Thursday, September 30, 2010

In Milwaukee

I arrived (with Zari, Dio, and my youngest sister, who's helping watch the kids) in Milwaukee this afternoon for the Lamaze/ICEA Mega Conference. If you're at the conference, come say hi!
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Tuesday, September 28, 2010

Conversation with Dr. Abdulla Al-Khan about maternal mortality

I emailed Dr. Abdulla M. Al-Khan, the maternal-fetal medicine specialist at Hackensack University Medical Center who was quoted in the NBC report on the risks of repeat cesareans. I asked him for more information on placenta accreta-related deaths: Were the numbers the journalist mentioned accurate and indicative of extensive underreporting of maternal deaths? Or had the journalist misquoted or misinterpreted the figures?

This afternoon*, I received a telephone call from Dr. Al-Khan. He was happy to speak with me more about these issues. First off, we talked numbers. Had 40 women in New Jersey died last year due to placenta accreta? He clarified that in 2009, there were about 42 maternal deaths in New Jersey; the journalist had inaccurately interpreted the numbers. Twelve of those 42 deaths he identified as "preventable losses," all related to hemorrhage: placenta accreta, uterine atony, etc. These numbers are very disturbing, he told me, because we're talking mostly healthy, young women. He couldn't give a precise number of how many of those twelve deaths were related to accreta--the figures haven't been released yet--but he said that a good proportion of the twelve were from accreta.

His hospital has seen a lot of placenta accretas. And almost every day, he hears personally from colleagues and other hospitals of another case of placenta accreta. He was very concerned about the high incidence of accreta and emphasized that public awareness of this issue is essential.

We then discussed underreporting of maternal mortality. New Jersey is the only state in the U.S. with a Maternal Mortality Review, which collects and investigates pregnancy-associated and pregnancy-related deaths. The latest Maternal Mortality Review covers 2002-2005 (PDF). Subsequent years will be reviewed in the next report. In those years, maternal mortality figures from New Jersey are as follows:

2002: 39 cases
2003: 49 cases
2004: 51 cases
2005: 34 cases

Of these deaths, slightly less than half were pregnancy-related. The overall maternal mortality rate in New Jersey during those years was 37.4/100,000. The pregnancy-related mortality rate in NJ, a subset of maternal mortality, was 12.6/100,000.

I asked Dr. Al-Khan about the reliability of maternal mortality figures. New Jersey is the only state with reliable figures due to its unique mortality review committee. Underreporting of maternal mortality is a widespread problem in the US. Without a comprehensive state- or nationwide- review process, the figures we have (13.3/100,000 live births as of 2006) still do not accurately reflect the true maternal death rate. (For more information on maternal mortality in the U.S., read Amnesty International's detailed report.) In the United States, litigation is one major factor in this underreporting, because it holds up many details and figures surrounding maternal deaths for several years while litigation is underway.

We concluded our conversation with a brief chat about cesarean rates. He is deeply troubled by New Jersey's 40% cesarean rate, and also by the fact that the national cesarean rate is not far behind.

My academic & blogging activities do not take place in a vacuum. When he called, I was stirring a batch of granola in the oven. Zari was in the kitchen helping. Dio had just woken up from a nap and was a bit cranky. I kept feeding the kids spoonfuls of hot granola to keep them happy and quiet during the phone call. C'est la vie chez les Freezes!
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Babies at Work

I've been in touch with Carla Moquin, founder of the Parenting in the Workplace Institute. PIWI helps businesses implement babies-at-work programs. Mothers and fathers bring their babies with them to work until the babies are around 9 months old or mobile. What a wonderful way to bridge the work-parenting dilemma--especially in the United States, where maternity/paternity leave is almost nonexistent.

The following is reposted from the PIWI blog with Carla's permission. Stay tuned for an interview with Carla Moquin in the near future. If you have questions for Carla, please leave them in the comments section! 

Help Create a Babies-at-Work World

The Parenting in the Workplace Institute (PIWI) has a vision of a world in which interacting with babies is just part of a regular day at the office.  For nearly 150 confirmed businesses and more than 1,600 babies, this world is already a vivid and enchanting reality.  Will you help our Institute to bring this reality to thousands of other businesses and millions of other families?

Baby At Work

Adler at the Nevada State Health Division
PIWI has already helped five businesses to set up successful and sustainable babies-at-work programs.  We have documented successful baby-inclusive programs in law firms, consulting firms, retail stores, credit unions, government agencies, schools, and even in the offices of manufacturing companies, as well as many other kinds of organizations.  We know that well-structured baby programs work in companies as small as three employees and as large as three thousand.

We are excited to announce the launch of a fully-supported and thoroughly-documented pilot babies-at-work program at Hot Studio, an “experience design company” with offices in San Francisco and New York City.  We will be featuring pictures, videos, interviews, and survey results over the course of this pilot on our Babies in the Workplace website, this blog, and our Facebook and Twitter pages, as well as through various other outlets that support our work, such as MomsRising with their new website, the Custom-Fit Workplace.  Our goal is to optimize the assistance and resources that we provide to businesses to implement programs, as well as to show the business benefits and transformation of the work culture that occur when babies start coming to work.  We will then begin the next wave of simultaneous pilot programs in several companies in a range of industries and sizes.  These pilot programs will be featured in a documentary by Chithra Jeyaram, a graduate student at the University of Texas, Austin, who is pursuing an MFA in film production.  We are also going to start producing short online videos that show babies-at-work programs in action and that illustrate how highly-responsive parenting and the social network of the office result in happy babies who thrive in the workplace.

We are prepared to enable a dramatic expansion of this world in which babies come to work every day with their mothers or fathers and in which parents can lovingly care for their children while also getting their jobs done:
  • A world in which bank tellers and grocery store employees cuddle their babies while helping clients, and customers come to the businesses more often specifically to visit the babies
  • A world in which coworkers and managers start out skeptical about starting a babies-at-work program, but then find themselves bonding with the babies and wanting them to continue coming to work
  • A world in which parents can stay with their babies and work to support their families at the same time
  • A world in which both men and women in the workplace provide a social network for these new families and volunteer to help care for the babies
  • A world in which the business benefits of these programs are so significant that executives rave about how integral a baby program has been in the success of their business
We are building a team to ensure that we can provide the best possible resources and assistance to expand babies-at-work programs (and, eventually, sustainable parenting-at-work programs for children of all ages).  We are working with high-quality child development researchers and advocates to provide resources and information to parents about how to keep babies happy and healthy, and we will be providing comprehensive lactation support for mothers who want to nurse.  We are going to start gathering survey information in baby-inclusive companies so that we have reliable data to combine with the tremendous anecdotal evidence of the benefits of babies-at-work programs for businesses and families.  Every day, we will be updating our tally of baby-inclusive companies and babies hosted in the workplace.  We also plan to work with our supporters to apply for a Pepsi Refresh grant in October to dramatically expand this movement (we’re still developing our plan for this).

But we need your help.  Here’s how you can get involved–we cannot do this without you:

1.   Join the PIWI Network.  Whether you’ve taken a baby to work, work in a baby-inclusive company (or want to), or are simply supportive of our efforts to build a world in which families of all kinds are supported, we would love to hear your experiences and opinions.  Joining is free, and you can choose to donate $30 if you wish to receive a PIWI mug and a seal for your website to show your support.  We are also starting a PIWI Blog Network for advance notice of PIWI initiatives and opportunities to participate in blog carnivals and other events.  If you wish to join the Blog Network, please enter your information when you join our Network.

2.   Tell Companies About Our Bridge Project.  Spread the word to current baby-inclusive companies that might be interested in joining the Bridge Project—the first wave of our plans to celebrate and expand babies in the workplace.  Companies who join the Bridge Between Career and Family will have their baby program permanently featured on our website and will receive free initial baby-inclusive certification services and a discount on services to enhance the effectiveness of their baby program, outreach avenues for sharing their products and services with Institute supporters, an outlet for finding skilled employees among PIWI supporters, and priority for being included in future media pieces.

3.   Follow PIWI on Facebook and Twitter. Join our Facebook community and Twitter page; we will be communicating frequently in the upcoming days with our supporters there as well as on PIWI Place, our private community for PIWI Supporters.

4.   Grow Our Baby-Inclusive DatabaseTell us if you know of companies anywhere in the world that have allowed an employee to bring a baby to work (even informally) so that we can contact them and add them to our list.  Share with us your suggestions of companies that might be willing to work with us to set up a formal babies-at-work pilot program (at no charge for the Institute’s services).

