After Thoughts Part 2

So I named the last post "after thought part 1", intending to write more later... I have been racking my brain trying to remember what it was I was planning to post.  This may be the first post where I am completely making it up as I go, with no real plan.  The one thing that has kept coming to my mind that I have been wanting to share is this:

 Yes, it hurt.  But that's OKAY! There are worse things in life than physical pain.

And, yes, I suppose there are worse things than putting your baby and yourself at risk of serious medical complications by simply (and naively) doing everything the doctors and nurses suggest.  That comment was more for me than you, by the way, as I really do need to keep telling myself it is okay that not everyone chooses natural birth.  It is kind of crazy how passionate I am about the whole thing.  How difficult it is for me to hear stories about c-sections and being induced.  How I literally feel sick to my stomach hearing about someone mention they got an epidural without even attempting it without.  I kind of wonder, like, why do I care so much?  I know I am being way too real now, but really, why does it bother me so much that some lady I don't even know got an epidural simply because she was bored and uncomfortable sitting in the hospital bed.  Why am I really, really hoping my dear friend in Payson can pull off a VBAC and not get a repeat cesarean and another one in SLC can get the home birth she wants.  I guess it would have to be one of two things.  Either I want everyone to attempt natural birth to prove me right and to be like me (although, of course, I have always been the type that rather likes being the one-of-a-kind oddball - and of course just because everyone does something does not make it right) OR because I really, really do feel like more women should be attempting natural birth, that women are much more capable than they realize and that women are robbing themselves of amazing, life-changing experiences.  In other words, I want to tell everyone what I wish someone would have told me before I had cowboy.  No, this whole thing is not about regret.  Cowboy's birth is over, he is four year's old now and perfectly healthy.  And it really doesn't even bother me a ton how his birth went (anymore).  But I guess it comes down to the choice between good and great, or between tolerable and empowering.

Back to the "what I wish someone would have told me":  I think if someone would have said "You should have a natural birth for the health of yourself and your baby"  I don't think it would have done a thing.  It wouldn't have been enough.  After all, I did walk into that hospital with baby number one intending to "try it without the epidural", but of course gave in after a few minutes of pain. Probably what I needed to hear was "You CAN have a natural birth and it will be the best thing for you and your baby".

So this is what I have been wanting to tell all of you: YOU CAN DO IT!  You can give it your whole-hearted best shot.  If in the end that turns out to be 16 hours of intense labor followed by an epidural, then good for you for that 16 hours, that is an amazing gift to your baby that you will be glad you gave him.  If it means waiting just one more day (or even two more weeks) as a humongous, horribly uncomfortable 9 months pregnant ornery mom until you go into labor naturally instead of getting induced, then that is exactly the time your baby needed to prepare for one of the hardest events of their life.  You are telling them "It's up to you, my child.  Your being fully ready is more important to me than my comfort or schedule".

So, read, study, research your options because it IS a big deal.  Your babies are a big deal and it is worth the effort - you need to know what you are really risking here.  Do the best you can... and then some, because the best you can is WAY more than you can imagine.

After thoughts part 1

Little Johnny Cash is one month old today.

Most of the reason I chose to give birth at home was to insure having a completely natural birth. At this point I believe nearly the only ways to have a natural birth are to either have a home birth or have a doula. If I had thought it certain for me to have a natural birth in the hospital (again), I would have birthed in the hospital. But I didn't think I could do it. I know myself to not be good at saying no - thought it would be too easy for the doctor/nurses to talk me into Pitocin, breaking water, etc. I also thought it would be hard for me to resist the epidural offer every ten minutes with it being 'right around the corner'. (Though, yes, of course I know how dangerous and bad for the baby and mom the epidural is, but wasn't sure how my reasoning would change in the heat of labor).
So the funny thing is that I never once desired an epidural. By the time I was in basically "unbearable" pain I was pushing - or maybe it is better to say that the pushing is what caused the unbearable pain. So the epidural wouldn't have helped anyway.
And also, surprisingly, the most awesome part about the birth turned out to be the location: Home. It really was SO nice to be home. I am not sure why I hadn't expected that. Before I would've gone to a birth center had there been any within a half hour of here, but that wasn't an option. Now, even if I did live next door to a birthing center, I would totally choose a home birth again. I think a lot of it had to do with how comfortable hubby was. It is hard to imagine him being that attentive and right by my side the whole time had we been in a hospital. One of my favorite parts of the labor was that first hour or so, that otherwise would have been spent driving to, checking in, and settling into the hospital. It was just Hubby and I and that was a simple, quiet, excited time - where I knew "this is it", but we just got to be together and relax. He was also just as comfortable with the midwife and her assistant as I was so that he still hugged and massaged and did whatever I needed him to do without hesitancy. (Plus the midwife really knew what she was doing and could show him how).

The Birth Story!

Hands down the hardest thing I have ever done. I will describe birth one, Cowboy's, as being a whole lot of work, but no pain and the second birth, Lady's, as a whole lot of pain, but no work. Well, double the amount of work exerted at Cowboy's birth and double the amount of pain experienced at Lady's birth, and then add a little more of each and that is about how this birth went. I am writing this as soon after the birth as possible since the 'bad' memories fade so quickly and I have already gone from thinking "I will never have children again" to "Well, maybe one more...in at least three years". And now that I have this gorgeous little boy in my arms and he is so perfectly healthy and I am recovering so quickly, I am already thinking "it was totally worth it".

