Michel Odent on breech

Whenever I pull Michel Odent's book Birth Reborn off the shelf, it feels like phoning a dear friend after a long absence. We catch up on life and I remember why I enjoy this person so much.

Michel Odent is a French surgeon and obstetrician who was in charge of the Pithiviers Maternity Unit for over 20 years. At a time when cesarean rates were rising and births in France were highly medicalized, Odent turned the maternity wing at his state hospital into a haven for undisturbed, physiological birth. Most of his changes were low-cost and low-tech: creating an environment in which women were private and completely undisturbed during labor. He replaced delivery tables with big, low mattresses and cushions, birth pools, and simple furniture to aid spontaneous movement. His maternity unit had a 6-7% cesarean rate during the 1970s and 80s, even though it accepted an unscreened population.

I just opened Birth Reborn after a good year or two and turned to a section on breech birth. In his words and photos (pages 103-105 in the 2nd edition):

~~~~~

Finally, within the realm of labor and birth, one quickly learns to expect the unexpected. Sometimes a woman will have a quick and easy labor when professionals believed only a cesarean was possible. For example, women who have previously had a cesarean are sometimes told that they will always give birth that way. Yet at our clinic, one out of two women who have previously had cesareans succeed in giving birth vaginally. Nor do breech deliveries always justify the operation, although this has, nevertheless, become almost the rule in many conventional hospitals. From our experience with breech babies, we have found that by observing the natural progression of first-stage labor, we will get the best indication of what to expect at the last moment. This means we do nothing that will interfere with first-stage labor: no Pitocin, no bathing in the pool, no mention of the word "breech." If all goes smoothly, we have reason to believe the second stage of labor will not pose any problems. Our only intervention will be to insist on the supported squatting position for delivery, since it is the most mechanically efficient. It reduces the likelihood of our having to pull the baby out and is the best way to minimize the delay between the delivery of the baby's umbilicus and the baby's head, which could result in the compression of the cord and deprive the infant of oxygen. We would never risk a breech delivery with the mother in a dorsal or semi-seated position.

If, on the other hand, contractions in the first-stage labor are painful and inefficient and dilation does not progress, we must quickly dispense with the idea of vaginal delivery. Otherwise we face the danger of a last-minute "point of no return" when, after the emergence of the baby's buttocks, it is too late to switch strategies and decide on a cesarean. However, although we always perform cesareans when first-stage labor is difficult and the situation is not improving, most breech births in our clinic do end up as vaginal deliveries.

Here is a brief video of a breech birth at Pithiviers. Notice that the baby does not rotate to sacrum-anterior after the trunk is born (the most likely culprit is a nuchal arm). Odent steps in right away and frees the arm. The baby is born very quickly.

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Rebekka Visser: Guidelines and Realities, Dreams and Controversies

First International Breech Conference, Day 1

Rebekka Visser

Guidelines and Realities, Dreams and Controversies

A Dutch midwife from Usquert, Rebekka Visser is an advocate for women who want hands-off, self-directed breech births. Her midwifery practice is called Springtij.

In lieu of posting a summary of Rebekka's remarks, I will direct you to her blog, where she posted her presentation: "Let's Look Beyond Our Fishbowl."

At the end of Rebekka's lecture, an audience member asked other attendees about how breech skills are taught in their locations. Is breech taught as an emergency procedure? Or is it taught as a normal birth skill?

We had responses from many other audience members. I remember hearing someone comment that when breech is taught as an emergency skill, the rate of vaginal breech birth in a maternity unit actually goes down. This emphasizes the importance of teaching breech as part of normal birth skills, rather than labeling it as an "emergency."

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Thoughts about unassisted birth: part II

If you had the time to read back through the selected posts listed in part I, you might have noticed a gradual shift in tone. During Zari's pregnancy and immediately after her birth, I was on my "honeymoon" phase in my relationship with unassisted birth: a bit idealistic, breathlessly in love with the idea of undisturbed birth as the pinnacle of the birth experience, enraptured and fascinated with the practice. Now, it was still me writing, which means that my pragmatic and analytical selves were still present even when I was strongly advocating unassisted birth. But compared to how I feel now, after a second pregnancy and birth, I would say that my relationship with unassisted birth has settled into a more mature, complex, and nuanced pattern.

Towards the end of writing my dissertation about unassisted birth, I was already finding myself critical of certain trends I saw emerging in online UC communities--the trend toward dogmatism, the distrust or even demonization of midwifery, the embracing of slogans (trust birth! breech is just a variation of normal! etc.) that mask the complexity of reality. In particular, the abandonment of education and preparation--and of midwives--in favor of "trusting my body/following my intuition."

Here's an excerpt from my dissertation on this topic (from chapter 4):

After years of immersion in UC communities, I have started to notice a trend toward dismissing the necessity of knowledge and preparation, toward emphasizing intuition to the exclusion of almost anything else....I am not sure if this anti-education and risk-denying undercurrent has always existed and just I never noticed until now, or if it really is a new development. This tendency is not universal, but it is prevalent enough that others besides me have noticed it....

Over-reliance on any one type of knowledge can be dangerous. No one source of knowledge about birth is infallible or complete. Even if intuition is believed to be inherently accurate, it is not omniscient or omnipresent. UCers and midwives have separate sets of challenges regarding intuition. As Lucia Roncalli noted, midwives need to incorporate intuition into their clinical training and experience and give it adequate respect. For UCers, the challenges are to sufficiently refine one’s intuitive skills and to balance education and preparation with a trust in intuition. This is a difficult process—walking the knife’s edge of embracing intuition as a “knowledge that matters” without falling into the trap of intuition becoming “the only knowledge that matters.”