5.   Expand Our Outreach.  Write and talk about parenting in the workplace–show the world that this is being done successfully in many different environments.  Send us your pictures and videos of bringing your babies to work.  Spread the word about our effort to bring parenting at work to the mainstream, and share your own experiences and thoughts about this concept.  Let us know when you post your work and we’ll do our best to share your thoughts with other supporters of parenting in the workplace.

Ambrosha and River at HometownQuotes

Ambrosha and River at HometownQuotes
Babies-at-work programs and PIWI have been discussed in dozens of major media pieces in recent years, including the New York Times, National Public Radio’s Morning Edition, Time Magazine, People Magazine, the Wall Street Journal, NBC Nightly News, the Today Show, the Boston Globe, USA Today, Workforce Management, Redbook, and Inc. Magazine, among many others.  As we show that we can successfully implement babies-at-work programs in large and small organizations of nearly every type, we expect that the publicity (and public awareness of the viability and benefits of babies at work) will expand dramatically.

We welcome your ideas on how we can more effectively expand our efforts, and we look forward to sharing this journey with you.

Carla Moquin
Founder and President
Parenting in the Workplace Institute
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Monday, September 27, 2010

17 months old!

Dio has been out of sorts with a fever the past few days...poor guy. Zari got the same thing a few days ago, but she recovered quickly with lots of movies and juice (the only time we have juice is when someone is sick, so it's a real treat).

Dio is able to say more and more words. Today, for example, he said breast, apple, bread, banana, dirty, mama, papa, dog, meow, baby, juice, cup, pee, poop, burp, bird, and dark among others. His enunciation still has lots of room for improvement, but I can interpret what he's saying. One thing I love is that he pats his diaper and says "pee pee" or "poop" when he needs to go or has just gone. Very helpful. He also announces when any of us are using the bathroom! I guess bodily functions are quite fascinating to a little toddler.

He loves playing outside on the swings and slide and sandbox. Carrying sticks around, digging in the dirt, chasing squirrels, scooting on his vintage Radio Flyer push bike, watching bugs, and kicking walnuts are also favorite activities. I love watching him and Zari playing together. If they're occupied and the weather is nice and I don't have a pressing task like laundry or dinner, I sometimes have time just to sit and do nothing. What a luxury.

Everything is a competition for Zari right now. Is my cup fuller than Dio's? Is my bread bigger than Dio's? Did Dio eat slower than me? Did I run faster than Dio? I usually say "yes" to everything because it avoids meltdowns and temper tantrums. A few times I have held out and said "I don't know if it was bigger/faster/fuller and it doesn't matter." That drives Zari crazy and she won't stop asking until she gets an answer. I use that as a motivating tool for Zari. "Look, Dio is doing ___ faster than you!" That gets her into gear because SHE wants to be the biggest and the fastest right now. I hope that's not a bad strategy...

Dio loves to mimic what we're doing. One of Zari's jobs is unloading the clean silverware from the dishwasher, and Dio always wants to help. If Zari sees him "helping," she quickly takes over because it's HER job--even if two seconds previously she ignored my request to do the silverware. Dio loves to hold the dustpan when I'm sweeping. He even angles it just right and then carries it carefully to the garbage can and dumps it in. I help, of course. Another favorite is getting a cloth wipe, blowing his nose (actually he blows really loud through his mouth), and then putting the wipe in the diaper pail.

He's so much fun to have around. Like me, his default look is serious, almost somber. People often think he's sad or mopey when in fact he's having a blast. I tell people, "If he's not crying, he's happy!"
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Saturday, September 25, 2010

Maternal deaths from placenta accreta

In a 2009 article about the risks of repeat cesareans, Dr. Marlin Mills, medical director of perinatal services with Banner Desert Medical Center in Arizona, noted that the rate of placenta accreta has risen sharply since the 1950s:
"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."
Just today, I read at Birthing Beautiful Ideas that New Jersey has witnessed several maternal deaths from placenta accreta in the past year. I watched the NBC video about the risks of multiple cesareans, in which an accreta survivor shared her story. Her physician was Dr. Abdulla Al-Khan, Director and Section Chief of the Division of Maternal-Fetal Medicine/Surgery at Hackensack University Medical Center. The NBC report quotes Dr. Al-Khan:
"We have lost a lot of mothers in the State of New Jersey from accreta." The doctor says about 40 women died last year in New Jersey as a result of accreta....Dr. Al-Khan says he's seen more and more cases of this potentially deadly condition, and he blames the continued rise in the number of c-sections. "If we don't do anything about decreasing cesarean section rates in this country, we are going to have a lot of mothers who will lose their lives." [Note: the NBC report misquoted Dr. Al-Khan; the total number of maternal deaths in NJ last year was around 42, of which several were from accreta. Read more in my interview with Dr. Al-Khan.]
Now, I agree with Kristen at Birthing Beautiful Ideas that this shouldn't turn into yet another scare-fest for pregnant women. She commented:
To be clear, I do not want to cast such a dark pallor over placenta accreta (or any other placental abnormalities whose risks are increased with multiple cesarean surgeries) that I end up adding just as much hype to the risks of repeat cesarean section as many others do to the risk of uterine rupture during a VBAC.  These are serious risks, and they are risks that are both associated with prior c-section.  But they should be communicated in a way that offers women the opportunity to make an empowered and informed decision about their births–not a hyped-up exaggeration that makes them terrified about their births.
Still, the reality of placenta accreta should make both pregnant women and maternity care providers think carefully before entering into a cesarean section, whether a primary or repeat. Neither VBAC nor ERCS is without risk, but in our obstetrical climate, VBAC is often discussed largely in terms of risks and repeat cesarean largely in terms of benefits.

Although I haven't personally had to weigh these risks & benefits, a good friend of mine is in the middle of this struggle. Her first baby was vertex, born fairly uneventfully, and attended by an OB. (Incidentally, she gave birth kneeling, which her OB had never seen before. This blows my mind a can someone with probably thousands of births under their belt never have attended a single kneeling/hands & knees birth?) When she became pregnant the second time, she planned a home birth until her baby was discovered to be breech. She found the one OB in the entire area who would attended a vaginal breech birth, only to go into labor when he was out of town. So with no other options, she very reluctantly agreed to a cesarean.

Now she's 37 weeks pregnant with another persistently breech baby. The only legal home birth midwives cannot attend primary VBACs at home, nor do most of them have much experience attending breech births. After searching high and low, she finally found a CNM/OB practice that she liked. If all is normal, the CNM will attend the birth, and the OB comes in only if there's a more complicated situation. Once she found out this third baby was again breech, she began grilling her OB about vaginal breech birth. It turns out he's done some vaginal breeches. While he's not thrilled at the prospect, he's at least willing. I recently sent her OB more information about Dr. Frank Louwen and upright breech births, including a DVD of his presentation at the 2nd International Breech Conference.

Anyway, back to my point: my friend has told me multiple times: "I really, really don't want a c-section with this baby. I hated having a cesarean last time; I was totally devastated by it. I worry about all of the things that could happen during a second surgery. I worry about the long-term health consequences 10, 20, 30 years down the road. I know it will be so much harder to have a VBAC if I have two previous c-sections. I might want to have more children and the risks of yet another c-section really concern me. Plus I don't know how I would cope with three small children and abdominal surgery to recover from; I have no family who can help out after the baby's born."

Giving birth after cesarean is about so much more than the risk of uterine rupture.

Just this morning, my friend called me with good news. She had just had a successful external cephalic version! For now, her breech dilemma is solved, and VBAC looks a lot more likely (and a lot less stressful!). I'm hoping that her baby stays head-down. And if not, that her OB is willing to try an upright vaginal breech birth. In any case, I hope that she can give birth the way she wants: vaginally, autonomously, and with  respectful, compassionate caregivers.
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Friday, September 24, 2010

Ethicurean produce bag giveaway

If you live in Australia, please enter the ethicurean's produce bag giveaway. I've "known" the founder Kelly online for the past few years. I first found her blog soon after her son was born (pictures here), and we keep up with each other's adventures in parenting and PhD work via our blogs.

If only I lived in Australia...I'd love some of these!
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Thursday, September 23, 2010

Why didn't I do this sooner?

I've never had an outdoor clothesline in any of the houses I've owned. Once we moved here, I thought about installing one but then was faced with a myriad of decisions. Should I buy T-post, retractable, or umbrella-style clothesline? And where should I put it?

