Friday, September 30, 2011

Pregnancy Update: 29 weeks!

I haven't been keeping you posted on my pregnancy! This pregnancy is going by SO fast! It has been a bit tough for me, emotionally. I have been a bit overwhelmed about the idea of three children so close together (my oldest will turn 4 about 2 months after this baby will be born) and have just felt out-of-balance and at times, overwhelmed. I am feeling better lately, though.

I had a midwife appointment today. I am 29 weeks, 5 days. We did a blood draw for my glucose screening and a CBC, mostly to see how my iron levels are doing. The midwife I saw today said she prefers to do the version of the test that uses a meal, rather than the glucoa drink, so that's what we did. I considered choosing not to do the test at all because I have easily passed the screen with my other two pregnancies, I am not overweight, never gain excessive weight in pregnancy (I'm only up about 17 lbs from my pre-pregnancy weight so far), my babies have been average-sized (7 lbs 3 oz and 7 lbs 10 oz), etc. But I decided, considering the risks of GD and the fact that I was diagnosed with PCOS in 2007 before we conceived our first, it was better to just do it, and I wanted my iron checked anyway.

My fundal height was 28 cm (It was 20 cm at my 19 w 5 d appointment and 26 cm at my 24 w 5 d appointment). The baby is positioned oblique right now (I had pretty much determined that by where I've been feeling kicks), and that probably has something to do with the slightly lower fundal height measurement. Heart-tones were in the 130s. I have gained one pound per week since my last appointment, so weight gain is going fine. No sugar or protein in my urine. (I love that I get a copy of all of the numbers so I can refer to them later!) .

My midwife recommended a great website, The World's Healthiest Foods. They have a page with a list of nutrients where you can click on each nutrient and it will take you to a list of the foods that are highest in that nutrient. Pretty cool.

Went to the health foods store after my appointment and picked up a liquid whole food vitamin, some probiotic capsules (been having issues with vaginal yeast), almonds (to eat when I have heartburn), and some nettle and red raspberry leaves for my herbal pregnancy tea that I have just started drinking daily.

The fact that this baby is going to be born hardly feels real. I better start adjusting to the idea, because I don't have much time. I am teaching my first Hypnobabies class starting next Tuesday, and am planning on doing all of the homework along with my first student to prepare for my own birth--maybe that will help it feel real for me!

I haven't been taking belly pictures, maybe sometime soon when my husband is home, I'll get him to take one and I can post it!

Saturday, September 24, 2011

Can Hypnosis Increase Your Chances of Having an Uncomplicated Birth?

The Hypnobabies (Official) facebook page recently shared a research study published in April 2004 in the American Journal of Clinical Hypnosis.  I think the findings of the study were very interesting, so I am summarizing them for you here.

The researcher performed psychological evaluations on 540 women and randomized them to two groups:  one group received prenatal hypnosis to prepare for birth and the other recieved supportive pyschotherapy.  It compared these two groups to each other, and also to a third group of women who had no contact with the research.  The study used cesareans, pitocin use (for induction and augmentation), diagnosis of fetal distress, low apgar scores, and postpartum hemorrhage as measures of whether a birth was "complicated" or "uncomplicated."   The results between the no-contact group and the psychotherapy group were similar, with rate of epidural use being the only significant difference between the two.  I think the following findings of the study are significant:
  • The hypnosis group had a statistically significantly lower rate of complicated births than the other two groups.
  • Women whose psychological assessments showed psychological factors such as high levels of fear, poor maternal self-identity, negative beliefs about birth, depression, high anxiety, and high levels of stress were more likely to experience complicated births.
  • When compared with the supportive psychotherapy group, prenatal hypnosis was shown to decrease the negative effects of these psychological factors on rates of complications.
The findings of this research appear to support the theory that psychological factors (sometimes called the "mind-body connection") play a role in childbirth.  It appears that the way that hypnosis works to change subconscious beliefs can contribute to less psychology-related complications in birth.

In Hypnobabies, we use hypnosis to help women decrease anxiety and stress, change negative beliefs about birth, and identify and reduce fear.  I believe this contributes to the great outcomes Hypnobabies students experience.  Of course, not all complications are related to psychological factors, some are physiological.  We teach moms about how a healthy lifestyle in pregnancy can give them the best chance at staying low risk.

For those times when unpreventable complications requiring intervention occur, Hypnobabies has a wonderful Change of Plans script, included in the student materials, that can be read to the mom to help her accept changes and move forward.  I used the Change of Plans script with a doula client who had a lot of changes to her plans come up, and she later told me she thought it was very helpful.  In the end, this mom was satisfied with her unplanned cesarean birth and felt that everything that happened during it was for the best.