To be fair, I wonder if some of the things I'm perceiving is just that--a problem of perception. Since I finished my dissertation, I haven't followed online UC communities as closely as I used to. I'm more of a casual browser/eavesdropper now, rather than regular reader and participant. I know that just dropping in on certain messages might not give me the full context of the larger discussion--just as overhearing bits of a conversation is not the same as participating in it from start to finish. Knowing the full context really does make a difference.

What I am not doing in this post is disavowing unassisted birth. I am just trying to explain that I feel many different ways towards the idea all at the same time. I do feel less comfortable "promoting" UC than I used to. If a woman hires a midwife or a physician, she can shirk the responsibility of education and preparation, and things will probably be okay--in a "everyone comes out alive and relatively healthy" sense--because there is someone else there with extensive knowledge and training and skills to fill the gap (even if we might debate the usefulness of, say, surgical skills for a normal vaginal birth). But with UC, all of the weight is on you and you alone. There's no one else to catch you if you stumble.

I am reminded of one of my favorite professors: ethnobotanist Dr. Paul Cox. He served an LDS mission in Samoa, and his approach when teaching people interested in his church was to talk them out of joining. He wanted them to be 100% sure that they were joining because they had a personal testimony and unwavering belief. If he couldn't talk them out of it, he knew they were really serious. I feel the same way about UC. I think giving birth unassisted is wonderful--but I don't want to talk anyone into it. I don't want to over-romanticize it, or promise women a pain-free ecstatic birth if they just get rid of the midwife/their fears/their doctor/the hospital. I want women to have an undeniable inner knowing that an unassisted birth is right for this baby, this pregnancy. And to have the concomitant desire to do the necessary preparation for giving birth without a care provider present.

I absolutely stand by my decision to give birth to Zari unassisted, just as I do my midwife-attended birth with Dio. If anything, both experiences have taught me to trust that inner voice--call it intuition, divine/spiritual guidance, whatever you like--no matter where it takes me. It might sound airy-fairy for some readers, but nevertheless it was undeniably real for me in both pregnancies. I hope I never need to give birth in a hospital, but if I do feel drawn towards that for a future pregnancy, I hope I can embrace that guidance and move forward with confidence.

If I didn't feel strongly guided one way or another, I'd probably hire the same midwife if I became pregnant again. I really enjoyed our prenatal visits. Her presence at Dio's birth didn't disturb me or interfere with the birth in the least--of course it helps that she arrived only 30 minutes before he was born! And I do like having someone with extensive knowledge and skills that I can call upon. I would not have access to that where I live if I were planning an unassisted birth and doing my own prenatal care. But I also recognize that my unassisted birth with Zari played a huge role in knowing what I wanted from a midwife and in knowing how I labor and birth. If anything, that first unassisted birth gave me more confidence in myself to be able to labor successfully in many different settings.

Stay tuned for part III, in which I respond specifically to Barb Herrera's post The UC Oxymoron.

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Not staying true to my word…whatever that means

In the past few days a reader posted the following comment:

why are you using a medwife? I was a little disappointed in you for not UCing, and now it's like wow you must not really stay true to your word.

She also emailed me this message:

Are CPM's illegal in your state if not why are you [not] using one? CNM's are really dangerous and I thought every unassisted birther knows this. They are more like medwives which to me would be way too scary. So why are you using one?

I would like to respond to these two comments. I am trying really hard to keep my tone restrained. Believe me, you don’t want to fall on the wrong side of someone who taught university-level rhetoric. So pardon me if I come off a bit strong at times.

Overall, these comments epitomize dogmatism and fanaticism at their worst—blind adherence to a belief system, inability to see beyond a narrow worldview, lack of experience with the messiness and subtleties of real life (or should I say real birth?), a black-and-white perspective in which choices are either absolutely Right or Wrong regardless of context, and gross generalizations.

Now, onto some particulars:

The “medwife” comments
Without having ever met the midwife I am seeing, the poster makes sweeping assumptions about her practice style and philosophy of care, simply because of the initials behind her name. I have worked with and know both direct-entry and nurse-midwives, and I have learned that you cannot assume anything about their style of practice from their educational background. To automatically label any CNM a “medwife” (a term used disparagingly to indicate a midwife who acts more like an OB than a midwife, in other words someone who is very medically/technocratically oriented) is not only insulting to the many CNMs who are very holistically minded, it also functions as a red herring, diverting attention away from important issues. We’re not going to move forward in our effort to improve birth culture and practices if we throw around pejorative terms like these.

For an interesting examination of the ideological conflicts (perceived or real) between DEMs and CNMs, I suggest reading Mainstreaming Midwives: The Politics of Change, edited by Robbie Davis-Floyd. It is true that there is, at times, an ideological divide between DEMs and CNMs. Davis-Floyd includes these two quotes in her introduction:

CNMs think DEMs have copped out, and DEMs think CNMs have sold out.
Joyce Roberts, President of the American College of Nurse-Midwives, 1999

One group needs to tighten up, and the other group needs to lighten up!
Katherine Comancho Carr, President of the American College of Nurse-Midwives, 2005

“I was a little disappointed in you for not UCing”
I’m always a bit surprised to hear people tell me this. These comments imply that other birth choices are somehow inferior, less worthy of admiration, or indicative of weakness or lack of principle. If anyone is going to be disappointed in my birth choices, it should be me and me alone. If having an unassisted birth is right for one birth but not for another, then why should anyone be disappointed? Is there some hidden contest I’m supposed to be participating in, some Uber-Alternative-Mama medal I’m supposed to be aiming towards?

