwich. When the only thing you know about pregnancy and birth comes from "A Baby Story" it's not a wonder the comments she received were so inane.

Amber, I want to tell you that you did everything right and congratulations on your baby and your marathon! I can't wait to read about then next one. :)

More reading:
Photo finish: Woman gives birth after running (and walking) marathon - chicagotribune.com
Woman gives birth after running Chicago Marathon - CBS News
Woman gives birth after running Chicago Marathon - Chicago Sun-Times

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

The "Truth" about Pelvic Organ Prolapse

I'm not a Dr. Oz fan, but couldn't help noticing that he was talking about something not many women like to discuss: pelvic organ prolapse. I also was intrigued not only because of my birth nerdiness, but because I share some of these complaints and wondered: does anybody else?

Supposedly the "last taboo topic" in gynecology (nah, I think that'd be having a homebirth) I was curious, because I too was hesitant to talk about it. With strangers, sure; but friends - I wasn't really anxious to share that info with people I went to high school with (which is why I don't advertise my blog around casual acquaintances - I really don't want them knowing the intimate state of my vagina.)

Anyway, Dr. Oz revealed just how common pelvic prolapse - when your reproductive organs come out through the vagina - really is. The crowd was hushed as women in many age groups looked like they were hanging on to the edge of their seats. We all cruise through the female incontinence aisles at the grocery store (on our way to somewhere else, right?) and know those problems exist, and that they're actually pretty common. (There's even an entire company devoted to sending you your incontinence products, in discreet packaging directly to your house, so as to avoid being spotted at the grocery store.)

The primary risk factors are childbirth (especially after having several children), weight, and age. The problem is, Dr. Oz - and pretty much everyone else outside the birth advocacy circle - don't tell you that how you give birth can impact your risk factors.

If there's one thing I'd like to change about my vaginal birth, it's directed pushing. As one article on Dr. Oz's website said, "You take a genetic predisposition, a 9 pound baby, and three hours of pushing" and it's not a wonder we have these problems.

Back up a minute.

Three hours of pushing - even the one hour and ten minutes I pushed - is probably more common than it should be in hospitals. From my experience, I know I had absolutely no desire to push. Laboring down was not an option, and I wish I knew better to just wait for my body to do it on its own. Even if you were knocked unconscious, your body would still involuntarily contract and push that baby out on its own, but who has time for that anymore? It's rush rush rush to get the baby out (even in the absence of problems) and move on to someone else.

Consider what happens when you're constipated and trying to have a bowel movement. Pushing and straining - much like during childbirth - are probably going to do little more than produce a wicked case of hemmorhoids and even rectal bleeding. But if you wait until you have the urge (which is involuntary, much like pushing out a baby) it's a lot easier with a lot less work. So even though I personally detest the phrase 'it's like taking the biggest crap of your life' to describe childbirth, in some ways it can be compared, yes.

In the process of laboring down, the body can actually stop the labor process altogether, sort of as a last-ditch effort to conserve energy for the big event. And like a bowel movement, most women describe the urge to push as uncontrollable and something they just had to do. Unfortunately, I have never experienced that feeling, the feeling of knowing my body is doing something on its own volition because that's what it's supposed to do - not push a baby out at lightning speed just because somebody told me to.

In reading about the subject, some physicians simply blame childbirth in and of itself for prolapse, while others say traumatic childbirth is a cause. I'm not sure women realize there is any other kind, which is sad. Things like cord traction - literally pulling on the cord to get the placenta to detach from the uterine wall - is another risk factor. Forceps deliveries, episiotomies (again, largely unnecessary but done anyway) and prolonged, directed pushing are other causes, and yet all are considered standard procedure in many labor and delivery wards. In other words, we've experienced this crap for so long that we don't even know it's the cause - and that it's not really as normal as we think it is. We're normalizing the abnormal.

Many times, in an effort to avoid postpartum hemmorhaging after birth, they use cord traction to avoid a "retained placenta" - and cause even more bleeding as a result.

