What if something goes right?

I love reading birth stories where everything goes right. Where mothers plan and prepare and get what they want. Where their wishes are respected and they feel elated at what they accomplished. Where things work out perfectly in the end, even if labor throws them a curveball or some initial plans have to be abandoned.

Here are a few such stories I'd like to share:

First off, my youngest sister whose son was born two days before Inga. She had care with a hospital-based midwifery practice and also hired a doula. She hoped for a spontaneous, unmedicated vaginal birth--and that's what she got! Read all about it here at Grayden's birth story. Way to go little sis!

baby Grayden, from low-maintenance.blogspot.com

Next is the story of Busca's fourth child and second home birth. Busca blogs at Birth Faith. This was her longest pregnancy, going to 41.1 weeks. Her other three children were all 5-10 days early. She also had a much different labor pattern this time, hardly feeling any pain or intensity until the last few minutes. Read her story of Surrender in four parts: part 1, part 2, part 3, and part 4.

Busca with her newborn baby, from birthfaith.org

And you've probably heard that Gina, aka The Feminist Breeder, just had her third baby! It was her second VBAC and first home birth. Gina also had a different labor pattern than her first two. After lots of prodromal labor, Gina finally got labor to kick in using a combination of sex, breast pumping, and AROM. She even took a nap at around 9 cm dilated (and still wasn't feeling much pain at that point). Gina, you rock! Read the story of Jolene's birth here. She also had a friend who live-blogged the birth, where you can watch video clips of labor and pushing.

Gina & Jolene, from TheFeministBreeder.com

And finally, Desiree of Hitting My Stride had her baby Sofia! We started corresponding during our pregnancies and have become friends along the way (and she's letting me stay with her during the Lamaze conference this September!). She has two serious clotting factors, which meant heparin injections twice a day throughout her pregnancy. It also meant induction if she didn't go into labor by 38-39 weeks. She was induced at 39.2 weeks with a very favorable Bishop score and had a fantastic birth. Her birth story comes in four parts--Suck Ball City, Labor Faces, The Mirror, and After Birth.

All I can say is: a Pitocin induction with no pain meds? Amazing! She also sent me her birth video, and I was amazed at how non-medical it felt. The atmosphere in the room was calm and quiet. No shouting or coaching or anything, just her pushing and vocalizing when the urge hit.

Desiree, Drew, & Sofia from desireesdaydreams.com

A big congratulations all around. And here's hoping for many more birth stories where everything goes right.

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Elective induction, patient choice, and physician preference

The CNM I am seeing recently wrote about how both patient choice and physician preference play into elective inductions. While she was doing her CNM clinicals a few years ago, she worked at a small community hospital that had two obstetricians (now there are four). At the time, it was common practice to do elective inductions at 37 or 38 weeks.

While working at Witham Hospital, I became well aware of how good physicians can obtain bad reputations from the natural birth community simply based on their induction rate. At the time, Dr. Winkler and Dr. McCarty were the two obstetrical providers in the practice and both held stern ground in not inducing labor without a genuine medical indication prior to 39 weeks. However, once reaching 39 weeks, most all moms were lining up for their induction, leading to a fairly high induction rate by World Health Organization standards.

It is quite common in obstetrical units for nurses to triage phone calls of clients sharing concerns that are nothing more than normal discomforts of pregnancy, yet they aren't seeking reassurance that their pregnancy is healthy and normal, but instead the perfect complaint that will justify an early end to their miserable pregnancy.

I distinctly remember being told by a pregnant mother that if the on-call physician did not induce her labor (at 37 weeks), then she would be happy to take her business elsewhere. The truth was she could go to any other local hospital and her wish would be granted. These two doctors declined her request and risked losing her as a client. They refused to put her baby and herself at risk, for the sake of her own convenience.

Not one of these physician's peers would fault them for inducing women earlier. They all did it in their own practice. Women want early inductions, and we're all about women's rights. However, they would have failed to withhold the oath, "do no harm." These physicians stood firm in the face of persecution and I was quite impressed.

Around the same time, one of the physicians discontinued his routine practice of artificially rupturing the amniotic sac in elective inductions. This would otherwise commit the client to birth, or more specifically, cesarean section because too often mom or baby simply wasn't ready. If the attempt to induce failed, this physician was comfortable telling mom after a day or two's effort to induce, "Sorry, we need to discharge you home as your induction was not successful. We can reschedule you in a few days." The nurses gave this physician a round of applause and many of us began to choose him as our own provider.