Now, this doesn’t mean that I am abandoning unassisted birth in principle or even in practice. To be more precise, my seeing a midwife this pregnancy, or my having an unassisted birth last time, goes no further than myself and my own experiences. I don’t uphold any one path to giving birth as The Only Right Way To Have A Baby. I do believe strongly in undisturbed birth, in supporting and facilitating the physiological and hormonal process whenever possible, and in gentle and empowering births that bring health and healing to mothers and babies. So yes, I do think that our national cesarean rate is atrocious, that far too many mothers and babies come out wounded and shell-shocked from their births, and that we have a lot of changes to make in both hospital and home birth culture. But I don’t for a minute believe that UC is more “pure” than having a midwife, which in turn is supposedly “better” than a birth center, which is of course preferable to a CNM-attended hospital birth. And don’t even mention those awful OBs who just want to slice & dice women, who only care about getting home for dinner…

So let’s please get beyond these trite beliefs and assumptions. I understand why some readers might be curious about why I am seeing a midwife this time, and I am more than happy to enter into a dialogue about that. But I am surprised at the inference that my actions during this pregnancy constitute a betrayal (of what? I’m not sure) or that I am “not staying true to my word.” I never remember making a vow to have unassisted births for the rest of my reproductive life. (Now granted, if I felt it was right for each pregnancy, I would gladly do so!) Did I miss something here?

I will be honest and admit that I do have some trepidations about having a midwife present. I think with any birth choice there are unknowns that can bring worry or doubt. During Zari’s pregnancy, I had moments when I wondered if I was really making the right choice, wanting to be sure my personal preferences weren’t getting in the way of what was best for me and the baby. This time around, as I have mentioned in other blog posts, I have wondered how I will be able to balance my need for privacy and autonomy with my desire to have a midwife present for her emergency skills & knowledge. I don’t know if there’s ever a perfect balance to these sometimes conflicting, sometimes converging, needs. Last time, I knew clearly that I needed to do it alone. This time, I feel more strongly the need for additional options and resources, even as I wonder if or how the midwife's presence might alter my ability to labor. Still, I feel good about continuing along the path I have chosen. A lot depends on what happens as labor unfolds—will I call her early? late? will my birth unfold quickly enough that she arrives after the fact? I don’t know—I can only say that I will be closely following the intuitive and spiritual promptings that guided me strongly and clearly during Zari’s birth. If I do that, then there is no room for doubt.

To conclude this post, I wanted to include a recent comment from another reader, Irene, in the hopes that I have answered her questions and concerns adequately. She has identified the core tensions that I, and many other women, experience between privacy, autonomy, and security. After reading my post about working through some conflicted feelings, she wrote:

Hi Rixa, I just breathed a huge sigh of relief. At first your choice in having a midwife this time around alarmed me, I even felt somewhat confused and betrayed as I saw you as such a wonderful spokesperson for UC moms. But as I read this last blog, I realized that pregnancy and birth are so personal and intimate it is so difficult to make the choices we make. I truly hope you have the birth you desire and that your baby is healthy and that you are happy…

For myself, the only reason I would want a midwife around would be for the afterbirth--in case of an emergency situation and to help with the cleanup but the pros are pretty even with the cons as my need for privacy and birthing alone would definitely result in more complications. (I learned that with my first birth too, even having hubby in the room slowed my labor a lot, I really needed to be alone). So I think that for myself, having a midwife around would ease some concerns but ironically open up Pandora's box to a slew of new concerns and perhaps complications that could have otherwise have been avoided.

Thanks so much for your blog. I am sorry that I at first somehow felt betrayed by your desire to have a midwife; I guess you made me second question UC but after reading this blog (I do check your blog but not too frequently so I missed this one at first, stating your reasons for wanting a midwife), I realized just what a tough position you are in. In a way I think you are looking for what we all want—privacy & autonomy, but a midwife would provide the added benefit of security. Ironically, a midwife would also take away some of the privacy and autonomy so really it is such a tough call.

I look forward to reading your birth story.

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Teleseminar tonight with Dr. Sarah J. Buckley

You're invited to attend a free teleseminar (via phone or webcast) tonight featuring Dr. Sarah J. Buckley, an Australian physician with specialization in GP obstetrics. Dr. Buckley gave birth to all four of her babies at home, the last unassisted and a surprise breech. Visit MyBabyBelly blog for more details. Dr. Buckley just released a new edition of her 2005 book Gentle Birth, Gentle Mothering. It's one of my favorites as it combines scientific research into the hormones of birth and mothering with her personal experiences of pregnancy, birth, and breastfeeding. I am excited to read the new edition, which contains several new chapters and updated medical evidence.

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"I could NEVER do that"

Thanks to The Human Pacifier for an intriguing post about how achieving a "natural" birth in a hospital is an incredible feat. She raises a very important point that having an unmedicated birth at home or in a freestanding birth center is worlds apart (and arguably much, much easier) from a "natural"* hospital birth. Women who achieve this in a hospital really DO deserve a medal! It's so much more challenging than doing it out of hospital. I think women sometimes assume that it would have been/felt the same no matter the location. Perhaps when we're holding conversations about this, we need to emphasize that a lot of the things that cause pain, discomfort, and stress aren't present when you birth outside a hospital, so things are usually much less painful in the first place.

Now, I don't want to turn this into a simplistic home vs hospital kind of post. But that is one of the fantastic advantages of laboring outside of a medical institution! No IVs or heplocks.** No Pitocin augmentation. No fetal monitor straps. No internal monitors. No restrictions to bed. No one asking you to "rate your pain 1 to 10" or "would you like something to take the edge off/help you relax/help you sleep." Generally vaginal exams are limited-to-none or only on the mother's request. No mandatory birthing in the stranded beetle position. No Valsalva pushing ("hold your breath and count to ten and push Push PUSH!!").***

In some ways, I feel like I got off easy. All I had to do was labor and give birth! No fuss, no fighting, no declining this or that. Just birth.

* I really dislike the term "natural birth." It's too vague to be useful and carries a "holier-than-thou" connotation. You know, "natural" is better than "artificial" kind of thing. So I generally use a more specific word depending on what I am trying to convey: unmedicated, physiological, undisturbed, etc.