Ok, from the start. On September 5th (this being significant for several reasons: was his actual due date, was 'labor' day, and is the 5th day of the month, which makes everyone in our family either born on the 5th day of the month or during the 5th month/May) - anyway, on this day, I woke up about 2am with contractions that actually had a little kick to them, unlike the painless ones I had been feeling for the last 7 weeks off and on. And these were about 5 to 10 minutes apart and were not going away. I woke up hubby around 3a.m. and said "I am going to call the midwife". He got up and started sterilizing the bathroom and bedroom and going cleaning crazy :). I called the midwife and left her a message, figured I would call her again in a half hour or so, if she didn't call back. She has never not answered her phone before. She called back about 4a.m. and got here by 4:30, having been at another birth all night and was coming strait from it. When her assistant got here around 5:00 we made her go take a nap. My contractions were getting pretty intense and more like 3 to 5 minutes apart. Hubby was totally awesome and rubbing my lower back exactly right so that the contractions were totally bearable. Both midwives helped a ton, too. Around 7:00 they were pretty bad so I tried the shower, which was amazing and made those contractions totally bearable - though it may have worked a little too well because the contractions seemed to lessen in intensity and get farther apart.

Well, the midwife told me I needed to try pushing a little with each contraction and that is when things got really, really hard for me. That hurt like crazy and took a whole lot of effort. I could only think of one contraction at a time. It was really frustrating because I didn't feel like the pushing was doing anything and wasn't even sure why I had to push then anyway. With Lady I only had to push twice and she came right out - I did have to push for an hour and half with Cowboy, but had blamed that on the Epidural and his ginormous head. One thing I had really not wanted to do became inevitable - she had to break my water. The baby was not moving down at all. I had my water broken with my other two children and she explained that our bodies have a memory and perhaps my body was not going to get back a certain point until my water was broken. (and it was actually pretty difficult for her to rupture it, so I guess my bag is made of neoprene or something :). Well I kept nudging this baby down for the next hour or two, it seemed like one microscopic increment at a time. Finally after pushing harder than I am sure is physically possible and it felt like my head was going to pop off, his head came out and that was the biggest relief of my life and hubby said "I can see his head! I can see his two little eyes!" and then out came the rest of the baby. I was kneeling on the bed. I really wanted to hold him and could tell right away that it was a boy. But it took a little maneuvering to get around to sitting so I could hold him.

My mom was in the next room with the kids and said as soon as they heard the baby crying she couldn't hold them back any longer and they burst in the room to meet their new little brother. It was Cowboy's job to tell everyone whether it was a boy or a girl, so hubby said "come in and tell us if it's a boy or a girl" and before he even got to the baby, he said, "It's Johnny Cash" in such a matter-of-fact way, like, "duh! That is what I have been telling you the whole time, that it's a boy". They were so cute and so in awe of this brand new baby, so euphoric. Hubby was on the verge of tears. I was relieved beyond reason, and so, so happy to hold this little baby. He was so perfect and precious and sweet and special...and still is :)

The placenta came out and we left the cord attached until it stopped pulsing, maybe 15 minutes or so. A lot of people keep it or bury it or even eat it, but I decided against those so the midwives just took care of it. I tore a little and the midwife proficiently sewed me up. I also finally researched circumcision and have decided that it is a completely unnecessary medical procedure, comparable to plastic surgery. So this lucky little guy won't have to have a horrid painful operation to welcome him the day after he enters this world. He ate right away. I got to hold him and hold him and hold him some more. Eventually we weighed him at 8 pounds 13 ounces and 21 and 3/4 inches long!

It was so great to be right at home during the whole labor and afterwards when my whole family just got to soak up this little angel strait from Heaven. It was really awesome. A really special time.
Welcome 'Johnny Cash'! I love you so much!

My poor midwife got a call from another lady in labor and off to her third birth in a row she went. She and her assistant were both totally awesome. I never felt nervous about anything going wrong and felt like I was in much more capable, and more familiar, hands than at either other birth.

My Birth Plan

My Birth Plan: Hubby will catch the baby.

Haha. Yes that is it. By birth number three I realize the danger in trying to control and force things to happen your way. Just let the baby and God lead the way and things will go much smoother. But based on questions I have gotten from a few people I thought I would run through the details of how this home birth is going to and I think it will help me to run through it in my head and visualize it as far as possible.

So my midwife has already visited my house so that she knows where it is. She brought a bag of supplies to leave here. It looks like a bunch of medical supplies you would get from the hospital. Mostly protective absorbent pads for the birth area (like the bed), depends (as opposed to messing with the annoying mesh panties and bulky pad), surgical gloves, squeezy water bottle, nose sucker, etc. She will bring more medical equipment with her at the birth such as oxygen tank (for baby), scale and measuring equipment. She will prepared to deal with excessive bleeding or tearing. She has two assistants, one of which I have gotten to know pretty well and will be coming at my request.
When I am seriously thinking I am in labor, first I will get hubby home (if he is at work), and then probably call the midwife just to tell her what is happening. She and I will guess how close I am and whether she should come then or if I should call her later. I will pawn my two kids off on my mom who will be staying here for 3 weeks. She will focus solely on them. I have the option to pick up a birthing pool from the midwife at my next appointment, but have decided not to use one, as I think the shower would be more soothing to me and keep the heat better. Plus the bathroom is right off the bedroom, where I plan to do the laboring and delivery. Also with my last delivery take barely an hour and a half, I am not sure that we would even get it set up and filled in time to do any good. I haven't picked a specific position or location - I guess the baby will come whenever it is ready. I just know I don't want to be lying on my back. I am looking forward to being able to try a bunch of different positions based on comfort and just see what works.
After the birth the midwife and her assistant stay here for several hours until baby and I are definitely stable. They clean everything up and do the laundry :) They won't really be hanging around in my face the whole time. They will just be at the house if and when needed.
I have called the baby's pediatrician who said to just call them after the baby is born and then bring the baby in a few days after birth for a check-up. But the midwife does a thorough check-up at birth and also a home visit a few days and two weeks after the birth.

