Who has the right to speak for the baby?

Please welcome guest blogger Roanna Rosewood! I met her at the Human Rights in Childbirth Conference in the Netherlands. She spoke eloquently about her own experiences giving birth and about who has the right to speak for the baby. Below are her remarks from her presentation and letter to the conference. 

If you like Roanna's writing, keep an eye out for her upcoming book Cut, Stapled, and Mended: A Do-It-Yourself Birth. Forthcoming spring 2013.

I’ve been preparing for to the responsibility speak for my unborn baby since long before anyone else considered it. While my brother play-battled with swords, I sat next to my mother as she nursed, and I nursed my own “baby doll” imagining the day when the baby that I held in my arms would pulse sweet milk dreams and curl his toes around the touch of my fingertips as I rocked him.

Twenty some-odd years later, my belly as round as the moon, I could barely contain my excitement. “I love you.” I told him. I repeated it again and again, not out of doubt, but because I knew – even then, that I would fail him. I would make mistakes. “I love you” was the one thing that I could offer unconditionally. No matter what hardships he would face, he would never doubt my love.

Believing it was best, I willingly surrendered our bodies to the hospital. I was wrong. They coerced me into what I would later learn was an unnecessary cesarean.

I remember watching as they lifted him up over the operating curtain. I caught a glimpse of his black hair. I waited for them to hand him to me. They didn’t. They carried him away. He wailed loud, uncontrollable screams, one on top of the other. I wondered how he could breathe.

Every instinct in my body demanded that I get up and go to him, that I sooth him with the same simple words he had heard me repeat since his perfect ears had formed inside of me. I couldn’t. I was tied down. My womb was sitting outside of my body. There was vomit dripping down my cheek.

There was no reason for them to take him from me. My son was healthy. His distress was emotional, not physical. The doctors were so bloated with power that their routine more important than his well-being. While he screamed, they took his footprints, cleaned him, and measured him.

Why must a baby be measured at birth?

How much can he grow in an hour?

To them, the cesarean was routine. To us, it was everything. It cost fifteen-thousand dollars. I was forced to leave my newborn with others and returned to work early to make payments. Nightmares of being tied down and cut open that haunted my nights.  Where I used to rub and caress my belly with love, it is now cold and numb to the touch. Though it’s been twelve years, my eyes tear at the memory of failing my son. The sound of him screaming his first and simplest request of the world will forever echo through my body. I’ve tried to make it up to him. A million times I’ve told him that I love him. But there is no way to heal my son’s introduction to the world – his first breath, his first sight, and his first touch were filled with fear, pain, and disregard.

Pregnant again, the doctor I chose would have allowed a trial of labor but administration refused it. The decision was made by people who would never look into my eyes or see my baby’s entry to the world. Their business choices overruled both her medical expertise and my constitutional right to bodily integrity.

Why have others been given the power to deny me a basic bodily function? We are each of us, here right now, because a woman opened and bled for us so that we might live. The people and institutions managing birth have nothing to do with impregnating us. Our babies are a gift from something bigger, stronger, and more important than they are. The way that we choose to give birth is between us and the powers that entrusted us with this child.

I have deep respect and appreciation for birth professionals and the important work that they do in the world. But I would like to, not so humbly, remind everyone that women and babies are not products. We are consumers. Birth providers work for us. Their expertise in birth is no more important than our expertise in our bodies. Nobody can guarantee good outcomes. Medical errors continue to be a leading cause of death here and in other developed countries.

In spite of everyone’s best intentions, some mothers and babies will die surrounding childbirth. If there is a mistake to be made, let it be made by the one who has already proven her commitment to this child by willingly putting her very life on the line in choosing to give birth to him, let it be the one who will live with the resulting disability or death for the rest of her life. Let it be the one who will grieve and pray. Let it be the mother.

I was created to give life and speak for the interests of my baby. I cannot separate from it. It is who I am. It’s in the breadth of my hips that widened on their own volition to cradle them. It’s in the curve of my breasts, heavy with milk to sooth them. Every month, my womb aches in preparation to receive life because, as a woman, it is my responsibility, my honor, and my choice to bring new life into the world. I alone have earned the right to speak for my baby’s interests.

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Implementing skin-to-skin in a hospital

Alethea, a labor & delivery nurse in a small community hospital, wrote this guest post about how to implement skin-to-skin in a hospital. Sometimes a big change in policy starts with just one nurse's efforts! 


If you would like to get in touch with Alethea, please leave your email address in the comments or send me an email, which I will forward on to her. She is more than happy to answer your questions.

As expectant mothers near the end of pregnancy, they begin to prepare themselves mentally and physically for the upcoming birth of their baby. While imagining what labor and birth might be like for them, they often daydream about holding their baby in their arms for the first time, immediately after birth. It is instinctive for new mothers to want to hold their babies close, nourish them, and keep them safe and warm.

In recent years, studies have shown what mothers have known in their hearts since the beginning of time: that skin-to-skin contact immediately following birth is best for mothers and their healthy babies. Healthy newborns placed skin-to-skin on their mother have a surprisingly easy time adjusting to life outside the womb. Skin-to-skin contact helps keep babies warm. Babies also cry less, have more stable blood sugar levels, sleep more, experience less pain from painful procedures, and are interested in breastfeeding sooner than newborns who are separated from their mothers.