** Occasionally you will see IVs/heplocks used outside a hospital setting, usually to administer abx if the woman is GBS positive and requests that treatment, or to correct severe dehydration due to vomiting. But these are really exceptional circumstances.

***Okay, okay, I betcha some out-of-hospital birth attendants have done this...and I know that not every hospital does either. But it's true generally.

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Comments about To The Contrary

I part ways with Lynn Griesemer over the father's role in unassisted births. We've talked about this, and she has more of a "daddy delivery" philosophy about unassisted birth. I don't think men should be "front and center" in births. Women should be. After all, they are the ones giving birth! It's really not that hard to catch a baby, yet when men (or doctors) do it, they get all sorts of glory and acclamation. My husband's role at the birth was to sit in the other room and wait as I birthed our daughter (and to be errand boy when I needed food & drinks). Now, that was exactly what I wanted and needed him to do, so it's not like I resent that in any way. The most significant thing he did for me--more important than any coaching or catching or delivering--was giving me blessings when I asked for them. (LDS lingo here...let me know if you haven't a clue what I'm talking about.) The blessings gave me absolute certainty that both I and Zari would be perfectly healthy and that the birth would go smoothly. There is no machine, no test, no care provider who could do that!

Even though Lynn would not identify herself as a feminist, I do agree that birth issues are noticeably absent from almost any feminist platform. That's a shame, I think. The National Organization for Women has recently made some statements about birth issues, including a statement against VBAC bans, but otherwise feminism has been oddly silent on the birth side of "reproductive rights." I also think that the almost exclusive focus on abortion has alienated many women who are concerned with the rights of childbearing women. Women need more opportunities to unite, and unfortunately the abortion issue is one really good way to keep women divided.

Dr. Healy claims that she supports patient's rights to refuse treatment, yet she undermines that by her statement that "when you’re making that decision for a child, it’s a very different situation." Is it different? Pregnant women have the same medical and legal rights as non-pregnant people (with the very disturbing exceptions of court-ordered obstetrical interventions). This is the same double-talk that ACOG uses in its statement against home birth: "Although ACOG acknowledges a woman's right to make informed decisions regarding her delivery, ACOG does not support programs or individuals that advocate for or who provide out-of-hospital births" because "the American College of Obstetricians and Gynecologists believes that the hospital...is the safest setting for labor, delivery, and the immediate postpartum period." ACOG's active opposition to out-of-hospital births stands in direct contradiction with its claim to support women's choices in health care.

It's kind of like saying "We support your right to choose any color of car you wish. But you can only have a blue car, because we believe that all other colors are unsafe. In addition, we will actively oppose any car manufacturers who promote, sell, or distribute non-blue cars. We can do this, because we have a monopoly on the $33 billion-a-year business of car manufacturing, sales, and advertising. But remember, we support your right to choose!"

I agree with other commenters that Dr. Healy skimmed over the issue of babies dying in hospitals. Yes, it's true that neonatal deaths are fairly uncommon anywhere in developed countries. But her comments imply that a hospital is the only place that the low death rate can be ensured, and that any infant deaths that occur in hospitals are unavoidable.

The doctor also shows a blatant lack of knowledge about unassisted birth, or home birth in general, with her claim that first-time mothers do not make that choice. What irks me is that her statement will be taken as factual and authoritative, simply because she is a physician.

I am also puzzled by her comment that "you don’t know the health of that baby until that baby arrives." Isn't that one of obstetric's main claims--that it can monitor, assess, and predict the health of babies during pregnancy and birth? Why else all the monitoring during pregnancy (ultrasound, screening tests, etc) and birth (electronic fetal monitoring)? Is her statement an admission that the standard obstetric care really cannot predict outcomes with any accuracy, let alone avert them? Or is her comment meant to mean that women birthing at home cannot know whether or not their baby is healthy while it is in utero? Because certainly women can and do feel their baby kicking and moving, listen to the heartbeat, and keep track of the baby's growth. Read that way, her statement implies that a physician has a better knowledge of the unborn baby than the mother herself.

Of Eleanor's comment--which I find immensely condescending and anti-woman--let me just say that safety, satisfaction, and empowerment are not mutually exclusive. In fact, the factors that bring unassisted birthers pleasure (privacy; security; complete freedom to move about, eat, drink, and vocalize; not feeling observed or monitored or pressured to birth in a certain amount of time; lack of drugs and interventions and their known side effects; absence of stress and fear; optimal hormonal levels that help the mother experience ecstasy and bliss; ability to focus on labor and not on outside distractions) also enhance the safety of both mother and baby. The pitting of fetal safety versus maternal satisfaction is a cornerstone of the obstetric worldview, as Robbie Davis-Floyd notes in Birth as an American Rite of Passage. The midwifery paradigm, in contrast, perceives the mother and baby as an inseparable, mutually dependent unit. What is good for the mother is good for the baby, and vice-versa.

I fear that this discussion of safety is quickly turning into a dissertation itself, but let me briefly add some insights from Sarah J. Buckley. She argues that the safest, easiest, and most ecstatic births are ones that are undisturbed:

"Anything that disturbs a labouring woman’s sense of safety and privacy will disrupt the birthing process. This definition covers most of modern obstetrics, which has created an entire industry around the observation and monitoring of pregnant and birthing women...On top of this is another obstetric layer devoted to correcting the 'dysfunctional labour' that such disruption is likely to produce. The resulting distortion of the process of birth—what we might call 'disturbed birth'—has come to be what women expect when they have a baby and perhaps, in a strange circularity, it works."