Hubby and I are both more calm about this birth than either one before. I wouldn't have thought how liberating skipping the part where you have to drive to and get settled in at the hospital would be, especially with short labors like mine. It is so nice to not have to stress "Is this it?" every time I start having contractions. So nice to not have to go to the hospital just in case it is the real deal and then just start getting pumped with Pitocin because they don't really care if it is the real deal or not. If you're there, you are going to have the baby. (At least that is what happened with my first birth - at 12 days early).
Oh I am so excited to meet the little one - and find out if it is a boy or a girl already!! I will let you all know how it went in a few weeks :)

Birthing Upright

Here's a few things I did not know:

• Movement greatly helps cervical dilation during early labor and helps bring baby into most advantageous position for passage through pelvis. (Of course this makes perfect sense, as I was hiking just hours before giving birth to Lady, who had the easiest delivery I can imagine).
• Women in traditional societies all over the world almost always choose upright positions in labor.
• So the worldwide consensus is this: women don't choose to lie down to labor unless culture pressures them to. (Also true of Lady's birth. I REALLY didn't want to lie down, that is when it got really painful... So excited to not have to do that this time)
• Common postures (worldwide): sitting, kneeling, standing, squatting, hands-and-knees.
• Supports are also used commonly, such as: overhead rope to pull on, birth chairs, ground stake, or embracing someone else.
• Benefits to upright position: better use of gravity, maximum circulation between mom and baby, no compression on mom's major blood vessels, better alignment of baby to go through pelvis, stronger rushes and increased pelvic diameters when squatting or kneeling.
• The first recorded instance of a woman lying on her back was not until 1663 when a king's wife told her to do so, so that he could watch from behind a curtain.
• Lying on back was created to benefit the physician and male-midwife who might want to use forceps. There is no benefit for the woman.
• In the 1860's Queen Victoria used chloroform, which popularized the use of various anesthesias and led to more lying down, and was seen as more "ladylike"
• Some women MUST be upright or on all fours to have a baby.

"Instinct will guide the woman more correctly than the varying customs of the times"

Two Models of Care

I read about a couple approaches to birth: the Midwifery Model (or Humanistic model) of care and the Techno-medical Model of care. It was pointed out that a midwife and a physician can practice either model of care, so I have to say that calling it the "Midwifery Model" is kind of misleading, though I suppose that most midwives have the humanistic philosophy and a lot of physicians practice the techno-medical model of care, whether through personal belief or through pressure of avoiding lawsuits, following procedures, etc.
But let's get onto what each model of care is before you get too lost.

Humanistic Model:
-female-centered
-birth is something women do, not something that happens to them
-recognizes essential oneness of mind and body
-birth and pregnancy are inherently healthy processes
-emotions of mother have very real impact on baby: baby has no choice but to feel what mother feels
-good nutrition is best way to prevent most common complications
-companionship and encouragement during labor to minimize technological intervention
-no arbitrary time limits, not expected in any rigid time frame
-move, drink, eat during labor
-medical intervention should be applied when needed, and is harmful when used for convenience or profit

Techno-medical Model:
-has existed for barely two centuries
-the human body is a machine
-the female body is full of shortcomings and defects
-pregnancy and labor are illnesses best treated with drugs and medical equipment
-some medical intervention is necessary for every birth
-birth must take place within 24 hours
-mind and body considered separate
-labor in bed hooked up to fetal monitors, IV's, and pressure reading cuffs
-pain is unacceptable and analgesia/anesthesia are encouraged
-episiotomies are routinely performed
-the woman is a passive, almost inert object seen as a barrier to baby's passage
-women are treated as one homogenous group, not as individuals

So, of course every level of practice exists between these two, I am sure. But there are some interesting things to think about when you decide who is going to help you have your baby.

Home birth!

I am very excited about this post: home birth! Sometimes it is still surprising to even me that I am going to have a home birth. I honestly didn't even think of it as a legitimate option probably up until 3 years ago. There are so many funny little things that I am looking forward to about having the home birth rather than the hospital:
I am excited to have my kids meet their sibling just minutes after he/she is born. (Yes, we still haven't found out whether I am carrying a boy or a girl - we have held out strong :)
I am excited to have pictures where I am not wearing an ugly hospital gown.
I am excited that those pictures will be in my very own home.
I am looking forward to being able to walk around freely during labor.
I am glad I will have a shower that I am comfortable with right there, easily accessibly, before and after the birth.
I am glad I will not have to lay on my back when pushing or during any part of labor, if I don't want to.
I am looking forward to trying unique things during labor to distract, ie: playing the piano, passing a volleyball with hubby (guess you have to know me to get that one)
I am relieved of the pressure of knowing "is this really it or not?" and whether to pack everything up and head to hospital. My midwife lives 10 minutes away, and hubby and I will prepare in every way we can, just in case she is few minutes late, so that we can handle everything until she gets here, even the delivery itself.
I am looking forward to spending at least part of my labor OUTSIDE, my favorite place on Earth.

So there are some of the personal reasons, well maybe not the original reasoning, but some of the great side benefits I am looking forward to with the home birth. But here are a few facts and statistics about home birth:
-Women choosing home birth have the lowest chance of needing drugs and intervention and the highest chance of a normal birth of any modern birthing option.
-Globally most babies are still born at home.
-Home birth was the norm in westernized countries until 50 years ago (that's our grandparents).
-Mortality for women is equal for hospital and home birth - but there is an increased risk of infection and other medically caused problems for mother and baby in the hospital.
-The major risk of hospital birth is the risk of unnecessary intervention.
-Cesarean surgery is much more likely if choosing a hospital for your birth.
-Hospital stats: 1/2 are induced, 3/4 use an epidural, 1/3 end up a C-section
-Home birth stats: 70-80% have no intervention, and only 5-10% result in cesarean
-Right now only 1% of births occur outside of the hospital in the U.S.