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Tips for a successful induction

A reader emailed me yesterday with questions about how to increase her chances of a successful induction. I thought this would be a good opportunity for a discussion. Let's look at her situation in particular, and inductions in general, and share ways to make them more likely to succeed--i.e., to end in a spontaneous vaginal birth.*

My reader has a few extenuating circumstances: a previous cesarean section (followed by a VBAC), which means prostaglandins are out of the question. She also has a history of malpositioned babies, so she wants to keep her bag of waters intact.

I am wondering if you have information on how to minimize intervention during an induction and tips on how to have a successful induction.

I am 42 weeks 2 days today and my OB is letting me prolong the induction for 2 more days, so I'll be 42 and 4 days. My first child was an induction at 41 weeks with the OB rupturing membranes and then Pitocin. It ended in a C- section for fetal distress. My second child was a VBAC with a spontaneous labor at 42 weeks 2 days.

Mentally I feel that 42 and 4 is as long a I can go, but I am so anxious about an induction. My OB said he could rupture my membranes and see if labor starts, but I have had poorly presented babies in the past (both posterior) and I think this third one is following suit. So I do not want my membranes ruptured; I want them kept intact as long as possible. I will be induced with Pitocin because my OB feels the cervical gel has too great of a uterine rupture risk. So my question is: what can I do to promote a successful, safe, vaginal birth with a Pitocin induction? 

I already emailed her back with some ideas. I'd like to hear from you now!

*Meaning a birth without cesarean section, forceps or vacuum extraction

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Lamaze/ICEA Conference part 3

I woke up Sunday morning feeling so much better. I took Dio to breakfast with me and brought him back before the first breakout session. 

Mary Lou Moore, PhD, nurse, and faculty member at Wake Forest School of Medicine, spoke about The Perinatal Care System in the 21st Century: Induction, Cesarean Birth and Late Preterm Birth, sponsored by the March of Dimes. Her presentation covered recent research showing that elective deliveries (induction and cesarean) should not be performed before 39 weeks. In addition, it's advisable not to induce at that point unless the Bishop score is 8+ for primips and 6+ for multips.

These "early term" births at 37 & 38 weeks have increased rates of complications for baby and mother. (We're not talking about mothers who go into labor spontaneously at these weeks.) It's not just an issue of fetal lung maturity, but a wide range of other physiological changes the term baby undergoes before labor beings. We only understand a small number of these complex mechanisms. We know, for example, that a baby's brain grows rapidly between 34-40 weeks; the frontal lobes are especially vulnerable to elective deliveries as they are the last to fully develop.

She then outlined several hospitals around the country that have implemented these new guidelines for elective deliveries:

• Starting in 2004, Magee Women's Hospital in Pittsburgh implemented a policy of no elective deliveries before 39 weeks. Between 2004-2007, their rate of elective induction (EI) went down 30% and the overall induction rate fell 33%. The cesarean rate for primips dropped 60% over those years from 34.5% to 13.8%.
• The Perinatal Quality Collaborative of North Carolina (PQCNC, pronounced "picnic") decided to stop elective deliveries before 39 weeks in 38 hospitals across the state. This led to a 12% reduction in elective deliveries, a fall in newborn complications and NICU admissions. 
• The Ohio Perinatal Quality Collaborative (OPQC) has had similar outcomes.

For more information and resources on reducing early term elective deliveries, visit The March of Dimes' toolkit on reducing elective deliveries before 39 weeks. What I found most remarkable about Dr. Moore's presentation was how rapidly changes have occurred in some places. The Joint Commission backs these new guidelines for elective deliveries as part of their Perinatal Care Core Measures, giving hospitals increased motivation to implement them.

Zari joined me for the final keynote speaker: Linda Smith, author of Impact of Birthing Practices on Breastfeeding. I missed about the first third of the presentation because Suzanne Arms pulled me aside and said, "I hear I need to meet you!" (How cool is that??!) We talked about what we're both working on and her future plans in trying to gather people from all walks of life and all parts of the world to envision a new global strategy for improving all things related to birth and breastfeeding.