This study also looked at social support factors, such how well-supported the women felt by her family, friends, and partner.  It also found lack of support to be associated with more complicated births, which makes sense with what we know about the benefits of doula support.  The study found hypnosis to reduce complications in women with low support from friends and family, but not as much from her partner.

Monday, September 19, 2011

Armchair Quarterbacks

Ok, I'm not talking exactly talking about that kind of "armchair quaterback," but with it being football season, it seems appropriate.

 I recently stayed up late to watch a birth that took place a The Farm midwifery center broadcast live on the internet.  A mom named Talina (@TalinaN on twitter, blog: Harvest of Daily Life) was giving birth to her second baby, and Pamela Hunt was her midwife, along with two midwifery assistants.  I got into the event, and even posted a few tweets with the hashtag #twitterbirth.  The first site I was watching it on stopped working, but I found it on another site.  The second site had a live chat running to the side of the video, and, honestly, it started to really annoy me.  I was really bothered by the "armchair quarterbacking" (or perhaps in this case, "armchair midwifing") of the birth.  Many people were judging the birth and imposing their ideas about the best kind of birthing on it. People complained that the midwives were doing vaginal exams, that one of them was sitting on the birth bed while the mom was in the shower, that they were touching things and not changing gloves, that they were using a Doppler to listen to the baby's heartrate, etc.  They also questioned Talina's birthing position (semi-sitting on the bed with her husband behind her), claiming that the birth would go faster if she squatted.  As the birth was getting closer, I switched the video to full screen, both to see the birth better, and so that I wouldn't see any more comments from the peanut gallery.  I watched a beautiful, healthy baby girl born with her daddy and (adorable) big sister in the room.  The whole family seemed very happy with the birth, and in the end, isn't that all that matters?

A few days later, I followed updates on facebook of the birthing experience of Navelgazing Midwife's daughter, Meghann, giving birth to her first baby and NgM's first grandchild.  Meghann was using Hypnobabies.  I posted comments of support throughout a long and obviously challenging journey to the birth of her baby by cesarean.  I did not see the actual birth announcement because I was at the park with my kids (and that was before I got my new phone, so I didn't get facebook on my phone yet!), and I also apparently missed some comments (deleted by the time I was reading) on the fact that Meghann had a cesarean section that were offensive to the new grandmother.  She wrote about her feelings on this here.  An excerpt:
But, when things shifted and it was obvious a cesarean was necessary, a couple of purists felt it was their place to comment… er, judge… what they thought was happening, without the benefit of actually knowing because I wasn’t expressing everything online.
My recent doula client also gave birth by cesarean because her baby turned breech during active labor.  In my postpartum visit, she told me that she had shared her birth story online and she had people telling her that it was because she had her membranes stripped the day she went into labor (after three days of non-progressing pressure waves, and at the same gestation that her previous child was born) that she ended up with a c-section.  Apparently, according to comments she got, having your membranes stripped is "just asking for a c-section." Come on, people!  Are you kidding me?

I just think the judging of other people's births has got to stop.  We don't have all the information, and even if we did, we are not that woman and we can't know her heart.  What she chooses is her choice, and if she seems happy with it, can we please just leave it at that?  Can we please leave the armchair quaterbacking to the sports fans and focus on supporting other women in whatever is the best birth for them?

Wednesday, September 14, 2011

To staceyjw: Reply-Turned-Post

staceyjw left a comment on a post I previously had a link to in my list of "favorite posts" in my sidebar, which prior to receiving this comment, I hadn't updated in a very long time.  I have now updated the list, and chose to no longer include that post, because I feel it no longer reflects the direction of this blog, and I have more recent posts that are "more favorite" for me currently.

The post, published October 23, 2010, was called Elective Cesareans as Commentary on a Failed Birth Model.  In it, I explored one woman's writing about her view of the choice of cesarean vs. vaginal birth, and how her assumptions about vaginal birth, which, in my opinion, were largely informed by our culture's negative image of childbirth and common obstetric practices that are often seen as dehumanizing, appeared to color her view.  I contrasted that with the view of birth held by the natural childbirth community, suggesting that perhaps if our system could make vaginal birth a better experience for the majority of women, perhaps less women would request cesareans.

This is the comment:
You don't have to think VB is dehumanizing or rape like to prefer the risks and recovery from a surgery to the risks and recovery from a VB. Sure, VB can go well, but when it doesn't, it can be very damaging (NCB or not, it happens). Personally, I would trade a belly scar and ab pain for vaginal pain and possible damage anyway. This doesn't mean we see "modern" VB as horrible, or anything else, just that when looking at all the ways to birth, we prefer one to the other.

