I made an appearance in central Mass. the other night for a screening of the "Business of Being Born," an event organized by doula/Mothers & Co. owner Jeanette Mesite Frem. Jeanette was telling me that she is in a new film called "Being Dad," filmed by Australians and premiering in the US this summer. The film is meant to answer the question what should men expect when they're expecting?
To view the trailer, see: http://apac.vividas.com/5784_BeingDad/web/
I believe there are clips on YouTube, as well.
It's a great idea for a film. Whatever it takes to keep men connected and from saying things like, "Do you really want another piece of cake," when his wife is 9 mos. pregnant.
Meanwhile, today I got an email from Clay Nichols, who runs DadLabs, which is back from a five-day excursion to Stockholm to see first-hand the most dad-friendly place on earth. They were hosted by Baby Bjorn, who introduced the to politicians, daycare centers, and dads that have benefitted from Sweden’s progressive pro-family policies. DadLabs was most impressed with how connected to their children and happy with the paternity leave policy the dads of Stockholm were. The trip culminated with a meeting with the man behind the brand, Bjorn Jacobson.
www.dadlabs.com
Sunday, June 15, 2008
Wednesday, June 04, 2008
Breakfast with Gloria Steinem
I had breakfast with Gloria Steinem this morning -- me and 1,000 other of her BFFs in Boston, at an event put on by The Commonwealth Institute, an organization that promotes women in business. She said a few things that really made me think. And a few things that really made me laugh, including: "I'd like to create a button that says 'The truth shall set you free, but first it will piss you off.'" Amen sistah.
She also talked alot about how family forms have a real connection to international and governmental relations. For example, the Native Americans had egalitarian family structures, where gender was never an issue. That lack of bias or set roles was reflected in their government, where female elders chose a chief and they could remove a chief. With three boys in the house, I will consider it a job well done if, when they grow up, they empty the dishwasher without their wives having to ask.
Later in the program a member of the audience asked her why younger women don't seem to appreciate all the hard-fought freedoms they have. This question posited -- without saying it -- why is this generation of women getting MBAs and then become stay-at-home moms? Gloria said she did not think young women don't appreciate their freedoms. It's just that women tend not to become activists about anything until they are older, and begin to feel their personal power slip away. Young women have all the power; they are fertile, pretty, etc., she said. As we age, all that changes.
She also talked alot about how family forms have a real connection to international and governmental relations. For example, the Native Americans had egalitarian family structures, where gender was never an issue. That lack of bias or set roles was reflected in their government, where female elders chose a chief and they could remove a chief. With three boys in the house, I will consider it a job well done if, when they grow up, they empty the dishwasher without their wives having to ask.
Later in the program a member of the audience asked her why younger women don't seem to appreciate all the hard-fought freedoms they have. This question posited -- without saying it -- why is this generation of women getting MBAs and then become stay-at-home moms? Gloria said she did not think young women don't appreciate their freedoms. It's just that women tend not to become activists about anything until they are older, and begin to feel their personal power slip away. Young women have all the power; they are fertile, pretty, etc., she said. As we age, all that changes.
Sunday, June 01, 2008
From today's New York Times, an absolutely outrageous tale of insurance companies denying coverage for women with previous cesareans. As always, it is money dictating the rules of health care. Of course, money (malpractice fears) is one of the reasons why the c-section rate in the US at 1 out of every 3 births. Honestly, it is surprising that it took insurance companies this long to wake up to the fact that they are paying either way -- for the c-sections that don't get done when they should, those that get done poorly (regardless of whether they were necessary) or when a woman is denied access to a vaginal birth after cesarean, which is happening more and more...
June 1, 2008
After Caesareans, Some See Higher Insurance Cost
By DENISE GRADY
When the Golden Rule Insurance Company rejected her application for health coverage last year, Peggy Robertson was mystified.
“It made no sense,” said Ms. Robertson, 39, who lives in Centennial, Colo. “I’m in perfect health.”
She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified.
Ms. Robertson had been shopping around for individual health insurance, the kind that people buy on their own. She already had insurance but was looking for a better rate. After being rejected by Golden Rule, she kept her existing coverage.
With individual insurance, unlike the group coverage usually sponsored by employers, insurance companies in many states are free to pick and choose the people and conditions they cover, and base the price on a person’s medical history. Sometimes, a past Caesarean means higher premiums.
Although it is not known how many women are in Ms. Robertson’s situation, the number seems likely to increase, because the pool of people seeking individual health insurance, now about 18 million, has been growing steadily — and so has the Caesarean rate, which is at an all-time high of 31.1 percent. In 2006, more than 1.2 million Caesareans were performed in the United States, and researchers estimate that each year, half a million women giving birth have had previous Caesareans.
“Obstetricians are rendering large numbers of women uninsurable by overusing this surgery,” said Pamela Udy, president of the International Caesarean Awareness Network, a group whose mission is to prevent unnecessary Caesareans.
Although many women who have had a Caesarean can safely have a normal birth later, something that Ms. Udy’s group advocates, in recent years many doctors and hospitals have refused to allow such births, because they carry a small risk of a potentially fatal complication, uterine rupture. Now, Ms. Udy says, insurers are adding insult to injury. Not only are women feeling pressure to have Caesareans that they do not want and may not need, but they may also be denied coverage for the surgery.
“You have women just caught in the middle of this huge triangle of hospitals, insurance companies and doctors pointing the finger at each other,” Ms. Udy said.
Insurers’ rules on prior Caesareans vary by company and also by state, since the states regulate insurers, said Susan Pisano of America’s Health Insurance Plans, a trade group. Some companies ignore the surgery, she said, but others treat it like a pre-existing condition.
“Sometimes the coverage will come with a rider saying that coverage for a Caesarean delivery is excluded for a period of time,” Ms. Pisano said. Sometimes, she said, applicants with prior Caesareans are charged higher premiums or deductibles.
“In many respects it works a lot like other situations where someone has a condition that will foreshadow the potential for higher costs going forward,” Ms. Pisano said.
Her group has reported that although most Americans with health insurance, 160 million, have group plans through employers, the number needing individual policies will probably keep rising, because more and more people are becoming self-employed or taking jobs without health benefits.
In a letter to Ms. Robertson, Golden Rule, which sells individual policies in 30 states, said it would insure a woman who had had a Caesarean only if it could exclude paying for another one for three years. But in Colorado, such exclusions are considered discriminatory and are forbidden, so Golden Rule simply rejects women who have had the surgery, unless they have been sterilized or meet the company’s age requirements.
“If you don’t work for someone who has insurance, and you have to get insurance on your own, this is terrifying,” Ms. Robertson said.
A spokeswoman for Golden Rule declined to explain how long it had been excluding Caesareans, how it had decided to do so or how many were affected, saying the information was proprietary. The company, based in Indianapolis, is owned by UnitedHealthcare, which collects more than $50 billion a year in premiums and has 26 million members, most with group coverage.
In Colorado, people denied individual health insurance can obtain it through a state program, Cover Colorado, which insures about 7,200 people. But the premiums are high, 140 percent of standard rates, a spokeswoman said, adding that some women had enrolled specifically because prior Caesareans had disqualified them from private insurance.
Blue Cross Blue Shield of Florida, which has about 300,000 members with individual coverage, used to exclude repeat Caesareans, but recently began to cover them — for a 25 percent increase in premiums for five years. Like Golden Rule, the company exempts women if they have been sterilized.
“After five years, if there is not a complication of pregnancy, another C-section, or if they get their tubes tied and are no longer in that risk situation, that rate-up goes away,” said Randy M. Kammer, the vice president for regulatory affairs and public policy.
The higher rate is based on a Caesarean costing an average of $2,700 more than a vaginal birth (assuming no complications in either type of delivery). Ms. Kammer said Blue Cross Blue Shield could not provide a tally of how many members were paying the higher rates because of Caesareans.
“The aggravating thing is, there are a lot of elective Caesareans, and that adds to costs,” she said.
Elizabeth Bonet, who lives in Sunrise, Fla., learned about the higher rates this year when she applied to Blue Cross Blue Shield of Florida.
“I was very angry, outraged, shocked,” Ms. Bonet said. “It made me feel very helpless. These were not Caesareans I wanted. They were not elective Caesareans. I very much wanted natural births with both babies and was not able to have them, and to have to pay for that for years is outrageous, and I feel it’s discriminatory as well.”
Each state’s Blue Cross Blue Shield plan sets its own policies. In Texas, a spokeswoman said, a prior Caesarean will not affect a woman’s premiums or insurability, as long as she has recovered fully.
A spokeswoman for another major insurer, Wellpoint, said the company’s decisions about prior Caesareans varied case by case, but declined to explain further.
Aetna does not treat a Caesarean itself as a pre-existing condition, but does factor in chronic or recurring problems that might have led to the Caesarean, like diabetes or high blood pressure, a spokeswoman said.
A spokeswoman for another company, Mega Life and Health Insurance, in North Richland Hills, Tex., said: “If the Caesarean section was considered by the physician to be medically necessary for the safety of the mother or child then coverage is issued without conditions. If the procedure was determined to be ‘elective,’ coverage would be offered with a temporary waiver or at a higher premium rate.”
Insurers often accuse women and obstetricians of scheduling unneeded Caesareans for their own convenience — to deliver the baby at a certain time, or to avoid labor. But it is not known how much of the overall increase in Caesareans is because of a rise in unnecessary operations, or how many Caesareans are done at the mother’s request, according to a 2006 report by the National Institutes of Health.
“I think it’s really a very small amount, but we need more data,” said Dr. Mary D’Alton, chief of obstetrics and gynecology at Columbia University Medical Center, and an author of the report.
She said she was amazed to hear that insurers would charge higher premiums or deny coverage because of a past Caesarean.
“I would think if it’s happening, the medical profession has to take a stand,” Dr. D’Alton said.
But to people familiar with the rough and tumble world of individual insurance, the companies’ practices are no surprise.
Individual insurance differs sharply from the group coverage with which most people are familiar. Group policies generally require that the insurer cover everybody in the group, and charge the same rates for all. But with individual coverage, insurers in many states can vary their prices based on medical history, exclude certain services or reject anyone they consider a bad risk. (Several states, however, including New York, New Jersey and Massachusetts, ban such practices.)
Insurers say they need these strategies to protect themselves, because some customers apply only after they get sick or pregnant, skewing the pool toward people with high expenses.
Ms. Robertson said that had she known a Caesarean was grounds for rejection, she would not have even applied to Golden Rule, because the denial may be held against her in the future. Insurers routinely ask applicants if they have ever been denied, and red-flag anyone who says yes.
“My understanding is that once you’re denied it’s hard to get other insurance,” Ms. Robertson said. “Man, is that a scary thing.”
June 1, 2008
After Caesareans, Some See Higher Insurance Cost
By DENISE GRADY
When the Golden Rule Insurance Company rejected her application for health coverage last year, Peggy Robertson was mystified.
“It made no sense,” said Ms. Robertson, 39, who lives in Centennial, Colo. “I’m in perfect health.”
She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified.
Ms. Robertson had been shopping around for individual health insurance, the kind that people buy on their own. She already had insurance but was looking for a better rate. After being rejected by Golden Rule, she kept her existing coverage.
With individual insurance, unlike the group coverage usually sponsored by employers, insurance companies in many states are free to pick and choose the people and conditions they cover, and base the price on a person’s medical history. Sometimes, a past Caesarean means higher premiums.
Although it is not known how many women are in Ms. Robertson’s situation, the number seems likely to increase, because the pool of people seeking individual health insurance, now about 18 million, has been growing steadily — and so has the Caesarean rate, which is at an all-time high of 31.1 percent. In 2006, more than 1.2 million Caesareans were performed in the United States, and researchers estimate that each year, half a million women giving birth have had previous Caesareans.
“Obstetricians are rendering large numbers of women uninsurable by overusing this surgery,” said Pamela Udy, president of the International Caesarean Awareness Network, a group whose mission is to prevent unnecessary Caesareans.
Although many women who have had a Caesarean can safely have a normal birth later, something that Ms. Udy’s group advocates, in recent years many doctors and hospitals have refused to allow such births, because they carry a small risk of a potentially fatal complication, uterine rupture. Now, Ms. Udy says, insurers are adding insult to injury. Not only are women feeling pressure to have Caesareans that they do not want and may not need, but they may also be denied coverage for the surgery.
“You have women just caught in the middle of this huge triangle of hospitals, insurance companies and doctors pointing the finger at each other,” Ms. Udy said.
Insurers’ rules on prior Caesareans vary by company and also by state, since the states regulate insurers, said Susan Pisano of America’s Health Insurance Plans, a trade group. Some companies ignore the surgery, she said, but others treat it like a pre-existing condition.
“Sometimes the coverage will come with a rider saying that coverage for a Caesarean delivery is excluded for a period of time,” Ms. Pisano said. Sometimes, she said, applicants with prior Caesareans are charged higher premiums or deductibles.
“In many respects it works a lot like other situations where someone has a condition that will foreshadow the potential for higher costs going forward,” Ms. Pisano said.
Her group has reported that although most Americans with health insurance, 160 million, have group plans through employers, the number needing individual policies will probably keep rising, because more and more people are becoming self-employed or taking jobs without health benefits.
In a letter to Ms. Robertson, Golden Rule, which sells individual policies in 30 states, said it would insure a woman who had had a Caesarean only if it could exclude paying for another one for three years. But in Colorado, such exclusions are considered discriminatory and are forbidden, so Golden Rule simply rejects women who have had the surgery, unless they have been sterilized or meet the company’s age requirements.
“If you don’t work for someone who has insurance, and you have to get insurance on your own, this is terrifying,” Ms. Robertson said.
A spokeswoman for Golden Rule declined to explain how long it had been excluding Caesareans, how it had decided to do so or how many were affected, saying the information was proprietary. The company, based in Indianapolis, is owned by UnitedHealthcare, which collects more than $50 billion a year in premiums and has 26 million members, most with group coverage.
In Colorado, people denied individual health insurance can obtain it through a state program, Cover Colorado, which insures about 7,200 people. But the premiums are high, 140 percent of standard rates, a spokeswoman said, adding that some women had enrolled specifically because prior Caesareans had disqualified them from private insurance.
Blue Cross Blue Shield of Florida, which has about 300,000 members with individual coverage, used to exclude repeat Caesareans, but recently began to cover them — for a 25 percent increase in premiums for five years. Like Golden Rule, the company exempts women if they have been sterilized.
“After five years, if there is not a complication of pregnancy, another C-section, or if they get their tubes tied and are no longer in that risk situation, that rate-up goes away,” said Randy M. Kammer, the vice president for regulatory affairs and public policy.