I first thought of placing it in the back yard near our gardens and compost bins. But that would mean I'd have to walk across the yard for every load of wash...and I knew that I'd probably not use it much if it were too far out of the way. So I settled on a great spot: right outside the back door. I see it every time I come in or out of the house, which means it gets used a lot.
I wanted to install it last summer, but it turns out clotheslines are hard to find in my town. Unless it's April or May, our local hardware & home improvement stores don't carry them. I decided on an umbrella-style clothesline (around $40), because they don't take up lots of space, fold up when you're not using them, and can be easily removed for storage during the winter months. The post has a plastic sleeve that you set in concrete. I dug a hole 8" wide and 12" deep and filled the first 5" with gravel to allow water to drain out of the sleeve. It's one of those simple things that I wish I'd done a long, long time ago.

With a few exceptions (rainy days or the occasional diaper crisis when I needed dry ones STAT), I've used the clothesline for all of our laundry. Now I'm going to play chicken and see how long I can continue using it before winter weather sets in.

My next project is insulating our attics, basement, and crawlspaces. I know our insulation is nowhere near sufficient. Problem is, our attic spaces are not interconnected from room to room (we have a quirky old house that was essentially built room-by-room), and we don't have any access holes. That means we have to cut and frame several holes before we can even get up into the attics...which is why we haven't done it sooner!

What projects do you have on your "why didn't I do this sooner?" list?
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Sunday, September 19, 2010

Sleep during pregnancy

I've never slept well during pregnancy. Right about when my children started sleeping through the night, I became pregnant again. Zari was 21 months old and Dio, who slept through the night earlier, was around 13 months when this happened. Almost as soon as I'm pregnant, I start waking 4-6 times every night to pee. It's crazy, and I have no idea where all of the fluid is coming from. I only let myself have a small sip of water when I wake up at night, even though I'm thirsty enough to drink a cup or two each time I wake up. This frequent waking usually lasts through the first trimester.

A few weeks ago, I started waking up only 2-3 times a night to use the bathroom and it felt heavenly. But I think it will be short-lived. I'm a back sleeper, but I've started to feel a bit dizzy when I lie down on my back, so I've tried sleeping on my side. I know that as my belly gets bigger, I'll have to switch over entirely to side-sleeping. I dread it. Even though I have really thick memory foam topper, my bottom hip starts to ache and I spend the whole night flip-flopping from one side to another, sometimes every 30 minutes. This is one of my least favorite things about the third trimester.

I've tried just about every combination of pillows I can imagine--rolled up behind my back, between my knees, underneath my belly. I even tried sleeping with my bottom leg extended, my top leg bent, and my body rolled over slightly towards my stomach, like in the illustration. Still, nothing helps me sleep well when I'm on my side. And the night-time bathroom trips will increase in frequency again as my baby nears full-term.

It's just not fair! 9 months of sleep deprivation does NOT prepare you for a newborn's waking patterns (something I've heard before). Being tired doesn't help you cope with or "be ready for" fatigue! I wish there were a magic anti-gravity mattress topper so I could sleep without aching hips and constant flip-flopping. Until then, I'm open to other suggestions...
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Thursday, September 16, 2010

Birth Around the World: Origins of Plenitude birth center

This is a long, but fascinating, account of the origins of the Plenitud birth center in Guadalajara, Mexico. It was written by Joni Nichols in 2004 and reposted here with permission. You'll read about how women began leaving their physicians and changing hospitals in favor of Dr. José Luis. You'll see the transformation of a physician as he learns what undisturbed birth really looks and sounds like. You'll gain glimpses into the institutional protocols of Mexican hospitals and understand how truly different the Plenitud birth center is.

Asking how we built a birth center is a little bit like asking how any of us made a baby. Certain aspects are pretty universal to everyone’s’ experience ... but what folks usually mean is that they want to hear the details that make the event a “story” rather than a “how-to” guide. In this way we savor the unique details, the personal anecdotes, and perhaps even the ideas that we might want to borrow to make our own dreams come true. To this end, I share with you how our center Plenitud came to be.

So who am I? I am a childbirth instructor (Informed Homebirth/Informed Birth and Parenting), professional labor assistant/doula (ALACE & DONA), midwife assistant, full time wife, and mother of three. My partner is José Luis Grefnes, an obstetrician & gynecologist, homeopath, childbirth educator certified through the Mexican national association, DONA workshop attendee, husband and father of four. We both live and practice in Guadalajara, Jalisco, México.

We met in April 1994 when I was a faculty member for the childbirth certification course in which José Luis was enrolled. Asked to speak about birth practices in the different countries where I had lived and birthed, I meticulously prepared an hour-long talk in Spanish. Although fluent, I sometimes confuse the pronunciation of similar words and I wanted this presentation to be flawless. During the course of the talk I departed from my well rehearsed “script” and mentioned hand reflexology. I began to explain how grasping combs during labor can exert pressure on the balls of the hand and mid finger tips to facilitate smooth and less painful functioning of the uterus. To my great chagrin, rather than say “peine” (pay...nay) which is “comb”, I said “pene” (pen...nay) which is....gulp.....”penis”! The audience was either dumbfounded or else very polite, but in either case stifled their response. It was only after the talk was completed that José Luis approached me and said, “Those must be some homebirths you attend....maybe a little hard on the husbands, but I’d sure like it if you invited me to one some time.”

At the time I was attending some of the most marginalized women of the state in the vast public teaching hospital known as the Hospital Viejo or Old Hospital in the city center. I offered free childbirth preparation in the corridors and accompanied the women during their labors and births. It was really a two-pronged educational program because I was also given the opportunity occasionally to teach their doctors as a guest of the faculty of the medical school. Those three years were exhausting, exhilarating, frustrating and fruitful.

One particular woman attending my classes was extremely faithful. Without exception, every Tuesday and Thursday morning Sandra and her toddler son took two long bus rides in order to participate in these active learning sessions. Perhaps you are imagining a quiet nook in the hospital where childbirth materials are on display and the women have mats to sit upon the floor. A place where a push of the button displays videos on the television monitor and the women share their dreams and hopes with one another. Our 10am classes began instead with the question “How many of you have felt your babies move today?" When only one or two hands among 20 or more women would go up, I would ask how many of them had eaten that day. Nearly all would respond that they were in “ayuno” or fasting from the day before. As the basket of homemade fruit bread threaded its way through the group I would remind them to raise a finger during the course of the class when their baby moved. And so began a practice that has continued to this day of providing homemade breads, fresh fruit and raspberry tea to every pregnant woman who attends my classes, consultations or meetings.

The “classroom” seating was a combination of hard wooden benches and molded plastic seats. The floors were a speckled linoleum, and the walls showed the effects of the hundreds of women who had leaned upon them in labor. Our instruction was punctuated with young residents calling out the name of the next woman to be examined from the row of cubicles at one end of the room, and with the cries of labor from the women being examined to determine if their labor was advanced enough to allow their admission to the hospital’s labor rooms at the other. What the atmosphere lacked in coziness was definitely balanced by realism!

The classes were a joy to impart. The women were initially shy but loved brainstorming sessions or “lluvia de ideas” -- meaning a “rainstorm” of ideas and suggestions. Over time they were up and out of their molded plastic seats and adopting kneeling, squatting, all fours and variations of all the upright positions. We had some very difficult realities to face. These women would be required to labor without any family members once they were accepted in the hospital. Issued a hospital gown which might not even have ties, they were required to place all their personal property in large plastic bags which were given to their family members waiting outside the building. No beverage (not even water) or food was available and the toilets had neither doors nor toilet paper. Their caregivers were young residents in their early 20’s under the supervision of one experienced obstetrician who wasn’t always eager to be disturbed. Each woman was assigned a bed and her presence indicated on a large blackboard. Denied an identity, most were referred to as “mi hija” (literally, my daughter) or “fulana en cama # 2” (the one in bed #2).

The women were gathered in one large communal labor room, each confined to her bed with its plastic mattress and one flat sheet which generally came loose within minutes of her lying in the bed. The bed were iron and only rarely adjustable. The sunshine filtering in through the tall windows contributed considerably to making the room hot and uncomfortable. The student doctors ate their tacos from the street and read their newspapers and overall acted as though the laboring women were an inconvenience.

I saw how early on many medical caregivers were learning to distance themselves from their patients and offering automatic and robotic answers to the infrequent questions they posed. Knowing that this teaching hospital was the gateway to further medical practice for the doctors throughout the city, I grew more curious about this José Luis who seemed so eager to see a natural homebirth. Could it be that he had been trained in an environment such as this but remained loyal to his profession’s commitment to compassionate healing?

