Just today I came across two UC stories. They illustrate the wide range of experiences women can have. One story is happy (she is a blogger I recently came across, and LDS too!); one is not (not because of anything that went wrong with the UC per se, but because of how people treated her when she decided to transfer to a hospital).
The second story illustrates some of the potential downsides of UC'ing in our current medical and legal climate. Some UC transfers go quite smoothly, and the hospital staff are respectful of the woman's wishes and of her birth experiences. But others can be nightmares. (The same can be said about midwife-attended home birth transfers.) I'm not sure what can be done to prevent this from happening to other women. In the second story, the physician's treatment of the woman precipitated a major obstetrical emergency. Legally, it would be considered assault and battery. The woman was screaming at the doctor to stop, yet the doctor persisted, ignoring the woman's very vigorous protests.
Both of these stories illustrate the benefit of having people to call upon during labor if the need arises. In the first story, the woman called a friend over to lend assistance with practical stuff like boiling water for the birth pool, so her husband could focus all of his attention on his laboring wife. In the second, the woman knew she needed another person's assistance when she was pushing, but had to call the EMTs and eventually transfer to the hospital because she didn't know anyone she could call on.
I had a friend lined up for my own labor in case I felt the need for female companionship. She was a mother of four children, two younger boys and two teenagers. I felt an instant affinity with her, and she had this very motherly sense about her that I really liked. It turns out I didn't need her company, but it was reassuring to me, and especially my husband, that we had someone we could call.
Monday, March 31, 2008
Friday, March 28, 2008
Moving!
My husband recently accepted a job offer at another liberal arts college. He'll be teaching English and creative writing. The offer was so fantastic we couldn't turn it down. He has a lower teaching load (3/3 instead of 4/4), a higher salary (37% increase), and tremendous faculty support.
The new town also has a ridiculously low cost of living, with many houses starting in the $40-50K range. We're hoping to buy a cute old house, close to campus, that needs some cosmetic renovations for under $70K. We love our huge historic Arts & Crafts bed & breakfast, but we are dreaming of a cosy little place with a lower utility bill! I'm going to miss our house, though. Built-in cupboards everywhere, an inglenook, pocket doors, a real Harry Potter room under the stairs, walk-in closets original to the house, wood floors, casement windows that swing inward and close with little turn latches, 17 windows in our master bedroom...sigh...
We are hoping to put our house on the market in the next week or so. We'll be working in France again for 6 weeks, so it's still up in the air whether we'll be moving before or after France. Either way it's going to be crazy. I really detest packing. The actual moving part is fine, since we get lots of help from church members on both ends of the move. But packing is a royal pain. I'd love to be able to sell all of our belongings and start fresh.
The new town also has a ridiculously low cost of living, with many houses starting in the $40-50K range. We're hoping to buy a cute old house, close to campus, that needs some cosmetic renovations for under $70K. We love our huge historic Arts & Crafts bed & breakfast, but we are dreaming of a cosy little place with a lower utility bill! I'm going to miss our house, though. Built-in cupboards everywhere, an inglenook, pocket doors, a real Harry Potter room under the stairs, walk-in closets original to the house, wood floors, casement windows that swing inward and close with little turn latches, 17 windows in our master bedroom...sigh...
We are hoping to put our house on the market in the next week or so. We'll be working in France again for 6 weeks, so it's still up in the air whether we'll be moving before or after France. Either way it's going to be crazy. I really detest packing. The actual moving part is fine, since we get lots of help from church members on both ends of the move. But packing is a royal pain. I'd love to be able to sell all of our belongings and start fresh.
I love Freecycle
It's a brilliant way to get rid of stuff. Even junk. Today, I got rid of:
- 50 feet of green wire fencing and 8 fence posts
- 17 marble tiles left over from tiling our master bathroom shower & tub in the house we lived in 3 years ago (pictures here--scroll down for the finished results)
- wooden rocking horse
- firewood from some small trees we cut down last summer
- wood floorboards from our attic that had been ripped out by a previous owner
- leftover OSB and lumber from building our garage
- exersaucer with built-in toys
- old but working vacuum cleaner
- 25 empty egg cartons
- 2 wooden curtain rods we found in our attic
- bread machine
- random kitchen gadgets that I never use
Thursday, March 27, 2008
Let's talk about pain
With some of the buzz around this recent article Epidurals: Time to stop labouring over 'natural' childbirth, I thought I would add a few thoughts and mention some older blog posts worth revisiting.
Okay, first thing: the obstetric anesthesiologist quoted in the article discusses the "lucrative natural childbirth industry" and claims that "Natural childbirth has become a multimillion-dollar industry." First, we have to put this into perspective. He gave no sources for those figures, but I suspect he is referring to childbirth educators who work for organizations such as Bradley or Lamaze. Thing is, childbirth educators make no more or no less money if women take drugs during labor; their work occurs prenatally. If a woman declines pain medications during labor, no one profits. But if she accepts an epidural, a lot of people do: in particular, the hospital, the pharmaceutical company, and the anesthesiologist. I sense some anxiety from the author of Enjoy Your Labor over the viability of his profession if women choose natural childbirth. He has a very vested interest in encouraging as many women as possible to accept epidurals, because that, after all, is what pays his mortgage.
Second, he claims that "much of the information that women receive is incomplete or inaccurate." This phrase implies that natural childbirth advocates--whoever they might be--are the ones doing the withholding. I would argue that the opposite is more often the case; those with a vested interest (monetary or otherwise) in promoting or administering epidurals have an obligation to share all of the possible risks and side-effects of epidural anesthesia. (By the way, Dr. Sarah J. Buckley has written an excellent article reviewing the risks in Epidurals: Real Risks For Mother and Baby.) How often do women receive full informed consent about this procedure, meaning a thorough discussion of all risks, benefits, and alternatives? I do not know, and I would appreciate input on this.
Third, there's all this talk about the "natural childbirth industry" as if it is one unified conglomerate. Who exactly makes up this "industry?" Childbirth educators? Certainly childbirth educators discuss the risks and benefits of pain medications, as well as non-pharmaceutical alternatives, but that is only a small part of their job. Doulas? Not really, since doulas attend births in all settings and encourage the mother to make her own decisions. I really don't know who else might be part of this "lucrative industry" that he claims is profiting heavily from women's non-use of epidurals.
Last, the article itself was poorly written and poorly organized. The sections do not flow well together, and the transitions from one point of view to another were totally lacking. The article relied almost entirely on quotes or paraphrases from other authors, with little explanation or discussion of the ideas. The university rhetoric teacher in me gives it a thumbs-down.
Now, on to some of my old blog posts:
In a different approach to pain relief, I linked to Britain's National Institute for Health and Clinical Excellence, which recommended that "all expectant mothers should be offered a water birth for the safest form of pain relief." NICE found that birthing pools were the most effective non-pharmacological form of pain relief and second-most effective overall (with epidural anesthesia being the most effective but having more risks than water immersion).
In my Comments on To The Contrary, I briefly mentioned some of my own experiences of pain during labor. I wrote a long post about pain two weeks after Zari's birth called Some thoughts about a four-letter word.
In my review of Jennifer Block's Pushed, I ended with two quotes about the role that hospital policies play in creating pain. On the same topic, it's worth reading this recent blog post on NYC Moms about how epidurals are for tolerating the hospital; labor is the easy part.
Food for thought had some discussion about pain medications and whether or not they were pushed/encouraged by hospital staff. Several comments from blog readers on this topic.
In Labor and marathons, I examined the similarities between the two events and how attitude and beliefs greatly influence the way we experience and interpret them.
Speaking of marathons, I want to end with a plug for Elemental Mom's post Only One Word. She argued that we just don't have language adequate to describe the sensations of labor, so we use the word "pain" as a distant runner-up. I love how Laureen described labor pain as purchasing an endorphin rush! A quote from her post:
Okay, first thing: the obstetric anesthesiologist quoted in the article discusses the "lucrative natural childbirth industry" and claims that "Natural childbirth has become a multimillion-dollar industry." First, we have to put this into perspective. He gave no sources for those figures, but I suspect he is referring to childbirth educators who work for organizations such as Bradley or Lamaze. Thing is, childbirth educators make no more or no less money if women take drugs during labor; their work occurs prenatally. If a woman declines pain medications during labor, no one profits. But if she accepts an epidural, a lot of people do: in particular, the hospital, the pharmaceutical company, and the anesthesiologist. I sense some anxiety from the author of Enjoy Your Labor over the viability of his profession if women choose natural childbirth. He has a very vested interest in encouraging as many women as possible to accept epidurals, because that, after all, is what pays his mortgage.