The higher rate is based on a Caesarean costing an average of $2,700 more than a vaginal birth (assuming no complications in either type of delivery). Ms. Kammer said Blue Cross Blue Shield could not provide a tally of how many members were paying the higher rates because of Caesareans.
“The aggravating thing is, there are a lot of elective Caesareans, and that adds to costs,” she said.
Elizabeth Bonet, who lives in Sunrise, Fla., learned about the higher rates this year when she applied to Blue Cross Blue Shield of Florida.
“I was very angry, outraged, shocked,” Ms. Bonet said. “It made me feel very helpless. These were not Caesareans I wanted. They were not elective Caesareans. I very much wanted natural births with both babies and was not able to have them, and to have to pay for that for years is outrageous, and I feel it’s discriminatory as well.”
Each state’s Blue Cross Blue Shield plan sets its own policies. In Texas, a spokeswoman said, a prior Caesarean will not affect a woman’s premiums or insurability, as long as she has recovered fully.
A spokeswoman for another major insurer, Wellpoint, said the company’s decisions about prior Caesareans varied case by case, but declined to explain further.
Aetna does not treat a Caesarean itself as a pre-existing condition, but does factor in chronic or recurring problems that might have led to the Caesarean, like diabetes or high blood pressure, a spokeswoman said.
A spokeswoman for another company, Mega Life and Health Insurance, in North Richland Hills, Tex., said: “If the Caesarean section was considered by the physician to be medically necessary for the safety of the mother or child then coverage is issued without conditions. If the procedure was determined to be ‘elective,’ coverage would be offered with a temporary waiver or at a higher premium rate.”
Insurers often accuse women and obstetricians of scheduling unneeded Caesareans for their own convenience — to deliver the baby at a certain time, or to avoid labor. But it is not known how much of the overall increase in Caesareans is because of a rise in unnecessary operations, or how many Caesareans are done at the mother’s request, according to a 2006 report by the National Institutes of Health.
“I think it’s really a very small amount, but we need more data,” said Dr. Mary D’Alton, chief of obstetrics and gynecology at Columbia University Medical Center, and an author of the report.
She said she was amazed to hear that insurers would charge higher premiums or deny coverage because of a past Caesarean.
“I would think if it’s happening, the medical profession has to take a stand,” Dr. D’Alton said.
But to people familiar with the rough and tumble world of individual insurance, the companies’ practices are no surprise.
Individual insurance differs sharply from the group coverage with which most people are familiar. Group policies generally require that the insurer cover everybody in the group, and charge the same rates for all. But with individual coverage, insurers in many states can vary their prices based on medical history, exclude certain services or reject anyone they consider a bad risk. (Several states, however, including New York, New Jersey and Massachusetts, ban such practices.)
Insurers say they need these strategies to protect themselves, because some customers apply only after they get sick or pregnant, skewing the pool toward people with high expenses.
Ms. Robertson said that had she known a Caesarean was grounds for rejection, she would not have even applied to Golden Rule, because the denial may be held against her in the future. Insurers routinely ask applicants if they have ever been denied, and red-flag anyone who says yes.
“My understanding is that once you’re denied it’s hard to get other insurance,” Ms. Robertson said. “Man, is that a scary thing.”
Wednesday, May 28, 2008
A new c-section product
I received an interesting email from Digital Influence Group, a social media agency that actively engages in online conversations on behalf of their clients -- in this case, Genzyme, the biotech firm. Here's what the email said: "Digital Influence has been "raising awareness about c-sections; particularly c-section related adhesions, for Seprafilm, an adhesion barrier manufactured by Genzyme which helps minimize the risk of forming adhesions following abdominal surgery. As a result of our research, we’ve found that few women are aware of this potential complication, and that even fewer know there are preventative measures that can be taken. We’ve put together a quick list of links on this topic at http://del.icio.us/adhesion_awarenesss to help spread awareness, and thought you might be interested in the content there as well."
Monday, May 26, 2008
The constant gardener
This is Harrison today, at 5 months, enjoying his first picnic in the park, after which we decided to go home and plant my placenta. I took it out of the freezer last night, as if it were a piece of steak, but somehow it just did not seem right sticking it in the ground frozen. This morning, I couldn't look at the plastic Ziploc bag anymore and made haste to buy a plant to go in the ground. I chose a climbing rose bush with fragrant peachy blooms. I dug a hole in the one spot in the garden where the rose bush would fit, hard by a tree stump. I couldn't dig quite so far because I kept hitting roots. So I eyeballed the depth and, with sweaty brow, unwrapped the placenta and its loooong cord, marveled at it, was thankful for it, and tried not to wretch. I put it in the ground, placed the bush on top and began back filling. Of course, the hole was not deep enough. The only other place to plant it was in a large whiskey barrel. I dug a hole there, yanked up the bush, and then kept digging looking for the placenta. Suddenly, I felt like I was living an episode of CSI. What was wrong with me? I glanced up to see if any neighbors were looking. I grabbed the earth-encrusted placenta, dangling from its cord, and placed it in the planter, dropped in the bush, and covered it all up quickly.
I can't wait to see -- and smell -- it bloom.
Saturday, May 24, 2008
ACNM's Annual Meeting
I gave a little talk and signed some books at the American College of Nurse Midwives' Annual Meeting in Boston today. And after the book signing, there was a screening of the "Business of Being Born," a documentary that every woman should see. Anyway, what really struck me was how transformative the film can be for lay people. After the show, a young couple who had wandered in off the street to see the film came up to me, clearly moved by what they had seen. "Where do I even begin to look for a midwife?" she asked. "To think that an hour ago I was making fun of the word 'doula,'" he said. "What a cute couple," I thought. Another person made the comment that home birth midwives are suddenly very, very busy. Music to my ears.
Friday, May 23, 2008
Placental palliative
As we head into Memorial Day weekend, and I finally pull my placenta out of the freezer and plant it (your suggestions have been fantastic, thank you!) I came across this news story on Indian MSN and it made me think even harder about what an interesting organ the placenta is.
http://lifestyle.in.msn.com/health/article.aspx?cp-documentid=1413857
Birth waste to heal wounds faster
The delicate and durable membrane that protects the baby in the mother's womb called amnion is normally discarded after the baby's birth. But now this membrane is being used here in eye surgery besides ulcers, burns, diabetic ulcers, bedsores et al
Eighteen-months old Raju (name changed) screamed with pain when boiling dal fell on him. His tender skin - half his body - had suffered second-degree burns. Panic-stricken parents rushed him to Mumbai's known plastic surgeon Dr Kalpesh Gajiwala.
After cleaning the wound and removing the dead skin, Dr Gajiwala placed the transparent biological dressing ‘Amnion' directly on the wound. The transparent thin dressing stuck easily to the oozing surface and sealed it completely . It automatically peeled off after the wound had healed. The child was saved from the trauma of daily dressing.
In the words of Dr Kalpesh who uses amnion quite extensively either in preparing the burn wounds for a skin graft or to help heal the sites from which a skin graft has been taken says, "It helps in faster healing and causes much less scarring."
Perhaps there can't be a better recycling of "after birth waste."
The delicate and durable membrane that protects the baby in the mother's womb called amnion is normally discarded after the baby's birth. But now this membrane is being used here in eye surgery besides ulcers, burns, diabetic ulcers, bedsores et al. And it is available in ‘ready to use' packs at India's only ISO 9001:2000 certified Tissue Bank of Tata Memorial Hospital.
As of now the hospital recovers this precious after birth waste from the two maternity hospitals in its vicinity to be processed; freeze dried, sterilised by gamma radiation and packaged. As amnion dressings are stored at room temperature, packets are easily mailed anywhere in the country .
Unfortunately this amazing membrane is going waste in the rest of the city and country. The solution lies in setting up a national bank. As its production is directly linked to the childbirth, the raw material availability will never be a problem in a country that is battling to arrest the birth rate. Only the donors will have to come forward as their consent is required even though it is a discarded tissue.
"The donor has to know its specific use and also give consent for the testing of the do- nated blood sample for HIV Hepatitis , etc," says Dr Astrid Lobo Gajiwala, head of the Tissue Bank. As many as 5,00,000 patients are treated in United States every year with amnion.
The biological wound dressing can be used on any part of the body. The largest size available is 20X20cms and smallest is 4X4cms. It sticks like a stamp, seals off the wound and peels off as the wound heels. Its cheap, it's transparent, and is usually preferred as it mimics the skin. Analgesic use is also reduced, as there is almost immediate pain relief.
http://lifestyle.in.msn.com/health/article.aspx?cp-documentid=1413857
Birth waste to heal wounds faster
The delicate and durable membrane that protects the baby in the mother's womb called amnion is normally discarded after the baby's birth. But now this membrane is being used here in eye surgery besides ulcers, burns, diabetic ulcers, bedsores et al
Eighteen-months old Raju (name changed) screamed with pain when boiling dal fell on him. His tender skin - half his body - had suffered second-degree burns. Panic-stricken parents rushed him to Mumbai's known plastic surgeon Dr Kalpesh Gajiwala.
After cleaning the wound and removing the dead skin, Dr Gajiwala placed the transparent biological dressing ‘Amnion' directly on the wound. The transparent thin dressing stuck easily to the oozing surface and sealed it completely . It automatically peeled off after the wound had healed. The child was saved from the trauma of daily dressing.
In the words of Dr Kalpesh who uses amnion quite extensively either in preparing the burn wounds for a skin graft or to help heal the sites from which a skin graft has been taken says, "It helps in faster healing and causes much less scarring."
Perhaps there can't be a better recycling of "after birth waste."
The delicate and durable membrane that protects the baby in the mother's womb called amnion is normally discarded after the baby's birth. But now this membrane is being used here in eye surgery besides ulcers, burns, diabetic ulcers, bedsores et al. And it is available in ‘ready to use' packs at India's only ISO 9001:2000 certified Tissue Bank of Tata Memorial Hospital.
As of now the hospital recovers this precious after birth waste from the two maternity hospitals in its vicinity to be processed; freeze dried, sterilised by gamma radiation and packaged. As amnion dressings are stored at room temperature, packets are easily mailed anywhere in the country .
Unfortunately this amazing membrane is going waste in the rest of the city and country. The solution lies in setting up a national bank. As its production is directly linked to the childbirth, the raw material availability will never be a problem in a country that is battling to arrest the birth rate. Only the donors will have to come forward as their consent is required even though it is a discarded tissue.
"The donor has to know its specific use and also give consent for the testing of the do- nated blood sample for HIV Hepatitis , etc," says Dr Astrid Lobo Gajiwala, head of the Tissue Bank. As many as 5,00,000 patients are treated in United States every year with amnion.
The biological wound dressing can be used on any part of the body. The largest size available is 20X20cms and smallest is 4X4cms. It sticks like a stamp, seals off the wound and peels off as the wound heels. Its cheap, it's transparent, and is usually preferred as it mimics the skin. Analgesic use is also reduced, as there is almost immediate pain relief.
Wednesday, May 14, 2008
Placenta puzzle
OK, it's spring, and I am as behind on gardening as I have been on posting to this blog. I blame the mommy vortex for sucking up any free time. But anyway, I am realizing that I have a short window to take my placenta out of the freezer, bury it in the garden and perhaps plant something on top of it. Any recommendatins? We live in the city and have a very small backyard, already full with flowers and lilacs and forsythia. In other words, a maple tree won't work. Thoughts welcome!
Monday, April 21, 2008
Cast a vote
The headline in the paper today made my heart leap: "Push for Labor Support." Really? I thought. It's about time! Every woman deserves encouragement when giving birth. But then I realized the story was about Obama and Clinton and trade unions. Bummer. Clearly my head is in a different place.
Saturday, April 05, 2008
Our new baby, installment #36
... and second guest appearance by the home birth husband. Americans get entrenched in a set way of doing things; the years go by and all the protocols become automated, the accepted process is the path of least resistance, and it takes real effort to do anything differently. It's that way with sprawl, a subject I've written about, and this kind of self-reinforcing dynamic is very much at work in the business of being born. The hospitals take care of all the little details of bringing a new person into the world. Two specifics: the birth certificate and the social security number. In the days following Harrison's birth I called City Hall to see what I had to do to get a birth certificate, and wasn't given the full story. I came in armed with what I thought was sufficient documentation, only to be told I needed our marriage license; not immediately apparent why the city needed to know if we were married or not, but if we weren't, the mother needed to come apply. There was no answer at City Hall in Cambridge where we were married -- it was a Friday -- so I drove down to the state bureau of vital statistics to pull a copy (for about $20). Then I had to fill out a lengthy questionnaire with all kinds of personal questions that I had to ask Tina on the mobile phone in the busy municipal office. Needless to say this took the better part of a day. Next task: taking said birth certificate down to the Social Security administration to apply for Harrison's number. We need it for our tax return to prove the addition of a dependent, but the mutiple pages of instructions on the web seem to indicate it could take 12 weeks. And so we're forced to enter into another tried and true convention: the filing extension. Small price to pay, all of this, but just another indication of how the system makes us feel like we did something really unusual.
Monday, March 31, 2008
You call that a vacation?
So we're just back from Disney World...I have two things to say. First, we paid ten bucks for a balloon. One balloon. And second, the only billboard between the Magic Kingdom and the airport that was not for a theme park? It was for www.vasectomy.com.
Monday, March 24, 2008
Our new baby, installment #35
About 10 weeks after Harrison was born at home, my mother asked me to come down to Bellani Maternity, a boutique near her house, to watch a screening of "The Business of Being Born," Ricki Lake's new documentary, for which I was interviewed. What was special for me about this night was that my grandmother and my sister-in-law would be coming, too. Before we watched the film, my mother and I added up all the births among the surviving women on our one side of the family. My grandmother had three children. My mother two. My aunt 2; her daughter, 1; my sister-in-law, 1; and I had two. Out of those 11, 10 births were either horrendous, cesareans, or extremely painful. Only one birth was absolutely without complications and would be remembered for how simply wonderful it was -- the one that happened at home, with a midwife, my second child. Although my mother finally understands why hospitals can get in the way of childbirth, the results of our little mathematical exercise was still surprising. After the film, I mentioned the family statistics to my grandmother, who was unconscious during her births thanks to Twilight Sleep, and I think for the first time she, too, understood that birth could be better if we left it alone. It was a small triumph.
Monday, March 17, 2008
Our new baby, installment #34
Our midwife came to check on us three times after the baby was born, each time staying for more than a hour, weighing the baby, giving me a once-over, talking with the older boys. From a service perspective, it was downright luxurious, not having to dress a newborn and head out to a doctor's office in the freezing cold. This postpartum care was included in the fee we had to pay out-of-pocket for a home birth -- a cost that our premium insurance policy does not cover even though we are fully insured. Just because it happened at home. Knowing that insurers had spent $25,000 for my cesarean four years ago, and had just spent $11,000 for my cousin's vaginal birth in a hospital (she was later readmitted for infection but that was a separate bill), the thought that the insurance company could pay a fraction of those costs and have better outcomes and happier moms is nonsensical. It's a very dysfunctional system.