About this time I received a phone call from a very young woman insistent on having a truly natural birth. She had already taken some childbirth classes with another educator I knew and seemed to be ready to take the next step of making the classroom theory of natural birth a reality. I met with her and her husband (both still students) and their enthusiasm, willingness to work for their birth, and faith in their ability to do so was contagious. I reported back to their childbirth educator whose response was probably meant to be cautionary but to me was incendiary .... “Oh they probably won’t even be able to pay you!” That was all it took for me to ask José Luis to consider attending their birth. He told us about a tiny charity hospital near his office where he frequently attended births and this young couple agreed it would meet their needs perfectly..

Accustomed to all-in-one LDR rooms in the United States I didn’t think twice about remaining in the room where Flor and Horacio were laboring when she began to push spontaneously. Having seen women use any position they wanted in the homebirths I saw during my years living in Holland, I was completely at ease when she assumed a hands and knees position on the bed. As her baby emerged over a completely elastic perineum I looked over to see José Luis scurrying to put on hospital scrubs and a mask!!! That was the only indication I had that this kind of natural birthing was perhaps a couple of standard deviations removed from what he had previously experienced. Fluidly and gracefully, José Luis passed baby Paola through Flor’s legs and Flor sitting back on her haunches smiled broadly. How was I to know that this doctor was seeing a baby born facing him for the first time in his career?

Months passed and Sandra (the mom from the public hospital) continued attending classes and asking more pointed questions of her doctor concerning the VBAC birth she wished to have. She approached me after class distraught saying that she realized that her caregiver wasn’t invested in the idea of a vaginal birth and asking if I knew of any other doctor who would help. Knowing her economic resources were severely limited but that her determination was abundant, I again thought of José Luis’ enthusiasm at seeing a birth without interventions. What could we lose by asking him? And so it came to be that José Luis attended a VBAC in the same tiny charity hospital a few blocks from his consultorio.

A birth that began early one fall morning and continued as the mother swayed and rocked and crooned to her unborn child into the long hours of the night. A birth in which he saw his first rice sock and then disappeared for a brief while, only to reappear with a thermos containing an identical rice sock he had gone home to make! A birth in which the mother ate and drank and walked and moaned. A birth in which after hearing the campana (bell) announcing mass, the mother dressed and walked to the chapel to take confession. A birth in which a classical trained medical doctor pulled up on a small bench and gently massaged the mother’s belly with herbal creams sold by a Zapotecan midwife. A birth with intermittent auscultation and constant support and company. A birth that was a triumph!

When Sandra’s posterior positioned baby descended and she floundered for a moment looking for a way to support herself, I climbed onto the bed and with her husband Enrique. With each of us beside her, we held her aloft in a supported squat. Baby Diana slid into José Luis' waiting hands and was immediately enfolded in her mother’s arms. The euphoric look on José Luis' face told me that this was truly a unique experience for him. Sandra brought her daughter to breast and her suckling was interrupted by a sudden grimace. With a laugh and crinkling eyes showing his mirth, José Luis cried out, “of course, the placenta!” A classically trained caregiver in this city would have never seen a spontaneously expelled placenta, because like everything else related to birth, it was a doctor-controlled event with cord traction. When the pediatrician joined us shortly afterwards he was told “No, there will be no need to send this baby to the nursery, thank you.” And so Sandra passed the night with her baby in her bed.

For a casual passerby this was a poor person’s hospital. A slightly shabby and dimly-lit building with toilets lacking lids and a sad air about it. A place that closed in upon itself at night when the throngs of waiting families were no longer clogging its corridors and the food vendors were no longer hawking their wares. To us it was a magical and sacred place. A transformation had occurred. Sandra’s: her vaginal birth after cesarean in an atmosphere of trust and respect. José Luis’: his further introduction into the world of midwifery.

This first in a succession of “firsts” occurs in November of 1995. I continued teaching childbirth classes and attending births as a doula in the Hospital Civil 3 days a week while teaching private childbirth classes in my home. José Luis continued his daily employment at a governmental hospital 7 hours a day and at a governmental health agency another 9 hours a week while maintaining his private practice in the evening hours and giving childbirth classes on Saturdays!

On the surface our daily professional activities continued with a certain “sameness” but really nothing was the same at all! We knew about each other and that in itself changed everything. How to be satisfied with the work we were accomplishing individually when the possibilities for forging some kind of work together are unspoken but definitely “there.” I knew normal physiological and uninterrupted birth as a mother, childbirth educator and labor assistant but certainly lacked the skills to responsibly attend births alone. José Luis had the credentials that permit him to attend births but has had so few opportunities to see birth completely uncontaminated. Who was supposed to ask whom to dance?

My certification letter from Informed Homebirth/Informed Birth and Parenting reminded me that I was not to recommend a particular birth attendant, but rather to give parents the choices available and the help to make an intelligent and informed choice. What’s a woman to do? Why, share the news of the new option of course! I trusted that the women I am teaching would be captivated by this possibility and I was not disappointed.

And so the additional “firsts” followed. Home visits in anticipation of home births were scheduled and attended. There was Minou’s homebirth in May, followed by Becky’s the day after. Two homebirths in as many days.....what an adventure! Guadalajara is enormous and these women lived at opposite ends of the city’s borders. Minou’s birth was completed at midnight in a bustling apartment complex amidst labyrinthian crowded streets at the edge of the deep forested gorge that marks one end of the city. Becky’s took place in a large home in a sylvan residential golf community an hour drive in the opposite direction. One family spoke only Spanish and the other only English. Oh yes, the possibilities were definitely abounding and José Luis’ eyes were sparkling!

Less than two weeks elapsed. A couple taking private classes with me received approval for their formal request that they remain in their private hospital room rather than make the mandatory trip to the OR for the actual birth. We entered one of the more protocol-ridden institutions of the city with some trepidation. This was the most American-like facility in our community with formal registration procedures, bustling nurse stations, and a very rigid protocol. Each time a nurse entered the room and saw Sylvia in her own clothes she returned with a hospital gown. By the time the baby was born with Sylvia on her knees, the room was festooned with three of these gowns and the chairs were littered with the IV equipment brought to us that we never used. When we straggled out of the birth room euphorically a couple of hours later, we were stopped in the corridor by a nurse who asked, “what religion are you?”

A couple of months later I was called by a laboring woman during my Saturday childbirth class. She and I had met at a MANA conference in San Miguel de Allende earlier in the year and her 3rd homebirth was going to be attended by the midwife who had come from a small outlying community for the other 2 births. This time, though, the labor was imminent, and the midwife woudln’t be able to arrive in time. She requested me to come. I called José Luis and asked him to join me. He responded as though I were inviting him to a celebration. It turnsed out that he was correct!

We walked into her house and were greeted with a radiant mother holding her newborn while her two other young children looked on. A neighbor produced the plastic tub with the placenta and shyly explained that she was keeping it in another room so the children wouldn't trip over it. The mother’s words echoed in our hearts and spirit: ”I always believed that women could give birth, but now I really know they can!” We listened to her happy and proud story and were witnesses to her triumph. We remained with her until her husband arrived from work and spent some additional time as the father repayed us by offering to draw our Mayan astral charts. José Luis and I left their home with the satisfaction of having shared a woman’s strength and determination without even being present for the actual birth. This birth laid the foundation for the trust she has to birth twins at home two years later with José Luis and for my first solo homebirth as a caregiver that occurred within the week!

Monica was a fervent LLL apprentice with a little 3-year-old boy. She graciously helped me during my public childbirth classes in the hospital. She was at my side during many births I attended at the Hospital Civil. I had more formal birth education than she, did but she was bilingual and often translated my garbled Spanish with humor and patience. She and her husband requested I attend their birth; their second planned homebirth. I explained that the births I attended at the hospital were always in the presence of an intern or a resident and with an experienced doctors on call and that I wasn’t a midwife. They agreed to come for hour-long talks at my home, but the emphasis was on education and their emotional and spiritual needs. This was now my opportunity to make a discovery. Faithful attention week after week to what the woman identifies as her “needs,” independent of whether clinical responsibility is assumed, IS midwifery care!

They continued their sporadic visits with their midwife (actually an MD living about 2 hours from Guadalajara) and the plan was that I would attend their birth as a doula. When the call came asking me to join them at their apartment, it was accompanied by a deep guttural ahhhhhh heard even by my 8 ½ year old son, who offered me his primary school scissors with the admonition ”You might need these mommy” as I left my home. A few hours later, I took off my white linen outfit appropriately baptized by the placenta and came home in the father’s jogging clothes. My son’s scissors were useful after all .........they cut the umbilical cord!