Yay, it gets me excited all over again to talk (write) about it. Thanks all you readers for listening :)

C-section

Cesarean surgery provides an opportunity to deliver a baby and save the life of a mom for deliveries that wouldn't have been possible a hundred years ago. Unfortunately this type of delivery has gone from its' original purpose of saving the life of mother and baby, to being used merely out of convenience in some cases, made as the only option for moms who have already had a cesarean, and is being caused by many of the routine medical interventions that I have mentioned in my other blog posts (such as induction and epidural). In 1970 the percent of births that were cesareans in the U.S. was 5.5%. In 1993 it was 22.8%, and in 2006 the rate was 31.1%, which is about where it sits now. This is at least double anywhere else in the world, where their medical skills and opportunity are just as high as our country. So the increased percentage is not due to the fact that they are getting more proficient at the procedure and that is is more available for those who need it.
"At rates above 15%, the risks to mother and baby begin to outweigh the benefits." In other words, really only 15% of women NEED a cesarean - yet here we are in America where the rate is over 30%.

I do not know anyone that has elected for a cesarean, but I know there are still a few women out there that do. Elective cesareans that have no medical reason and are based on convenience/scheduling are completely preposterous and should never happen.
Cesarean being the only option because you have already had one are turning out to be a myth as well. Many, many women have delivered vaginally after a cesarean (VBAC) without any complications - so you should thoroughly research the option for yourself if you have already had a cesarean.
And, finally, a cesarean should be avoided at all costs. How is this done? By avoiding all the medical interventions leading up to it at all costs. Remember all my other posts that state that Pitocin and epidural increase your risk of cesarean, and yes I am using the word "risk", because, quite frankly, cesareans are very risky. They are only worth it if it is an actual emergency and there are no other options. Unfortunately the "emergency" is unnecessarily created by all of the unnecessary medical interventions.
Well, let's get onto to specifically what is at risk to mom through having a cesarean:
-The risk of the mom dying after an elective cesarean is 2 in 10,000, which is 4 times higher than a normal vaginal birth
- Twenty to forty percent of women have post-cesarean complications. Infections of the uterus and urinary tract are the most common.
- Women are twice as likely to have severe complications
- Five times more likely to require antibiotics (remember the effect those have on baby!)
- Up to 1 in 10 women experience an accidental cut elsewhere in the uterus
- Three times more likely to have major infection, hysterectomy, and cardiac arrest
- There is more than a 50% increased risk of having a stroke in the year following cesarean
- Less satisfied with birth experience
- More likely to be re-hospitalized
- Less confident with their babies
- Less likely to breastfeed
- More fatigued (even up to 4 years later)
- NOT better for pelvic floor function (as sometimes thought)
- Reduces fertility: this may be voluntary and involuntary, as 1 in 4 women are still fearful of birth 5 years later

A cesarean does effect any following pregnancies and births as well:
- An ectopic pregnancy is more likely
- It doubles your risk of unexplained stillbirth
- Doubled chance of breech baby
- Increased risk of uterine rupture
- Placental problems increased 2 to 4 times, all of which are life-threatening to mom and baby
- Seven to 15 times the risk of emergency hysterectomy after two cesareans
The risk of most of these complications increase with the number of previous cesareans, but a VBAC is actually just as safe (has the same mortality rate) as a first time birth. And a VBAC is most successful at home - so look into it!

Most importantly, the risks to a healthy baby include:
- Baby is 2 to 5 times more likely to need the NICU (around 10% of cesarean babies are born MORE than two weeks early)
- Breathing difficulties
- Over 4 times more likely to get persistent pulmonary hypertension
- Seventy to 90% more likely to die before hospital discharge (this is of babies who were originally low risk!)
- One to 2% risk of cutting the baby with the knife

Okay, but like I said at the beginning, sometimes cesareans are actually necessary. In other words, due to actual complications, a cesarean provides a higher chance of a successful outcome than a vaginal birth.
These are some GOOD reasons to have a cesarean:
-Severe placental previa
-Placental abruption
-HIV infection
-First time herpes at end of pregnancy
-Severe fetal distress/complications (remember Pitocin/Epidural causes this, so avoid those in the first place at all costs)

These are some BAD reasons to have a cesarean:
-Large baby and/or small pelvis
-More than one week overdue
-Hepatitis B
-Uncomplicated infection with Hepatitis C
-Multiple births
-Small-for-date babies (remember how inaccurate ultrasound readings can be anyway)
-Premature babies
-Recurrence of herpes in mom
-Breech baby: this one is still somewhat debatable, but I do know that my midwife has delivered many breech babies vaginally - at home!

When a cesarean is warranted, here are suggestions as how to have a good cesarean:
*Wait for labor to begin
*Use an epidural or spinal
*Lower the drapes to see the birth
*Clamp cord late or not at all (see last blog post on cord-clamping)
*See or take home placenta
*Immediate skin-to-skin contact with Mom or Dad and continue as much as possible
*Choose a Baby-Friendly Hospital
*Use the lowest dose of painkillers possible following the birth
*Get the two-layer suturing (not one-layer)
*Breastfeed!

So the jist is this: NEVER elect for a cesarean without a GOOD medical cause. Avoid causing the need for a cesarean by not being unnecessarily induced with Pitocin and avoid an epidural at all costs, as both of these increase your chance of cesarean. When a cesarean does have to occur, follow that last list of suggestions. And if you have already had a cesarean and will have another birth, VBAC is definitely an option! And if you really want to increase your chance of avoiding a cesarean, homebirth is your best bet, with only at 3.7% rate of homebirths resulting in cesarean.

As always, I am not claiming to be the know-it-all on childbirth. I am just sharing some of the things I have discovered by educating myself through reading and strongly encourage all of you to do the same.

Cord cutting

Alright what we are talking about here is WHEN to clamp and cut the umbilical cord.

Though I did discover that it is practiced occasionally to never cut or clamp the cord at all, and just allow the cord to separate naturally from the baby, which takes several days (seven days in the case I read). It is called a lotus birth. The placenta was carried around in a bag near the baby until the cord naturally detached from the baby. Just saying it is an option...