Wednesday, March 12, 2008
Our new baby, installment #33 (guest blogger/the husband)
I guess you can consider me the home-birth husband. When Tina first suggested it, I wondered if there was a middle ground -- a birth attended by a midwife in a birth center. No such thing, she reminded me, in Massachusetts. I then said a home birth is one thing, but a home birth VBAC sounded hard-core. Wrong again, as our wonderful midwife explained; no particular issues there. Then why don't hospitals do VBACs? A questionnable study, insurance, and lawsuits. Such was the process of my re-education. I learned I had to buy-in 100 percent and nothing less. No emphasis on the back-up plan, transport to the hospital if 'something goes wrong.' No dwelling on something going wrong. So when it was clear that Tina was in labor that Friday night, I felt disciplined, and was thinking positive, which helped me be less nervous. Although I did want the midwife to be there the minute after the first strong contraction. In retrospect I thought maybe I put my heart and mind in the hands of the midwife in the place of the doctors at the hospital -- the new expert to calm my fears -- but that wasn't really what happened. She came, I parked her car, she had a suitcase of stuff, and she went to my wife. The next two hours were between Tina and her. I fetched things and paced around the tub I had set up. After reading Tina's book, I was at peace with a man's minimal role. I caressed her forehead but it didn't seem like she was too aware of my doing so; she was busy, in the zone. It was an incredible athletic event, and I didn't feel like saying 'You're doing great' or any such thing, any more than it would be effective to say something encouraging to Derek Jeter ranging for a sharply hit ground ball. Maybe I was in a trance, but I even went along with the gag on the whole thing happening in the water. My surprise was that it was a boy. I was impressed by how attentive the midwife team was on checking Harrison out, and examining Tina -- checklists, all very thorough. I had no idea there was any kind of issue about the placenta and didn't worry at that stage, either. When it was delivered the midwife showed me what an ingenius contraption it was, sustaining Harrison for 39 weeks. It was a cold night, and I remember thinking, all they had to do was move one room over, mother and child. We were home.
Sunday, March 09, 2008
Our new baby, installment #32
Once labor and birth were finished, the reality of being at home really kicked in. The midwife weighed Harrison (7 pounds even) in a sling right by my side. She did her check up of him beside me on the bed. There were no heel pricks. No Hep B vaccines. No sugar water on the tongue. No discussion of circumcision. No incubator. No one saying they were taking him away for a bath.
My husband rummaged through the dark to find the baby something to wear -- no standard issue hospital garb. I jumped in the shower and gingerly got back in bed. My husband made me a sandwich and brought me a big pitcher of water to slake my thirst and we toasted the midwives and Harrison with some champagne and cake, which the midwives ate downstairs to give us time alone.
Harrison was born at 5 minutes past midnight. The midwives stayed to check on us all until close to 4 a.m., when they finally said goodbye, with assurances of a visit later in the day. We were too excited to fall asleep, and stayed in bed marveling at the baby. At 5:30, our 4-year-old came in and did a double take when he saw his new brother in the bed. It was like Christmas morning. He crawled in with us and we all stayed happily together until my parents, grandparents, aunt and cousin arrived with breakfast. It felt so great having them all there at the house, knowing they could stay as long as they wanted. My 85-year-old arthritic grandfather endured a long car ride, and even climbed a big flight of stairs to the bedroom, to see Harrison. He scooped up the baby and there we both cried. My grandfather was the one, throughout the entire decision to have a VBAC at home, to support it vocally. Having served on New Guinea during World War II, he saw many indigenous women give birth there. That exposure made him appreciate, respect and understand the process in ways that my grandmother and mother -- who had never known birth outside a hospital -- could not. I was grateful for his support. And loved that he could be there that morning.
My husband rummaged through the dark to find the baby something to wear -- no standard issue hospital garb. I jumped in the shower and gingerly got back in bed. My husband made me a sandwich and brought me a big pitcher of water to slake my thirst and we toasted the midwives and Harrison with some champagne and cake, which the midwives ate downstairs to give us time alone.
Harrison was born at 5 minutes past midnight. The midwives stayed to check on us all until close to 4 a.m., when they finally said goodbye, with assurances of a visit later in the day. We were too excited to fall asleep, and stayed in bed marveling at the baby. At 5:30, our 4-year-old came in and did a double take when he saw his new brother in the bed. It was like Christmas morning. He crawled in with us and we all stayed happily together until my parents, grandparents, aunt and cousin arrived with breakfast. It felt so great having them all there at the house, knowing they could stay as long as they wanted. My 85-year-old arthritic grandfather endured a long car ride, and even climbed a big flight of stairs to the bedroom, to see Harrison. He scooped up the baby and there we both cried. My grandfather was the one, throughout the entire decision to have a VBAC at home, to support it vocally. Having served on New Guinea during World War II, he saw many indigenous women give birth there. That exposure made him appreciate, respect and understand the process in ways that my grandmother and mother -- who had never known birth outside a hospital -- could not. I was grateful for his support. And loved that he could be there that morning.
Wednesday, March 05, 2008
Our new baby, installment #31
I still have a fair amount to say about my home VBAC. For starters, a faithful reader of this blog asked me if I was worried about having a placenta issue, since a prior cesarean can cause the placenta to adhere to the scar or even implant through the uterus -- both serious problems. The short answer is no. Despite having researched such problems while writing my book, a sort of haze effected my brain while I was pregnant and I thought nothing but positive thoughts, perhaps reinforced by my ever positive midwife. So, even when she seemed slightly concerned that the placenta was not coming out quickly, and told me to get on the bed and push, I was not worried. And sure enough, it all came out smoothly, in one piece. And when the weather turns nice, it will be taken from the freezer (it's wrapped in a towel in a Ziploc bag beneath some ice cream sandwiches the boys love) and buried in the backyard. Mom, are you rolling your eyes?
Tuesday, March 04, 2008
Our new baby, installment #30
This is Harrison. And me. If you look closely, you can see that the cord is still not cut. We waited until it stopped pulsing and it was tied off with a string. Still no sign of that placenta. So after what seemed like an eternity holding Harrison in the tub, the midwife told me I should get out, and let gravity help expel the afterbirth. I felt a little wobbly in the knees. I handed the baby to my husband, climbed out and walked to my bed, which I had made up like a layer cake of sheets and shower curtains.
Monday, March 03, 2008
Our new baby, installment #29
One more contraction, and our baby was out, a successful and stunningly uplifting home VBAC.
"It's a boy!" the midwife said, her first words in a long while, as his body popped up to the surface.
Although his head had emerged with the cord wrapped around his neck, the midwife had reached into the birth tub to check on him, felt the cord pulsing, and knew he was OK. All through the two hours I spent kneeling in the water, she never once told me to push. And I never did. My body did the work on its own and I let everything take its time. I think the reward was in not needing a single stitch.
I sat in the tub holding him, transfixed, looking in his dark eyes, his hair curled from the wetness. He was breathing just fine, very alert, not crying, checking out his new bedroom, moving his eyes across the room. His body, covered with creamy vernix, was incredibly soft and I held him close. He took to nursing like a champ. My husband finally decided it was OK to take a picture (maybe I will post one tomorrow)and we all rejoiced in the moment.
A couple minutes later, our second midwife, who had gotten caught in a construction tangle on the turnpike, arrived -- deflated she had missed the birth.
All seemed well. But where the heck was the placenta?
"It's a boy!" the midwife said, her first words in a long while, as his body popped up to the surface.
Although his head had emerged with the cord wrapped around his neck, the midwife had reached into the birth tub to check on him, felt the cord pulsing, and knew he was OK. All through the two hours I spent kneeling in the water, she never once told me to push. And I never did. My body did the work on its own and I let everything take its time. I think the reward was in not needing a single stitch.
I sat in the tub holding him, transfixed, looking in his dark eyes, his hair curled from the wetness. He was breathing just fine, very alert, not crying, checking out his new bedroom, moving his eyes across the room. His body, covered with creamy vernix, was incredibly soft and I held him close. He took to nursing like a champ. My husband finally decided it was OK to take a picture (maybe I will post one tomorrow)and we all rejoiced in the moment.
A couple minutes later, our second midwife, who had gotten caught in a construction tangle on the turnpike, arrived -- deflated she had missed the birth.
All seemed well. But where the heck was the placenta?
Friday, February 29, 2008
A book in the mail
I just have to share about a very sweet note tucked into a book that arrived on my stoop today. Both the letter and the book, Artemis Speaks: VBAC Stories and Natural Childbirth Information, were written by Nan Koehler. (The book in 1985, the letter two weeks ago.) Nan says she still has a 1,000 copies of her book "in the barn" but that used book dealers are selling them for $50 a copy. I haven't checked Amazon.
Anyway, in her book it says that Nan is (was?) a traditional birth attendant/botanist/herbalist living in California who was part of the home birth movement back in the day.
In her letter, she remarks that the hormone relaxin is very close to insulin. "One atom different," she writes. "So the solution for easy birth is walking - exercise...to circulation the relaxin in the pelvis."
She also said I should have mentioned that in some cultures there are dietary taboos "that ensure that babies remain smaller - then they are fattened up after birth..." Fair enough. I'd love to know more on this. I bet lots of New York women would buy that diet book.
And then she wrote that the real reason why labor begins at night for so many women is because their hormonal output is greatest at 3 a.m. (when most labors begin) and the low point is 3 p.m., when labor tends to stop. Makes sense.
She also highly recommends castor oil over pitocin. (My response: Anything is better than pitocin...)
She concludes the letter by responded to a section in my last chapter, on the postpartum period, where I discuss various methods traditional midwives have used to dress the cord stump, including cow dung and ashes.
"Cow dung is very sterile," she says. "Check that some more."
Indeed I will!!
Can't wait to read Artemis Speaks.
Anyway, in her book it says that Nan is (was?) a traditional birth attendant/botanist/herbalist living in California who was part of the home birth movement back in the day.
In her letter, she remarks that the hormone relaxin is very close to insulin. "One atom different," she writes. "So the solution for easy birth is walking - exercise...to circulation the relaxin in the pelvis."
She also said I should have mentioned that in some cultures there are dietary taboos "that ensure that babies remain smaller - then they are fattened up after birth..." Fair enough. I'd love to know more on this. I bet lots of New York women would buy that diet book.
And then she wrote that the real reason why labor begins at night for so many women is because their hormonal output is greatest at 3 a.m. (when most labors begin) and the low point is 3 p.m., when labor tends to stop. Makes sense.
She also highly recommends castor oil over pitocin. (My response: Anything is better than pitocin...)
She concludes the letter by responded to a section in my last chapter, on the postpartum period, where I discuss various methods traditional midwives have used to dress the cord stump, including cow dung and ashes.
"Cow dung is very sterile," she says. "Check that some more."
Indeed I will!!
Can't wait to read Artemis Speaks.
Thursday, February 28, 2008
Our new baby, installment #28
Much like labor itself, this story may seem to have no end, and to some, it may even be painful. For that, I apologize. But if I could play the role of midwife to my readers, I would say: "Almost there! Don't give up! You've stuck it out this far!"
You would think that I would have many details to share, and that, being a writer by profession, I would have carefully chronicled, perhaps even videoed our planned home VBAC. But I didn't. I didn't want to. I lived every moment of it for myself. So while there were things that I do remember clearly -- the thoughts in my head that played over and over like a skipped record as I was in the birth tub, my lack of self-consciousness, my inability to tell time, my need for silence and the presence of those I knew I could count on -- there are some things about this story I just cannot recall.
I have no idea what my poor husband was doing. I know he was in the room but I did not see him once. My eyes were closed tight. When they were open, I was not seeing. I remember that in that moment, I was dissecting the pain, trying to understand it and get my arms around it. But today, I honestly cannot remember the pain. I cannot explain it. I cannot compare it to anything. Not because it was worse, but because I don't know what it was. I cannot say if I moved from my kneeling position. Ever.
However, I knew the end was near when my hips reflexively thrust forward, uncontrollably. I had read about this. Michel Odent, the French obstetrician credited with "inventing" water birth, calls this, well, something like the reflexive hip thrust! It is nature's way of opening the pelvis to expel the baby. I don't know how many times that thrust happened to me, but sure enough, I felt the head move down quickly. I absorbed the meaning of "ring of fire" and began a high-pitched chant of OW OW OW OW...
The head was out. My midwife reached in. She felt the cord wrapped around the baby's neck. But kept that information to herself.
You would think that I would have many details to share, and that, being a writer by profession, I would have carefully chronicled, perhaps even videoed our planned home VBAC. But I didn't. I didn't want to. I lived every moment of it for myself. So while there were things that I do remember clearly -- the thoughts in my head that played over and over like a skipped record as I was in the birth tub, my lack of self-consciousness, my inability to tell time, my need for silence and the presence of those I knew I could count on -- there are some things about this story I just cannot recall.
I have no idea what my poor husband was doing. I know he was in the room but I did not see him once. My eyes were closed tight. When they were open, I was not seeing. I remember that in that moment, I was dissecting the pain, trying to understand it and get my arms around it. But today, I honestly cannot remember the pain. I cannot explain it. I cannot compare it to anything. Not because it was worse, but because I don't know what it was. I cannot say if I moved from my kneeling position. Ever.
However, I knew the end was near when my hips reflexively thrust forward, uncontrollably. I had read about this. Michel Odent, the French obstetrician credited with "inventing" water birth, calls this, well, something like the reflexive hip thrust! It is nature's way of opening the pelvis to expel the baby. I don't know how many times that thrust happened to me, but sure enough, I felt the head move down quickly. I absorbed the meaning of "ring of fire" and began a high-pitched chant of OW OW OW OW...
The head was out. My midwife reached in. She felt the cord wrapped around the baby's neck. But kept that information to herself.
Wednesday, February 27, 2008
Our new baby, installment #27
The birthing tub, as I had learned the week before labor started by submersing myself in it, brought instant relief in so many way because it took gravity out of the equation. The pressure and weight of a big belly, the inability to move into a comfortable position, these were nonissues in the water. When the home birth midwife suggested I get in the tub, I flung off my nightgown, grabbed an elastic and a headband and twisted my hair into a crazy style, and got in -- quickly -- between contractions, with help. We had set the tub up in the baby's room, which was warm and dark. The house, thankfully, was quiet. I immediately settled into a kneeling position, gripping with white knuckles the side of the tub and pushing my forehead into the padded lip. The midwife checked me for the first time, and said I was fully dilated, after about only 3 hours of active labor. Every time a contraction hit, I marveled at the sound coming from my throat and kept thinking I would wake up our 4-year-old, or the neighbors, as our old town house is attached on two sides. For the next two hours, the only words I remember saying are: "When will this end?" "Soon," was her response.