Second, he claims that "much of the information that women receive is incomplete or inaccurate." This phrase implies that natural childbirth advocates--whoever they might be--are the ones doing the withholding. I would argue that the opposite is more often the case; those with a vested interest (monetary or otherwise) in promoting or administering epidurals have an obligation to share all of the possible risks and side-effects of epidural anesthesia. (By the way, Dr. Sarah J. Buckley has written an excellent article reviewing the risks in Epidurals: Real Risks For Mother and Baby.) How often do women receive full informed consent about this procedure, meaning a thorough discussion of all risks, benefits, and alternatives? I do not know, and I would appreciate input on this.
Third, there's all this talk about the "natural childbirth industry" as if it is one unified conglomerate. Who exactly makes up this "industry?" Childbirth educators? Certainly childbirth educators discuss the risks and benefits of pain medications, as well as non-pharmaceutical alternatives, but that is only a small part of their job. Doulas? Not really, since doulas attend births in all settings and encourage the mother to make her own decisions. I really don't know who else might be part of this "lucrative industry" that he claims is profiting heavily from women's non-use of epidurals.
Last, the article itself was poorly written and poorly organized. The sections do not flow well together, and the transitions from one point of view to another were totally lacking. The article relied almost entirely on quotes or paraphrases from other authors, with little explanation or discussion of the ideas. The university rhetoric teacher in me gives it a thumbs-down.
Now, on to some of my old blog posts:
In a different approach to pain relief, I linked to Britain's National Institute for Health and Clinical Excellence, which recommended that "all expectant mothers should be offered a water birth for the safest form of pain relief." NICE found that birthing pools were the most effective non-pharmacological form of pain relief and second-most effective overall (with epidural anesthesia being the most effective but having more risks than water immersion).
In my Comments on To The Contrary, I briefly mentioned some of my own experiences of pain during labor. I wrote a long post about pain two weeks after Zari's birth called Some thoughts about a four-letter word.
In my review of Jennifer Block's Pushed, I ended with two quotes about the role that hospital policies play in creating pain. On the same topic, it's worth reading this recent blog post on NYC Moms about how epidurals are for tolerating the hospital; labor is the easy part.
Food for thought had some discussion about pain medications and whether or not they were pushed/encouraged by hospital staff. Several comments from blog readers on this topic.
In Labor and marathons, I examined the similarities between the two events and how attitude and beliefs greatly influence the way we experience and interpret them.
Speaking of marathons, I want to end with a plug for Elemental Mom's post Only One Word. She argued that we just don't have language adequate to describe the sensations of labor, so we use the word "pain" as a distant runner-up. I love how Laureen described labor pain as purchasing an endorphin rush! A quote from her post:
What we’re lacking is the linguistic differentiation, in two syllables or less, to say "pain that is the sign of pathology and illness and needs to be obliterated by any means possible" and "pain that is your body’s way of kicking in an endorphin payoff down the road."
Got that? I’m not enduring labor pain. I’m purchasing my endorphin rush, one sensation at a time.
Wednesday, March 26, 2008
Short survey about LDS breastfeeding culture
If any of you are LDS (Mormon) and have children, please take the time to complete this short survey about breastfeeding.
Saturday, March 22, 2008
Easter egg hunt
I'm up visiting my parents over Easter. Only in Minnesota do you have easter egg hunts in the snow...
Thursday, March 20, 2008
Sleeping & Pottying
I'm doing my usual late night internet browsing while Zari sleeps. Here's an update on our daily sleeping & pottying happenings:
I nurse Zari down to bed at 7 pm and put her in the crib, which is next to our bed. Then it's dissertation writing time for a few hours until she wakes up around 11-11:30 pm. I potty her and nurse her back down to sleep. She stays in our king-size bed the rest of the night. She wakes up maybe twice more during the night to nurse, and then she's up for good around 7 am, sometimes later if it's overcast outside. I'd like to encourage her to sleep longer stretches and nurse a bit less at night, but when I try to put her back down without nursing, she gets very distressed and signs "nurse, nurse, nurse." How can I say no?
On to pottying, diapering, and elimination communication: Zari has been wearing size M Chloe Toes AIOs since December. They supposedly fit 14-28 lbs, but I kept her in size S until she was over 20 lbs. This new set (18 total) are plain white and made out of bamboo velour. I didn't have time to make fancy Canadian diaper or dalmatian designs like my first two sets. I bought a pack of disposables to use when I was in California last week, my 3rd pack since she's been born. (One pack was for newborn meconium and the other for when we were in France last summer and it was so cold & rainy that her diapers took a few days to dry).
Zari can totally control her elimination, and she knows exactly what the potty sign and sound (psssssss) mean. The biggest challenge right now is convincing her to sit down and relax for long enough to pee. She has started making the potty sign when she starts peeing. Oh, and sticking her hand in her pee while she's going and giving me a huge smile. I figure it won't hurt her and we can always wash her hands afterward. She's almost always dry through the night if I potty her once during the night. Poops are a bit more on-and-off; if I see her squat and grunt I'll bring her to the potty but often she's already done by time we get there.
I nurse Zari down to bed at 7 pm and put her in the crib, which is next to our bed. Then it's dissertation writing time for a few hours until she wakes up around 11-11:30 pm. I potty her and nurse her back down to sleep. She stays in our king-size bed the rest of the night. She wakes up maybe twice more during the night to nurse, and then she's up for good around 7 am, sometimes later if it's overcast outside. I'd like to encourage her to sleep longer stretches and nurse a bit less at night, but when I try to put her back down without nursing, she gets very distressed and signs "nurse, nurse, nurse." How can I say no?
On to pottying, diapering, and elimination communication: Zari has been wearing size M Chloe Toes AIOs since December. They supposedly fit 14-28 lbs, but I kept her in size S until she was over 20 lbs. This new set (18 total) are plain white and made out of bamboo velour. I didn't have time to make fancy Canadian diaper or dalmatian designs like my first two sets. I bought a pack of disposables to use when I was in California last week, my 3rd pack since she's been born. (One pack was for newborn meconium and the other for when we were in France last summer and it was so cold & rainy that her diapers took a few days to dry).
Zari can totally control her elimination, and she knows exactly what the potty sign and sound (psssssss) mean. The biggest challenge right now is convincing her to sit down and relax for long enough to pee. She has started making the potty sign when she starts peeing. Oh, and sticking her hand in her pee while she's going and giving me a huge smile. I figure it won't hurt her and we can always wash her hands afterward. She's almost always dry through the night if I potty her once during the night. Poops are a bit more on-and-off; if I see her squat and grunt I'll bring her to the potty but often she's already done by time we get there.
Wednesday, March 19, 2008
Upright birth in hospitals
I am taking the liberty of reposting some comments from doctorjen from my earlier post Get Off Your Back--References about how she facilitates upright and active births in a hospital environment, including when women have epidurals. I'd love to hear from other people who attend births in hospitals about how they make this possible.
It seems that there are two major factors important for making this happen in a hospital setting:
1) The hospital staff must have a strong commitment to active, upright labor.
2) The staff must also have first-hand experience facilitating this, especially for moms who have epidurals, IVs, fetal monitors, etc.
Okay, enough of me. Here's doctorjen:
It seems that there are two major factors important for making this happen in a hospital setting:
1) The hospital staff must have a strong commitment to active, upright labor.
2) The staff must also have first-hand experience facilitating this, especially for moms who have epidurals, IVs, fetal monitors, etc.
Okay, enough of me. Here's doctorjen:
I find that with some help it is possible to get almost all epidural moms upright. Most have enough sensation to support themselves on hands and knees. We put the back of the bed up most of the way so mom can drape her upper body over the top of the bed and then help them get their knees securely under them, and it usually works. They may need assistance to get in this position, but they usually can sustain once we get them up. Also, squatting is not too hard. My labor bed goes into a full chair position with the feet dropped all the way down. We then put the squat bar on the bottom of the bed. Mom can sit at the edge of the top of the bed between contractions and with help when a contraction starts and leaning on the squat bar, they can drop down into a squat to push. Some epidural moms have enough sensation to get themselves up and down and if not, they can use their arms for support and we just help them get up and down. Again, once they are in the squat they usually have enough sensation to support themselves. I have a policy of no operative vaginal delivery without trying a full squat first, and it almost always works. And very importantly, I try to let all epidural moms labor down as much as possible and not do any pushing until they have some urge and sensation. If we get to 2 hours of complete dilation with no sensation yet, we negotiate about turning it off and then most moms eventually get an urge to push.