I am a labor and delivery nurse in a small community hospital. We attend the deliveries of 350-450 births per year. I began recognizing that it was not a part of our culture to support immediate skin-to-skin contact with new moms and babies. Often, doing as they were trained to do, nurses would whisk the baby over the warmer, clean her up, weigh her, measure her, administer baby meds, etc while the placenta was being delivered and the physician was repairing the mom’s perineum if needed. Often, I then witnessed the baby being wrapped up in multiple layers of blankets, with only his face visible to finally meet his mother mother for the first time 15-20 minutes after birth. My colleagues and I were simply task-oriented; we did not recognize what we were denying these moms and babies. We were all trained under a medical model of obstetrical care, and we were simply trying to get our jobs done as efficiently as possible. Ah, but old dogs can be taught new tricks (or ancient tricks that they just didn’t know yet)!

When I was first training as a labor and delivery nurse, I worked in a large urban city hospital that had both midwifery-model care delivered by certified nurse midwives, as well as medical-model care delivered by physicians. (Granted, some midwives seemed to function under the medical model and some physicians seemed more midwifery-model oriented, but that is another story.) In my training and subsequent employment, I witnessed the beauty and the benefits of providing immediate skin-to-skin contact between moms and babies, as it was strongly supported by the midwives with whom I worked. I feel so blessed to have had the midwifery model of care as a part of my training. Many moms and babies have benefited from what I learned from those midwives (and some physicians).

So, how did we go about changing the culture of our little community hospital? It all seems to be a bit of a blur, and I might be getting some of the details out of order. My apologies to my colleagues if that is the case! Taking into consideration that the predominate culture of our department has always been doing what is best for moms and babies, I think this particular change started with leading by example. When I attended a birth as the baby nurse (we always have two nurses attend every delivery, one for mom and one for baby), I began to put babies skin to skin with their moms. When I was the labor nurse, I urged the baby nurse to get the baby skin to skin as soon as possible, asking them to leave all the non-urgent admission tasks for me to complete later. If the baby was brought to mom all wrapped up, I would simply unwrap the baby and get him skin to skin with his mom. We began to have discussions at the nurse’s station about which of our nursing tasks can wait (most of them), and we talked about how easy it really is to do those tasks that could not wait right on the mom’s chest. For those nurses who felt they did not have time to come back later to do admission procedures on my babies, I volunteered to do everything myself. And slowly the culture started to shift.

In 2007, AWHONN published an article, Skin-to-skin Contact: Giving Birth Back to Mothers and Babies (PDF). I printed up copies of the article and left them around the department, requesting that all the nurses read it. I sent copies to the recovery room staff and anesthesiologist. Over time, I began to notice more nurses starting to incorporate skin-to-skin into their routine practices. We were gaining momentum.

Over the past couple of years, the nursing staff and physicians I work with have successfully integrated immediate skin-to-skin contact as a standard of care for healthy babies born by vaginal birth. Because we strongly believe in the importance of providing safe, quality, family centered maternity care, we are always looking for ways to improve the services we provide the new families in our community. So why stop what we now know is the right thing to do with just vaginal births?

We all know that when cesarean birth becomes necessary, it often brings an unexpected and unwelcome separation of the mother from her newborn baby. Even when cesarean births are planned, I can’t imagine the longing so many mothers must have felt during the time they are separated from their babies. It is not uncommon for it to take between 40 minutes to over an hour be reunited with their baby. (Side note: because we are a very small hospital, we do not staff our own operating room or recovery room.) As we witnessed the gentle transition to life outside the womb with infants placed skin to skin with their mothers after vaginal birth, I began to wonder why we could not also support this amazing time for healthy moms and their babies born by cesarean.

Our department was looking for a quality improvement goal for the upcoming year. At our staff meeting in November 2010, I suggested we begin to offer and support skin-to-skin contact in the operating room. We had already tried, with inconsistent success, to bring babies back to PACU (a recovery room that is staffed with different staff than the LD unit) to breastfeed. (Again, another story as to why that hasn’t been very successful.) So why not just prevent the separation in the first place and keep the babies with mom in the OR?


My colleagues were all on board and we set a very ambitious goal of providing skin-to-skin contact in the OR for 75% of our cesarean-born babies within 3 months of beginning the initiative. I am excited to report that after two months into our initiative we have supported immediate skin-to-skin with 53% of cesarean-born babies at our hospital. We do have a little ways to go, but it is absolutely worth celebrating that over half of babies born by cesarean are now getting to spend this valuable time with their mothers.

Prior to beginning the initiative, we did a little ground work. I spoke to the head of anesthesia about our plan. While some of his colleagues were not as enthusiastic about it as I had hoped, we got the go-ahead to move forward on a case-by-case basis. As the anesthesiologists have all been able to witness the beauty of this time, they are now all very supportive (or at least not negative) about it! We also decided to clearly define the criteria for both mom and babies to participate in the initiative (stable vital signs, no O2 requirement or respiratory distress for baby, no nausea/vomiting for mom, mom wants to participate, etc). We got the full support of the Neonatal Nurse Practitioners who attend all cesareans and let the pediatricians know that the babies would not be coming back to labor and delivery for their first admission exam as soon as they previously had been. We were all set to begin on December 1st, 2010.