"Retained placenta" is another term I have a problem with. While the standard seems to be around 30 minutes after birth, it seems that, like everything else, it's different for everyone. While I'm obviously not an expert, I'd guess that in the absence of bleeding - and with the presence of breastfeeding right away - leaving it more than half an hour is probably okay. When I did some quick searching on it, I found several who said an hour, two hours - even 30 hours - and she lived to tell the tale. *gasp!*

More often than not it seems doctors are too quick to expect the placenta to come out and rush it with cord traction, which is often quite painful and dangerous if too much force is applied. I've also talked with people who agree their doctor was way too eager to detach the placenta and literally yanked on it - which can cause the very complications you're supposed to be preventing.

One study has shown that injections of oxytocin into the umbilical cord vein does not decrease the need for manual placenta removal; however, you're back to that murky definition of 'retained placenta' again. According to the article, retained placenta is more likely to happen to women in "wealthier nations." Not surprisingly, the study found that among women in the UK, Uganda and Pakistan, the women in the UK were more likely to have a retained placenta:

The researchers also found that the need for manual removal was higher in the United Kingdom (69 percent) than in Pakistan (62 percent) or Uganda (47 percent).

Many are quick to point out how dangerous it is to give birth in third-world nations like Pakistan and Uganda. While there is no doubt some truth to that, giving birth with overloads of obstetrical interventions - like in the UK - is probably just as bad. (Side note: not surprisingly, Uganda is the only nation of the three that doesn't have a relatively low rate of breastfeeding, which is often a good way to encourage the placenta to detach by itself. Incidentally, the CDC has determined that most US hospitals are severely lacking in their breastfeeding support, which could be further contributing to this problem. Add to that the frequent, often prolonged separation of mother and baby immediately following birth and it could add to further reliance on active management of the third stage of labor.)

Ironically, many in the UK scratch their hands and wonder why women in the UK are experiencing this problem, despite having access to all the best care and resources. Dr. Andrew D. Weeks of the University of Liverpool thinks prolonged cord traction might be an issue. Ya think?

Some sites list things like "unusually large babies" as a cause - perhaps it's more the interventions perceived as necessary in delivering that "large" child (and the idea that everyone has a different definition of what a large baby really is) that are key here. It's not uncommon for someone to have a very actively managed labor with a larger baby that results in significant trauma to the pelvic floor. Conversely, we hear of many women successfully delivering bigger babies with little if any tearing - which can depend on the birth setting. (Home birth? Natural hospital birth?) and the attendant (midwife vs. doctor? Someone who is more pro-natural birth?)

Sadly, doctors like Dr. Oz and urologist Jennifer Berman might hand out less-than-helpful advice because they've never actually seen a normal birth in progress. They often see the end result of years worth of obstetrical manipulation and intervention and chalk it up to just plain old childbirth itself, perhaps recommending an elective cesarean to avoid all that damage (even though studies have shown it doesn't). Yes, some women will be prone to this - for a number of factors besides childbearing - despite having an intervention-free birth. Some women get it and they've never even given birth. But until you can compare what often is and what could be, you have no real idea that the process is totally tampered with.

In doing some reading, I came across a very sad post by a nurse who experienced a pretty difficult birth, no doubt precipitated by the fact that she was induced at 37 weeks. The baby sounds like it just wasn't ready, but doctors attempted every means possible to get that child to come out, resulting in some nasty-sounding results. She wondered if she had a case against them because of everything she went through.

Some of the answers she got were quite shocking. Daring to call the normal 'abnormal,' she got berated, told she was a liar, and that what she went through didn't happen as she said it did. She was told that "controlled cord traction" was basically no big deal and an "acceptable practice." Maybe so, but it shouldn't be, especially in the absence of other complications. In the end, another forum user piped up and said "You think you had it bad??" as it to get into a virtual pissing contest about who could tell the most Horrible Birth Story Ever. I felt sad for the woman, not only because these women attacked her for questioning the status quo, but because they echoed what our legal system tells us: that unless you have something permanently wrong with either you or the baby, that you should just shut up and get over it.

After seeing some of the audience members on Dr. Oz's show, you realize that women have basically been giving birth violently for decades, perhaps even more than a century. I didn't see any hippie mamas standing up in the audience saying, "Well, I had a natural home birth and mother-led pushing in any position I wanted to, so I don't have that problem." She'd probably be stoned to death if she did. That, and the number of what we could call near-failed inductions - those where a vaginal birth happens but I'm not sure I'd call it successful, exactly - probably means more women are continuing to suffer.

While Dr. Oz's segment was titled "Suffering in Silence: The Shame of Pelvic Prolapse," I really think the people who should be feeling shame are those who insist on continuing these practices even though it's not in the best interests of their patients.