I find it much harder to move a mom with an epidural around, and they don't tend to be changing positions frequently like a mom laboring spontaneously without anesthesia, but it's both possible to do it and helpful. My nurses were way skeptical at first, but after seeing a few babies come sailing out quickly in a squat they are all big believers now and will be telling me to get mama up if I haven't for some reason thought of it! The hardest part is moving all the wires we have going with an epidural --external fetal monitor, external contraction monitor, urinary catheter, IV, epidural line, and blood pressure cuff. We have it down to a science now, though--we unplug everything that unplugs, pull all wires to one side, flip or move the mama, and replug everything in, passing them under the mama's belly if we've moved to hands and knees. I enforce with my labor clients and my nurses that the mama's comfort is our number one concern and the monitors are our job to keep track of. So mama moves as she needs to, and we chase the cords....
Thought you might like to hear about a nice upright birth I attended an hour and a half ago. Second baby, spontaneous labor at 40 weeks 4 days, no augmentation, no IV, no AROM, just labor. Mama did a lot of laboring in bed because she was tired, but at the very end of labor, she got up. She had been grunting a bit with contractions, but not really pushing, and she thought she needed to pee. We went to the bathroom, but she wasn't able to get comfortable and wasn't able to go. She hopped up and down from the toilet several times, and then squatted on the floor holding on to the sink for a bit. Finally, she said "forget it" and we headed back into the labor room. At this point, she stopped at the end of the bed and squatted down on the floor holding on to the end of the bed. This felt good to her, so we spread some pads on the floor, and over the next few contractions she would go from kneeling to squatting, to kneeling on one knee, to hands and knees. Suddenly, her water broke with a huge gush. Then she decided to try the bathroom again and we went back in the bathroom, but again, a lot of up and down but not able to go. She decided to head back into the labor room, but then she knelt back down on the floor in the door of the bathroom suddenly and pushed all out with a contraction, and gave me that wide eyed "baby's coming" look. I asked her if she was comfortable there in the doorway, and she didn't answer but got up and headed back towards her pile of bed pads on the floor and knelt back down. Over the next 3 contractions she knelt, squatted, leaned back on her hands and feet (like a crab walk position almost!) and then back to squatting, sometimes holding the edge of the bed for support with both hands, sometimes with one hand, sometimes with her hands on the floor.
Finally, she pushed out the baby's head in a squat but almost sitting over one leg, so that leg was flexed and the other one a little extended, and then for baby's big, tight-fitting shoulders, she first knelt, then leaned back on her hands and lifted her hips in the air and the little linebacker finally slid out. The dad then sat down on the floor behind the mom and we slid a dry bit of pad under her and she sat down on the floor, leaned back into her partner's lap, and snuggled her baby on her tummy. The thing that always impresses me about a spontaneous second stage in an upright mother is that it's not a matter of getting in one position and pushing the baby out, but most mamas move frequently including during contractions. In the 3 long pushing contractions she had, she probably changed position 15 times--and with that baby's kind of sticky shoulders, I'm glad she was freely mobile and able to wiggle all over and push him out! That, in my experience, is what a true upright birth looks like! Most docs, though, would be driven nuts by having the baby be such a moving target (of course he was never more than a couple inches from the floor and could have easily just slid onto the pads on the floor) and having to get on the floor themselves. Luckily, I'm young and healthy and can kneel or squat myself pretty well, and fortunately tonight I didn't have one of the 2 currently 3rd trimester pregnant nurses trying to get down there with me.
Anyway, that's what an upright birth can look like in the hospital - even with a doctor.
Tuesday, March 18, 2008
The Baby Borrowers
Thanks to a reader for alerting me to a new reality show called The Baby Borrowers. I could go off on a tirade about sensationalizing every single facet of life in order to make a TV show. But I am sure most of us agree that this, like every other reality TV show, is ridiculous, trivial, inane, etc. (Okay, I admit that I am a bit intrigued by home renovation reality shows, and I like to think that my husband and I would kick some royal home improvement butts if we were ever given the opportunity...)
But here is a thought I had when I was reading through the show's description. Watching someone else's children is nothing at all like having your own. I really don't care for other people's children. I don't like babysitting. I don't like children in general. I don't get all mushy and sentimental about them. But. BUT...I am completely head-over-heels in love with my own child. It's nothing at all like what Hallmark makes it out to be. It's very intense, very passionate. It's much more visceral and primal than romantic love.
But here is a thought I had when I was reading through the show's description. Watching someone else's children is nothing at all like having your own. I really don't care for other people's children. I don't like babysitting. I don't like children in general. I don't get all mushy and sentimental about them. But. BUT...I am completely head-over-heels in love with my own child. It's nothing at all like what Hallmark makes it out to be. It's very intense, very passionate. It's much more visceral and primal than romantic love.
Monday, March 17, 2008
Mind Reader
Hathor the Cow Goddess has apparently been reading my mind; her most recent comic takes on both lying down and coached pushing! I got to sit near her during a panel discussion about unassisted birth, but I never had time to introduce myself or to chat. Maybe next time?...
Sunday, March 16, 2008
The conference...
There's so much to say, so I am going to do some copying & pasting from my journal so I don't have to type it out twice...
I was really busy getting ready for the conference, and then at the conference I had the misfortune of being sick the whole time. So back to last Tuesday: I flew to LA and then took a bus to Bakersfield to visit my aunt & uncle before the conference. I had a great time visiting. The weather was beautiful, it was sunny, we went in the hot tub every day and played at a nearby park on Wednesday. Anyway by Wednesday night I was feeling feverish and sick. And it got worse and worse. Bleh. It also didn't help that I had no appetite so I was so weak by the end that I felt like i was going to faint on Sunday. I had a lot of healthy food but had no desire to eat it.
We drove down to Redondo Beach on Thursday afternoon and made pretty good time except Zari puked 3 times and we had to stop to clean her up. It must have been motion sickness, I think, because she didn't feel feverish at all. I went in the hot tub with Zari that evening and had a great time before we settled into bed. I woke up several times during the night, partly from feeling so achy and hot, and partly from thinking about my presentations.
Friday Morning
At the opening general session on Friday morning, Carla Hartley gave a short intro and then it was my turn. I gave a presentation about "Intuition as Authoritative Knowledge" and got lots of good feedback from it afterwards. Sarah Buckley spoke next about the hormones of birth--nothing entirely new if you've read her book, but it was informative to hear her speak.
The last morning speaker in the general session was Rachel Correa from New Zealand. It was phenomenal. She shared the story of the stillbirth of her first baby, Stella--from finding out that her baby was dead when her midwife first came over during labor, to living with her baby's body for a few days before the cremation. She shared a video of her and the baby immediately after the birth, where she's stroking her baby and caressing her body. It was so touching and of course heart-breaking. She talked about how she didn't want Stella's memory to always be about "the baby who died." She has three more children now, all born at home. Anyway I would highly recommend buying a download of her presentation; it'll be available soon at the AAMI store.
Friday Afternoon
1) Shoulder dystocia panel with Gail Hart, Dana Combest, Sheehan Ednie-Rosen,
Patricia Ann Edmonds, & Jan Tritten. It was very interesting but, for someone who is not a practicing birth attendant, very technical.
2) "Ask Dr. John" session. Dr. John Stevenson is a physician who has attended over 1,300 home births in Australia and was deregistered by the Australian OB association for doing so. He had a 3% transport rate and a 1.5% c/s rate. He was quite soft-spoken and very unassuming. It was great to hear his wisdom.
Friday Evening
We had a much-needed break before dinner. I organized an informal hot tub get-together with Pamela Hines-Powell, Linda Hessel, Lennon Clark, Gail Hart, and more. Then it was off to the Trust Birth Awards Dinner. At the dinner, Ricki Lake spoke briefly before she left for a friend's birthday party. Poor Zari had to stay up till it was over at 10 pm because I just couldn't get her back to sleep with all the talking. There were lots of awards, and then Michel Odent spoke about dispelling the disempowering birth vocabulary. He brought up a lot of new information in the first half of his presentation about the origins of the words we use around birth and how the language of the natural childbirth movement has substituted one set of disempowering vocabulary with another--especially the idea that women need to be taught or coached how to breathe, how to act, and how to give birth. Another download I need to buy!
Saturday morning sessions:
Prenatal Testing and Ultrasound by Sarah Buckley. I was glad I had recently read Testing Women, Testing the Fetus by Rayna Rapp. It looks at the social impact of amniocentesis and is a very fascinating read.
Postdates Babies presentation by Gloria Lemay, who is a very funny speaker. I do wish we'd had more info on the studies used to support or disprove some of how mainstream medicine treats post-dates babies. The presentation was more about her first-hand experiences with post-dates babies. She did reference one study, "Nonsensus Consensus"* which I read a few years ago, so I'll need to go back and re-read it.