I also had two constant thoughts running through my head: "Now I know why women considered childbirth the Curse of Eve...because if one did not choose to go through this, and had to do so every couple years, it could make you a very bitter woman."
The second thought was more of a question -- "How many other babies were born in this house, built in 1874? And what was it like for them?"
I also had two constant thoughts running through my head: "Now I know why women considered childbirth the Curse of Eve...because if one did not choose to go through this, and had to do so every couple years, it could make you a very bitter woman."
The second thought was more of a question -- "How many other babies were born in this house, built in 1874? And what was it like for them?"
Sunday, February 24, 2008
Our new baby, installment #26
Continuing my story about planning a home VBAC, when I called the midwife to tell her my water had broken and the fluid was greenish, she very calmly said, "that's OK, about 1/3 of all water is tinged and it's not a problem."
On the other occasions throughout the pregnancy when I needed reassuring (uterine rupture risk? elevated blood pressure? confusion over whether to have a Step B test...)her positive attitude and patient answers propelled me up some hill I could not climb alone. I cannot say how important these little words were. They were little. And they were huge. I cannot say for sure, but I believe that had my greenish waters broken in the hospital, it would have caused more of a stir, which would have made me scared, which would have made me doubt.
On this night, I did not doubt. I gamely timed my contractions on a piece of paper. I broke out into a sweat leaning on my husband and it made me think of all those Hollywood films when the laboring woman has a mop of wet hair. I always thought that was overly dramatic. But I had not worked that hard on a treadmill. Ever.
And when I could not write times anymore, I put down the pen. My husband dialed the phone. The midwife asked to speak with me. She wanted to hear what my voice sounded like. And 10 minutes later the midwife was hauling her bag up the main staircase in our house. She whispered something to my husband, dropped her bag and suddenly a nuclear contraction hit and a sound came from my toes up through my throat. She told me to get in the tub right away.
On the other occasions throughout the pregnancy when I needed reassuring (uterine rupture risk? elevated blood pressure? confusion over whether to have a Step B test...)her positive attitude and patient answers propelled me up some hill I could not climb alone. I cannot say how important these little words were. They were little. And they were huge. I cannot say for sure, but I believe that had my greenish waters broken in the hospital, it would have caused more of a stir, which would have made me scared, which would have made me doubt.
On this night, I did not doubt. I gamely timed my contractions on a piece of paper. I broke out into a sweat leaning on my husband and it made me think of all those Hollywood films when the laboring woman has a mop of wet hair. I always thought that was overly dramatic. But I had not worked that hard on a treadmill. Ever.
And when I could not write times anymore, I put down the pen. My husband dialed the phone. The midwife asked to speak with me. She wanted to hear what my voice sounded like. And 10 minutes later the midwife was hauling her bag up the main staircase in our house. She whispered something to my husband, dropped her bag and suddenly a nuclear contraction hit and a sound came from my toes up through my throat. She told me to get in the tub right away.
Saturday, February 23, 2008
Our new baby, installment #25
So after getting a testy email from my mother, who says I am not blogging fast enough for her taste (yes, she knows it has been school vacation week)I am posting over coffee while my husband cleans up the hot chocolate that our 4-year-old just spilled all over the kitchen.
Where did I leave off?
I was pretty sure I was in labor with intermittent contractions. My husband was rushing home through traffic. I had a car full of groceries and a kid in tow. I emptied the car, thinking it might help me realize if I was, in fact, in labor. With everything put away and my husband home, I began to time the contractions. They were about five minutes apart.
"You should call the midwife," he said.
We called, told her what was happening, and said we were OK on our own for now. She said to call her back as soon as I needed her and she was going to lay down and get some rest. It was about 7 p.m. I wanted to read our son a book before bed. But because I was so huge, and his twin bed sits high, I had been having difficulty reading to him in his own bed. So we all climbed into my bed and plugged in The Polar Express movie. My son and I drifted off to sleep. And then -- S-P-L-A-T. My water broke. It woke me up and I immediately jumped out of bed. My husband ran to get towels. This was no trickle. It was then that I noticed that the waters were tinged, a slight greenish brown.
"Quick!" I said. "Call the midwife!"
Where did I leave off?
I was pretty sure I was in labor with intermittent contractions. My husband was rushing home through traffic. I had a car full of groceries and a kid in tow. I emptied the car, thinking it might help me realize if I was, in fact, in labor. With everything put away and my husband home, I began to time the contractions. They were about five minutes apart.
"You should call the midwife," he said.
We called, told her what was happening, and said we were OK on our own for now. She said to call her back as soon as I needed her and she was going to lay down and get some rest. It was about 7 p.m. I wanted to read our son a book before bed. But because I was so huge, and his twin bed sits high, I had been having difficulty reading to him in his own bed. So we all climbed into my bed and plugged in The Polar Express movie. My son and I drifted off to sleep. And then -- S-P-L-A-T. My water broke. It woke me up and I immediately jumped out of bed. My husband ran to get towels. This was no trickle. It was then that I noticed that the waters were tinged, a slight greenish brown.
"Quick!" I said. "Call the midwife!"
Wednesday, February 20, 2008
Our new baby, installment #24
The cousin is home, feeling better and the hospital says they have no proof it was an infection, at least that was what they said when she inquired if it could be staph...Hm...Don't know why they would put her on antibiotics if it wasn't an infection. But anyway.
As I waited for my own labor to begin, I cleaned the refrigerator (naturally) and had to squeeze in one more trip to the grocery store. I was like a squirrel with a nut, having to put everything in order quickly, before the first frost.
It's amazing how strong the mind-body connection can be. On my way home from the grocery store, with my entire to-do list checked off, and my son picked up from school, I started getting contractions. Of course, it was a Friday and I knew my whole family would be around that night and through the weekend. My husband called to say that he had to stay a bit late for work. I told him he needed to come home.
As I waited for my own labor to begin, I cleaned the refrigerator (naturally) and had to squeeze in one more trip to the grocery store. I was like a squirrel with a nut, having to put everything in order quickly, before the first frost.
It's amazing how strong the mind-body connection can be. On my way home from the grocery store, with my entire to-do list checked off, and my son picked up from school, I started getting contractions. Of course, it was a Friday and I knew my whole family would be around that night and through the weekend. My husband called to say that he had to stay a bit late for work. I told him he needed to come home.
Monday, February 18, 2008
Our New Baby Installment #23
My cousin is still in the hospital with a postpartum infection....
But I figured I would add another installment about my journey toward a home VBAC.
At our next midwife appointment (horns and drum roll, please...) my blood pressure was FINE. Back to normal. I was relieved. My family was relieved. My midwife didn't say 'I told you so.' But she had told me so. I tried to listen. I gagged myself on protein, soaked in the tub, quit working and tried to be nice to my poor husband.
Now, with my blood pressure in the 117/70 range, there were no worries. I was just really eager and centered. When I went home and started cleaning my refrigerator, I knew I was ready for labor.
But I figured I would add another installment about my journey toward a home VBAC.
At our next midwife appointment (horns and drum roll, please...) my blood pressure was FINE. Back to normal. I was relieved. My family was relieved. My midwife didn't say 'I told you so.' But she had told me so. I tried to listen. I gagged myself on protein, soaked in the tub, quit working and tried to be nice to my poor husband.
Now, with my blood pressure in the 117/70 range, there were no worries. I was just really eager and centered. When I went home and started cleaning my refrigerator, I knew I was ready for labor.
Sunday, February 17, 2008
Another birth in the family
I have been a delinquent poster not just because of my own family circus, but because of an extended family drama. We were delighted on Thursday to welcome another baby into the family: My cousin had a baby girl, Elyse. Anyone who has read my book knows that one of the things that inspired me to write about the history of childbirth was trying to understand three generations of births (my grandmother, my mother and aunt, my own) all of which were quite different, and also quite bad. As I was concluding the book, my sister-in-law's twin had a baby, which became fodder, and I ended the book questioning whether my sister-in-law, when she had a baby, would schedule a c-section, as she hoped to do. Well, I've already blogged about my sister-in-law here, who had her baby about 7 months ago. Today, I am focused on my cousin, who had a relatively easy vaginal birth in the hospital with her first son. This being her second child, labor progressed just fine and despite being 7 cm and feeling no pain, she got an epidural. A couple hours later, she had a girl and a few stitches. The next day, she said she felt an unusual amount of stomach pain. And the next day they sent her home. Last night, she raced back to the hospital with a raging infection. Her baby stayed home with her dad. The last three women I have personally known to give birth in a hospital have had to return to treat an infection. And given the post below, this is very frightening in an age when infections are becoming resistant to antibiotics. More women should know that this happens.
Tuesday, February 12, 2008
C-section leads to quadrupal amputation
This is the first installment of a two-part piece being published in the Boston Globe.
http://www.boston.com/bostonglobe/magazine/articles/2008/02/10/saving_monica/
http://www.boston.com/bostonglobe/magazine/articles/2008/02/10/saving_monica/
Our new baby, installment #22
In the days before we were to meet with our home birth midwife again, a few things happened. First, our midwife, who knew I was at my tattered edge with the elevated blood pressure issue and just generally Done Being Pregnant, sent me a long and thoughtful email that basically boiled down to this: Relax. Soak regularly in the birth tub to get used to it (it will also lower the BP). Stay home and listen to your body. Force feed the protein (a homeopathic remedy for elevated BP). Walk twice a day. Let your husband do nice things for you -- and stop yelling at him (I had entered the grouchy phase I am sorry to say...) She wrote many other thoughful words but I will keep those for myself. I was moved that she sensed I could use a pep talk. And it worked. I did as she advised. I did NOT go back to the doctor for a blood pressure check, a decision I came to on my own. And given my recent frustrating experiences going to those medical offices I decided to forgo a Strep B test, embracing instead a prophylactic homeopathy.
At our next appointment, I was eager to see what my blood pressure was.
At our next appointment, I was eager to see what my blood pressure was.
Monday, February 11, 2008
Our new baby, installment #21
Continuing the story of my plan for a home VBAC, I was mulling what to do about Strep B testing, the enormous birthing tub was finally set up, and I was meeting with the midwife for a weekly appointment. It was then that she took my blood pressure and found that in the space of a week, it had jumped from about 115/70ish to 139/80ish, with 140/80 being the benchmark for preeclampsia, a mysterious and potentially fatal afflication for which the only cure is delivery of the baby. Yikes. For the first time, I was worried, even though she did not appear to be. She said she did not think I was preeclamptic; that elevated blood pressure was just one symptom and I had no others. I was swollen but not more than most pregnant women in the last weeks. Still, we agreed to monitor this closely.
The next day, I felt a bit more swollen, so instead of trekking a few miles to my midwife's office, I thought I'd go to the medical practice right next door to my office. In my naivete I thought I could simply call up and ask to have my BP taken. Which I did. And they all but laughed. Who is your primary care doctor, they asked. My primary care doctor had left the state some time ago and I never bothered to find a new one. (There is a shortage in Massachusetts, by the way, and long waiting lists.) Anyway, I was outraged that no doctor or nurse would take my BP, even though I had insurance and saw doctors in that practice.
I quit working that day and followed the midwife's advice to consume as close to 120 grams of protein per day as possible. Not easy to do. I tried to pack in the protein by drinking Kashi protein shakes, eating lots of eggs. It was gross.
A couple days later I felt a bit more swollen and wanted to check my blood pressure again. Although my midwife's office was not far away -- just a few miles -- it was more convenient to go to the medical practice office where my kids go for their pediatrician visits and where I had been seeing a certified nurse midwife for my primary screens and GYN appointments long before I was pregnant. I had not seen an OB in about 4 years, since my first son was born. So, I waddled into the office and asked if I could have my blood pressure checked.
"Do you have an appointment?"
"No," I said, giving her the name of provider I last saw there.
"Why do you want your blood pressure checked?"
I told her it was elevated.
She told me to take seat.
Then someone whom I think was a nurse called me in and asked with big huge eyes and hushed tones what was wrong. I repeated the situation again. She looked very concerned. She asked me what hospital I was delivering at. I stuttered. I said I just wanted my blood pressure checked. She asked me who my OB was. I felt like I was about to be grounded. For some reason I panicked and gave her the name of my last OB. I thought I would get kicked to the curb if I told her straight. Anyway, it was no surprise that when she took my blood pressure it was 140/80. The. Stress. Of. Going. To. That. Office. Was. Awful. She told me to get to the OB immediately.
I left really upset and called my midwife. She told me to go home and rest and offered to come to me to take my BP. It seemed like a silly thing for her to have to do, given that I had closer options.
I demurred, went home and had a protein shake. The next day, I was feeling stubborn. I figured I would go to the local health clinic around the corner from my house, a clinic where people without health insurance go. I knew they would gladly take my health insurance and co-payment and take my blood pressure. They did. It was a few points lower. I skipped the blood tests, went home, and had more protein. I talked my midwife, who reassured me that all was well.
Again she said she would come to me. But I figured I could wait until my next appoinment with her a few days out. At least I hoped I could. In the meantime, I fumed about the health care system.
The next day, I felt a bit more swollen, so instead of trekking a few miles to my midwife's office, I thought I'd go to the medical practice right next door to my office. In my naivete I thought I could simply call up and ask to have my BP taken. Which I did. And they all but laughed. Who is your primary care doctor, they asked. My primary care doctor had left the state some time ago and I never bothered to find a new one. (There is a shortage in Massachusetts, by the way, and long waiting lists.) Anyway, I was outraged that no doctor or nurse would take my BP, even though I had insurance and saw doctors in that practice.
I quit working that day and followed the midwife's advice to consume as close to 120 grams of protein per day as possible. Not easy to do. I tried to pack in the protein by drinking Kashi protein shakes, eating lots of eggs. It was gross.
A couple days later I felt a bit more swollen and wanted to check my blood pressure again. Although my midwife's office was not far away -- just a few miles -- it was more convenient to go to the medical practice office where my kids go for their pediatrician visits and where I had been seeing a certified nurse midwife for my primary screens and GYN appointments long before I was pregnant. I had not seen an OB in about 4 years, since my first son was born. So, I waddled into the office and asked if I could have my blood pressure checked.
"Do you have an appointment?"
"No," I said, giving her the name of provider I last saw there.
"Why do you want your blood pressure checked?"
I told her it was elevated.
She told me to take seat.