Back to Linda Smith's presentation...I entered right before she showed an excerpt from a fantastic new breastfeeding DVD Skin to Skin in the First Hour After Birth: Practical Advice for Staff after Vaginal and Cesarean Birth. Here's an excerpt for you to watch:

I really hope I can obtain a copy of this DVD to review. It was produced for health care providers and teaches immediate, uninterrupted skin-to-skin for both vaginal and cesarean births. It also shows nine stages that newborns go through in the first hour after birth when they are placed skin-to-skin immediately after the birth. Really amazing stuff!

Linda emphasized that 30+ years of birth advocacy have done little to change childbearing practices. However, using the breastfeeding angle to change birth practices has been remarkably successful. In fact, the new Baby-Friendly curriculum includes a Mother-Friendly module as part of step 3: "Inform all pregnant women about the benefits and management of breastfeeding." I wasn't able to write down the details, since I was keeping Zari occupied, but you can email Linda if you'd like more information about this. She urged us to keep an eye out for the Surgeon General's breastfeeding statement that will be coming out in the next few months. There's a lot of support behind breastfeeding--witness Michelle Obama's many supportive statements about breastfeeding--especially because it is associated with lower obesity rates. In sum, if you want to change birthing practices, use the breastfeeding angle. There's a lot of money, government support,  momentum behind breastfeeding, so run with that to improve health care for both mothers and babies!

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Lamaze/ICEA Conference part 2

Saturday did not start well for me. I slept maybe 2 hours the night before, due to a combination of congestion and two little children who decided to wake up and either cry (Zari) or party (Dio) most of the night. I wondered how I would make it through the day...

But I didn't have much choice. My presentation--based on my article Attitudes Towards Home Birth in the US (PDF)--was in the morning. I arrived early and ran through my presentation to make sure I wouldn't go over time. I used prezi rather than PowerPoint, as I think it's a much more dynamic and visually interesting platform.

Safe or Selfish? Attitudes about home birth in the US on Prezi

I had a fun time giving the presentation. We had lots of discussion and comments both during and after my talk. Even though I was dead tired, I didn't feel it while I was speaking. We had to cut the discussion short to make it to the big celebratory luncheon. I sat with April, a lovely CPM from Dayton, Ohio, who works closely with Dr. Guy of Miami Valley Hospital in Dayton and Dr. Can't-Remember-His-Name in Cincinnati. These OBs are known for supporting women who want VBACs, vaginal breech births, vaginal twins & triplets, etc. She and I talked about her training (master's level degree from the Midwives College of Utah) and her reservations about the loopholes in the CPM certification process.

Later in the day, I found out that Geradine Simkins, president of MANA, and Dr. Raymond De Vries were both in my audience! I had never met them face-to-face before and so didn't know who they were at the time. I talked with Geradine afterwards for a while. She urged me to consider doing research with the home birth statistics MANA has been compiling over the past decade or so. She was especially curious about my suggestion that NARM upgrade the CPM certification into a 4-year university degree. We weren't able to talk much because of our busy schedules, so I'll have to continue our conversation via email or phone.

I did double duty in the afternoon breakout sessions. First, I listened to Christine Morton's presentation about the historical evolution of doulas and how the profession is intimately connected with the development of childbirth education. Really fascinating! I've "known" Christine online for a while--she's a sociologist at Stanford University and doula--but never saw her in person before the conference. I never had time to talk with her face-to-face, unfortunately. But here's a virtual wave hi, if you're reading!

I then ran to another session about MoreOB, an evidence-based program being adopted throughout Canada. The presenters were an obstetrician, Dr. Karen Bailey, and two nurses/childbirth educators, Liz DeMaere and Sharon Dalrymple. With MoreOB, what childbirth educators teach in the classroom is exactly what happens once the laboring woman arrives in the hospital. This is definitely not the case in most parts of the US, as attendees emphasized over and over again throughout the conference.

The speakers gave a case study about how MoreOB works in their hospital regarding fetal monitoring. The hospital staff has a clear set of guidelines for when to use intermittent auscultation (IA) and when to use continuous electronic fetal monitoring (cEFM). Basically, unless a woman has certain clearly-delineated risk factors, she will only be monitored with IA. If a nurse, midwife, or physician wants to use cEFM, they have to document which specific medical condition warrants using cEFM. If it does not meet the established criteria, they won't be allowed to use cEFM. And they'll receive a talking-to from the charge nurse!