Lunch in my room with Linda & Pamela!
Saturday afternoon sessions:
Physiologic Pushing Panel with Karen Strange, Gloria Lemay, and Heather Brock: it was interesting and enjoyable, but basically all stuff I already knew.
Then I gave my "Safety, Risk & Responsibility" presentation. It was well-attended and I was happy with how it turned out. There was a medical student present who's starting her OB residency next fall. Let's just say that she was very brave to sit through all of the critiques of the obstetrical model during the conference! We chatted a bit after the session, and I got her contact information.
Saturday Evening
Dinner break, then I participated on the panel about "Why women stay home--alone." It was a fantastic discussion. There were about 8 panelists; we briefly told our stories and then had an amazing discussion with the attendees. There were a lot of midwives present who really wanted to help, who wanted to know what UCers wanted out of midwives. It was probably the most energizing of all the sessions for me personally.
We formed a new Yahoo group that is specifically for bridging the gap between unassisted birth and midwifery. Please join if you are interested in participating in this discussion! It's called Sisters For Birth Freedom.
Sunday morning:
I was a few minutes late to my "Childbirth in Cinema" presentation because I forgot to set my clock ahead for DST. Feeling a little sheepish about that one...But it was fun nevertheless.
Then I went to Sarah Buckley's 3 B's of Mother-Baby Bliss, but I missed a lot of it because Zari was noisy. I'll have to buy a download of her presentation once it becomes available.
Sunday Afternoon:
I was the first speaker at the closing general session, and my presentation was about moving beyond the medical/midwifery models. Then there was an amazing presentation about getting our message out using multimedia by ICAN Publications Director Laureen Hudson. Another download I need to buy! Carla wrapped things up and then they did the drawings for prizes.
Sunday Evening
I went to the straggler's dinner that night and chatted a lot with Sarah Buckley and Laura Shanley. Lots of fun!
Overall I noticed two recurring themes at the conferences: the importance of intuition and the power of language to shape reality.
I thought I'd have a lot more time to chat between sessions and in the evenings (you know, girl talk / birth talk kind of stuff) but it was incredibly busy the whole time. There were so many people who I wanted to talk with more but didn't have enough time. We need a conference just for getting together and meeting each other!
*Menticoglou SM and Hall PF. "Routine induction of labour at 41 weeks gestation: nonsensus consensus." BJOG 2002;109:485-91.
I was really busy getting ready for the conference, and then at the conference I had the misfortune of being sick the whole time. So back to last Tuesday: I flew to LA and then took a bus to Bakersfield to visit my aunt & uncle before the conference. I had a great time visiting. The weather was beautiful, it was sunny, we went in the hot tub every day and played at a nearby park on Wednesday. Anyway by Wednesday night I was feeling feverish and sick. And it got worse and worse. Bleh. It also didn't help that I had no appetite so I was so weak by the end that I felt like i was going to faint on Sunday. I had a lot of healthy food but had no desire to eat it.
We drove down to Redondo Beach on Thursday afternoon and made pretty good time except Zari puked 3 times and we had to stop to clean her up. It must have been motion sickness, I think, because she didn't feel feverish at all. I went in the hot tub with Zari that evening and had a great time before we settled into bed. I woke up several times during the night, partly from feeling so achy and hot, and partly from thinking about my presentations.
Friday Morning
At the opening general session on Friday morning, Carla Hartley gave a short intro and then it was my turn. I gave a presentation about "Intuition as Authoritative Knowledge" and got lots of good feedback from it afterwards. Sarah Buckley spoke next about the hormones of birth--nothing entirely new if you've read her book, but it was informative to hear her speak.
The last morning speaker in the general session was Rachel Correa from New Zealand. It was phenomenal. She shared the story of the stillbirth of her first baby, Stella--from finding out that her baby was dead when her midwife first came over during labor, to living with her baby's body for a few days before the cremation. She shared a video of her and the baby immediately after the birth, where she's stroking her baby and caressing her body. It was so touching and of course heart-breaking. She talked about how she didn't want Stella's memory to always be about "the baby who died." She has three more children now, all born at home. Anyway I would highly recommend buying a download of her presentation; it'll be available soon at the AAMI store.
Friday Afternoon
1) Shoulder dystocia panel with Gail Hart, Dana Combest, Sheehan Ednie-Rosen,
Patricia Ann Edmonds, & Jan Tritten. It was very interesting but, for someone who is not a practicing birth attendant, very technical.
2) "Ask Dr. John" session. Dr. John Stevenson is a physician who has attended over 1,300 home births in Australia and was deregistered by the Australian OB association for doing so. He had a 3% transport rate and a 1.5% c/s rate. He was quite soft-spoken and very unassuming. It was great to hear his wisdom.
Friday Evening
We had a much-needed break before dinner. I organized an informal hot tub get-together with Pamela Hines-Powell, Linda Hessel, Lennon Clark, Gail Hart, and more. Then it was off to the Trust Birth Awards Dinner. At the dinner, Ricki Lake spoke briefly before she left for a friend's birthday party. Poor Zari had to stay up till it was over at 10 pm because I just couldn't get her back to sleep with all the talking. There were lots of awards, and then Michel Odent spoke about dispelling the disempowering birth vocabulary. He brought up a lot of new information in the first half of his presentation about the origins of the words we use around birth and how the language of the natural childbirth movement has substituted one set of disempowering vocabulary with another--especially the idea that women need to be taught or coached how to breathe, how to act, and how to give birth. Another download I need to buy!
Saturday morning sessions:
Prenatal Testing and Ultrasound by Sarah Buckley. I was glad I had recently read Testing Women, Testing the Fetus by Rayna Rapp. It looks at the social impact of amniocentesis and is a very fascinating read.
Postdates Babies presentation by Gloria Lemay, who is a very funny speaker. I do wish we'd had more info on the studies used to support or disprove some of how mainstream medicine treats post-dates babies. The presentation was more about her first-hand experiences with post-dates babies. She did reference one study, "Nonsensus Consensus"* which I read a few years ago, so I'll need to go back and re-read it.
Lunch in my room with Linda & Pamela!
Saturday afternoon sessions:
Physiologic Pushing Panel with Karen Strange, Gloria Lemay, and Heather Brock: it was interesting and enjoyable, but basically all stuff I already knew.
Then I gave my "Safety, Risk & Responsibility" presentation. It was well-attended and I was happy with how it turned out. There was a medical student present who's starting her OB residency next fall. Let's just say that she was very brave to sit through all of the critiques of the obstetrical model during the conference! We chatted a bit after the session, and I got her contact information.
Saturday Evening
Dinner break, then I participated on the panel about "Why women stay home--alone." It was a fantastic discussion. There were about 8 panelists; we briefly told our stories and then had an amazing discussion with the attendees. There were a lot of midwives present who really wanted to help, who wanted to know what UCers wanted out of midwives. It was probably the most energizing of all the sessions for me personally.
We formed a new Yahoo group that is specifically for bridging the gap between unassisted birth and midwifery. Please join if you are interested in participating in this discussion! It's called Sisters For Birth Freedom.
Sunday morning:
I was a few minutes late to my "Childbirth in Cinema" presentation because I forgot to set my clock ahead for DST. Feeling a little sheepish about that one...But it was fun nevertheless.
Then I went to Sarah Buckley's 3 B's of Mother-Baby Bliss, but I missed a lot of it because Zari was noisy. I'll have to buy a download of her presentation once it becomes available.
Sunday Afternoon:
I was the first speaker at the closing general session, and my presentation was about moving beyond the medical/midwifery models. Then there was an amazing presentation about getting our message out using multimedia by ICAN Publications Director Laureen Hudson. Another download I need to buy! Carla wrapped things up and then they did the drawings for prizes.
Sunday Evening
I went to the straggler's dinner that night and chatted a lot with Sarah Buckley and Laura Shanley. Lots of fun!
Overall I noticed two recurring themes at the conferences: the importance of intuition and the power of language to shape reality.
I thought I'd have a lot more time to chat between sessions and in the evenings (you know, girl talk / birth talk kind of stuff) but it was incredibly busy the whole time. There were so many people who I wanted to talk with more but didn't have enough time. We need a conference just for getting together and meeting each other!
*Menticoglou SM and Hall PF. "Routine induction of labour at 41 weeks gestation: nonsensus consensus." BJOG 2002;109:485-91.
Saturday, March 15, 2008
Lie down and PUSH!!
Lying on one's back with legs propped up often comes as part of a bigger "package deal" that includes Valsalva pushing, aka purple pushing, aka coached pushing, aka "hold your breath and tuck your chin and push Push PUSH!" while the staff counts to 10.