Throughout the rest of 1996, nearly all of my private childbirth students transferred care to José Luis, and I attended their births as the labor assistant. We thought we had found a supportive hospital with a small birthing room housed in the short corridor leading to the OR and considered ourselves fortunate to promote and attend natural childbirth with little interference.

In the new year, Carolina Oropeza, a childbirth educator who had mentored my participation at the Hospital Civil, took on the enormous project of organizing a DONA doula workshop for more than 75 participants throughout the Mexican Republic. While other doctors registered for the 2 ½ day course, only José Luis and another general practitioner completed the entire weekend’s program. (That MD was to ask us to attend his first child’s home birth 5 years later!)

At the time, no provision was given for documenting/certifying a male doula, but that didn’t dissuade José Luis from becoming everyone’s favorite "doul-o." No sooner did the workshop end on Sunday than did José Luis and I experience another “first”. A cesarean. This was to be this young mother’s ONLY birth (something she emphasized beforehand) and looking back at the hours of labor leading to the surgical decision, I know we gave the best of with-woman care in spite of the attendance of a cynical partner who mocked the use of our newly-learned comfort measures. We were still somewhat at a loss as to how to utilize them once we were confronted with the indication for a cesarean. But taking to heart Penny Simkin’s admonition that preserving the mother’s positive memory of the birth was vital, we ensured that the baby roomed in with her immediately, and we stayed with the mother and her baby for the first hours postpartum.

About this time another obstetrician, Tonatiuh Nuñez, whom we had met in 1995 at the International Childbirth Conference in Guadalajara, contacted us to participate in a conference he was organizing for the educational and investigative division of obstetrics at the Hospital de Ginecologia y Obstetricia. This was a wonderful opportunity, but I insisted that I had to work alongside him in the monolithic IMSS medical facility in preparation for the 3 hour long talks I would give. My rationale was that the OBs and nurses participating in the conference would doubt the feasibility of offering with-woman care and so the only way to show that it could be done was to jump in and do it under the same working conditions they had to contend with!!

During 3 months we attended births together--cheerfully offering beverages instead of IV’s, walking with the women instead of talking to them while they remained tethered to their beds, introducing the birth ball, drowning out the incessant noise and clamor of the hospital with cassette players, and transmitting confidence that they could birth naturally and in whatever position they wished within the labor area and without being channeled through the anesthesia department on their way to the OR. Tonatiuh kept the statistics on 50 births in order to show quantitatively that the APGARS of the baby’s born with expectant management fared as well as or better than the babies born with active management. Best of all, we videotaped it and I could assuage all the naysayers at the conference!

José Luis and Tonatiuh were natural allies, since each man was a single voice within the highly routinized and interventive facility where each worked. Tonatiuh’s participation, though, was directed more to working within the system, while José Luis was growing more desirous of leaving the institution with each passing day

Another major “first” occurred just a few months later. Gaby, a VBAC hopeful, asked José Luis to help her have a waterbirth. And so on July 6th 1997, all three of us experienced our first waterbirth using an inflatable tub in a small hospital. The only rupture we had to contend with was the pool, which flooded the OR while the mother joyfully and obliviously caressed her 9 lb baby son! Throughout the rest of the year we continued to use water as a comfort measure. However, there were no more waterbirths until early February 1998, when one of the OB residents I knew from my activities at the Hospital Civil called to ask for my labor support during his wife’s homebirth.

José Luis and I arrived as a doula team. He for the father and I for the mother. The laboring woman, Arcelia, had taken group childbirth classes with my dear friend Adriana Peregrina but had met us both during one of our tri yearly “swim with the dolphins” excursions which Adriana organized. Though her only experience with water had been the dolphin swim and no mention had ever been made about waterbirth, Arcelia began to murmur about wanting to labor in water during active labor. Her husband disappeared into the granero (barn) and returned with a metallic wash tub. I have a photo of the two OBs intently washing it while the laboring woman (at 7cm dilation) is mopping the floor, ridding it of all the water left in its wake! I kept imagining how fabulous it would be for Arcelia to have both of the women who had accompanied her during this pregnancy with her now. She agreed and I called Adriana, who got to experience her first waterbirth as well. In keeping with the Midwifery Today motto of “each one teach one,” Arcelia’s husband Gustavo later invited me to offer labor support for two more of his family members who wanted waterbirths after seeing the video we taped of his wife’s birth.

By now José Luis and I had established a great synchronicity at births and found our skills complementary. It wasn’t until March, however, with Bety’s birth that I discovered just how flexible he really was. Bety and her husband Peter came to Guadalajara from the mountain town of Mascota. Her parents were doctors and had made all the arrangements for the birth. As they began investigating their childbirth options in private classes with me, Peter realized that they weren’t birthing with caregivers compatible with their values. When labor began, their caregiver dismissed Bety’s belief that she was in labor and suggested that she have a pelvic x-ray to find out whether her pelvis was “adequate.” They called me instead and I invited them to come to my home. It didn’t take long to perceive that she was actively laboring and I invited them to use my bedroom and Jacuzzi tub.

When Bety left the pool to use the toilet we received a phone call from her OB asking how she was doing. When I suggested a home visit to confirm that her labor was well-established--since a couple of hours earlier she undermined Bety’s confidence when she laughed that this was NOTHING compared to what was to come--she indignantly told me that SHE had a consultorio for “these things” and hung up. I called José Luis, described the situation, and asked if he would pleeeeeease come by. When he arrived at the house about a half hour later, he gently introduced himself to Bety and asked what she needed. She wanted to know her dilation. He agreed and with a broad smile told her she was dilated to 8cm. We suggested that if she was planning on going to the hospital this was a good moment to be moving in that direction. Instead, she looked wistfully at the tub and asked “can I just get back in?” “If you are committed to birthing right here than yes, of course” we told her. She and Peter left the tub an hour and a half later with their daughter Justina in their arms.

There was still another member of the group we-are-to-become, but I didn’t meet her until the next month at José Luis’ 40th birthday. He told me about a very passionate neonatologist, Rosy Gonzalez, and she and I left the party to review a video on Kangaroo Care and “talk babies” instead. A MANA conference was being organized the following month in Oaxaca and we made plans to attend together. This “equipo” or team of birth professionals was starting to come together!

We attended 24 more births together in 1998 both at home and in the hospital, but we are constantly having to “pedir posada” or request/beg permission to stay in the hospital room rather than use the OR, or assure the staff that the baby is better off in the mother’s arms (and her bed) than in the nursery. The constancy of the arguments, “favors” we have to ask, and unfavorable climate for births in the midwifery model of care sometimes made us weary. We'd tried so many hospitals…. Mexico Americano, Guadalajara, Versalles, Sta Monica, Guadalupe, San Javier…but the protocol and the administrative obstacles were always the same.

José Luis recommended two smaller hospitals in two very distinct parts of the city. Santa Isabel and Hospital Atemajac. We attended a few births at them and indeed, the protests were a little less forceful. Throughout 1999 the three of us attended 38 births together (14 at home) but we still didn't have a place that felt like “ours”. We had a small flotilla of water tubs, and an array of hoses, wrenches and a vacuum for tub inflation. We made quite an entrance when we arrived! Sometimes the family members in the adjacent rooms looked at us quizzically and wondered about the noise of our vacuum at 2am. Odd hour for housekeeping! When we told them that we are attending a waterbirth, they were always surprised since the majority of them were accompanying a family member who was recuperating from a cesarean. With private hospitals having between 50 and 90% cesarean rates this was hardly surprising.

We felt badly about disturbing their recuperation, but we really had no other options within the hospital setting and frankly, even homes had their problems. At one homebirth there wasn’t enough water pressure and so grandpa, grandma and the doula formed a water brigade from three different faucets in the apartment. At another home the water heater wasn’t working and so we heated pots on the stove all night long. We’ve prevailed on a neighbor to cart over water on occasion and many times just hit the water boiler and pleaded! The time after the birth was sometimes a struggle too with having to empty, clean and collapse the tub when everyone was exhausted or simply wanted to bask in the endorphin afterglow!

When MANA held its next annual conference in Oaxtepec we attended in force. Marilu Navarro (a childbirth educator who teaches in the classroom adjacent to José Luis’ consultorio and attends the births of her students who select him as their caregiver) joined José Luis, Rosy, Adriana and me when we traveled to Oaxtepec.

During those three and a half days we attended workshops, commiserated with the rural midwives, recognized the strength we have in our camaraderie with each another, and relished meeting with the midwives we have come to know and admire over the past three years. We were starting to identify with one another and talk about “us” and “we” when describing our birth activities.

