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!