A recent post on the Better Birth blog describes what a birth with purple pushing looks like.
Why do we do this? Is it helpful? Is there a better way to push?
The answers are:
A) We do this because of a strange combination of ideas: that women need to be taught how to push, that they won't know how/when to do it otherwise, that the faster the baby gets out of the birth canal the better. It probably evolved from women being heavily anesthetized and unable to feel the natural urge to push, thus creating a need to "coach" women how to push their babies out.
B) Not really, if you look at the risks (several, including more pelvic floor damage to the mother and reduced oxygen supply to the baby) and benefits (not many at all--possibly a slightly shorter pushing stage, but at the expense of both mother and baby). This comment from Dr. Joseph I. Schaffer, a researcher investigating coached vs. physiologic pushing, summarizes the current situation quite well: "Everyone uses coached pushing, but it has no known maternal or fetal benefits, and we found that it was associated with negative effects on several urodynamic indices."
C) Yes: it's called physiologic pushing, in which the woman follows her bodily cues and pushes only when and how her body tells her to. Physiologic pushing has a fairly characteristic pattern: the woman usually will not hold her breath, but instead will push for shorter intervals while exhaling or grunting; she generally uses open-glottis pushing, as opposed to the closed-glottis pushing of the Valsalva technique.
There's lots of research on coached versus physiologic pushing, so I will direct you to just a few:
A recent post on the Better Birth blog describes what a birth with purple pushing looks like.
Why do we do this? Is it helpful? Is there a better way to push?
The answers are:
A) We do this because of a strange combination of ideas: that women need to be taught how to push, that they won't know how/when to do it otherwise, that the faster the baby gets out of the birth canal the better. It probably evolved from women being heavily anesthetized and unable to feel the natural urge to push, thus creating a need to "coach" women how to push their babies out.
B) Not really, if you look at the risks (several, including more pelvic floor damage to the mother and reduced oxygen supply to the baby) and benefits (not many at all--possibly a slightly shorter pushing stage, but at the expense of both mother and baby). This comment from Dr. Joseph I. Schaffer, a researcher investigating coached vs. physiologic pushing, summarizes the current situation quite well: "Everyone uses coached pushing, but it has no known maternal or fetal benefits, and we found that it was associated with negative effects on several urodynamic indices."
C) Yes: it's called physiologic pushing, in which the woman follows her bodily cues and pushes only when and how her body tells her to. Physiologic pushing has a fairly characteristic pattern: the woman usually will not hold her breath, but instead will push for shorter intervals while exhaling or grunting; she generally uses open-glottis pushing, as opposed to the closed-glottis pushing of the Valsalva technique.
There's lots of research on coached versus physiologic pushing, so I will direct you to just a few:
- Bloom, S. L., Casey, B. M., Schaffer, J. I., McIntire, D. D., & Leveno, K. J. (2006). A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. American Journal of Obstetrics and Gynecology, 194, 10–13. (Available here; you need to scroll down a bit to get to the research summary).
- Less Pelvic Floor Damage Associated With Uncoached Pushing
- Schaffer et al, "A randomized trial of coached versus uncoached maternal pushing during the second stage of labor on postpartum pelvic floor structure and function," American Journal of Obstetrics and Gynecology, May 2005
- MCN Am J Matern Child Nurs. 2000 May-Jun;25(3):165.
- Caring for women with epidurals using the "laboring down" technique. MCN Am J Matern Child Nurs. 1998 Sep-Oct;23(5):274.
Thursday, March 13, 2008
Childbirth in cinema
Several people expressed interest in the film clips I complied for my conference presentation about depictions of childbirth in cinema. Here is a list of the clips on the DVD that I put together:
There are 2 versions; both have all the same film clips, but the way I put the title menu together is different. Version 1: Each clip has its own title, which you can select from the main menu, and the clips play continuously one after each other.
Version 2: Clips are arranged in thematic groups (for example, all clips of wild taxi rides are together in one title). After each group of clips is done playing, the DVD goes back to the title selection page.
1. She's Having a Baby: Time Bomb (Video Title, 0h 02m 40s)
2. 9 Months: Water Broke (Video Title, 0h 00m 45s)
3. The Island : In Labor (Video Title, 0h 00m 50s)
4. Look Who's Talking: In Labor (Video Title, 0h 00m 27s)
5. Home Fries: Helicopter Chase (Video Title, 0h 01m 23s)
6. Knocked Up: Where's my doctor? (Video Title, 0h 01m 03s)
7. She's Having a Baby: Car (Video Title, 0h 00m 49s)
8. Father of the Bride II: Car (Video Title, 0h 00m 39s)
9. Father of the Bride II: Breathe! (Video Title, 0h 00m 24s)
10. Look Who's Talking: Taxi Ride (Video Title, 0h 02m 02s)
11. 9 Months: Accident Victims (Video Title, 0h 02m 12s)
12. The Nativity Story: Baby is pressing (Video Title, 0h 01m 35s)
13. Knocked Up: Bathtub (Video Title, 0h 00m 43s)
14. Look Who's Talking: Check In (Video Title, 0h 00m 29s)
15. Father of the Bride II: Wheelchair (Video Title, 0h 00m 19s)
16. Father of the Bride II: Contraction (Video Title, 0h 00m 22s)
17. Father of the Bride II: Nina in bed (Video Title, 0h 00m 31s)
18. Home Fries: Gurney (Video Title, 0h 01m 03s)
19. 9 Months: Check In (Video Title, 0h 00m 35s)
20. Father of the Bride II: Dr. Eisenberg (Video Title, 0h 00m 26s)
21. Knocked Up: Rude Doctor (Video Title, 0h 00m 52s)
22. Father of the Bride II: Ice Chips (Video Title, 0h 00m 25s)
23. She's Having a Baby: Lamaze breathing (Video Title, 0h 02m 37s)
24. Waitress: Breathing (Video Title, 0h 00m 13s)
25. The Ex: No Epidural (Video Title, 0h 00m 30s)
26. Look Who's Talking: I quit Lamaze (Video Title, 0h 00m 25s)
27. Look Who's Talking: Give Me Drugs (Video Title, 0h 01m 51s)
28. Waitress: I Want Drugs (Video Title, 0h 00m 18s)
29. 9 Months: Epidural, Asshole! (Video Title, 0h 01m 16s)
30. 9 Months: Men can't handle the pain (Video Title, 0h 00m 34s)
31. Hulk (Video Title, 0h 00m 31s)
32. Father of the Bride II: Husband Arrives (Video Title, 0h 00m 44s)
33. She's Having a Baby: Klutz (Video Title, 0h 00m 15s)
34. She's Having a Baby: Gowned Up (Video Title, 0h 00m 33s)
35. Waitress: Video Camera (Video Title, 0h 00m 17s)
36. 9 Months: Video Camera (Video Title, 0h 00m 24s)
37. Knocked Up: Complication (Video Title, 0h 03m 00s)
38. Father of the Bride II: Nina's complicatoin (Video Title, 0h 00m 45s)
39. She's Having a Baby: Complication (Video Title, 0h 02m 26s)
40. Eastern Promises: Placental Abruption (Video Title, 0h 02m 01s)
41. My Family: Hemorrhage (Video Title, 0h 02m 35s)
42. Waitress: Pushing & Birth (Video Title, 0h 02m 01s)
43. 9 Months: Pushing & Birth (Video Title, 0h 01m 55s)
44. Big Fish: Slippery Baby (Video Title, 0h 00m 26s)
45. Look Who's Talking: Pushing & Birth (Video Title, 0h 01m 52s)
46. Knocked Up: Pushing & Birth (Video Title, 0h 02m 57s)
47. Waitress: Bonding (Video Title, 0h 01m 55s)
48. 9 Months: Nursery (Video Title, 0h 00m 39s)
49. Look Who's Talking: Nursery (Video Title, 0h 00m 44s)
50. Brothers Solomon (Video Title, 0h 02m 49s)
51. Big Momma's House (Video Title, 0h 04m 02s)
52. Meet the Fockers (Video Title, 0h 01m 18s)
53. Like Water For Chocolate (Video Title, 0h 01m 12s)
54. Dr T and the Women (Video Title, 0h 01m 54s)
55. Children of Men (Video Title, 0h 02m 47s)
56. The Island : Birth (Video Title, 0h 01m 30s)
57. The Island : Human C-Section (Video Title, 0h 01m 51s)
58. The Nativity Story: Elizabeth
59. The Nativity Story: Mary (Video Title, 0h 02m 22s)
60. Cleopatra (Video Title, 0h 01m 30s)
61. The Machine That Goes Ping ! (Video Title, 0h 04m 29s)
Get off your back: references
This is a collection of references about maternal positioning during labor and birth. It's from the endnotes of Jock Doubleday's book Spontaneous Creation. Bold text is the original body text, and the plain text are his references.