With 2000 came the opening of a new hospital in Guadalajara and the possibility of attending births in their spacious private rooms with ample hot water and plenty of water pressure. Inevitably though, José Luis had to face the barrage of questions from the administration after the birth asking why we don’t use the OR like everyone else, questioning how they were supposed to run a business if we don’t use any materials or services, confused that our babies aren’t in the nursery and wondering why we don’t consider using epidural anesthesia! We had to agree it was better than the hospitals where I have had to hold my foot against the door while the mom is birthing the baby or where we have received phone calls every 15 minutes from the reception checking that we aren’t going to “cheat” and remain in the room rather than go to the operating room for the birth, but it was dispiriting all the same. Half of the births I attended with them this year turned out to be at home, but we don’t have enough families considering that option to have a full-time practice.

We all gathered at my house one morning and discussed what we needed to do. While some were talking about attending another conference or the possibility of us offering a workshop or bantering about the idea of taking continuing education coursework, it occured to me that we have everything we need seated right there in my living room! Why not collaborate with each other and do more than just attend births together? We need an identity and a way to make our presence felt in the community. The group grew animated and we began brainstorming ideas for our name. Marilu, our resident numerologist, starts her calculations and suddenly the group was abuzz. This city has 5 million residents and we have to make our presence felt. We have appeared on television programs and on the radio, had articles published in magazines and journals, given talks at schools, universities, conferences and workshops but with each of us acting independently. Now we need to do these activities combining our energies and using one name! There is no hierarchy. We are an “equipo” or team. Looking for a word that characterizes abundance and the fullness of pregnancy and birth,  we decided upon “plenitude” and thus is born our official name, “Plenitud; embarazo, parto digno y lactancia”. (Plenitude; pregnancy, birth and lactation)

We decided that we will offer free monthly informational meetings, during which we can promote private and group childbirth classes, explain the advantages of labor support, and extol the benefits of the midwifery model of care. We vacillated between the idea of showing a film or not, and then we lit on the idea of offering two visualizations that will compare traditional active management birth versus gentle respectful woman-centered birth. Rather than provide the images, we will allow the families to “see” them in their own heads and decide which feels best for them. José Luis contacted the hospital and within the month we were holding our first evening meeting. We wrote a script and had the obstetricians (José Luis and Tonatiuh) speak about the benefits of natural birth from the perspective of the mother, while the neonatologist reviewed the advantages for the baby. The three childbirth educators/doulas had more than 35 years of combined experience teaching and were definitely in their element without any scripts! We invited a family to share their birth experience with the audience and the 2 hour meeting was a success.

We continued to meet monthly at the Hospital Atemajac for the rest of 2000 and all of 2001 using the facility for the majority of the births we attended. It was a small facility of only 18 beds, but we noticed that one corridor leads to a 4 room cluster that is a dumping ground for broken fans, rickety chairs, extra bed tables, and all the by-products of hard use. The debris was staggering but then so were the possibilities! José Luis asked permission over and over again to use these rooms for Plenitud’s births. He is told that the “socios” (financial backers) needed to approve this idea, which takes an additional 4 months, but finally, they hesitantly agree to let us transform the rooms.

Once we received approval we were off to visit tub makers, plumbing stores, tile setters, lighting departments and furniture makers. We were going to have a simple and rustic place to call our own! Our waterbirths in March 2002 were accompanied by the steady cadence of the plumber’s tools as he carveed out the niche for our fiberglass tub. With each clunk and thud our dream was turning into reality. Fabrics for curtains were selected, the old metal blinds were taken down, beds were tested and dimmer lights were bought. We marched off to furniture showrooms and mulled over price and quality. We definitely had a small budget but we bought a few durable and serviceable pieces. We looked over our personal collections of posters and prints and started to imagine this group of rooms as “ours.”

Finally in April 2002 the first waterbirth took place in our small cluster of rooms. Outwardly, it was only the presence of the fiberglass pool and the double beds that signaled that there were other expectations for birth here, but the sense of this being a safe haven was palpable.

We are only slightly removed from the activity of the hospital (which has a 90% cesarean rate), but once inside our doors a completely different atmosphere reigns. We avoid the “institutional” with furniture that is simple but homelike. We have plain white candles available for every birth (though our families can bring in whatever they would like to personalize their space) and Gentle LED Birth Lights grace the bedside tables for safe illumination during the night. The nursing staff enter only to bring supplies and do not return until after the birth or at our invitation. The maintenance and security at the hospital can be shoddy though and we are plagued (again!) with a recalcitrant hot water boiler, theft of our new sheets, and a dearth of towels and bed pillows. We hang blue curtains in one room and green in the other and somehow return to always find the blue bedding in the green room and vice versa. Finally we take the finials off the ends of the curtain rod and are often seen marching from room to room to exchange the curtains so they will match! Considering the difficulties that our sister midwives face in other communities, these are small annoyances though.

What prevails is the sense of faith in birth. Once through our doors there are no clocks, machines that go ping or otherwise, no blaring messages relayed on the intercom, no televisions, no hustle or bustle. The rhythm of each woman’s birth is the drummer to which we march and she is the leader of the band. The months of dreaming and planning have arrived and the unknown of labor is shared with her loved ones, the OB/midwife and the doula.

Now when we hold monthly meetings we congregate afterwards with the families to enjoy fresh fruit juice and homemade breads in our center aglow with candle lights and soothing music. Why shouldn’t we enjoy the only took 8 years to create!
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Wednesday, September 15, 2010

Birth Around the World: Birth at a midwife clinic in Japan

Sarah of Delightful Pregnancy gave me permission to repost Jamie's birth story. Jamie (who blogs at High Countries) gave birth in Japan to her second baby at her midwife's house. Sarah wrote to me in an email: "Not mentioned in my post are other tidbits from Jamie about her experience, including that during her stay at the midwifes home for several days postpartum, the midwife made her 3 home-made meals every day! Love that personal nurturing...every woman should receive this kind of care. Jamie even sent me some pictures of her meals, which I didn't post because of space, but they looked delicious."

Jamie's Birth Story

Sarah's words in black; Jamie's words in purple.

Jamie is one of those people that I can’t believe I’ve never met in person. We used to live in the same city, we have oodles of friends in common and both my husband and I have met her husband, Bryan. Jamie and her family moved from Nebraska to Japan a few years ago, which is where her second son, little Ezra, was born last fall. I always love to read birth stories, of course, but I also love to learn about birth in other cultures (because we Americans have so much to gain!). Jamie shared these details about her experiences having a midwife-attended birth:
  • The midwife experience in japan is rather rare — only about 10% of births happen in midwife clinics, so my experience wasn’t the norm.  Many of my japanese friends were surprised and interested in giving birth at a midwife clinic (josanin).  All of the births in hospitals and birthing centers, however, are attended by midwives, and the dr. comes in to catch the baby.
  • The midwife’s clinic is in her home.  She and her family live on the first level, where her office is also located, and there are three birth rooms upstairs.  She provided a few things (the baby’s clothes, blankets and diapers, and pads for me), but i had to bring my own pajamas, toiletries, and pain meds. 
  • I gave birth and stayed in the same room.  Ezra slept in the bed with me, and if you have other co-sleeping kids, they are welcome to stay and sleep with you. (in japan, they co-sleep until age five or six.)
  • She came and took the baby every day for a bath and to weigh him, and i took a shower while she did that.  Then she weighed me and “wrapped” me — she did a traditional japanese wrap around my waist and hips to help my hips close after giving birth.  It felt amazing!  After giving birth, you kind of walk around for a while feeling like your insides are going to fall out, but with that hip wrap, I felt totally normal.
**Renowned anthropologist/childbirth author Sheila Kitzinger said this about the practice of post-partum binding in Rediscovering Birth:  
My mother, who was a midwife in the years after First World War, described to me how she bound the new mother’s body firmly with wide strips of cloth from below the breasts to the top of the legs. Each time the midwife visited in the days following the birth she unwound the cloth strips, gave the mother a bed-bath, patted her dry, and then rebound her. She offered the intimate and nurturing touch which was considered an important part of postnatal care. In modern hospitals new mothers are rarely touched except to examine them, to check that the uterus is firm and…to examine the perineum. (p. 221)
This is the story of Ezra Dean’s birth:

on a rainy night in october, with less than 20 minutes left in the day, you came.  you were pink and slimy and quiet as you drew your first breath, and i was so happy to be done.  we leaned over you, your daddy and i both with our hands under your body, taking in our first looks of your nose, your mouth, your fingers and your toes.  you were beautiful.