Then someone whom I think was a nurse called me in and asked with big huge eyes and hushed tones what was wrong. I repeated the situation again. She looked very concerned. She asked me what hospital I was delivering at. I stuttered. I said I just wanted my blood pressure checked. She asked me who my OB was. I felt like I was about to be grounded. For some reason I panicked and gave her the name of my last OB. I thought I would get kicked to the curb if I told her straight. Anyway, it was no surprise that when she took my blood pressure it was 140/80. The. Stress. Of. Going. To. That. Office. Was. Awful. She told me to get to the OB immediately.
I left really upset and called my midwife. She told me to go home and rest and offered to come to me to take my BP. It seemed like a silly thing for her to have to do, given that I had closer options.
I demurred, went home and had a protein shake. The next day, I was feeling stubborn. I figured I would go to the local health clinic around the corner from my house, a clinic where people without health insurance go. I knew they would gladly take my health insurance and co-payment and take my blood pressure. They did. It was a few points lower. I skipped the blood tests, went home, and had more protein. I talked my midwife, who reassured me that all was well.
Again she said she would come to me. But I figured I could wait until my next appoinment with her a few days out. At least I hoped I could. In the meantime, I fumed about the health care system.
Sunday, February 10, 2008
Thanks
Can I just say that I am grateful for all of the amazing posts I've been getting from this blog's readers. Intelligent. Witty. Insightful. That includes you, mom. You are all keeping me going.
Saturday, February 09, 2008
Pushing back
In response to the ACOG statement on homebirth, The Big Push for Midwives Campaign issued the following press release, quite well done. If you aren't familiar with the Big Push, check out the link below.
PushNews from The Big Push for Midwives Campaign
CONTACT: Steff Hedenkamp, (816) 506-4630, RedQuill@kc.rr.com
FOR IMMEDIATE RELEASE: Thursday, February 7, 2008
ACOG: Out of Touch with Needs of Childbearing Families
Trade Union claims out-of-hospital birth is “trendy;” tries to play the “bad mother” card
(February 7, 2008) — The American College of Obstetricians and Gynecologists (ACOG), a trade union representing the financial and professional interests of obstetricians, has issued the latest in a series of statements condemning families who choose home birth and calling on policy makers to deny them access to Certified Professional Midwives. CPMs are trained as experts in out-of-hospital delivery and as specialists in risk assessment and preventative care.
“It will certainly come as news to the Amish and other groups in this country who have long chosen home birth that they’re simply being ‘trendy’ or ‘fashionable,’” said Katie Prown, PhD, Campaign Manager of The Big Push for Midwives 2008. “The fact is, families deliver their babies at home for a variety of very valid reasons, either because they’re exercising their religious freedom, following their cultural traditions or because of financial need. These families deserve access to safe, quality and affordable maternity care, just like everyone else.”
Besides referring to home birth as a fashionable “trend” and a “cause célèbre” that families choose out of ignorance, ACOG’s latest statement adds insult to injury by claiming that women delivering outside of the hospital are bad mothers who value the childbirth “experience” over the safety of their babies.
“ACOG has it backwards,” said Steff Hedenkamp, Communications Coordinator of The Big Push and the mother of two children born at home. “I delivered my babies with a trained, skilled professional midwife because I wanted the safest out-of-hospital care possible. If every state were to follow ACOG’s recommendations and outlaw CPMs, families who choose home birth will be left with no care providers at all. I think we can all agree that this is an irresponsible policy that puts mothers and babies at risk.”
The Big Push for Midwives calls on ACOG to abandon these outdated policies and work with CPMs to reduce the cesarean rate and to take meaningful steps towards reducing racial and ethnic disparities in birth outcomes in all regions of the United States. CPMs play a critical role in both cesarean prevention and in the reduction of low-birth weight and pre-term births, the two most preventable causes of neonatal mortality.
Moreover, their training as specialists in out-of-hospital maternity care qualifies CPMs as essential first-responders during disasters in which hospitals become inaccessible or unsafe for laboring mothers. In addition, CPMs work to ensure that all babies born outside of the hospital undergo state-mandated newborn screenings and are provided with legal and secure birth certificates.
Currently, Certified Nurse-Midwives, who work predominantly in hospital settings, are licensed and regulated in all 50 states, while Certified Professional Midwives, who work in out-of-hospital settings, are licensed and regulated in 24 states, with legislation pending in an additional 20 states.
The Big Push for Midwives (www.TheBigPushforMidwives.org) is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.
Media inquiries should be directed to Steff Hedenkamp (816) 506-4630, RedQuill@kc.rr.com.
#####
PushNews from The Big Push for Midwives Campaign
CONTACT: Steff Hedenkamp, (816) 506-4630, RedQuill@kc.rr.com
FOR IMMEDIATE RELEASE: Thursday, February 7, 2008
ACOG: Out of Touch with Needs of Childbearing Families
Trade Union claims out-of-hospital birth is “trendy;” tries to play the “bad mother” card
(February 7, 2008) — The American College of Obstetricians and Gynecologists (ACOG), a trade union representing the financial and professional interests of obstetricians, has issued the latest in a series of statements condemning families who choose home birth and calling on policy makers to deny them access to Certified Professional Midwives. CPMs are trained as experts in out-of-hospital delivery and as specialists in risk assessment and preventative care.
“It will certainly come as news to the Amish and other groups in this country who have long chosen home birth that they’re simply being ‘trendy’ or ‘fashionable,’” said Katie Prown, PhD, Campaign Manager of The Big Push for Midwives 2008. “The fact is, families deliver their babies at home for a variety of very valid reasons, either because they’re exercising their religious freedom, following their cultural traditions or because of financial need. These families deserve access to safe, quality and affordable maternity care, just like everyone else.”
Besides referring to home birth as a fashionable “trend” and a “cause célèbre” that families choose out of ignorance, ACOG’s latest statement adds insult to injury by claiming that women delivering outside of the hospital are bad mothers who value the childbirth “experience” over the safety of their babies.
“ACOG has it backwards,” said Steff Hedenkamp, Communications Coordinator of The Big Push and the mother of two children born at home. “I delivered my babies with a trained, skilled professional midwife because I wanted the safest out-of-hospital care possible. If every state were to follow ACOG’s recommendations and outlaw CPMs, families who choose home birth will be left with no care providers at all. I think we can all agree that this is an irresponsible policy that puts mothers and babies at risk.”
The Big Push for Midwives calls on ACOG to abandon these outdated policies and work with CPMs to reduce the cesarean rate and to take meaningful steps towards reducing racial and ethnic disparities in birth outcomes in all regions of the United States. CPMs play a critical role in both cesarean prevention and in the reduction of low-birth weight and pre-term births, the two most preventable causes of neonatal mortality.
Moreover, their training as specialists in out-of-hospital maternity care qualifies CPMs as essential first-responders during disasters in which hospitals become inaccessible or unsafe for laboring mothers. In addition, CPMs work to ensure that all babies born outside of the hospital undergo state-mandated newborn screenings and are provided with legal and secure birth certificates.
Currently, Certified Nurse-Midwives, who work predominantly in hospital settings, are licensed and regulated in all 50 states, while Certified Professional Midwives, who work in out-of-hospital settings, are licensed and regulated in 24 states, with legislation pending in an additional 20 states.
The Big Push for Midwives (www.TheBigPushforMidwives.org) is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.
Media inquiries should be directed to Steff Hedenkamp (816) 506-4630, RedQuill@kc.rr.com.
#####
Latest ACOG statement against home birth
On Feb. 6 the American College of Obstetricians and Gynecologists issued the statement below on how the group is opposed to home birth. What is interesting to me is why they are issuing the statement now. A clue comes in the paragraph that begins: "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre." Does this mean ACOG ackowledges that home birth is suddenly trendy? Did you all see the article in Vogue a couple months ago, a favorable essay by a New York City mom who gave birth at home? Perhaps the people at ACOG saw that and got worried... home birth was literally in Vogue...Then of course there is also the Ricki Lake documentary, "The Business of Being Born," which comes out this month on Netflix! I would be worried if I were ACOG, too, as the film makes a compelling case against The System.
The statement goes on to say: "Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades..." (SO WHY DOES THE RATE KEEP GOING UP, NOW EXCEEDING 30 PERCENT, WHEN THE WORLD HEALTH ORGANIZATION ESTIMATES THAT ANY RATE ABOVE 10-15 PERCENT IS DOING MORE HARM THAN GOOD?)..."Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice" (THIS IS A SMALL PERCENT BUT GROWING AS DOCTORS BOTH ALLOW AND ENCOURAGE SECTIONS FOR NO MEDICAL REASON; SCARE THE DAYLIGHTS OUT OF WOMEN WHO THEN THINK THEY MUST HAVE A SECTION; AND REFUSE TO ATTEND VBACS) "and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes." (SO BLAME THE MOM). Nowhere in this statement is there any mention of malpractice fears among OBs, how overly managed labor is resulting in countless iatrogenic problems, leading to even more sections, etc.
Finally, where ACOG questions studies about the safety of home birth (there have been many large-scale ones, recognized around the globe as being well done)it is important to note that in the UK, the government there is actually advocating for MORE home birth, precisely because it is safe and because they recognize that birth in the hospital will almost always end up being more complicated because it is made so by the people who work there. Period.
Anyway, here is the ACOG statement in full. Feel free to write a letter. The address is at the bottom.
Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies.
ACOG acknowledges a woman's right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).
Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk.
Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it, but there is no scientific way to recommend an 'ideal' national cesarean rate as a target goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean Delivery to assist physicians and institutions in assessing and reducing, if necessary, their cesarean delivery rates. Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes.
The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.
It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.
ACOG encourages all pregnant women to get prenatal care and to make a birth plan. The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby. For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.
http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm
ACOG Office of Communications
202.484.3321
communications@acog.org
The statement goes on to say: "Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades..." (SO WHY DOES THE RATE KEEP GOING UP, NOW EXCEEDING 30 PERCENT, WHEN THE WORLD HEALTH ORGANIZATION ESTIMATES THAT ANY RATE ABOVE 10-15 PERCENT IS DOING MORE HARM THAN GOOD?)..."Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice" (THIS IS A SMALL PERCENT BUT GROWING AS DOCTORS BOTH ALLOW AND ENCOURAGE SECTIONS FOR NO MEDICAL REASON; SCARE THE DAYLIGHTS OUT OF WOMEN WHO THEN THINK THEY MUST HAVE A SECTION; AND REFUSE TO ATTEND VBACS) "and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes." (SO BLAME THE MOM). Nowhere in this statement is there any mention of malpractice fears among OBs, how overly managed labor is resulting in countless iatrogenic problems, leading to even more sections, etc.
Finally, where ACOG questions studies about the safety of home birth (there have been many large-scale ones, recognized around the globe as being well done)it is important to note that in the UK, the government there is actually advocating for MORE home birth, precisely because it is safe and because they recognize that birth in the hospital will almost always end up being more complicated because it is made so by the people who work there. Period.
Anyway, here is the ACOG statement in full. Feel free to write a letter. The address is at the bottom.
Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies.
ACOG acknowledges a woman's right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).
Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk.
Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it, but there is no scientific way to recommend an 'ideal' national cesarean rate as a target goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean Delivery to assist physicians and institutions in assessing and reducing, if necessary, their cesarean delivery rates. Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes.
The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.
It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.
ACOG encourages all pregnant women to get prenatal care and to make a birth plan. The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby. For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.
http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm
ACOG Office of Communications
202.484.3321
communications@acog.org
Thursday, February 07, 2008
Our new baby, installment #20
As I was pondering how to handle testing (or not) of Group B Strep, we began to set other plans in motion for a home VBAC, or HBAC. My primary focus was on setting up the birthing tub. Our midwife said her favorite (lucky) tub was one that was six feet around, which sounded enormous. I knew I wanted the tub for labor, but was unsure whether I wanted to actually give birth in it. I thought about the origins of water birth, how in some tropical climates women would have waded in the ocean during labor. I also saw how strongly my midwife encouraged the use of the tub.
We made arrangements with another family who had the tub on loan(that home birth went swimmingly)and were ready to pass it along. The dad dropped off the tub, which was broken down into a large box and several hockey bag-sized duffles. I nagged my husband for days to set it up, which he finally did, in the baby's room upstairs. And then we realized that in our ancient house, with 130-year-old original faucets, no modern hose would connect with them so we could fill the tub!
Eventually, we rigged a board and hose and used gravity to accomplish the job but my husband sat there for hours directing the water into the tub. We treated the water, ran the motor to heat the pool to a safe temperature and put a lid on it to make sure the 4-year-old didn't go for a dip when we weren't looking. I couldn't wait to get in the water, as even our deep clawfoot tub was no longer big enough for me to submerge my entire belly.
We made arrangements with another family who had the tub on loan(that home birth went swimmingly)and were ready to pass it along. The dad dropped off the tub, which was broken down into a large box and several hockey bag-sized duffles. I nagged my husband for days to set it up, which he finally did, in the baby's room upstairs. And then we realized that in our ancient house, with 130-year-old original faucets, no modern hose would connect with them so we could fill the tub!
Eventually, we rigged a board and hose and used gravity to accomplish the job but my husband sat there for hours directing the water into the tub. We treated the water, ran the motor to heat the pool to a safe temperature and put a lid on it to make sure the 4-year-old didn't go for a dip when we weren't looking. I couldn't wait to get in the water, as even our deep clawfoot tub was no longer big enough for me to submerge my entire belly.
Tuesday, February 05, 2008
Our new baby, installment #19
OK. So that was not so brief a pause after all. Whoo.
But I am moving on here, perhaps to even more controversial territory in this serialized tale about a journey back to the future, with a home VBAC.
One of the bigger questions I was facing was: What to do about having a Strep B test? Did I need it? Did I want it? Is it necessary? What were the homeopathic options and were they effective?
I knew that testing positive for Strep B COULD prove fatal to a newborn, which might pick up the bacteria on its way down the birth canal.
These were some of the homeopathtic options up for consideration -- things one might do prophylactically, in place of being tested.
ORALLY:
500-1000 mg Vitamin C with bioflavinoids, twice per day.
Vitamin C is water soluble and extra is excreted by the kidneys.
Eat cranberries and garlic daily; or take cranberry capsules and garlic pearls three times per day.
Plenty of live culture yogurt; or Acidophilus capsules daily.
Bee propolus; or tincture.
Echinacea is very Strep specific, according to one source. As a preventative, use 10-15 drops of tincture in a glass of water twice a day for a minimum of five days. [As a curative, use two cups of E. infusion daily for five days followed by one cup daily for another five days. Continue for a full ten days. If only the tincture is available, use 1 drop per two pound of body weight. (ie.. 150 pound Mama = 75 drops.) Repeat the dose three to four times a day until fever abates, then two times a day for an additional week.]