I entered when Dr. Bailey was talking about the before and after experiences in her hospital. She works in a small rural hospital in High River, Alberta that cares for only low-risk laboring women. Before adopting MoreOB, every woman would automatically be hooked up to the fetal monitors and confined to bed. After MoreOB was put into place, no one goes on the monitors--no 20-minute admission strips, even--unless there's a very specific reason for it. At her hospital, that means almost everyone receives IA and is encouraged to stay out of bed. Dr. Bailey explained it like this: "I'm an old cowgirl. And every cowboy or cowgirl worth their salt knows that you can't just slip your feet into a good-fitting pair of cowboy boots. You have to wiggle and jump and shimmy your way into your boots!" (This said as she's hopping around the room on one foot demonstrating the gymnastics required to put on cowboy boots). She was adamant about keeping women walking and moving and out of bed. She joked about how they used to always know where to find the laboring women--in bed. But now, they never know where to find them. "Where's patient X? Not in her room? Not in the shower? Where could she be? Oh....probably the staircase!"

We then moved into three small groups, each tackling a common scenario in US hospitals: augmentation, induction, and restriction of food/drink. We were instructed to discuss how to implement evidence-based, consistent policies, similar to what their hospital has done, for these various scenarios. I joined the induction group, which Dr. Bailey was part of. Our group, I sensed, felt extremely hampered and frustrated with how little they felt they could do to change the rampant rates of both elective and quasi-medical inductions (i.e., for a "big baby" or being "overdue" at 40 weeks and 1 day). Where Dr. Bailey works, they only do elective inductions for really extreme circumstances--such as a grand multip with a history of 30-minute labors who lives two hours away from the hospital and a really big snowstorm is moving in (close to a direct quote from Dr. Bailey). They don't start offering inductions for post-dates until 41 weeks 3 days. So if a physician wants to book a patient for an induction, and the induction doesn't meet certain evidence-based criteria, the charge nurse will tell the doctor--and I quote Dr. Bailey--"Bullshit."

The last session on Saturday was a general session by Dr. Warren P. Newton. He teaches at the UNC School of Medicine and works with UNC's department of Family Medicine. He spoke about developing a systems approach to health care. While the quality of individual physician-patient (or midwife-client) interactions is key, we also need to ensure that everyone has equal access to such care. He explained the implementation of the Family Centered Medical Home into the UNC Family Medicine Center and demonstrated very impressive results: much less waiting time for appointments, better health outcomes, etc. I'm still fuzzy on what exactly a FCMH is and how it different from standard medical care systems, but it was very intriguing.

The last part of his presentation explained how he applies these approaches to maternal-child care. His staff includes family physicians, nurse-midwives, nurse practitioners, and acupuncturists. They have really impressive numbers with their maternity patients. They do about 350 births/year and have a primary cesarean rate twice as low as the overall primary c/s rate at UNC. Their practice's epidural rate is 25%, compared to 82% for the rest of the hospital's maternity patients. (He noted that not allowing the anesthesiologists into the woman's room soon after admission to "talk about her pain relief options" and "assess her airway in case she needs an emergency cesarean under general anesthesia" had a significant impact on lowering the epidural rate.) He's also been involved in backing up the only freestanding birth center currently in North Carolina, the Women's Birth and Wellness Center, which does about 400 births per year. He demonstrated a strong belief in the normality of the childbearing process and of women's inherent ability to give birth, especially when given the time and space to do so.

By time 5:15 pm rolled around, I was beat. I could hardly stand upright and was feeling quite unwell. I wanted to stay longer and talk, but I needed to get back to the kids, eat dinner, and go to bed. My sister and I split a Tylenol PM; the sleep aid is benadryl, so it was perfect for our congested noses. (Thanks to April for finding someone with medications on hand!) It did the trick, and I was able to have a good night's sleep (which meant I only woke up 3 times to pee, and Dio only woke up once at 2am.) My apologies to anyone who thought I seemed disinterested or distracted on Saturday...it was just the fatigue!

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News roundup

Lots of interesting things have come my way lately. Today's news roundup touches on cesareans, home birth, epidurals, and kangaroo care.

Caesareans: Majority Done Before Labor
The New York Times reports on a new study that finds--big surprise--that the majority of cesareans are done before labor begins.