Just a few days before Christmas, I was working with a first-time laboring mom and her partner. Kelly was in the middle of a medically indicated induction, and was hoping for a vaginal birth with minimal intervention. As the day progressed and despite that fact that she had been working extremely hard for many hours, she experienced very little cervical change. She was exhausted and disheartened by the news. At that point she decided to receive an epidural. After many more hours, and despite exhausting all other options, there was still no cervical change. Kelly and her physician agreed that a cesarean birth was necessary. As I was preparing her for this change in plan, I let her know that there was a good possibility that at least one part of her birth plan would not be disturbed. All went as planned. Both Kelly and and her baby Simone did very well and met our defined criteria. Not only did we place Kelly and baby Simone skin to skin in the OR for nearly 30 minutes, Simone even breastfed briefly in the OR!

When she later sent me copies of the photos I took of this special time with their camera, Kelly said:

It was incredibly meaningful to have Simone with me immediately after her birth. That very special moment of togetherness is what so many mothers look forward to, and I did, too: After 9 months of pregnancy and the effort of labor, it felt like a huge reward to finally touch our baby, to face her and have her in my arms. A cesarean birth really enforces a distance between mom and child, but the opportunity to embrace Simone right away really did help me overcome those feelings of alienation. It allowed me to be one of the first to welcome her into the world, which is, I think, a mother's right--certainly it's something I think all moms hope for.

Pictures of Kelly and Simone in the OR:

 

 

 

 

Cindy, a LD RN, loves witnessing the bonding and connectedness that skin-to-skin in the OR promotes. “It makes it so much more real,” she commented. Kristi (RN) added that “it makes the surgical birth experience so much more personal and meaningful.” As a Birthing From Within mentor as well as and LD nurse, I know in my heart that cesarean birth is still a sacred time for new families. All births, cesarean or vaginal, represent not only the birth of a baby, but also the birth of a mother, a father and a family. My hope is that supporting ways to make cesarean birth feel less clinical and more sacred will save a lot of heartache, feelings of disconnectedness, and feelings of loss over an unexpected and often unwished-for outcome. Allowing moms and babies to connect immediately after any birth is the right thing to do, and I feel it is my job to protect this sacred time.

I believe that with a little time, patience and education, all LD departments can do what we are now doing to support skin-to-skin for all mothers and babies. If you are interested in learning more about how you too can bring skin-to-skin in the OR in your hospital, please don’t hesitate to contact me. (Send Rixa an email, and she will forward it on to me.)

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Guest Post: Summer Reading on Maternal Care

The following is a guest post by Christine H. Morton, PhD, Research Sociologist and List owner of ReproNetwork.org. You can reach her at christine@christinemorton.com.

Summer Reading on Maternal Care:

Mis-Steps and Steps Forward….

As a medical sociologist interested in childbirth practices, I’ve got a library of fiction and nonfiction that has grown exponentially over the years. I’ve read all the usual suspects but recently have come across some compelling gems that somehow I missed over the past few years.

Now that I’m working with the California Maternal Quality Care Collaborative on the issue of maternal mortality and morbidity, I’ve been drawn into the world of quality improvement, patient safety and that bogyman of defensive obstetrics, ‘liability and malpractice.’ So imagine my delight when I discovered What do I say?: Communicating Intended or Unanticipated Outcomes in Obstetrics by James R Woods and Fay A Rozovsky — an obstetrician and a lawyer, respectively.  Their book (Jossey-Bass 2003) is designed to help obstetricians improve communication about bad outcomes while avoiding liability. It’s an interesting, if ultimately unsatisfying, book because it is very narrowly construed along those lines. While it fulfills its own goals admirably, for me it doesn’t take the issues further by examining the lack of communications and teamwork skills in medical school curricula or the real patient safety issues that emerge with some standard obstetric practices that are not evidence based. The case examples are very interesting though. How does an obstetrician who fought with a nurse about the appropriate course of action in the hearing of the laboring woman, discuss the adverse outcome with the new mother afterwards? I think I snagged the last used copy at a reasonable price off Amazon but perhaps your local library can get you a copy; it’s worth a read.

The next book I read followed as a perfect complement: the story of an obstetrician and her journey through self-discovery and healing after she is sued in the course of her work. Delivering Doctor Amelia The Story of a Gifted Young Obstetrician's Error and the Psychologist Who Helped Her (Vintage 2004, and many cheap used copies online). Dr. Amelia Sorvino is a well liked obstetrician who has been in practice a few years when, in order to respect her patient’s desires for a vaginal birth, delays a cesarean section. Subsequently, her patient’s baby is diagnosed with cerebral palsy; she loses her nerve, stops practicing and faces a lawsuit. The narrative structure centers around the therapy sessions with the author Dan Shapiro and Dr. Amelia, and the story is told through the psychologists’ lens. So many issues emerge that struck me as very illuminating in terms of how current medical training gets in the way of self-knowledge and personal growth of these young, hard working men/women. It fails to help them see the larger structures of politics/law/medicine, etc., affect their work (ok, the sociology of it all...). It’s a gripping read. I feel like we are missing the sense that doctors, yes, even obstetricians, are people, not perfect clinicians all the time, and our health care (and liability) systems are not set up to allow authentic engagement on a number of levels.

There is also a good novel about a Seattle anesthesiologist who gets sued, and her experience: Oxygen, A Novel by Carol Cassella, if you can bear to expand your reading beyond birth topics!.

The issue of ‘trauma’ among obstetric clinicians regarding their experience and fear of lawsuits is an interesting counterpoint to the ‘trauma’ experienced by birthing women — see this nice piece by an Australian journalist, Hard Labour, which really captured some of these issues.