In contrast, undisturbed birth and its “optimal hormonal orchestration provides safety, ease, and ecstasy." She explains: “When a mother’s hormonal orchestration is undisturbed, her baby’s safety is also enhanced, not only during labour and delivery, but also in the critical transition from womb to world....[I]interference with this process will also disrupt this delicate hormonal orchestration, making birth more difficult and painful, and potentially less safe.” She uses two analogies to explain the optimal conditions for undisturbed birth: lovemaking and meditation, both of which necessitate privacy, quiet, and freedom from feeling watched. “If we were to consider giving birth as the deepest meditation possible, and accord birthing women the appropriate respect, support, and lack of disturbance, we would provide the best physiological conditions for birth.” [1]

I also want to say that childbirth was definitely something that I embraced and enjoyed in many ways. Some parts were challenging, some were very very exhilarating. Pain was present at times, but so was immense pleasure, experienced in the form of an incredible endorphin rush between every contraction. Five minutes after the birth, I said, "that was hard work, but definitely doable." Distance runners experience this same mixture of pleasure, pain, exertion, and exhilaration. I can say this from personal experience, since I am very close to running a half-marathon. My longest run so far has been 10 miles.

Now, in case you are tempted to dismiss my experience by figuring that I must have an unusually high pain tolerance, let me set the record straight: I was known for my extremely low pain tolerance growing up. I would scream and wail over every little thing, so much that my mom didn't believe me when I broke my wrist and waited 10 days before taking me in to the doctor!

Eleanor's disparaging comment about enjoying labor and birth is destructive and indicates either some very traumatic personal experiences giving birth or very strong cultural programming that birth is inherently and inescapably traumatic.

And the final panelist...where to start? She reiterates that choosing to birth at home unassisted is selfish, yet her own childbirth preferences (using drugs, including general anesthesia) confer no physiological benefits to mother or baby during normal labor, and also pose many significant risks, as Dr. Buckley has thoroughly documented. We could very well argue, with much more substantial evidence than any of the panelists had, that any mother taking drugs for pain relief is selfish--caring more for her own experience than for the baby. (Not saying that I want to use this label, because there is too much woman-hating and guilt spreading out there already).

This concludes tonight's episode of "Rixa writes, raves, and rants whilst remaining reasonably restrained in her responses."

---

[1] Gentle Birth, Gentle Mothering 110-114.

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If I were looking for a midwife...

Sage Femme would be a great fit for me. Read about her practice style on her recent post Midwife Identity Crisis. Too bad we live several thousand miles apart!!

The midwife I apprenticed with before I moved has started doing more of these kinds of births. Here's a brief description from an email conversation we had about two years ago:

My midwifery partner and I have done a few births this summer in which the parents did not want to be bothered with at all...no heart tones, no vag checks, etc. OK...so that's what we did. Many first time moms, too. When mom was getting away from herself and feeling out of control, I would go over to the tub, get to eye level with her and tell her she was strong and powerful, and that this is normal. She is doing fine. Then I would give her a drink (Dad, too) and give her a cool cloth...then back to couch! Same when baby was out...mom caught her own baby and sat back w/Dad to admire their son. We checked that baby was breathing without difficulty and pinking up, Mom didn't look too bloody, so we retreated to the couch again until they called us to get out of the water.

We need more midwives like you!

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Judit's Birth Story

One of my friends Judit, a regular commenter here, recently had her baby! Read all about it here: Life with Magda.

(Her story has lots of nude laboring pictures, so it isn't work appropriate, obviously!).

Judit had considered UC, but felt more drawn to hiring a midwife as her pregnancy progressed. She made her desires for an autonomous, undisturbed birth very clear, and the midwife respected that. I think you'll find her story quite inspiring!

Some of my favorite parts:

• her experience getting the baby to turn vertex
  
• her descriptions of pain and laboring alone at night
• how she KNEW she had to get her baby out quickly at the end
• how baby Magda managed to come on the day of her husband's comprehensive exams: good timing, right??

Anyway enough of my own commentary. Now go read the birth story!

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Another UC article

"Going It Alone," from The Guardian, a UK publication.

Regarding the study the author referenced, it was about a certain religious sect that rejected any medical care for childbirth. Here is the citation to the original study:

Kaunitz AM, Spence C, Danielson TS, Rochat RW, Grimes DA. “Perinatal and maternal mortality in a religious group avoiding obstetric care.” Am J Obstet Gynecol. 1984 Dec 1;150(7):826-31.

A summer 2003 issue of Midwifery Today had some responses to that study, including these comments:

Midwives who have been working in the freebirth community for these last 25 years have a different story....Many families choosing unassisted birth are highly educated and responsible; their births are a far cry from those that are unattended for reasons of poverty, distrust in medical attendants or ignorance.
~ midwife Jeannine Parvati Baker

There has never been a study done that consisted of data from planned, unassisted births of healthy women who wanted their babies, were in emotionally and physically supportive environments, were somatically aware and comfortable with their bodies, had full access to health care as they needed it and who made the choice freely and gladly. We really don't know (statistically speaking) what happens when the human body is allowed to give birth instinctively and undisturbed under such conditions.
Linda Hessel

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Hats off!

Ever wondered why we put hats on newborn babies? Is it really necessary? Are there risks in doing so?

Read this midwife's response to why she doesn't put hats on newborns.

Of particular note is her last paragraph. By striving to keep the "birth bubble" intact immediately after a birth (having the mother pick up her own baby, no hats, no bulb syringes, staying out of eyesight of the parents, no talking to parents after the birth), she has noted these changes:

I've had a huge decline in hemorrhage. The transition feels more peaceful, more gentle and more aware for all involved. I find myself more often moved to tears by being able to sit back and observe the entire scene instead of being on edge looking for something wrong. I think the babies prefer it, as well. :)

Michel Odent explains why distracting a mother right after birth predisposes her to postpartum hemorrhage:

It is after the birth of the baby and before the delivery of the placenta that women have the capacity to reach the highest possible peak of oxytocin. As in any other circumstances (for example sexual intercourse or lactation) the release of oxytocin is highly dependent on environmental factors. It is easier if the place is very warm (so that the level of hormones of the adrenaline family is as low as possible). It is also easier if the mother has nothing else to do than to look at the baby’s eyes and to feel contact with the baby’s skin, without any distraction.

