why are you using a medwife? I was a little disappointed in you for not UCing, and now it's like wow you must not really stay true to your word.She also emailed me this message:
Are CPM's illegal in your state if not why are you [not] using one? CNM's are really dangerous and I thought every unassisted birther knows this. They are more like medwives which to me would be way too scary. So why are you using one?I would like to respond to these two comments. I am trying really hard to keep my tone restrained. Believe me, you don’t want to fall on the wrong side of someone who taught university-level rhetoric. So pardon me if I come off a bit strong at times.
CNMs think DEMs have copped out, and DEMs think CNMs have sold out.“I was a little disappointed in you for not UCing”
Joyce Roberts, President of the American College of Nurse-Midwives, 1999
One group needs to tighten up, and the other group needs to lighten up!
Katherine Comancho Carr, President of the American College of Nurse-Midwives, 2005
Hi Rixa, I just breathed a huge sigh of relief. At first your choice in having a midwife this time around alarmed me, I even felt somewhat confused and betrayed as I saw you as such a wonderful spokesperson for UC moms. But as I read this last blog, I realized that pregnancy and birth are so personal and intimate it is so difficult to make the choices we make. I truly hope you have the birth you desire and that your baby is healthy and that you are happy…
For myself, the only reason I would want a midwife around would be for the afterbirth--in case of an emergency situation and to help with the cleanup but the pros are pretty even with the cons as my need for privacy and birthing alone would definitely result in more complications. (I learned that with my first birth too, even having hubby in the room slowed my labor a lot, I really needed to be alone). So I think that for myself, having a midwife around would ease some concerns but ironically open up Pandora's box to a slew of new concerns and perhaps complications that could have otherwise have been avoided.
Thanks so much for your blog. I am sorry that I at first somehow felt betrayed by your desire to have a midwife; I guess you made me second question UC but after reading this blog (I do check your blog but not too frequently so I missed this one at first, stating your reasons for wanting a midwife), I realized just what a tough position you are in. In a way I think you are looking for what we all want—privacy & autonomy, but a midwife would provide the added benefit of security. Ironically, a midwife would also take away some of the privacy and autonomy so really it is such a tough call.
I look forward to reading your birth story.
I filled the bucket to within 3" of the top with cold tap water, plugged the heater in, and set a timer. Here's the breakdown for heating a full 5-gallon pail:
Zari gives her stamp of approval.
The first two blessing follow each other closely with only minor changes in the wording here and there. The blessings were specific and comprehensive.We anoint your spinal column that you might be strong and healthy no disease fasten upon it no accident belaff [befall] you, your kidneys that they might be active and health and preform [sic] their proper functions, your bladder that it might be strong and protected from accident, your Hips that your system might relax and give way for the birth of your child, your sides that your liver, your lungs, and spleen that they might be strong and preform their proper functions, . . . your breasts that your milk may come freely and you need not be afflicted with sore nipples as many are, your heart that it might be comforted.They continued by requesting blessings from the Lord on the unborn child's health and expressed the hope that it might not come before its "full time" and thatthe child shall present right for birth and that the afterbirth shall come at its proper time . . . and you need not flow to excess. . . . We anoint . . . your thighs that they might be healthy and strong that you might be exempt from cramps and from the bursting of veins. . .The document combines practical considerations, more common to women's talk over the back fence, with the reassuring solace and compassion of being anointed with the balm of sisterhood. The women sealed the blessing:Sister ___ we unitedly lay our hands upon you to seal the washing and anointing wherewith you have been washed and anointed for your safe delivery, for the salvation of you and your child and we ask God to let his special blessings to rest upon you, that you might sleep sweet at night that your dreams might be pleasant and that the good spirit might guard and protect you from every evil influence spirit and power that you may go your full time and that every blessing that we have asked God to confer upon you and your offspring may be literally fulfilled that all fear and dread may be taken from you and that you might trust in God. All these blessings we unitedly seal upon you in the name of Jesus Christ Amen.The tender attention to both the women's psychological and physical state is an example of loving service and gentleness. That this widespread practice continued in similar form for several more decades is illustrated by the account written by a Canadian sister.In the years from the early 1930s on, in the Calgary Ward R.S. under presidents--Bergeson, Maude Hayes, Lucile Ursenbach, the sisters often asked for a washing and blessing before going into the hospital for an operation or childbirth. In this ordinance two sisters washed the parts of the body, pronouncing appropriate words of prayer and blessing, . . . and at the conclusion put their hands on the head of the recipient and, in the name of the Lord pronounced a further blessing.