This is because many Moms, including myself, see the actual arrival of our child as the life changing event- the act of becoming a parent, welcoming a new member of the family and enlarging our hearts with another human to love. How the baby gets out/into the family is irrelevant. I dont have to push a baby out my vagina to be a Mom! Focusing on a biological act to make a woman/Mom is also the very antithesis of feminism.

By focusing on VB as a "rite of passage", instead of the actual arrival of the baby (or child, in adoption) you cause a lot of hurt to Moms who didn't VB. This is not necessary, as women have enough to deal with without creating a distinction between Vb and CS, adoption, surrogacy as a way to parent.
Here is my response:

In this post, I was responding to the view of vaginal birth expressed in the Pregnancy Zone article.  I was disturbed by the way the author described vaginal birth, and it did sound very negative and verging on sexual assault to me. I do think that particular writer's negative view of vaginal birth was largely formed by the negative image of vaginal birth in our culture and common medical practices that disrespect women. Obviously, each woman is different, and each woman's reasons for her birth choices are going to be different as well, so your reasons for your choices will be different from hers.

You are right that vaginal birth does sometimes cause serious vaginal damage.  I don't deny that.  With good care, though, it is relatively rare, just like serious complications from c-sections (that some of us NCB people are so afraid of) are also rare.

I understand what you are saying about the arrival of the child being the significant, life-changing event.  I also believe that welcoming a child into your family is always special and sacred, no matter how it happens.  I have problems with saying that the baby getting there is all that matters, because that is hurtful to all the women who are traumatized by the way they are treated while giving birth.  Mistreating a women is never okay, even if you hand her a healthy baby at the end of it.  I do believe that the process by which a woman brings her baby into her family matters a great deal.  I do not, however, believe that there is only one correct way to go about it.  If you read my post Why Natural Childbirth is Not Important, you will see that I feel that  going through the literal biological process of natural birth or vaginal birth is not as important as being an informed participant in the process of a birth (which can also extend into other methods of acquiring a child).  I was referring mostly to medically necessary cesareans in that post, but it also applies to elective cesearans.  Only you know your body, your priorities, and your circumstances, and only you can make the best decision for you. 

The way you have interpreted my use of the term "rite of passage," will lead me to use a lot more care in how I use that term in the future.  There are some who believe women who do not experience natural childbirth will not be as good of mothers for not having gone through that experience.  I may also have believed this in the past, but I was wrong.  Just because one woman feels a certain experience was important or necessary to her development as a mother does not mean all women have to have that same experience to become a mother.  We are all different and all of our "rites of passage" into motherhood will be unique.  I believe that God gives us each individual experiences that best help us learn and grow in our own individual ways.  I feel that whatever you go through to get your child is your rite of passage into motherhood.  For some women, the rite of passage will be adoption or surrogacy--which are often very long and difficult journeys.  For one woman the rite of passage is joyfully pushing her baby out with an epidural, for another it is choosing a cesarean as her preferred method of birth, and for another it may be having an unmedicated birth.

Many women have described their unmedicated birth experiences as significant self-discovery journeys, that made their baby's arrival into their life special in a way that was right for them.  You may feel it wouldn't have be an awesome experience for you to give birth that way, and not all women who give birth unmedicated feel that way about it, but that shouldn't lessen the experience for the women who do.  A woman may feel giving birth on their own terms, without feeling powerless to authority figures or controlled by an obstetric system (that many feel is patriarchal), was an important part of her life, motherhood (and possibly feminist) journey.  Another may feel that having experienced the intensity of unmedicated birth is something she can draw strength from in the future.  Another woman may feel that giving birth naturally brought her closer to God.  To say that there is never value in the experience of natural birth is to discredit these women's experiences.  Not every woman wants or needs that experience for her personal growth, but those who choose it should be free to attach whatever personal significance to it that they see in it.  Seeing significance in the journey of birth doesn't take away from the joy of welcoming a child into your home, not any more than appreciating personal growth one might achieve through a challenging adoption journey would take away from that joy.  It is not a one-or-the-other choice between appreciating the process and the product.