More reading:
Diagnosis and management of retained placenta after vaginal birth - Dr. Andrew Weeks talks about the risks and complications of retained placenta, but admits:

There is no consensus worldwide as to the length of the third stage after which a placenta should be termed "retained" and intervention initiated.

Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial - This study suggests the use of CCT is beneficial and says that a continuous infusion of oxytocin were given to each patient after delivery of the placenta. I'm curious, though, what percentage of mothers breastfed immediately after birth, and how long were their placentas retained before someone decided to manually remove it?

Controlled Cord Traction During Third Stage of Labor - This study seems to contradict what the previous one said, in that

"Controlled cord traction (CCT) is actively promoted in combination with prophylactic uterotonics for the prevention of PPH. While the administration of uterotonics has been proven effective, there is no evidence of CCT being beneficial or safe. 

The purpose of the study was to determine: 

1. In women having term, single vaginal deliveries in hospital settings, in whom the third stage is managed with prophylactic oxytocin, does CCT produce a clinically significant reduction in the incidence of postpartum blood lose? (sic)
2. In these women, does CCT produce a clinically significant increase in the incidence of severe complications, including uterine inversion or the need for subsequent surgical evacuation of retained placental tissues and membranes (curettage or manual removal)?

Injections Aren't Solution for Retained Placenta: Study - ABC News
Management of the Third Stage of Labor - Medscape

The third stage of labor refers to the period following the completed delivery of the newborn until the completed delivery of the placenta. Relatively little thought or teaching seems to be devoted to the third stage of labor compared with that given to the first and second stages. A leading North American obstetrics text devotes only 4 of more than 1500 pages to the third stage of labor but significantly more to the complications that may arise immediately following delivery.^[1] One respected author states: "This indeed is the unforgiving stage of labor, and in it there lurks more unheralded treachery than in both the other stages combined. The normal case can, within a minute, become abnormal and successful delivery can turn swiftly to disaster."

While that may be true to some extent, why do our bodies have these built-in mechanisms to aid this natural, physiologic process?
Postpartum Hemorrhage - Wikipedia 

A Cochrane database study^[5] suggests that active management (use of uterotonic drugs, cord clamping and controlled cord traction) of the third stage of labour reduces severe maternal bleeding and anemia compared to expectant management. However, the review also found that active management reduced the baby’s birthweight and increased the mother's blood pressure, afterpains, nausea, vomiting, and use of drugs for pain relief. The number of women returning to hospital with bleeding also increased. Another Cochrane database study^[6], focusing specifically on the timing of the administration of the uterotonic drug oxytocin as part of the active management of the third stage of labour, suggested that administering the drug before the expulsion of the placenta did not have any significant influence on the incidence of postpartum hemorrhage when compared to administering the drug after the expulsion of the placenta.

 Eight Ways to Avoid Pitocin in Labor and Why You Should - Birth Sense blog 

Peggy Vincent: Baby Catcher

After many stops and starts, I was finally able to finish this wonderful book. Baby Catcher (once I got started) was a quick read, and Vincent is a talented writer.

A couple chapters stood out for me the most, namely the first one, about a young black woman named Zelda, laboring with her third or fourth baby. She wanted to do it her way, but doctors and nurses - namely the nursing supervisor, Mrs. Purdue - were adamant that she labor in silence, on the bed. Doctors insisted on injecting her with pain meds even though she was coping well on her own, and one physician, as the baby was being born, finally gassed her - probably as a matter of course, because that's just how it's done, right? It was depressing - and launched Vincent onto her crusade as a midwife.

Fast forward a couple chapters, to where Vincent is assisting in the labor of none other than Mrs. Purdue herself. The wife of a university professor and herself an obstetrics instructor, she was laboring her way, with only Vincent's help. She didn't want drugs, she just wanted Vincent - to rock with her, sway, lean forehead to forehead in a motion of support. She coped with the pain, her way, vocalizing and doing whatever she had to do. Doctors - who were also colleagues - tried to intervene with pain medication, which she refused, and they finally acknowledged, "She's doing this her way."