I’m starting now to read Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out (Hudson Street Press, 2010) by Peter Pronovost and Eric Vohr, a book about patient safety initiatives that were started at Johns Hopkins after poor communication, inflexible hierarchy, lack of appreciation for team perspectives and medical egos resulted in the preventable death of 18 month old Josie King. Not about maternal quality care or obstetric patient safety per se, but I see plenty of parallels in terms of the practices engaged in maternity care systems that put everyone at risk. Probably the only reason more pregnant women aren’t harmed by some of these practices is that they, unlike most hospital patients, are relatively healthy to begin with. The big insight for Pronovost is that hospitals, and the units within them, have their own culture, and this affects how patients are cared for. This isn’t news to medical sociologists and anthropologists (or doulas), but physicians are discovering it for themselves. It’s also a clear ‘news’ item in the quality improvement literature.... interesting.

Next on my list, where it’s been for some time, is medical anthropologist Elisa J Sobo’s excellent foray into this literature, Culture and Meaning in Health Services Research (Left Coast Press, 2009). All this to gear me up for thinking about the book in my brain after years of research on maternity care advocates – the doulas, childbirth educators, midwives, and now at CMQCC, obstetric and neonatal clinicians who want to make birth better for women and their babies.

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Guest Post #2: Judgment, Fear, and Focus

Laureen is the technical editor and online community advocate for java.sun.com and developers.sun.com at Sun Microsystems, a freelance editor for Hunt Press, and a contributor to several peer-reviewed group blogs. She's a blogger, a podcaster, a website manager, and an enthusiastic geek enabler. She's the mother of two gorgeous children, and the wife of a man who understands her birth passion. She's had one iatrogenic unnecesarean, and one triumphant HBAC.

Judgment, Fear, and Focus

For only having two children, I have pretty much the range of birth experience; my first was a planned birth center birth turned hospital transfer with epidural turned cesarean. So there's the complete spectrum of medicalized birth. (At the time I was planning it, I thought my birth center birth was non-medicalized. I learned the hard way about medical midwifery.) My cesarean was brilliant, as these things go. The doctor was near retirement, had a 40% cesarean rate in his private practice, and knew what he was doing. I was too ignorant to even ask for things, but upon examination of my medical records, I got a Cadillac of a cesarean. Sheer dumb luck, that was. But despite that, due to hospital protocols, my baby spent the first four hours of his life with strangers; four hours we'll never get back.

For my second birth, I had an unassisted pregnancy, followed by a home birth with a midwife.

The move from home to hospital for birth in our culture involved a paradigm shift, whereby medical professionals convinced women that they were incompetent to birth without assistance, despite millennia of successful field testing to the contrary. The move to reclaim women's power by bringing birth back under their control is involving another paradigm shift, and that's going to be uncomfortable, and it's going to upset people. I think it matters that I know all kinds of women who've gone from hospital births to home births, but only two who've gone the other way, even if the home birthers ended up transferring ultimately. Because of my own experience, I am strongly biased towards home birth, and I admit that up front. On the other hand, because of the experiences of women I know personally, I would rather gnaw off my own arm than deny women the right to choose to birth in a hospital.

One of the things that really bothers me about the comment-foo on Rixa's blog is the complete abandonment of logic. Instead of classical logic, symbolic logic, the construction of actual arguments based on fact, we saw logical fallacies. Use of fallacy in argument invalidates the whole thing, in addition to bringing the entire discussion down to blows in short order. This does nothing to contribute to the betterment of women and babies; it sets us against each other for no purpose whatsoever. The thing about a good, solid, well-constructed argument is that invariably, both sides of the issue learn something and see further into their opponent's mindset. Everyone is bettered, perspective is gained, and we're that much closer to being a unified force...unified behind the true betterment of the situation here for mothers and babies.

I'd like to address a few of the real arguments brought up in the course of the commentary on Rixa's post...

Always be suspicious of motive when someone tries to make you do something that makes a lot of money for them

Maternity "care" is critical to the profitability of a hospital, and the more this can be managed, the more profit a hospital makes. The cesarean rate in the US is at levels so high (31.1% in 2006) that the World Health Organization considers it to be a "crisis." Scheduled cesareans are the epitome of optimally profitable managed birth. UnitedHealthcare sends maternity patients a brochure in late second trimester, offering them the option of a scheduled 39-week cesarean.

My cesarean, NICU stay, and hospital stay netted the hospital nearly $27,000, the anesthesiologists nearly $11,000, and a heap of other people other monies, and cost my insurance company a bundle.

My home birth cost my insurance company $3,000. Period.

So who stands to make money off my choice of birth? Hmm...

"You should be grateful you have a healthy baby/All that matters is a healthy baby"

Well, yeah, of course. But that's so not the whole story. Read Gretchen Humphries' brilliant essay "You Should Be Grateful."

There is room in this world for good experiences for both.

"Birth is about the baby, not the mother"

This letter, published in the ICAN eNews a little while back, says it all.

I am a lawyer who went to a top ten law school and then to a top tier firm. I used to be very mainstream in my views. I thought women who chose to give birth at home were reckless. When I got pregnant and was given the option of having a c-section, I readily agreed. I never went into labor and my c-section went flawlessly. I researched it, so I expected that my arms would be tied down, that I would likely shake from the anesthesia, and that I would not be able to hold my baby. That was ok, because I was ready for it. I handled the drugs well and, as a result, actually remember the first 24 hours. My recovery was uncomplicated.