Let's talk about what is going on at birth and right after with the baby and the placenta they are still attached to via the umbilical cord:
-After birth the baby's body is going through huge circulatory changes
-The blood in the cord and placenta are a reservoir to aid this placental transfusion (or redistribution).
-As baby squeezes through birth canal, some blood leaves baby and goes back into the placenta
-With each afterbirth contraction, blood is transfused back into baby and then back to placenta during rest periods.
-Crying slows the intake of blood, as does vessel constriction within cord, which basically means the baby can regulate how much blood is being transfused according to their individual needs.
-The majority of the transfusion is done in about 3 minutes (but sometimes as quick as 1 minute and sometimes longer than 3 minutes).
-A skin-to-skin newborn (with their mom) with an unclamped cord can continue to redistribute blood volume until the ideal amount is reached. THEIR optimum amount, which is NOT standard - every baby is different.

This system is currently inoperable in many places since cord-clamping is commonly done 10 to 30 seconds after birth. Early cord clamping deprives baby of an estimated 1.8 to 5.1 ounces of blood. At the upper limit of 5.1 ounces, that is almost half of baby's total volume! The average (natural) placental transfusion is one-fourth to one-third of newborn's total blood volume. Cesarean-born baby's have an even higher risk of no placental transfusion, as the cord is often cut right away.
The best thing to do for the baby is to place naked baby on mom, skin-to-skin, with wrapped placenta until the cord stops pulsating. Then the blood transfusion is done, and baby has their individual, ideal blood volume. Waiting even one minute shows marked improvement in baby.

Risks of early cord clamping:
-Baby loses the iron in that blood they didn't get
-Increased risk of anemia by five times, for baby
-Related to cerebral palsy, autism, and learning difficulties
-Wet lungs are more likely when cesarean babies are deprived of their full placental transfusion
-Especially important to not clamp the cord when resuscitation is needed, as you don't want to deprive them of any of the oxygen in that blood

The practice of clamping the cord right away by doctors is done, supposedly, 'to prevent postpartum hemorrhage'. Though 1 in 6 women who were "actively managed" this way, bled anyway. Whereas a "blood transfusion for postpartum hemorrhage was never necessary" in any of the 26,000 Bantu women who all birthed baby and placenta upright and did nothing to the cord until placenta was delivered.

Side note: It is not worth paying to have the baby's cord blood stored. Research is showing that very rarely (3 total cases ever), is the blood actually helpful, and not infected with the disease they are trying to treat. And in those three cases, there were other possible treatments anyway. And cord blood banking requires early cord clamping. It seems to me that it makes a lot more sense to just let that blood go into and be stored in the baby, rather than pay a bazillion dollars to store it elsewhere.

EPIDURAL

Here goes: the hottest topic out there -> The Epidural.

The epidural provides a painless labor - what could be so bad about that? Let's see, shall we?

First, a quote from Gentle Birth, Gentle Mothering: "Epidural analgesia is one of the most striking examples of the medicalization of normal birth, transforming a physiological event into a medical procedure."

Before diving into all of the physical risks to yourself and your baby of getting an epidural, I want to talk about studies on overall birth satisfaction of women. "Several studies have shown that women who use no labor medication are the most satisfied with their labor at the time, at six weeks, and one year after birth." Yes it did say "at the time", meaning even during the pain of labor. Having experienced one birth with an epidural and one without, I absolutely agree with this. Mostly because of all the complications, interventions, and difficulties for my little one that the epidural ultimately led to (the epidural that was caused by the Pitocin that was caused by going to the hospital too early). I remember when I was a kid asking my mom about childbirth and her saying something like "yeah, it hurt, but you forget pretty fast since you have such a cute baby". And I thought something like "yeah right, she just doesn't want to scar me for life". But there is sort of some truth in what she said. The pain is productive, you make it through, you have an amazing, beautiful baby as a result. It is quite different than worthless pain (like the kind when you push for an hour and a half and absolutely nothing happens because you cannot feel anything because you have an epidural). There is honestly something empowering and valuable about feeling that pain for your child. I wouldn't take it back.

So, onto the thoroughly researched physical effects that an epidural puts you and your baby at risk of. Also, note that there is absolutely no benefit to baby of getting an epidural - only to the mom - if you still consider it a benefit.
-Prolongs labor (average from 4.7 hours to 7.8 hours)
-Doubles the chance of oxytocin augmentation (Pitocin)
-Doubled need for instrumental delivery (forceps/vacuum)
-1.5 times increased risk of cesarean
-Deficits in newborn abilities (drug toxicity/a baby's immature system takes longer to eliminate epidural drugs than adult
-Acidosis in baby (low blood and oxygen supply)
-Decrease in uterine-stimulating prostaglandin F2 alpha (this is what causes the increased labor time)
-Alterations in newborn blood glucose and lipid (fat) levels
-Inhibits the fetus ejection reflex
-Increased length of 2nd stage of labor
-Miss final powerful contractions - must use own effort to compensate (often against gravity due to lying on back)
-Inhibit natural alteration in consciousness
-Inhibit oxytocin production or stop its' rise (hence the need for Pitocin)

There are many more, but let's pause for a minute. Note the one about increase vacuum/forceps use. Instrumental delivery can cause these ongoing problems:
-twice as likely to have severe perineal lacerations
-four times more likely to have perineal pain
-two times more likely to have sexual problems
-two times more likely to have urinary incontinence
-baby is more prone to bruising, facial injuries, displaced skull bones, blood clot in scalp, and is four times more likely to have bleeding in the brain

And more about the possibility of cesarean: When combining epidural with pitocin, your chance of cesarean shoots up to two-thirds of those women. And first time moms that use both an epidural and even a low dose of Pitocin are three times more likely to have a cesarean.