My mind - and Vincent's - went back to Zelda, who as a young, unmarried, poverty-stricken black woman, was also doing it her way, but there was a clear difference. Vincent noticed the white, affluent, insurance-carrying wife of a professor had the rights to refuse meds and do whatever she liked, on her terms, but Zelda did not. The disparity in maternity care probably exists today, although few women want the natural birth that Mrs. Purdue sought, as Vincent notes. Her eventual return to hospital nursing reveals the differences in care between a home birth midwife and one who works in a labor and delivery unit: more time is allotted with patients at home, and Vincent notes that she often knew the personal lives of her patients; their relatives, children, lifestyles, and on and on. In the hospital, Vincent sadly acknowledges that she saw these women once and it's done, on to another patient.

One story that struck me, though, was the one about a home-birthed baby with clubfoot. Vincent, in her shock, tried to hide the baby's feet, but the mother knew better and immediately suspected something was wrong.

As a mother of a child born with clubfoot, I can relate on some level. As someone who was also born with severely clubbed feet, I wondered if this was how they treated my mom when I was born.

When I was born, my dad immediately came to her and said, "What's wrong with her feet?" My mom had no idea what he was talking about, which meant they had come to my dad and told him first before even telling my mom, perhaps in a measure to shield her from grief. It was my dad's worst nightmare confirmed: he had passed the "defective" clubfoot gene onto his child, and he felt terribly guilty about it. I was in casts for almost a year before having surgery.

Although ultrasound was not obviously a perfect science when Vincent delivered this baby, we knew ahead of time that my son had a clubfoot. While it was a big deal to us, we knew it wasn't life-threatening and were hoping for the best. Vincent may have been correct in her assumption that the baby's feet were really that bad. Who knows. I remember watching A Baby Story (gag) and was shocked out of my chair to see a baby girl with what looked like mildly clubbed feet, and an overzealous orthopedist who was scheduling her surgery at three months old. "No!" I practically screamed at the TV. I thought of the elderly Dr. Ponseti, who in his 90s, was still practicing orthopedics and employing his Ponseti Method on countless children, likely sparing them surgery that often causes pain and arthritis as the patient ages. I look at my own feet and wonder what could have been sometimes, but it's hard to say.

One thing I noticed in the book was the dad's comment about the foot not responding to gentle, or firm, massage. Perhaps the baby's feet were really that bad, and perhaps a gentler technique could have been employed; it's hard to tell. One thing I do think, though, is no parent is going to want to perform that kind of correction, however necessary, on his own child's feet. An objective, third-party orthopedist would likely have much better luck, simply because he's detached - it's not his kid. They suspected at first that it was positional, but in my experience those cases are rarely treated with surgery and can be manipulated rather easily.

Dr. Ponseti working his magic on a young patient.
(Photo: University of Iowa)

I thought back to our course of treatment on my son. He was casted while still in the hospital, and my mom watched as the doctor manipulated his foot into place. The baby cried, as any baby would that's having its' feet touched. My mom said the orthopedist wasn't necessarily being rough, but certainly wasn't gentle, either. I'm glad I wasn't there to see it. In my drug-induced state, I don't even remember seeing my son without a cast, and wished they'd just been upfront with me about it rather than trying to hide it from me.

When we were pregnant with our daughter, we saw on the ultrasound what appeared to be two very clubbed feet. While we were anxious, because we knew the family history, and the fact that while it's more common in boys, it usually affects girls even worse. We knew what we had to do: our son had been casted right away and then moved into corrective shoes at 8 weeks old, which is when correction should be complete, ideally. By five months, I knew his foot still wasn't in the right position, so we sought a second opinion and had a minor surgical procedure performed so his foot could be flat on the ground. I figured that while weekly orthopedist appointments were a huge pain in the butt, it wouldn't be too terrible since we'd been through it before.

My son was fitted with boots and bar
much like these. He wore them 23 hours
a day until he was about two years old,
and then only at nighttime after that
for about a year. 

Since our doctor had practiced the Ponseti Method on our son, it required regular manipulation of the foot and serial casting to hold the correction, which would be an alternative to surgery. The technique, which Dr. Ponseti had developed in the early 1940s, was often performed on pediatric patients by the doctor himself. The dude was ancient, respected and well-loved across the nation by parents and kids alike, who had been spared multiple, disfiguring surgeries because of this low-tech technique.

When we told my father-in-law, a retired orthopedist, about the baby's feet, he was skeptical. "I would just schedule the surgery," he scoffed. "I wouldn't even bother with that Ponseti stuff."