My daughter, however, got the worst of it--which isn't even really that bad considering other stories I've heard. She was so sleepy and zoned out from the drugs that we had to put ice on her bare skin to wake her up enough to feed. She developed jaundice as a result of not eating enough. Because she couldn't feed properly (because she was so drugged), my milk never came in properly--which was a problem since it turned out she was allergic to all of the formulas they had. Given her allergies, breast milk would have really helped. She kept losing weight. She was diagnosed with failure to thrive. It was a very scary time, because we thought she might die.

On a long term basis, because she never came through the birth canal, her gut didn't get colonized with the right bacteria. That translates into the gut and immune system dysfunction she has today and the medicine that we give our 3.5 year old 5 to 6 times a day. She is also on a severely restricted diet--no wheat/gluten, dairy/casein, soy, citrus, etc. Bacteriologists say that the first germs that the baby is exposed to will set the tone for the baby's life. Those germs really need to come from the vagina.

The c-section went well for me, personally. I was very, very lucky as you will see from other stories you read. It did NOT go well for my daughter. I am now pregnant with a second child and plan to do all I can to deliver vaginally. A c-section still seems like an easy choice sometimes. Indeed, if I were giving birth to a tumor, not a baby, I might be inclined to do it, in spite of the crazy risks. But I will not put this baby at risk.

I'm a litigator and I love evidence. Crazily enough, the evidence is strongly in favor of vaginal birth. I believe that the cavalier attitude of OBs toward this major surgery is a result of a combination of factors (preference for control, fear of malpractice, higher payment, surgery is more "fun," lack of education on natural birth as opposed to how to manage an impending crisis, etc.). But carefully look at the evidence first, before you make up your mind. The evidence really does speak for itself and I'll let someone else who is better versed in the evidence point you in the right direction.

And with cesarean delivery, the baby itself is more likely to die. The US has the second worst newborn death rate in the developed world, despite the fact that we spend more money on "medical care."

How is it that we forgot that babies and mothers are a dyad? You can't truly separate the well-being of the mother from the well-being of the baby, not even with a scalpel. Go ahead; tell me that a mother who lives and a baby who dies, or a baby who lives and a mother who dies, deserve to be a separate statistic. I don't know a mother or a child in either circumstance who doesn't have a little bit of them die too, even if the statistics don't neatly account for it.

"But women used to die in childbirth!"

Read the news; they're dying now. Ask the families of Tatia Oden French, Valerie Scythes, Melissa Farah, Caroline Wiren, how they feel about the safety of hospital birth. Ask Claudia Mejia. Ask Amber Marlowe. Ask Dennis Quaid how safe hospitals are for babies.

Disaster can strike anywhere. But the idea that hospitals are inherently safe is not valid, and demonstrably so. There is no choice you can make that's an automatic get-out-of-jail-free card. The reason most women default to hospital birth is because that choice is presented as being blameless. If something happens in the hospital, well, that's just bad luck, but if it happens at home, that's bad decision making, with the mother occupying the role of bad guy, all by herself. This is not fact, this is not logic; this is marketing spin.

On Judgment

I have been told that my cesarean was a personal failure. I have been told that having a midwife present for my second birth was a personal failure. I have seen fully-medicalized birthers rip midwifery advocates apart, both live and online. I have seen women spend an ungodly amount of energy and time shredding at each other.

For what? I deeply believe that women who choose hospital birth do so because they want the safest and best for their babies. I deeply believe the same thing of the home birth set. So why are we still attacking each other?

Fear. And Judgment.

In the final analysis, birthing carries risk. Living carries risk. There are no guarantees anywhere that if you make all the "right" choices, you and yours will be saved from tragedy. Lightning strikes, and all the planning and research and analysis in the world will not save you from that. It comes down, in the end, to supporting each other the best we possibly can, to making our choices from a place of confidence, not a place of fear. If you're birthing in a hospital, do so because that's what feels safest to you. If you're birthing unassisted at home, do so because it speaks to you and feels right to you. Fear has no place in any decision about birthing.

A friend of mine who just had what she calls her "victorious homebirth after two cesareans" says:

Since our life-changing home birth I've encountered so much more support than we imagined possible. I cannot believe how many friends and acquaintances have said, "I sure wish WE had seriously considered birthing our children at home." Obviously there is a slow shift being made in the birthing climate of America. But there are also many other comments we've heard like, "I'm glad it worked out for you," which I now see as such a pitiful way to view birth--like it's a matter of luck. But I know that's the reality for most people. If these critics knew the amount of time, prayer, and research we put into this decision and into the type of provider we selected, they might have to consider why EVERYONE doesn't invest that kind of time and prayer in their own birthing decisions. For us, the search was priceless and ultimately put us in far better control of our decisions. And beyond the stats and truths we uncovered during this journey, we discovered something far more valuable: faith. After asking for guidance, begging for deliverance, and recognizing our answer, I was overcome with a peace that I have to say I've never experienced after praying before--and as the preacher's daughter I've spent a good many years on my knees in prayer. It was amazing to simply ask and to find the undeniable peace we so desperately desired. So THIS is what answered prayer feels like. I understand that's not much of a factor in modern society, which makes me incredibly sad.