~~~~~
"Except for being hanged by the feet, the supine position is the worst conceivable position for labor and delivery." (Dr. Roberto Caldeyro-Barcia, The Family Practice News, 1975:11) in Laura Kaplan Shanley, Unassisted Childbirth, 15)
Being hanged by the feet may in fact present considerable advantages over lying on one's back. No studies have been performed. But a number of trials do suggest that upright positions give greater advantages in childbirth than do backlying positions. See, for instance, Allahbadia, G.N., and P.R. Vaidya, "Why deliver in the supine position?" Aust NZ J Obstet Gynaecol 32(2) (1992):104-106; Bhardwaj, N., J.A. Kukade, S. Patil, and S. Bhardwaj, "Randomised controlled trial on modified squatting position of delivery," Indian J Maternal and Child Health 6(2) (1995):33-39; Chen, S.Z., K. Aisaka, H. Mori, and T. Kigawa, "Effects of sitting position on uterine activity during labor," Obstet Gynecol 79 (1987):67-73; Liddell, H.S. and P.R. Fisher, "The birthing chair in the second stage of labour," Aus NZ J Obstet Gynaecol 25 (1985):65-68; Gardosi, J., S. Sylvester, and C.B. Lynch, "Alternative positions in the second stage of labour: a randomized controlled trial," Br J Obstet Gynaecol 96 (1989a):1290-1296; Gardosi, J., N. Hutson, and C.B. Lynch, "Randomised, controlled trial of squatting in the second stage of labour," Lancet 2 (1989b):74-77. See also Golay, J., et al., "The squatting position for the second stage of labor: effects on labor and maternal ad fetal well-being," Birth 20(2) (June 1993):73-78.
Pam England and Rob Horowitz write: "When a mother having back labor lies on her back, the pain becomes unbearable as the [back of the] baby's head pushes hard against her sacrum during contractions. Lying flat on her back will not only slow (or stop) cervical dilation, but may also prevent the rotation of the baby's head to a face-down position. This is one cause of "posterior arrest," which doctors may try to correct with pitocin, epidurals, forceps or a Cesarean birth. . . . Avoid the lithotomy position. This unnatural position is advantageous only to the doctor. . . . Stirrups also may cause painful cramping, numbness, or blood clots in the legs. In addition, some women experience this position as degrading, vulnerable and powerless." (Birthing from Within, 143, 145)
Janet Isaacs Ashford writes: "According to the controlled clinical trials surveyed by Enkin, Keirse, and Chalmers, lying down on the back and sitting during labor are associated with reduced blood flow to the uterus, resulting in contractions that are less effective and more frequent. Lying on the side or standing up improves blood flow and the efficiency of contractions. In addition, women who are upright or lying on their sides have shorter labors and use less narcotic analgesia, epidural anesthesia, and oxytocin augmentation than those who are supine (Roberts, 1989). Many hospitals now allow women to walk and assume comfortable positions during labor, though the use of continuous electronic fetal monitoring can restrict the mother's mobility. . . . Enkin, Keirse, and Chalmers also found that use of an upright posture when the mother is pushing shortens the length of second-stage labor. . . . Babies born to women in upright postures have fewer abnormal hear rate patterns and less chance of low Apgar scores (Sleep, Roberts, and Chalmers, 1989). Women prefer the upright posture for birth and report less pain and backache than in the supine posture. . . . The use of a squatting posture for birth has been shown to increase intra-abdominal pressure and also increase the sagittal diameter of the pelvic outlet (Davies and Renning, 1964; Borell and Fernstrom, 1967; Russell, 1982). Both factors can contribute to a shorter, more effective labor. However, researchers note that Western women are not accustomed to assuming a squatting posture (for defecation or resting, for example) and many find it difficult to assume this position for birth. Conventional maternity wards are often equipped with labor beds and delivery tables that encourage or enforce the supine posture." ("Posture for Labor and Birth," The Encyclopedia of Childbearing, Barbara K. Rothman, ed., 314). See also Golay, J., et al., "The squatting position for the second stage of labor: effects on labor and maternal ad fetal well-being," Birth 20(2) (June 1993):73-78.
For information on the squatting position for birth, see Russell, J.G., "The rationale of primitive delivery positions," Br J Obstet Gynaecol 89 (September 1982):712-715; McKay, S., "Squatting: an alternate position for the second stage of labor," The American Journal of Maternal/Child Nursing 9 (May/June 1984):181-183. See also Golay, J., et al., "The squatting position for the second stage of labor: effects on labor and maternal ad fetal well-being," Birth 20(2) (June 1993):73-78. See also Robbie E. Davis-Floyd, Birth as an American Rite of Passage, 86-87.
When you endeavor to give birth on your back, your heavy uterus compresses the major maternal blood vessels (Bienarz, J., et al., "Aortocaval compression by the uterus in late human pregnancy: II. An arteriographic study," Am J Obstet Gynecol, 100 (1968):203; Goodlin, R.C., "Aortocaval compression during cesarean section: a cause of newborn depression," Obstet Gynecol 37 (1971):702; Humphrey, M., et al., "The influence of maternal posture at birth on the fetus," J Obstet Gynaecol Br Commonwealth 80 (9173):1075 in Yvonne Brackbill, et al., Birth Trap, 13)
...interfering with circulation and decreasing blood pressure (Bienarz, J., et al., "Aortocaval compression by the uterus in late human pregnancy: II. An arteriographic study," Am J Obstet Gynecol, 100 (1968):203; Goodlin, R.C., "Aortocaval compression during cesarean section: a cause of newborn depression," Obstet Gynecol 37 (1971):702; Humphrey, M., et al., "The influence of maternal posture at birth on the fetus," J Obstet Gynaecol Br Commonwealth 80 (9173):1075 in Yvonne Brackbill, et al., Birth Trap, 13; see also Flowers, C., Obstetric Analgesia and Anesthesia (New York: Hoeber, Harper & Row, 1967); James, L.S., "The effects of pain relief for labor and delivery on the fetus and newborn," Anesthesiology 21 (1960):405-430; Blankfield, A., "The optimum position for childbirth," Med J Aust 2 (1965):666-668 in Doris Haire, The Cultural Warping of Childbirth, 17)
...increases the possibility of fetal distress (Flynn, A.M. et al., "Ambulation in labour," Br Med J 26 (1978):591; Humphrey, M., et al., "The influence of maternal posture at birth on the fetus," J Obstet Gynaecol Br Commonwealth 80 (1973):1075 in Yvonne Brackbill, et al., Birth Trap, 13. See also Laura Kaplan Shanley, Unassisted Childbirth, 24. See also Lumley, J., "Antepartum fetal heart rate tests and induction of labour," in Young, D., ed., "Obstetrical intervention and technology in the 1980s," Women's Health 7 (1982):9.)
Upright birthing positions are associated with more intense and more efficient contractions (See Marjorie Tew, Safer Childbirth? A Critical History of Maternity Care, 33; Chan, D.P.C., "Positions during labour," Br Med J 1 (1963):100-102; Flynn, A.M. et al., "Ambulation in labour," Br Med J 26 (1978):591; McManus, T.J. and A.A. Calder, "Upright posture and the efficiency of labour," Lancet 1 (1978):72-74; Diaz, A.G., R. Schwarcz, R. Fescina, and R. Caldeyro-Barcia, "Vertical position during the first stage of the course of labor, and neonatal outcome," Eur J Obstet Gynecol Reprod Biol 11 (1980):1-7; Williams, R.M., M.H. Thorn, J.W.W. Studd, "A study of the benefits and acceptability of ambulation in spontaneous labour," Br J Obstet Gynaecol 87 (1980):122-126; Hemminki, E. and S. Saarikoski, "Ambulation and delayed amniotomy in the first stage of labor," Eur J Obstet Gynecol Reprod Biol 15 (1983):129-139; Melzack, R., E. Belanger, and R. Lacroix, "Labor pain, effect of maternal position on front and back pain," J Pain symptom Manegem 6 (1991):476-480 in World Health Organization, Care in Normal Birth, 1999)
Elizabeth Noble writes: "Squatting, while uncomfortable for most people without prior practice, offers one of the most functional positions for birth. According to studies in Sweden by Dr. Christian Ehrstrom, when a mother squats the pelvic outlet is at its widest, increased by one to two centimeters. The pelvis is completely tilted to align with the spine, making the most curved passage for the baby's descent. The contraction of the abdominal muscles is very efficient in squatting as they are in a shortened, middle position of their range. Not only does gravity provide additional force from above, but there is no counterforce from below. The vagina becomes shorter and wider, and less effort is required by the mother to open up and let the baby out at her own pace. During crowning of the baby's head, there is an equal stretch all around the perineum, so that this muscular membranous "cuff" is least likely to tear . . . Women who squat for birth can generally deliver their babies without any manual assistance at all. Gravity and the free space around the perineum allow the baby's rotation maneuvers to be accomplished spontaneously." (Childbirth with Insight, 78). See also Golay, J., et al., "The squatting position for the second stage of labor: effects on labor and maternal ad fetal well-being," Birth 20(2) (June 1993):73-78.