Boy, was I pissed. There was no way, I told him, that I would subject my daughter to a surgery that might not even be necessary. (Turns out it wasn't at all, because her feet were beautifully perfect when she arrived into the world.)

His reluctance to accept non-surgical technique reminds me of the medically-minded birthing community: why do what Mother Nature can in her own sweet time, with a much gentler approach, when we can get it over with more quickly? In their minds, science is better, faster, more efficient. Because it's available, we should use it, and use it often - whether it's needed or not. Because it's there.

While this isn't a pregnancy and childbirth book, I would almost consider it suggested reading simply for the perspective: births that are crazy, unpredictable, beautiful, and normal. Those kinds of tales never get old.

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.

Book Giveaway and Other Cool Stuff!

I've discovered the best way to beat the winter doldrums: go shopping!

I pre-ordered a copy of Ina May Gaskin's new book Birth Matters, which is due out in March. When my FaceBook fan page reaches 250 "likes," I'll give away this book to a lucky fan! (If you pre-order your copy before March, Amazon.com will give you a discount price.)

The UK version of
Ina May's book, from
Pinter & Martin LTD.

The first thing I noticed about this book was the cover: the British versions feature a photo of Ina May next to a nekkid kid, umbilical cord clamped, little doinky in full view of the world in all its newborn glory. In the US version of the book, this portion of the photo is cropped - perhaps to preserve this child's dignity, or because it's perceived as child pornography in the eyes of discerning US censors (or perhaps they're a little uneasy at the sight of an intact penis). Whatever the case, it almost seems like they're heading Ina May off at the pass - the title of the book is, after all, "Birth Matters: How What We Don't Know About Nature, Bodies, and Surgery Can Hurt Us." (emphasis mine.)

My next purchase was inspired by Birth Without Fear's blog post on Peggy Vincent's Baby Catcher. So far it's an easy, thought-provoking read and I can't wait to really get into it. I love her description of her own labor: wracked with pain and trying desperately to adhere to the advice of the Lamaze pamphlet ("the little blue book of lies") and her own humiliation, even as a childbirth educator, in asking for drugs during her labor. Vincent chronicles many of the births she's attended throughout her years as a midwife, and one thing is for sure: birth stories never get old!

I also picked up a copy of Marsden Wagner's Born in the USA, which I've been meaning to check out for some time. I haven't had much of a chance to really delve into it, but the introduction caught my eye over morning toast:

"Much of what is in this book will come as a shock to women and families in America. There are two reasons for this. The first is that accepting that our present maternity care system is as abusive as documented here is a hard pill to swallow. No society wants to believe itself capable of putting its most vulnerable members - pregnant women and their babies - at such risk. The second reason is that the American obstetric profession has managed to keep a big secret from the public for fifty years."

Right on, Dr. Wagner.

I also snagged a second copy of Tina Cassidy's Birth, just in case. Perhaps for a future book giveaway, perhaps to lend to someone who needs to read it. Come fall, I'm seriously considering suggesting this to my book club - I chickened out last time and wished I hadn't. Why? Because I was concerned that for some women, it might highlight the vulnerability they perhaps experienced while pregnant and laboring, maybe even bring back memories of past bad birthing experiences. While I want people's eyes to be opened, if they're not as birth-nerdy as me, they might take it as an affront to the choices they made while laboring, and I don't want it to end up that way. (But mostly now, I think the word needs to get out, so if they have issues with reading it, let the chips fall where they may.) If we do read it, I'm really interested to see what kind of discussion comes out of it: especially since I think women who otherwise don't discuss such intimate details with each other flow like Niagara Falls when it comes to discussing their births of their babies.

And because I just couldn't help myself, I stopped over at Barnes & Noble and picked up a copy of Swedish photographer Lennart Nilsson's "A Child is Born." I remember seeing photos that this miraculous photographer has taken over the years, and even caught part of the Discovery show's TV special on it. Unbeknownst to my husband and I, the very process of fertilization was taking place in my body, almost as if it were being orchestrated with the broadcast. We found out about two weeks later that we were pregnant with our first baby.

When I  gleefully brought the book home to show my husband, he cried. (He tends to be a very emotional guy as it is; when it comes to babies, he's a big ball of blubbering mush.)

Wow. Just...wow. 