Oxytocin is the hormone that causes uterine contractions. Anti-hemorrhagic drugs (Pitocin, Methergine) are made from synthetic oxytocin.

Hats off to hands-off midwives and doctors!

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Passionate Mothering

I recently bought Dr. Sarah J. Buckley's book Gentle Birth, Gentle Mothering. It is fantastic--well worth the money. She writes about birth and mothering as both a mother of four children and as a physician and scientist. She makes a compelling argument for undisturbed, instinctive birth. If you cannot find the book in your local library, which is likely since it is published in Australia, you can read many of her articles on her website. If you are pressed for time, read this one first.

Here are some excerpts from a chapter called "Healing Birth, Healing the Earth."

The ecstasy of Birth—her capacity to take us outside (ec) our usual state (stasis)—has been forgotten, and we are entering the sacred domain of motherhood post-operatively, even post-traumatically, rather than transformationally....

Giving birth is, inherently and hormonally, a passionate and sexual act. From the perspective of hormone levels in both mother and baby, we could say that birth is the most passionate experience that we will ever have....

These passionate hormones [oxytocin, prolactin, endorphins, and adrenaline] are not just feel-good add-ons. They actually orchestrate the physical processes of birth (and sexual activity) and enhance efficiency, safety and ease for both mother and baby. This hormonal cocktail also rewards birthing mothers with the experience of ecstasy and fulfillment, making us want to give birth again and again....

The problem in our times is that the passion of birth is neither recognized nor accommodated. Birth has become a dispassionate medical event, usually occurring in a setting that discourages emotional expression. If we are to reclaim our birthing passion, we must give ourselves permission to birth passionately and we must choose our birth setting and birth attendants with this in mind. Birth in these circumstances will be more straightforward, with less need for interventions, helping us to step into new motherhood with confidence and grace.

Passion, to my mind, is an opposite and an antidote for despair and depression. This is clear physiologically and hormonally. If we gave birth, and were born, in passion, how different would our primal emotional imprint be? And what about our brain chemistry, which is being set even as we are born?...As a birthing mother I have both witnessed and experienced the enormous passion that can be unleashed at birth, and that can fuel both passionate motherhood and a lifetime’s work on behalf of mothers, babies, and the Earth, and I ask: “Can we afford, as a species, to be born, and to give birth dispassionately?”

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"Barbarians in Blogistan"

Apparently I am part of an ultra-extreme movement, according to a recent article in the Ottawa Citizen, "Barbarians in Blogistan." Here is what the author has to say about people who give birth at home without a paid attendant:

Then there are the medical amateurs, who conduct their own research, attempt to heal themselves on their own, and even give birth by themselves. Devotees of the "unassisted birth movement" hold that newborns should be delivered by the mother herself, without a doctor or midwife or doula present...Certainly, do-it-yourself ob-gyn is amateurism at its most extreme. The majority of the millions of amateurs out there are not far-out obsessives...

Sweet! Now I am a "far-out obsessive." I get a kick out of the idea that allowing an involuntary bodily function to happen is somehow extreme. Sure, DIY brain surgery would be extreme. Or for that matter, a DIY cesarean. Ouch!

But giving birth isn't something you do; it's something you simply let be. For almost all labors, nothing needs to be "done." You just stand aside and enjoy the ride. Dutch obstetrician (and ardent midwifery and homebirth supporter) Gerrit-Jan Kloosterman agrees:

Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine--nil nocere [do no harm].

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I am selfish

Another response to an anonymous comment that "in my opinion unassisted birth is not only dangerous but selfish."

I am selfish. I admit it.

I am selfish because I want a birth experience that leaves me feeling fulfilled as a mother, that gives me confidence and joy.

I am selfish for giving birth at home, because I want to minimize the chances that my newborn will acquire an infection. Infection rates of newborns are many times higher in hospitals than at home. (1)

I am selfish because I want to avoid an unnecessary cesarean section; healthy women birthing at home have average cesarean rates of 1 to 4%, compared to around 20% in healthy women birthing in hospitals.

I am selfish because I do not want my vagina cut open by scissors (the nationwide episiotomy rate is STILL around 30%) or my belly cut open by knives. I have a 60% chance of acquiring a surgical wound if I give birth in a hospital.

I am selfish because I would prefer not to have to go into labor, pack my bags, get in the car, drive to the hospital, check in, sign consent forms, refuse the standard hospital procedures, and fight for what I want—all while giving birth to a baby.

I am selfish because I do not want to be separated from my baby. I want to hold my baby as soon as she is born. I do not want her to be taken from my arms to be weighed and measured, injected and bathed. I am selfish because I want to nurse her freely, without interruption.

I am selfish because I want to be washed in a “cocktail of love hormones,” to borrow a phrase from the French obstetrician Michel Odent. These hormones—endorphins, oxytocin, and prolactin—are released in full force only to women birthing without medications, in safe and private environments. Narcotics, anesthesia, surgery, and even high levels of stress and adrenaline inhibit the release of these hormones.

I am selfish because I want my baby to be born into her parents’ hands and to know only the safety and warmth of our arms. I want her be born in an atmosphere of love and ecstasy.

I am selfish because I want to avoid postpartum depression. Women who birth at home have much lower rates of postpartum depression. (2, 3)

Sometimes we need to be selfish.

(1) Mehl, L., Peterson, G., Shaw, N.S., Creavy, D. (1978) "Outcomes of 1146 elective home births: a series of 1146 cases." J Repro Med. 19:281-90
(2) Jones, Carl. Alternative Birth. Los Angeles: Jeremy P. Tarcher, 1990 p. 24.