"It was established in 1976 than an increase of 30 to 40 mmHg pressure is exerted by the fetal head on the cervix as a result of the effects of gravity, that is, standing instead of lying down. This means that, although the frequency of the contractions is the same, the effectiveness of the contractions is much greater, and hence the efficiency and rate of the dilatation of the cervix is improved. . . . In order to prove the superiority of the upright position in practice, the 1976 study alternated the posture of women volunteers every half-hour from the dorsal to the standing position. There was an abrupt fall in the intensity of the contractions when the women lay down, and the effectiveness of contractions in dilating the cervix was doubled when they stood up. The mothers also found the standing half-hour much less uncomfortable or painful; it was often difficult to persuade them to lie down again."
Sally Inch, Birthrights, 31; see Schwarcz, R., A.G. Diaz, R. Fescina, and R. Caldeyro-Barcia, Latin American Collaborative Study on Maternal Posture in Labor (1977); reported in Birth and the Family Journal 6(1)1979.
~~~~~
"Except for being hanged by the feet, the supine position is the worst conceivable position for labor and delivery." (Dr. Roberto Caldeyro-Barcia, The Family Practice News, 1975:11) in Laura Kaplan Shanley, Unassisted Childbirth, 15)
Being hanged by the feet may in fact present considerable advantages over lying on one's back. No studies have been performed. But a number of trials do suggest that upright positions give greater advantages in childbirth than do backlying positions. See, for instance, Allahbadia, G.N., and P.R. Vaidya, "Why deliver in the supine position?" Aust NZ J Obstet Gynaecol 32(2) (1992):104-106; Bhardwaj, N., J.A. Kukade, S. Patil, and S. Bhardwaj, "Randomised controlled trial on modified squatting position of delivery," Indian J Maternal and Child Health 6(2) (1995):33-39; Chen, S.Z., K. Aisaka, H. Mori, and T. Kigawa, "Effects of sitting position on uterine activity during labor," Obstet Gynecol 79 (1987):67-73; Liddell, H.S. and P.R. Fisher, "The birthing chair in the second stage of labour," Aus NZ J Obstet Gynaecol 25 (1985):65-68; Gardosi, J., S. Sylvester, and C.B. Lynch, "Alternative positions in the second stage of labour: a randomized controlled trial," Br J Obstet Gynaecol 96 (1989a):1290-1296; Gardosi, J., N. Hutson, and C.B. Lynch, "Randomised, controlled trial of squatting in the second stage of labour," Lancet 2 (1989b):74-77. See also Golay, J., et al., "The squatting position for the second stage of labor: effects on labor and maternal ad fetal well-being," Birth 20(2) (June 1993):73-78.
Pam England and Rob Horowitz write: "When a mother having back labor lies on her back, the pain becomes unbearable as the [back of the] baby's head pushes hard against her sacrum during contractions. Lying flat on her back will not only slow (or stop) cervical dilation, but may also prevent the rotation of the baby's head to a face-down position. This is one cause of "posterior arrest," which doctors may try to correct with pitocin, epidurals, forceps or a Cesarean birth. . . . Avoid the lithotomy position. This unnatural position is advantageous only to the doctor. . . . Stirrups also may cause painful cramping, numbness, or blood clots in the legs. In addition, some women experience this position as degrading, vulnerable and powerless." (Birthing from Within, 143, 145)
Janet Isaacs Ashford writes: "According to the controlled clinical trials surveyed by Enkin, Keirse, and Chalmers, lying down on the back and sitting during labor are associated with reduced blood flow to the uterus, resulting in contractions that are less effective and more frequent. Lying on the side or standing up improves blood flow and the efficiency of contractions. In addition, women who are upright or lying on their sides have shorter labors and use less narcotic analgesia, epidural anesthesia, and oxytocin augmentation than those who are supine (Roberts, 1989). Many hospitals now allow women to walk and assume comfortable positions during labor, though the use of continuous electronic fetal monitoring can restrict the mother's mobility. . . . Enkin, Keirse, and Chalmers also found that use of an upright posture when the mother is pushing shortens the length of second-stage labor. . . . Babies born to women in upright postures have fewer abnormal hear rate patterns and less chance of low Apgar scores (Sleep, Roberts, and Chalmers, 1989). Women prefer the upright posture for birth and report less pain and backache than in the supine posture. . . . The use of a squatting posture for birth has been shown to increase intra-abdominal pressure and also increase the sagittal diameter of the pelvic outlet (Davies and Renning, 1964; Borell and Fernstrom, 1967; Russell, 1982). Both factors can contribute to a shorter, more effective labor. However, researchers note that Western women are not accustomed to assuming a squatting posture (for defecation or resting, for example) and many find it difficult to assume this position for birth. Conventional maternity wards are often equipped with labor beds and delivery tables that encourage or enforce the supine posture." ("Posture for Labor and Birth," The Encyclopedia of Childbearing, Barbara K. Rothman, ed., 314). See also Golay, J., et al., "The squatting position for the second stage of labor: effects on labor and maternal ad fetal well-being," Birth 20(2) (June 1993):73-78.
For information on the squatting position for birth, see Russell, J.G., "The rationale of primitive delivery positions," Br J Obstet Gynaecol 89 (September 1982):712-715; McKay, S., "Squatting: an alternate position for the second stage of labor," The American Journal of Maternal/Child Nursing 9 (May/June 1984):181-183. See also Golay, J., et al., "The squatting position for the second stage of labor: effects on labor and maternal ad fetal well-being," Birth 20(2) (June 1993):73-78. See also Robbie E. Davis-Floyd, Birth as an American Rite of Passage, 86-87.
When you endeavor to give birth on your back, your heavy uterus compresses the major maternal blood vessels (Bienarz, J., et al., "Aortocaval compression by the uterus in late human pregnancy: II. An arteriographic study," Am J Obstet Gynecol, 100 (1968):203; Goodlin, R.C., "Aortocaval compression during cesarean section: a cause of newborn depression," Obstet Gynecol 37 (1971):702; Humphrey, M., et al., "The influence of maternal posture at birth on the fetus," J Obstet Gynaecol Br Commonwealth 80 (9173):1075 in Yvonne Brackbill, et al., Birth Trap, 13)
...interfering with circulation and decreasing blood pressure (Bienarz, J., et al., "Aortocaval compression by the uterus in late human pregnancy: II. An arteriographic study," Am J Obstet Gynecol, 100 (1968):203; Goodlin, R.C., "Aortocaval compression during cesarean section: a cause of newborn depression," Obstet Gynecol 37 (1971):702; Humphrey, M., et al., "The influence of maternal posture at birth on the fetus," J Obstet Gynaecol Br Commonwealth 80 (9173):1075 in Yvonne Brackbill, et al., Birth Trap, 13; see also Flowers, C., Obstetric Analgesia and Anesthesia (New York: Hoeber, Harper & Row, 1967); James, L.S., "The effects of pain relief for labor and delivery on the fetus and newborn," Anesthesiology 21 (1960):405-430; Blankfield, A., "The optimum position for childbirth," Med J Aust 2 (1965):666-668 in Doris Haire, The Cultural Warping of Childbirth, 17)
...increases the possibility of fetal distress (Flynn, A.M. et al., "Ambulation in labour," Br Med J 26 (1978):591; Humphrey, M., et al., "The influence of maternal posture at birth on the fetus," J Obstet Gynaecol Br Commonwealth 80 (1973):1075 in Yvonne Brackbill, et al., Birth Trap, 13. See also Laura Kaplan Shanley, Unassisted Childbirth, 24. See also Lumley, J., "Antepartum fetal heart rate tests and induction of labour," in Young, D., ed., "Obstetrical intervention and technology in the 1980s," Women's Health 7 (1982):9.)