My friend Julie arrived in the afternoon with her 14-month old Joyce. She is a fellow LDS graduate student and home birther who lives about an hour and a half away. She found me via my blog a few months ago, and we started emailing and talking to each other. She's finishing her master's degree and just got accepted into a PhD program and will probably be focusing on some aspect of childbirth. We had arranged to meet in person at least three times before the Blessingway, but one or both of us had had to cancel each time at the last minute. So we saw each other in the flesh for the first time yesterday! It's good that we felt comfortable around each other, because one of the first things I did was strip down to a bikini and ask her to take some belly shots of me. She took some lovely ones, which I'll post soon.
Julie on the left and my mom holding Julie's daughter. Zari kept asking to play with her today.
Once we were all sitting down, the guests took turns introducing themselves and describing how they knew me. There were several women I had met at church, some friends who are Eric's collegauges (or faculty spouses), the midwife and her four assistants/apprentices, my mom, my sister from Dayton, and my friend Julie, who organized the event.
Julie then invited my midwife to give a short thought/devotional. She talked about overcoming fear & pain in childbirth. Each of us spoke about things that had given us fear or anxiety during pregnancy or motherhood.
While we were doing this, I had my guests read cards and hold up the quilt squares that my out-of-town friends and family had sent in. If you are one of those who are still working on your squares, this is a friendly reminder to send it to me soon so I can put the quilt together!Next, an article in the Arizona Republic discussing how C-sections are linked to future birth risks. The article focuses on one worrisome trend due to the rapid rise of c-sections: placenta accreta. Once something that was an obstetrical rarity (1 in 30,000 in the 1950s when the c-section rate was in the low single digits), accreta now is as high as 1 in 2,500 to 1 in 500. The article also stresses the relative safety of VBAC, emphasizing that as many as 90% of women with a previous c-section are candidates for a VBAC.WOMEN who choose to have an elective caesarean in the belief that it will prevent incontinence and genital prolapse are "misguided" and may be putting their health, and that of their baby, at unnecessary risk.
That is the view of Jenny King, a urogynaecologist at Westmead Hospital, who questions the right of women to choose surgical births to avoid pelvic floor problems.
Evidence is mounting that repeat caesareans cause harm and there are doubts that they provide the protection they were thought to provide, she said.
Dr King will present the findings of a review of about 9000 births at Westmead Hospital in 2004 at the annual scientific meeting of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in Auckland on Sunday.
She projected that surgical birth could prevent 35 per cent of urinary incontinence in women under 50, but the method of delivery made minimal difference to pelvic dysfunction later in life.
"Incontinence is an emotional issue, but I looked at the data and you have got more chance of losing a baby from the complications of a caesarean section than getting incontinence problems," she said.
"If a young woman of healthy weight asked a gastric surgeon for lap-band surgery to prevent the possibility of becoming obese later in life, surely no one would agree to that.
"So why does a pregnant woman have the right to surgery she doesn't need?"
Women who have a caesarean are at much greater risk of a ruptured uterus, hysterectomy or infection. And their babies are more likely to be born premature, have serious breathing problems or need intensive care.
I've posted about this before, but I wanted to remind readers of this recent study about Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries. Not surprisingly, it found that cesareans become progressively more dangerous for the mother. I bolded the parts relating to placenta accreta. It seems the 60% statistic from the previous article comes from women with two previous c-sections who also have placenta previa. Here's the abstract:Studies and textbooks suggest that the risk of developing an accreta is as high as 4 percent in women who have had two previous Cesareans; that jumps to 60 percent with three C-sections, their physicians said.
And while Valley hospitals can't say exactly how many women they are seeing with the complication, those that traditionally deliver the most babies say it's a trend they're watching.
Earlier this year, St. Joseph's saw three women with the condition in one week, Chambliss said.
"In the 1950s, the incidence was something like 1 in 30,000 women," Mills said, adding that newer studies, conducted within the last decade, suggest that the rate has climbed to as high as 1 in 2,500 or even 1 in 500.