And for some women, the process has nothing to do with it.  Some women will define their transformation into "motherhood" as being completely unrelated to it.  I understand not caring about how the baby gets there.  I used to say I was sure I wanted all the drugs I could get.  My own paradigm shift was more about the belief that it would be safer to avoid drugs and procedures as long as there weren't complications (I do still believe this, and it would take a lot to change my mind) than it was about wanting some great experience.  However, learning that it is possible to have a joyful, empowering experience birthing naturally, and that it wasn't necessarily the horrific ordeal I always assumed it would be was also part of it.  Attempting to birth without pain medication in my first birth turned out to be harder than I expected, and I chose to have an epidural.  For my second birth, I used hypnosis (Hypnobabies, which I now teach), and it helped me increase my endorphins and think of the sensations I was feeling in a positive light.  It allowed me to remain mobile when I wanted to be, and feel connected to what was happening as my baby emerged, which was important to me.  I was overall, really happy with the experience, and felt I learned a lot from it about my strength and the power of my mind, just like I learned a lot about being flexible and accepting change in my first birth.  Both birth experiences were different, both were significant learning experiences for me, neither was superior to the other, and I don't think either gives me any advantage over any other woman--we all have different needs for our growth.

I admit that I have difficulty wrapping my head around the idea of a woman wanting to choose a cesarean without a medical reason.  I know this is because of things in my background that influence my perception of the choice.  It has to do with my faith--my belief that vaginal birth is God's design, as well as my desire to have the option of having a large family for religious reasons (since having cesareans is likely to limit how many children a woman can have), my lack of experience with major surgery, and yes, my history of exposure to natural childbirth literature.  But I recognize that you may have a different background, beliefs, and life priorities than I do.

I take your point and I apologize, for myself and the rest of the natural birth community (though I guess I don't really have the right to speak for anyone else) for hurt feelings caused by the idea that there is any best way for all women to become mothers.  There may be a best way for me to welcome my child (and that "best way" may not be the same for each child--it hasn't been for me so far), but what is best for me and my baby may not be best for another mother and hers.  I will do my best in the future to avoid talking about vaginal birth or unmedicated birth in ways that are hurtful to those who do not have those experiences.

Friday, September 9, 2011

Tempering Extremism in the Natural Birth Community

The online world of natural childbirth is often heavily influenced by extremism. People claiming things like "Birth is safe. Interventions are risky" sometimes leads women to believe that as long as there is minimal intervention in their birth and they listen to their intuition, there will be a good outcome. Worse yet is the belief that a bad outcome occured because the woman didn't "trust birth" enough or the ridiculous logic that anything makes a baby's preventable death okay.

Most people who promote natural childbirth also promote that women educate themselves, but as I have said before, the problem with not knowing is we don't know what we don't know. Many women may think that they are educated about birth when they really aren't. And if you really believe that "birth is safe," then what do you really need to know? The same is true of under-trained women who act as "midwives"--many of them follow this same mentality and are unaware of the information out there that they don't have. To be clear, I do not mean all direct-entry midwives. Some are well educated. Some are not. And having the CPM credential doesn't mean anything. Having a state license may mean something, depending on the individual state's requirements--they range from having a CPM (which, as I understand, at minimum, can be achieved by doing an apprenticeship involving at least 40 births, getting CPR and NRC certified, and passing the NARM exam) and being required to graduate from a three-year program at an accredited midwifery school, attend at least 100 births, and pass the NARM exam (Washington State).

I mentioned the homebirth midwifery laws in Oregon in a previous post. A recent tragedy in Oregon has opened debate about these laws, and many are calling for mandatory licensing. I think that this unfortunate event may be a consequence of extremism--untrained midwives thinking they were qualified enough to attend births and a poor mom who didn't know or believe that looking into their training was important.

There will always be extremists in every movement. The internet, with its power to bring people together, sometimes gives the illusion of normalcy to the extreme. Sometimes it is necessary to push back against the influence of extreme ideas--to nudge the proverbial pendulum back the other way a little. Those who do so will often be accused of being "from the other side" or "causing division." I think voices of reason are essential. I have recently come across a circle of bloggers who fight to temper extremism in natural childbirth and homebirth, and to raise standards for midwifery in the U.S. They promote Certified Nurse Midwives as the optimal caregiver for a homebirth and believe that the Certified Professional Midwife credential should be changed to match the CNM standard of education or be done away with. Amber and Jessie are both former CPM students who have now chosen to pursue CNM education. Deb ("The Sensible Midwife") is a CNM with a homebirth practice. While I may not agree with everything these women have to say, I do believe the natural birth movement needs voices like theirs to help keep it in check.
Temper (verb): to dilute, qualify, or soften by the addition or influence of something else: moderate (

Monday, September 5, 2011

Tomorrow is the first day of our Preschool Co-op!