Nillson started taking pictures in utero in the mid 1960s, including well-known photos of pregnancy on a cellular level - which astounded everyone (as it should!). Also included in the book are wonderful photos  - mostly emphasizing normal birth. One image shows mom pushing on all fours; and while analgesics are mentioned, nearly all of the photos of laboring mothers are free of IV tubing and monitors. The book does extensively cover preemies, and shows beautiful shots of moms (and dads!) in skin-to-skin contact with their babies, including plenty of images of babes at their mama's breast.

The book has been updated several times since its first publication in 1965, to include advancements in medical technology like IVF. There is also quite a bit of coverage devoted to artificial insemination, and interestingly enough only one page is devoted to cesareans. Among the reasons listed for them is "fear of childbirth," which in some ways is true, while in other ways isn't. I think the photographs are more representative of the normal birth culture in Sweden, where I assume most, if not all, of the photographs are taken. In this blog post, a dad talks about the process of midwives assisting throughout the pregnancy and birth and why he and his wife feel it's superior to giving birth in the US. He also mentions that Sweden's cesarean rate, not surprisingly, is around 17 percent.

While perhaps some of the text is out-of-date (the cesarean rate in the US is reported to be between 20 and 25 percent) that can easily be overlooked due to the amazing photographic content. While at first I was hesitant to buy this book, I thought of my kids and how soon they would be wondering, Where do babies come from? I figure this is a good place to start: with pictures of normal pregnancies and normal birth. When they're ready to be intrigued by naked boobies and body stuff, I want this to be the book they turn to.

The Obstetrical BS Series: Redefining Normal

What is normal birth, anyway?

Whenever I have conversations about birth with people and see comments on pregnancy forums, I'm saddened at how our definition of "normal" has totally been taken off course. I don't know why I'm surprised by this, but am continually amazed at some of the lies, misinformation and half-truths that lurk out there, and how the Reality of Childbirth is one big rumor that just won't let itself be put to rest.

When people think of the "history of childbirth," they probably think that there isn't any: how can one woman getting pregnant and delivering a baby be any different than it was 100, or even 1,000 years ago? How can there be a 'history' to a basic biological function that has taken place in millions, even billions, of women since the dawn of man?

I've decided to compile a few of the things that I consider "BS" when it comes to obstetrical practices, starting with our perceptions of what "normal" birth is. Much of it is rooted deeply in myth, some in fact that has been extrapolated (I love that word!) to include everyone now, even though they often present no symptoms and fit no risk categories. We fail to see ourselves as "birth consumers" and trust our doctors to tell us what we need to know, which in some ways we should. But because we often don't understand the mechanics of birth and how it relates to the capabilities of the human body, or the politics surrounding it, we often trust them in ways that we shouldn't. I suppose it's different for everyone, but I cringe whenever I hear people refer to a vaginal birth as "natural," especially when it's far from it. Natural in the sense that that's the preferred mode of delivery for humans. But that's about where it leaves off. Perhaps they should use the word "normal," but even that's a matter of debate.

If you're like most American women, you get pregnant, find an OB, and think that's the end of it. When it comes to delivery, you know that one of several things usually happen: you are either induced for a variety of reasons, or "allowed" to go into labor on your own time. Occasionally you are "permitted" to go overdue, but not without some level of concern first. You've heard that the placenta can deteriorate after a period of time once the baby reaches a certain gestational age, and it has you worried that you might go overdue .

You've long-since chosen your care provider. In your case, you probably have chosen an OB, because that is usually just the 'thing to do' when you're pregnant. You've heard a lot about midwives , but it just doesn't sound like a good idea to you. After all, what if there was an emergency? Your second cousin had a midwife and it worked out for her, but a neighbor told you that midwives don't know what they're doing and can't be trusted . You figure that's probably true, because so many people see an OB. Besides, your OB's practice doesn't allow midwives, and neither does your hospital. It's probably for the best.

As your due date looms large along with your waistline, friends start asking: "When is your doctor going to induce you?" One friend says she was induced at 38 weeks and two years later, doesn't know why, which leaves you scratching your head. Most of your friends agree that your doctor will only induce you if it's deemed medically necessary , or if you're tired of being pregnant or relatives will be in town . A few other friends say how they were induced and in all but one, had cesareans . "But that's just how it is," says one friend, shrugging her shoulders. "No big deal." You know that one friend was induced because of a baby they thought would be big , weighing a little over 8 pounds. You worry, but don't think too much about it and remain happily pregnant a little while longer, but you are concerned that something might be wrong when your doctor brings up induction at every appointment from 36 weeks on. You ask him about it and he shrugs you off like it's no big deal and says, "See you in two weeks!"