More side effects:
FOR BABY:
-changes in fetal heart-rate (lack of oxygen and blood)
-low APGAR, poor tone, require resucitation, jaundice (even cerebral palsy and brain damage)
-1.3 times the mortality rate for babies born to feverish moms
-invasive tests and antibiotics result from the prolonged separation from mom
-more frequent crying up to 6 weeks old
-less adaptable, more intense
-more bothersome in behavior
-less alertness and ability to orient
-less mature motor abilities
-more response to stress
-more tremulousness and startling
-elevated baseline temperature
-twice as likely to stop breastfeeding by 24 weeks

Effects FOR MOM:
-Life threatening for 1 in 4,000
-twice as likely to have postpartum hemorrhage
-Unexpected breathing difficulties
-Five times more likely to have fever over 100.4 (increased baby mortality, as mentioned above)
-Nausea/vomiting
-Sedation
-Shivering
-Itching of skin
-Inability to pass/hold urine (when epidural is in place)
...and my personal favorite:
-Drop in maternal blood pressure

Seriously?? This is listed as the most common side-effect of an epidural; drop in blood pressure. Remember my 'darling' nurse that nearly killed me by LOWERing my already too low blood pressure, due to a faulty cuff reading. Really people - educate yourselves!! If this nurse had known anything - --ok, sorry. Enough about the nurse.

Anyway, I strongly believe God will not give us more pain than we can handle. It is quite possible to inflict it upon yourself by being induced and lying on your back on a hard hospital bed. The epidural is absolutely a blessing in those horribly long, problematic labors, and of course in NECESSARY C-sections. But I really believe that a lot more women could do it without an epidural if they completely and absolutely made up their mind beforehand to do so, studied natural birth techniques thoroughly, had a super supportive husband or doula, and did not get any labor-inducing interventions.

You can do it ladies! You are stronger than you think!

Birth is Awesome!

One of the best childbirth books I have read and recently finished is called "Adventures in Natural Childbirth." - Edited by Janet Schwegel
It is a book with four sections, all of which have a short intro of the type of birth stories that follow. And the bulk of the book is childbirth stories - those that had natural births with a physician, midwife, doula, or unassisted (hence the four sections). So there is a huge range in the type of women and type of births - though all of them are natural births.
It is a wonderful book because, not only are the experiences of other women really the most educational thing for a pregnant woman, but I really think hearing other stories is the best way to prepare ourselves for our own births. You can read all the statistics and medical proof etc. to explain the harm of unnecessary interventions in normal, healthy deliveries. But hearing experiences like these makes you want to have a natural birth for much more important, 'higher level' reasons than those of just the safety of yourself and your baby. It is hard to explain until you read some of these stories. Natural birth or not - this book really brings out the amazing, exciting, wonderful miracle of birth. Really it is an amazing opportunity that every pregnant woman should look forward to with awe and excitement, not fear or anxiety. A lot of the books out there are about 'what is wrong with non-natural births'. Whereas this one is more about 'what is right with natural births'. Birth can really be a life-changing, mind-altering, transcending, spiritual, awe-inspiring experience. And it should be!
Obviously any kind of birth is awesome because the outcome is a darling, precious gift from God. But it is natural births where the labor and delivery themselves are actually amazing experiences that the women love to talk about and share with their loved ones - not just get it over with (such as most hospital births).

At the beginning of one woman's birth story she said the following so concisely and eloquently that I had to write it down. It's great when other people put your thoughts into words better than you ever could have:
"I thought natural childbirth was for granola-bar hippie types at best or fanatical masochists at worst. It was most certainly not for me, a modern woman of the 21st century... Why not take advantage of the wonderful tools available to us now through the miracle of modern medicine?
"It soon became clear to me that the medical establishment in which I had placed such blind faith was not necessarily treating my pregnant self with my own and my baby's best interests in mind. I am not saying that the medical establishment intended me any harm per se; rather, I think the traditional obstetrical model has become so burdened by the threat of costly litigation and so hamstrung by the insurance industry that it has been forced to manage childbirth and mold it to serve the needs of the medical establishment, not the needs of the women.
"If I could shout to the rooftops so all pregnant women could hear, I would tell them, 'You are stronger than you think, you can have your birth your way, and birth is something to anticipate with joy, not something to dread and fear." (Valerie Larenne's Story, p. 200)

Here are few ditty's from "Gentle Birth, Gentle Mothering" (Buckley):
"Birth is as safe as life gets."
"To be consciously present at birth is equivalent to seven years of meditation."
"We diminish our own authority in birthing and in mothering - we dis-empower ourselves - when we put more faith in information from the outside (tests, scans, others' opinions) than our own internal knowing of our bodies and our babies." p. 31
" I want my babies to do more than merely survive the birth; I want them to be as whole in brain and body as possible." - p. 44

Is the goal just a physically healthy mom and baby, just avoiding death in each case? Or is it more? I'm a shoot-for-the-stars type - if I'm going to do anything at all, I want to do it great, exceptional, in fact. It is pretty amazing how many things in life have prepared me for childbirth - and now particularly for having a home birth. A few things about Janis: loves physical challenges, kind of a dare devil, values the right way more than the common way, and has always had a yearning for an old-fashioned, less complicated way of life...
I am so excited to have this baby! Is it September yet? :)

Pitocin

Okay, let's just dive right in.
I got to admit that as a mathematician I would have hoped this blog was a little more scheduled and organized with some type of pattern, but let's be realistic here - I have two kids!
I decided to do this post about Pitocin (synthetic oxytocin) because getting it when there was no reason to was my first mistake with Cowboy, well except for maybe going to the hospital way too early. Let me summarize what I have learned about Pitocin. A lot of this is taken from the book: Gentle Birth, Gentle Mothering by Sarah J. Buckley, MD. chapter 6. So check it out if you want more info, specific studies and statistics as proof, etc.

First, a word on oxytocin (the real kind that your body makes). Oxytocin is described as the hormone of love. Side note: During the first hour after birth, the highest levels of oxytocin for mother and baby are reached. That first hour after birth is really a rare opportunity for both of you to bond and 'feel the love' - I wouldn't miss it for the world!