Estragalus tincture ½ tsp or one dropper full 2 times a day. Can use equal parts with Echinacea tincture.
Note: Tinctures can be purchased in either a glycerine or alcohol base. Might have to special order glycerine based tinctures.
VAGINAL RINSES FOR GROUP B BETA STREP:
Do not douche in pregnancy. Rinse. Go easy. Separate labia and spray externally. Rinse anal area also. Remember to treat your partner.
1. Thyme, Rosemary, Calendula, Yarrow: Mix equal parts of herbs in a bowl.
Take 6 tablespoons of mixture and add 1 quart of boiling water. Infuse in covered
container 4 hours. Strain into a clean jar. Discard herbs.
Use 1 ½-2 cups per time as a rinse.
Optional: Add ¼ cup sea salt, 10 drops of lavender oil, 1 oz Echinacea tincture.
2. Echinacea infusion.
3. After 37 weeks, use Golden Seal gel capsules, deep in the vagina, if possible up
behind the cervix (not in cervix). Can cause uterine contractions.You can use these infusions for Sitz baths too.
4. Some practitioners recommend a very dilute solution of Hibiclens (an over-the-counter product which has in it an antimicrobial skin cleaner), Hydrogen Peroxide (food grade), or a very dilute solution of bleach: one teaspoon in a quart of water as a genital area rinse.
VAGINAL SUPPOSITORY RECIPE:
Place 1 cup Echinacea agustifolia root, cut; 1 cup Usnea lichen, cut; and 1 cup Calendula flowers in a quart jar.
Melt 8 oz. cocoa butter with 16 oz. coconut oil; pour over herbs.
Heat-infuse by placing the covered jar in a crockpot; add water to immerse the jar three-quarters of the way; set on low and cook 12-24 hours. Cool and strain.
To 1 cup of the infused oil add 1 tablespoon of these herbs: Slippery Elm Bark, Comfry Root, and Marshmallow Root.
Add 20 drops of these essential oils: Lavender, Rosemary and Tea Tree.
Chill slightly in an ice cube tray. When blocks are solid, cut them into quarters.
Insert one small cube into vagina before bed.
MISCELLANOUS CONSIDERATIONS:
Use cotton underpants.
Use vinegar or baking soda in the rinse cycle of washing machine when washing your
underpants.
Change your underpants (or panty liner) if damp. Best to go without - to air out!
Use warm water wash from squeeze bottle after pooping, then pat yourself dry.
Beta strep can be more prevalent in conjunction with urinary track infection. Urine should be checked for B-strep in this case.
Yeast infection conditions can give rise to increased Beta strep population.
So...what to do? Sit in a bucket of bleach????
But I am moving on here, perhaps to even more controversial territory in this serialized tale about a journey back to the future, with a home VBAC.
One of the bigger questions I was facing was: What to do about having a Strep B test? Did I need it? Did I want it? Is it necessary? What were the homeopathic options and were they effective?
I knew that testing positive for Strep B COULD prove fatal to a newborn, which might pick up the bacteria on its way down the birth canal.
These were some of the homeopathtic options up for consideration -- things one might do prophylactically, in place of being tested.
ORALLY:
500-1000 mg Vitamin C with bioflavinoids, twice per day.
Vitamin C is water soluble and extra is excreted by the kidneys.
Eat cranberries and garlic daily; or take cranberry capsules and garlic pearls three times per day.
Plenty of live culture yogurt; or Acidophilus capsules daily.
Bee propolus; or tincture.
Echinacea is very Strep specific, according to one source. As a preventative, use 10-15 drops of tincture in a glass of water twice a day for a minimum of five days. [As a curative, use two cups of E. infusion daily for five days followed by one cup daily for another five days. Continue for a full ten days. If only the tincture is available, use 1 drop per two pound of body weight. (ie.. 150 pound Mama = 75 drops.) Repeat the dose three to four times a day until fever abates, then two times a day for an additional week.]
Estragalus tincture ½ tsp or one dropper full 2 times a day. Can use equal parts with Echinacea tincture.
Note: Tinctures can be purchased in either a glycerine or alcohol base. Might have to special order glycerine based tinctures.
VAGINAL RINSES FOR GROUP B BETA STREP:
Do not douche in pregnancy. Rinse. Go easy. Separate labia and spray externally. Rinse anal area also. Remember to treat your partner.
1. Thyme, Rosemary, Calendula, Yarrow: Mix equal parts of herbs in a bowl.
Take 6 tablespoons of mixture and add 1 quart of boiling water. Infuse in covered
container 4 hours. Strain into a clean jar. Discard herbs.
Use 1 ½-2 cups per time as a rinse.
Optional: Add ¼ cup sea salt, 10 drops of lavender oil, 1 oz Echinacea tincture.
2. Echinacea infusion.
3. After 37 weeks, use Golden Seal gel capsules, deep in the vagina, if possible up
behind the cervix (not in cervix). Can cause uterine contractions.You can use these infusions for Sitz baths too.
4. Some practitioners recommend a very dilute solution of Hibiclens (an over-the-counter product which has in it an antimicrobial skin cleaner), Hydrogen Peroxide (food grade), or a very dilute solution of bleach: one teaspoon in a quart of water as a genital area rinse.
VAGINAL SUPPOSITORY RECIPE:
Place 1 cup Echinacea agustifolia root, cut; 1 cup Usnea lichen, cut; and 1 cup Calendula flowers in a quart jar.
Melt 8 oz. cocoa butter with 16 oz. coconut oil; pour over herbs.
Heat-infuse by placing the covered jar in a crockpot; add water to immerse the jar three-quarters of the way; set on low and cook 12-24 hours. Cool and strain.
To 1 cup of the infused oil add 1 tablespoon of these herbs: Slippery Elm Bark, Comfry Root, and Marshmallow Root.
Add 20 drops of these essential oils: Lavender, Rosemary and Tea Tree.
Chill slightly in an ice cube tray. When blocks are solid, cut them into quarters.
Insert one small cube into vagina before bed.
MISCELLANOUS CONSIDERATIONS:
Use cotton underpants.
Use vinegar or baking soda in the rinse cycle of washing machine when washing your
underpants.
Change your underpants (or panty liner) if damp. Best to go without - to air out!
Use warm water wash from squeeze bottle after pooping, then pat yourself dry.
Beta strep can be more prevalent in conjunction with urinary track infection. Urine should be checked for B-strep in this case.
Yeast infection conditions can give rise to increased Beta strep population.
So...what to do? Sit in a bucket of bleach????
Saturday, February 02, 2008
Repeated VBACs are safe; repeated cesareans are not
I am taking a brief brake from my serialized birth story to report on a study out of Case Western that just came out in Obstetrics & Gynecology (2008;111:285-291).
The study's OBJECTIVE: To estimate the success rates and risks of an attempted vaginal birth after cesarean delivery (VBAC) according to the number of prior successful VBACs.
METHODS: From a prospective multicenter registry collected at 19 clinical centers from 1999 to 2002, we selected women with one or more prior low transverse cesarean deliveries who attempted a VBAC in the current pregnancy. Outcomes were compared according to the number of prior VBAC attempts subsequent to the last cesarean delivery.
RESULTS: Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52% (P=.03). The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter.
CONCLUSION: Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy.
Contrast that study with another from Obstetrics & Gynecology (2006;107:1226-1232) which found that there is maternal morbidity associated with multiple repeat cesareans.
OBJECTIVE: To estimate the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries.
METHODS: Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999–2002).
RESULTS: There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively.
CONCLUSION: Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery.
Thanks to Carol Sakala at the Childbirth Connection for sending me those...
The study's OBJECTIVE: To estimate the success rates and risks of an attempted vaginal birth after cesarean delivery (VBAC) according to the number of prior successful VBACs.
METHODS: From a prospective multicenter registry collected at 19 clinical centers from 1999 to 2002, we selected women with one or more prior low transverse cesarean deliveries who attempted a VBAC in the current pregnancy. Outcomes were compared according to the number of prior VBAC attempts subsequent to the last cesarean delivery.
RESULTS: Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52% (P=.03). The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter.
CONCLUSION: Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy.
Contrast that study with another from Obstetrics & Gynecology (2006;107:1226-1232) which found that there is maternal morbidity associated with multiple repeat cesareans.
OBJECTIVE: To estimate the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries.
METHODS: Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999–2002).
RESULTS: There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively.
CONCLUSION: Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery.
Thanks to Carol Sakala at the Childbirth Connection for sending me those...
Thursday, January 31, 2008
Our new baby, installment #18
Having written a book, read every book, seen every video (except for the dolphin one), it was time to start making some hard decisions about our plan for a home birth. First, did we want a waterbirth? If so, which rental pool should we use? The midwife had a few to offer. She recommended the "lucky" one six feet around and said it should be set up at least a week before I went into labor. But gee, when would that be? Where was I going to put something that big? How would I keep the boys out of it in the meantime? And my mother, always on the lookout for catastrophe, wanted to know if the pool that size filled with water would crash through the floor of our 140-year-old house.
Second, what to do about Strep B, that nasty bacteria that sends OBs running for antibiotics? I had tested negative for that the first time around. Did I need another test? And if I tested positive this time, would it throw the whole plan a curveball?
Little did I know it, but all of these decisions were making my blood pressure rise. Little. By. Little.
Second, what to do about Strep B, that nasty bacteria that sends OBs running for antibiotics? I had tested negative for that the first time around. Did I need another test? And if I tested positive this time, would it throw the whole plan a curveball?
Little did I know it, but all of these decisions were making my blood pressure rise. Little. By. Little.
Wednesday, January 30, 2008
Our new baby, installment #17
In addition to the copy of Optimal Foetal Position, our home birth midwife each week would send us home from our appointment with something else to read or watch. On one ocassion, it was a vintage VHS of a film called "Birth in the Squatting Position," which was only about 10 minutes long but showed the crowning and births of a handful of babies in stark anatomical fasion. The only sound one hears in addition to the background music is the narrator in his English accent sounding like the host of Wild Kingdom's World of Animals as he explains in awe that women actually give birth squatting -- and smile as they do it! It took many weeks for my husband to bring himself to watch the film, which left him sort of speechless. It left me sort of speechless, too. One of the births shows a baby whose head molded so incredibly that it looked more like a summer squash than a human!
Tuesday, January 29, 2008
Our new baby, installment #16
During one of our regular visits with a home birth midwife, we talked about my first birth (in the hospital, back labor, epidural, hours of pushing, cesarean, yadda, yadda, later to learn that the baby was posterior, or facing the wrong way, face up, as he tried to make his exit.) Recently, I told the midwife, I had heard a statistic that some 30 percent of all first births involve a posterior baby.
"Why is that?" I asked.
The answer seems to be a bit of a mystery but one thing is for sure: Posterior babies in general are becoming increasingly common. Perhaps that is because of our sedentary lifestyle, sitting at desks all day using poor posture, driving home in a car with bucket seats and then lounging on the couch at night...the baby settles into the mother's body as if it were laying in a hammock, its back curved against the slouch of the mother's spine, she explained.
Alarmed, I sat up as the midwife reached over to her shelf and handed me an older book called Optimal Foetal Positioning (I don't even think the book is in print anymore, but please correct me if I am wrong), written by a midwife and a childbirth educator, one of whom had been trained in engineering. They explain that if the mother sits forward and upright, the baby is nudged out of the hammock and will assume the proper position. I devoured the book and began to keep better posture immediately.
Of course it is tricky for a very pregnant woman to sit forward because the belly gets in the way. So I made it a habit of sitting in a very unladylike fashion, legs spread, belly pushed forward, sitting on the edge of my seat. I was pretty sure the technique was working, if for no other reason than I did not feel the same sort of back pain toward the end of my pregnancy that I had felt the first time.
The solution seemed so easy and so low-tech. If every pregnant woman in America could read this book, would the c-section rate still be more than 30 percent?
In the end, I wondered, would the book save me from having another posterior baby?
"Why is that?" I asked.
The answer seems to be a bit of a mystery but one thing is for sure: Posterior babies in general are becoming increasingly common. Perhaps that is because of our sedentary lifestyle, sitting at desks all day using poor posture, driving home in a car with bucket seats and then lounging on the couch at night...the baby settles into the mother's body as if it were laying in a hammock, its back curved against the slouch of the mother's spine, she explained.
Alarmed, I sat up as the midwife reached over to her shelf and handed me an older book called Optimal Foetal Positioning (I don't even think the book is in print anymore, but please correct me if I am wrong), written by a midwife and a childbirth educator, one of whom had been trained in engineering. They explain that if the mother sits forward and upright, the baby is nudged out of the hammock and will assume the proper position. I devoured the book and began to keep better posture immediately.
Of course it is tricky for a very pregnant woman to sit forward because the belly gets in the way. So I made it a habit of sitting in a very unladylike fashion, legs spread, belly pushed forward, sitting on the edge of my seat. I was pretty sure the technique was working, if for no other reason than I did not feel the same sort of back pain toward the end of my pregnancy that I had felt the first time.
The solution seemed so easy and so low-tech. If every pregnant woman in America could read this book, would the c-section rate still be more than 30 percent?
In the end, I wondered, would the book save me from having another posterior baby?
Monday, January 28, 2008
Our new baby, installment #15
Continuing the drama about my decision to attempt a home VBAC, also known as an HBAC, or home birth after cesarean, I had disinvited my parents from being at the house while I was in labor. This decision was despite my mother having met the midwives over dinner at our home, despite my mother having read my book, despite how strongly she knew how I felt. She just could not change her position. She could not change who she was. And that was fine. We agreed to disagree. Of course, she was not the only one in the family who thought I was nuts. My grandmother, whom I adore, accused me of "going backwards." This, despite that Gram had her three children in the hospital under the spell of Twilight Sleep, a mix of morphine and the amnesiac scopalamine. Thus, she does not remember giving birth except for the fact that "it hurt" and the nurses told her to "shut up." My aunt, who is only 13 years older than me and has always been the "cool" one in the family and saw a midwife (in the hospital) for her oldest child's birth, sort of understood where I was coming from in deciding to stay home. But she kept calling and asking what my backup plan was. In a nice way. There were a couple of surprising supporters. My sister-in-law, who had had a cecearean a few months before, was very supportive, saying I was better educated than anyone in the family on the subject and therefore I would be OK. And my grandfather, who is well into his 80s, was quietly approving, perhaps in his old fashioned way appreciating that women have been doing this forever.
But the remark about me going backwards is one that I keep thinking about. Was shunning the hospital and its malpractice fears, its MRSA infections, its aggressive obstetrics, its lack of support for VBAC, really going backwards? Or was it the most progressive thing I could do? Should the new post-modern reality be all about less is more, whether we are talking about calories, house size, miles driven or medical interventions?