We've also had to endure a number of horrible birth stories where someone nearly died "even in a hospital birth" (the fetal and maternal monitors didn't discover there was a problem until it was too late). I'm never sure how to take this kind of response to the introduction of our new baby. If these tactics are in an effort to get me to debate the home vs. hospital issue, I'm not taking the bait. My decision isn't up for debate--especially with those who've invested little in the search for truth other than personal experience and hearsay. I can respect your birthing decision if you can respect mine.

Standing together, we can do so much more good for everyone, than we can by compartmentalizing each other and shredding on anyone who doesn't share our precise set of birth circumstances. Different does not have to equal wrong. But the way things are right now, fear is controlling the cards, and we need to put down our differences, and stand together for a set of choices in birth and baby care that puts the U.S. back up at least in the top 10, because when it all comes down...the choice between home and hospital is not the point. The point is that women and babies are dying in utterly unacceptable numbers, and they're dying because our social, medical, and economic systems are not supporting women.

And women are not supporting women either. So let's focus on what matters.

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Guest Post #1

This first guest post comes from Sheridan Ripley, a proud VBAC mom of 3 busy boys, Loving Lactivist, Positive Birth Story Collector, Hypnobabies Instructor and Hypno-doula. She has several websites and blogs: Orange County Hypnobabies, Positive Birth Stories, and a Birth Blog.

I invited Sheridan to write a guest post because of some of the comments about LDS birth choices. At least one commenter asserted that TopHat and I were fanatical homebirthers and that we were not practicing what we preach when we chose unassisted births. I assert that, by following spiritual guidance and seeking Priesthood blessings for our pregnancies and births, we were definitely practicing what we preach. Sheridan's birth stories--as different as they are from my own--show how she also followed spiritual promptings.


Each birth is different and unique. Our views of birth change over time and with our experiences. Birth is unpredictable and that is part of its beauty. I have had 3 very different birth experiences. Each taught me something important and each changed me as a women and a mother. I learned that my intuition (or the promptings of the Holy Ghost) is one of my most powerful tools as a mother. This has proven to be true not just during my pregnancy and births, but also as I continue to raise my boys. The first part of my post focuses on my pregnancies and births.

My Births

Devon: I was hoping for a NCB (natural childbirth) with my first baby. I took a Bradley class and things were moving along nicely when suddenly I ended up on bedrest at 25 weeks for pre-term labor (PTL). I wasn’t able to finish my classes, but was still hoping to have a NCB. I ended up changing care providers at 27 weeks because I felt my OB was not listening to me and my concerns. I was in and out of the hospital 7 or 8 times. One day while driving, Rob and I started talking about why I this was happening, and we both felt there was a BIGGER reason than just the PTL. We might never know why, but it was important I was experiencing this. That brought me a lot of comfort, as it was pretty mind-numbing being on bedrest.

I woke up one morning at 34 weeks and noticed the baby wasn’t moving. I knew the importance of being aware of your baby’s movements from a TV show I had watched years ago. (I think this is the reason I was on bedrest; I doubt I would have noticed so fast the decrease in movement if I hadn’t been on bedrest.) I drank some juice and still nothing. I suddenly KNEW in my heart something was wrong with the baby. I really thought I had lost him. I called the OB who had me drink more juice and told me to call back an hour later.

I “obeyed” and after about 30 minutes with still no movement, I woke my husband up (he is a late sleeper) and was crying and told him something was wrong and we were going to the hospital no matter what they said when we called back. We got ready to go, called and they set up an appointment at 1:30 pm for a NST (non-stress test). I still wish I had truly followed my intuition and just gone in right then, but we waited.

My husband gave me a blessing to help calm me down. In it he blessed that Devon would be ok and that he would come when he was ready. As soon as he said he would be ok, I felt a large weight come off of my shoulders. I KNEW that the baby was going to be ok. The blessing brought me a lot of comfort.

We got to the NST place early but had to wait until they got back from lunch. They got me on the monitors; there was his heartbeat, and I thought everything was fine. They used a little noisy vibrator on my belly to try and wake him up. Devon kept on sleeping, but it made me have contractions, which made his heart rate drop. (I didn’t understand the significance of that at the time.) A new nurse came in and said we would be having our baby that day. I thought she was in the wrong room. Quickly it became apparent that there was a problem and it was safer for the baby to be out NOW.

We headed across the street to the hospital. Rob wanted to know if I wanted another blessing. I said I didn’t need one; the first one said he would come when he was ready, so I trusted that he was ready. My NCB dream was shattered. I was thrust into this emergency cesarean situation. I am grateful I was able to have a spinal so I was awake when Devon was born. He was 4 pounds 3 ounces. It was a very surreal and scary situation. I had been lying in bed for 9 weeks so the baby wouldn’t come early, and now I was having a surgery to get him out early.

I got to see him for a few minutes, and then Rob went to the NICU with him. I was left alone in the recovery room in a lot of pain and feeling so empty. It was not the birth I had hoped for, but the farthest thing from it. It took years to really get over it. But I knew it was a life-saving operation for Devon, so I was never angry. I always say that day was the scariest and happiest day of my life.

It is amazing what a mother will do for her child. If I said to you, “will you lie in bed for 9 weeks and then have a major surgery to help somebody you have never met?” odds are you would think I was crazy. But if it was for your baby of course you would.

So from this birth I learned that birth is unpredictable; we can plan for one thing and get something totally different. That there are moments in time that will be seared in our memory. That scary things can be happy things. That with sadness there can be joy. The most important thing I learned is that our intuition can save lives and we must listen to it and follow as we are led.