A new study suggests several reasons for the nation’s rising Caesarean section rate, including the increased use of drugs to induce labor, the tendency to give up on labor too soon and deliver babies surgically instead of waiting for nature to take its course, and the failure to allow women with previous Caesareans to try to give birth vaginally....

[Co-author] Dr. Zhang said one thing that surprised him about the study was that a third of first-time mothers were having Caesareans. Although it was known that the overall Caesarean rate was 32 percent, some of that was thought to be due to repeat Caesareans.

The main reason for a Caesarean was a prior Caesarean. But in women who have not had Caesareans before, one factor that may increase the risk is the use of drugs to induce labor. The practice has been increasing, and the study found that induced labor, compared with spontaneous labor, was twice as likely to result in a Caesarean.

In the study, 44 percent of the women who were trying vaginal delivery had their labor induced. When Caesareans were done after induction, half were performed before the woman’s cervix had dilated to six centimeters, “suggesting that clinical impatience may play a role,” the authors wrote. Full dilation is 10 centimeters, and a Caesarean before six centimeters may be too soon, the researchers said. 

Home Birth: Refuse a cesarean, lose your baby
My midwife lists have been buzzing about a family whose baby was removed by CPS after being born at home. The baby was breech, and the parents refused a cesarean and left the hospital AMA. The parents explain on their Facebook page Bring Ruth Home:

Ruth Abigail Light was born at home on July 21st at 7:38PM. She weighed 7 lbs. 10 oz. and was 20 inches long. During the birth, her shoulders were stuck momentarily (Shoulder Dystocia) but once they were free, she came right out. Ruth was doing well but a few hours later she seemed to be fussier than usual and we decided to take her in to get her checked out just to be sure. We took her to the ER in the middle of the night. Over the next few days, they told us that her arms had nerve damage from her shoulders getting stuck and a couple of days later, someone filed a complaint against us citing medical neglect for having her at home vs. the recommended C-section since she was breech. Since that time, Ruth has had every test possible run and so far, she seems to be doing very well. Her arms are recovering and she is a very content baby. 

CPS removed the baby to foster care. The parents' contact was limited to a few hours per week at first. Ruth is now in the custody of her grandmother. The parents recently received permission to increase their daily visitation hours from 4 to 8. They are currently waiting for their next custody hearing.

(Question--because I am too lazy right now to pull out my midwifery textbooks--can a breech baby really have a shoulder dystocia? SD is when the baby's shoulders become lodged behind the pubic bone. But if the head is facing the other direction, it wouldn't really be a shoulder dystocia...more a case of entrapped arms, right?)

Home Birth: Paramedic accused of denying transport to laboring woman
In the UK, a woman planning a home birth needed urgent transport to a hospital when the baby's heart rate dropped. The midwife phone an ambulance, but the paramedic allegedly refused to transport the woman and lied about why his ambulance team could not take her to the hospital. Another ambulance arrived 11 minutes later, bringing the woman in for a cesarean section. Both mother and baby are doing well. Read more about it at the Dorset Echo and the BBC news.

Do epidurals protect the pelvic floor?
According to The Globe and Mail, a study from Australia of first-time mothers planning a vaginal birth found that women with epidurals experienced pelvic floor damage. But is this really the case? Certified nurse-midwife Amy Romano explains what the study actually did and did not find. You'll learn about "levator microtrauma" (a term invented by the study's authors) and how it is not associated with pelvic floor damage.

They [the study's authors] excluded the 13% of vaginal births in which levator avulsion [tearing of the pelvic floor muscles] was diagnosed and evaluated the rest of the women for "microtrauma". We put "microtrauma" in quotes because no one has ever defined or determined the prevalence of this "condition". The researchers invented it themselves!...

In the case of “levator microtrauma,” there is absolutely no data whatsoever linking the author’s definition of microtrauma to pelvic organ prolapse or other important pelvic floor problems such as incontinence or sexual dysfunction. The aforementioned corporate-sponsored researcher showed in an earlier study that macrotrauma (aka levator avulsion) is an appropriate surrogate for pelvic organ prolapse, but remember that epidurals were not associated with macrotrauma in this study. Forceps deliveries were – and what’s the major modifiable risk factor for forceps delivery?  Epidurals!