What do you think? Was I going backwards?
But the remark about me going backwards is one that I keep thinking about. Was shunning the hospital and its malpractice fears, its MRSA infections, its aggressive obstetrics, its lack of support for VBAC, really going backwards? Or was it the most progressive thing I could do? Should the new post-modern reality be all about less is more, whether we are talking about calories, house size, miles driven or medical interventions?
What do you think? Was I going backwards?
Friday, January 25, 2008
Our new baby, installment #14
As I was saying in my previous post, it is a statistical fact that the majority of women around the world tend to labor through the night. (For nocturnal creatures, the opposite is true.) Why? Well, some scientists posit that laboring at night is the result of evolutionary biology. Going back to early human times (and as is the case with the majority of other mammals) we want to give birth safely surrounded by those we trust - our tribe, clan, family etc. During the day, the men would have been off hunting woolly mammoth and the other women far flung gathering nuts and berries. At night, everyone would have been around to protect the space from predators.
I wondered whether I would fall into that pattern with this birth. Of course, I hoped I would because my mother, whether she remembers it or not, was disinvited from coming to the house to take care of our other two boys during labor. And having an active four-year-old and an 11-year-old who did not really want to see or hear any of this birth, we were worried how it would work out.
I wondered whether I would fall into that pattern with this birth. Of course, I hoped I would because my mother, whether she remembers it or not, was disinvited from coming to the house to take care of our other two boys during labor. And having an active four-year-old and an 11-year-old who did not really want to see or hear any of this birth, we were worried how it would work out.
Thursday, January 24, 2008
Our new baby, installment #13
After the home birth midwife and my husband and I discussed the logistics of who would watch the kids when I went into labor (like, on a Saturday afternoon)I called my parents.
"Do you want to be there?"
"Of course," they said. "We would love to."
"Can you check your nervousness and negativity at the door?" I asked.
"Yes," they both said.
So I went and reported this back to my husband and the midwife, who both looked at me skeptically.
Then, a few weeks later, having Sunday dinner with my parents, we discussed this plan some more.
"Well, just tell me what to do if you say you want an epidural," mom said, knowing that such pain relief would require transfer to the hospital.
That was the deal breaker. It was clear that the default setting in her brain was THIS WILL BE UGLY AND MY ROLE IS PROTECTOR.
I called mom later to tell her she and dad were off the hook. We now had no plan B for childcare.
Mom admitted to being relieved. I guess I was too.
There was one phenomenon working in my favor, however. It is a statistical fact that the majority of women tend to labor through the night. (For nocturnal creatures, the opposite is true.) In my next post I will explain why.
"Do you want to be there?"
"Of course," they said. "We would love to."
"Can you check your nervousness and negativity at the door?" I asked.
"Yes," they both said.
So I went and reported this back to my husband and the midwife, who both looked at me skeptically.
Then, a few weeks later, having Sunday dinner with my parents, we discussed this plan some more.
"Well, just tell me what to do if you say you want an epidural," mom said, knowing that such pain relief would require transfer to the hospital.
That was the deal breaker. It was clear that the default setting in her brain was THIS WILL BE UGLY AND MY ROLE IS PROTECTOR.
I called mom later to tell her she and dad were off the hook. We now had no plan B for childcare.
Mom admitted to being relieved. I guess I was too.
There was one phenomenon working in my favor, however. It is a statistical fact that the majority of women tend to labor through the night. (For nocturnal creatures, the opposite is true.) In my next post I will explain why.
Tuesday, January 22, 2008
Our new baby, installment #12
Continuing the story of our experience with a home birth midwife, at one of our visits we discussed the logistics of what would happen when I went into labor -- who would watch the other two boys, a four-year-old and my 11-year-old stepson. We have many nice neighbors with kids of their own, and we could probably ask them for a favor. But still, I felt as if the right person for the job was my own mother. She's a very attentive grandmother. The boys adore her. But she is a terrible Nervous Nelly. Could she deal with being in the house when I was in labor? With my first son, I vowed I would not call her until after the baby was born, to save her the fret. (I crumbled, and called her on the way to the hospital.) She did, however, keep it together when she saw me wheeled out of the operating room, post-unwanted c-section. I was devasted and exhausted. She was nothing but supportive. Still, she and I were not on the same page this time. She was horrified by the idea of a home birth. It was time for a heart-to-heart with her.
Monday, January 21, 2008
Our new baby, installment #11
As the summer progressed, I saw my midwife regularly. And everything was fine. My belly grew and so did my confidence.
Thursday, January 17, 2008
Our new baby, installment #10
Continuing the story of our visits with a home birth midwife, there were a couple of occasions where there was very little talk about childbirth. On one day, when my husband could not make the appointment, the midwife had an antique book of poems on the table waiting for me. She had selected some readings in advance and, after I peed in the cup but before she listened to the baby's heart, she read them to me. They weren't about birth. They weren't about courage or anything thematically related to birth. But they were lovely and relaxing and she must have known that as I crammed this appointment between the insanity of work/end of the school day/dinner/laundry/kid baths/bed, that I needed a quiet moment. Maybe the fetus needed a quiet moment too. I am sure she was right. I remember thinking, what would an OB say if he/she witnessed this moment?
On another day, again sensing that I was tired and stressed, she encouraged me to sing. HA! I went along with the gag, but I really don't sing. Maybe I should. Maybe I would be less tired and stressed. But mostly I smiled and watched her sing. What a voice. Regardless, the trick worked, and although I had begun swelling like a tick as I reached the final trimester, I left her office feeling lighter.
On another day, again sensing that I was tired and stressed, she encouraged me to sing. HA! I went along with the gag, but I really don't sing. Maybe I should. Maybe I would be less tired and stressed. But mostly I smiled and watched her sing. What a voice. Regardless, the trick worked, and although I had begun swelling like a tick as I reached the final trimester, I left her office feeling lighter.
Tuesday, January 15, 2008
The Business of Being Born reviews
Before my next installment about my own recent childbirth esxperience, I wanted to comment on several reviews of the "The Business of Being Born," Ricki Lake's documentary about home birth, which is about to come out in select theaters and on Netflix. (Disclaimer, I am in the film).
http://www.slate.com/id/2181860/
Boo Hiss. My big complaint here is the "kicker," which is journalism-speak for the ending. The reviewer says birth is nobody's business but that of the woman doing it. Fine. But this is the sort of attitude that has stopped women from discussing childbirth in any meaningful way. Stifling conversation leads us down the road of ignorance.
http://www.salon.com/ent/movies/review/btm/2008/01/10/business/
Pretty enlightened for a guy.
http://lifeandhealth.guardian.co.uk/health/story/0,,2237865,00.html (written by a home birther in London who tells me an editor inserted the words "gross" into this piece...)
http://www.slate.com/id/2181860/
Boo Hiss. My big complaint here is the "kicker," which is journalism-speak for the ending. The reviewer says birth is nobody's business but that of the woman doing it. Fine. But this is the sort of attitude that has stopped women from discussing childbirth in any meaningful way. Stifling conversation leads us down the road of ignorance.
http://www.salon.com/ent/movies/review/btm/2008/01/10/business/
Pretty enlightened for a guy.
http://lifeandhealth.guardian.co.uk/health/story/0,,2237865,00.html (written by a home birther in London who tells me an editor inserted the words "gross" into this piece...)
Our new baby, installment #9
With a home birth midwife on board, my husband and I would meet her at her office, a little detached structure behind her house, every two weeks. Unlike the OB visits with my first son when a nurse would have me pee, stand on a scale and offer an arm for blood pressure and pulse, all in less than five minutes, time with the midwife was more relaxed. Altough the appointments were scheduled for an hour each, they often ran over, sometimes by 30 minutes, as we talked. Yes, I peed in a cup in the private bathroom, but the midwife showed me how to take a special dipstick, put it in the Dixie Cup, and watch it change colors; the test would check everything from protein to sugar in the urine. She even encouraged me to perform the test myself, which I did. (I often showed her the results to make sure I was doing it right, though she never asked). This was not laziness on her part. Clearly she had me do it myself as a way of making me feel empowered about my care. There was nothing paternalistic about these visits. She trusted that I could read a dipstick! Alas, I could!
Of course the visits also included weighs-ins, though she would ask me if I wanted to step on the scale -- again a subtle but nice gesture. I did not have to get weighed, and a couple times, I skipped it. She could tell by looking at me if my weight was in check or if I was retaining too much water. She took my blood pressure, and listened to the baby's heart using a fetoscope. She would also measure my belly and feel the baby's position. There were no internal exams, except for one, at the very end.
For the most part, the time was spent talking about how I was feeling, not just physically, but emotionally. She asked about my family, the other kids, if I was stressed out at work. Was any of this relevant? Maybe, maybe not. But my midwife and I were getting to know each other.
Two hundered years ago, if a midwife was called to attend a birth, she likely would have been a member of the extended family or a woman who lived in the village. Everyone would have known her. Trust would have been inherent. It is important to feel comfortable and trust your birth attendant. It takes away the fear and helps you to relax.
I watched the movie "Knocked Up" recently and there is a scene where the expectant mother interviews all these OBs and settles on one after he tells her (falsely) that he would be there for her birth, not someone else in the medical practice. Of course, he was not there when she went into labor and she flipped out.
I was getting to know my midwife. And one of the first things I came to know: She would be there for me.
Of course the visits also included weighs-ins, though she would ask me if I wanted to step on the scale -- again a subtle but nice gesture. I did not have to get weighed, and a couple times, I skipped it. She could tell by looking at me if my weight was in check or if I was retaining too much water. She took my blood pressure, and listened to the baby's heart using a fetoscope. She would also measure my belly and feel the baby's position. There were no internal exams, except for one, at the very end.
For the most part, the time was spent talking about how I was feeling, not just physically, but emotionally. She asked about my family, the other kids, if I was stressed out at work. Was any of this relevant? Maybe, maybe not. But my midwife and I were getting to know each other.
Two hundered years ago, if a midwife was called to attend a birth, she likely would have been a member of the extended family or a woman who lived in the village. Everyone would have known her. Trust would have been inherent. It is important to feel comfortable and trust your birth attendant. It takes away the fear and helps you to relax.
I watched the movie "Knocked Up" recently and there is a scene where the expectant mother interviews all these OBs and settles on one after he tells her (falsely) that he would be there for her birth, not someone else in the medical practice. Of course, he was not there when she went into labor and she flipped out.
I was getting to know my midwife. And one of the first things I came to know: She would be there for me.
Sunday, January 13, 2008
What Hemingway had to do with my birth
We knew immediately when we walked out of that first meeting that we would sign the contract to hire the midwife. And indeed, we did. One of the reasons was that when we asked what her depth of experience was with VBACs she said she had done many -- especially lately, since so many women were increasingly feeling pressure from hospitals to have repeat cesareans. When we asked her if she treated VBAC clients differently than those who have never had a cesarean, she replied without blinking: "No."
My husband piped up: "Isn't there a greater risk for uterine rupture?
She did not take the bait, saying that the scar just does not come into play.
"We grow stronger in the broken places," my husband offered, quoting Hemingway.
The midwife nodded. I cried. Love that guy.
My husband piped up: "Isn't there a greater risk for uterine rupture?
She did not take the bait, saying that the scar just does not come into play.
"We grow stronger in the broken places," my husband offered, quoting Hemingway.
The midwife nodded. I cried. Love that guy.
Friday, January 11, 2008
Our new baby, installment #7
This post is for Vanessa, who commented in response to installment #6, saying she is not telling her family about her home VBAC (HBAC) for her third child...Vanessa, I don't blame you. Although I told my side of the family -- before we stopped talking about it -- I was initially selective about whom we told of our plans. My mother-in-law is a Freudian analyst. I did not mention this to her, as you might imagine. (Remind me later to elaborate on her at the end of the installment series.) Also, I was reluctant to mention the decision to colleagues and neighbors and anyone else who asked what hospital I was going to. Eventually, however, as I became more resolute in the plan, I was straightforward even with strangers. "The baby is being born at home," I would say, as if it were an affirmation.
In early fall, I attended a Birth on Labor Day Event in Cambridge and shared the Q&A session with a very nice OB I knew from my research. An OB who might be a midwife in another life. She noticed I was pregnant and after the program we chatted on the sidewalk.
"Where will the baby be born?" she asked.
"Not where my last child was born," I said coyly. (She knew where my last child was born.)
"Come on," she begged. "Where?"
"Oh, at home," I 'fessed.
She then lectured me on a VBAC uterine rupture that she had to section in emergency fashion just weeks before.
"Really?" I asked? "Did the woman have Pitocin?"
"Yes," she said.
"Well why would you give a VBAC Pitocin?" I pressed. Pitocin, of course, can hyperstimulate the uterus, causing it rupture - and much of the VBAC studies include rupture cases caused by Pitocin, thereby skewing the actual safety of a VBAC with no intervention, part of the reason why many hospitals are now not even allowing women to attempt a VBAC.
"I guess we were impatient," she conceded.
She wished me luck before we parted ways.
I remember thinking that I don't need luck. I just need a midwife who is patient. I just need to be in a place where there is no Pitocin.
In early fall, I attended a Birth on Labor Day Event in Cambridge and shared the Q&A session with a very nice OB I knew from my research. An OB who might be a midwife in another life. She noticed I was pregnant and after the program we chatted on the sidewalk.
"Where will the baby be born?" she asked.
"Not where my last child was born," I said coyly. (She knew where my last child was born.)
"Come on," she begged. "Where?"
"Oh, at home," I 'fessed.
She then lectured me on a VBAC uterine rupture that she had to section in emergency fashion just weeks before.
"Really?" I asked? "Did the woman have Pitocin?"
"Yes," she said.
"Well why would you give a VBAC Pitocin?" I pressed. Pitocin, of course, can hyperstimulate the uterus, causing it rupture - and much of the VBAC studies include rupture cases caused by Pitocin, thereby skewing the actual safety of a VBAC with no intervention, part of the reason why many hospitals are now not even allowing women to attempt a VBAC.
"I guess we were impatient," she conceded.
She wished me luck before we parted ways.
I remember thinking that I don't need luck. I just need a midwife who is patient. I just need to be in a place where there is no Pitocin.
Thursday, January 10, 2008
Our new baby, installment #6
Despite the pressure, we made an appointment to speak with another midwife. When she gave us directions to her home office, she described her house as being the color of a clay pot. Her office, actually a detached cottage-like space, was comfortable and welcoming. There was a bowl of cherries between the plush chairs where she told my husband and me to sit. She pulled up a stool and told me to put up my feet. As she answered our questions -- all the tedious ones that I now grow impatient at answering, I gazed out the backdoor, which was slightly ajar. This being summer, I could see birds and bees keeping busy in the garden. Inside, on the wall, along with some artful birth photos and oil paintings, was a neon sign that read "open." I appreciated the metaphor. We took a contract home.