Carson: I had a lot of baggage from the first pregnancy and birth. I was scared, but I didn’t want fear to motivate me in my choices. My husband had seen a Dateline show on hypnosis and birth and suggested I look into it. I found a HypnoBirthing class an hour away and we took the class. I found it very healing, I was able to let go of my fears about carrying full term and about my ability to have a vaginal birth. I moved forward in this pregnancy with faith in my body. I think that had I not had these tools, I would have remained very fearful of pregnancy and birth, and that would have in turn affected my pregnancy and birth.

I was of course highly aware of Carson’s movements. I chose to have biweekly NSTs from 34 weeks on; they gave me a level of comfort that I needed. My goals for this birth were to go full term, to have a vaginal birth, and to double Devon’s birth weight, so I was shooting for an 8 pound 6 ounce baby. While I knew birth could be unpredictable and of course if an emergency arose I would do whatever needed to be done for my baby, I still wanted to focus on what I WANTED—my ideal birth.

I was pregnant for 42 weeks with Carson, 8 weeks longer than I had been with Devon. After Devon I had said, “I will never complain about getting big or going over.” Well, I had a lot of chances to prove it that was possible. I did get HUGE. I might have complained a bit, but overall I was content. I was hoping to go un-medicated for this birth. But after 14 hours of comfortable labor I lost focus and was having back labor, so at 17 hours I chose to get an epidural. This was the right choice for me at the time and I never regretted getting it.

After 21 hours of birthing time with almost 3 hours of pushing, my 9 pound 4 ounce baby boy was born vaginally. I felt exhausted but thrilled. I had done it! Carson was in my arms and I was so proud. It was a healing birth in so many ways.

Bryson’s pregnancy: I wanted to use hypnosis again, because I knew it could work, but I wanted more tools, so I found Hypnobabies. My main goal for this birth was an un-medicated vaginal birth. I knew I could do it.

At my 33 week appointment I said I wanted to get my NST scheduled. My OB said I didn’t need it; all was well. I wasn’t sure why, but I really insisted I get it scheduled. My intuition said I needed that. I pointed out a weird rash on my leg and my stomach was itchy. She brushed it off and said to go to my primary care physician. This led into the most challenging section of any of my pregnancies. Yes, it was even harder than bedrest!

I had PUPPS, a pregnancy-related rash, which care providers don’t seem informed about or really care about because there is “no medical effect” on mom or baby. Well, let me tell you it rocked my world and stressed me out to no end, and that surely had an effect on my baby. It took prayers, blessings and that NST to help me survive.

Labor Day weekend was coming up and that Friday I went to my first NST. I almost didn’t go because putting clothes on was painful. I knew the baby was ok, so I was tempted not to go. I really felt I should (intuition again). I got there and the nurses saw my belly, which by now was a red inflamed horrific sight. They quickly got the high risk OB, who diagnosed me with one of the worse case of PUPPS he had ever seen. I was thrilled that someone was finally listening to me and caring. He gave some prescriptions.

Now, I typically do not take even a Tylenol when pregnant. Each situation is different and I have learned not to judge others, because, let me tell you, I ran to the pharmacy and slathered that cream on my belly and popped a pill in my mouth. I was at the point where I would have signed up for a repeat cesarean at 37 weeks to make this rash end. Though I have since learned that birth does not always end PUPPS, I have also since learned of more natural remedies that can help PUPPS moms, including acupuncture, which I would certainly try first if I had it again. This is a great example of how limited information affects your choices. The medical establishment has one answer and that is drugs or intervention. When a woman is fearful or uncomfortable she makes that choice, because it seems to be the only one.

That night I had another blessing and continued with my prayers. The medicine helped, I still had PUPPS the rest of my pregnancy. I slept with socks on my hands, so I wouldn’t scratch myself to bleeding while sleeping. I was naked (well, loose PJs, no underwear) for the majority of the days, dressing only when I had to leave the house. But I was able to handle that compared to what it had been. I carried Bryson to 41.5 weeks. I only wish I had taken pictures. I still have scars on my legs. I can only imagine had I not gone to that NST I would have ended up in the ER over Labor Day weekend for a mental breakdown of some sort.

Bryson’s birth itself was the most amazing experience of my life. (You can read the complete story here or see the video here.) I had my husband, a doula, a good hospital with a supportive nurse, and my Hypnobabies tools. I had a completely unmedicated COMFORTABLE birth.

I woke up at 1 in the morning with pressure waves that would shock me out of sleep. I popped in a Hypnobabies CD and was able to “sleep” as long as a CD was on. It kept me aware enough that I could stay relaxed if a pressure wave came and I could stay comfortable. This allowed me to stay well rested. In the morning I just wanted to be left alone, so we got the boys off to school or with friends. I hung out, puttering around, wondering if this was really the day. (I had had days of prodromal labor.)

By 10:30 am I decided this was it. I was settled into my hospital room with my husband and doula by my side by 1 pm. I was comfortable and walking the halls, chatting between pressure waves. At 4:30 pm I choose to have my water broken, as I was still 5cm with a bulging bag of waters (which I had been at noon). Things quickly progressed and I was ready to start pushing around 6:45 pm.