"So there is definitely an increase in occurrence," he said. "And in women with C-sections, that's where we've really seen an explosion."
OBJECTIVE: Although repeat cesarean deliveries often are associated with serious morbidity, they account for only a portion of abdominal deliveries and are overlooked when evaluating morbidity. Our objective was to estimate the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries.Thanks to Unnecessarean and Birth Faith for the links!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.
The next article by the same author, Modern medicine increasingly intervenes in the birth process, discusses many of the same issues, in addition to the increasing medicalization of childbirth.Two weeks before Kristi Ashley gave birth to a son in 2007, an ultrasound exam estimated the baby at a hefty 12 pounds, 10 ounces — too big, her doctor believed, for a safe vaginal delivery. After the child weighed in at 9 pounds, 4 ounces in the delivery room, Ashley came to believe that the planned cesarean section she had, with its attendant pain, long recovery and what she called "emotional damage," may have been a rush to judgment.
"It's very hard to go up against your physician, especially at the 12th hour," said Ashley, 38, of Hopewell Junction. "I think doctors are very quick these days to get scared. They would rather opt for the surgical solution."
Determined to avoid another surgical birth and aided by a supportive doctor, hospital and birthing coach, Ashley last month did something that has become increasingly rare for post-cesarean women today: She gave birth vaginally, to another son.
In an era of soaring malpractice premiums, technology that sometimes sets off false alarms, physicians pressed for time and mothers-to-be conflicted by fear, cesarean-section birth is soaring to its highest levels ever. Read the rest of the article here.
In the decade through 2002, something momentous happened to babies in the wombs of American women, especially white women. The average time fetuses spent there decreased from 40 weeks to 39.The decline, reported in a 2006 study in the medical journal Seminars in Perinatology, appears to have little to do with nature.
Instead, earlier births may be the outcome of “increased use of induction (of labor) and other obstetric interventions such as cesarean delivery,” said a January report by the U.S. Centers for Disease Control. Prematurity rose 20 percent since 1990, the report said, and the rate of low birth-weight babies hit a 40-year high.
“We are shortening the gestational age,” said Dr. Carol Sakala, program director for the research and advocacy group Childbirth Connection. “That is a big interference with mammalian evolution, human evolution.”
Researchers, midwives, birth coaches and mothers point to such data as symptoms of a flawed system of birthing in America, one they say over-manages, over-medicates and over-monitors labor and delivery, often leading to unnecessary cesarean-section births. Read the rest of the article here.
The last article is a glimmer of hope amidst the gloom of our contemporary obstetrical culture. In C-section births fall, one hospital has lowered its cesarean rate (18% last year, usually around 16%). Some of the key practices the hospital has adopted are taking a midwifery approach to childbearing with a focus on facilitating spontaneous, natural births, minimizing the routine use of technology and interventions, and offering and encouraging VBACs.
North Adams Regional Hospital performs significantly fewer c-sections than other hospitals around the state — an average of 18 percent of all births at the hospital compared to the state average of 34 percent, according to reports released by the state Department of Public Health. The hospital also has a better prenatal care record, according to the reports: 94 percent of women giving birth have had nine or more prenatal care visits versus the state average of 87 percent having that many visits. "I think what is being reflected in our numbers is that we are taking a more 'midwifery' approach with our practice then before," Robin Rivinus, a certified nurse midwife with Northern Berkshire Obstetrics & Gynecology at the hospital, said last week. "It means that we do fewer unnecessary interventions — inductions, Cesarean sections, episiotomies. We treat childbirth as the normal, natural thing that it is. We only step in when it's medically necessary, which is much better for both the mother and the baby." Read the rest of the article here. While more and more women choose to undergo Cesarean section births despite a national push by the federal government to decrease the number, the local rate has declined and is well below the state average.
I finally found a family doctor in town and he's only 1 1/2 blocks away, right next door to the dentist's office and video rental store. I brought Zari in today for a meet & greet and to ask him about selective/delayed vaccinations. Zari hasn't had any yet and I'm still trying to figure out what, if any, I will give her. He was upfront that he strongly supports vaccinating, but respectful of whatever I wanted to do. So he said to do some reading & research and let him know my plan at our next visit.