Upright birthing positions are associated with more intense and more efficient contractions (See Marjorie Tew, Safer Childbirth? A Critical History of Maternity Care, 33; Chan, D.P.C., "Positions during labour," Br Med J 1 (1963):100-102; Flynn, A.M. et al., "Ambulation in labour," Br Med J 26 (1978):591; McManus, T.J. and A.A. Calder, "Upright posture and the efficiency of labour," Lancet 1 (1978):72-74; Diaz, A.G., R. Schwarcz, R. Fescina, and R. Caldeyro-Barcia, "Vertical position during the first stage of the course of labor, and neonatal outcome," Eur J Obstet Gynecol Reprod Biol 11 (1980):1-7; Williams, R.M., M.H. Thorn, J.W.W. Studd, "A study of the benefits and acceptability of ambulation in spontaneous labour," Br J Obstet Gynaecol 87 (1980):122-126; Hemminki, E. and S. Saarikoski, "Ambulation and delayed amniotomy in the first stage of labor," Eur J Obstet Gynecol Reprod Biol 15 (1983):129-139; Melzack, R., E. Belanger, and R. Lacroix, "Labor pain, effect of maternal position on front and back pain," J Pain symptom Manegem 6 (1991):476-480 in World Health Organization, Care in Normal Birth, 1999)
Elizabeth Noble writes: "Squatting, while uncomfortable for most people without prior practice, offers one of the most functional positions for birth. According to studies in Sweden by Dr. Christian Ehrstrom, when a mother squats the pelvic outlet is at its widest, increased by one to two centimeters. The pelvis is completely tilted to align with the spine, making the most curved passage for the baby's descent. The contraction of the abdominal muscles is very efficient in squatting as they are in a shortened, middle position of their range. Not only does gravity provide additional force from above, but there is no counterforce from below. The vagina becomes shorter and wider, and less effort is required by the mother to open up and let the baby out at her own pace. During crowning of the baby's head, there is an equal stretch all around the perineum, so that this muscular membranous "cuff" is least likely to tear . . . Women who squat for birth can generally deliver their babies without any manual assistance at all. Gravity and the free space around the perineum allow the baby's rotation maneuvers to be accomplished spontaneously." (Childbirth with Insight, 78). See also Golay, J., et al., "The squatting position for the second stage of labor: effects on labor and maternal ad fetal well-being," Birth 20(2) (June 1993):73-78.
"It was established in 1976 than an increase of 30 to 40 mmHg pressure is exerted by the fetal head on the cervix as a result of the effects of gravity, that is, standing instead of lying down. This means that, although the frequency of the contractions is the same, the effectiveness of the contractions is much greater, and hence the efficiency and rate of the dilatation of the cervix is improved. . . . In order to prove the superiority of the upright position in practice, the 1976 study alternated the posture of women volunteers every half-hour from the dorsal to the standing position. There was an abrupt fall in the intensity of the contractions when the women lay down, and the effectiveness of contractions in dilating the cervix was doubled when they stood up. The mothers also found the standing half-hour much less uncomfortable or painful; it was often difficult to persuade them to lie down again."
Sally Inch, Birthrights, 31; see Schwarcz, R., A.G. Diaz, R. Fescina, and R. Caldeyro-Barcia, Latin American Collaborative Study on Maternal Posture in Labor (1977); reported in Birth and the Family Journal 6(1)1979.
Wednesday, March 12, 2008
On your back, please
On the heels of this wonderful conference--which I am sure you're all dying to hear about--I came home and heard that my SIL had her third baby, their first boy and born OP! Welcome to the world little one!
I'm going to tell a story about her birth, with her permission (and correct me if I have any details wrong, J.!) My SIL had her second baby with a hospital CNM, but when she became pregnant with her third, the midwife had closed the practice. So she was left with two fairly undesirable options: drive over an hour away to the nearest CNM practice or use a local OB practice. She did the latter, figuring she's done this twice before anyway. No biggie, right? Her second birth was fairly quick and straightforward and she gave birth to the baby on her hands and knees.
So, this third birth was a rude awakening for her. She did almost the whole labor at home and got to the hospital an hour before the baby was born. She was laboring on her hands & knees, as comfortably as you can when a baby is on the way, but when she was ready to push the nurse asked her to flip over onto her back. She didn't want to, and her husband spoke up several times for her as well. The doctor (one she had never met, since she was with a large OB group that rotated call) came into the room and insisted--I kid you not--that she flip over "because it's easier for me." She really didn't want to but she was in no place to argue since she was now in Get-The-Baby-Out-Mode...So she flipped over and then started the most excruciatingly painful experience of her entire life.
Here's a little of what she wrote about pushing on her back:
So, here's to a ridiculous custom that does no one any good--no birthing woman, that is. I vote that we force any doctor, nurse, or midwife who asks women to birth on their backs to do 1,000 hours of the most unpleasant community service imaginable!
So my slogan of the week is...
I'm going to tell a story about her birth, with her permission (and correct me if I have any details wrong, J.!) My SIL had her second baby with a hospital CNM, but when she became pregnant with her third, the midwife had closed the practice. So she was left with two fairly undesirable options: drive over an hour away to the nearest CNM practice or use a local OB practice. She did the latter, figuring she's done this twice before anyway. No biggie, right? Her second birth was fairly quick and straightforward and she gave birth to the baby on her hands and knees.
So, this third birth was a rude awakening for her. She did almost the whole labor at home and got to the hospital an hour before the baby was born. She was laboring on her hands & knees, as comfortably as you can when a baby is on the way, but when she was ready to push the nurse asked her to flip over onto her back. She didn't want to, and her husband spoke up several times for her as well. The doctor (one she had never met, since she was with a large OB group that rotated call) came into the room and insisted--I kid you not--that she flip over "because it's easier for me." She really didn't want to but she was in no place to argue since she was now in Get-The-Baby-Out-Mode...So she flipped over and then started the most excruciatingly painful experience of her entire life.
Here's a little of what she wrote about pushing on her back:
So...instead of using gravity and an easier position I was forced into birthing on my butt. They wanted me to pull my legs towards me and curve my back and tuck my chin and push. It was the MOST painful experience of my life. And the thing that was killing me is that I knew it would have been better in the position I was previously. So...while I'm going through all this pain. I said something like,...I can't do this, it hurts so much....which in my head was meaning...I can't birth in this ridiculous position, it's too painful. Lovely Angela [her nurse] smirked..."sweetheart, it's supposed to hurt." Had I any expendable energy, I would have drop kicked her. Angela, sweetheart...it doesn't HAVE to hurt...not like that at least. Trust me, sweetie....I've done it before. Brandon eventually almost passed out from all this, and just as the baby was coming, he disappeared...meaning he had to sit down and take a few breathers. I was confused and wondered where my man had gone. He quickly came back to my side and Wade came out soon there after.This kills me. Here we have a doctor and a nurse inflicting pain on someone, for no good reason, just for their convenience! She told me that the ironic part was that she was staring at a framed poster on the wall while having her baby, and the poster said all these things about the hospital being concerned about the patient's comfort and to let the staff know if they could do anything to help make the experience more comfortable.
I don't want to take away from the amazing experience it is to have a child naturally. But, it is NO wonder to me why women have epidurals if they are required to birth in such a ridiculous and painful position. So...what did we learn?
1. What's easier for the Doctor is best.
2. Labor is supposed to hurt.
Those are two lessons I hope never to learn again.
So, here's to a ridiculous custom that does no one any good--no birthing woman, that is. I vote that we force any doctor, nurse, or midwife who asks women to birth on their backs to do 1,000 hours of the most unpleasant community service imaginable!
So my slogan of the week is...
Stand and Deliver--Don't Give Birth Lying Down!
(my business name and motto, by the way)
(my business name and motto, by the way)
Tuesday, March 11, 2008
Wednesday, March 05, 2008
Ice cream extravaganza
Imagine you had free, unlimited access to all the Haagen-Dazs ice cream you ever wanted...sound too good to be true?
Not if you are my aunt & uncle out in sunny California! My uncle develops new ice cream flavors for Haagen-Dazs, and tonight he brought home a case of different flavors. (I am visiting them on my way to the Trust Birth Conference.) I got through 5 flavors before I had to call it quits.
Here are the ones I tasted, in rough order of preference:
Not if you are my aunt & uncle out in sunny California! My uncle develops new ice cream flavors for Haagen-Dazs, and tonight he brought home a case of different flavors. (I am visiting them on my way to the Trust Birth Conference.) I got through 5 flavors before I had to call it quits.
Here are the ones I tasted, in rough order of preference:
- Toasted Coconut Sesame Brittle
- Amazon Valley Chocolate
- Caramelized Pear & Toasted Pecan
- Fleur de Sel Caramel (so new I can't find it on their website!)
- Vanilla Honey Bee