Oxytocin is the most powerful contraction-causing hormone. Oxytocin pulsates in a rhythmic pattern during labor for a woman, whereas sythetic oxytocin (most common brand is Pitocin) is given in a steady stream. Pitocin-induced contractions will be longer, stronger, and closer together than natural contractions. This causes stress on their baby because there is little time to recover from each contraction. Here is Doris Haire's description:
"The situation is analogous to holding an infant under the surface of the water, allowing the infant to come to the surface to gasp for air, but not to breathe."
Let's make a list here of the possible risks of using Oxytocin: uterine rupture, deprivation of blood and oxygen to baby, acidosis of baby (deprivation of oxygen during labor), increased need for NICU, and assisted ventilation (breathing) in the newborn period. Right on the label for Pitocin it warns that Pitocin can cause fetal heart abnormalities, low APGAR, jaundice, retinal hemorrhage, brain damage, and fetal death.
Forty-two to fifty-five percent of women using Pitocin experience hyperstimulation and 3% to 6% of those result in caesarean due to fetal distress. There is a three times higher risk of asphyxia for babies born after augmentation with Pitocin. Induced babies are five times more likely to have signs of brain damage at birth.
Okay, that is a lot of risks that all seems crazy, (but the studies are right there in the book!). And my own first-born suffered from fetal stress, had low oxygen levels, had to be transported to NICU and had to have a breathing mask - all of which I feel were directly related to the use of Pitocin.
Late in labor our bodies naturally prodice catecholamines (hormones) that allow our baby to tolerate low levels of oxygen, but not in early labor, so Pitocin used in early labor is especially risky.
Strong contractions (such as those caused by Pitocin) are much more painful and generally lead to the use of pain-killing drugs or an epidural, which leads to less naturally produced oxytocin, which leads to the lack of many of the psycho-emotional benefits of natural oxytocin and the enhanced feelings of calm and connection during labor and after birth.
Pitocin stimulates contractions, but has minimal effects on cervix dilation. So despite the regular, painful contractions, there may be no actual progress in the labor, which will ultimately lead to a necessary cesarean.
A few other risks: Pitocin increases the risk of postpartum hemorrhage, inhibits the natural increase of our bodies' beta-endorphins, reduces the rate of breast-feeding (stress in labor leads to low milk production), affects the autonomic nervous system of baby (that which regulates body temp.) And lastly, Autism, though having many complex causing factors, includes that of exposure to Pitocin at birth.
There is a time and a place for everything - but I am currently having a hard time coming up with a warranted reason to pump Pitocin into a laboring woman's body.

A book you need to read: Gentle Birth, Gentle Mothering - sarah J. Buckley (MD)

The truth

Yeah, yeah, so it is not actually true that I am super brave or tough because I am going natural and having a home birth. In truth, I have really short, and comparatively easy labors and deliveries. After Lady's birth; how short it was, and how much 'easier/better' before, during, and after, than Cowboy's birth was, my hubby and I knew I wanted to go natural with the next birth.
Hubby is into documentaries and with the recent use of Netflix, he spotted one called "The Business of Being Born". Yes, it was hubby's idea to watch this together - great guy! Well, seriously, this was an eye-opening, possibly life-changing movie for me. I strongly encourage any pregnant (or ever planning to be pregnant) woman to see it (though I better put in a warning that you are going to see more naked, pregnant women than you ever wanted to, and hear the F-word screamed by laboring women more times than you want to). After that movie and letting it sink in for a few days, realizing that the 'Pictocin - Epidural - C-Section' pattern referred to that happens all too often in the hospitals is exactly what happened with Cowboy, minus the C-section part -phew! amongst many other staggering statistics (stay tuned: many posts from here on out will be facts, statistics, info, etc.), I seriously started considering alternatives to the hospital, such as a birthing center. (And if we are going to be perfectly honest here, it just so happens that with the birth of my second child and me no longer teaching, I no longer had health insurance).
Discovering that the closest birthing center was an hour away, and let's remember here that Lady's entire labor was about an hour, I naturally started looking into home birth. I have to mention how much of an influence and support my husband is in all of this. I can say, simply, that if he were not completely supportive and just as passionate about the whole thing and wanting to be so involved in the delivery, I don't think I would do a home birth. Fortunately I have a fabulous husband.
Another part of not wanting to deliver in a hospital: I am kind of a pushover. This seems contradictory? Let me explain. I would rather be home, with my husband and midwife who want exactly what I want: to have the baby exactly how I want to have it, and more importantly, exactly how the baby wants it to go - than to be at the hospital where everyone seems to have an opinion and a preference as to how this baby is going to get out. No, it is not that I always like things my way. Kind of the opposite, really. I know myself well enough to know that I struggle saying no or disagreeing with 'authority' under pressure. Right now, under calm circumstances, after much praying, studying, pondering, etc., I know what is best for this baby. And I know that the way that is most likely to happen for me is at home.
I believe the hospital has a very important role in births. The doctors, nurses, and technology have saved countless babies and mothers in high-risk situations, prevented many diseases, dysfunctions, and handicaps, etc. There are times when the best place for a baby to be delivered is at the hospital. But pregnancy and birth are natural and normal, not a medical condition to be treated. So for me, with a normal, healthy pregnancy thus far, home birth is the way to go.

Remember to watch "The Business of Being Born" - a documentary, hosted by Ricki Lake. (On-demand on Netflix, or go buy, rent it or whatever). Here is a link:

http://www.thebusinessofbeingborn.com/testimonials.php

Birth Two: Accidentally Natural

So the second time around I scheduled the week before I was due off of work, mostly so i wouldn't be tempted to go to the hospital prematurely just to get out of work. This time I went with a 'midwife' (CNM). She was good and I liked her, but I honestly waited longer for her appointments than the ones with a doctor. (Honestly as longs as two and half hours one time). She didn't seem quite so paranoid and make me take every test and precaution possible, which was nice. Due to the fact that I had already had one healthy delivery, that makes sense, though. I had 90% made up my mind not to get an epidural and really wanted to try it naturally. Didn't want to use Pitocin, either.