i was certain that you would come late, as your brother was late, and your nana said i was late, and so was your uncle — it was the way of birth in our family, and you were no exception.  twice, i thought you were coming.  twice, i woke up in the middle of the night, experiencing the sensations and pains of your arrival.  once, i called our friend to come be with your big brother at 3am.  once, your father and i walked to pick up gum at the 24-hour convenience store at 4am.  twice, i fell back asleep after contractions stopped and my tears were dried, convinced that you were not coming like i thought you were.

five days after your due date, i woke early in the morning at 5:30a, once again feeling those pains.  they were slightly different, so this time, i was sure. we made the calls.  we packed the bags.  i took my time getting ready, not knowing how long it would be.  i did laundry and washed dishes.  i straightened my hair and put in my contacts.  i brushed my teeth and ate tiny snacks.  at 9am, your dad and brother and i went to a park to play.  i was having contractions 10 to 15 minutes apart, and they were getting stronger.  yes, i thought, this is it.  today, we would meet you — ezra dean.

around 11am, after about five hours of here and there contractions that weren’t too bothersome, we went to get checked at the midwife’s.  i was 4cm dilated. and the contractions had stopped.  so we went for a walk.

your papa and i drove to kendai university and spent a few hours walking its hills, taking in the fall scenery, talking and musing and dreaming.  i even cried a little, which is normal for me these days.  it was a lovely time, but things had completely subsided.  it was 3pm.  perhaps you would not come.

we went home and i talked with a friend on the phone.  i ate a snack and fell asleep, sadness and frustration seeping over my heart.  am i doing something wrong?  why will he not come? at 5pm, i woke up and cried and prayed with your papa.  you would come when the time was right and determined, i wanted to believe it.  i would wait for that time.  God knew when it was, and things were safe in His hands.  i breathed a sigh of relief, knowing it wasn’t my will that made things happen.  our spirits lightened, we set out to fully enjoy the evening.  and we did.

at 6:30p, as we were on our way to eat, i started getting contractions again, only every half-hour.  the midwife wanted us to come after dinner so she could see how things were progressing. by 7:30, they were every 15 minutes, and more intense, and i was beginning to feel very ‘serious,’ as they say.  no more small talk. no more laughter. no more playing around.

at 8p, we arrived at the midwife’s, and she checked me — dilated to 6/7cm, and she told me you may come fast, so it would be better to come and stay at her house now.  we dropped off your big brother and our friend at home and returned to the midwife’s, excitement in your papa’s eyes and seriousness in mine, so very ready to meet you.

we listened to music.  we read.  i stopped everything to breathe and survive the contractions.  by 10pm, they were coming every 5 minutes and i could have no noise or distraction in the midst of them.  your papa gently stroked my back and did what he could to encourage me.  you were coming.  you were finally coming.
at 10:45, the contractions were one on top of the other, and i started to make a lot of noise.  the midwife rushed upstairs to help, and at 11:15, with a squeal of pain, my water broke.  i was ready.  i was so ready.
i had been laboring on my hands and knees and was too tired to move, so i started pushing from there and making more noises that sounded strange to my own ears.  i wanted this over.  i wanted to be done.  i wanted you here.  the midwife let your head crown just a little, and would gently push you back inside to help me stretch.  it was painful, and i kept asking your papa, “is he out yet? is his head out?”  finally, she let you make your way, and it was nothing but bliss to finally leave my hands and knees and sit with you in front of me on that october night.
you slid out into your father’s hands, and as i said, we both hovered over you, taking you in.  you were so distinctly you to my eyes.  not like your brother.  you had your own eyes, your own nose, your own hair.  just you.  your papa cut the cord and i took it all in. i could hardly believe the blonde haired, blue eyed babe in my hands was you, and you were mine.
and i was so glad the wait was over.  and you had finally made your way.
welcome, ezra dean, to this life of ours.
ezra dean o’donnell
6lbs 12oz
born in shizuoka, japan, october 22, 2009

Bryan, Jones, Jamie and Baby Ezra
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Monday, September 13, 2010

Birth Around the World: Birth Center in Guadalajara, Mexico

In 2009, Carly gave birth in the Plenitud birth center in Guadalajara, Mexico. The birth center is the first of its kind in Mexico and unlike almost anything found in the US. It's housed in its own wing in a hospital, but is run independently by a team of midwives, childbirth educators, doulas, OBs (José Luis Grefnes), and pediatricians. To read the story of how the birth center came to be, click here (Word document).

Carly lives in Guadalajara, Mexico with her husband Brendon, daughter Jessica, and cats Parker and Puck. She enjoys running, travel, reading, and good food and drink.

The Most Awesome Experience Of My Life
by Carly V.

I had been undecided about whether I wanted to have any children until a couple of major life events made it clear to me that I most certainly did. My beloved grandmother, whom I called “Grandma Helen,” passed away right before Thanksgiving in 2006. The following spring, I learned that I had Stage 0 cervical cancer—two kinds of it, actually—and had to have a cervical conization to remove it. The good news was that the pathology report that followed showed clear margins, meaning that the surgery had successfully removed all of the cancerous cells. Still, my gynecologist recommended that I have a hysterectomy after I finished having children or after I decided that I definitely did not want to have any children. These events made me consider the “circle of life,” and I realized that I did not want that circle to end with me. After a normal pap smear in the fall of 2007, my husband Brendon and I began to discuss the possibility of trying to conceive. By early 2008, we were ready.

Meanwhile, an opportunity began to unfold for Brendon at work. There was talk that he might be offered a three-year assignment in Guadalajara, Mexico. The experience of living in another country was something we both had wanted for a long time. He asked me if giving birth in Mexico was something that I was willing to do. After only a minimal amount of consideration, I answered in the affirmative. So, we continued trying to conceive as we waited to see if this international assignment would materialize. Those efforts proved successful on my fourth cycle of trying to conceive, when a home pregnancy test revealed two pink lines. That was May 7, 2008. Just a few weeks later, we told our family and friends that we were expecting. Just a few more weeks after that, we told them that we also were moving to Mexico for three years.

When both the pregnancy and the international move became realities, I began to do some serious research about birthing in Mexico. The first stories I found and read concerned me. I learned that, at many hospitals in Mexico, Caesarean sections were the norm, and babies were whisked off to the nursery after birth—instead of staying with their mothers to bond and to breastfeed, which is what I wanted. Then I typed four fateful words into the Google search engine: “natural birth center Guadalajara.” At the time, I was not sure whether an unmedicated birth was for me, but I knew I did not want the standard Mexican hospital birth. At the top of the search results, I found midwife Joni Nichols’ website, which featured the little birthing center that she helped create at Hospital del Valle de Atemajac in Guadalajara. Water birth was common at the birthing center. I was intrigued and excited. I began corresponding with Joni, who graciously answered all of my questions. I also bought a self-hypnosis CD, as I was interested in using self-hypnosis for relaxation and pain control during birth.

As my belly grew, our moving plans solidified. We had an investigatory trip, during which time we were able to meet Joni, as well as Dr. José Luis, the OB/GYN with whom she worked. I was thrilled when Brendon was as impressed with both of them as I was. I committed to an unmedicated birth. I told Brendon that I wanted to move no later than early November (at which time I would be seven months along). Otherwise, I would want us to stay put in Michigan until the baby was at least a couple of months old. As it turned out, we arrived in Guadalajara on October 31, 2008, after a five day road trip with our two cats, which actually proved to be enjoyable.

Soon after our arrival, we visited the birthing center. It was candlelit, warm, and cozy. The birthing tub had a soft cloth “rope” suspended from the ceiling. Just a few days earlier, I had read in Birthing From Within by Pam England and Rob Horowitz about Native American women hanging onto a rope while birthing, and it was a possibility that appealed to me. The presence of that particular tool in the birthing center was a sign that I was in the right place. It was surreal standing there and knowing that in two months, I would be giving birth to our baby there.

Over the next two months, while Brendon worked, I had the luxury of spending my days mentally preparing myself for childbirth. Joni provided me with an abundance of great information. I learned about pain-free births, even orgasmic births. I practiced self-hypnosis and practiced positive affirmations about the coming birth. A link that Joni gave me led me to find Journey Into Motherhood: Inspirational Stories of Natural Birth, compiled by Sheri L. Menelli. Ultimately, it was that book that most helped me to feel confident and ready to birth my baby. My “due date” was January 10, 2009. I wondered whether the baby would arrive early or late, but the only thing to do was to wait.