If you haven't been induced by now, you're probably laboring on your own. The next course of action is often to administer Pitocin, sometimes even if you have a regular pattern of contractions . This is often just to speed things up, even though you're doing fine. Assuming that both you and the baby's heart rate look good - detected through external continuous fetal monitoring, of course - you will be "allowed" to continue laboring, usually. If it takes a long time , though (and everyone's definition of "long" varies), other things might be considered, usually resulting in more Pitocin or eventually a cesarean.

If you haven't been sectioned by now, you might be experiencing stronger, more painful contractions. Your doctor might tell you "No, that's not any different than normal contractions," and if this is your first baby, you have nothing to compare it to, so you don't question it. You request the epidural, and you can't get up and move around now that you've been confined to bed. Your hospital dictates that you can't have fluids and food in labor , so you're near exhausted and just want this baby out. However, the epidural is administered - either it doesn't take and they have to give you another one, or you muddle through without it - flat on your back, in agony. The baby is starting to go into distress , which worries you. The doctor looks concerned and tells you it's time to consider a cesarean. At no point has anyone suggested turning down the Pitocin .

Finally it looks like progress is being made. At first you are worried because the doctor says you're "not progressing fast enough," even though you are a first-time mother who has only been laboring for less than 10 hours. You've been pushing for what seems like forever, even though you have no urge  whatsoever. You're seeing stars and getting light-headed from holding your breath and pushing when they tell you to , and it's so hard to push the baby out that the doctor begins to use vacuum extraction. You feel intense pressure and tearing that feels like your insides are being ripped out. And then, the baby is born and it's all over. Thank God!

You hold your baby for a brief moment and then she's whisked away to a warmer. They don't want her to get cold, and after all, there are those very important tests to perform to make sure she's okay. You want to hold your baby, but you know all those tests and everything are necessary, so you watch as nurses huddle around her in the isolette and swaddle and bathe her.

Then you're taken to your room and the baby is finally handed to you a little while later. You try to nurse, but it's kind of difficult because you're a first-time mother, after all. She's not very interested in breastfeeding, likely because you had several doses of the epidural after the first one didn't take. Finally she latches on, but a nurse tells you that you can't do it and your nipples will start bleeding and get excoriated and it hurts too much . What she doesn't tell you is that they've already given her a bottle of formula without asking because your baby's blood sugars were low , and you don't realize she has nipple confusion. The nurse is breathing down your neck, the baby is crying, and there is a huge bag of formula "just in case" you needed it. You decide to use it because the baby seems really hungry , or at least the nurse thinks so.

The doctor comes in and tells you you did a "good job," and that it might be advisable to have a planned cesarean the next time, just in case . You agree, because, after all, he's the doctor and knows what he's talking about.

Fast forward six months. You've had time to heal, you love your baby, and she is thriving. You're at a baby shower for a friend, surround by aunts, your sisters, female cousins, and coworkers. You're sharing stories with each other about birth - and they ask you, since you're the last one to have a baby - how it was. You tell them, frankly, that it was the worst thing in your life, terribly painful, but so worth it for this wonderful daughter you have. Based on your story, most of the room agree that when they have children, they are "definitely getting an epidural!" One says, "My mom had c-sections with me and my brother, I'll probably have to have one, too." Another says, "Yeah, my grandmother had a vaginal birth with my uncle and she nearly died!" Still another says, "I had a natural delivery. They had to give me Pitocin and do an episiotomy, but all I had was Demerol while in labor. It wasn't too bad."

The seed of doubt has been planted. When everyone you know has had the same "normal" experience, not realizing that it's anything but, it suddenly takes on a life of its own. The idea that our bodies are somehow defective has taken hold and runs rampant, like a bad rumor that just won't die and go away.

And so is our definition of "normal" childbirth.

More reading:
Tabby Biddle: Women Speak Out About What's Gone Wrong with the United States Birthing System
Melissa Bartick: Peaceful Revolution: Motherhood and the $13 Billion Guilt