But let’s say that microtraumabest strategy for preventing pelvic floor problems?  Maybe doing away with coached pushing, fundal pressure, episiotomy, and supine positioning might be the better strategy. Maybe postpartum exercises can help reverse changes associated with pregnancy and vaginal birth so they don’t turn into symptomatic pelvic floor problems.

Kangaroo care saves a premature baby's life
An Australian woman gave birth to 27-week-old twins. The first, a girl, was born healthy. But the doctor was unable to revive the second twin, a boy. The mother recounts what happened next:

The doctor asked me had we chosen a name for our son,' said Mrs Ogg. 'I said, "Jamie", and he turned around with my son already wrapped up and said, "We've lost Jamie, he didn't make it, sorry". 'It was the worse feeling I've ever felt. I unwrapped Jamie from his blanket. He was very limp.

'I took my gown off and arranged him on my chest with his head over my arm and just held him. He wasn't moving at all and we just started talking to him. 'We told him what his name was and that he had a sister. We told him the things we wanted to do with him throughout his life.

'Jamie occasionally gasped for air, which doctors said was a reflex action. But then I felt him move as if he were startled, then he started gasping more and more regularly. 'I gave Jamie some breast milk on my finger, he took it and started regular breathing.'

The skin-to-skin contact, known as kangaroo care, saved her baby's life. She recently appeared on national television with her healthy 5-month-old son to emphasize the importance of skin-to-skin contact, especially for premature infants. You can read one verision of the story here
, but it was edited after its initial release to omit less flattering details about the physician's conduct. A more complete version of the story is found here.

Dr. Nils Bergman responded to this news story (you can download it here as a Word document), noting how skin-to-skin contact "restores the basic biology for survival." 

My own research and "hypothesis" on this is based on the fact that to almost all newborn mammals, separation from mother is life-threatening. This activates a very powerful defence response, which is to shut down and immobilise ( freeze and dissociation by vagal nerve activation)....

Our resuscitation technology can force some regulatory oxygen and breathing and blood pressure and temperature ... but it is working against the "autonomic nervous system tide". There is great variability in sensitivity and resilience in all human beings, and some are sensitive and succumb despite our technology.

What "kangaroo care" does is restore the basic biology for survival. It is "skin-to-skin contact" which is the key, because the deep sensory fibres from the skin go to the "emotional processing unit" of the brain (amygdala), and tells the brain "you are safe". This de-activates the dissociation (un-safe mode), and restores the regulation (safe mode) - which is the real function of the vagal nerve.

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Investment

Investment

by Carol Lynn Pearson

How enviously
I watched
The rose bush
Bear her bud --
Such an easy
Lovely birth.
And
At that moment
I wished
The sweet myth
Were true -
That I could
Pluck you
My child
From some
green vine.

But now
As you breathe
Through flesh
That was mine,
Gently in the small circle
Of my arms,
I see
The wisdom
Of investment

The easy gift
Is easy to forget.
But what is bought
With coin of pain
Is dearly kept.

Carol Lynn Pearson is a Mormon author and playwright. Read more about her here.

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At least the pregnancy police said sorry

We've heard the term "pregnancy police" used figuratively, to mean people who try to police pregnant women's behavior with unsolicited advice or admonishment (such as telling them not to smoke or drink or eat certain foods). But one Australian mum recently had a run in with real live pregnancy police, or Pitocin Police as Jill at The Unnecesarean called it. Her hospital wanted her to be induced because she was 12 days post-dates, but she declined since there was nothing wrong with her or the baby. When she did not show up at her scheduled induction, the hospital sent police to her door.

Rochelle Allan, who is reluctant to be induced even though her baby is 12 days overdue, was told by the hospital they intended to go ahead with the procedure when she came in.

But after speaking to her midwife following a visit to the hospital the day before, and being assured her baby was fine, she decided not to attend the hospital the next day.

Now Ms Allan is furious after the two police officers arrived on her doorstep after they were called by Bathurst Hospital.

Wanting a home birth, Ms Allan, 24, has been under the care of a private midwife and had been attending the hospital daily to monitor the baby's health.

"I couldn't believe it when I saw the police officers at my door," Ms Allan said.
"They told me they had been asked by the hospital to check on my welfare because I had not attended.

"The hospital knew I did not want to be induced and they gave me no medical reason why I should be."