Around 2:30 p.m. Central time on Sunday, January 11, Brendon and I were getting ready to eat lunch (some chipotle-flavored tortillas with leftover refried beans and cheese—and some cucumber slices, I think). I felt a tiny warm gush and thought that it felt interesting. Then I felt another and made a little "hmmm" noise. Brendon asked, "What?" I said I wasn't sure, but I thought maybe my water had broken. I decided we should just go ahead and eat our lunch and then I would investigate the situation. I was a little giddy during lunch, laughing happily at the idea that maybe our baby would be with us soon.

After eating, I headed upstairs. On the way up, my pants got soaked. Indeed, my water had broken! I cleaned up and noted that the fluid was yellow in color. I knew that clear was good and that green or brown was indicative of meconium, but I wasn't sure about yellow. So, I felt a little nervous. I called Joni but got her voice mail. I then called Dr. José Luis, who told me that fluid the color of pineapple juice was a good thing, so I relaxed. He said to go about my life and to call if anything changed. Soon Joni called back and reiterated what the doctor said and also told me that as long as I didn't have a vaginal exam, I could wait for the contractions to start labor, even if it didn't happen that day or even the next day.

We talked to Brendon's mother on the webcam a little later in the afternoon but did not tell her that my water had broken. I had decided previously that I did not want to tell our families when I was in labor and that we should wait until the baby arrived to contact them. If the labor took a long time, I didn't want to be thinking about people back home worrying and wondering what was happening. And, now that my water had broken without any sign of contractions (and we would not be following the rule typical in the U.S. medical community that labor must start within 24 hours or else they will induce), I especially didn't want people worrying about that. During the chat with Brendon's mom, at around 4:30 p.m., I had my first noticeable contraction. It was pretty mild, so I was able to keep my secret easily.

By about 6:00 p.m., I was having regular contractions that were uncomfortable enough that I was changing my position to deal with them. Brendon started casually keeping track of them, and by 7:00 p.m. or so, we were amazed that they had been regularly coming every five minutes or so. I decided to call Joni. While talking to her, I had one contraction, but it was milder than most of the ones I had been having, and I easily talked through it. She encouraged me to labor at home awhile longer. She told me that I should wait for the contractions to take my breath away.

I decided to lie down on our bed for awhile. Brendon brought me juice, water, and dry toast. It wasn't long before I was moaning through some of the contractions. I decided to call Joni back a little after 8:30 p.m. I was surprised that she seemed to be discouraging me from leaving for the birth center again. Later, she told me that typically the laboring moms get adamant that they are going to the hospital NOW, so she does not tell them when the time is right. I was a bit different and was patiently looking for direction. I had three contractions three minutes apart while talking to Joni, and she then told me that she thought we should get on our way to the birth center.

We left the house a little after 9:00 p.m. I dreaded the drive to the birthing center. The streets here in Guadalajara are SO bumpy and rough. Brendon drove carefully but quickly. It took about a half an hour to arrive. By the time we got settled, it was about 10:00 p.m. Joni showed us our room—a cute little bedroom with its own bathroom, including shower. The birthing center was candlelit and very warm, just like when we visited. She told me that my tub was almost ready. I was excited to hear that. I had wanted to be in the tub for awhile at that point! She gave me a birthing ball to lean over on the bed. I stayed there briefly and then remembered that I had to pee. As I got up to go to the bathroom, I felt nauseated. I threw up as soon as I got to the bathroom. Joni told me that that was a very good sign. I returned to the birthing ball on the bed and asked how the tub was. Joni said it was ready, and I said I wanted to go there.
Shortly after I arrived, with Dr. Jose Luis listening for baby's heartbeat before I went to the birthing tub

In the tub, things continued to move quickly. With every contraction, I grabbed the soft cloth "rope" hanging from the ceiling and leaned back while lifting up my hips. Brendon, Joni, and Dr. José Luis made sure I got drinks of water in between contractions. No one could believe how much water I drank. Brendon said I probably drank two gallons! Joni also offered little juice ice cubes, which tasted really good to me. It wasn't long before I felt my body starting to push. I was stunned that it was happening already. I asked Joni if it was okay, and she said it was.
Me smiling in between pushing contractions

The pushing stage tested my endurance, even though it really didn't last all that long. It took me a few contractions to get used to the pushing sensations and really let them happen. Soon Dr. Franky, the pediatrician, arrived. I was kneeling/squatting in the tub and hanging on the "rope" through contractions, then leaning back on Brendon (who was sitting on the edge of the tub with his legs in it) in between contractions. I knew I was SO close, and I got a little impatient with waiting for the baby to come. The contractions had slowed down, giving me a nice break in between. When Joni pointed that out, I appreciated that aspect of it.

Finally, the baby's head was just about to emerge. Joni warned me that if I felt burning, I should breathe through the contraction to ensure that my tissues stretched slowly rather than tearing. I did feel some mild burning, so I did this. But, after a few contractions, the burning was still there. I told Joni what was happening, and she told me that I might have to go ahead and just push through it. I gladly did. As my baby’s head crowned, Joni told us that the baby had light hair. It took a bit longer to push her ears out, but soon I felt her whole body sliding out. I was so excited, saying, "My baby, my baby..." It was 12:12 a.m. on January 12, 2009.
Jessica latching on to nurse for the first time while still in the tub, cord still attached

Dr. Franky scooped her up and handed her to me. I took a quick look and pulled her to my chest, saying to Brendon, “I think it’s a girl.” Dr. Franky helped me check her out more thoroughly. "It is a girl," I said. Then they put her on my chest, and she immediately started crying loudly, but that did not last long. She soon settled down and opened her eyes. Both Brendon and I were instantly smitten.

Jessica scored a perfect 10 on her Apgars. She stayed on my chest for awhile and even started nursing while still in the tub. After a bit, our caregivers had Brendon check the cord to see if it was still pulsating. It had stopped, so they clamped it and let Brendon cut the cord. Then they took Jessica to dry her off and dress her for us. Joni also clipped her fingernails. Brendon and I washed up a bit. After that, I delivered the placenta, and the doctor inspected it. We looked at it, too. Then I felt lightheaded and had to lie down in the tub for a few minutes. Once I was feeling better, Dr. José Luis helped me into a wheelchair, and we went to our room. Brendon held our daughter, whom we named Jessica Helen. The doctor inspected me for tearing, along with Joni. I only had a superficial tear, and Dr. José Luis considering not giving me any stitches, but Joni thought it would be better to give me a couple to ensure that I healed without any problems. So, he gave me two stitches, after administering a local anesthetic. I was nervous about the injections, but they didn't hurt any more than the ones I'd had at the dentist.
The 3 of us, ready to go to our room to rest for the night

Then, our caregivers left us alone for the night to bond, to nurse, and to try to get some sleep. We called our parents to share the news. Jessica cried for awhile but ultimately cuddled up with her daddy and went to sleep. The next day, each of our caregivers (Joni, Dr. José Luis, and Dr. Franky) stopped by to see how we were doing and to give us additional instructions. Joni was delayed until mid-afternoon, so it was about 5:00 p.m. when we left the hospital. Otherwise, we would have left even earlier, as neither Jessica nor I needed any medical attention. We all just needed to rest, which we were happy to do at home.

I am now an unmedicated childbirth fanatic, because this was the most awesome experience of my life. I found birthing to be "painful" only in the way that the hard work of strenuous exercise is painful. It was not painful in the sense of something being wrong with my body, like an injury. When I was in labor, Joni told me that I must have given birth in another life or something. She also told me that I did everything perfectly, and that the superficial tear did not mean that I had done anything wrong. I felt so strong and powerful for having brought our beautiful little Jessica Helen into the world. I did not get to use my hypnosis much during labor, because the contractions became intense very suddenly, making deep concentration impossible. Instead, I focused on relaxing as much as I possibly could and on letting my body do its job. I believe the hypnosis practice I did and the affirmations I practiced helped with that significantly. I was far more vocal than I thought I might be--lots of primal, guttural growling and groaning. Some of the things I was said kind of cracked me up, even as I was saying them. When the pushing sensations started, I said, "Oh, my" a couple of times. I was thinking, "Oh, my? Who says THAT in labor? Apparently I do." I also said, "Yes, yes" and "oh, yeah" a lot while contractions were subsiding, prompting Joni to ask Brendon if he could see why a lot of medical professionals discourage women from making noise in labor—because it sounds a lot like lovemaking and makes them uncomfortable.

I had a natural high for at least a good week after the birth, if not two. I am amazed at what my body did in birthing and how efficiently it did it. I am amazed by little Jessica Helen. I am amazed and thrilled at what an awesome father Brendon is. Now I am enjoying every moment of life with my healthy, happy, wonderful baby girl. I hope that by sharing this birth story, I might inspire and encourage other women to have an equally great experience that is uniquely their own.
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