I really loved pushing. I felt like a lion roaring my baby out. It was so powerful and amazing. I was still comfortable. The OB said, “You are going to feel the ring of fire now.” I remember thinking, “I haven’t felt any pain yet; no need to now.” And I bounced her comment right off my bubble of peace. (Hypnobabies tool.) I felt only pressure through the whole birth.

Bryson was in my arms at 6:59 pm, and he didn’t leave them for almost 2 hours. Here is what I wrote about it that night…

That was amazing, beautiful, a miracle. Everything I wanted and more. I feel so empowered that I gave birth, completely un-medicated to a healthy 9 pound baby boy. He came straight from inside me—onto my chest, where he stayed undisturbed for over an hour. The first 20 minutes or so his eyes stayed closed and he just hung out snuggled to my chest. Then he started rooting around. Someone helped me get him latched on—it is funny you forget how to do these things, he has a STRONG suck—he went to town—then slowly he started opening his eyes—looking around at the world—at me, his mom. It was honestly almost surprising to see a BABY laying on me. I actually have another baby of my own. I am so blessed. He looks like his own little person.

Bryson’s birth showed me the power of my mind and the power of my body. It was such an empowering experience. It has changed the way I think about myself and birth. I wish every mom could experience a birth like that.

My thoughts about birth as a spiritual event

Birth is a spiritual event in our lives. (At least it can be.) Pregnancy and Birth are an amazing time where a spirit is making this step of his journey into this mortal world. I know that the Holy Ghost can guide us as we plan our families, comfort us as we deal with losses, warn us if something is wrong, reassure us if all is well.

I think that it is a gift that not enough people use or trust. It can be a HUGE help as we plan our births, it can let us make the best choices for OUR family and THIS birth, even if it is different than what we planned or what we had chosen for our other births. We need to do our research, we need to make our choices, but the spirit can confirm if it is a good choice for us. It isn’t for me to judge what the best choice for others is. I am happy to share information and encouragement, but I will support them in what they chose is best for them. I can’t know what is best for their family, it isn’t my birth, it is their birth!

Birth is a learning event in our lives. (At least it can be) It has taken me 3 births and reading a lot of books to get to the point where I would feel comfortable having a homebirth. This comfort level also has a lot to do with what I have seen as a doula. Watching a birth as an observer rather than the birthing mom is very eye opening. It really shows how a mom in a hospital is just on a conveyor belt of institutionalized care, getting one size fits all care. It is sad and scary to me to see all that goes on in hospitals and how a lot of the routine interventions they do actually cause problems.

I also know that if I were planning a homebirth, but felt the need to switch to a hospital birth, I would follow that impression. I would trust that Heavenly Father would guide me in my next pregnancy and birth as He has guided me through my first three. I would trust that if I listen and respond to the impressions I receive, all would end like it was meant to.

It is important to respect others’ birth choices. The more I learn and have experiences the more I realize it is such an individual thing and all I can do is offer information and support. Three years ago if a friend told me she was planning an unassisted birth, I would have thought something along the lines of "that is crazy." I hope I would have been kind enough to say, "that is your choice and I wish you well." But today I can understand it and respect it. I would probably ask some questions and see what her motivation is. If she isn’t aware of supportive care providers, I would give her some names. Then I would support her in her choice. Since I have had fantasies of having an unplanned unassisted birth in my kitchen…I would probably share that with her. :)

Unassisted birth wouldn’t be my first choice for a future birth. But I know that if I were in a location where I couldn’t find a care provider to support me in a VBAC, I would choose an unassisted birth over a repeat cesarean. It would take a lot of prayer and blessings to be comfortable with that, but I personally couldn’t choose to have an elective cesarean if it was not medically necessary.

In the past I have had the same gut reaction of "that is crazy" to moms telling me they were planning cesareans. But today I ask questions and share information and then support them in their choices. It is such a hot topic and very emotionally charged. I have a whole series of posts on moms choosing cesareans on my blog.

So, this has been a very long post about birth choices and how each and every birth is different. We can learn from our own and from others’ choices. The most important part is that we can receive guidance from our intuition throughout our pregnancy and birth. If we trust birth, trust ourselves and make the best choices we can, the journey will be an empowering one.

Sheridan recommended a few birth stories that show the power of a mother's intuition:

Here is a GREAT birth story about a mom who was planning a home birth and early in her birthing time she knew she needed to go to the hospital.

Another great story, planned homebirth, but mom doesn’t feel right about it when things start, so she goes to the hospital. Turns out baby is breech, but she has a vaginal breech birth, with a doctor who keeps his cool and supports mom in her choice.

FAST planned homebirth story, midwife didn’t have time to get there. There is a scary moment of baby getting stuck, BUT mom listened to her intuition and it ended great.

Read more ...

It's time for a lecture

The comments in the last post degenerated into one of the ugliest mud-slinging, epithet-hurling, and name-calling episodes I have ever seen on this blog. Even after I requested--not once but twice--to refrain from personal attacks and to keep the comments civil, rude and insulting comments kept coming.

And the logical fallacies. Oh, the logical fallacies... I saw character attacks, slippery slope arguments, emotional appeals, false dilemmas, begging the question, hasty generalizations, non sequiturs, red herrings, and straw man arguments.

If you don't know what these logical fallacies are, you had better refresh the skills you (should have) learned in freshman rhetoric or composition.

If you do know what they are, and used them anyway, shame on you!

As punishment, you are going to have to read several guest posts addressing some of the issues raised in the comments section. And you will be hearing from me, of course. And boy do I have some good things to say!

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