Wednesday, January 09, 2008
Our new baby, installment #5
My husband and I may have been sure about a home a birth, but no one else among my family or friends could understand our decision. What was frustrating for me was not being able to penetrate their logic. Some knew that old saying "once a cesarean always a cesarean," though they may not have known why, unless they read my book, that that saying even came into being. Others could not stop asking, "What if something goes wrong at home?" The answers to these questions, even now, are (I concede) so fundamental, but so tedious that I cannot even bear to write about it.
The conversation with family came to a head at a birthday party last June. My sister-in-law was about a month away from her due date with her first baby. I suggested that we all chip in and hire a doula for my brother (who was very nervous about the process) and his wife. I explained how the hospital can actually inhibit birth if a woman feels afraid or not totally supported through labor. Well, the doula idea didn't fly. And instead, the conversation turned to focus on my own birth plan. Tears were shed. And from that day on, we decided not to discuss home birth amongst ourselves.
To find out how my sister-in-law's birth went, see my blog post from that time. http://tinacassidy.blogspot.com/2007/07/new-baby-in-family.html
My parents witnessed the above birth and finally started to understand where I was coming from.
The conversation with family came to a head at a birthday party last June. My sister-in-law was about a month away from her due date with her first baby. I suggested that we all chip in and hire a doula for my brother (who was very nervous about the process) and his wife. I explained how the hospital can actually inhibit birth if a woman feels afraid or not totally supported through labor. Well, the doula idea didn't fly. And instead, the conversation turned to focus on my own birth plan. Tears were shed. And from that day on, we decided not to discuss home birth amongst ourselves.
To find out how my sister-in-law's birth went, see my blog post from that time. http://tinacassidy.blogspot.com/2007/07/new-baby-in-family.html
My parents witnessed the above birth and finally started to understand where I was coming from.
Tuesday, January 08, 2008
Our new baby, installment # 4
So there I was, 12 weeks pregnant, in for an "early risk assessment," which is a blood test and an ultrasound, intended to take the place of an amniocentesis, which I had ZERO interest in having. However, there is an additional step in the ERA that I was not aware of. Before the ultrasound or bloodtest, you are ushered in to see the "genetic counselor," a sanitized name for someone who basically scares the living daylights out of you. After taking a family history (no issues, either side) the counselor began to explain everything that could go wrong with the fetus. To illustrate her points, she matter-of-factly flipped through laminated pages in a booklet showing missing chromosomes. I was flabbergasted.
Stopping briefly on one page, she explained: "This child would not live."
"Why are you showing me this now? I haven't even been tested yet?" I pleaded.
"Well, we just want you to know what we are looking for," she said, totally unaware of how alarming her whole performance had been.
Spare me. It was a horrible hour, and when I retreated to the waiting room to be called in for the ultrasound, almost every woman I saw come out of the counselor's office had been reduced to tears. To make a long story short, my ultrasound showed a perfect fetus, my blood test was fine, and I was angry that I was put through that display for no good reason.
I vowed that I would have no more tests and was more sure than ever that I had to sign a home birth midwife.
Of course, there was just one more glitch: Despite spending hours on the phone with our blue chip health insurance plan, it did not appear that they would spend a dime to pay for a home birth. Unfortunately, they paid plenty for the ERA, which did nothing but elevate my blood pressure.
Stopping briefly on one page, she explained: "This child would not live."
"Why are you showing me this now? I haven't even been tested yet?" I pleaded.
"Well, we just want you to know what we are looking for," she said, totally unaware of how alarming her whole performance had been.
Spare me. It was a horrible hour, and when I retreated to the waiting room to be called in for the ultrasound, almost every woman I saw come out of the counselor's office had been reduced to tears. To make a long story short, my ultrasound showed a perfect fetus, my blood test was fine, and I was angry that I was put through that display for no good reason.
I vowed that I would have no more tests and was more sure than ever that I had to sign a home birth midwife.
Of course, there was just one more glitch: Despite spending hours on the phone with our blue chip health insurance plan, it did not appear that they would spend a dime to pay for a home birth. Unfortunately, they paid plenty for the ERA, which did nothing but elevate my blood pressure.
Sunday, January 06, 2008
Our new baby, installment #3
So how does one choose a home birth midwife exactly? In some states, they aren't even legal. In Massachusetts, there are various, well, levels of legality related to home birth. Regardless, I was focused on finding someone who was understanding, experienced and, to use an old midwifery adage, knew when to use her hands and when to sit on them. In the last couple of years, in doing research for my book and in doing readings after it was published, I had met lots of midwives. And I think I can honestly say that I have not met one that I did not like. Still, finding the right midwife was alot like finding the right spouse. There had to be chemistry. I spoke and met with several, asking them all the same questions about their qualifications and experience. We invested many hours in this process and it dawned on me that, years before, when I had signed up with an obstetrician, I did so simply because her name was listed among providers in my insurance booklet, and she could squeeze me in for a pap smear this side of six months. What had I been thinking? Or, more precisely, not thinking? I guess I was just so busy, and perhaps so totally realistic, that having a 'relationship' with my OB (gotta love those five minute appointments) was a non-issue. Of course, she was not on call the night my first son was born and he was surgically delivered by someone whose name I do not know and have never heard of again.
Anyway, in our search for a midwife a couple months passed and we still had not settled on one. I wondered if I was being irresponsible letting time pass without having regular prenatal visits with SOMEONE. But I did not want to get sucked into a medical practice, with all of its tests, only to leave.
Meanwhile, family and friends were nudging me about getting an early ultrasound/blood test at 12 weeks given that I am 38 and considered at higher risk for fetal abnormalities. I really did not want an ultrasound, and didn't think I needed one, despite that I was quite intent to have one with my first son. I am not sure why I had a change of heart about the procedure between pregnancies. Perhaps it was seeing my sister-in-law, among others in my family, go through hell when ultrasounds raised false alarms and caused months of unnecessary stress (oh the hysterics)! I did not want or need any negativity. I knew my baby was fine and if it wasn't, it wasn't. That was OK, too. But my husband was particularly uneasy, so I relented.
It was a decision that really cemented how this birth would unfold.
Anyway, in our search for a midwife a couple months passed and we still had not settled on one. I wondered if I was being irresponsible letting time pass without having regular prenatal visits with SOMEONE. But I did not want to get sucked into a medical practice, with all of its tests, only to leave.
Meanwhile, family and friends were nudging me about getting an early ultrasound/blood test at 12 weeks given that I am 38 and considered at higher risk for fetal abnormalities. I really did not want an ultrasound, and didn't think I needed one, despite that I was quite intent to have one with my first son. I am not sure why I had a change of heart about the procedure between pregnancies. Perhaps it was seeing my sister-in-law, among others in my family, go through hell when ultrasounds raised false alarms and caused months of unnecessary stress (oh the hysterics)! I did not want or need any negativity. I knew my baby was fine and if it wasn't, it wasn't. That was OK, too. But my husband was particularly uneasy, so I relented.
It was a decision that really cemented how this birth would unfold.
Our new baby, installment #2
So here we were, dealing with the news that continual fetal monitoring was now the standard policy in the maternity unit at the one hospital in the Boston area that I thought would be truly supportive of a VBAC, or vaginal birth after cesarean. Why, some may ask, is continual fetal monitoring a bad thing? Afterall, all the machine is doing is making sure the baby is not in distress. Well, having asked the question of so many experts during the course of writing my book, I knew all too well that the machines are often mistaken, indicating the baby is in distress when it is not, leading to many unnecessary c-sections; that hospitals use the machines to protect themselves from malpractice; and that cerebral palsey cases have not declined since the machines became popularized in the 1970s, perhaps because, as it is now believed, fetal oxygen deprivation can frequently happen before labor even begins. Meanwhile, much research has shown that intermittent monitoring is effective and has the bonus of allowing the mother to move into a comfortable position during labor, as well as facilitating the baby to ease into the birth canal.
My husband and I knew we could sign a release rejecting the continual EFM but because of my previous experience giving birth, at a major teaching hospital here, we also knew that when you walk into a maternity unit saying all the things you DON'T want, the staff sort of lines up against you, viewing you as trouble. And who needs that during labor?
This time, I wanted nothing but support, encouragement...heck just NICE people around me. Was that too much to ask?
After digesting the situation for a couple weeks, my husband and I both intiutively knew that going to that hospital would not work.
Not long before we made this decision, we had gone to New York, to the Tribeca Film Festival, for the screening of the "The Business of Being Born," Ricki Lake's documentary about birth at home vs. the hospital.
I was interviewed at length for the film, and we were excited to see it. We were truly captivated, my husband especially. Although he had read my book (so many times, the poor guy!)he was really moved by the evidence in the film that home birth can be a wonderful, safe experience. He also finally understood in his gut some of the problems hospitals can actually trigger during labor. Of course, I knew all this already, but the film had driven it home for both of us and now the one hospital that we considered for a VBAC -- purely on the level of 'Oh, let's just check it out...' -- was off the table.
Also, several months before, I had written a magazine article about how women who wanted a VBAC were choosing home birth because they did not believe they could get a fair shake in the hospital. Those I interviewed were overwhelmingly happy with their choice to stay home.
All of these experiences pushed me to start interviewing home birth midwives, not for another article, but for my own needs.
My husband and I knew we could sign a release rejecting the continual EFM but because of my previous experience giving birth, at a major teaching hospital here, we also knew that when you walk into a maternity unit saying all the things you DON'T want, the staff sort of lines up against you, viewing you as trouble. And who needs that during labor?
This time, I wanted nothing but support, encouragement...heck just NICE people around me. Was that too much to ask?
After digesting the situation for a couple weeks, my husband and I both intiutively knew that going to that hospital would not work.
Not long before we made this decision, we had gone to New York, to the Tribeca Film Festival, for the screening of the "The Business of Being Born," Ricki Lake's documentary about birth at home vs. the hospital.
I was interviewed at length for the film, and we were excited to see it. We were truly captivated, my husband especially. Although he had read my book (so many times, the poor guy!)he was really moved by the evidence in the film that home birth can be a wonderful, safe experience. He also finally understood in his gut some of the problems hospitals can actually trigger during labor. Of course, I knew all this already, but the film had driven it home for both of us and now the one hospital that we considered for a VBAC -- purely on the level of 'Oh, let's just check it out...' -- was off the table.
Also, several months before, I had written a magazine article about how women who wanted a VBAC were choosing home birth because they did not believe they could get a fair shake in the hospital. Those I interviewed were overwhelmingly happy with their choice to stay home.
All of these experiences pushed me to start interviewing home birth midwives, not for another article, but for my own needs.
Saturday, January 05, 2008
Our new baby
Installment #1. I've sort of been keeping a secret -- a cyber secret, anyway, because it was obvious by looking at me --that I was pregnant over these nine (10?) long months, culminating in the birth of a gorgeous boy five minutes past midnight on Dec. 8. The delay in posting since then has more to do with the avalanche of work and sleeplessness that a newborn brings than my desire to withhold the information about Harrison's arrival. In fact, I have a lot to say about this most recent birth. Including where and how it happened. But I think I will serialize the story on my blog, starting today.
After writing a book about the history of childbirth, processing the unexpected cesarean birth of my first son, born 4 years ago, and hearing from some hard-core readers pick apart my book for not being forcefully anti-hospital or decidedly pro-natural enough for their taste, you might imagine how difficult it would be to discuss the pregnancy and birth and my choices as they were happening.
Well, when we found out I was pregnant, my first stop was not at the office of my former OB. I knew enough that five minute office visits, curt answers to my questions and the rash of tests they throw at you without even fully explaining them was not how I wanted to proceed. I wanted to slow down. Be seen by someone whose was not afraid of being sued, who accepted the idea that a vaginal birth after a cesarean was not just OK, but a good move. I decided to see a very well respected midwifery practice at a smaller local hospital that supports VBAC. (No way will I ever go back to one of Boston's enormous teaching hospitals unless I am in cardiac arrest, need an organ transplant or have cancer.)
Anyway, the midwife I saw was delightful. She asked about my previous birth and I burst into tears. She said she understood. When we talked about VBAC, she was encouraging, and when it was time to leave she handed me a red folder with all of the hospital's obstetrical practices explained. I asked about electronic fetal monitoring, and whether they offered it intermittently. She looked me in the eye, said they had always offered EFM intermittently, giving the mom the ability to get up and move around during labor, but that practice had just been ceased weeks before.
"You can sign a form saying you do not want continuous monitoring," she said.
I was devastated. I intuitively knew that being flat on my back, hooked up to an epidural and an EFM for hours had doomed my ability to give birth vaginally with my first son. And if I chose to go to this hospital, I would walk in having to fight against standard procedure.
My husband and I had to make a decision about what to do.
In installment #2, what happens next.
After writing a book about the history of childbirth, processing the unexpected cesarean birth of my first son, born 4 years ago, and hearing from some hard-core readers pick apart my book for not being forcefully anti-hospital or decidedly pro-natural enough for their taste, you might imagine how difficult it would be to discuss the pregnancy and birth and my choices as they were happening.
Well, when we found out I was pregnant, my first stop was not at the office of my former OB. I knew enough that five minute office visits, curt answers to my questions and the rash of tests they throw at you without even fully explaining them was not how I wanted to proceed. I wanted to slow down. Be seen by someone whose was not afraid of being sued, who accepted the idea that a vaginal birth after a cesarean was not just OK, but a good move. I decided to see a very well respected midwifery practice at a smaller local hospital that supports VBAC. (No way will I ever go back to one of Boston's enormous teaching hospitals unless I am in cardiac arrest, need an organ transplant or have cancer.)
Anyway, the midwife I saw was delightful. She asked about my previous birth and I burst into tears. She said she understood. When we talked about VBAC, she was encouraging, and when it was time to leave she handed me a red folder with all of the hospital's obstetrical practices explained. I asked about electronic fetal monitoring, and whether they offered it intermittently. She looked me in the eye, said they had always offered EFM intermittently, giving the mom the ability to get up and move around during labor, but that practice had just been ceased weeks before.
"You can sign a form saying you do not want continuous monitoring," she said.
I was devastated. I intuitively knew that being flat on my back, hooked up to an epidural and an EFM for hours had doomed my ability to give birth vaginally with my first son. And if I chose to go to this hospital, I would walk in having to fight against standard procedure.
My husband and I had to make a decision about what to do.
In installment #2, what happens next.
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