Today, the health authorities responsible for the police visit issued an apology. Emphasis mine.

The Greater Western Area Health Service today offered Ms Allan an apology for the unexpected police visit, saying they just wanted to check she was alright.

"We are sorry if it ... caused her any distress but our intention was to check on her welfare," area health spokeswoman Sue-Anne Redmond told ABC Radio today.

The health service denied it was trying to pressure Ms Allan into being induced.

The irony of this last statement is just about killing me.

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Due Dates

Something I wrote last year...enjoy.

Due dates are a bunch of nonsense. Let me explain why:

1. Only 5% of women go into labor on their due date (In other words, it is wrong for 95%!).

2. The notion that pregnancy lasts 40 weeks from the last menstrual period came from a German physician in 1807 (Hermann Boerhaave). He didn't do any statistical studies on average length of pregnancies--he just came up with this number based on observations. In part, because it was a nice, easy number to remember (10 lunar months). This method of calculating due dates later became called "Naegele's Rule" and is the one that most doctors use today, even though there is no statistical evidence that 40 weeks is the correct average length of pregnancy.

3. Naegele's Rule is based on the last menstrual period and assumes a 28-day cycle. However, many women have cycles longer or shorter than 28 days. Ovulation usually occurs 14 days before the next period (NOT 14 days after the previous), so a woman with a 35-day cycle will ovulate later in her cycle than a woman with a 28-day cycle.

Let me illustrate this with an example: Let's say there are 3 women whose menstrual periods all began on the same day. I'll say Jan 1st for convenience.. They all became pregnant during the same cycle. Naegele's Rule (and most doctors) would give them all the same due date. However, that is flawed:

Amy has regular 28-day cycles. Her 40-week "due date" would fall on Oct 7.
Becky has regular 35-day cycles. Her 40-week mark is Oct 14.
Cindy has irregular cycles, ranging from 30 days to 55 days. Thus, her 40-week mark could be on Oct 9, or Nov 2, or anywhere in between.

4. The average length of pregnancy is not 40 weeks (okay, technically 38 because there are 2 extra weeks thrown in there before conception, but that is confusing to most people so I'll stick with 40). Women gestate babies for different amounts of time. Just like some of us grow faster, hit puberty at different times, or start our periods at different ages, women also grow babies at different rates. For example, in studies done of healthy Caucasian women, the average length of pregnancy was 41 weeks 1 day for first babies, and 40 weeks 3 days for second babies.

Next, you'll remember from statistics class that averages are calculated from a wide range of possibilities. Term pregnancy is generally considered to be from about 37 weeks and beyond. Many women go into labor between 37-42 weeks. However, a substantial minority gestate much longer--often 44 or 46 weeks. The longest documented pregnancy is 52 weeks. Yes, one full year. And you thought "Ten Month Mamas" had it hard!

So, even if you take into account the length of your menstrual cycle, and the fact that average pregnancies are 41 weeks 1 day for first babies if you're Caucasian, that still tells you nothing about what specific day you will go into labor. Hence the 95% inaccuracy rate. It just gives you a 5-6 week (or more) window in which your baby will probably be born.

5. Ultrasound dating is not 100% accurate, and gets worse farther along in pregnancy. 1st trimester estimates are +/- 5 days, while 3rd trimester estimates are +/- 22 days (or a 44-day window of possibility).

6. Way too many women go through unnecessary stress worrying about their due date. No wonder, since 95% of them are wrong!

I got most of my information from Anne Frye's Holistic Midwifery Vol 1, and Henci Goer's The Thinking Woman's Guide to a Better Birth.

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News

My last day of internet access for a little while...So here is all the latest news:

• Zari just got her first tooth yesterday!
• I think I have mastitis, but it's getting better. The fever/chills are pretty much gone now.
  
• We found a dog sitter last minute. Whew!

I'll be without internet for a week, then once we arrive in France I'll have occasional access. So this blog will be a bit quiet over the summer.

I am hoping to bring back lots of beautiful sling fabrics from France. I'll post them to my Second Womb site when I return in August.

I'll leave you with this quote from Gloria Lemay, a midwife in British Columbia:

Attending births is like growing roses. You have to marvel at the ones that just open up and bloom at the first kiss of the sun but you wouldn't dream of pulling open the petals of the tightly closed buds and forcing them to blossom to your time line.

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