(3) Kitzinger, Sheila. Home Birth. London: Dorling Kindersley, 1991 p. 193.

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Trusting Birth Even More

This essay was written on November 6, 2006 by Carla Hartley, director of the Ancient Art Midwifery Institute. Begun in 1981, AAMI is a distance learning program for direct-entry midwives. Carla also founded the Trust Birth Initiative, a grassroots movement that inspires women to trust in the birth process. Many thanks to Carla for giving me permission to post her essay here!

I hear lots of birth stories. Most of them are wonderful. Today a friend emailed a very tragic story of loss and despair. A mom going in for her second cesarean suffered a massive rupture and lost her baby and her ability to have another. It shook my friend to the core and I certainly understand why. I have been in similar situations and know how desperately everyone involved wants answers. I wish I had them.

When tragedy strikes sometimes there are no answers. I do not know if it was attributable to induction or pitocin and know nothing about the previous cesarean. But even if this mom had been just walking down the street when this catastrophe happened, it doesn’t affect my faith in the intrinsic safety of birth. I am terribly sad for them but I still believe that birth is safe.

Living is synonymous with risk. There is no escaping it. Everything we do carries some risk and there are many reminders of the fragility of life. Some years ago a young friend of mine died just moments after she had given a presentation at a summer church camp where she was a counselor. I had known her for more than 7 years. She was a beautiful, vivacious girl. The autopsy report could not tell her parents why their child died. At 16, she just sat down on a bench and her heart stopped beating.

Just this last week I have learned four people I know have died very recently. One was an apparent SIDS death of a 6 month old. A few months ago a family friend, who was only 18, ran a stop sign and was killed. So many people in my life have been killed in car wrecks that I am absolutely convinced that driving is a considerably riskier than we do on a regular basis. That is why I made Jessie take her driving course twice.

In fact, there are many, many things riskier than birth. I am positive that unhindered, unmanaged birth is really, really safe . . . as safe as breathing. I did not believe birth was as safe in 1975 as I do today. I wasn’t scared of birth as far as I knew, but I thought I needed an authority, and an expert or something bad might happen. That birth, and everything that has happened concerning birth in my life since, has taught me that if something bad does happen it is more likely to be due to interference with birth, rather than a flaw with the design or deficiency in the process.

I preach to all who will listen that the best way to serve a woman during her pregnancy is to help her to realize that she is her own authority and that a midwife or doctor or doula is ONLY a paid consultant. A consultant may be an expert about birth, but I believe that a woman is her own best expert for her birth, and that her body knows EXACTLY what to do if given the chance.

Some of you know about the June twelfth birth of my namesake, Carla Rae. I attended as Baba only. I toted water to the tub as the hose was too short to reach the spot where the kiddie pool was. I also handed the mom the honey spoon from time to time. I said almost nothing. I did not do anything midwifey. The mother had a previous section 3 years prior almost to the day. She knew nothing about birth then but afterwards was sure that she wanted something different. She wanted a home birth. She had watched What Babies Want at my house and it “opened the curtain.” From that point on, my daughter-in-law read and watched everything she could. Her favorite book was The Power of Pleasurable Childbirth. She loved hearing my birth stories and especially my “did not push, just let my body do it birth.” And Marcela did just that with the birth of Carla Rae. If I had been her midwife I would have suggested that she do some things differently. As her mother in law, I suggested nothing, did nothing. I just loved her and did what she asked.

If I had been her midwife I would have most assuredly said something when it took soooooo long for another contraction after the head was out. As the mother in law, I said nothing. And after what seemed an eternity to the midwife in me, I observed her powerful uterus rise up and push that baby out in one contraction, with no assistance from the mother. Truly, as many of you have heard me preach, the body that managed conception, and pretty much grew a healthy baby with little assistance or direction, did not forget what to do at the end. In fact, it was quite efficient in ejecting that baby.

Last Monday, I observed this amazing phenomenon again as I was with my first home born baby as she gave birth to her second child. Heather’s first birth was a lovely midwife attended water birth. Excruciatingly painful for my daughter but a beautiful birth, nonetheless. This time, she prepared the same way in terms of nutrition, labor prep and daily chlorophyll, with a few additions. She did a lot more kegels this time. She went to the chiropractor regularly because of her incredibly uneven pelvis due to scoliosis. She took arnica in the last three weeks to help with the hip pain. The difference that made the difference, in my humble opinion, was that she determined she was not going to call the midwife this time. Heather adores her midwife and was very happy with how she assisted in the first birth. This time, though, she wanted to “do it herself.” She read everything she could find about unassisted birth and she read Sarah Buckley’s Gentle Birth, Gentle Mothering repeatedly. She read it so often that she could quote long passages of Sarah’s take on the wisdom on the body.

In spite of the fact that Heather had almost no sleep in the last month and was totally exhausted, once real labor started, it lasted just under two hours. She had a lot of back labor and she and her husband were alone almost all of those two hours as I was out running errands for them. I got back less than a half hour before the birth. Once again I spent most of that time toting water, but this time because the hose was just not filling fast enough. Heather stood up out of the birthing tub and leaned on me while her husband continued to try to get more air into the blow up pool. During her last water birth, the sides had been under inflated and there was considerable water spillage. Her husband is somewhat of an efficiency expert and did not want a repeat of that. (That is funny to us now, that he just would not fit it in his head that the birth was imminent. I can assure you though, that at the time it was very irritating to Heather. The speed at which this labor progressed was a shock to both of them. In fact when she stood up and felt the baby move down dramatically, she asked in disbelief how it could be happening so soon as she had not had time to dilate. There had been no exams but she was comparing it to her 21 hour labor the first time!)