During the school year, a friend of mine does a "music time" for young children and their moms on Wednesday mornings. She has instruments and cute paper cut outs that go along with the songs. It is great. After the singing, she opens up her playroom and the children play while the moms chat. It is lovely.
One of the moms was saying how she was trying to find a pre-school for her daughter for the fall, but was having difficulty because her child's late birthday meant she would not turn three until after school started. Somehow, we decided to just do our own preschool for 2- and 3-year-olds this fall. There are four moms in the group (and 5 kids--one of the moms has 2 who are close-spaced), and we will be doing preschool two days a week for a two hours and fifteen minutes a day. Each week, we will rotate to another mom's house. So, I get to teach preschool again for 2 days out of each month (Maybe I will write some about the lessons I teach on my days here, as a break from some of the birth stuff.) On weeks I don't teach, my daughter will have opportunities to be with other kids, learn to follow a school rhythm and how to act appropriately in school, and I will have 2 days a week to be with just my son (and probably go grocery shopping!) It will be good for me to have some one-on-one time with my current baby before the new baby comes.

It will also be good to help get a little more structure in our weeks. The mom who does "music time" will be starting it up again as well, so we will have "planned days" 3 days out of the week. The lack of structure has been making life kind of chaotic (and often very lazy) around here lately. I'm excited for it! It will be a school experience for my daughter, at a much lower cost and with more input from me than a more traditional preschool. The first day, which will be an "orientation," will be Tomorrow!

Friday, September 2, 2011

Video from One World Birth

I thought this video related to what I wrote about in my last post.

One World Birth: Is there a conflict in birth?

For those who are not familiar with it, One World Birth is a documentary-in-progress that is uploading new footage from interviews with various experts in birth-related fields as it is ready to be viewed. The project seeks to build an online community to participate in the film-making process. It is an original idea and very interesting. The footage that is up right now is mostly from the U.K., but they plan to come to the U.S. and Canada to do more filming soon, and hope to travel all around the world to get a complete picture of all of the issues in birth all over the world. These short videos are great for sharing on social media--I am posting one video on facebook and twitter each day.  Visit the site to view more videos and leave comments for the film producers.

Thursday, September 1, 2011

More Thoughts on Research

The comments on Homebirth Research: Another Side of the Story have been interesting. Thank you to everyone who has shared your thoughts or other information you found about the study. I think the letter to the editor from De Jonge that one anonymous commenter shared was interesting, especially the point about how the methods of data collection in the study may have inflated the perinatal mortality rate in the low risk group. If she is correct in this assessment, I believe it does call the validity of the study into question.

That said, I think that the Evers study raises a lot of questions that require further research.
  • is midwifery care, with referral to obstetric care if complications arise, optimal care for low risk women?
  • are there specific aspects the midwifery system in the Netherlands that are suboptimal (such as, protocols for intervals to check the fetal heart rate, as mentioned in the paper, or as one response to the study pointed out, the use of midwives assistants to watch over women until close to time of birth)?
  • how might midwifery care be improved to result in better outcomes?
  • how might collaboration between midwives and physicians be improved to result in better outcomes?
I think that many questions such as "Is homebirth safe?" or "Are midwives or obstetricians better caregivers for low risk women?" are questions that may never be fully answered with research. There will always be people who find a flaw in a study's design or some other way to discredit it, because most people have basic beliefs about birth that are not easily changed. There will always be people who focus (some because it is their job) on the cases where things go wrong and work their hardest to save those lives. There will also always be people who want put their primary trust in either a divine design for the process of birth or its thousands of years of improvement through natural selection (whichever is their belief, mine is these former) and who prefer to use the technology of the past hundred years or so as mostly a back-up. Most people find ways to dismiss "evidence" that does not support their basic view while accepting that which is in line with it. It is human nature.

The answer to safety in maternity care is not to convince one side that the other is "right." The answer is respectful collaboration. This is not the first time I have talked about this. In October 2010, I committed to make my blog a doctor-friendly zone, and I hope that I have held true to that promise. I believe now, as I did then, that peaceful dialogue between doulas/activists/midwives and obstetricians and other hospital providers is essential for improving our maternity care system to protect the lives and and best meet the needs of mothers and babies. I believe that hospital and out-of-hospital providers could learn a lot from each other, which I think could help improve the safety of the practice of homebirth and care in transfers, as well as improve the environment and the options available to women in hospital birth. I have started to see dialogue opening up a little more in the past months, as more physicians are creating online presences and the internet is becoming a larger platform for conversation. I'm curious also, to see where the upcoming Home Birth Summit will lead.