The night before the due date we were hiking around at about 8:30 pm and i was feeling my stomach flex every five minutes, not painful, though. Because we were going to have to leave Cowboy with a neighbor, we thought it would be more polite to drop him off then, than at 3 in the morning. So we went ahead and dropped him off at our friends and then took our time and headed over to the hospital, checking in around 10:30 p.m. I was told I was dilated to a 7! Within a half hour my midwife said I was a 9 and then broke my water. Then it started to hurt - a TON, plus she told me that I was actually only a 7, she could tell better after she broke the water. Well with that 2cm of wind leaving my sail, and being in more pain than I had ever been in my life i asked for an epidural. A nurse had me stand up and then baby came down and, did I mention contractions REALLY HURT - they forced me back on the table (Ouch! that hurt the lower back a LOT) and I pushed once - Hubby is silently freaking out because he can see our daughter's head and there is not a nurse or doctor in the room. The nurse had ran out to grab another doctor - my midwife had run over to the other hospital to deliver another baby. A doctor I had never met runs in, puts on gloves, I push a second time and he catches my daughter, then plops her straight onto my lap (I love that!). I get to hold her and nurse her and love her and it was awesome (and such a relief to be done!) By now it was midnight - yes, an hour and a half after we checked in 'early', or so I thought. Oh, and the epidural doctor had come in to give me the epidural right about the time Lady was crowning, so he said "uh, never mind" and walked back out.

(Just look at that fat belly! She was a full two pounds heavier than her 'big' brother,
weighing in at 9 pounds 4 ounces).

I am so glad Lady came quick and I was able to 'accidentally' experience a natural birth. I was up and walking 10 minutes later. Recovery was a whole lot easier. I was only in serious (and I mean SERIOUS) pain for about 45 minutes of the labor, but I remember thinking only about an hour after she was born, "Yeah, I could maybe do that again (but give me a couple years)." I was honestly going to go to the last hour of church a day and a half after she was born, but couldn't get checked out of the hospital in time.

Lady nursed like a pro right away, was a very content, peaceful baby. Cowboy 'wasn't gaining enough weight' the first week of his life and took a couple days to really nurse. Lady was sleeping through the night in less than a month. Cowboy only took 2 months. I know, where did I get these perfect children, right? So they were both very happy, content babies - the delivery itself affected maybe the first week of their life. But who knows, Cowboy definitely had a lot more sleeping problems than Lady and 'separation' problems even until now, three years later.

What i would change...and will with the next birth: Do not labor while lying on my back, possibly not get my water broken, plan for a natural birth...at home

Birth One: Just what the doctor ordered.

Less than 24 hours after finding out I was pregnant, I asked my sister-in-law (who already had two children), "Now what do I do?" This illustrates pretty well how clueless I was on the whole birth thing. I did exactly what she suggested, made an appointment with her doctor and went to this doctor every four weeks until Cowboy was born. I read most of one book, "What to Expect When You are Expecting", lent to me be another sister-in-law, and went to a birthing class at the hospital with my husband (who was relieved that we at least didn't have to practice breathing exercises and laboring positions).
12 days before I was due, at a regular check-up, i was informed after taking a stress test that I was in Labor. "Uh...what? Isn't it supposed to hurt or something?" I thought. "Well this here monitor says you are having regular contractions." So I think, "Sweet! I won't have to go to work tomorrow and I will get to meet my son two weeks early! Nothing wrong with that, right?" So we head to the hospital that evening. Upon arriving at the hospital, I am immediately given Pitocin, which I think nothing of. The sooner this baby is out the better :) Everything is hunky-dory. I occasionally hear blurbs like"his heart rate is a little high" and "he is not getting quite enough oxygen" so "we are going to give you some more Pitocin." The Pitocin does exactly what it is supposed to do and I get seriously painful contractions and then ask for an Epidural (which I had not made an extremely firm decision about using or not at that point). By the time it is time to push, according to doc, I can't feel a thing. So I push for the most exhaustive hour and a half of my life and accomplish approximately nothing and Cowboy is eventually pulled out with a vacuum. I catch a glimpse of my long awaited first baby, who is not breathing great, so they put an oxygen mask on him and take him down to the NICU, and I wait another EIGHT HOURS until I get to hold my son for the first time.

During that eight hours? Of course I am exhausted and sleep on and off, wait for the epidural to wear off and try to walk again, and deal with all the fun aftermath of birth and tearing and what have you. But to top it all off, my darling nurse does some regular testing, including my blood pressure, and says,"Your blood pressure is a little high, so I am going to give you this drug to lower it." I reply, "High? I have only ever been told it is on the low side. That is strange." Checks a few minutes later, still high, more drugs. Then she has me get up and go to the bathroom and I proceed to throw-up for the third time in my entire life, and pass-out twice. She unplugs the BP cuff and plugs it back in, checks me again, and what do you know, my blood pressure is now dangerously low (due to the BP lowering drug)...uh, yeah. Shall we listen to the machine or the patient?

Anyway, my darling son is a perfectly healthy, rambunctious boy and I love him more than anything. All is well that ends well, right? I can't change the past, it is how it is. I think even if I had educated myself a lot better at that point in time, I still don't know how much I would have changed about the whole thing. What I strongly believe, though, is if we would have just waited until Cowboy was ready to come, instead of unnecessarily inducing him into the world, the whole birth would have gone a whole lot smoother.

Moral/What I would change...and will with the next birth: Let baby pick day to be delivered (not me, not doctor, not machine), do not get induced, no unnecessary Pitocin, no unnecessary epidural

I'm Pregnant!

I'm Pregnant!
I'm due on September 5, 2011, which happens to be Labor Day.
We do not plan on finding out whether it is a boy or girl until after the baby is born.
I plan on having this baby at home with a midwife and my husband.

This blog was created to share a little bit of what I have learned about childbirth, what I wish I had known before my first child was born, and why I am choosing a Home Birth.