The water broke just before the baby was born. Much to my surprise, I heard a gurgly inspiration and cry immediately after that. I have never heard a baby cry before the head was out. Heather had just asked me to confirm that was indeed the baby’s head emerging between her legs so I could tell her husband that now was the time for him to get in position! The water broke on my hand. After I heard the cry, the midwife in me wanted that baby to be born pretty quickly, but Heather’s body, being much wiser than I, waited a bit. And that was a good thing in the end as it gave her husband time to turn off the air compressor, put down the air hose, get into the tub and get behind her to catch his baby. In the position I was in, supporting her front to front I was able to literally feel her amazingly powerful uterus bring her baby into the world. It was incredible to feel my daughter’s body doing its job for her. Heather did NOT push, even once. It took 3 or 4 contractions from the time she stood up until the time her baby was born. She told me later that once she realized her body was doing it, she literally could not have pushed if she had wanted to. She had given her body permission to do it’s job with no interference from her and there was no going back.

Heather is convinced that not pushing was beneficial in other ways. She had no trauma to her perineum or vagina whatsoever. No swelling, tears or skidmarks. Honestly, she did not look like she had had a baby ever. She bled very little and her lochia is almost completely gone at 6 days. She feels great. She is in a perpetual state of awe when she talks about her birth. In spite of the pain, she would love to do it again today. I can completely identify with the feeling. After Jessie was born I had the incredible desire to put her back in and do it again. It was the most amazing feeling I can imagine. For Heather, the sensual, powerful feeling of allowing her body to do what it was designed to do has changed her life as well. She has always been a committed believer in the safety of birth, but now she has experienced a whole new level of trusting her own body to give birth, as well.

My wish for every woman would be to experience the power of unhindered birth as I have, and as Marcela and Heather and many others I know have experienced. We are so conditioned to believe that we have to work hard to push babies out, when more likely, most would come out better if we just allow our bodies to do their job.

So, once again, I find myself trusting birth more than I did last week!

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Pushed and Pulled

I’ve been following a recent discussion thread on MDC (Mothering Dot Commune) about unassisted birth. One of the posters wrote:

“It's one thing to be motivated by a desire to NOT have something happen. It's another to be motivated by a desire to HAVE something happen.

See the difference?
Pain pushes.
Vision pulls.”

Embracing what we DO want, rather than just avoiding what we DON'T, has really resonated with me. I've been thinking a lot about the term "unassisted birth." It's interesting that so many of the words we use for birth focus on what is absent:
un-assisted
un-medicated
un-hindered
un-inhibited

These words are important because they help identify what is wrong with our current birth culture. A great deal of my motivation to birth at home is to avoid unnecessary and harmful hospital procedures. I don’t want an IV, electronic fetal monitoring, artificial rupture of membranes, vaginal exams, Pitocin, epidural, narcotics, time limits on labor, forceps, vacuum extraction, cesarean section, immediate cord clamping, cord traction, sepatation from baby for bathing or measuring, bright lights, narrow hospital beds.... The list goes on.

I have a healthy fear of birthing in a hospital. Just a quick comparison of cesarean rates in healthy women planning home or hospital births is enough to keep me securely at home. In the year 2000, roughly 19% of healthy (or “low risk” in medicalese) women planning hospital births had cesarean sections. Cesarean rates among women planning home births are consistently between 1-4%.

But birthing at home merely to avoid the hospital is only part of the picture. I love words that focus on what we're gaining, not just what we're leaving behind, when we reject the rituals and confinements of institutional birth:
freebirth
empowered birth
ecstatic birth
autonomous birth (see Linda Hessel’s blog for an excellent discussion of this term, especially her posts titled “Laura Shanley” and “Terminology”)

Early books about unassisted childbirth often use the term “Do-It-Yourself childbirth.” I like that term--I'm a big DIY girl myself. Over the past several years I've learned how to do plumbing, electricity, framing, plastering, drywall, roofing, tiling.... Almost anything you can do to a house, my husband and I have done it! A DIY-er isn't afraid to get dirty, to make mistakes, to make a mess at times. I trust myself to do the job right, whereas when I hire someone (which I've done twice, once for a big job and once for a little job) I'm always fretting about whether or not it's good enough. Plus there's something so satisfying about accomplishing a big task and having professionals come over and admire the quality of your work! Or when people ask you which contractor you hired, seeing the look on their face when you say, "oh, I did it all myself. Piece of cake."

Home repair manuals are filled with dire warnings about leaving certain jobs up to professionals—anything from refinishing wood floors to electrical work. And yes, there are certain things that I will hire out, such as working on gas lines. I’m sure that I could figure it out if I wanted to, but it’s not worth the hassle. But most of these things we have done ourselves, and the results were fantastic.

On the other hand, DIY also conjures up images of Bob Vila and middle-aged men wearing toolbelts and red plaid shirts. It’s probably why the term “DIY childbirth” fell out of vogue.

But enough talk of home repairs. I think freebirth speaks to me the most. Because there's nothing attached to it. There is no "right" way to freebirth. Just you and the baby and the freedom to do whatever is necessary to have that baby.

I don’t have any one particular vision of how this birth should unfold. Perhaps I will labor at night in our fireplace nook, warmed and lit by a fire. Maybe I will give birth by candlelight in our oversized Jacuzzi tub. I might push the baby out kneeling on our bed, at mid-day, with sunlight streaming in from the seventeen windows in our bedroom. (Can I say that our house has good birthing vibes?? So many nice places to labor in.) I may have a “wham, bam, thank you ma’am” labor that leaves me feeling somewhat stunned. Or labor could be long and slow. The point of freebirth is that there is no script I have to follow, no rules for what is right or wrong. In the end, what I really want is to be able to experience birth on my own terms, on my own power. I want my baby to emerge in an atmosphere of love and peace, and to know only the warmth of his parent’s arms. I want to come away feeling exhilarated and to be able to say "Don't mess with me. I can do anything now!"

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